1. Featured Article: Medical Ethics: The Giving and
Taking of Organs by Gilbert Meilaender
In The Patient
as Person, published almost forty years ago when transplantation technology
was still in its early stages, Paul Ramsey considered different ways of
procuring organs for transplant. One
might invite people to "opt in," to donate organs to be used after
their death (or, in the case of a paired organ such as the kidney, even before
death). One might require people to
"opt out" if they did not wish to have their organs taken after death
for transplant, presuming their consent to this taking unless they (while living)
or their next of kin (after their death) specifically declined to consent. Or one might establish some kind of system
whereby organs needed for transplant could be bought and sold (though he was
thinking only of cadaver organs).
The third of these possibilities should, Ramsey believed,
be rejected altogether. But his verdict
with respect to the first two was more nuanced, a comparison of their relative
merits and demerits. "If giving is
better than routinely taking organs to prolong the lives of patients needing
transplants, then it must also be said that routinely taking them in hospital
practice would be better than for us to make medical progress and extend
treatment to patients by means of buying and selling cadaver organs. That society is a better and more civilized
one, I have said, in which men join together in a consensual community to
effect these purposes, than a society in which lives are saved routinely,
without the positive consent and will of all concerned to do so. It must also be said, however, that a
society would be better and more civilized in which men are joined together
routinely in making cadaver organs available to prolong the lives of others
than one in which this is done ostensibly by consent to the ‘gift' but actually
for the monetary gain of the ‘donor.'"
I recalled this passage when reading of the proposal
by Gordon Brown, prime minister of Great Britain, to deal with what he called
"an avoidable human tragedy" and encourage more people to
"donate" organs. Britain's
National Health Service, Brown announced on January 14, 2008, should move to a
system in which organs of the deceased would be taken for transplant, with
their consent presumed, unless before death they had opted out or, after death,
their family members objected to such use of their organs.
Ramsey's comparative analysis might remind us that the
Prime Minister's proposal is not the worst we can envision. Ours is a world in
which an increasing number of voices support some form of payment for organs
(or, sometimes, for organs from specific populations, such as prisoners nearing
death)--thereby turning potential donors into vendors and the body into a
collection of parts that are available and alienable if the price is
right. This would, Ramsey seemed to
think, and I am inclined to agree, be worse than what Mr. Brown has in mind.
Nor, I think, will it do to object to Mr. Brown's
proposal on the ground that my body is my property alone, no part of which
should be taken or used without my explicit consent. There are, after all, occasions - if, for example, an autopsy is
deemed necessary - when we allow the needs of the larger society to override
the bodily integrity of a deceased individual.
More important, though, is the fact that "property" does not
seem to be the right way to think of my body's relation to me. Thinking in those terms may, in fact, leave
us defenseless in the face of arguments supporting a market in organs.
Nor is the body of the deceased best thought of as
property of his surviving family. If
their wishes about its disposal ought to be honored, that is not because they
own the body. It is because the life
they shared with this one who has died obligates them to give his body proper
burial - and the rest of us should do nothing that makes their duty more
onerous than it of necessity is or that forces them, while grieving, to fight
for the right to carry out such a fundamental human duty. "There is," as William F. May once
put it, "a tinge of the inhuman in the humanitarianism of those who
believe that the perception of social need easily overrides all other
considerations."
Still, there are good reasons to draw back from
procuring organs for transplant by means of an opt-out system. We need an Orwell among us to note how
strained the language of those, like Mr. Brown, becomes when they describe what
they have in mind. His aim, he wrote,
is "a different consent system" that would "increase donation
levels" significantly. But, of
course, it is not really "donation" that he has in mind. It is taking, not giving - and a consent
that must be presumed is one that only the articulate and the powerful are
likely to avoid giving. Those from whom
the organs are taken, whose consent is presumed, might better be thought of as
useful resources than as donors.
Moreover, it would place a special burden upon some groups whose beliefs
- often, religious beliefs - lead them (except in special circumstances) to
object to the giving or taking of bodily organs after death.
The Prime Minister's language - of "an avoidable
human tragedy" that could be averted were more organs available for
transplant - is the sort of talk that has come to characterize most discussions
of transplantation, and it begs for careful examination. It is the sort of language that can be used
to justify almost anything that promises to help avoid the tragedy of
death. And this is exactly the sort of
language that, we have come to see, has often distorted the practice of
medicine, teaching us to suppose that anything that can be done to ward off
death must be done. But the deeper
moral truth is that how we live, not how long, is what matters most. And among the possible "tragedies"
with which we must reckon would be to live longer by means that debased or
undermined our humanity.
