MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VII, No 8, July 29, 2008
In This Issue:
MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE's SiCKO
a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the
truth about socialized medicine. Clements is the former publisher of
"American Venture" magazine who made news in 2005 for a property
rights project against eminent domain called the "Lost Liberty
For more information visit www.sickandsickermovie.com or email firstname.lastname@example.org.
* * * * *
The Neuroscience of Dance; Scientific American Magazine; by Steven Brown and Lawrence M. Parsons; July 2008; 6 Pages
Dance is the most synchronized activity people perform. Neuroscientists are trying to discover not only how but why we do it.
So natural is our capacity for rhythm that most of us take it for granted: when we hear music, we tap our feet to the beat or rock and sway, often unaware that we are even moving. But this instinct is, for all intents and purposes, a . . . novelty among humans. Nothing comparable occurs in other mammals nor probably elsewhere in the animal kingdom. Our talent for unconscious entrainment lies at the core of dance, a confluence of movement, rhythm and gestural representation. By far the most synchronized group practice, dance demands a type of interpersonal coordination in space and time that is almost nonexistent in other social contexts.
Even though dance is a fundamental form of human expression, neuroscientists have given it relatively little consideration. Recently, however, researchers have conducted the first brain-imaging studies of both amateur and professional dancers. These investigations address such questions as, How do dancers navigate though space? How do they pace their steps? How do people learn complex series of patterned movements? The results offer an intriguing glimpse into the complicated mental coordination required to execute even the most basic dance steps.
I Got Rhythm
Neuroscientists have long studied isolated movements such as ankle rotations or finger tapping. From this work we know the basics of how the brain orchestrates simple actions. To hop on one foot—never mind patting your head at the same time—requires calculations relating to spatial awareness, balance, intention and timing, among other things, in the brain's sensorimotor system. In a simplified version of the story, a region called the posterior parietal cortex (toward the back of the brain) translates visual information into motor commands, sending signals forward to motion-planning areas in the premotor cortex and supplementary motor area. These instructions then project to the primary motor cortex, which generates neural impulses that travel to the spinal cord and on to the muscles to make them contract [see box on next page].
At the same time, sensory organs in the muscles provide feedback to the brain, giving the body's exact orientation in space via nerves that pass through the spinal cord to the cerebral cortex. Subcortical circuits in the cerebellum at the back of the brain and in the basal ganglia at the brain's core also help to update motor commands based on sensory feedback and to refine our actual motions. What has remained unclear is whether these same neural mechanisms scale up to enable maneuvers as graceful as, say, a pirouette.
To explore that question, we conducted the first neuroimaging study of dance movement, in conjunction with our colleague Michael J. Martinez of the University of Texas Health Science Center at San Antonio, using amateur tango dancers as subjects. We scanned the brains of five men and five women using positron-emission tomography, which records changes in cerebral blood flow following changes in brain activity; researchers interpret increased blood flow in a specific region as a sign of greater activity among neurons there. Our subjects lay flat inside the scanner, with their heads immobilized, but they were able to move their legs and glide their feet along an inclined surface [see box on page 81]. First, we asked them to execute a box step, derived from the basic salida step of the Argentine tango, pacing their movements to the beat of instrumental tango songs, which they heard through headphones. We then scanned our dancers while they flexed their leg muscles in time to the music without actually moving their legs. By subtracting the brain activity elicited by this plain flexing from that recorded while they "danced," we were able to home in on brain areas vital to directing the legs through space and generating specific movement patterns.
As anticipated, this comparison eliminated many of the basic motor areas of the brain. What remained, though, was a part of the parietal lobe, which contributes to spatial perception and orientation in both humans and other mammals. In dance, spatial cognition is primarily kinesthetic: you sense the positioning of your torso and limbs at all times, even with your eyes shut, thanks to the muscles' sensory organs. These organs index the rotation of each joint and the tension in each muscle and relay that information to the brain, which generates an articulated body representation in response. Specifically, we saw activation in the precuneus, a parietal lobe region very close to where the kinesthetic representation of the legs resides. We believe that the precuneus contains a kinesthetic map that permits an awareness of body positioning in space while people navigate through their simply walking a straight line, the precuneus helps to plot your path and does so from a body-centered or "egocentric" perspective.
Next we compared our dance scans to those taken while our subjects performed tango steps in the absence of music. By eliminating brain regions that the two tasks activated in common, we hoped to reveal areas critical for the synchronization of movement to music. Again this subtraction removed virtually all the brain's motor areas. The principal difference occurred in a part of the cerebellum that receives input from the spinal cord. Although both conditions engaged this area—the anterior vermis—dance steps synchronized to music generated significantly more blood flow there than self-paced dancing did.
Albeit preliminary, our result lends credence to the hypothesis that this part of the cerebellum serves as a kind of conductor monitoring information across various brain regions to assist in orchestrating actions [see "Rethinking the Lesser Brain," by James M. Bower and Lawrence M. Parsons; Scientific American, August 2003]. The cerebellum as a whole meets criteria for a good neural metronome: it receives a broad array of sensory inputs from the auditory, visual and somatosensory cortical systems (a capability that is necessary to entrain movements to diverse stimuli, from sounds to sights to touches), and it contains sensorimotor representations for the entire body.
Unexpectedly, our second analysis also shed light on the natural tendency that humans have to tap their feet unconsciously to a musical beat. In comparing the synchronized scans with the self-paced ones, we found that a lower part of the auditory pathway, a subcortical structure called the medial geniculate nucleus (MGN), lit up only during the former set. At first we assumed that this result merely reflected the presence of an auditory stimulus—namely, music—in the synchronized condition, but another set of control scans ruled out this interpretation: when our subjects listened to music but did not move their legs, we detected no blood flow change in the MGN.
