MEDICAL TUESDAY . NET                 NEWSLETTER

Community For Better Health Care     Vol IV, No 6, June 28, 2005

In This Issue:

1.    Featured Article: International Medical Meetings Fine Honing Medical Practice Decisions

2.    In the News: AMA Gets Facelift to Attract New Members

3.    International News: Social Security Insolvency Should Learn from Other Countries’ Solutions

4.    Pending Shutdown of State Governments Is also a Lesson on Government Medicine

5.    Medical Gluttony: Tossing Drugs the Morning after Their Expiration Date

6.    Medical Myths: Tobacco Moneys Are to Help Patients? Not Necessarily So

7.    Overheard in the Medical Staff Lounge: Why Should You Get Paid for Completing Forms?

8.    Voices of Medicine: Pain Management and End-of-Life Care - Is Untreated Pain a Disease?

9.    Book Review: Lives at Risk by John C Goodman, Gerald R Musgrave and Devon Herrick

10.   Hippocrates and His Kin - Resumption of a Popular Column

11.   Related Organizations: Restoring Accountability in Medical Care and Society

1.   Featured Article: International Medical Meetings Fine Honing Medical Practice Decisions

A frequent question from non-medical professionals, attorneys, health care executives, patients and others is, "If the insurance companies and the government didn't tell doctors how to practice, how would they ever know when to operate or how to treat?" Perhaps the public comes by this information honestly. If the public schools are unable to teach math and basic science to our primary and secondary students today, and even prestigious universities have to teach bone-head English, how can we be sure that college graduates have even basic communication skills? And why should things be any different after another four years of Medical School? So bureaucrats are having a heyday convincing the public that we need quality improvement when really what we need is for the administrators to allow doctors to practice what they've been taught. It may be difficult to comprehend the extent of learning that goes on during a medical education. My lectures on medical education and how physicians arrive at their specialties and subspecialties has been one of my more popular presentations in the non-medical school academic lectures. A brief survey may be of some interest to our MedicalTuesday readers.

After four years of college (completing 16 years of education), a student enters medical school. The first years are the basic science years that include gross anatomy, neuroanatomy, physiology, biochemistry, pathology, histology, microbiology, psychology, statistics and pharmacology. The professors are PhDs who spent four years acquiring the knowledge in their respective fields through study and research and are now able to teach the medical essentials to their medical students over a three or four month period.

While the two years of basic sciences are important for acquiring the foundation of clinical medicine and its decision-making capability, the ability of the physician professors to teach the essentials of their specialties in one to three months during these two years of medical school is even more demanding. These specialties include Internal Medicine (and the Medical Subspecialties of Allergy & Immunology, Cardiology, Dermatology, Endocrinology & Metabolism, Gastroenterology, Neurology, Pulmonary and Rheumatology), Pediatric Medicine (Pediatric subspecialties are essentially the same as internal medicine), Obstetric and Gynecology, Psychiatry and Surgery (and the surgical subspecialties of Otorhinolaryngology, Ophthalmology, Cardiac Surgery, Neurosurgery, Orthopedic Surgery, Pulmonary or Thoracic Surgery and Urology).

After medical school, all graduates proceed to an additional four to six years of clinical hands-on training in their chosen specialties and subspecialties (as listed above), so they can enter the real world of clinical practice to help patients avoid diseases or get well if they have acquired diseases.

After physicians enter practice, they will normally join a hospital staff, the medical societies and their specialty societies. The hospitals will have conferences or weekly medical grand rounds that will bring the latest advances in medicine and surgery to their staff. The medical societies may have monthly or quarterly seminars to accomplish the same. The specialty societies will have national meetings to inform their membership of the very latest advances in their specialty. Thus, even in clinical practice, physicians will partake in 25 (yearly requirement) to 100 hours of advanced continuing medical education (CME) that is documented and recorded for the medical board. My yearly CME routine includes my hospital weekly grand rounds from Labor Day to Memorial Day (about 30 CME), the weekly university medical grand rounds, attending 30 of the 50 conferences, and attending my specialty society meeting (averaging 30 to 40 hours over four days). Thus, with the tests provided by journals to which I subscribe, I average between 150 to 200 hours per year of CME. This routine covers the entire gamut of related issues, including pain management and end of life management for the diseases in question.