Why is giving of organs better than taking, even if
taking may provide a greater supply for transplant? To look upon potential "donors" chiefly as handy
collections of spare parts to be used by others is to lose the sense of the
embodied human person as one who, because made finally for God, transcends
every location in space and time. A
person does not belong, to the whole extent of his being, to any earthly
community.
Even the deceased person does not. Why, for example, did an al Qaeda-led group
in Iraq release footage of two corpses that it said were those of US soldiers
killed in June, 2006? The video showed
a decapitated body and several dead bodies being stepped on. This dishonoring of the corpses could have
no point were not even the dead body still a reminder of the presence of the person,
who can be the "property" of none of us, nor merely a
"resource" to be used for our purposes, however important they may
be.
To see this, however, is to begin to see the deepest
truth of all: even the giving of organs for transplant is not unproblematic. And we can understand why, if organs are
used, they should be given rather than taken only if we first see how troubling
even the giving is. . .
We will avoid it, though, only to the degree that we
cease to be simply cheerleaders in the cause of transplantation and regain,
instead, an older wisdom of and about the meaning of the body. Fortified in that way, and aware of what is
troubling about all organ transplantation, we will be better able to think
about how it may be done rightly and how it should not be done even in the name
of avoiding tragedy.
Gilbert
Meilaender holds the Duesenberg Chair in Christian Ethics at Valparaiso
University
Read the entire article at www.firstthings.com/article.php3?id_article=3852&var_recherche=meilaender+%2B+body+parts.
* * * * *
2.
In the News: Is
It Your Fate to be Fat?
Surprises on saccharin,
obesity, genetics scramble the rules By Dorothy Korber and Carrie
Peyton Dahlberg - dkorber@sacbee.com
February 12, 2008
If you're worried about your weight – and who isn't? –
you may have the feeling lately that science is really jerking you around.
Consider recent findings: Rats fed saccharin gain
weight faster than rats fed sugar. Some overweight humans live longer than
skinny ones. Diabetics who drive down their blood sugar to "normal"
levels are more likely to die of heart disease.
Even the end result of "just eat less and
exercise more" is under scrutiny, as researchers find that some obese
people are destined by their genes and metabolism to stay fat.
Maybe it's time to be realistic and play the cards
we're dealt.
"The reality is that people have less control
over their weight than they realize," said Gina Kolata, whose book
"Rethinking Thin" looks at the science of weight loss. "Weight
is inherited almost as strongly as height. No matter how much you'd like to be
skinny, you may not be able to be as thin as you would like."
Kolata suggests that Americans should stop blaming
people for obesity.
"It's just as hard for a thin person to gain 100
pounds as it is for an obese person to lose it – or even 50 pounds, or even, I
hate to say it, 20 pounds," she said Monday. "It's not that easy to
change your weight just because you will yourself to."
Hard as dieting is, losing weight is easier than
keeping it off.
Even Oprah Winfrey, one of America's wealthiest women
with personal trainers and chefs, struggles with gaining and losing repeatedly,
points out UC Davis nutrition professor Judith Stern.
"It's really hard to keep weight off," Stern
said. "Some of it has to be biology. Some of it has to be the
environment."
And some of it is probably
interactions between the two that we don't fully understand. . . To read the
entire article, go to www.sacbee.com/health/v-print/story/705326.html.
To read reviews of diet books, click on DIET at www.healthcarecom.net/bkrev_Health.htm.
To obtain Bob Schwartz' book Diets Don't Work, go to www.amazon.com/gp/offer-listing/0942540166/ref=sr_1_olp_2?ie=UTF8&s=books&qid=1204435754&sr=1-2.
To obtain Bob Schwartz' book, Diets Still Don't Work,
go to www.amazon.com/Diets-Still-Dont-Work-Schwartz/dp/0942540042/ref=sr_1_4?ie=UTF8&s=books&qid=1204435754&sr=1-4.
* * * * *
3. International Medicine: Luckily, GPs are wiser than
their leaders By Richard Horton, The Sunday Telegraph,
17 Feb 08
GPs are
angry. Recent pay freezes (despite a 30 per cent salary increase three years
ago that took their average earnings to £110,000), service upheavals, political
scapegoating, GP "bashing" in the media, betrayal by their own
leaders, and unilaterally imposed changes to contracts by government have all
led family doctors to declare that enough is enough.
· News:
Families pay £1,200 a year on medical care The average family spends
almost £1,200 a year on medical care - on top of the £3,850 contributed
annually to the NHS via tax - in a "creeping privatisation", a study
has found. (£5,050 approximates $10,000 USD. Socialism still didn't deliver.)
