MEDICAL TUESDAY . NET

NEWSLETTER

  Community For Better Health Care

Vol V, No 6, June 27, 2006

 

In This Issue:



 

1.      Featured Article:  Why Politicized Science is Dangerous by Michael Crichton, MD

Imagine that there is a new scientific theory that warns of an impending crisis, and points to a way out.

This theory quickly draws support from leading scientists, politicians and celebrities around the world. Research is funded by distinguished philanthropies, and carried out at prestigious universities. The crisis is reported frequently in the media. The science is taught in college and high school classrooms.

I don't mean global warming. I'm talking about another theory, which rose to prominence a century ago.

Its supporters included Theodore Roosevelt, Woodrow Wilson, and Winston Churchill. It was approved by Supreme Court justices Oliver Wendell Holmes and Louis Brandeis, who ruled in its favor. The famous names who supported it included Alexander Graham Bell, inventor of the telephone; activist Margaret Sanger; botanist Luther Burbank; Leland Stanford, founder of Stanford University; the novelist H. G. Wells; the playwright George Bernard Shaw; and hundreds of others. Nobel Prize winners gave support. Research was backed by the Carnegie and Rockefeller Foundations. The Cold Springs Harbor Institute was built to carry out this research, but important work was also done at Harvard, Yale, Princeton, Stanford and Johns Hopkins. Legislation to address the crisis was passed in states from New York to California.

These efforts had the support of the National Academy of Sciences, the American Medical Association, and the National Research Council. It was said that if Jesus were alive, he would have supported this effort.

All in all, the research, legislation and molding of public opinion surrounding the theory went on for almost half a century. Those who opposed the theory were shouted down and called reactionary, blind to reality, or just plain ignorant. But in hindsight, what is surprising is that so few people objected.

Today, we know that this famous theory that gained so much support was actually pseudoscience. The crisis it claimed was nonexistent. And the actions taken in the name of theory were morally and criminally wrong. Ultimately, they led to the deaths of millions of people.

The theory was eugenics, and its history is so dreadful -- and, to those who were caught up in it, so embarrassing -- that it is now rarely discussed. But it is a story that should be well known to every citizen, so that its horrors are not repeated.

The theory of eugenics postulated a crisis of the gene pool leading to the deterioration of the human race. The best human beings were not breeding as rapidly as the inferior ones --- the foreigners, immigrants, Jews, degenerates, the unfit, and the "feeble minded." Francis Galton, a respected British scientist, first speculated about this area, but his ideas were taken far beyond anything he intended. They were adopted by science-minded Americans, as well as those who had no interest in science but who were worried about the immigration of inferior races early in the twentieth century --- "dangerous human pests" who represented "the rising tide of imbeciles" and who were polluting the best of the human race.

The eugenicists and the immigrationists joined forces to put a stop to this. The plan was to identify individuals who were feeble-minded --- Jews were agreed to be largely feeble-minded, but so were many foreigners, as well as blacks --- and stop them from breeding by isolation in institutions or by sterilization.

As Margaret Sanger said, "Fostering the good-for-nothing at the expense of the good is an extreme cruelty … there is not greater curse to posterity than that of bequeathing them an increasing population of imbeciles." She spoke of the burden of caring for "this dead weight of human waste."

Such views were widely shared. H.G. Wells spoke against "ill-trained swarms of inferior citizens." Theodore Roosevelt said that "Society has no business to permit degenerates to reproduce their kind." Luther Burbank, "Stop permitting criminals and weaklings to reproduce." George Bernard Shaw said that only eugenics could save mankind.

There was overt racism in this movement, exemplified by texts such as "The Rising Tide of Color Against White World Supremacy" by American author Lothrop Stoddard. But, at the time, racism was considered an unremarkable aspect of the effort to attain a marvelous goal --- the improvement of humankind in the future. It was this avant-garde notion that attracted the most liberal and progressive minds of a generation. California was one of twenty-nine American states to pass laws allowing sterilization, but it proved the most-forward-looking and enthusiastic --- more sterilizations were carried out in California than anywhere else in America.

Eugenics research was funded by the Carnegie Foundation, and later by the Rockefeller Foundation. The latter was so enthusiastic that even after the center of the eugenics effort moved to Germany, and involved the gassing of individuals from mental institutions, the Rockefeller Foundation continued to finance German researchers at a very high level. (The foundation was quiet about it, but they were still funding research in 1939, only months before the onset of World War II.)

Since the 1920s, American eugenicists had been jealous because the Germans had taken leadership of the movement away from them. The Germans were admirably progressive. They set up ordinary-looking houses where "mental defectives" were brought and interviewed one at a time, before being led into a back room, which was, in fact, a gas chamber. There, they were gassed with carbon monoxide, and their bodies disposed of in a crematorium located on the property.