Thus, we concluded that MGN activity related specifically to synchronization and not simply listening. This finding led us to postulate a "low road" hypothesis that unconscious entrainment occurs when a neural auditory message projects directly to the auditory and timing circuits in the cerebellum, bypassing high-level auditory areas in the cerebral cortex. . .
Tantalizing Tango Finding
In a study published in December 2007, Gammon M. Earhart and Madeleine E. Hackney of the Washington University School of Medicine in St. Louis found that tango dancing improved mobility in patients with Parkinson's disease. The condition stems from a loss of neurons in the basal ganglia, a problem that interrupts messages meant for the motor cortex. As a result, patients experience tremors, rigidity and difficulty initiating movements they have planned.
The researchers found that after 20 tango classes, study subjects "froze" less often. Compared with subjects who attended an exercise class instead, the tango dancers also had better balance and higher scores on the Get Up and Go test, which identifies those at risk for falling.
Ballet for Better Balance?
Roger W. Simmons of San Diego State University has found that, when thrown off balance, classically trained ballet dancers right themselves far more quickly than untrained subjects, thanks to a significantly faster response to the disturbance by nerves and muscles. As the brain learns to dance, it also apparently learns to update feedback from the body to the brain more quickly.
To read the rest of this report, charts and illustrations, go to www.sciamdigital.com/index.cfm?fa=Products.ViewIssuePreview&ARTICLEID_CHAR=5F4F2FE1- 3048-8A5E-105D5AF1137F48F3.
* * * * *
HealthBlog: A possible sea change on how to share health data by Bill Crounse, Director, Worldwide Health, Microsoft Corporation, July 23, 2008
I'm writing today from Boston, Massachusetts, where I just delivered the opening keynote at the World Congress Leadership Summit. The conference is being held at the new and very lovely Renaissance Waterfront Hotel.
If you've noticed a nautical theme on HealthBlog from time to time there's a very good reason for it. I grew up in the Pacific Northwest in a fishing village on the waters of Puget Sound. The sea is very much in my blood. I find that whenever I'm near a seaport and can smell the ocean air or hear the cry of a gull, I not only get nostalgic about my boyhood but I have an almost uncontrollable desire to get down to the water. So after my keynote this morning, I took a long walk. That's when it hit me; the connection (at least metaphorically) between today's topic on HealthBlog and the sea. The theme at this year's Leadership Summit is "The Road to Interoperability". My keynote on global healthcare industry trends was followed by a "reactor panel" moderated by Janet Marchibroda, CEO of the eHealth Initiative. Panelists included Bill Beighe, CIO of Physicians Medical Group of Santa Cruz; Barbara Blakeney, RN, Innovation Specialist at Mass General Hospital and Past President of the American Nurses Association; and G. Daniel Martich, MD, CMIO and Associate CMO, at the University of Pittsburgh Medical Center.
In my presentation I had discussed the 5 global trends; increasing personal responsibility, "retailization" of health services, "commoditization" of services and providers, information everywhere, and globalization. The panel reacted to my keynote by giving examples of how their organizations are being impacted by these global trends and what they are doing to address them. The conference continued with a number of other presentations and breakout sessions on how to achieve interoperability in our health system, and what it will take to get us there.
In 2004, George Bush proclaimed that most Americans would have an electronic health record by 2014. So here we are 4 years later, and despite a lot of focus on establishing the Office of the National Coordinator for Health IT, promoting the concept of a National Health Information Network and seeding Regional Health Information Organizations with millions of dollars in federal and foundation grants, one could argue that we aren't much closer to getting where we need to be than we were four years ago. However, in those four years something else has emerged that is proving to be truly disruptive. It's the idea of aggregating health information around the consumer as perhaps a better and certainly less costly solution than trying to interconnect every hospital, clinic, doctor's office, imaging center, lab, payer and other player in our complex ecosystem of care. And what is at the center of this change? It is patients and healthcare consumers themselves and the emergence of new technology models such as HealthVault, Google Health, Medical Record Banks, Dossia, and other solutions that appear to be leapfrogging the need for NHIN, RHIO's, or other efforts to hard wire a connection between every health facility. If there is a buzz in the air at this conference it is that bow wave of new ideas. This truly represents a "sea change" in our thinking on how to achieve a portable, always available, and interoperable "electronic record" for most Americans by 2014. In fact, I now believe we may get there well before that date rolls around.
* * * * *
This study regularly (since 2005) compares Canadian and American retail prices for an identical group of the 100 most commonly prescribed brand-name (mostly patented) drugs and the 100 most commonly prescribed generic drugs in Canada. In 2007, this sample of drugs represented approximately 70% of the entire brand-name market and approximately 55% of the entire generic market.
The results confirm that, in 2007, Canadians continued to pay more than double the prices that Americans pay for identical generic drugs because government policies in Canada distort the market for prescription medicines. Meanwhile, Canadian prices for brand-name drugs remain more than half as expensive on average as American prices for identical drugs and are declining over time relative to prices in the United States.
In currency-equivalent terms, Canadian retail prices for generic prescription drugs in 2007 were on average 112% higher than retail prices observed in the United States for identical drugs (see figure 1). Last year's study found similar results; generic prescription drugs in Canada were on average 115% higher than American prices in 2006.
This year's findings indicate that average generic drug prices in Canada have slightly declined relative to American prices, yet Canadians are still paying too much (more than double US prices) for their generic medicines. A previous analysis of Canadian and American drug prices found that average prices for generic drugs were 78% higher in Canada in 2003, indicating that over a five-year period the average cost of generic drugs in Canada has risen substantially relative to US prices.
This year's study also found that in 2007 Canadians paid on average 53% less than Americans for identical brand-name drugs; in 2003 the average price for brandname drugs was 43% lower in Canada. For Canadians, this means that since 2003 the cost of brand-name drugs has decreased relative to US prices for identical drugs.