And so their leaders marched the troops into war. At
the start of this month, their trade union, the British Medical Association,
opposed ministers' plans to open surgeries for an average of three extra hours
a week. The BMA may have hoped that public sympathy for GPs, combined with poor
political polls for Labour, would force health ministers to surrender. Instead,
it was the BMA that had to climb down, days after the Health Secretary wrote
directly to GPs. It was a humiliating defeat. And an utterly pointless episode
of medical demagoguery.
The
Government wants to widen access to GP services to evenings and weekends. And
it is prepared to redirect and add extra money to do so. The BMA has argued,
crazily, that this idea "could undermine the very basis of the NHS".
For
some time, doctors have wanted their leaders to exercise some muscle. The BMA
forced out its last chairman, James Johnson, in a brutal putsch, for not doing
more to oppose Government reforms. His successor, Dr Hamish Meldrum, has
responded in the way many GPs want: by opposing the Government at every step.
Meanwhile, the organisation's chief GP, Dr Laurence Buckman, is contemptuous of
elected politicians. "They don't care about patients," he says.
But the
public cynicism displayed by Doctors Buckman and Meldrum is perplexing. It is
also quite at odds with the idealism and selflessness shown by most GPs. Family
doctors manage 86 per cent of all health needs in Britain. They make more than
250 million consultations every year. Without GPs, the health of the nation
would collapse.
However,
one in three patients still finds it hard to see their doctor, the Government
reports. Ministers say that four times as many working hours are lost because
of visits to the doctor as are lost to strikes. The 2.5 million lost working
days mean £1 billion lost to the economy. . .
From
the birth of the NHS in 1948 to this latest row, the BMA has been on the wrong
side of the winning argument. It passionately opposed the idea of a state-run
health service from the start. Sixty years later, it opposed working an average
of less than one hour extra each week in return for the best financial
settlement GPs have ever been offered.
But while
ministers and the public know all too well what the BMA is against, they have
little idea what the BMA is for. Meldrum and Buckman predict apocalypse. They
claim government wants to destroy general practice. Ministers want
privatisation by the back door. Mass resignation from the NHS may be the only
way out.
GPs
will vote on the Government's proposals later this month. The BMA's leaders say
it was forced "to choose between two unacceptable alternatives". They
are now recommending that GPs accept the Government's offer: £158 million
reinvested into extended hours, greater financial incentives for GPs to provide
better access, an average of an extra hour's work for most, and a 1.5 per cent
increase in the total value of their contract. Not bad. I have confidence that
doctors will do what is best for patients. They will vote overwhelmingly for
this plan.
The
BMA's strategy of public scare and professional paranoia has driven GPs into a
dangerous corner. Its resistance to change is undermining the work of thousands
of other doctors, who are trying hard to strengthen standards of care across
the NHS.
General
practice is the foundation stone of the NHS. But the BMA is stopping the NHS
from creating a more personalised service, building care around the needs of
patients, rather than around the needs of doctors. The BMA must ask itself: why
do we exist? As of today, no one truly knows.
Richard Horton is
editor of The Lancet
www.telegraph.co.uk/opinion/main.jhtml?xml=/opinion/2008/02/17/do1705.xml
The NHS does not give timely
access to healthcare, it only gives access to a waiting list.
* * * * *
4. Medicare: Senior benefit costs up 24%
'Health care crisis' leads to 8-year rise
By Dennis Cauchon, USA TODAY
The cost of government benefits for
seniors soared to a record $27,289 per senior in 2007, according to a USA TODAY
analysis.
That's a 24% increase above the inflation
rate since 2000. Medical costs are the biggest reason. Last year, for the first
time, health care and nursing homes cost the government more than Social
Security payments for seniors age 65 and older. The average Social Security
benefit per senior in 2007 was $13,184. . .
The federal government spent $952 billion
in 2007 on elderly benefits, up from $601 billion in 2000. It's the biggest
function of the federal government. States chipped in $27 billion more in 2007,
mostly for nursing homes.
All three major senior programs Social Security,
Medicare and Medicaid experienced dramatically escalating costs that
outstripped inflation and the growth in the senior population.
Benefits per senior are soaring at a time
when the senior population is not. The portion of the U.S. population ages 65
and older has been constant at 12% since 2000.
The senior boom, however, starts big time
in 2011, when the first baby boomers 79 million people born between 1946
and 1964 turn 65 and qualify for Medicare health insurance. The oldest baby
boomers turn 62 this year and qualify for Social Security at reduced benefits.
USA TODAY used a variety of government
data to calculate the cost of providing Social Security, medical benefits and
long-term care to an aging population. Billions of dollars paid to
non-seniors, the disabled, children and others in the programs were
removed to create an estimate that focuses exclusively on seniors.
Findings include:
·
Medicare experienced the most explosive growth from 2000 to 2007. The Medicare prescription-drug
benefit, started in 2006, accounts for about one-fourth of the increase in
Medicare, which provides health benefits for people 65 and older.