Eventually, this program was expanded into a vast network of concentration camps located near railroad lines, enabling the efficient transport and of killing ten million undesirables.

After World War II, nobody was a eugenicist, and nobody had ever been a eugenicist. Biographers of the celebrated and the powerful did not dwell on the attractions of this philosophy to their subjects, and sometimes did not mention it at all. Eugenics ceased to be a subject for college classrooms, although some argue that its ideas continue to have currency in disguised form. . .

The past history of human belief is a cautionary tale. We have killed thousands of our fellow human beings because we believed they had signed a contract with the devil, and had become witches. We still kill more than a thousand people each year for witchcraft. In my view, there is only one hope for humankind to emerge from what Carl Sagan called "the demon-haunted world" of our past. That hope is science.

But as Alston Chase put it, "when the search for truth is confused with political advocacy, the pursuit of knowledge is reduced to the quest for power."

That is the danger we now face. And this is why the intermixing of science and politics is a bad combination, with a bad history. We must remember the history, and be certain that what we present to the world as knowledge is disinterested and honest.

To read Crichton's entire essay, go to www.crichton-official.com/fear/index.html.

To read Michael Crichton's Op-Ed in the Sunday, March 19, 2006, New York Times, go to www.michaelcrichton.net/.

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2.      In the News: The Resurrection of Al Gore, by Karen Breslau, Wired Magazine, May 2006

He invented the Internet (sort of). He became President (almost). Now Al Gore has found his true calling: using the power of technology to save the world.

 

One evening last December, in front of nearly 2,000 people at Stanford's Memorial Auditorium, Al Gore spoke in uncharacteristically personal and passionate terms about the failed quest that has dominated much of his adult life. Save for his standard warm-up line - "Hi, I'm Al Gore, and I used to be the next president of the United States" - there was hardly a mention of the White House. Instead, during the next 90 minutes, Gore had plenty to say about thinning polar ice caps, shrinking glaciers, rising carbon dioxide concentrations, spiking temperatures, and hundreds of other data points he has woven into an overpowering slide show detailing the catastrophic changes affecting the earth's climate. The audience was filled with Silicon Valley luminaries: Apple's Steve Jobs; Google's Larry Page and Eric Schmidt; Internet godfather Vint Cerf; Yahoo!'s Jerry Yang; venture capitalists John Doerr, Bill Draper, and Vinod Khosla; former Clinton administration defense secretary William Perry; and a cross section of CEOs, startup artists, techies, tinkerers, philanthropists, and investors of every political and ethnic stripe.

After the souped-up climatology lecture, a smaller crowd dined at the Schwab Center on campus. There, at tables topped with earth-shaped ice sculptures melting symbolically in the warmth of surrounding votive candles, guests mingled with Gore and his wife, Tipper, along with experts from Stanford's Woods Center for the Environment and the business-friendly Environmental Entrepreneurs. The goal: to enlist the assembled leaders in finding market-driven, technological solutions to global warming and then, in quintessential Silicon Valley style, to rapidly disseminate their ideas and change the world. "I need your help here," an emotional Gore pleaded at the end of the evening. "Working together, we can find the technologies and the political will to solve this problem." The crowd fell hard. "People were surprised," says Wendy Schmidt, who helped organize the event and, with her husband, Google CEO Eric Schmidt, supported Gore's 2000 presidential campaign. "They think of a slide show about science, they think of Al Gore. But they come out later and say, 'He's funny, he's passionate, he's real.'"

 . . . Along the way, Gore has become a neo-green entrepreneur, taking his messianic faith in the power of technology to stop global warming and applying it to an ecofriendly investment firm. The company, Generation Investment Management, which he cofounded nearly two years ago, puts money into businesses that are positioned to capitalize on the carbon-constrained economy Gore and his partners see coming in the near future. All the while, he has been busy polishing his reputation as the ultimate wired citizen: Not far from the Stanford campus, Gore sits on the board of directors at Apple and serves as a senior adviser to Google. Farther up Highway 101 are the San Francisco headquarters of Current TV, the youth-oriented cable network he cofounded with legal entrepreneur Joel Hyatt.

For Gore, the private-sector ventures are all pieces of the same puzzle. He's challenging the power of the investment and media industries to decide what information matters most and how it ought to be distributed. "I find a lot of joy in the fact that these parts of my life post-politics have connected into what feels like a coherent whole, in ways that I didn't consciously plan," Gore told me at the Technology Entertainment Design conference in Monterey, California, where - again - he was the star attraction. "I think I'm very lucky."