My specialty is Pulmonary Medicine (also referred to as Chest, Lung, Thoracic or Respiratory) and our national professional organization is the American Thoracic Society (ATS). Several years ago, we separated from the American Lung Association. This year was the 100^th anniversary of the American Thoracic Society, formerly the American Trudeau Society, with our roots in the great white plague of tuberculosis. The sanatoriums have all but disappeared.

Our 100^th anniversary scientific assembly was held last month in San Diego. There were 17,000 specialists present comprised of adult pulmonologists, pediatric pulmonologists, thoracic and transplant surgeons, pulmonary pathologists, respiratory physiologists, respiratory cell biologists, respiratory pharmacologists, respiratory nurse clinical specialists, respiratory therapists and pulmonary technologists. Our society has a 40 percent international membership, and our national meetings are now the ATS International Scientific Assembly. West coast meetings have a higher attendance from countries of the Pacific Rim, although we had our usual three jumbo jets of doctors from the UK (1000), and lesser numbers from about 50 other countries. It's always a highlight to spend time with my colleagues from around the world.

What do physicians do for 12 hours a day in scientific meetings? There are always sunrise sessions at 7 AM, which I missed this year for the first time in 30 years. I went to the 8:15 morning session of the Clinical Year in Review each day (2000 chair auditorium) in which the experts from around the world present their perspectives on the advances in their chosen fields. Thus we heard the latest advances in lung cancer, ventilator care, pulmonary vascular disease, lung transplantation, sleep disorders, interstitial lung disease, lung infections, lung imaging, pleural disease, neuromuscular disease, asthma, pulmonary rehabilitation, COPD, critical care medicine, to name a few. However, there were 65 other concurrent scientific and poster presentations that I could have attended instead, which I did do every afternoon in smaller rooms seating 50 to 500. Every evening from 7-9 PM there were four large seminars (1500 each) on the various drugs being brought to market by the pharmaceutical industry. The entire research budget of the National Lung Institute is about $3 billion per year. The pharmaceutical industry spends nearly $1 billion per new drug brought to market which is by far the largest source of private research funding in the world. This source is drying up in much of the socialized world. We are the last hope for this continued advancement.

During the lunch and coffee breaks, there is always an active discussion among the participants on how they manage the disease in question. It is not hard to sense an intense search by every doctor to find the best possible treatment and management program for every disease that his or her patient may have.

It is incomprehensible that insurance carriers and government bureaucrats are telling this profession the best way to treat any disease. Why would anyone in medicine listen to or believe that insurance carriers and government decrees are relevant to patient care and the practice of medicine when the administrators I've spoken with have no concept of the rigors of medical education, specialty education, continued post-doctoral education and hands-on management of complicated medical problems. That an administrative team, even if it includes a physician who never sees the patient in question, can determine optimal treatment, is beyond any rational human concept. Physicians accepting this insult of superficial health care that degrades their training and ethical standards reflects years of being sidelined from their primary goals and professional pursuits in medicine.

So the answer to our initial question about how would doctors ever know when to operate or how to treat their patients is this: Simply allow them to bring the full armamentarium of their skills to the patient in need. It’s time we rationalize the practice of medicine by putting those who spend their entire life providing excellence in health care in charge. The bureaucrats that interfere with this process are the ones who are reducing the standards and quality of care. It's they who should be sidelined from the practice of medicine.

AMA promo campaign panned according to Stokely Baksh in the UPI release of June 22, 2005.

"The American Medical Association hopes a more focused agenda, a national advertising campaign and a new logo will reverse a trend of declining membership and strengthen its position with the public.

"Despite the AMA's efforts, however, critics say the organization will continue to deteriorate because of its business ventures, including an embarrassing 1997 endorsement of Sunbeam Corp health products, a deal it later backed out of....