·
Long-term care costs per senior have declined slightly in the past three years
because of a move away from nursing homes to less expensive home care.
·
The cost of senior benefits is equal to $10,673 for every non-senior
household.
·
About 35% of the federal budget is spent on senior benefits, up from 32% in
2004.
Eugene Steuerle, a senior fellow at the
non-partisan Urban Institute, notes that the full cost of senior benefits goes
beyond Social Security, Medicare and Medicaid. A complete estimate would
include other programs for retirees, such as military and civil servant pensions
and medical benefits, he says.
The Urban Institute estimates that kids
receive an average of about $4,000 per child in benefits, including the child
tax credit and other indirect assistance. . .
To read the entire article, please go to www.usatoday.com/news/nation/2008-02-14-senior-charticle_N.htm?loc=interstitialskip.
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
The best way to reduce Medical Gluttony is a percentage co-payment
Much of Medical Gluttony or excessive health care
costs is physician induced. Some of it is on the patient's insistence to have
more tests and x-rays. Now MRI is the clarion call - MRI of anything, even the
lungs. With an open shutter, lung movement would not produce any detail.
Last week, Mr. McHenry, an 82-year-old veteran,
decided to get his medications at the VA which offers them essentially free. He
had to go to the clinic to get his prescriptions rewritten, however. In the
process, he mentioned that he always felt bloated and the doctor on the Front
Line decided to get an Ultrasound of the abdomen on the way to the pharmacy. It
showed a small aortic aneurysm, 2.8 cm in diameter, considerably smaller than
the 4.5 cm when surgery is frequently suggested. This was confirmed on a CT of
the abdomen and the veteran was advised he would have to go to the USAF
hospital 50 miles away to have his aneurysm repaired. He and his wife came in
expecting his aneurysm to explode, at any second, and for him to drop dead any
minute. She couldn't bear to spend another night with him for fear he would
rupture and die next to her. We reassured them that it was not considered to be
in the danger zone and repair at age 82 could possibly shorten his life.
This reminded me of another patient, Mr. George, who
had a 4 cm aneurysm of his aorta. He was about 60 when this was found. His
vascular surgeon had him come back every six months for an ultrasound to see if
it had grown. When it grew to be 4.5 cm, he would immediately operate and
insert a Teflon graft. Fortunately, for Mr. George, and unfortunately for Dr.
Jones, it never got over 4.0 cm. At age 85, his coronary caught up with him but
his aneurysm never did.
Were these 40 abdominal ultrasounds required? His
insurance kept paying for them. So Mr. George didn't create a fuss. After about
ten years, he was told he should reduce it to once a year, but his vascular surgeon
advised him to continue twice a year, which he did. The vascular surgeon did
these in his own office, which would be about one-third of what it would have
cost in the hospital outpatient department.
It would be very difficult for a personal physician to
totally contradict the vascular surgeon and thus there was no good mechanism to
reduce this exorbitant cost – roughly $300 x 40+ procedures or $12,000 of which
more than 30 were unnecessary. He had health insurance, Medicare plus HMO, with
a fairly rugged oversight mechanism, which never interfered with this Medical
Gluttony. Government oversight seldom interferes with unnecessary expenses but
more frequently seems to limit important needed medical procedures.
If this patient would have had the only tenable type
of health insurance that controls costs where the patient pays a percentage of
every charge, say 20 percent of outpatient procedures, that $60 every six
months would have gotten a fairly good discussion going between the patient and
his vascular surgeon. After 4 or 5, he would have insisted on maybe once a
year. After 4 or 5 years, he would have insisted on perhaps one every other
year. After another 4 or 5 ultrasounds he would have insisted on doing them
every three or four years. All the discussions would have been two-way friendly
interchanges and health care costs would have been reduced by about 75 percent.
There would have been no animosity between his several doctors and the patient
would have been leading the cost-cutting team.
Although a percentage co-payment would have reduced
this cost by 75 percent, the average reduction in health care costs in our
experience would have been about one-third to one-half. When looking at $2
trillion per year that is a reduction that even our Congress or President could
never hope for in the most rigid and policing efforts ever devised. There is no
better cost-control than patient responsibility for a percentage of all costs,
which puts him/her at the head of the utilization team.
A percentage co-payment on every health care charge
would put all of health care in a market place environment and reduce our
national health care costs by 30-50 percent overnight. Why won't the insurance
companies do this? Would they lose control of the patient? That would return
control to the doctor-patient relationship. Nirvana from one simple change in
an insurance plan.
* * * * *
6.
Medical Myths:
Treatment of AIDS is cost effective in reducing AIDS
Health Alert: Saving Africans from Limousine Liberals and People
Who, Although Not as Rich as Barbara Streisand, Think Just Like She Does;
Part I.
