MEDICAL TUESDAY . NET |
NEWSLETTER |
Community For Better Health Care |
Vol VIII, No 6, June 23, 2009 |
In This Issue:
1.
Featured Article:
A
Prescription for American Health Care
2.
In
the News: "Thought
Crimes" Bill Advances to the Senate
3.
International Medicine: Zambian economist who challenges the liberal aid
establishment
4.
Medicare: Please
take a lesson from Government Sewage and Water Care.
5.
Medical Gluttony:
Much of patient Gluttony is seen as expected service.
6.
Medical Myths:
Hospitals Judge Physicians Appropriately, Just as a U. S. Court
7.
Overheard in the Medical Staff Lounge: Abusive Peer Review - The Medical Mafia
8.
Voices
of Medicine: Autism:
"Let's wait and see" is not an option!
9.
The Bookshelf: Why
America's Quest for Perfect Health Is a Recipe for Failure
10.
Hippocrates
& His Kin: If
Government has difficulty treating water, how will they treat patients?
11.
Related Organizations: Restoring Accountability in Medical Practice and Society
Words of Wisdom,
Recent Postings, In Memoriam . . .
* * * * *
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records to make an impersonal decision on your life and health.
* * * * *
1. Featured
Article: A Prescription for American Health Care
By John C. Goodman, President,
National Center for Policy Analysis
The
following is adapted from a speech delivered in Naples, Florida, on February
18, 2009, at a Hillsdale College National Leadership Seminar.
I'll start with the bad news: When we get through the
economic time that we're in right now, we're going to be confronted with an
even bigger problem. The first of the Baby Boomers started signing up for early
retirement under Social Security last year. Two years from now they will start
signing up for Medicare. All told, 78 million people are going to stop working,
stop paying taxes, stop paying into retirement programs, and start drawing
benefits. The problem is, neither Social Security nor Medicare is ready for
them. The federal government has made explicit and implicit promises to
millions of people, but has put no money aside in order to keep those promises.
Some of you may wonder where Bernie Madoff got the idea for his Ponzi scheme.
Clearly he was studying federal entitlement policy.
Meanwhile, in the private sector, many
employer-sponsored pension plans are not fully funded. Nor is the federal government
insurance scheme behind those plans. We have a potential taxpayer liability of
between 500 billion and one trillion dollars for those private pension plans,
depending on the markets. And on top of that, roughly one-third of all Baby
Boomers work for an employer who has promised post-retirement health care. As
with the auto companies, almost none of that is funded either. Nor are most
state and local post-retirement health benefit plans. Some California
localities have already declared bankruptcy because of their employee
retirement plans and the first of the Baby Boomers is still only 63 years old.
What all this means is that we're looking at a huge
gap between what an entire generation thinks is going to happen during its
retirement years and the funds that are there—or, more accurately, are not
there—to make good on all those promises. Somebody is going to be really
disappointed. Either the Baby Boomers are not going to have the retirement life
that they expect or taxpayers are going to be hit with a tremendously huge
bill. Or both.
The Mess We're In
How did this crisis come about? After all, the need to
deal with risk is not a new human problem. From the beginning of time, people
have faced the risks of growing old and outliving their assets, dying young
without having provided for their dependents, becoming disabled and not being
able to support themselves and their families, becoming ill and needing health
care and not being able to afford it, or discovering that their skills are no
longer needed in the job market. These risks are not new. What is new is how we
deal with them.
Prior to the 20th century, we handled risks with the
help of family and extended family. In the 19th century, by the time a child
was nine years old, he was usually paying his own way in the household. In
effect, children were their parents' retirement plan. But during the 20th
century, families became smaller and more dispersed—thus less useful as
insurance against risk. So people turned to government for help. In fact, the main
reason why governments throughout the developed world have undergone such
tremendous growth has been to insure middle class families against risks that
they could not easily insure against on their own. This is why our government
today is a major player in retirement, health care, disability and
unemployment.
Government, however, has performed abysmally. It has
spent money it doesn't have and made promises it can't keep, all on the backs
of future taxpayers. The Trustees of Social Security estimate a current
unfunded liability in excess of $100 trillion in 2009 dollars. This means that
the federal government has promised more than $100 trillion over and above any
taxes or premiums it expects to receive. In other words, for Social Security to
be financially sound, the federal government should have $100 trillion—a sum of
money six-and-a-half times the size of our entire economy—in the bank and
earning interest right now. But it doesn't. And while many believe that Social
Security represents our greatest entitlement problem, Medicare is six times
larger in terms of unfunded obligations. These numbers are admittedly based on
future projections. But consider the situation in this light: What if we asked
the federal government to account for its obligations the same way the private
sector is forced to account for its pensions? In other words, if the federal
government suddenly closed down Social Security and Medicare, how much would be
owed in terms of benefits already earned? The answer is $52 trillion, an amount
several times the size of the U.S. economy. . .
Cleaning Up the Mess
The only sensible alternative to relying on a welfare
state to solve our health care needs is a renewed reliance on private sector
institutions that utilize individual choice and free markets to insure against
unforeseen contingencies. In the case of Medicare, our single largest health
care problem, such a solution would need to do three things: liberate the
patients, liberate the doctors, and pre-fund the system as we move through time.
. .
In summary, if health care consumers are allowed to
save and spend their own money, and if doctors are allowed to act like
entrepreneurs—in other words, if we allow the market to work—there is every
reason to believe that health care costs can be prevented from rising faster
than our incomes.
The Market in Action
Let me offer a few examples of how the free market is
already working on the fringes of health care. Cosmetic surgery is a market
that acts like a real market—by which I mean that it is not covered by
insurance, consumers can compare prices and services, and doctors can act as
entrepreneurs. As a result, over the last 15 years, the real price of cosmetic
surgery has gone down while that of almost every other kind of surgery has been
rising faster than the Consumer Price Index—and even though the number of
people getting cosmetic surgery has increased by five- or six-fold.