This is not, of course, the image of Al Gore stored in the nation's memory. He's been filed away as a tragic character who saw his victory hijacked by the Supreme Court. (In the film, he addresses the experience in a poignant passage: "That was a hard blow, but what do you do? You make the best of it.") How Gore has reengineered himself as a hero of the new green movement is a story known so far by only the relative few who have seen him in action lately. "You have a sense that this is the moment in his life, as though all the work he's been doing is now coming to a head," says film director Davis Guggenheim, who spent months traveling with Gore while shooting An Inconvenient Truth. "City by city, as he gives this presentation, he is redeeming himself in a classically heroic way - someone who's been defeated and is lifting himself out of the ashes."

To read the entire article, please go www.wired.com/wired/archive/14.05/gore_pr.html

To decide whose ashes, read the Feature above and the Book Review below.

To read George Will on Gore, please go to www.washingtonpost.com/wp-dyn/content/article/2006/06/09/AR2006060901550.html

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3.      International Medicine: Was the Artic Really Tropical in The Past? Are We in the Ice Age Now?

Studies Portray Tropical Arctic in Distant Past, by Andrew C Revkin, New York Times, June 1, 2006

. . .The findings, published today in three papers in the journal Nature, fill in a blank spot in scientists' understanding of climate history. And while they show that much remains to be learned about climate change, they suggest that scientists have greatly underestimated the power of heat-trapping gases to warm the Arctic.

Previous computer simulations, done without the benefit of seabed sampling, did not suggest an ancient Arctic that was nearly so warm, the authors said. So the simulations must have missed elements that lead to greater warming.

"Something extra happens when you push the world into a warmer world, and we just don't understand what it is," said one lead author, Henk Brinkhuis, an expert on ancient Arctic ecology at the University of Utrecht in the Netherlands. 

The studies draw on the work of a pioneering 2004 expedition that defied the Arctic Ocean ice and pulled the first significant samples from the ancient layered seabed 150 miles from the North Pole: 1,400 feet of slender shafts of muck, fossils of ancient organisms and rock representing a climate history that dates back 56 million years.

While there is ample fossil evidence around the edges of the Arctic Ocean showing great past swings in climate, until now the sediment samples from the undersea depths had gone back less than 400,000 years.

To read the entire report, go to www.nytimes.com/2006/06/01/science/earth/01climate.html.

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4.      Medicare: Government & Bureaucratic Medicine by Any Name Always Put Patients on Hold

Needs of Patients Outpace Doctors, by Lisa Girion, Staff Writer, Los Angeles Times, June 4, 2006

An aging America and a shortage of physicians will severely tax the healthcare system, experts say. The effects are already being felt.

A looming doctor shortage threatens to create a national healthcare crisis by further limiting access to physicians, jeopardizing quality and accelerating cost increases.

Twelve states - including California, Texas and Florida - report some physician shortages now or expect them within a few years. Across the country, patients are experiencing or soon will face shortages in at least a dozen physician specialties, including cardiology, radiology, and several pediatric and surgical subspecialties.

The shortages are putting pressure on medical schools to boost enrollment, and on lawmakers to lift a cap on funding for physician training and to ease limits on immigration of foreign physicians, who already constitute 25% of the white-coated workforce. . .
"People are waiting weeks for appointments; emergency departments have lines out the door," said Phil Miller, a spokesman for Merritt, Hawkins & Associates, a national physician search firm. "Doctors are working longer hours than they want. They are having a hard time taking vacations, a hard time getting their patients in to specialists." . . .

The number of medical school graduates has remained virtually flat for a quarter-century, because the schools limited enrollment out of concern that the nation was producing too many doctors.

But demand has exploded, driven by population gains, a healthy economy and a technology-driven boom in physicians' repertoires, which now include such procedures as joint replacement and liposuction. . . .
 
Yet much of the physician workforce also is graying, and headed for the door. A third of the nation's 750,000 active post-residency physicians are older than 55 and likely to retire as the boomer generation moves into its time of greatest medical need.

By 2020, physicians are expected to hang up their stethoscopes at a rate of 22,000 a year, up from 9,000 in 2000. That is only slightly less than the number of doctors who completed their training last year . . .

How did so many smart people and groups - including the American Medical Assn. - predict a doctor glut not too long ago?

They say they bought into a notion that health maintenance organizations would ratchet down physician demand by promoting preventive care and reducing tests and procedures. Tightly managed care was expected to become so widespread and effective that it would put many physicians out of work. . .

The predictions didn't come true. . .


Another idea that didn't pan out was that technology would reduce the use of physicians. Minimally invasive surgical techniques and other advances, however, actually have expanded demand for physicians by making it possible to perform operations on patients who are older and sicker than those who got surgery in the past, said Dr. David Etzionsi, a surgical resident who studied future surgeon needs for the UCLA Center for Surgical Outcomes and Quality.

What's more, older people generally are healthier today than in the past, Etzioni said. "Operating on a 70-year-old now is much different than 30 years ago. So surgeons are more aggressive about patients they would do procedures on."