Note to Bill Clinton, Elton
John, Madonna, Bono, Sting, Ashley Judd and all their Hollywood friends: Stop
killing Africans. And here you probably thought that all these people - with
their concerts, fundraising campaigns and AIDS awareness activities - were
actually doing something good. Welcome
to the world of political correctness.
If you're a regular reader
of Health Alerts, in all probability you are not a subscriber to the kind of
literature that would clue you in on socially acceptable charitable giving. So you can be forgiven for not knowing that
(1) AIDS is a politically correct thing to be concerned about (in fact, it is
far and away the most politically correct disease) and (2) making a distinction
between AIDS prevention and AIDS treatment is boorish, gauche, insensitive,
uncaring, unfeeling and completely politically incorrect.
[Aren't you glad you have me
to guide you through the nonsyllogistic world of Hollywood thought?]
First things first. It is too bad that all these celebrities did
not get involved 25 years ago when virtually all the experts were predicting
that AIDS would kill millions of Africans.
But, hey, what's the point of getting involved in a cause if none of
your friends knows anything about it?
Anyway, now that 29 million Africans are HIV positive, what is the best
use of scarce health care dollars?
It turns out that most of
the hoopla in the West and most of the actual AIDS dollars are focused on AIDS
treatment, whereas there is a much better return to be had on AIDS prevention
and an even better payoff from the treatment and prevention of other diseases.
Further, by the very act of
spending billions of dollars on AIDS treatment, resources will be drawn away
from AIDS prevention and other health needs.
In this way, African AIDS programs almost certainly cost more lives than
they save!
• The World Health Organization estimates the cost of
treating a patient with AIDS with the "triple drug cocktail" known as
highly active antiretroviral therapy is about $1,500 per patient per year; and
this treatment adds only 3 to 5 years to each patient's life.
• By contrast, a study in the British medical journal, The
Lancet, estimates that prevention interventions such as condom distribution,
blocking mother-to-child transmission, and voluntary counseling and testing
could cost as little as $1 to $20 per year of life saved.
• The medicines that cure tuberculosis cost about $10 per
case.
• A package of interventions designed to prevent maternal
and infant deaths costs less than $3 per person.
• Worldwide, 3 million children die every year because they
do not get vaccines that cost pennies per dose.
A study by Harvard economist
Michael Kremer estimates that for every year of life gained by giving
antiretroviral therapy to an AIDS patient, 25 to 110 (quality adjusted) years
of life could have been saved by spending those same dollars in more productive
ways.
Even AIDS prevention is not
always cost effective. An article in
The Lancet lamented that 5.5 million child deaths could have been prevented
using the same money that was aimed at preventing the small number of child
deaths due to AIDS.
If all this is ruining your
day, I have more bad news. Over the
past five decades, the developed countries of the world have given
less-developed countries $2.3 trillion in foreign aid. What difference has all this money
made? Amazingly, economists aren't
sure. How can you spend $2.3 trillion
and not have any obvious beneficial effects?
That's a subject for next week's Health Alert.
PS #1: I intentionally left Bill Gates off the
list. Why? Because he has at least read
the four must-read books for anyone contemplating giving money to Africa (and
one hopes he learned from them). See, however, Bill Easterly's op-ed on Gates
in The Wall Street Journal. http://online.wsj.com/article/SB120235183917849631.html
PS #2: Here are the four must-read books:
William Easterly, The White
Man's Burden: www.amazon.com/White-Mans-Burden-Efforts-Little/dp/1594200378
Gregory Clark, A Farewell to
Alms: www.amazon.com/Farewell-Alms-Economic-History-Princeton/dp/0691121354/ref=pd_bbs_1?ie=UTF8&s=books&qid=1202489401&sr=1-1
Paul Collier, The Bottom
Billion: www.amazon.com/Bottom-Billion-Poorest-Countries-Failing/dp/0195311450/ref=pd_bbs_1?ie=UTF8&s=books&qid=1202489361&sr=1-1
Jeffery Sachs, The End of
Poverty: www.amazon.com/End-Poverty-Economic-Possibilities-Time/dp/1594200459
The Sachs book represents
conventional - and almost certainly wrong - thinking. I include it only for
balance.
These books are summarized
along with other material in John Goodman, "Message to Debaters" www.debate-central.org/ and Christa Bieker,
"Topic Overview" www.debate-central.org/research/overview-of-the-2007-2008-cx-topic at the NCPA's high school
debate site.
To view the comments for
this blog entry: www.john-goodman-blog.com/africaaids/#comments
Cheers,
John Goodman, President,
National Center for Policy Analysis
12770 Coit Rd., Suite 800,
Dallas, Texas 75251
* * * * *
7.