In Dallas there is an entrepreneurial health care
provider with two million customers who pay a small fee each month for the
ability to talk to a doctor on the telephone. Patients must have an electronic
medical record, so that whichever doctor answers the phone can view the
patient's electronic medical record and talk to the patient. This company is
growing in large part because it provides a service that the traditional health
care system can't provide . . .
Finally, consider the international market for what
has become known as medical tourism. Hospitals in India, Singapore and Thailand
are competing worldwide for patients. Of course, no one is going to get on a
plane without some assurances of low cost and high quality—which means that, in
order to attract patients, these hospitals have to publicize their error rates,
their mortality rates for certain kinds of surgery, their infection rates, and
so on. Their doctors are all board-certified in the United States, and they
compete for patients in the same way producers and suppliers compete for
clients in any other market. Most of their patients come from Europe, but the
long-term threat to the American hospital system can't be denied. Leaving the
country means leaving bureaucratic red tape behind and dealing instead with
entrepreneurs who provide high-quality, low-cost medicine.
As these examples suggest, liberating the medical
market by freeing doctors and patients is the only way to bring health care
costs under control without sacrificing quality. Continuing on our current
path—allowing health care costs to rise at twice the rate of income under the
aegis of an unworkable government Ponzi scheme—is by comparison unreasonable.
JOHN C. GOODMAN is the president, CEO, and
Kellye Wright Fellow at the National Center for Policy Analysis. He received
his Ph.D. in economics from Columbia University, and has taught and done
research at Columbia University, Stanford University, Dartmouth College,
Southern Methodist University and the University of Dallas. He writes regularly
for such newspapers as the Wall Street
Journal, USA Today, Investor's Business Daily and the Los Angeles Times, and is the author
of nine books, including Patient
Power: Solving America's Health Care Crisis and Lives at Risk: Single-Payer National Health Insurance Around the World.
* * * * *
2.
In the News: "THOUGHT
CRIMES" BILL ADVANCES TO THE SENATE
"A government powerful enough to pick and choose
which thoughts to prosecute is a government too powerful."
Why is the press remaining mostly silent about the
so-called "hate crimes law" that passed in the House on April
29? The Local Law Enforcement Hate Crimes Prevention Act passed in a
249-175 vote (17 Republicans joined with 231 Democrats). These Democrats
should have been tested on their knowledge of the First Amendment, equal
protection of the laws (14th Amendment), and the prohibition of double jeopardy
(no American can be prosecuted twice for the same crime or offense). If
they had been, they would have known that this proposal, now headed for a
Senate vote, violates all these constitutional provisions, says Nat Hentoff, a
senior fellow with the Cato Institute.
·
This bill would make it
a federal crime to willfully cause bodily injury (or try to) because of the
victim's actual or perceived "race, color, religion, national origin,
gender, sexual orientation, gender identity or disability" -- as explained
on the White House Web site, signaling the president's approval.
·
A defendant convicted on
these grounds would be charged with a "hate crime" in addition to the
original crime, and would get extra prison time.
The extra punishment applies only to these
"protected classes," says Hentoff. As Denver criminal defense
lawyer Robert J Corry Jr. asked (Denver Post April 28): "Isn't every
criminal act that harms another person a 'hate crime'?" Then,
regarding a Colorado "hate crime" law, one of 45 such state laws,
Corry wrote: "When a Colorado gang engaged in an initiation ritual of
specifically seeking out a "white woman" to rape, the Boulder
prosecutor declined to pursue 'hate crime' charges." She was not
enough of one of its protected classes. . .
Whether you're a Republican or Democrat, think hard
about what Corry adds, says Hentoff: "A government powerful enough to pick
and choose which thoughts to prosecute is a government too powerful."
Source: Nat Hentoff, "'Thought Crimes' Bill
Advances," Cato Institute, May 13, 2009.
For text: www.cato.org/pub_display.php?pub_id=10188.
For more on Legal Issues: www.ncpa.org/sub/dpd/index.php?Article_Category=35.
* * * * *
3.
International
Medicine: Opposition builds to
Zambian economist who challenges the liberal aid establishment By William Wallis in
London, May 23 2009
Ms Moyo argues that [Aid] has fostered dependency
and perpetuated poor governance.
A swell of
opposition is building in the aid world to a new protagonist who has thrown
down a strident challenge to the rock stars and liberal economists who have
long dominated debate over foreign assistance to developing countries.
Galled by the ease with which Dambisa Moyo, the Zambian
economist and former investment banker, has suddenly risen to prominence this
year, activists are circulating detailed critiques of her ideas and mass
mailing African non-government organisations to mobilise support against her.
Yet it is proving hard to suppress the hyper-active
graduate of Oxford and Harvard, who pops up weekly in a new capital to promote
her book Dead Aid - the title itself an affront to rock star Bob
Geldof's Live Aid campaigns.
The former Goldman Sachs strategist has become something
of a phenomenon. In April, she hit the New York Times bestseller list, this
month she was named on Time Magazine's list of the 100 most influential people,
and she has been appointed to the board of brewer SAB Miller.
Within days of reading about her, Paul Kagame, Rwanda's
president, flew Ms Moyo out to address his government. This month, Col Muammar
Gadaffi, the Libyan leader, invited her to Tripoli.
Broadly, Ms Moyo argues that official development
assistance has fostered dependency and perpetuated poor governance. She
proposes a blend of commercial debt, microfinance, fairer trade and investment
in its place. . .
"It is ludicrous because we now have leaders like
President Kagame supporting the anti-aid campaign. . . despite the clear
successes of aid in promoting Rwanda's growth," he told the Financial
Times. But Ms Moyo has struck a chord in Africa.