"Among the issues that will top the AMA's expanded agenda, medical-liability reform - already a priority - remains at the top. Other issues member surveys showed were important include Medicare physician payment reform, care for the uninsured and improving public health....

"Critics, however, said the AMA campaign will not work, especially when the organization depends mainly on business revenues rather than membership dues.

"‘Unfortunately, the AMA is running a business that doesn't represent patients and physicians - it represents its own business interests,’ said Andrew Schlafly, general counsel for the Association of American Physicians and Surgeons.

"Schlafly told United Press International memberships are less than 20 percent of AMA's revenue, which means more than 80 percent of revenue comes from business ventures.

"In 1997 the AMA agreed to endorse Sunbeam products but backed out when members protested the deal, forcing the organization to pay millions of dollars to end the venture.

"‘Ethics aren't even in their agenda,’ Schlafly said. "‘They are slowly dying; in 10 years, they are going to be irrelevant, heading for extinction.’

"Leana Wen, national president of American Medical Student Association, told UPI the AMA does not represent the idealistic nature of today's medical students, who are interested in their patients rather than money." See http://www.upi.com or read the blog at http://www.aapsonline.org/blogs/?blog=5&page=1&disp=posts&paged=2.

John Goodman, PhD, from the National Center for Policy Analysis (NCPA), informed us of a new report by Consulting Economist Estelle James about 30 countries that have reformed their pay-as-you-go social security systems with personal retirement accounts (PRAs).

In the 1980s, Chile, Switzerland, the Netherlands and the United Kingdom were the first countries to reform. Most countries in Latin America, Eastern and Central Europe, and some in the Asian-Pacific region created similar systems during the past 10 years. The Latin American and Eastern European countries funded their worker-based personal account systems by diverting money from a pre-existing payroll tax. By contrast, the industrial countries in Western Europe, along with Australia and Hong Kong, made employer-based retirement plans mandatory, in addition to their tax-financed systems.

These countries span the ideological spectrum. The movement started with the socialist British Labour Party in the 1970s, a fascist government in Chile in the 1980s, and more recently the communists in China and the social democrats in Sweden.

Further, because workers, say, in Chile, do not have to drop out of the workforce in order to receive benefits from their PRAs, many keep working. In fact, James estimates there has been a 30 percent increase in labor force participation by Chilean workers in their 60s.

As a result of these changes, Britain, Chile and many others have virtually no unfunded liability. By contrast, ours is $11 trillion - about the size of the entire U.S. economy.

As the United States considers Social Security reform, including some form of personal accounts, it may be useful to examine options that other countries have implemented. This paper surveys the approaches these countries have used to resolve key issues, such as how to keep costs and risks low, protect vulnerable groups and make sure that the accumulation in the account lasts for the individual’s lifetime. The experiences of these countries do not offer answers to all our questions, but they do suggest the range of options available to us and some of their potential effects (both good and bad).

Prefunding Social Security through investments that earn a market rate of return can help make the system more sustainable. It would avoid passing a large debt on to our children, and could help to increase national saving, and therefore productivity and growth. But if the government manages the funds, several dangers emerge that could negate these potential advantages: If invested exclusively in government bonds, the funds may end up increasing government deficits; if invested in the stock market, they may lead to conflicts of interest between government as regulator and as investor, and their use could be subject to political manipulation and the mis-allocation of capital. These are the main arguments for establishing personal accounts, with private management of the funds.

To read Estelle James' entire report "Reforming Social Security: Lessons from Thirty Countries" go to http://www.ncpa.org/pub/st/st277/.

James was scheduled to testify on her study before the House Ways and Means Committee last week. http://waysandmeans.house.gov/hearings.asp?formmode=view&id=2771.

See John Tierney's New York Times op-ed at: http://www.nytimes.com/2005/06/14/opinion/14tierney.html.

Estelle James is principal author of Averting the Old Age Crisis: Policies to Protect the Old and Promote Growth (Washington, D.C.: World Bank and Oxford University Press, 1994) and is currently a consultant to the World Bank and other organizations. She was previously Lead Economist in the Research Department of the World Bank and Director of its Flagship Course on Social Security Reform. She also served as a member of the President’s Commission to Strengthen Social Security in the United States.