The AMA changed its position on the physician workforce a year ago, acknowledging that a shortage was emerging. The consensus has shifted so quickly that experts who view the physician workforce as adequate - though poorly distributed, inefficient or wasteful - now are seen as contrarians.

Momentum for change is building. This month, the executive council of the Assn. of American Medical Colleges will consider calling for a 30% boost in enrollment, double the increase it called for last year.

The University of California built its last three medical schools - Davis, Irvine and San Diego - in the 1960s. Administrators are considering raising UC medical school enrollment by as much as 25% by expanding existing schools, building new ones or both. UC Riverside and UC Merced are eager to host new medical schools. . . .

 

To read the entire article, please go to www.latimes.com/business/la-fi-doctors4jun04,1,302429.story.

Government is not the solution to our problems, government is the problem.

- Ronald Reagan

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5.      Medical Gluttony: Will Making Doctors Look Gluttonous Reduce Medicare Costs?

Pricing Out Medicare - will unveiling the expense of care help cut costs? by Avery Comarow, USNews and World Reports

Medicare paid hospitals more than $35,000 on average in 2005 to insert a heart defibrillator; an uncomplicated spinal fusion ran nearly $17,000--not including physician and various other charges. How will Americans react to knowing such numbers? With heightened appreciation for the escalating cost of medical care, the Centers for Medicare and Medicaid Services hopes.

Last week, to sensitize consumers to the need to rein in costs, CMS revealed its latest reimbursements for more than 40 inpatient conditions and procedures, from chronic lung disease to intestinal surgery (cms.hhs.gov/healthcareconinit). Adjustments for local variations in wage levels and other factors create a wide payment range--$30,151 to $41,193 for heart valve surgery, for instance. A bonus: The number of cases per hospital is included, so consumers can quickly weed out low-volume centers.

For now, making prices public is primarily a consciousness-raising exercise, says CMS official Herb Kuhn, because hospitalized Medicare patients don't pay a percentage of the cost and wouldn't benefit from lower prices. But Medicare outpatients have to shoulder a 20 percent copay and might shop for cheaper care if and when prices for their procedures are posted. That, at least, is the eventual goal.

www.usnews.com/usnews/health/articles/060612/12cost.htm

[Medicare telling patients what their inpatient costs are will not be a conscious-raising exercise. Patients don't really care if it continues to be essentially free. They feel they are entitled to this care and fully deserve it, regardless of cost. But requiring patients to pay a 10 percent co-payment for all inpatient procedures will be conscious-raising immediately - or before if their friends tell them about it before they even reach the hospital. That will drastically reduce unnecessary health-care costs. We think by more than 50 percent.]

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6.      Medical Myths: Increasing Medical School Enrollment Will Reduce the Physician Shortage

Government and the medical bureaucracy limited medical school enrollment because they thought they had the magic formula to control medical costs with managed care and HMOs. However, demand continued upwards and another failed government program threw the country into another morass with a shortage of doctors. Now the prevailing wisdom is to reverse the unfortunate government and medical bureaucracy predictions and increase medical school enrollment. Congress and the government, including the medical bureaucracy, fail to see this as a problem. The huge cost they imposed on the taxpayers by their previous inability to predict the future is simply relegated to their learning curve.

But their learning curve does not progress upwards. It is always in a downward spiral. Just as the Medicare predictions of its cost in the 1960s were exceeded by hundreds of percents, these predictions will also fail. By using the monies forcibly taken from the taxpayers, which caused our present predicament, Congress sees no problem in forcing its citizens to pay even more taxes to correct their previous mistakes and create another problem. The current correction will not reduce the inequity between patient demands and physician supply. It will artificially skew them just in another direction. Only a free economy will correct the inequity. Is the obvious solution possible?

Getting the Government Out of Medicine Will Reduce the Physician Shortage

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7.      Overheard in the Medical Staff Lounge: Dr Sam and Medicare

Dr Sam announced a breakthrough in his dealings with Medicare. After several months of no reimbursements, he had received a check for $3 last week and a check for $6 this week. That would pay nearly 20 minutes of his insurance biller's wages for the extra 20 to 30 hours she had invested in researching the problem with Medicare. Or to look at it another way, he had received $9 for the extra $800 ($27/hour x 30 hours) he had paid his billing clerk in order to try to understand Medicare's harassment.  And now he will bear the cost of the many hours of research required to learn how to leave Medicare without putting his medical license in jeopardy.

Dr Rosen noted that the VA lost a large number of their medical records from the Electronic Medical Record system. The people developing EMR are working overtime to make them safe. We don't need artificial incentives from the federal government, former House of Representative Speakers and White House inhabitants to speed the process leading to further security risks. The electronic medical record will evolve as it should based on its merits.