Overheard in the
Medical Staff Lounge: Which Candidate Will Destroy American Medicine?
Dr. John: With
the second Super Tuesday completed yesterday, which candidate will be the best
for our patients?
Dr Sam:
That's easy. Both Obama and Clinton would destroy any freedom in health care.
Dr. Michelle:
How's that?
Dr. Sam: Both would
force our patients into the same corner that all National Health Plans and
Canadian Medicare have forced their patients into.
Dr. Michelle: Hold
on for a second. Obama wants to make it semi-voluntary.
Dr. Sam: Semi,
just means the gun's chamber is only half full. They're all headed in the same
direction. Total forced control.
Dr. Milton: Isn't
it amazing that Europe, especially in Sweden and the UK, is facilitating
privatization of their National Health Service? Both "L" candidates
in our country are trying to force Americans into the same failed systems.
Dr. Edwards:
Sweden, the granddaddy of socialized health care, is crumbling and hospitals
are being privatized trying to salvage the system.
Dr. Milton: The
UK with their NHS for nearly 60 years is beginning to recognize that it hasn't
worked and can't work and is looking at its options.
Dr. Rosen: The
Canadian system which outlawed private practice is crumbling. Their Supreme
Court has ruled that Canadian Medicare gives access to a waiting list, but not
to health care.
[Canadian Supreme Court
Decision 2005 SCC 35, [2005] 1 S.C.R. 791 http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html}
Dr. Sam:
Canada has absolutely the worst health care in a relatively free country. The
other two that have outlawed private practice are Cuba and North Korea. What a
group for Canada to be in!
Dr. Dave: But
many Canadian's don't understand their system. They think its fine until they
experience American Health Care. I had a patient last week who moved to the
states because his wife wanted to return to California. He said he had always
thought the Canadian Medicare was the norm. He just assumed everyone throughout
the world had to wait weeks, months and years to get such things as an MRI. He
was astounded to experience obtaining an MRI the day after it was ordered.
Dr. Sam:
Ignorance is Bliss, isn't it?
Dr. Rosen: Yes
it is, I've had similar feedback from Britons who were in the US for a period
of time. They couldn't believe that they could have an operation, even a heart
operation, the very same day as the need arose. They just assumed it would take
six months of wait.
Dr. Sam: This
general ignorance is what ultimately will get people to implement what they
will regret forever. That's how political solutions always work.
* * * * *
8.
Voices of Medicine: Cops and Doctors By Dr SCOTT GOTTLIEB, WSJ, February 27, 2008
The death of actor Heath Ledger from an accidental overdose
of six pain and anxiety medicines -- including the narcotics OxyContin and
Vicodin -- has prompted warnings about misuse of prescription drugs, which
ranks as one of the fastest growing segments of drug abuse. Nobody disputes the
problem. But the strategies for tackling it aren't changing the trends, they
are just hobbling doctors and patients, and may retard the development of new
medications.
The Drug Enforcement Administration is, sensibly
enough, targeting the small number of physicians who inappropriately prescribe
drugs in violation of current laws, the "patients" who doctor shop
for painkillers and hoard drugs to abuse or sell them, and the criminal
diversion of these medications from pharmacies and distribution centers. But
the DEA is also trying to influence clinical decisions about when these drugs
are prescribed.
This is a mistake. Clinical issues are not the
expertise of the DEA. Placing more restrictions on the legitimate prescribers
can harm real patients and ethical physicians.
Innovative new drugs such as OxyContin that have been
developed in the last two decades provide targeted relief for intractable pain.
While they have helped innumerable patients, they have also been abused. The
DEA response?
One was to try and get the power (now exclusively
vested in the FDA) to have a final say over whether new narcotic medications
should come to the market. Legislation to do so was temporarily passed in 2004
and the DEA sought its reauthorization in 2005 -- as a "rider"
attached to its appropriations bill, without Congressional debate. At one time,
the DEA even sent out solicitations to hire clinicians to review new drug
applications for narcotics, a role reserved for the FDA. The DEA has stepped
back from that effort -- at least for now.
There have also been efforts to place additional
restrictions on existing drugs. The DEA is carving out a role for itself in the
creation of risk-management programs that manage how new narcotics are used.
These programs often place burdens on doctors and patients that can discourage
legitimate prescriptions, for example by requiring additional reporting by
physicians who dispense these drugs, as well as certification that they
received additional training in handling them.
The DEA is leading a campaign to "reschedule"
drugs like Vicodin into a stricter classification -- placing them under the
same restrictions as opium, methadone and morphine. It is widely believed that
the DEA has also been quietly pressuring the FDA to reach a similar conclusion.