4.    Pending Shutdown of State Governments Is Also a Lesson on Government Medicine

Brian Bakst, AP, reports, from St. Paul, Minnesota, that the first state to shutdown for lack of a budget hits Minnesota. "More than 9,000 state employees were told to stay home Friday and drivers found highway rest stops closed at the start of the busy Fourth of July weekend as a budget stalemate led to the first government shutdown in Minnesota history.

"The Democrats, who control the state Senate, were locked in a standoff with Republican Gov. Tim Pawlenty and the GOP-controlled House over how much to spend on schools and health care and how to pay for it. As a result, the new fiscal year began Friday, just after midnight, with only a partial spending plan in place.

"‘I'm frustrated and aghast,’ said Ellen Paquin, a clerical worker and 25-year state employee who said she worried about paying her mortgage after being thrown out of work. ‘We elected these individuals to do their jobs and it's a complete failure.’

"Essential services such as the state patrol continued to function, and an 11th-hour agreement was reached to keep state parks open over the holiday weekend. But drivers on one of the busiest travel days of the year found highway rest stops barricaded, and driver's license exam stations and other state offices were closed. Nearly one-fifth of the state workforce was told to stay home and use either vacation time or go without pay. They will be officially laid off if the impasse extends beyond July 15. . . .

"The shutdown led to finger-pointing by both parties, with the Democrats accusing the governor of making shifting demands, and the Republicans charging that the Democrats wanted at least a brief shutdown to hurt Pawlenty as he prepares for a 2006 re-election campaign. . . .

"The Capitol has been beset with partisan gridlock in recent years. The Legislature has 101 Democrats and 99 Republicans, and one third-party member.

"During the months of budget negotiations, the Democrats had sought a tax increase for upper-income residents. The Republicans fought that, with Pawlenty advancing the possibility of higher levies on cigarettes and a casino at a racetrack. . . .

"Larry Reid of Waupaca, Wis., and his family were headed to Montana and stopped at the Big Chief to walk their dog. ‘We can't get to North Dakota fast enough,’ Reid said. ‘The sad part is that Minnesota used to be so good with these services, but they have let everything go to hell.’

To read the whole story and other related stories, go to http://www.startribune.com/stories/670/5485570.html.

If the Government of Minnesota would control health care, as it has tried to do, then health care would be at the same feeding trough as all the other programs and could be shut down during any political turmoil. We should never allow our health care to be place in such jeopardy.

A common problem in the practice of medicine is that patients read the expiration date on their pill container and on the morning after the expiration day, they will toss the remainder of their pills into the toilet and flush them, even if the drugs are worth hundreds of dollars. It’s almost as if the pill contains an electronic mechanism that will change it to something unknown or dangerous within the next 24 hours and therefore should be sent to the sewer.

The Medical Letter On Drugs and Therapeutics in October 28, 2002, updated their previous study of how long drugs were effective beyond their expiration date. The previous study suggested that drugs could be considered safe and retain 90 percent of their potency for about two years after the expiration date. The new guidelines suggest an average of five years. Some drugs are good for longer and theophylline can be good for up to 30 years.

When the Anthrax scare occurred, the preferred drug was Cipro. There was a huge stock of Cipro on hand that had expired in 1989. It was rechecked and given a new expiration date 15 years later - 2004.

Many drugs may only be 80-85 percent effective after 10 years, but that may be adequate therapy in most instances.

DRUGS PAST THEIR EXPIRATION DATE - Physicians and pharmacists are often asked if patients can use drugs after their expiration date. Pharmaceutical companies, because of legal restrictions and liability concerns, will not sanction such use and may not even comment on the safety or effectiveness of using their products beyond the date on the label.

THE EXPIRATION DATE — The expiration date on the manufacturer’s package is based on the stability of the drug in its original closed container. The date does not necessarily mean that the drug was found to be unstable after a longer period; it means only that real-time data or extrapolations from accelerated degradation studies indicate that the drug will still be stable at that date. The expiration date for new drugs is usually 2-3 years from the date of manufacture. Once the original container is opened for use or dispensing, the expiration date on the container no longer applies. Retail pharmacists who repackage drugs, in accordance with the standards of the US Pharmacopoeia (USP), label them with a "beyond-use" date, generally one year from the date the prescription is filled.

SAFETY — The only report of human toxicity that may have been caused by chemical or physical degradation of a pharmaceutical product is renal tubular damage that was associated with use of degraded tetracycline. Current tetracycline preparations have been reformulated with different fillers to minimize degradation and are unlikely to have this effect.

STABILITY — Shelf life is the time a product, stored under reasonable conditions, is expected to remain stable (generally retain >90% of potency). Data from the Department of Defense/FDA Shelf Life Extension Program, which tests the stability of drug products past their expiration date, showed that 84% of 1122 lots of 96 different drug products stored in military facilities in their unopened original containers would be expected to remain stable for an average of 57 months after their original expiration date. Storage in high humidity may interfere with the dissolution characteristics of some oral formulations. In one published study, however, captopril (Capoten) tablets, flucloxacillin sodium (Flucloxin) capsules (a penicillin not available in the U.S.), cefoxitin sodium (Mefoxin) powder for injection and theophylline (Theo-Dur) tablets stored under both ambient and "stress" (40EC and 75% relative humidity) conditions remained chemically and physically stable for 1.5-9 years beyond their expiration dates. Amantadine (Symmetrel) and rimantadine (Flumadine) remained stable after storage for 25 years under ambient conditions, and retained full antiviral activity after boiling and holding at 65-85EC for several days. In another report, theophylline retained 90% of potency for about 30 years.

LIQUID DRUGS — Drugs in liquid form (solutions and suspensions) are not as stable as solid dosage forms. Suspensions are especially susceptible to freezing. Drugs in solution, particularly injectables, that have become cloudy or discolored or show signs of precipitation should not be used. When oral drugs are in solution with dyes, however, color changes may be due to degradation of the dye and not the drug. Epinephrine in EpiPen injections loses potency after its expiration date; in one study, 5 of 7 autoinjectors contained less than 90% of the labeled epinephrine content 10 months after the expiration date, without necessarily being discolored or showing signs of precipitation (FER Simons et al, J Allergy Clin Immunol 2000; 105:1025). Drugs prepared by addition of a solvent before dispensing or administration (such as suspensions of antibiotics for oral use or lyophilized drugs in vials for parenteral use) tend to be relatively unstable in the liquid state. With ophthalmic drugs, the limiting factor may not be the stability of the drug, but the continued ability of the preservative to inhibit microbial growth.

To read the entire article with supporting references on DRUGS PAST THEIR EXPIRATION DATE, see the October 28, 2002 issue of The Medical Letter at www.medicalletter.org.

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6.   Medical Myths: Tobacco Moneys Are to Help Patients? Not Necessarily So. Tobacco Lawsuits Are a Legal Goldmine and the Fines Are a Business Enterprise. Patients Have Been Sidelined Again.

The driving forces behind anti-tobacco litigation are the legal profession and the pharmaceutical industry, both of which will profit handsomely if litigation in other states is also successful, and if awards are upheld on appeal. The benefit to the legal profession is obvious. Less direct is the benefit to Big Pharma. Their hope and their plan is that the monies awarded by the juries and ear-marked for smoking cessation programs will flow into their coffers via the sale of nicotine replacement therapies and a small number of antidepressant medications that are used as aids to smoking cessation.

Here in Michigan, voters were asked to respond to Proposal 4 during the last election. Proposal 4 asked that tobacco settlement money in Michigan be dedicated to cessation programs. Past Surgeon General of the United States C. Everett Koop barnstormed Michigan days before the election supporting Prop 4, and his bills were paid by Big Pharma. Most states have smoking cessation offerings for their citizens, but what they amount to are taxpayer subsidized infomercials, complete with discount coupons, for the pharmaceutical companies manufacturing nicotine replacement therapies and medications for cessation.

Visit www.stopthat.biz for additional information.

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7.    Overheard in the Medical Staff Lounge: Why Should You Get Paid for Completing Forms? (Or Why Should I Have to Pay Ten Dollars to Have You Make Money for Me for Life?)

Dr Edwards mentioned that he had spent considerable time with a state employee concerning his medical examination for which he got about 60 percent of his usual fee. The patient returned a week later with a number of forms to be completed so that he could get hazard duty pay. Dr Edwards thought this was about an extra $165 a month or about $2,000 a year. This would also increase his retirement income beginning at age 55. After completing the forms, which took about 15 minutes, or the average office follow-up visit, Dr Edwards said the patient declined to pay the required copayment stating that this should be a free service that any doctor should gladly provide.

When healthcare is relatively free, it has no value to the patient and even a $10 copayment is resented. The patient that pays the full $120 for the complete annual examination, $80 for the chest x-ray (CXR), $65 for the electrocardiogram (ECG), and $150 for the pulmonary function test (PFT), understands the value of healthcare and gladly pays for the second office visit.

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8.    Voices of Medicine: Pain Management and End-of-Life Care - Is Untreated Pain a Disease?

The California Society of Anesthesiologists have a series of 12 modules beginning in 2004 and published quarterly thereafter. Completing this series of CME Modules published in their bulletin will satisfy the California law that requires 12 credit hours in pain management and end-of-life care by end of 2006. The first five modules are now available on the CSA website, the rest to be completed by December 2006. All physicians can register and take the course at www.csahq.org/xtpl.php?tpl=internal.xtpl&section=cme&name=cme_list_online . (Sounds like a relatively pain-free way of obtaining the pain credits demanded by a naive and uninformed Assemblywoman trying to control the legislative Medical Curriculum Committee, as well as practice medicine from the Dome.)

Module 1: Repeal of Triplicate Prescribing and the New Security Paper Prescription Requirement in California

Module 2: Is Untreated Pain a Disease?

Module 3: Concepts in Opioid Tolerance

Module 4: Pain Physiology

Module5: Complex regional pain syndromes.

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9.    Book Review: Lives at Risk by John C Goodman, Gerald R Musgrave & Devon Herrick, Rowman & Littlefied, Publisher, Lanham, Maryland, http://www.rowmanlittlefield.com © 2004, ISBN 0_7425_4152_5, 275 pp, $25, Prepublication Copy Reviewed.

Goodman, Musgrave & Herrick have written a large number of policy reports and newsletters on health care. Their extensive treatise on the Twenty Myths of National Health Insurance was reviewed at one "Myth" per month in MedicalTuesday from April 2002 to Dec 2003, http://www.medicaltuesday.net/index.asp. Now comes the definitive work on Single-Payer National Health Insurance Around the World – How National Health Insurance Fails Patients.

The authors note in their introduction that as we move further into the twenty-first century, it is clear that we are living with a number of institutions that were not designed for the Information Age. One of these institutions is health care.

Virtually everyone agrees that our health care system needs reform. But what kind of reform? Some on the right would like to see us return to the type of system prior to Medicare. Some on the left would like to see us copy one of the government-run systems established over the past century in a large number of countries around the world. This system of health care goes by various names such as socialized medicine, national health insurance and in the United States as the proposed single-payer health insurance. The Physicians for a National Health Program, claiming 8,000 physicians and medical student members (one percent of all physicians in the United States), contends that "single-payer national health insurance would resolved virtually all of the major problems facing America’s health care system today."

The authors believe that this alternative will not work. They feel that most commentaries on health policy tend to ignore three very important facts about modern health systems: 1) We could potentially spend our entire gross domestic product (GDP) on health care in useful ways. 2) We would likely want to increase the portion of our income that we are spending on health care in the future. 3) We have suppressed normal market forces in dealing with one and two.

These facts are not disputed but readily acknowledged by all health policy analysts. The first two are not unique to health care, but true of many other goods and services. When combined with the third characteristic, however, they have devastating implications.

Physicians deal with this on a daily basis. Essentially every patient who thinks that socialized or single-payer medicine is the answer feels that any impediment to unlimited testing would be removed. But this is removing all market forces from the equation. If 100 million Americans would increase the dozen or so blood tests that they medically need to the 900 blood tests that are available, that one maneuver would equal $1.5 trillion, the entire health care costs in this country. If 10 million Americans would want the 1,100 tests that can now be done on our genes to determine predisposition to a number of diseases, that alone would add another $10 trillion dollars to our health care costs. (To see how absence of market forces become ludicrous, just think: If every American would want to be screened genetically, that would add up to $300 trillion or ten times our total GDP. Imagine instead of health care being 15 percent of our GDP it would be 1000 percent of our GDP! One patient said we can afford 1000 percent of our income for health! When I ran this by a teacher, she said, "Why can’t something be 1000 percent of the total?" Yes our education system is also in need of reform.)

Evidence presented in Lives at Risk shows that patients in single-payer countries routinely face a reduction in the quality of health care, especially for the sick; lack of access to doctors; lack of access to new medical technology; and unreasonable waiting periods.

In New Zealand, 20 percent of people wanting health care are on a waiting list. In the United States, 14 percent are without insurance. Although the numbers are larger in the United States, the percentages are less. Thus more people proportionately are without health care in a socialized environment.

Lives at Risk is a further extension and definitive analysis of single-payer health care systems and shows that national single-payer health care systems have not delivered on the promise of a right to health care. http://www.healthcarecom.net/JGLivesAtRisk.htm

To read the Executive Summary, go to http://www.ncpa.org/edo/lives_sum.htm.

To read the reviews of the first twenty chapters, go to http://www.medicaltuesday.net/index.asp and click on the issues between April 2002 and December 2003.

Be sure to order a copy of this definitive work at http://www.ncpa.org/pub/lives_risk.htm.

http://www.rowmanlittlefield.com/Catalog/Reviews.shtml?command=Search&db=^DB/CATALOG.db&eqSKUdata=0742541525

About the Authors

John C. Goodman is the founder and president of the National Center for Policy Analysis. The Wall Street Journal called Dr. Goodman "the father of Medical Savings Accounts," and National Journal declared him "winner of the devolution derby" because his ideas on ways to transfer power from government to the people have had a significant impact on Capitol Hill. He is the author of seven books, including Patient Power: The Free-Enterprise Alternate to Clinton's Health Plan.

Gerald L. Musgrave is President of Economics America, Inc., a senior fellow at the National Center for Policy Analysis, and a fellow at the National Association of Business Economists and chairman of its Health Economics Roundtable. Dr. Musgrave has written widely on health care and other issues and is the author or co-author of more than 60 publications.

Devon M. Herrick is a senior fellow at the National Center for Policy Analysis.

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From 1993 to 2001, I wrote a monthly column in Sacramento Medicine that was titled Hippocrates and His Kin (HHK). This was a running monthly commentary for the medical profession and other interested readers on a variety of subjects that impacted the practice of medicine. It greatly increased the readership of the journal and created a dynamic dialogue because it sparked considerable interest. When I began posting this column, I received email from several states and foreign countries. Since Sacramento Medicine was initially published 11 times per year, later reduced to six times per year, there were a total of 78 columns published during those eight years. These can be reviewed at my online journal, HealthCareCommunication.Network, where several colleagues have also posted articles.

Hippocrates is considered by many to be the Father of Medicine and the most recognized of the early men of medicine. Although Aristotle, Galen, Harvey and others may have come further in physiology, such as realizing separate cardiovascular and respiratory systems, I felt that we, his 20^th Century KIN, were having unique struggles in the 1990s, which provoked me to write about Hippocrates’ Kin in HHK. The struggles that our profession is having in caring for the sick and dying are continuing, yet changing. Hence, I hope to continue a monthly dialogue and commentary in this electronic journal, about the problems placed in our path during the twenty-first century. We had given this column a slightly different name: Hippocrates’ Modern Colleagues (HMC). However, at this time I will combine the two series and resort to the original HHK and offer these sometimes satirical comments about physicians' struggles to help their patients.

11.    Restoring Accountability in Medical Practice, HeathCare and Government

• PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist states: "Our point-of-care payment clinic makes acute and chronic primary medical care affordable to the uninsured of our community by refusing to accept any insurance (along with the hassles and crushing overhead that inevitably come with it). As a result, our average professional fee is about $40, typically half that of surrounding clinics and less than 20 percent of local ER’s. Even patients with insurance, including those with Medicare and Tenncare (Tennessee’s Medicaid), choose to pay amounts such as these from their own pockets for health care they have been unable to obtain in a timely fashion with their health coverage." Read the rest of the story at www.emergiclinic.com. To read Dr Berry's testimony in Congress, click on the sidebar. Read Dr Berry’s response to Physician’s Support of Single-Payer Health Care or Socialism at www.delmeyer.net/hmc2004.htm.
• Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association and Association of American Physicians and Surgeons, 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 served in the U.S. Air Force as the Chief of Urology at Eglin Regional Hospital in Ft. Walton Beach, Florida, for two years and as an instructor of surgery and urology at Wilford Hall USAF Medical Center in San Antonio, Texas. Dr Harris pioneered the development of a contemporary and anatomically correct method of radical perineal prostatectomy for prostate cancer while teaching urology in San Antonio. In 1993, he entered the private practice of urology and continue clinical research which has been expanded to other common urologic procedures. His publications reveal some of the most comprehensive analyses of clinical outcomes in the management of prostate cancer. Dr Harris is also 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.
• 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.
• Madeleine Pelner Cosman, JD, PhD, Esq, has made important efforts in restoring accountability in health care. She has now published her important work, Who Owns Your Body. To read a review, go to 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.
• Dr Richard B Willner , President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story as well as a wealth of information at www.peerreview.org.
• Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also observed 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. Be sure to consider attending their Health Care Summit: "American Medicine in Crisis- A Time for Action" in Pittsburgh on Saturday, October 22, 2005, with an impressive array of speakers. 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. Last week’s column is "The FDA Does More Harm Than Good" and can be read at http://www.newsmax.com/archives/articles/2005/6/13/161850.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.
• Special Offer for Medical Tuesday readers: Receive a free gift subscription to the Newsletter and Journal of the Association of American Physicians and Surgeons (AAPS). "Founded in 1943, AAPS is the greatest voice for private physicians. Each month we report on our actions promoting free market and ethical medicine. In the past year AAPS has helped defeat the California medical board, the FDA, the DOJ and currently has briefs pending in multiple federal circuits. Learn how to opt out of insurance and succeed with a cash practice. Benefit from our network of thousands of like-minded physicians, and legal support."
• "Please send an email to jeremy@aapsonline.org or call 800-635-1196 to take advantage of this no-strings offer to new subscribers. Regular price is $160 (half-year), but it can be yours now for free. Act now, while supplies last! "

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Stay Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same.

Del Meyer

DelMeyer@MedicalTuesday.net

www.MedicalTuesday.net

6620 Coyle Avenue, Ste 122, Carmichael, CA 95608

Words of Wisdom

George Bernard Shaw: A government which robs Peter to pay Paul can always depend on the support of Paul.

G. Gordon Liddy: A liberal is someone who feels a great debt to society, which he proposes to pay off with your money.

Douglas Casey: Foreign aid might be defined as a transfer from poor people in rich countries to rich people in poor countries.

On This Date in History - June 28

On this date in 1914, Gavrilo Princip assassinated Austria's Archduke Franz Ferdinand in Sarajevo, Bosnia, the heir to the thrown of the Austro-Hungarian Empire, which was the trigger for World War I.

On this date in 1919, the Treaty of Versailles was signed which ended World War I, which some termed as poetic justice.

On this date in 1976, terrorist hijackers seized an Air France plane and brought it to the airport at Entebbe, Uganda, holding the mostly Israeli passengers hostage. While the world was aghast, a week later, a daring Israeli raid freed the hostages and wrote finis to the terrorist's plans.