"The aid establishment is scared to death of the
public relations disaster that a growing movement of independent critical
African professionals would be," said William Easterly, the US academic.
Aid does not Improve Growth or Innovation,
it only Fosters Dependency and Destroys hope.
* * * * *
4.
Medicare: Take a
lesson from Government Sewage and Water Care.
About 82 percent of Americans receive drinking water
via publicly-owned water systems, according to the Environmental Protection
Agency (EPA). Many of these municipal and regional systems operate at a
loss, meaning users' fees don't cover the cost of treating and delivering the
water. Many water authorities are critically behind on maintenance.
They lack the capital to update their water purification and wastewater
treatment plants, or to secure additional water supplies to meet expected
growth in demand.
Experience in other countries shows that privatization
could solve these water supply problems.
Problem: Funding Infrastructure. The majority of drinking water supply and
treatment facilities and wastewater treatment plants in the United States are
owned and operated by the government. According to the EPA, many need to
be upgraded or replaced, at an estimated cost of nearly $350 billion over the
next two decades. . .
Problem: Public Health. The U.S.
population is expected to grow to 325 million by 2020. This increase will
create new demand for clean water services. Existing water systems must
be renovated, and new infrastructure must be built.
In a 2007 congressional hearing, the EPA warned that
"numerous treatment facilities that process water and wastewater are in
need of upgrading [in order to protect] public health." . . .
Solution: Private Financing. Local governments often contract with private
firms to replace infrastructure and provide financing. . . .
Solution: Increased Efficiency. According to the Rio Grande Foundation, a
research institute in New Mexico, private systems are more efficient than
government-run systems:
·
Operating expenses are 21 percent lower for privately
run systems than comparable
government-run water systems.
·
Maintenance costs for privately run water suppliers
are on average half that of public
water systems.
·
Private water companies require less than half as many
employees as public water systems and
spend one-third less of water sales revenue on employee salaries.
The public officials who manage water systems often
receive especially large salaries. For example, the superintendent of the
Great Neck Water Authority outside New York City earns more money than the
governor of New York. The manager of the Jericho, N.Y., water district
receives such additional benefits as a car and a residence. . .
Solution: Private Water Companies. In contrast to the United States, private
companies dominate the market for water delivery and wastewater treatment in
Europe. Private water delivery has long existed in France. In 1782,
around the time of the first French Revolution, the Perrier brothers' company
began providing clean, running tap water in Paris. In London, private
water companies operated for more than 200 years until a nationalization
movement in 1903. England reprivatized water delivery in 1989.
Today, private companies provide drinking water and
wastewater services to more than 70 percent of the people in France, England
and Chile. Other countries also depend on private water suppliers to
treat and deliver water for large percentages of their populations [see the
figure]:
·
Private companies
provide water for residential use for 30 percent to 50 percent of Greeks,
Italians and Spaniards.
·
And 50 percent to 70
percent of the people in the Czech Republic, Argentina, Hong Kong and Malaysia
get water from private systems.
Conclusion.
In order to ensure safe, sufficient and relatively inexpensive water supplies
in the future, the U.S. water delivery system must change. Historically,
municipal water authorities have been underfunded and many have been unable to
keep water delivery systems operating safely and efficiently. The gap
between needed resources and investments could grow due to the recession.
Accordingly, the move to private financing and private water suppliers already
taking place should be encouraged and expedited.
H. Sterling Burnett is a senior fellow and Ross Wingo
is a research assistant with the National Center for Policy Analysis.
Government is not the solution to our problems, government is
the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Much of patient Gluttony is seen as expected service.
Physicians have been ineffective in pointing out the
significant costs of health care that are submerged into medical practices.
Patients expect health care as their right. However, where does the right come
from and where does it proceed? Patients today receive mostly free care. They
pay a small fraction of the cost of being seen, almost none of the cost of the
laboratory and x-rays they demand; and this seems to expand the appetite for
"more 'n more" courtesies that are not understood as costs. For
physicians to even mention them as costs is considered greed on the part of the
physician. What are the unappreciated and unrecognized subtleties of excessive
health care consumption?
For their own convenience, patients make demands such
as having the doctor phone their prescriptions to the pharmacist in order to
have ready when they arrived at the pharmacy. Seemingly an obvious small
service rendered for their convenience. Any amount of explanation or comment
would only be interpreted as insensitive or uncaring. Most patients do not
understand the cost of time since they no longer pay for the physician's time.
To make the point in terms the patient could most likely understand, after one
such request when I was several minutes into the appointment, I placed the call
to his pharmacy on the speaker telephone so the patient could hear the menus
and the time taken to navigate those menus. While waiting to be transferred to
the pharmacist, I completed my examination and explained the diagnosis and the
treatment plan. At the conclusion of the 20-minute appointment and also the
writing of the prescriptions, I pressed the speaker button to disconnect the
phone from the pharmacist waiting list since I knew that 20 minutes is
frequently not enough time to phone in a prescription (I was still on hold with
the automated voice saying there was only one other customer ahead of me). I
got up, gave him the written prescriptions, and led him out the door explaining
we were already 10 minutes into the next patient's appointment. As I shook his
hand, I pointed out that his HMO pays about half the office call charge; now he
could obviously see that to ask for a personalized call-in prescription (as
patients frequently do) was like requesting a second full office visit time for
half the value of one office visit. Therefore, we would no longer be able to
honor phone-in prescription requests; he would have to use the paper
prescriptions or the electronic prescriptions available at the time of service.
I'm still not sure if the doubling of costs for half the revenue was
understood. But it certainly was not appreciated.