Socialized Medicine. The discussion move to how did the University Professors buy into Socialized Medicine. Aren’t they in the business of training doctors for community practice? A Medical Student on his preceptorship was at our table. He stated that the professors all seem to be funded by the National Institutes of Health or some other government program. He felt their allegiance shifted to the source of their funding. He thought that was just following the money? Did that mean that all the new doctors are basically socialists? Although he had no proof, it was his impression that more than half of the class was becoming socialistic. They were primarily interested in obtaining a 40-hour a week job with no continuing after hours or weekend patient responsibilities. He felt the appeal was the greatest among his female classmates, which are now the majority.

Is Government Funding of Research Destroying the Private Practice of Patient Centered Medicine?

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8.      Voices of Medicine: A Review of Local and Regional Medical Journals

Sonoma Medicine, the Magazine of the Sonoma County Medical Association. Spring 2006 Issue: Clinical Empathy  (www.scma.org/magazine/magazine.html)

Editorial: The Magic Promise by Brien Seeley, MD

One night, while being pampered at Syrah, I wondered how clinical empathy has survived the pressures of corporate medicine. Does heartfelt well-wishing bestow restorative powers?

J.M. Barrie thought so, invoking such magic in Peter Pan when children's earnest well-wishes restore Tinker Bell from being poisoned. Like many physicians, I have witnessed miraculous recoveries from life-threatening illnesses in patients surrounded by caring loved ones. Though fairy tale magic strains the science of medicine, I believe that clinical empathy survives because it bestows its own kind of magic--what I call the Magic Promise of medicine.

The Magic Promise inspires patients with faith that their physician's heart is with them. The promise goes beyond the tacit "integrity of intent" that their physician will do right and be competent. It is not mere trust or confidence. This promise convinces patients that their physician truly cares about them and will therefore ease their suffering and heal them with kindness as well as the most effective treatment available. The magic is that this promise comes true.

Like the twice-warmed woodchopper, when patient and physician exert the emotional labor needed to connect genuinely, they are later warmed by an easier course through the illness. Conversely, a bad outcome in a "needlessly nervous Nellie" may mark a failure to forge the Magic Promise.
The Magic Promise is built on the faith created by clinical empathy. Such empathy is born of sensitive attunement to nuance rather than from the knitted brow of convergent deliberation. It resides beyond signs, symptoms, and test results, and it takes more than merely "being together." Empathy is a two-way street where each must perceive the other's feelings. As the physician looks deeply into their eyes and listens to their concerns, patients must sense genuine, natural feelings of kindness in the physician in order to connect.

We can feel the connection when it happens. It is unmistakable; it burdens the heart as a kind of love. Physicians who connect with their patients enrich the meaning of their own lives, becoming artists rather than mere technicians.

The late Dr. Frank Norman was surely a Knight of the Order of The Magic Promise. His calm confidence paralleled his graceful, natural ability to connect to patients' feelings. Using humor, axiom, and personal anecdotes, he bonded his Magic Promise with his humanity. Such physicians, trained before the days of capitation, practiced perceptive and receptive attunement as the fundamental, time-honored creed of medicine. Today, less experienced physicians may need formal training to learn how to establish clinical empathy. Either way, the task is essential to healing.

The Magic Promise transcends the placebo effect. It is not a sugar pill, sham, or empty wishes. It is not manipulation. It is genuine. Its good outcomes do not rely on evidence-based medicine and cannot be measured under "pay for performance." It now appears that the promise's magic derives from a heartfelt, liberating faith that steadily moves the patient toward healing by actual neurobiologic mechanisms.

Recent fMRI studies show the neuro-anatomic substrates by which such faith consistently finds its way through uncertainty and contradiction to restore a peaceful mental state. A sense of teamwork between physician and patient breeds an inner desire for "us" to succeed, a hunger for recovery that amplifies each little sign of improvement into hope and expectancy. This induces salutary visceral, cardiovascular, and musculoskeletal effects via hormones, neurotransmitters, and autonomic pathways and generates endorphins, easing pain and anxiety.

Must we choose empathy over reason? No. Neuroscientist Dr. Antonio Damasio has shown that feelings are not a contaminant to reasoning, but rather are what make reasoning possible. Indeed, clinical autism would confront one with an endless decision tree. Feelings--wrought of a complex matrix of memories, innate drives, dreams, and emotions--are what sift our myriad choices into Plan A and Plan B. When Plan A fits the empathic connection, it instinctively becomes the right choice.

This issue of Sonoma Medicine examines clinical empathy. I hope it will strengthen the ranks of the Order of The Magic Promise. New members are always welcome.


Dr. Seeley serves on the SCMA Board of Directors and the Editorial Board.

To read the original article, please go to www.scma.org/magazine/scp/sp06/seeley.html. To review the entire series on Clinical Empathy, click on “Table of Contents” at the bottom of the webpage.

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9.      The Physician/Patient Bookshelf: State of Fear by Michael Crichton, MD, HarperCollins, New York, © 2004, 672 pp, $25.95, Avon PB $7.99, ISBN-13-978-0-06-101573-1, Harper Audio, 16 CDs, 18 ˝ hours, Performed by George Wilson, $49.95.

There is something fascinating about science. One gets such wholesale returns of conjecture out of such a trifling investment of fact.  -Mark Twain

Within any important issue, there are always aspects no one wishes to discuss.

-George Orwell

"In late 2003, at the Sustainable Earth Summit conference in Johannesburg, the Pacific island nation of Vanutu announced that it was preparing a lawsuit against the Environmental Protection Agency of the United States over global warming. Vanutu stood only a few feet above sea level, and the island's eight thousand inhabitants were in danger of having to evacuate their country because of rising sea levels caused by global warming. The United States, the largest economy in the world, was also the largest emitter of carbon dioxide and therefore the largest contributor to global warming."

In Paris, a young physicist performs an oceanographic experiment for a beautiful visitor - then dies mysteriously after a romantic tryst with her.

In London's warehouse district below the Tower Bridge, an American picks up a shipment but does not fail to note two posters on a wall. One says "Save the Earth" and beneath it, "It's the Only Home We Have." The other says "Save the Earth" and beneath that, "There's Nowhere Else to Go." After a struggle to load the 700-pound box, he becomes suspicious, sensing that he is being watched.  No sooner does he become wary than a woman accosts him and attempts to strangle him. He takes off down the street. The woman tells a warehouse attendant, "Go back to work. You did a good job. I never saw you. You never saw me. Now go."  The hapless American, however, succumbs to a mysterious paralysis and dies suddenly in the street as the woman drives the Van away with the "merchandise."

In the jungles of Malaysia, a mysterious buyer purchases, for an unspecified purpose, deadly hypersonic cavitation technology, built to his specification that is capable of toppling mountains with sound. After business has been concluded, his contact drives him to the airport. Unfortunately he leaves his cell phone behind.

 

In Vancouver, a businessman leases a small research submarine for use in the waters off New Guinea.

 

At the International Data Environmental Consortium (The IDEC): In a small brick building adjacent to a University in Tokyo, which bears the University's Coat of Arms – leading the casual observer to assume an association, but which is totally independent, a network of servers equipped with multilevel quad-check honeynets is at work. The nets are established in both business and academic domains, which enable them to track backward from servers to user with an 87 percent success rate.

 

"The National Environmental Resource Fund, an American activist group, announced that it would join forces with Vanutu in the lawsuit, which was expected to be filed in the summer of 2004. It was rumored that wealthy philanthropist Gorge Morton, who frequently backed environmental causes, would personally finance the suit, expected to cost more than $8 million. Since the suit would ultimately be heard by the sympathetic Ninth Circuit in San Francisco, the litigation was awaited with some anticipation."

 

In Los Angeles, George Morton begins checking some of the data on global warming and finds conflicting scientific information.  He finishes a bottle of Vodka in his private jet on his way to San Francisco to accept the National Environmental Resource Fund [NERF] award and gains the courage during his acceptance speech to urge more time for study.  He is physically pushed off the stage. Having downed a few more Vodkas during the course of his meal, he leaves the building, weaves past his waiting limousine, and slips behind the wheel of his recently purchased Ferrari. Despite the urgings of his lawyer not to drive, George speeds away.  Shortly after crossing the Golden Gate Bridge, the car crashes, leaving a mangled mound of steel, but the body of George Morton has disappeared.

In Antarctica, where the ice is getting thicker every year, an intelligence agent and members of his team race across glaciers in an attempt to put all the puzzling pieces together and prevent what will doubtless be a global catastrophe producing the largest iceberg in history.  However, his partners who have been following his lead vehicle slide into a deep crevasse.

"But the law suit is never filed."  Why was the Vanutu suit, which was to have been funded by George Morton, dropped?

Thus begins "State of Fear" an exciting and provocative techno-thriller. Author Michael Crichton who has given us a number of medical thrillers and the television series ER unravels the reasons while revealing some impressive research on the scientific pros and cons of global warming.

The novel is not politically correct and thus the reviews from the media were predictable. Or as David Kipen at the SF Chronicle states, "Unless I'm mistaken, State of Fear is the first thriller in history whose goals are to convince you that there's really nothing to be afraid of, and then to scare you to death about it."

Crichton has given us his own scientific point of view in a special message at the end. The Op-Ed in section one above is also recorded in the Appendix. There is an extensive bibliography consisting of 32 pages of more than 150 references in support of the author's position.

According to the Wall Street Journal,  "In STATE OF FEAR, Michael Crichton delivers a lightening technopolitical thriller...every bit as informative as it is entertaining." 

This book is informational reading and studying especially in view of the anxiety about global warming. Crichton's cautions are relevant and should give us insight into how the government uses taxpayer's monies to direct scientific and medical research.

The 16 CD audio version performed by George Wilson is very well done. For physicians who drive between hospitals and their office, it's an easy way to brush up on how political science works. In fact, it packs a more powerful punch than silent reading.

But be sure you do not have a tight schedule. Several times during the past month after parking, I was unable to cease listening, open the door to my car, and meet my time constraints. One evening on my way home, I phoned my wife, "Would you mind if I drive to San Francisco and back? I just can't turn off George Wilson and Michael Crichton."

www.harpercollins.com/global_scripts/product_catalog/book_xml.asp?isbn=0066214130

The Physician/Patient bookshelf began ten years ago in Sacramento Medicine. Books written by physicians and nurses on any topic were reviewed, as well as books by any author on a medical topic. Most of the more than 100 books reviewed have been published in the electronic journal, HealthCareCommunicationNetwork. They can be found topically at www.healthcarecom.net/bookrevs.htm.

They have been reposted alphabetically at www.delmeyer.net/PhysicianPatientBookshelf.htm. To see the posted version, click on “State of Fear”at the Bookshelf.

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10.  Hippocrates & His Kin: The Pros and Cons of Aging

Pro: You know so much more stuff.

Con: You can't remember any of it.


Pro: I used to burn the candle at both ends.

Con: Now I can't find the matches.


PDE-5 Inhibitors May Relieve Male Urinary Symptoms

Phosphodieterase-5 inhibitors may have a role in the relief of lower urinary tract symptoms, according to two studies presented at the Annual Congress of the European Association of Urology. 

Daily tadalafil (Cialis) therapy significantly improved symptom scores in men with benign prostatic hyperplasia in a placebo-controlled, phase II trial reported by Dr. Kevin T. McVary. The 12-week, double-blind study enrolled 281 participants. Not unexpectedly, a sexually active subset with erectile dysfunction also experienced significantly improved erectile function with tadalafil. In the second study, investigators combined sildenafil (Viagra) with alfuzosin (Uroxatral), an alpha1-blocker, as a therapy for previously untreated lower urinary tract symptoms (LUTS) and erectile dysfunction. Dr. Steven A. Kaplan reported that the combination was more effective than either agent alone in the three-armed study, which enrolled 62 men with the two conditions. www.internalmedicinenews.com/article/PIIS1097869006734035/fulltext 

I understand this study is over subscribed and has a waiting list of volunteers.


Hippocrates and His Kin column started in Sacramento Medicine during my editorship in 1994. These are posted at www.healthcarecom.net/hhkintro.htm. After it had run its course, it appeared briefly on my web page at www.delmeyer.net/HMC.htm as Hippocrates Modern Colleagues. It was resurrected one year ago this month in MedicalTuesday www.medicaltuesday.net/archives/June2805.html. Feel free to click on any of these sites during your spare time to review vignettes of interest during the past twelve years.

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11.  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. To read their latest postings, please go to www.zhcenter.org/world_link.asp?id=188800&page=1&showsite=true.


 

                      PATMOS EmergiClinic - www.emergiclinic.com - where Robert Berry, MD, an emergency physician and internist practices. Here is his story: Three years ago, I left ER medicine to establish a primary care clinic in a town of about 15,000 in northeast Tennessee - primarily for the uninsured, but also for anyone willing to pay me for my care at the time of service.  I named the clinic PATMOS EmergiClinic - for the island where John was exiled and an acronym for "payment at time of service."  I have no third party contracts...not commercial, not Medicare, TennCare or worker's compensation. A year ago, over 95 percent of the patients I saw had no insurance.  Today, that figure may be 75 percent.  But even those with insurance learn a simple lesson when they come to me: health insurance does not equal healthcare, at least not at my clinic. I clearly tell my patients how much a visit will cost.  Everything is up front and honest.  I will prepare a billing claim for my patients with insurance, for a small fee, but I expect them to pay me when I see them.  Because I need only one employee in my office, my costs are low.  For the same services, I charge about 60 percent of charges made by other local clinics, 40 percent of what the local urgent care clinic charges and less than 20 percent of what the local ER charges.  I am the best bargain in town.  If I can do it, caring for the uninsured in a small rural town, any doctor can. To read more on Dr Berry, please to go www.medicaltuesday.net/org.asp.

                      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" at www.northernurology.com/articles/healthcarereform/administrativectomy.html.