The hope is that tighter controls will help control illegal diversion --
although medical studies show that determined abusers don't typically get their
drugs through legal channels.
But there's a danger that the DEA will wade into areas
that involve appropriate clinical practice. There will always be some trade-off
between access and enforcement -- between the docs and the cops. The ensuing
tension helps ensure the right balance between enabling legitimate prescribing,
and maintaining restrictions that aid in reasonable enforcement efforts. The
problem is when DEA activities end up influencing legitimate prescribing.
For one thing, they prompt some law-abiding doctors to
think twice before writing legitimate scripts. A 2001 study of California
doctors found that 40% of primary-care physicians said fear of investigation
affected how they treated chronic pain. A recent survey of physicians by the
Center for Addiction and Substance Abuse found that one-third worry "a
great deal" or "somewhat" about review of their own prescribing
of controlled drugs by law enforcement agencies; and 44% report that this
actually influences which medications they prescribe. . .
As prescription-drug abuse and criminal diversion
escalates, there is a need for stepped-up law enforcement. But when it comes to
managing legitimate medical practice issues, the cops should step aside. The
risk is a return to an era when pain often went unrecognized, treated patients
were commonly undermedicated, and doctors were reluctant to prescribe powerful
narcotics -- sometimes out of fear of those looking over their shoulder.
Dr. Gottlieb, a resident fellow at the American
Enterprise Institute, was deputy commissioner of the Food and Drug
Administration from 2005 to 2007.
See all of today's editorials and op-eds, plus video
commentary, on Opinion Journal1.
http://online.wsj.com/article_print/SB120407467410795235.html
* * * * *
9.
Review: William
Buckley, Jr, author and columnist, wrote until his death on Feb 27, 2008.
From the Orange Country Register www.desertdispatch.com/opinion/buckley_2690___article.html/national_review.html
Just a listing of his accomplishments is a bit
wearying, causing one to marvel that he packed so much into what in context
seems like a mere 82 years of William F. Buckley Jr.'s life. The godfather of
modern American conservatism wrote at least 55 books, ranging from serious
political treatises to spy novels to celebrations of the oceanic sailing he
enjoyed so much.
There were about 5,600 newspaper columns, the TV
discussion program "Firing Line," which ran 1966-99, the magazine
National Review, which he founded and edited until 1999. Just in the past year,
he published a political novel, a book musing on National Review's history and
a personal memoir of Barry Goldwater, due in April.
And he did it all with a twinkle in his eye and gave
off the sense that it was all effortless.
In 1955, when National Review was founded, the
intellectual climate was so unrelentingly geared toward modern
"liberalism" and socialism that the critic Lionel Trilling was able
to write in 1950 that "it is the plain fact that there are no conservative
or reactionary ideas in general circulation." Buckley had help, of course,
but it is not too great an exaggeration to say that he changed that situation almost
single-handedly. As George Will wrote in 1980, "All great biblical stories
begin with Genesis. And before there was Ronald Reagan, there was Barry
Goldwater, and before there was Barry Goldwater there was National Review, and
before there was National Review there was Bill Buckley with a spark in his
mind, and the spark in 1980 has become a conflagration."
Fowlerspeak-Goodspeak By William F. Buckley Jr.
In the debate Thursday night, Hillary Clinton
pronounced herself glad that Barack Obama had brought up the subject of foreign
affairs. The technique is common. It says to the audience that Clinton is aware
of a deficiency in Obama and intends to exploit it for all it is worth. The
danger is that it gives Obama an opportunity to turn the score on Clinton by
saying that he just happens to have made his living for three years by writing
on foreign affairs for the Encyclopaedia Britannica.
These verbal traps are widely used and widely
counter-used. The best collection of them appears in the last few pages of
Fowler's Modern English Usage, but of course that section is only a
small part of his great work. It is worth acquainting the reader with the
teeming harvest of Fowler's analysis.
He offers us, for instance, a list of words owing
their vogue to the joy of showing that one has acquired them: allergic,
ambience, ambivalent, catalyst, complex, equate, global, idiosyncrasy,
protagonist, repercussion, seminal, streamlined.
He gives another list of words taken up merely as
novel variants on a more common word: adumbrate for sketch, blueprint for plan,
breakthrough for achievement, built-in for solid, ceiling for limit, claim for
assert, integrate for combine, intrigue for interest, liquidate for destroy,
reaction for opinion, optimistic for hopeful, redundant for superfluous,
rewarding for satisfying, significant for important, sabotage for wreck, target
for objective, smear for calumny.
And there are words owing their vogue to some
particular occasion, plus "popularized technicalities" (words
legitimately used in some scientific discipline, but brought carelessly into
general use): acid test, coexistence, exponential growth, geometric
progression, iron curtain, psychological moment, winds of change. And words of
rhetorical appeal: archetypal, challenging, dedicated, fabulous, fantastic,
massive, overtones, sensational, unthinkable.