In another instance, a patient presented himself at
our window during a busy schedule wanting all his prescriptions of the previous
week re-written for a mail order pharmacy that allows three-months supply
rather than one month at the local pharmacy. So, standing at my counter, after
pulling his chart, I rewrote all his prescriptions that had been for a 30-day
supply with eleven refills to a 90-day supply and 9 months of refills. I had
tried to talk him into using the mail order pharmacy the previous week. This
patient again did not comprehend that taking ten minutes or half an appointment
was an inordinate cost expected as a courtesy and an affront to the other
patients having to wait longer. When unions are rebelling to a 10 percent cut
in wages during the current recession, these patients have no realization of
the 50 percent cut in the doctor's wages for their 20-minute appointments, now
up to 30 minutes.
Last week, a patient wanted his prescriptions on a
"fax in" form that others normally bring with them from their mail
order pharmacies in order to expedite faxing in their prescriptions. Only this
patient did not have the forms. He reminded my front desk manager that she
could call his mail order drug plan and request the forms and then I could
complete them. It took my office manager 20 minutes to navigate the mail order
pharmacy phone menus to finally get the appropriate forms that the patient had
left at his home. I had to rewrite the prescriptions on the requested form and
my office then faxed them along with his credit card number to his mail order
pharmacy. He occupied the check-in/check-out counter at my front desk for about
35 minutes in addition to about 5 minutes of my duplicated work.
Would government medicine be more efficient in the
practice situations? Experience to date would not support such a view.
Physicians were the most efficient and cost effective when they did their own
x-rays, lab work, and other procedures in their offices. These have slowly been
driven out by mandates, some of which have actually prevented physicians from
doing their own laboratory work and basic x-rays. Most of the arguments have
centered on the premise that the physician is incentivised to excessive
utilization when in fact they are more efficient in their utilization. Studies
have shown that doctors who send their patients to the Lab, X-ray or ECG
facility order far more Lab tests, ECGs and CXRs than the internist,
cardiologist or the chest physician who do their own Lab, ECG and CXR.
Furthermore, the Lab, ECG and X-Ray facilities charge at least twice what a
private office charges.
More industries are going through the "lean"
revolution these days, some by force of bankruptcy and some by having a culture
of "lean manufacturing" or "lean marketing" that are being
put through greater challenges during our economic downturn. The most
cost-efficient hospitals of the mid-twentieth century were the physician-owned
hospitals. During my medical student preceptorship in a rural community where
the three physicians owned their own hospital, surgical unit, pharmacy, and
office building, they were considerably cheaper than the surrounding community
hospitals. When they did their yearly cost analysis, they seldom found a reason
to increase any hospital charges to the level of the surrounding community
since, in their estimation, they were making adequate profit.
Today, physicians have very little control over
hospital, x-ray, lab or pharmaceutical charges. However, in their practice they
have little choice but to utilize hospitals, labs, x-ray facilities and
pharmacies. Patients still tell me that the physicians control the hospitals.
No amount of data will convince most patients otherwise. The only answer will
be an integrated health plan outside the arena of government medicine in the
open medical market place, which doesn't exist today. If health care could be
restored to the open market place, this would be the most ruthless way to
reduce charges and all costs. That would also put the patient and his physician
in full control. This would require a very disruptive innovation. Almost all of
the current players, whether hospitals, physicians, or health insurance plans,
would resist and even fight such a change. Stay tuned.
Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on
Every Service.
* * * * *
6. Medical Myths: Hospitals Judge Physicians Appropriately,
Just as a U. S. Court.
Medical Truth: Hospital tribunals are
similar to a Military tribunals.
They are not the same as U.S. Courts.
Military tribunals not the same as U.S. courts
by Bob Egelko, Chronicle Staff Writer,
Saturday, May 23, 2009. This article appeared on page A – 1 (Read
the similarities in italics . . .)
President Obama says his
proposed reforms to the military commissions his predecessor established to try
suspected terrorists will bring the tribunals "in line with the rule of
law." But it isn't the same law that applies in U.S. courts.
Pentagon officials appoint the
judges and can remove them. Military commanders choose the jurors, who can
convict defendants by non-unanimous votes, except in death penalty cases. The
military can monitor defense lawyers' conversations with their clients.
When a doctor is accused of medical error, hospital officials appoint
the judges and can remove them. Hospital administrators choose the jurors,
who can convict defendants by non-unanimous votes. The hospitals can have their
expert witnesses hear the defense of the doctor's witnesses, but the doctor's witnesses cann not
monitor the hospital's witnesses' testimony.
Prosecutors can also present
evidence that would never pass muster in civilian courts. Confessions made
under physical or mental pressure could be admissible, despite Obama's
disavowal of torture and coercion. There's no ban on evidence from illegal
searches. And defendants may be convicted on the basis of hearsay - a second
hand report of an out-of-court accusation by another person, perhaps a fellow
suspect, whom the defense never gets to see or question. . .
Hospital Medical Executive Committees (MEC) can also present evidence
that would never pass muster in civilian courts. Confessions made under
physical or mental pressure could be admissible, despite disavowal of coercion.
There's no ban on evidence from illegal searches of doctors' offices and records
via oblique information from the doctor's employees or hospital employees. And
defendants may be convicted on the basis of hearsay - a second hand report of
an out-of-MEC accusation by another person, perhaps a fellow colleague or
defendant, whom the defense never gets to see or question. . .
"The system is designed
to ensure the outcome they want ... convictions in every case," said Ben
Wizner, an American Civil Liberties Union attorney who has attended proceedings
for prisoners at the U.S. naval base at Guantánamo Bay, Cuba. "This
suggests that the much-heralded improvements to the Bush military commission
system are largely cosmetic." . . .
"The hospital hearing system is designed to ensure the outcome
they want . . . convictions in every case," say Medical Defense Attorneyss,
who have attended proceedings for Doctors at many U.S. Hospitals. This suggests that the
much-heralded improvements in Peer Review of Doctors are largely cosmetic. . . .
In his speech . . . at the
National Archives, Obama promised to charge terrorism suspects with crimes in
federal courts "whenever feasible." But he said military commissions,
with proper safeguards, are a proper forum for war-crimes trials.
"They allow for the
safety and security of participants, and for the presentation of evidence
gathered from the battlefield that cannot always be effectively presented in
federal courts," Obama said. . .
A judge in a doctor's superior court appeal states that the hospital commission
has proper safeguards to assure the doctor a fair hearing, and since
"Hospitals are Bastions for Mercy," he would not interfere with the
hospital's stripping a doctor of his hospital privileges, despite itthat being the
source of his livelihood.
Some conservatives said
Obama's words vindicated Bush, who won congressional approval for the current
military commissions in 2006 over the opposition of then-Sen. Obama.
"Critics can no longer
dismiss this by saying (the commissions) were peculiar obsessions of Dick
Cheney and George Bush," said David Rivkin, an attorney who served in the
administrations of Ronald Reagan and George H.W. Bush.
Military commissions are
essential to try enemy combatants, Rivkin said, because incriminating evidence
often won't meet standards established by civilian courts. "If you have
virtually no chance of obtaining a conviction, that's not a viable justice
system," he said. . . .
Hospital hearings are essential to try enemy (to the hospital's
business) doctors because incriminating evidence often won't meet standards
established by civilian courts. "If you have virtually no chance of
obtaining a conviction of a doctor, you have no chance of pruning your medical
staff of unwanted doctors."
Like courts-martial, military
commissions employ officers as judges, lawyers and jurors and allow convictions
in non-capital cases by non-unanimous verdicts.
Like courts-martial, hospitals employ MEC officers as judges, lawyers
and jurors and allow convictions by non-unanimous verdicts.
But unlike courts-martial,
governed by laws that protect judges' independence and mirror civilian courts'
rules for trials, military commissions operate under a law that leaves the
proceedings largely in the hands of the Defense Department. One illustration
came a year ago, when the Pentagon-appointed chief judge at Guantanamo removed
a judge who had criticized prosecutors' handling of evidence in a case.
But unlike courts-martial, governed bylaws that protect judges'
independence and mirror civilian courts' rules for trials, hospitals operate
under a law that leaves the proceedings largely in the hands of the Hospital's
MEC. One illustration comes to mind, when the Hospital-appointed judge removed
an expert witness whose testimony would have vindicated the doctor.
Military officials also pick
the appellate tribunal that reviews convictions. A defendant can then take the
case to a federal appeals court, but its review is mostly limited to whether
the trial followed Pentagon rules.
Hospital officials also pick the appellate tribunal (the hospital Board
of Directors) that reviews convictions appealed by the doctor. A defendant can
then take the case to an appeals court, but its review is mostly limited to
whether the trial followed hospital bylaws.
Evidence standards are much
more permissive than in . . . civilian courts, which ban most types of hearsay
testimony. Military commissions allow hearsay if the judge decides it is
reliable. . .
Evidence standards are much more permissive in hospital hearings than
in civilian courts, which ban most types of hearsay testimony. Hospitals
proceedings allow hearsay if the judge decides it is reliable.. . .
Obama also wants to eliminate
a rule that allows jurors to consider a defendant's refusal to testify as
possible evidence of guilt, and to exclude all confessions extracted by
"cruel" interrogations, regardless of whether they involved torture.
But the commissions might hear
statements produced by tactics that would be barred in court - for example, the
technique known as the "frequent flier" program, in which prisoners
are awakened and moved to new cells every few hours for questioning.
Defenders of the commissions
say courtroom rules shouldn't be applied to battlefield conditions. . .
Defenders of the hospital kangaroo commissions say courtroom rules
should not be applied to the important mission of removing doctors that may
have made mistakes in the battlefield of healthcare even though the doctor's
experts from leading medical centers have testified no mistakes were made. . . .
Doctors are not terrorists and should be afforded direct access to civilian
courts and attorneys. Doctors are not dangerous. Doctors should not be
occupying prison cells when we're releasing prisoners who have committed
serious crimes. Peer review trials are primarily doctors and hospitals
eliminating unwanted competition from good physicians. Peer review should be
handed back to the civilian courts and attorneys who are much more effective in
eliminating bad doctors.
* * * * *
7.
Overheard in the
Medical Staff Lounge: Abusive Peer Review
Dr. Edwards: Roland, I see
you no longer have Dr. Green in your group.
Dr. Roland: Dr. Green was a bad apple and we had to get rid of
him.
Dr. Dave: How so?
Dr. Roland: He was always hogging all the patients and increasing
his bookings.
Dr. Dave: Aren't new patients distributed to your doctor on
call and the others on a rotating basis?
Dr. Roland: Yes it's supposed to act that way. But Dr. Green was
always the first one in the office, picked up the new consults for the day, and
saw his quota by mid afternoon. So I always got the 4:30 consult and had to
work until six.
Dr. Dave: But doesn't the workload rotate and so different
doctors work late?
Dr. Roland: That would be the case. So there were several in our
group that were getting annoyed. Every time they were on, they also felt they
got the shaft. So we just moved to get rid of him.
Dr. Edwards: But what kind of mistakes did Dr. Green make that you
could hang on him to remove him?
Dr. Roland: He was mixing up some of his total parenteral
nutrition orders a bit differently than the rest of us and we wanted him to
fall in line.
Dr. Dave: That's no reason to set him up for a Peer Review
trial to find him guilty. Guilty of what? You know any infusion can vary a lot
between doctors. That's not a kind thing to do.
Dr. Roland: Who said anything about being kind? The group no
longer likes him and wants him out. But he won't leave. So we'll force the
issue.
Dr. Edwards: You think you can talk the Medical Executive
Committee into doing this trial?
Dr. Roland: Yes we can and we have. One member of our group is on
the MEC and we have several friends on the MEC who will support the allegation
of bad medical practice.
Dr. Edwards: There is a lot being written about Abusive Peer
Review and your hanging of Dr. Green professionally certainly fits that
definition.
Dr. Dave: Who would testify for you?
Dr. Roland: We have several that would agree with us and will
testify against Dr. Green. In fact, one of them would like to move here and take
Dr. Green's place in our group.
Dr. Yancy: Maybe I'll testify for Dr. Green. He's got friends
also.
Dr. Roland: You have had two surgical complications in the last
three months Yancy. I don't think I would if I were you.
Dr. Yancy: You're getting real nasty. Remember what goes around
will come around.
Dr. Roland: I think we have all of the bases covered. Once Dr.
Green is served, his friends will all disappear into the tall grass. We won't
see them again until he's off the staff and moved someplace else.
Dr. Rosen: But he can't move any place else and practice. He
will be reported to the medical board and may lose his medical license. He will
then be reported to the Practitioner's Data Bank. Once he's there, he's in a
tomb - never to be heard of again.
Dr. Edwards: Don't you think that's rather cruel and inhumane?
Dr. Roland: Well, someone has to do the dirty work. Blame the
medical society for setting up Peer Review, which allows us to do this legally
and above board.
Dr. Edwards:
He may lose his wife, his family, his
home, and suffer severe financial straits and may even have to go on welfare
since he can never practice again.
Dr. Rosen: That's the unintended consequence that all this
favoritism costs us. Doctors felt they were privileged and shouldn't have
professional matters decided by courts of law and should be able to set up
their own courts made up of Peers rather than have attorneys prosecute them.
Now it's back firing. We should have let attorneys clean out bad doctors. And
many of the doctors the Peer Reviewers are cleaning out are not bad. Dr. Green
is not a bad doctor. In fact, he's a very good physician. One of the best on
our staff. Peer Review has allowed economic credentialing. Doctors are being
removed for economic reasons, not bad medical practice reasons.
Dr. Edwards: It's getting more frequent that Peer Review is not
eliminating bad doctors but good ones. I know a doctor who did a liver biopsy
on a patient on a ventilator and didn't have his assistant hold the breathing
while the needle went in and out. He ripped the liver and the patient died
promptly. The doctor later changed the cause of death so a finger couldn't be
pointed at him. He was on and protected by the Medical Executive Committee.
Dr. Roland: How did you find out about that?
Dr. Edwards: I was in the Medical Records room completing my
charts when the head of the department asked me if I would take a look at a
chart. She felt very uncomfortable with the change in the final death note. I
told her that she was correct, but I could not jeopardize my future as a
physician by being the teller of truth.
Dr. Rosen: That's a good example, Edwards, where Peer Review
protects bad doctors and a malpractice lawyer would be very effective in
getting a verdict against that doctor, stringing him up for millions. I think
there were fewer bad doctors during the Malpractice heydays than now with Peer
Review.
Dr. Edwards: Of course, you will have to agree Rosen, that the
Medical Societies did a great thing in controlling economic damages for pain and
suffering which were the extra millions that malpractice attorneys always
collected on top of the real damages. Attorneys are real good at exploiting
pain and suffering.
Dr. Rosen: I wish you would reconsider your plans, Roland.
There's no point in soiling your character with abusive Peer Review. Those
things will come back to haunt our profession. And if you proceed against Dr.
Green, it will come back to haunt you. You might find yourself in the Data
Bank.
Dr. Roland: I think you lost a young patient during a cardiac
arrest last week, didn't you Rosen? As I said, I think all the bases are
covered for a smooth sail through the Medical Executive Committee.
Dr. Edwards: Looks like it's Good-Bye, Dr. Green. Or it will be
good-bye to one of us.
Dr. Roland: I think you are beginning to understand Medical
Politics rather well, Edwards.
Dr. Rosen: Looks like the Sicilian Mafia has nothing on the Medical Mafia.
The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
* * * * *
8.
Voices of
Medicine: A Review of Local and Regional Medical Journals
SONOMA
MEDICINE, the Magazine of the Sonoma County Medical Association, Winter 2009
Autism:
"Let's wait and see" is not an option! By Cathryn Ross, MD
Autistic
spectrum disorders are common (1:150), chronic, biologically based
neurodevelopmental disorders that are highly heritable. Recognition of early
behavioral signs of autistic spectrum disorders (ASD) by physicians, followed
by immediate referral to early intervention programs, benefits autistic
children, their families, their future schools and society. The old "wait
and see" approach is no longer an option!
The cause of autism is being actively researched but remains
elusive because so many factors are involved. Several genes have been
identified that probably have to occur in multiples in the same person.
Researchers also believe that some environmental stressors may enhance the
penetrance of mutations conferring susceptibility to autism. The immune system
may be involved as well, because many cases of autism involve other organ
systems and not just the brain; reduced levels of immunoglobulin in children
with autism correlates with behavioral symptoms. There is also often increased
prevalence of maternal autoantibodies against the fetal brain in autism.
The American Academy of Pediatrics recommends surveillance for ASD
at all well-child visits and formal screening of all children
with a standardized test at 18- and 24-month visits, and whenever concern is
raised. An ASD toolkit from the pediatric academy contains screening tools and
fact sheets (for both physicians and parents) that address major issues
associated with ASDs.
Diagnosing ASD is challenging because there are no objective
laboratory tests or pathognomonic clinical signs. The physician must rely on
subjective guidelines provided by the latest edition of the Diagnostic and
Statistical Manual of Mental Disorders (DSM IV-TR) and use informed
clinical judgment, which requires training, supervision and feedback from
experts, as well as experience with many children of different functioning
levels and ages. Compounding the challenge is the variability in the expression
of the three core features of ASD:
·
Impaired
social reciprocity
·
Communication
deficits
·
Restricted,
repetitive and stereotypic behaviors
ASDs include
three subtypes: autistic disorder (AD), Asperger syndrome, and pervasive
developmental disorder—not otherwise specified (PDD-NOS), a threshold term used
when a child meets some but not all criteria necessary for a diagnosis of
either AD or Asperger syndrome. Since this article focuses on ASDs before 2
years old and the average age for diagnosing Asperger syndrome is 8-11 years
old, Asperger will not be discussed. When the word autism or ASD is used
in this article, it represents both AD and its milder form, PDD-NOS . . .
The earlier the ASD diagnosis is made, the better the outcome; and
yet many of the criteria address developmental skills that are not applicable
to children younger than 2 years developmental age. Therefore, many severely
autistic children may not meet full criteria. For example, the criteria
"failure to form age-appropriate peer relationships,"
"stereotypic or repetitive use of language" or "impairment in
initiating or sustaining a conversation with others" is not relevant to a
2-year-old who may be preverbal. Also many children who are later diagnosed
with ASD don't develop ritualistic behaviors or a need for routines until after
3 years of age. Taking these issues under consideration, some researchers have
suggested applying only four of the possible twelve DSM-IV-TR criteria for
children under 3 years of age:
·
Lack of
spontaneous seeking to share enjoyment, interests, or achievements with other
people (e.g., lack of showing, bringing, or pointing out objects of interest)
·
Lack of
social and emotional reciprocity
·
Marked
impairment in the use of multiple nonverbal behaviors, such as eye-to-eye gaze,
facial expression, body postures, and gestures to regulate social interaction
·
Delay in or
total lack of the development of spoken language (not accompanied by an attempt
to compensate through alternative modes of communication such as gesture or
mime)
The researchers propose that if all
four of the above criteria are met, then a provisional diagnosis of autism
should be made. After the third birthday, the child should be reevaluated using
the full DSM IV-TR criteria. . .
Read the entire article: http://scma.org/magazine/articles/?articleid=314.
Dr. Ross is a developmental-behavioral
pediatrician in private practice in Santa Rosa.
VOM Is Where Doctors' Thinking is Crystallized into Writing.
* * * * *
9. Book Review:
FALSE HOPES - Why America's Quest for Perfect Health Is a Recipe for
Failure by Daniel Callahan, Simon & Schuster, New York,
1998. 330 pp, $24, ISBN 0-684-81109-X
There is no
clear correlation between population health and medical care.
Daniel Callahan, cofounder of the Hastings Center and
the Director of its International Programs, takes on the entire medical
establishment--doctors, nurses, hospital administrators, medical researchers,
and pharmaceutical and medical technology companies--all of whom he believes
are united in a relentless pursuit of unlimited medical progress, stopping at
nothing short of the conquest of all disease and the indefinite extension of
life spans (see last month's review of Schwartz' Life Without Disease - The Pursuit
of Medical Utopia).
The Hastings Center is an avant-garde institution
where any idea can be explored (see "Duty to Die" in the HHK column).
Callahan, as the president of the Hastings Center from 1969 to 1996, must be
taken seriously. In the preface, he presents his political leanings, aligning
himself with the Clintons in their quest for healthcare reform. He bemoans the
fact that no plan made it through Congress--not one bill, not a single reform.
Callahan is even more appalled that at the next presidential election, both
candidates all but ignored the issue.
Initially, the reason he takes this stance is not
clear. However, he soon points out that the universal, if poorly financed and
often corrupt, healthcare systems in China, Southeast Asia, and in much of
Latin America, are turning to the marketplace and accepting privatization as
their new gospel. He finds it most unsettling that the popular, well-managed,
equitable health care systems of Western Europe have begun to unravel in the
post WW II welfare state. These systems, beset with rising costs, are high on
the budgetary hit lists of political leaders who are looking to the marketplace
to reduce public benefits, thus securing their own future.
Callahan realizes that if everyone is having a
problem, and all are looking for answers, there must be an underlying basic
issue. Almost all healthcare reform efforts assume that the solution lies in
better organization and financing. Callahan then observes that no matter how
much money is spent and no matter what the health gains may be, they never seem
to be enough. Conventional solutions do not address the real problem. No matter
how much progress, they always seem insufficient to meet the "needs"
of the day.
The most cherished and celebrated aims, commitments,
and values of modern medicine are beginning to give us trouble. But challenging
these ideas, Callahan reflects, is not new. Rene Dubois in his 1954 book Mirage
of Health questioned the then imminently anticipated total conquest of
disease and stated this would not happen, not soon, not ever. In the 1970s,
theologian Ivan Illich, British physician John Powles, American physician Rick
Carlson, and British professor of social medicine, Thomas McKeown, each showed
in a systematic way that there is no clear correlation between population
health and medical care. Carson boldly predicted the diminishing impact of
physicians and hospitals on health by the year 2000.
Callahan emphasizes that "A serious
transformation will require taking money away from the acute-care sector,
including research into the cure of many lethal diseases, and using it instead
on prevention research and massive educational efforts designed to change health-related
behavior." Callahan asserts that sustainable medicine will do the
following: give priority to preventing and treating diseases that afflict the
many rather than finding cures for diseases that effect the few, improve the
quality of life for the elderly rather than extend life indefinitely, and focus
on primary care and public health measures that benefit society as a whole
rather than satisfying the health needs of individuals. . .
This book review is found at . . .
To read more book
reviews . . .
To read book reviews topically
. . .
* * * * *
10. Hippocrates & His Kin: Government has difficulty
treating water systems efficiently.
Operating expenses are 21 percent lower
for privately run systems than comparable government-run water systems.
Maintenance costs for privately run water suppliers are on average half that of
public water systems. Private water companies require less than half as many
employees as public water systems and spend one-third less of water sales
revenue on employee salaries.
If government can't treat water
efficiently, how will they ever treat humans with diseases?
Single Payer is a Dying Issue. If Resuscitated, then Patients will be
Dying. Better that SP dies.
Leap
In U.S. Debt Hits Taxpayers With 12 Percent More Red Ink
Taxpayers are on the hook for
an extra $55,000 a household to cover rising federal commitments made just in
the past year for retirement benefits, the national debt and other government
promises...
Have you tried asking your employer for a
raise to cover that?
Making a Mockery of Being Green By Jamin
Brophy-Warren
Director Mike Judge's new animated television series "The Goode
Family" is a send-up of a clan of environmentalists who live by the words
"What would Al Gore do?" Gerald and Helen Goode want nothing more
than to minimize their carbon footprint. They feed their dog, Che, only veggies
(much to the pet's dismay) and Mr. Goode dutifully separates sheets of toilet
paper when his wife accidentally buys two-ply. And, of course, the family
drives a hybrid. The
creator of 'Beavis and Butt-Head' and 'King of the Hill' has a new target:
environmentalists.
That's one message you can only expose with
humor.
* * * * *
11.
Professionals Restoring Accountability in Medical Practice, Government
and Society:
•
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.patmosemergiclinic.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.
•
FIRM: Freedom and
Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org,
researches and studies the work of scholars and policy experts in the areas
of health care, law, philosophy, and economics to inform and to foster public
debate on the causes and potential solutions of rising costs of health care and
health insurance. There are a number of excellent articles on the website.
•
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, (1937-2006), is no longer with us. She made
important contributions in restoring accountability in health care. Her
obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html.
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. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. 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. View the Recession and its effect
on Health Care, also Terrorists
could stay home, yet launch a devastating attack on an unprepared and
vulnerable healthcare system.
•
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.
Don't miss section seven above on
Abusive Peer Review.
•
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.
To review a discussion on a Peer Review Case in progress, go to section six above.
•
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, who wrote an
informative Medicine Men column at NewsMax, have now retired. Please log
on to review the archives.
•
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. Follow the list of Third Party Free Practices. Be
sure to read News of the Day in Perspective: Kennedy releases draft
"health care reform" proposal. Don't miss the "AAPS
News," Doctors
Are The Key, written by Jane Orient, MD, and archived on this site, which
provides valuable information on a monthly basis. 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 Table
of Contents. Note some timely articles:
An Invasion of Medicine by the Information Technology Industry? What
America Needs to Learn from Canadian Medicare; Epidemiologic and Economic Research,
and the Question of Smoking Bans. The Book Review Section has four important
topics.
* * * * *
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Del Meyer
Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
"Is
life so dear, or peace so sweet, as to be purchased at the price of chains and
slavery? Forbid it, Almighty God! I know not what course others may take; but
as for me, give me liberty or give me death!" -Patrick Henry.
"He that has sense knows that learning is not
knowledge, but rather the art of using it." -Richard Steele: 17th-18th century English playwright and essayist
"If you change the way you look at things, the
things you look at change." -Dr. Wayne Dyer: Self-development author and speaker.
Some Recent
Postings
Why the Push for
Health Care Reform?
The Real Driving Force
behind Health Care Reform.
By Hudson Sangree hsangree@sacbee.com,
May 22, 2009
Steve Larsen, a world-class cyclist and triathlete who
grew up in Davis [CA] and owned a bike shop there, died during a workout
Tuesday at the age of 39 . . .
Larsen collapsed during a training run at a
middle-school track in Bend, Ore., the city he moved to when he left Davis in
2003. Dr. Steve Cross, the Decschutes County medical examiner, said there was
no obvious explanation for what happened to Larsen, who was in peak physical
condition.
When the elite athlete collapsed Tuesday evening, he
was given immediate CPR and arrived at the hospital quickly with two
experienced heart surgeons attending him but could not be revived, Cross said.
Larsen, who once owned Steve Larsen's Wheelworks
bicycle shop in Davis, twice competed in the Giro d'Italia and rode during his
amateur and early professional career as a teammate to superstar cyclist Lance
Armstrong.
His penchant for cycling began as a child when he
would ride several miles from his family's home on the outskirts of Davis to
town, friends said. Famed for his fierce drive, he completed the 200-mile Davis
Double-Century bike race when he was 11 years old.
"I was burned out on cycling for two years after
that," he told The Bee. "It took me 15 hours; I was practically
falling asleep on my bike. I couldn't walk for days."
But he recovered, and begin riding seriously again in
the eighth grade. After a stint as a professional road cyclist, Larsen
eventually switched to mountain biking and won several national titles.
His mountain biking career ended when he quit as the
reigning cross country national titlist in 2000.
Ever the athlete, Larsen in 2000 entered a triathlon
and won. He told cycling writer James Raia in a 2003 Bee story that not
competing in the Olympics or the Tour de France was a big disappointment: . . .
For more
information, go to www.rememberstevelarsen.com.
www.sacbee.com/obituaries/story/1883541.html
On This Date in
History - June 23
On this date in 963, the principality of
Luxembourg was founded. Luxembourg has survived occupations and invasions
by more powerful neighbors - and every other country is more powerful than Luxembourg,
except in its ability to survive.
On this date in 1961, an international
treaty for scientific cooperation and peaceful use of the Antarctic was signed.
It
will be a cold day in Antarctica when that treaty ends.
-After Leonard and Thelma Spinrad