The American market for prescription drugs is not distorted by the same public policies that are observed in the Canadian market. Canadian government policies insulate generic drug companies and pharmacy retailers from normal market forces that would put downward pressure on prices for generic drugs. A relatively freer market in the United States produces lower prices for generic drugs. Lower prices in the
United States give consumers incentives to substitute generic drugs for comparatively more expensive brand-name drugs at higher rates than the rates seen in Canada. If the Canadian market for prescription drugs was at least as free as the US market, we would expect Canadian prices for generic drugs to eventually fall to US levels. Over time, lower prices would be expected to lead to an increased substitution of generic drugs for brand-name drugs in Canada, as they have in the United States.
In 2007 alone, federal-provincial-territorial policies regulating prescription drugs cost Canadians an estimated $2.9 to $7.5 billion in unnecessary spending due to a combination of inflated prices for generic drugs and inefficient substitution of medicines. Canadians would be much better off if federal and provincial governments repealed policies that distort the market for prescription drugs.
Adjusting for the purchasing power parity of the Canadian and US dollars, retail prices for the 100 most commonly prescribed Canadian generic drugs in 2007 were 112% more on average than prices for the same generic drugs in the United States. Of the top 100 generic drugs in Canada that were available in both markets,
these drugs averaged 161% higher than US prices
lower than US prices.
By comparison, retail prices for the 100 most commonly prescribed Canadian brandname drugs cost, on average, 53% less in Canada than in the United States. Of the 100 most commonly prescribed brand-name drugs in Canada in 2007 that were available in both markets,
American consumers also substitute generic versions of drugs for their brand-name originals at higher rates than do consumers in Canada. Lower prices for generic drugs driven by market pressures in the United States create positive incentives for American consumers to make rational cost-benefit choices regarding their use of medicines. By contrast, Canadian public policies often try to force generic substitution by government edict and yet fail to achieve rates of substitution as high as a relatively freer market in the United States. In 2007, Canada-US generic substitution rates, measured by the percentage of total prescriptions dispensed in the year were,
If Canada repealed policies that distort the market for prescription drugs, net savings for Canadians could reach between $2.9 billion and $7.5 billion (2007) annually for total retail pharmacy sales of generic and brand-name drugs. The savings would result from greater competition for sales of generic drugs leading to much lower prices and greater voluntary use of generics. In the absence of massive cross-border demand from American consumers, Canadian prices for brand-name drugs should remain significantly below US prices for identical drugs. . . .
To read the entire report, go to www.fraserinstitute.org/commerce.web/product_files/CanadasDrugPriceParadox2008.pdf.
Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.
--Canadian Supreme Court Decision 2005 SCC 35,  1 S.C.R. 791
* * * * *
We ran a series on Medicare Harassment of doctors who have been in practice for many years who simply change their office address, frequently in the same zip code, sometimes on the same street and sometimes just a suite number change in the same building. Medicare treated these physicians in a very demeaning manner making them reapply as if they were interns applying for the first time, not physician members of Medicare for many decades. We thank all who have written concerning similar experiences.
We thought the following letter was a little different but illustrative of the arrogance of government programs and what to expect should the government ever gain a total monopoly on healthcare.
Medicare did the same thing to me that they are currently doing to you. Prior to opting out of Medicare, I was always a Non-Par in Medicare.
When I moved and opened a new office, I notified Medicare, via U.S. Mail, of my new address.
They wanted me to fill out a 30-page form just to change my address!! The form was basically an initial enrollment form in Medicare which contains all sorts of things that I would not agree to and sign as a Non-Par physician. I had been "enrolled" in Medicare as a Non-Par physician for 18 years at that point.
I refused to fill out and sign their abusive 30-page form.
Medicare retaliated by refusing to pay what they owed (i.e. they force assignment on physicians who treat dual eligible patients - Medicare + Medicaid). Medicare owed me a substantial amount of money.
I stood firm, and would not fill out and sign (agree to) their abusive "enrollment" form.
Within a few months, I opted out of Medicare under Sec. 4507 of the BBA of 1997.
As a result of opting out of Medicare, Medicare was forced to accept the change of address notification that I previously supplied to them - no 30-page form had to be filled out.
After Medicare was forced to acknowledge and accept my notification of change of address, they were then forced to send all the money they owed me.
This is the "standard operating procedure" for this highly abusive and coercive government bureaucracy.
The bureaucracy seeks to punish those physicians who refuse to "voluntarily" sign up with their abusive Medicare program which degrades and devalues physicians on an ever increasing basis.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
The telephone is an important item in the business/professional world. Many businesses have resorted to automatic answering programs with automatic direction of the calls to the desired party. Even automatic systems have become expensive. AT&T no longer provides the time of day for free. They can't afford to tie up the number of lines required to give out time even if it is totally free of human intervention.
Lawyers were the first professionals to develop a system of charging for calls or any other interface with their client. They can charge the same hourly rate whether at home, on the road, in the office, or indisposed. They have even developed a mechanism to charge for information relayed in unobtrusive fashion. I once reported some information on a case to my attorney in a Christmas card. Her secretary opens all mail and screens for legal information and is able to electronically insert the time into the attorney's time card on any case. Most attorneys have a minimum charge of one-sixth or one-fourth an hour. In the above case, the junior attorney's rate was $200 an hour; her supervisor, who always managed to get in one hour of consulting on my case monthly, it seemed, was at $320 an hour. The minimal rate in the firm was one-fourth hour. Therefore, a one- to 15-minute phone call to my personal attorney was $50 and to the senior attorney it was $80. Hence, the secretary entered a quarter-hour fee for the information entered in the Christmas card and it showed up on my statement the next month. In this way, attorneys are able to charge for any time spent, whether in your presence or on your behalf.
Physicians spend a lot of time on the phone often in many non-remunerative activities on behalf of their patients. Many of my colleagues estimate time spent on completing charts, making phone calls, discussing with consultants, and reviewing lab and x-ray reports for one patient takes about two to three hours a day. There is no mechanism to charge for these services with a third-party system such as Medicare, Medicaid, insurance carriers, and HMOs who all feel this would add to the cost of health care.
Charles Krauthammer, a physician columnist, once stated that if doctors charged even $2 for every phone call, this would reduce phone work to the absolute minimum. However, most insurance carriers, Medicare, and Medicaid will not let a doctor put through any additional charges. Thus, reasonable cost accounting for time spent cannot happen with current fiscal or insurance intermediaries.
Even charging $5 a phone call would be cost effective for the patient. Sometimes a $5 phone call would reduce the need for a $100 office call. The free market economy would work this out to the most cost-effective solution saving everyone money and making the professional's life more comfortable and palatable.
Likewise, a $25 email consultation on an established patient may also be cost effective for the patient if it saves a $100 office call. The physician's income wouldn't drop since this would work out as the process develops a schedule. The fluidity of office calls interspersed with paid phone calls and with paid email medical evaluations could make a wonderfully challenging practice environment. Health care costs would probably decrease.
Pharmacies are becoming a huge drain on a medical practice. Physicians give enough refills to last until the next designated appointment plus one in case of a schedule change. However, pharmacists have added to their practice the job of securing prescriptions from the doctor without the patient being present with the doctor. To treat without the medical chart or the patient in front of you, if it isn't malpractice, certainly is very poor medical practice. It is the pharmacist's job to inform the patient of his last prescription refill and encourage them to make an appointment with their doctor for their next evaluation and Rx renewals. Perhaps the pharmacists want to insure that they get the next prescription rather than have the patient shop around with an open or live prescription.
I called my pharmacist to request a refill. However, I never reached the pharmacist but their phone menu. I had no refills remaining and the recording said that they would call my doctor. However, I could not interrupt the system to tell them thank you for reminding me that this was the last refill and certainly not put my own physician to this unnecessary expense; I would see my doctor for reevaluation of my therapeutic program. They automatically called and interrupted my busy doctor for which he didn't get paid.
I made a trip to the pharmacy and asked the pharmacists not to call my doctor again. If I had no refills, just tell ME, NOT MY DOCTOR; it is my job to get the new prescription to them. I pointed out that such a simple call to my attorney would cost $50 to $80 and I objected to their calling my doctor at his expense. Phone calls are expensive. The challenge is to work them into the mainstream practice of medicine to economize everyone's valuable time, not into an additional two or three hours to a ten-hour work day.
The technology is here to incorporate phone calls and emails into the practice of medicine. This integration would be cost effective for the patient. It would also put health care costs on a more realistic basis. The patients and insurance companies’ expectation for doctors to do this additional time without remuneration will eventually collapse. We must have the system ready before this happens.
* * * * *
By KEVIN YAMAMURA and JIM SANDERS, Sacramento Bee August 20, 2008
A federal judge has ordered a temporary halt in the California's 10 percent reduction in Medi-Cal reimbursement rates, improving access to care for 6.5 million low-income patients but throwing a new wrench in already-difficult budget negotiation.
The U.S. District Court decision forces the state to reimburse most Medi-Cal providers at rates prior to the 10 percent cut, which lawmakers and Gov. Arnold Schwarzenegger made effective July 1 as a cost-cutting measure to help resolve a $15.2 billion budget shortfall this year.
The move increases reimbursement rates the state pays to doctors, dentists, pharmacists, adult day-care centers and other providers who serve Medi-Cal patients. It excludes some hospitals who do not contract with the state and do not provide emergency care.
"There's no question this is good news," said Anthony Wright, executive director of Health Access California, a consumer group. "We already have more than half of doctors not taking Medi-Cal patients because of low reimbursement rates, so the additional rate cut was going to further reduce access to care for millions of children, parents, seniors and people with disabilities."
But the injunction comes as lawmakers remain divided because they cannot agree whether to bridge the budget spending gap with new taxes, borrowing or spending cuts. If the state ultimately loses the Medi-Cal reimbursement case, it could face an additional $575 million hole on top of the $15.2 billion deficit, according to Schwarzenegger's Department of Finance. . .
The state is now 51 days into the new fiscal year without a budget, and some Medi-Cal providers stopped receiving payments in late July because the state does not have a spending plan in place. . .
"It looks like the judge recognized that these people have no access, and certainly not equal access to services, at least not the way the (federal) program was envisioned." To read the entire report, go to www.sacbee.com/111/v-print/story/1170735.html.
With state revenues at an all time high, that we have a budget deficit just points out the inability of our legislature to manage revenue and control spending. In these difficult times for taxpayers with loss of income, foreclosures, bankruptcies, that the liberal legislators can even think of raising taxes is cruel and inhumane. In the absence of a budget, we should reduce every legislator and their staff to a zero income. We should then recall every legislator that shows this total lack of regard for their fellow human beings so they can get a real job and understand income and expenses.
Lawmakers' fiscal irresponsibility would destroy our health care if they were given a chance.
* * * * *
Dr. Edwards: The medical practice act has limited the practice of medicine to physicians. Why are hospitals competing with us?
Dr. Milton: I remember it was a big thing in Medical School to point out that the practice of medicine should always remain in medicine. Most states had laws against the corporate practice of Medicine with physicians as employees.
Dr. Ruth: But we have always had large groups. Look at the Mayo Clinic.
Dr. Edwards: But that was group practice. The physicians of the clinic were always in charge. Mayo uses several hospitals but the doctors are solely responsible for their practice and the quality of health care. The hospitals are only the environment in which the very sick are treated. The rest were treated in the clinic.
Dr. Rosen: Then there was Kaiser. Although the Kaiser Health Plan and the Kaiser Foundation Hospitals were non-profit corporations, the Permanente Medical Group was always a physician-controlled group. They had a mutually exclusive contract with each other.
Dr. Milton: Then other large clinics developed all over the country maintaining the physician’s independence in the practice of medicine. The physician never had to answer to a corporate overlord. The primary responsibility was to the patient.
Dr. Dave: It seems that more and more hospitals are putting doctors on salary to practice administrative medicine which then controls the medical staff which in effect puts them under hospital control.
Dr. Rosen: This seems to be a hot issue throughout the country - how the independent hospital staff is gradually coming under the hospital thumb and is no longer independent. There are many articles in the medical practice journals speaking to this issue.
Dr. Milton: The hospitals have similarly created foundations that, though allegedly independent, seem to be beholden to the hospital corporation.
Dr. Dave: The veneer of the hospital foundation is so thin, that the doctor’s salary and practice patterns are quite well controlled. Have you noticed how short the physician’s stay is if he or she gets too independent?
Dr. Michelle: I rather like being a physician with the hospital practicing medicine. I think it makes me feel more secure than threatened.
Dr. Dave: You like the hours?
Dr. Michelle: That’s very important to a woman who has a family and a home to manage. I can’t work until 7 or 8 o’clock like you guys. You have someone at home that does all those things for you.
Dr. Joseph: Being a retired surgeon doing surgical assisting part time, I’m of a mixed mind. The hospital pays me directly for assisting in surgery at all hours several days a week. I train their family practice residents in surgery. Most of these residents are then hired by the hospital to practice on their staff.
Dr. Dave: So you are training the competition that will put the private practicing surgeons out of work?
Dr. Joseph: You got that right. But I’ve come to the conclusion that I don’t care who pays me. I just work my hours, take my pay, and enjoy life.
Dr. Dave: Sounds like that’s what all these residents you’re training plan to do also?
Dr. Joseph: That’s my conflict. These doctors will never have to hustle to make a living. It’s just a job from 8 to 5.
Dr. Dave: Just like any other day laborer?
Dr. Joseph: Isn’t that what we are? Laborers?
Dr. Dave: Will we have any more Christiaan Barnard’s who, after working a thirteen-hour day, had a heart available and then worked another nine hours doing the first heart transplant?
Dr. Joseph: I really don’t think so. There won’t be any innovations in America anymore than there are innovations in Sweden and elsewhere.
Dr. Rosen: I remember a discussion with a Swedish physician in Amsterdam once. He agreed that there was a complete homogenization in their country and he didn’t think that they would ever have another Nobel Prize winner in any scientific field again. There was no drive towards excellence.
Dr. Joseph: Maybe Nobel Prizes and innovations are no longer important. We’ll all just be cogs in a wheel and hopefully no one will be absent some day so that a patient misses an important cog in his trying to get well or get a transplant.
Dr. Dave: With the emphasis on dying and cost containment, who’ll care if the patient goes to the morgue instead of the heart surgical operating theater?
Dr. Michelle: I’ll care. But I have to admit that I won’t make any moves to change the modus operandi.
* * * * *
SONOMA MEDICINE, the Magazine of the Sonoma County Medical Association, Spring 2008
I've never begun an editorial in these pages with more misgiving. This won't be a "feel good" piece. The profession I've served and loved for over 30 years has provided me livelihood, fulfillment and inspiration. With rare exception, my colleagues have been diligent and dedicated professionals, committed to caring for the patients we mutually serve. To my colleagues, I say it is still a pleasure and privilege to work with you all. But we work inside a lousy system. In fact, it is no system at all. So if I seem critical, please understand that my complaint here is a lover's quarrel.
Medicine is a mess. We spend $2.2 trillion a year for health care in the United States, and it's not as good as we thought. "Best health care in the world" now refers to isolated islands of medical excellence in a sea of mediocrity. By the best health metrics our outcomes rank 37th in the world. Among the 13 industrial economies of the world we rank last. We can transplant organs and keep people alive through the terminal stages of chronic illness, but we can't immunize many of our children, guarantee adequate care to all our pregnant women, or provide basic care and preventive services for the estimated 45 million people in our population who are uninsured.
Not a pretty picture. Few want it this way, but the problem is complex, and it touches every level of values around which societies organize. Health care has been described by one bioethicist as "the largest social reform issue in the U.S. since the abolition of slavery."
For starters, health-care dollars comprise nearly a fifth of our domestic economy. President Eisenhower left office in 1960 with his famous warning of a vast "military-industrial complex." When Dr. Arnold Relman retired as editor of the New England Journal of Medicine in 1983, he warned: "Beware the medical-industrial complex." The financial juggernaut of the Big Three—pharmaceuticals, private insurance, and the medical technology marketplace—drives the current practice of medicine with an undue influence that has distorted our science, distracted us from the reason we practice medicine, and threatens a stranglehold on any meaningful reform. If you doubt this influence, consider our Congress, where drug lobbyists outnumber legislators two to one.
Congress is where the 2003 story of Medicare's "drug benefit" unfolded. Medicare Part D, which provides prescription drugs for the elderly at drug-company prices, was written by drug lobbyists. The bill forbids Medicare from negotiating the price it pays for drugs. As Billy Tozan, the Louisiana congressman who steered the bill through the House, boasted, "Not one word was written by Congress." Just six weeks after pushing the bill through Congress, Tozan took a $2-million-a-year position as president and CEO of PhRMA, the lobbying conglomerate of 12 major drug companies, including Abbott, Lilly, Bayer, Pfizer and Merck.
Tozan is not alone. Fifteen other representatives who voted the bill into law are now lobbyists for the drug industry. Thomas Scully, Medicare's top administrator at that time, now represents a half-dozen drug firms through a contract he negotiated while the bill was being debated. When his chief actuary, Richard Foster, found the cost-analysis to be almost twice the original estimate, Scully threatened to fire him if he disclosed the information before the congressional vote.
The result of Part D is a pharmaceutical windfall that requires Medicare to pay up to 10 times the price charged to others for the same drug. For example, Medicare pays $1,485 for a year's worth of Zocor, while the VA—which negotiates its price—pays $127. We're talking $800 billion over 10 years, up to 60% of which is a "gouge." Since the passage of Part D in 2003, the drug industry has raised its prices to Medicare by 30%. Who "benefited" the most?
The influence of drug companies extends well beyond Congress. Seventy percent of academic drug trials are sponsored by the drug industry, and the industry determines what gets published—and what doesn't. For example, Merck (the same company that brought us Vioxx) has now disclosed data that their lipid-lowering drug, Zetia, has no benefit in cardiovascular outcomes, despite reducing levels of LDL. They knew this two years ago and sat on the data, while they generated more than $4 billion each year in sales.
I'm not saying that drug companies are evil. I think, like any capitalist enterprise, they're trying to make a buck. And I believe they're honestly trying, along the way, to even help some people. But I no longer trust their judgment, or what we see of their data. I can no longer trust that their judgment of what's best for my patients is not compromised by what's best for their profits, conscious or otherwise. Would you buy a used car from Merck? And if not, why would you trust their judgment of what's best for your patient?
Unlike the pharmaceutical industry, which actually produces drugs that work, the insurance industry produces nothing. This Byzantine bureaucracy of 1,300 different companies, dealing over 27,000 different health plans, charges us a 15-30% "administrative fee" depending on whether the company is investor-owned or "not-for-profit." Compare this fee to Medicare's administrative cost of 3%. Most single-payer systems, worldwide, operate at under 10% administrative costs. Annually, the difference in the United States would mean an additional $300 billion for actual health services.
Recently, Blue Cross of California placed its member physicians in yet another new role, sending them copies of their patients' insurance applications and asking their help in canceling policies of patients who fail to disclose "material medical history" or other pre-existing conditions. Physician as informant: who are we working for?
Finally, there is the cost of technology. It is hard
to deny the modern daily miracles, but I would ask that the words technology
and appropriate be merged in medicine into one: approtechnology.
Last year 62 million CAT scans were ordered in the United States. By September
there will be more MRI scanners in Sonoma County than acute psychiatric beds.
Most Medicare dollars are spent in the last 30 days of life.
I recently saw a 14-year-old gymnast who received plain films, CT and MRI of his sore knee before ever getting a history or physical exam. He turned out to have Osgood-Schlatter disease, a common condition among teenagers that can be diagnosed with your thumb on the tibial tuberosity. Let's be reasonable. We should use our clinical skills first and only apply our technologies when they should be done, not just because they can be done.
Our medical heritage, passed on from the professors who taught us, by lecture and example, is that the practice of medicine, at its purest, is guided by science and driven by compassion. Money matters. But it has distorted the methodology of our science and has distracted us from the motive of our practice. As a professional, all I ask to know is what's best for my patient. I've been a good soldier who's preached the gospel of evidence-based medicine for 30 years. And now I learn that the evidence may be tainted.
Forty years ago, while I began studying for a career in medicine, a popular American songwriter declared, "I ain't gonna work on Maggie's Farm no more." Maggie's Farm was the perfect, modern metaphor for the classic relationship of serf to landlord. The laborer pours passion and sweat into his work, only to learn he's really working for someone else. The oath we took when we became physicians binds us as privileged servants to our patients, not to Pfizer, Blue Shield or General Electric. We need to assure ourselves—and the generation of young men and women now entering medicine—that we still work for the patient, not for some new-age corporate rendition of "Maggie's Pharm."
Dr. Flinders is a clinical professor of family and community medicine at UCSF and teaches in Santa Rosa's Family Medicine Residency Program.
To read more VOM, please go to www.healthcarecom.net/voicemed.htm.
To read HMC, please go to www.delmeyer.net/HMC.htm.
* * * * *
FORCED EXIT - The Slippery Slope From Assisted Suicide to Legalized Murder, by Wesley J Smith, Times Books, div of Random House, New York, 1997, xxvi, & 291 pp. ISBN: 0-8129-2790-7
Wesley J Smith, author of No Contest: Corporate Lawyers and the Perversion of Justice in America, opens his prologue of Forced Exit with the story of a dear friend who spent years planning her suicide and after inviting friends to the event, none of whom came, exited this life quietly. Smith, an Oakland attorney, contacted the executrix and obtained her suicide file wherein he found newsletters and other scurrilous documents from the Hemlock Society that thoroughly sickened him.
This motivated Smith to research into death, the inventing of the right to die that is driving people to embrace the death culture, and euthanasia's betrayal of medicine. He finds that a society that believes in nothing can offer no argument even against death. Seen in this light, support for euthanasia is not a cause but rather a symptom of the broad breakdown of "community" and the ongoing unraveling of our mutual interconnectedness. The consequences of this moral Balkanization can be seen in the disintegration of family cohesiveness; in the growing nihilism among young people that has led to a rise in suicides, drug use, and other destructive behaviors; in the growing belief that the lives of sick, disabled, and dying people are so meaningless that helping them kill themselves can be countenanced and even encouraged.
Smith calls acceptance of euthanasia "terminal nonjudgmentalism." He finds a good example in A Chosen Death by Lonny Shavelson, an emergency physician, who describes "Gene" who has had strokes and depression but is not terminal. Sarah, from the Hemlock Society, is given the task of assisting in his death. Sarah found her first killing experience tremendously satisfying and powerful, "the most intimate experience you can share with a person... More than sex. More than birth." Sarah gives Gene the poisonous brew as if she were handing him a beer. Gene drinks the liquid, falls asleep on Sarah's lap who then places a plastic bag over his head and croons, "See the light. Go to the light." But Gene, suddenly faced with the prospect of immediate death, changes his mind and screams out . . . and tries to rip the bag off his face. Sarah won't allow it, catches Gene's wrist and holds it. Gene's body thrust upwards and Sarah lays across Gene's shoulders. . . pinning him down, twisting the bag to seal it tight. Gene's body stops moving.
Smith says what happened to Gene is murder. He further feels that the ethical thing for Dr Shavelson to have done was to knock Sarah off the helpless man and then dial 911 for an ambulance and the police. Shavelson describes his thoughts on whether to act or observe the death, and Smith calls this non-decision "terminal nonjudgmentalism," or TNJ. He feels that what Shavelson and other death fundamentalists miss is that so-called protective guidelines for the "hopelessly ill" are meaningless; they provide only a veneer of respectability. Once killing is deemed an appropriate response to suffering, the threshold dividing "acceptable" from "unacceptable" killing will be continually under siege. But the fiction of control, essential to the public's acceptance of euthanasia, will have to be maintained, so the definition of what will be seen as "legitimate" killing will be expanded continually.
I personally observed this attitude at the last international meeting of my professional society as I spoke with pulmonologists from The Netherlands, Belgium, and other Western European countries who admitted that "killing patients" occurs rather frequently - sometimes the sickest in the hospital is killed simply to open a bed for a new admission.
As we are beginning to comprehend the holocaust; as African Americans are searching for the relics of their slavery, like the neck irons with their torture springs and who say that this was the real holocaust; when doctors are able to kill thousands of the millions that lie on beds of mercy every day, we will see the epithet of Shindler's List, when doctors directed those whose lives weren't worth living into lines toward the chambers. What was thought to be the efficient killing by the Nazis and the communist doesn't hold a candle to what a free misguided society can do as we open up Pandora's box for doctors to kill patients whose only crime was being ill, or alive with a life not thought to be worth living, We must act before it is too late. Otherwise, those who do act will be considered alive, but will not be after their first accident or illness that brings them in contact with ruthless bureaucratic state-controlled doctors, a horror we can't imagine or a thrill that not even Stalin or Hitler could envision.
To read more reviews on medical ethics, go to www.healthcarecom.net/bkrev_MedEthics.htm
To read more book reviews, go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
To read book reviews topically, go to www.healthcarecom.net/bookrevs.htm.
* * * * *
Sacramento Library can't add up the Fines that are Due!
Since the Sacramento County grand jury issued a scathing report that it found a major problem with uncollected fines totaled by the library at $2.5 million, which in fact totaled $4.6 million, the library responded by authorizing a $300,000 contract for a "performance audit" and is considering paying another $30,000 for a survey of how well it serves it customers.
Only a government entity can spend money like that when they're losing money already. The problem is that government has an unlimited supply of money - taxpayers.
Man denied treatment but offered Physician-Assisted Suicide
A reader writes that on Fox News at 11 PM on July 28, a man in Oregon who applied to Medicaid for cancer treatment was denied treatment but offered PAS (Physician-Assisted Suicide) by the state.
Looks like Oregon found a new way to cut health care costs - kill the patient.
California's Little Hoover Commission recommends state prisons for juveniles go out of existence.
State prisons for youthful offenders have been an expensive failure. A lawsuit filed on behalf of juvenile inmates in 2003 documented horrific conditions in what was then called the California Youth Authority. Violence was rampant and lockdowns so common that educational or counseling programs could not operate effectively. It's hard to conceive of a juvenile justice system that would be more costly and less effective than the one now in place. Three of four youths who leave state-run prisons commit new crimes within three years of release.
The CYA was an effective training program to prepare juvenile offenders for a lifetime of crime.
Inmate Care to cost an extra $8 billion for seven 1500-bed hospitals.
Frustrated and showing signs of temper, California's prison medical receiver on Wednesday asked a federal judge to give him what the governor, the controller and the Legislature have not - enough money to fix the state's correctional health care crisis.
The bill will be $8 billion over five years, J. Clark Kelso said at his downtown Sacramento office. It would go toward building seven new chronic-care facilities to house 10,500 inmate patients and upgrading medical units at all 33 state prisons.
In the legal motion filed in U.S. District Court in San Francisco, Kelso blasted ahead in what amounted to the receivership's boldest move yet in the 2 1/2 years since it was created by judicial mandate. . .
Besides the money, Kelso's motion also asked that Gov. Arnold Schwarzenegger and state Controller John Chiang be held in contempt of court for failing to provide the prison medical fix-it financing. The receiver wants Judge Thelton Henderson to fine them $2 million a day until they come through with the cash. . .
Kelso acted under authority granted to him by Henderson, the federal judge who ruled in 2005 that California is violating the Eighth Amendment of the U.S. Constitution by failing to provide adequate medical care to its prison population. The judge said in his fact findings that one inmate a week was dying due to medical neglect, a figure that has remained substantially unchanged, according to later surveys conducted by the receiver's office. . . Read the entire story at www.sacbee.com/capolitics/v-print/story/1155728.html.
"I think Mr. Kelso got their attention," political consultant Ray McNally said.
To read more HHK, go to www.healthcarecom.net/hhk2001.htm.
To read more HMC, go to www.delmeyer.net/hmc2005.htm.
* * * * *
• John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.
• PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.emergiclinic.com. To read more on Dr Berry, please click on the various topics at his website.
• PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. http://home.earthlink.net/~doctorlrhuntoon/. Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.
• Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."
• Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25–50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com.
· Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.
• Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Read her obituary that appeared in San Diego Union-Tribune. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.
• David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. Read his "Lessons from the Past." For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.
• Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.
• Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.
To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.
• Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.
• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or go to archives to see the last two years' topics. Don't miss the archived article A Solution for Global Warming.
• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: Medicare veto override a triumph for single-payer advocates at www.aapsonline.org/newsoftheday/0038. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site. Be sure to read this article: "The biggest barrier to acceptance of the electronic medical or health record (EMR/EHR) is said to be physician resistance. Cost, of course, is one enormous barrier." Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the most current issue. Don't miss the current debate: The Case for Bioidentical Hormones and The Case Against Bioidentical Hormones. There is an extensive book review section where you can find reviews of Twice Dead: Organ Transplants and the Reinvention of Death; Power to the People; The Criminalization of Medicine: America’s War on Doctors and others.
* * * * *
Thank you for joining the MedicalTuesday.Network and Have Your Friends Do the Same. If you receive this as an invitation, please go to www.medicaltuesday.net/Newsletter.asp, enter you email address and join the 20,000 members who receive this newsletter. If you are one of the 50,000 guests that surf our web sites, we thank you and invite you to join the email network on a regular basis by subscribing at the website above.
Please note that sections 1-4, 8 are entirely attributable quotes and editorial comments are in brackets. Permission to reprint portions has been requested and may be pending with the understanding that the reader is referred back to the author's original site. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.
ALSO NOTE: MedicalTuesday receives no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the research and writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country.
Spammator Note: MedicalTuesday uses many standard medical terms considered forbidden by many spammators. We are not always able to avoid appropriate medical terminology in the abbreviated edition sent by e-newsletter. (The Web Edition is always complete.) As readers use new spammators with an increasing rejection rate, we are not always able to navigate around these palace guards. If you miss some editions of MedicalTuesday, you may want to check your spammator settings and make appropriate adjustments. To assure uninterrupted delivery, subscribe directly from the website rather than personal communication: www.medicaltuesday.net/newsletter.asp
Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Words of Wisdom
What this country needs are more unemployed politicians. -Edward Langley, Artist 1928-1995
Washington can be counted on to create a crisis - usually by sheer incompetence. Then it rushes to the rescue, often doing more harm than good. -Ernest S Christian & Gary A Robbins, WSJ, 7-19-08.
"The most important consequence of
marriage is, that the husband and the wife become in law only one person . . .
Upon this principle of union, almost all the other legal consequences of
Some Recent Postings
HEALTH CARE CO-OPS IN UGANDA - Effectively Launching Micro Health Groups in African Villages, by George C. Halvorson www.delmeyer.net/bkrev_HealthCareCo-OPInUganda.htm
A CALL TO ACTION - Taking Back Healthcare for Future Generations by Hank McKinnell www.delmeyer.net/bkrev_ACallToAction.htm
PUTTING OUR HOUSE IN ORDER - A Guide to Social Security & Health Care Reform by George P. Shultz and John B Shoven www.delmeyer.net/bkrev_PuttingOurHouseInOrder.htm
Robert E. Boni got the attention of management at his company by blowing up thick steel ingots with dynamite.
It was all for a good cause. Mr. Boni, an engineer, was trying to save Armco Inc.'s contract with its biggest customer, General Motors Corp. The dynamiting helped him and other engineers examine the pattern of grains in the steel and fine-tune the casting process to eliminate rips and stretch marks in steel for car parts. Armco kept the contract.
Following that 1961 success, Mr. Boni rose to become Armco's chief executive in 1985. The company was ailing, like many American steel companies at the time. Initiating a deft combination of layoffs, spinoffs, and partnerships, Mr. Boni led a turnaround at the nation's fifth-largest steelmaker, now known as AK Steel Holding Corp.
"Some companies in our condition would have declared Chapter 11. I resolved we would not," Mr. Boni told Forbes in 1990. But two years earlier he admitted to Industry Week, "About April 1985, I felt as thought I had just bought the last ticket on the Titanic."
After receiving a doctorate at Carnegie Institute of Technology, Mr. Boni spent his entire career with Armco, based in Middletown, Ohio. He had a sheaf of patents for improved manufacturing processes and coatings. He was fond of citing a quotation attributed to Charles Kettering, GM's legendary head of research: "I have never heard of anyone stumbling on something sitting down."
After becoming CEO, Mr. Boni cut the company's work force in half, to 19,000. He sold nearly every nonsteel business the company had. In 1989, he attracted an infusion of $350 million by selling Japan's Kawasaki Steel Corp. 40% of Armco's Eastern Steel division in a bid to serve Japanese auto makers in the U.S.
Though workers complained when he moved the headquarters to a New Jersey office park -- he soon relented and went back to Middletown -- the back-to-basics strategy worked. Profit rebounded to $165 million in 1989, and Mr. Boni retired the next year. . . .
Read the entire obituary at http://online.wsj.com/article_print/SB121643504313167425.html.
On This Date in History - July 29
On this date in 1588, Sir Francis Drake and the British fleet routed the Spanish Armada, the reputed mightiest war machine ever assembled at that time, a classic David and Goliath battle.
On this date in 1883, Benito Mussolini, the father of modern fascism, a classic demagogue, and the son of a blacksmith, was born. In 1922, his band of political thugs marched on Rome and declared him as government head until executed in 1945.
On this date in 1905, Dag Hammarskjöld was born to Sweden’s Prime Minister Hjalmin Hammarskjöld and became the UN Secretary General in 1953. He died on a peace mission in the African Congo in 1961.
On this date in 1958, President Dwight D. Eisenhower signed the National Aeronautics and Space Act, creating NASA.
After Leonard and Thelma Spinrad