                      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). 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 Op-Ed 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. To read his article on When the Public Loses Faith in Physicians, go to www.ssvms.org/articles/0601gibson.asp. To read his article Why Pharmaceutical Companies Are Failing, go to www.ssvms.org/articles/0603gibson.asp

                      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. This month scroll down to read about the doctor that discussed a patient's obesity.

                      Semmelweis Society International, http://www.semmelweis.org/, 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 click on archives to see the last two years' topics at www.newsmax.com/pundits/Medicine_Men.shtml. This week's column is Huge Legal Win for Compounding Pharmacist and can be found at www.newsmax.com/archives/articles/2006/6/5/235137.shtml.

                      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 scroll down on the left to departments and click on News of the Day. The "AAPS News," written by Jane Orient, MD, and archived on this site, provides valuable information on a monthly basis. Scroll further to the 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 page of the current issue. www.jpands.org/ Don’t miss the excellent article on Sham Peer Review or the extensive book review section.

                      Be sure to Attend the 63rd Annual Meeting of the AAPS, in Phoenix, AZ, September 13-16. For info, please go to www.aapsonline.org/, your gateway to a vast amount of important information. 


 

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Del Meyer, MD, Editor & Founder

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Words of Wisdom

Dwight D Eisenhower: There are a number of things wrong with Washington. One of them is that everyone has been too long away from home. May 11, 1955

George Washington couldn't tell a lie because it would have had a harmful effect on American mythology.

Winston Churchill: We contend that for a nation to try to tax itself into prosperity is like a man standing in a bucket and trying to lift himself up by the handle.

Edward Langley, Artist 1928-1995: What this country needs are more unemployed politicians.

Some Recent Postings

Judge Rules Against FDA and in Favor of Compounding Pharmacies - 05/26/2006 www.aapsonline.org/judicial/medicalcenter.htm

Recent book and cinematic reviews: www.delmeyer.net/CinematicOpEdReviews.htm

In Memoriam

Lloyd Bentsen, Texas Democrat and treasury secretary, died on May 23rd, aged 85.

. . . Mr Bentsen, who thought of himself at school as the brightest boy in the class, wanted to be president. But the country did not, and he took it well. In 1976 he had tried on his own account, but dropped out quickly with only six delegates, all from Texas. His fate, from that point on, was to give an air of gravitas to others.

In 1993 he became Bill Clinton's first treasury secretary. Among the young president's equally young, excited and wet-behind-the-ears advisers, he cut a curious figure. But his job was a vital one. It was he, with his sleek grey suits and slow, soothing tones, who was to calm down Wall Street, persuading the markets that the new troop of wild-eyed Democrats would not add billions to the deficit in spending, but might even start to reduce it.

Not only Wall Street needed convincing. A battle royal broke out in Mr Clinton's inner circle between the left-wingers and the conservatives, led by Mr Bentsen. The left wanted a $30 billion stimulus programme [sic] to create jobs; Mr Bentsen recommended a deficit-cut of $500 billion over five years to put the fiscal house in order and pep up the bond market. Mr Clinton himself was fretful, aware that he had been elected by suffering common folk rather than rich investors. But Mr Bentsen, firm and fatherly, told him to wait and see; and the president, impressed by this voice from a corporate world he knew nothing of, obediently followed him. The budget was pushed through against the odds, and Mr Clinton gave his mentor generous credit for the boom that followed. . . .

Early in his time as chairman of the Senate Finance Committee, in 1987, he was found to be having breakfast with lobbyists ("Eggs McBentsen") in exchange for $10,000 donations. He gave them up, but the oil men from Houston had no trouble keeping in touch with him. Such sympathy, combined with hard work, kept Texas roughly in the Democratic column far longer than seemed feasible in the years of the Bush ascendancy. After Mr Bentsen's retirement in 1994, the state's upper offices turned solidly Republican.

If he regretted this, he was too self-controlled to say. As the face of respectability, and also as one of the best poker-players in Congress, he kept much quiet. At a Camp David retreat in 1993, in a typically touchy-feely bonding session, the Clinton cabinet gathered round to tell each other something about themselves that the others didn't know. Mr Bentsen said this was silly, and headed back to his cabin.

To read the entire obit, please go to www.economist.com/obituary/PrinterFriendly.cfm?story_id=7001042.

On This Date in History – June 27

On this date in 1880, Helen Keller, who was both blind and deaf, was born in Tuscumbia, Alabama. Because she was deaf, she couldn't talk. But she learned to talk; she learned to read lips by touching the lips and throat of the person speaking. She learned to read by touch as well. She became a professional writer and a crusader for education for the better treatment of the blind and deaf. People are courageous when they conquer one handicap. Helen Keller conquered many.

On this date in 1844, Mormon leaders Joseph and Hyrum Smith were murdered by a mob. They were dragged from jail in Carthage, Illinois, by a mob that proceeded to shoot them dead.

--Leonard and Thelma Spinrad.