My reluctance to quote at such length from the great
Fowler is mitigated by my serious wish that students of the English language
would themselves take the initiative of familiarizing themselves with the
profundities and niceties of the points being made by Mr. Fowler.
So Sen. Clinton will tell us that Sen. Obama has no
first-hand executive experience. Obama in turn will imply that the kind of
experience one gets as first lady is not of the same order as one gets as
president, and that he has felt as keenly as she the pulse beat that resonates
only in Congress, not in executive offices.
The viewer will have noted that it is expressions of
this kind - i.e., personalized derogation and hauteur -
that elicit the most vivid response from the audience. Presidential
candidates no longer even try to sound like the Lincoln-Douglas debates, yet it
is not bad occasionally to subject them to such analysis, to learn what it is
that is not being said.
The matter of health care that has been primary in
Mrs. Clinton's public career lends itself to special attention. She put forth
an ambitious program when her husband was in his first term as president. But
there were serious defects in that program, which her opponents were able to
locate precisely because of their experience in the practical world of politics
that she sought to gainsay. Those opponents, led by Rep. Newt Gingrich, were
able to derail the program the Clinton administration had billed as its most
important domestic initiative. And yet in Thursday night's debate Mrs. Clinton
cited that plan - which she implied she would revive unchanged - as
one of her principal claims to the presidency.
The two performers in the debate struck the observant
conservative as intelligent, resourceful, and absolutely uninterested in the
vector of political force. Both contenders should spend time on the problem of
omnipotent government, and both, while entitled to criticize what has happened
under President Bush, are obliged to an alert audience to speak the kind of
language Fowler preached and preached in.
http://article.nationalreview.com/?q=M2FkMjBjNzAzM2E0NmY1YjQyYjk5MDM1NWQzMDkxN2I=#more
To purchase God & Man & Yale by Wm F Buckley,
Jr, go to www.amazon.com/God-Man-Yale-William-Buckley/dp/089526692X.
A memorial service for the
writer and editor William F. Buckley Jr. will be held on April 4 at
10 a.m. at St. Patrick's Cathedral in Manhattan, his family said. The service
will be open to the public. Mr. Buckley's son, the writer Christopher Buckley, and Henry A.
Kissinger, the former secretary of
state, will speak. www.nytimes.com/2008/03/06/nyregion/06buckley.html?_r=1&ref=nyregion&oref=slogin
* * * * *
10. Hippocrates & His Kin: How to Become President
Mrs. Clinton states that she will implement her failed
health care proposal from 1992-93 as soon as she's elected president. However,
she has not significantly revised the plan. But she thinks her experience as
the first lady will stand her in good favor as the No 1 Lady.
Does she
really think she can fool the American people twice? But then, this is a new
century.
Mr. Obama reacted to Mrs. Clinton's criticism of no
experience in international affairs by saying he's been writing about
international experience for an encyclopedia for several years.
If you want
to be president, read and write about your future duties. Experience is not
necessary.
Mr. McCain states he's had war experience and
Washington experience. He's sorry he ever hooked up with Feingold in
Washington. He's best as an outsider.
Mistakes
happen.
What does the International
Press think of Mrs. Clinton? The Financial Times has an insightful article on
her sincerity. Check the UK perspective on Hillary Clinton gets it sincerely
wrong by Clive Crook, FT.
Are the media and her party
really tired of her?
The Other Side of Home
Assistance
A veteran was seen last week
for disability evaluation. When asked about his needs for living alone, he
stated that he was managing just fine with all his disabilities. If he were
provided aid, he saw himself becoming more dependent on the assistance and
would lose his independence. Thank you, but No.
Home Health
Aids Often Breed Dependency and Decrease Well Being.
The Other Side
of a Psychiatric Admission
On reviewing a request by
the Department of Disability Service, the psychiatric admission summary caught
my eye. He was admitted for suicide precaution. After three days of a clean
room and good food, he said that he really was not suicidal but had been
evicted from his apartment and needed lodging and food. He saw no other way to
obtain this than to make the call that his life was not worth living and he was
contemplating suicide. He thanked the staff for being so kind to him for three
days. He was now able to face homelessness where all his friends were and he
could obtain a good shoot of heroin.
Free Health
Care, Spending Other People's Money, Certainly Provides Many Comforts.
To read more vignettes,
please go to www.healthcarecom.net/hhkintro.htm.
To peruse other Hippocrates
Columns, go to www.delmeyer.net/HMC.htm.
* * * * *
11. Organizations Restoring Accountability in HealthCare,
Government and Society: