MEDICAL TUESDAY . NET
Community For Better Health Care
Vol V, No 23, Mar 13, 2007
In This Issue:
The Annual World Health Care Congress, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. Last year it was 50 percent, indicating open forums such as these are critically important. The 4th Annual World Health Congress will be held on April 22-24, 2007, also in Washington, D.C. The World Health Care Congress - Asia will be held in Singapore on May 21-23, 2007. The World Health Care Congress - Middle East will be held in Dubai, United Arab Emirates, on November 12-14, 2007. World Health Care Congress - Europe 2007 will meet in Barcelona on March 26-28, 2007. For more information, visit www.worldcongress.com.
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Molecules called predictive autoantibodies appear in the blood years before people show symptoms of various disorders. Tests that detected these molecules could warn of the need to take preventive action By Abner Louis Notkins
NOVEL CRYSTAL BALL: One day Y-shaped molecules called autoantibodies in a patient's blood may tell doctors whether a patient is "brewing" certain diseases and may even indicate roughly how soon the individual will begin to feel symptoms.
A middle-aged woman—call her Anne—was taken aback when one day her right hand refused to hold a pen. A few weeks later her right foot began to drag reluctantly behind her left. After her symptoms worsened over months, she consulted a neurologist. Anne, it turned out, was suffering from multiple sclerosis, a potentially disabling type of autoimmune disease. The immune system normally jumps into action in response to bacteria and viruses, deploying antibodies, other molecules and various white blood cells to recognize and destroy trespassers. But in autoimmune disorders, components of the body's immune system target one or more of the person's own tissues. In Anne's case, her defensive system had begun to turn against her nerves, eroding her ability to move.
Every story of autoimmune disease is sad—but collectively the impact of these illnesses is staggering. More than 40 autoimmune conditions have been identified, including such common examples as type 1 (insulin-dependent) diabetes, rheumatoid arthritis and celiac disease. Together they constitute the third leading cause of sickness and death after heart disease and cancer. And they afflict between 5 and 8 percent of the U.S. population, racking up an annual medical bill in the tens of billions of dollars.
Recent findings offer a way to brighten this gloomy picture. In the past 10 years a growing number of studies have revealed that the body makes certain antibodies directed against itself—otherwise known as autoantibodies—years, and sometimes a decade, before autoimmunity causes clinical disease, damaging tissues so much that people begin showing symptoms. This profound insight is changing the way that doctors and researchers think about autoimmune conditions and how long they take to arise. It suggests that physicians might one day screen a healthy person's blood for certain autoantibodies and foretell whether a specific disease is likely to develop years down the line. Armed with such predictions, patients could start fighting the ailment with drugs or other available interventions, thereby preventing or delaying symptoms. . .
The revolution in predictive medicine and preventive care will take time and effort to effect. Many autoantibodies have been uncovered, but only a few large-scale trials have been conducted to evaluate how accurately they can predict disease. If inexpensive, quick tests for predictive autoantibodies can be developed, though, they could become as standard a part of routine checkups as cholesterol monitoring.
People familiar with advances in genetics might wonder why researchers would want to develop tests for predictive autoantibodies when doctors might soon be able to scan a person's genes for those that put the individual at risk of various disorders. The answer is that most chronic diseases arise from a complex interplay between environmental influences and multiple genes (each of which makes but a small contribution to a disease). So detection of susceptibility genes would not necessarily reveal with any certainty whether or when an individual will come down with a particular autoimmune condition. In contrast, detection of specific autoantibodies would signal that a disease-causing process was already under way. Eventually, genetic screening for those with an inherited predisposition to a disease may help reveal those who need early autoantibody screening.
Studies of patients with type 1 diabetes provided the first clues that autoantibodies could be valuable for predicting later illness. In this condition, which typically arises in children or teenagers, the immune system ambushes the beta cells in the pancreas. These cells are the manufacturers of insulin, a hormone that enables cells to take up vital glucose from the blood for energy. When the body lacks insulin, cells starve and blood glucose levels soar, potentially leading to blindness, kidney failure, and a host of other complications. . .
Intensive research over the past 20 years has uncovered three major pancreatic autoantigens produced in people with newly diagnosed type 1 diabetes . . .
Interest in the three autoantibodies escalated with the discovery that they appear long before the onset of diabetic symptoms. In studies conducted by various laboratories, investigators took blood samples from thousands of healthy schoolchildren and then monitored the youngsters' health for up to 10 years. When a child came down with type 1 diabetes, the researchers pulled the individual's blood sample out of storage to see whether it contained autoantibodies. The vast majority of children destined to become diabetic had one or more of the three signature diabetes-related autoantibodies in their blood as long as 10 years before any recognizable symptoms arose.
Before this work, some experts thought that type 1 diabetes developed suddenly, perhaps within a matter of weeks. The new data demonstrated, instead, that in most cases the immune system silently assails the pancreas for years until so many beta cells die that the organ can no longer make enough insulin for the body's needs. That is the point when the classic early symptoms of diabetes arise, such as excessive hunger, thirst and urination.
More important, these studies also raised the prospect that doctors might forecast whether a child is at risk for type 1 diabetes by testing blood for the presence of these autoantibodies. Clinical researchers found that an individual with one autoantibody has a 10 percent risk of showing symptoms within five years. With two autoantibodies, the chance of disease jumps to 50 percent; with three autoantibodies, the threat rockets to between 60 and 80 percent.
The ability to predict whether a person is likely to fall ill with type 1 diabetes has had major repercussions for medical researchers trying to better understand and prevent the disease. Before the discovery of predictive autoantibodies, for example, it was almost impossible to conduct clinical trials of new preventive therapies, because the disorder is relatively rare, affecting about one individual in 400. Such odds meant that more than 40,000 subjects would have to be entered into a trial in order to assess the effects of an intervention on the 100 who would eventually be affected.
Now scientists can select for study those people whose blood shows two or more of the diabetes-related autoantibodies, because at least half the subjects, if untreated, will most likely come down with the disease within five years. Slashing the number of subjects who must be enrolled in a prevention trial has made such experiments feasible for the first time. In one investigation, doctors identified several thousand individuals at high risk of diabetes and tested whether injections of insulin could avert the disease. Sadly, this treatment proved unsuccessful; efforts to find useful interventions continue.
The discovery that autoantibodies frequently herald the onset of type 1 diabetes prompted scientists to examine whether the same might be true in other autoimmune diseases. One that has been the focus of especially intense research is rheumatoid arthritis, a debilitating condition that is highly prevalent, afflicting about 1 percent of the world's population. In those affected, the immune system attacks and destroys the lining of the joints, causing swelling, chronic pain and eventual loss of movement.
Immunologists have recently unearthed an autoantibody that is present in 30 to 70 percent of patients diagnosed with rheumatoid arthritis. The antibody latches onto citrulline (a modified version of the amino acid arginine), which is present in certain proteins. Studies have now revealed that the autoantibody appears in the bloodstream before the first symptoms turn up, in some cases more than 10 years before. Further, the likelihood that the illness will develop is as much as 15 times greater in people carrying that antibody than in those who lack it. . .
For certain other autoimmune disorders, the detection of predictive autoantibodies could potentially enable people to shut down autoimmune activity by avoiding certain triggers in their environment. A case in point is celiac disease. In people with this condition, the gluten protein found in wheat, rye and barley incites the immune system to attack the lining of the small intestine, which then fails to absorb food properly; diarrhea, weight loss and malnourishment then ensue. Patients must eliminate gluten from their diet, bypassing most bread, pasta and cereal for the rest of their lives.
Investigations into the underpinnings of celiac disease have revealed that many patients make an autoantibody that reacts with tissue transglutaminase, an enzyme that modifies many newly made proteins. This autoantibody emerges up to seven years before symptoms do, suggesting that high-risk individuals might forestall the disease entirely by eliminating gluten from their diet. This idea has not yet been tested, however.
To read the entire article, (subscription required) please go to
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By Michael Arnold Glueck, M.D., and Robert J. Cihak, M.D., The Medicine Men, Feb. 13, 2007
A recent ruling of the District of Columbia United States Court of Appeals weakened the Food and Drug Administration (FDA) drug-approval monopoly.
In the case of Abigail Alliance v. von Eschenbach, the court ruled "in some circumstances there is a constitutional right" to use drugs not approved in advance by the Food and Drug Administration (FDA), according to Robert F. Nagel writing in "The Weekly Standard."
If other levels and branches of the federal government maintain this ruling, it would put some additional meaning to Americans' unalienable right to life and liberty, as articulated in our Declaration of Independence.
UCLA law professor Eugene Volokh believes that access to medicines not yet approved by the FDA could be defended under a right to "medical self-defense."
Although Volokh describes the use of this right in several other scenarios, in this article we are only looking at it in the context of medicines not approved by the FDA for prescription or sale in the United States.
In an article forthcoming in the April 2007 Harvard Law Review, Volokh writes, "Lethal self-defense — protecting one's life against humans or animals (or preventing serious injury, rape, or kidnapping) — has long been a general exception to nearly all criminal laws, including laws against murder, weapons possession, and the like."
Therefore, Volokh reasons, "why shouldn't I be presumptively free to protect my life using medical procedures that don't involve killing, such as ... the use of experimental drugs?"
He hopes that others "who feel strongly about the right to lethal self-defense (as do I) ... will agree that the moral case for medical self-defense is at least as strong as the case for lethal self-defense."
Volokh prefers the term medical "self-defense" over medical "necessity" because each of the United States recognizes self-defense in state law, whereas only half the states recognize a necessity defense.
Under the law of lethal self-defense, Americans can defend themselves against being murdered by someone else by killing the threatening person, whether or not the person has an evil intent or is blameless because of insanity.
Likewise, the law of self-defense protects a person killing a threatening animal, even if the Endangered Species Act would otherwise protect the animal.
The right to medical self-defense would potentially allow a patient to use whatever potentially life-saving medical means desired. In contrast with lethal self-defense, patients using their own resources to acquire the potentially life-saving medicine would not kill or harm other people.
How did the FDA get between patients and medicines in the first place? This history now goes back a century, with the government first taking upon itself the authority to make sure that food and medicines were pure.
Next, the government took the authority to define whether medicines were safe.
More recently, federal laws called on the FDA to identify whether or not drugs were "effective" for proposed medical uses.
We've questioned the premise of FDA regulation of drug safety and effectiveness for some time. See www.newsmax.com/archives/articles/2005/2/22/142508.shtml.
Some people want drugs that have no side effects and are almost certain to have the desired effect. Others, such as patients with advanced cancer, are willing to try drugs that have a minimal chance of benefit, even less than 10 percent, and a high likelihood of bad side effects.
And people change their minds, sometimes from day to day, about the degree of safety and risk that they want to accept. . . To read the rest of the story, please go to www.newsmax.com/archives/articles/2007/2/12/152734.shtml.
Editor's Note: Robert J. Cihak wrote this week's column. Contact Drs. Glueck and Cihak by e-mail.
Michael Arnold Glueck, M.D., comments on medical-legal issues and is a visiting fellow in Economics and Citizenship at the International Trade Education Foundation of the Washington International Trade Council. Robert J. Cihak, M.D., is a senior fellow and board member of the Discovery Institute and a past president of the Association of American Physicians and Surgeons.
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3. International Medicine: A Single-Payer Health Care System Can Prove Fatal
She had attended parentcraft classes, met the midwives and packed her bag.
But nothing could prepare Gail Jordan for what happened when she rang the hospital to let staff know her baby was on the way.
A brusque voice at the end of the line told her all the maternity beds were full.
And instead of arranging for Mrs Jordan to go elsewhere, the nurse suggested she flick through the Yellow Pages to find somewhere for her delivery.
After a frantic search Mrs Jordan and her distraught husband, Dean, drove to another hospital 20 miles away where their son, Alexander, was born.
"It's disgraceful that they can treat a woman in labour like that," Mrs Jordan said.
"It's my first baby and I was absolutely terrified – anything could have happened. It was a dreadful beginning to what should have been a beautiful experience. They had held my hand every step of the way and then at the end of it, when I needed them most, this happened. I was really angry because her attitude was just 'tough luck, you can't come in.'"
The drama unfolded when the 38-year-old marketing director went into labour on January 31. She rang Solihull Hospital, two miles from her home, to inform staff her contractions had begun. . . .
But when she rang a second time, having packed her hospital bag, she was told there was no space for her and to ring round other hospitals for a bed.
"This rude woman told me not to bother coming in – it was as blunt as that," Mrs Jordan said. "
I explained I was having three contractions every ten minutes and she said, "Well what do you want me do to about it?"
"I asked if they had any overflow hospitals and she told me there were but I would have to look in the Yellow Pages for the number.
"It was the most inappropriate time imaginable to be dealing with somebody like this." Mrs Jordan and her husband, a 39-year-old marketing executive for Aston Martin, eventually found a bed at Warwick Hospital. . . .
Mrs Jordan's claims come as dozens of maternity units face closure in an NHS shake-up.
The NHS does not give timely access to health care, it only gives access to a waiting list.
When you're at the head of the list, and completed the waiting queue, you still don't have access.
And when you're in labor and delivery is imminent, it gives you the Yellow Pages.
Any American that wants this system should be given a free ticket to the UK.
One caveat: You have to renounce your American Citizenship so you can't come back.
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4. Medicare: The Rising Burden of Health Spending on Seniors, by Liqun Liu and Andrew J. Rettenmaier
The United States spends about 17 percent of its national income on health care, the highest in the world. Some have wondered how high spending can go and what difference it will make. In thinking about that question, the experience of our senior citizens provides a vital clue.
● Today, more than two of every five dollars of total potential consumption by the elderly (43 percent) is health care.
● In just 17 years (by 2024), health care will equal 50 percent of seniors' total consumption.
● For the oldest seniors — age 75 and older — health care already makes up more than half of all they consume.
Much of seniors' health spending is paid not by seniors themselves, but by public and private third parties like Medicare, Medicaid and previous employers. However, as spending on their health care rises, seniors will be asked to devote an increasing share of their own incomes to pay for it, crowding out other items like food, housing and travel.
● Today, seniors spend 17.2 percent of their cash incomes on health care, on the average, including out-of-pocket expenditures, as well as premiums for Medicare and individually purchased Medigap insurance.
● That level will grow to almost one out of every four dollars of income (23.5 percent) by 2030, and by midcentury seniors will potentially spend almost one-third of their cash incomes (31.4 percent) on health care.
Another way to look at health care spending by the elderly is to compare their total health consumption to their money incomes:
● Including all the spending by third parties, an amount approaching two-thirds of seniors' cash incomes is currently spent on health care.
● In another three decades (by 2039), an amount equal to 100 percent of seniors' cash incomes will be spent on health care.
Since Social Security represents such a large portion of seniors' retirement income — particularly for older seniors — examining health spending as a percentage of Social Security benefits is also informative:
● Today's seniors spend from their own resources an amount equal to 44.5 percent of their Social Security benefits on health care.
● That amount will almost double (to 81.3 percent) by midcentury.
If health care spending rises as expected, seniors will likely be called upon to share the burden.
That means current and future workers will need to extend their time in the labor market — or save and invest more money while working — to prepare for the higher expected health care costs waiting for them in retirement.
[When Franklin Delano Roosevelt initially started social security, retirement was set at age 65 with a life expectancy of age 62. If this had been partially indexed all these years, benefits would be starting at age 75 when life expectance reached age 78. President William Clinton did the greatest threat to social security when he made everyone eligible for full social security benefits even while earning a full salary. Most of us never expected to receive SS benefits until age 72 because we would have forfeited all benefits while we were working. We then would have been near to the age of 75 when benefits rightfully should be starting according to Roosevelt's initial criteria. Then the full indexing to age 75 would have been relatively painless. Then SS would not be in the current jeopardy. There is no way that with the average retirement years of just three or so in the 1930s and 30 years today we should expect taxpayers to pay us an income for 30 years instead of three years. No system could be sustainable with half a lifetime of a free ride. Medicare should be indexed in the same fashion as social security.]
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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5. Medical Gluttony: ER overuse burdens health care system by Michael Wilkes, MD
. . . Emergency departments are crowded with more people than ever. Each year, 20 percent of Americans visit the ER. This is puzzling, given that the wait to receive care for non-critical emergencies is often long and health care in the ER is extremely expensive. This is due in part to the fact that ER doctors are trained to fear the worst, and they are far more likely to order more blood tests and X-rays than general practitioners, who can follow up with patients the next day.
A recent study looked at patients' and doctors' use of the emergency room. According to both groups, most visits to the ER could have been avoided had only their doctor's office or a trusted clinic been open. Many patients reported that if they could have spoken to a doctor, they would not have used the emergency room.
A few people are frequent fliers in the ER. Not surprisingly, they are more likely to be those with chronic illness such as diabetes, asthma, alcoholism or heart failure. They are also more likely to be low-income, without access to a regular doctor, and see the ER as a convenient place to receive routine care.
This practice is not fair to anyone. The chronically ill deserve better. If their care was delivered by general doctors, it would be higher quality, more personal and far cheaper than the episodic care delivered by experts trained to care for people with life-threatening emergencies. For those who come to the ER with life-threatening or near-life-threatening conditions and need a doctor's immediate attention, it's not fair to have the ERs clogged with people with routine health issues.
The solution to overcrowded ERs needs to come from all sectors. Doctors need to provide care and advice to their patients in off hours. Only one in five doctors sees patients after 6 p.m. and only a small minority offer weekend appointments. Practices should be encouraged to use advice nurses, pagers and cell phones so that a patient can talk with an expert before going to an ER.
Patients should be told how to contact an expert for off-hours medical advice. Insurance companies and employers need to develop incentives to discourage non-life-threatening use of the emergency room. And patients need to ask their doctors how they can be contacted in off hours.
To read the entire article, go to www.sacbee.com/107/v-print/story/131120.html.
[When insurance companies, or Congress, or employers
provide incentives for more appropriate care, we are always at cross currents
with different agendas. No one wants to face the real facts or the real
solutions. For instance, if a patient had to make a 20% copayment on all ER
visits (welfare and poor people a 2% copayment provides identical incentives),
that would provide the incentive that insurance companies,
employers or doctors should like. Thus, a patient who trades a $100 office call
for a $500 ER visit would increase his copayment from $20 to $100. (Welfare or
poor patients would increase their copayment from $2 to $10.) That disincentive
to ER usage would reduce all unnecessary ER visits quite effectively. Very few
would ever make that mistake a second time. What is the fallout from such a
truly market-based plan?
1. ER usage would drop overnight from the majority being a clinic visit to the majority being emergency visits. This would save high cost center dollars.
2. Patients would start utilizing their private physicians more effectively saving personal and health-care costs.
3. Costly ineffective incentive programs could be abolished.
4. Patients would automatically seek the least expensive care consistent with their own evaluation of their medical needs, eliminating the cost of the insurance companies oversight and policing programs.
5. Managed care companies could also eliminate their pre-authorization policing activities, saving huge oversight costs.
6. The quality of care with the private physicians delivering consistent care would improve over that of emergency trained physicians doing routine office evaluations without benefit of the clinical record.
7. The cost of care would decrease inasmuch as an emergency physician, who doesn't know the patient and works in a high medical- and legal-risk environment, must practice defensive medicine and duplicate many tests that may have already been acquired, at huge unnecessary costs.
8. The hospitals would revert to their rightful place as the center of acute, emergency, and hospital care and not outpatient medicine.
9. Doctor's offices would revert to their rightful place as the center of low-cost outpatient medicine and could control their costs more effectively.
10. Insurance companies could revert to their right place of insuring high-risk health care, primarily hospital and surgical center health care.
Actuaries that have looked at this model have predicted that this would cut the cost of this segment of health care by more than 50 percent.
The only problem: Politicians would lose their favorite subject in running for political office, which takes all the joy out of the campaign.]
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Symptoms of an unsustainable system, By Jacob Weisberg, February 28 2007
America's healthcare system runs the gamut from capitalist to socialist, pausing at various points along the way. At the free-market extreme are the 10m people who buy private insurance without a subsidy and the 48m who have none at all. At the collectivised end are 5m military veterans who see government doctors in government hospitals, the 32m covered by Medicare (retirees) and 37m on Medicaid (the poor).
In between are the majority of Americans – the 153m workers and their families – who receive government-subsidised private insurance through their employers.
A growing consensus recognises [sic] this patchwork as economically disadvantageous and morally unacceptable.
Viewed as a whole, the American system is inefficient, expensive and possibly unsustainable. It consumes 16 per cent of gross domestic product and is growing 6.4 per cent a year. Europe provides universal, high-quality care for half as much per capita. Employer-based coverage is a drag on the economy, tethering workers to jobs they would otherwise leave and adding to the cost of goods. Healthcare spending is everywhere a budget wrecker. Yet, for all that the US spends, 16 per cent of the population, including 8m children, must make do at the system's charitable margins.
If the status quo is untenable, the Euro-alternative remains impossible to sell. Americans place a premium on personal liberty and individual choice. A "single-payer" system, in which government insures everyone directly, would diminish consumer freedom for the sake of equity and efficiency. The US invariably resists making that trade-off. Oregon, one of the most progressive-minded states, defeated a single-payer ballot initiative a few years ago by a margin of four to one.
All the action at the moment is in the space between these two extremes – the status quo and nationalised care. George W. Bush started the conversation last month when he proposed capping the tax deductibility of employer-provided plans and creating a deduction for individuals. By turning the healthcare tax deduction into a kind of voucher, the president would discipline spending and allow more individuals to afford insurance. But Mr Bush's plan risks undermining the employer-based system without replacing it and fails to grapple seriously with the problem of the uninsured.
John Edwards, a Democratic former senator, recently became the only presidential candidate to get specific on the subject when he laid out a plan bolder than Mr Bush's that would build on the employer-based system. Mr Edwards would require companies that do not insure their workers to pay into a fund for the uninsured. Following the trend in Massachusetts and California, he would add an "individual mandate", a requirement that anyone not covered at work buy insurance in a regulated market.
The chief advantages of Mr Edwards's plan are that it achieves universal coverage without disrupting the way most Americans now receive healthcare, and that it is explicit about raising taxes to pay for extending coverage. The chief disadvantages are that it would do little to control costs, and that it fails to break the anachronistic connection between employers and insurance.
Ron Wyden, a Democratic senator from Oregon, would directly sever that link. Mr Wyden is a savvy policy wonk who, in drafting the bill he recently introduced, has tried to learn from previous Democratic mistakes. He recently told me he had read The System, a massive tome on the failure of the Clinton healthcare reform plan in 1994, no fewer than five times. (Apparently, Starbucks now offers an intravenous drip.)
Mr Wyden's bill is 166 pages against Hillary Clinton's 1,364. Instead of trying to flatten the opposition as the Clintons did, Mr Wyden is courting Republicans. He recently got five of the most conservative men in the Senate to co-sign a letter to Mr Bush endorsing the principles of universal coverage and cost containment.
Under Mr Wyden's plan, American employers would no longer provide health coverage, as they have since the second world war. Instead, they would convert the current cost of coverage into additional salary. Individuals would use this money to meet the requirement that they be insured. Buying coverage directly would encourage consumers to use healthcare more efficiently. Getting rid of the employer tax deduction, which costs $200bn a year, would free funds to cover those who are not poor enough to qualify for Medicaid but not wealthy enough to afford insurance. The Lewin Group, an independent consulting firm, recently estimated that Mr Wyden's plan would reduce national spending on healthcare by $1,500bn over the next 10 years and save the government money through greater administrative efficiency and competition. . .
The writer is editor of Slate.com: www.ft.com/cms/s/e76a290a-c758-11db-8078-000b5df10621.html
[If Jacob Weisberg, who writes for Slate.com, feels
the American System is morally unacceptable, please read Int'l Med above about
the NHS being more political tha
t any American System, and far more
America's "Run the Gamut" Health Care System provides more complete coverage in time of need than any foreign socialistic system.
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Dr. Sam: I had a former drug abuser who had Hepatitis C and developed cirrhosis. He then went into liver failure. As he was being evaluated for a liver transplant, he was found to have developed cancer of the liver. It was the opinion of the transplant team that the cancer would be removed with the liver and he would be cured. After about one year, the cancer recurred in the transplanted liver and he died a few months later. This waste of transplant organs made me pull out my driver's license and remove the organ transplant authorization.
Dr. Rosen: I attended a medical ethics conference at UCD and the subject of transplants in inmates came up. I suggested a higher priority for a free man than an inmate. The pastoral adviser stated that I made a value judgment and that the inmate had every right to a transplanted organ that a free man did. I pulled my organ donation card at that time, which was years ago.
Dr. Milton: Having worked in a prison for a couple of years, I saw inmates cause their own heart failure by not taking pills, or not taking their antibiotics which caused them to become very sick forcing admission to an outside hospital. They also feign diseases to make other stabs at freedom. One inmate came to sick call all bent over as if in gallbladder or renal colic. The doctor examined him, couldn't find anything to substantiate it, and told the inmate to return to his cell. The inmate instantly jumped off the examination table and snapped his fingers at fellow inmates bragging that he almost fooled the doctors. An inmate with a transplant could easily cease taking his anti-rejection drugs and reject his organ so the transplanted organ would be lost. This could result in dialysis for life or another transplant organ when one became available and the whole scenario would replay itself. This would result in high outside medical costs.
Dr. Michelle: I agree with the chaplain that the inmate has the same right to the donated organ as you and I do.
Dr. Sam: So you're saying that your contribution to society is no greater than the felon's contribution to society? The felon is still paying his debt to society. Give me a break.
Dr. Milton: We can't forget the cost to society by the felon who requires dialysis or another transplant. Take the routine scenario of dialysis three times a week. To transport the felon to a private hospital or dialysis center would require two police cars (there is always a chase car with any transport) and four correctional officers, two in each car, being paid $25 an hour each for the six hours minimal for the time from the prison to the dialysis center, guarding and waiting for the dialysis to occur, and back to the prison. This is an exorbitant cost, which would occur three times a week, not counting all the complications that occur with dialysis.
Dr. Sam: So it's not just a choice between two individuals, there are huge differences in costs.
Dr. Rosen: We could play this same scenario with an HIV patient with organ failure having equal rights with the huge disparity in costs.
Dr. Milton: After this discussion, I'm pulling my organ donation card.
[This conversation should not be construed to imply that most physicians aren't organ donors. An open liberal dialogue should allow all points of view.]
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Kelly Pfeifer, MD, discusses The Best of Times in the Winter 2006 issue of Sonoma Medicine, the Magazine of the Sonoma County Medical Association.
It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness … it was the spring of hope, it was the winter of despair … — Charles Dickens
Physicians are practicing in times of such rapid change that Charles Dickens' description of the French Revolution could just as well depict the current state of Sonoma County medicine. Our era—with doctors in clinics and small groups struggling for simple survival—often feels more like the worst of times than the best. Many of our colleagues have simply given up and have either left Sonoma County or the practice of medicine altogether.
Yet, in many ways, now is the best of times. Exciting changes are occurring in medical practice, especially in primary care. Some of the momentum for change comes from consumer advocates demanding that physicians share power and decision-making. Other change is internally driven—physicians are trained to strive for excellence, and are constantly reassessing medical care and medical science, with a willingness to make improvements when needed and an openness to learning when mistakes are discovered.
Clinics for the poor have long existed in the United States, but they were generally dependent on insecure funding, and there was no oversight to ensure that the care given met community standards. In the 1960s, the number of free clinics increased dramatically; but over time they had difficulty sustaining funding and staffing, so the Bureau of Primary Health Care helped them transition to "Federally Qualified Community Health Centers." The ensuing federal grants came with regulations and an insistence on uniform structure. To this day, every clinic must have a nonprofit community board, and half of the board members must be patients of the clinic. Every clinic must have an executive director, a medical director, and a quality improvement program; and clinic staff must design a health plan with projects to be carried out in the next twelve months. The board of directors is ultimately responsible for ensuring that the health plan is completed.
Federally qualified clinics on the East Coast have been thriving for more than 40 years, and some have multiple sites, serving hundreds of thousands of patients. In contrast, most community health centers in Sonoma County are still young and growing. The Petaluma Health Center, for example, started 12 years ago as a small private practice. We had a free clinic on Wednesdays, and during those three hours providers were exempt from the worst headaches of modern medicine—no prior authorizations, no co-pays, and no lab fees—but no salaries! We saw a large volume of patients, enjoyed the camaraderie of dedicated volunteers, and had a wonderful population of grateful customers.
The free-clinic providers excelled at treating sore throats and abscesses, but were we good at preventing disease? There was very little time, and no structure, to ensure that patients received Pap smears, mammograms, and other cancer screens. We tried to help diabetics get their medications, but we depended on free samples from drug companies, and we were restricted by a meager formulary.
As the need for low-cost health-care services in Petaluma continued to increase, we grew from that small private practice to a federally funded clinic with 30 providers and more than 50,000 patient visits annually. In the process, we had to completely overhaul every function in the clinic, change all our protocols, and retrain all our staff. This was an arduous endeavor at best. To add to the challenges, we were also hit with an unexpected million-dollar shortfall in anticipated funding. We endured a year of painful and desperate survival measures. Productivity was pushed to an exhausting level. We didn't have enough staff, enough space, or adequate systems to handle our existing patients, much less the new patients who kept rolling in the door. Not surprisingly, many of our key staff members left during this time.
In the midst of our overhaul, government inspectors came for their required periodic evaluation. They asked, "What are you doing, and where is your data?" Clinics may initially be funded based on community need; but that funding is only continued based on evidence of work done and needs met. Each year, we are required to submit our upcoming year's detailed health plan, and to review last year's results. We track pediatric vaccine rates, for example, and monitor the percentage of female patients who receive mammograms and Pap smears. We measure our adherence to national guidelines for managing diabetes, high cholesterol, and heart disease. We track our successes and failures with screening for adolescent sexually transmitted disease. We judge ourselves, and are judged, on these facts. The inspectors asked, "Why aren't your uninsured patients getting podiatry care?" I started listing all the barriers our patients face, such as language, transportation, and poverty. The inspectors cut me off, saying, "Don't make excuses. Solve the problem." . . .
There is no reason why all of us who care for the variety of people in our region—rich or poor, insured or uninsured—cannot work together to accomplish meaningful and sustainable change. Many of the biggest problems in health care have yet to find the best solutions, but perhaps the Sonoma County medical community can learn from the achievements of our community health centers. With creativity and perseverance, we have achieved some success, even during these "worst of times."
The entire article can be found at www.scma.org/magazine/scp/wn07/pfeifer%20.html.
Dr. Pfeifer is medical director of the Petaluma Health Center and co-medical director of the Redwood Community Health Coalition.
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9. Book Review: The Mailbox, by Audrey Shafer, M.D.
Stephen Jackson, M.D, Editor of the California Society of Anesthesiology Bulletin, reviews
The Mailbox and interviews the author, Audrey Shafer, M.D.
Audrey Shafer, M.D., is Associate Professor of Anesthesia, Stanford University School of
Medicine, and staff anesthesiologist at the Veterans Affairs Palo Alto Health Care System. She
directs the Arts, Humanities and Medicine Program based at the Stanford Center for
Biomedical Ethics and co-directs the Biomedical Ethics and Medical Humanities Scholarly
Concentration. She teaches creative writing for medical students and is the author of Sleep
Talker: Poems by a Doctor/Mother (2001). Her children's novel, The Mailbox, about posttraumatic
stress disorder and Vietnam veterans was published recently by Random House.
I encourage you to read Dr. Shafer's first novel. Although proposed as a teen novel, The Mailbox is a book for all ages as it cleverly evokes powerful emotions of connectedness and caring so essential to the survival of the human race. The author intricately and colorfully interweaves a mysterious story of an orphan, unsuccessfully seeking to know more of his own traumatic past, who is adopted by an eccentric uncle with a purposely secretive past. Concomitantly, she inserts a subliminal spectrum of social, psychological, political and ethical commentary worthy of our deliberation. The troubled lives into which we are suspensefully enveloped occur within a milieu of sensitivity and caring that leaves one with a powerful feeling of how even the most challenging of lives can be fulfilled through a faith in the good that emanates from human ties and associations.
I work at the Veterans Affairs Palo Alto Health Care System as an attending anesthesiologist. In late 2002 and early 2003, during the build-up to the Iraq War, I felt I became a witness for my patients. The veterans were anxious, as was the country at large, about the impending war. In the short period of time that I have to meet and talk with patients prior to entry into the operating rooms, I found that my patients not only wanted, but needed to speak about their own war experiences and to express their empathy for the soon-to-be deployed soldiers. Just before induction of anesthesia may not be the best time to talk about a buddy dying on the field in a war decades ago, but that is what patients did. I was profoundly moved by this experience. I was honored to be entrusted with listening to my patients' stories and concerns, and I came to understand on a deeper level that the trauma of war experiences affects people in various ways for the rest of their lives. . .
The entire review can be found at www.csahq.org/pdf/bulletin/issue_15/bk_revw_064.pdf.
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Lawrence M. Small, the top official at the Smithsonian Institution, accumulated nearly $90,000 in unauthorized expenses from 2000 to 2005, including charges for chartered jet travel, his wife's trip to Cambodia, hotel rooms, luxury car service, catered staff meals and expensive gifts, according to confidential findings by the Smithsonian inspector general.
Small, who in 2000 became the 11th Smithsonian secretary, will earn $915,698 this year in total compensation -- more than that of the outgoing president of Harvard University, which has an endowment about 30 times the size of the Smithsonian's. Over the past seven years, Small has also received $1.15 million for making his house available for official functions.
[At a $20 per year membership, looks like about 4500 members' dues were squandered on lasciviousness and, with a $2 million salary plus housing allowance, another 100,000 members' dues were squandered. I'm glad I gave up my membership last year. Looks to me like a few more Americans should quit supporting government institutions.]
WellPoint Announces the Retirement of Larry C. Glasscock as President & CEO
WellPoint, Inc. the largest U.S. health benefits company, today announced that Larry C. Glasscock is retiring as President and Chief Executive Officer, effective June 1, 2007. Glasscock will continue to serve as Chairman of the Board. Concurrently, WellPoint's Board of Directors has named Angela F. Braly as President and Chief Executive Officer and a member of the Board of Directors, also effective June 1, 2007.
Glasscock, 58, has served as President and CEO of WellPoint, Inc, (formerly Anthem Inc.) since 1999 and as Chairman since November 2005. He joined Anthem Insurance in 1998. Under his leadership, WellPoint and its predecessor companies grew from 6 million medical members and $6 billion in revenue to more than 34 million medical members and more than $60 billion in revenue today.
His supplemental retirement plan calls for a lump sum payment of $31 million. Glassock also has more than $55 million in unexercised stock options.
But that's less than two dollars per member. Don't you
think that most Blue Cross members would want to contribute more to
retirement so the y do n't
have to downsize their homes and vehicles?
It is an extraordinary fact that those who moan loudest about global warming, and enjoin us to alter our lifestyles so as to minimise emissions, are very often themselves prodigious producers of carbon dioxide.
This is not a case of sinners who have repented urging us in the ways of righteousness. These people are asking us to do what they refuse to do themselves.
Earlier this week, we learnt [sic] that in the past 12 months the use of cars by government ministers climbed by 20 per cent over the previous year. They bang on about global warming and threaten us with new green taxes while actually increasing their own carbon emissions. . .
The Mayor himself is a serial flyer, accounting for 15 official flights abroad during this period, few of which can have been absolutely necessary to the proper discharging of his duties. . .
Even the saintly American politician Al Gore, whose powerful film warned of the terrible dangers of global warming, stands accused of consuming more electricity in his magnificent 20-room Tennessee home in a single month than an average U.S. household uses in a whole year.
Despite his belief that civilisation is threatened by man-made global warming, Mr Gore has been unable to summon up the will to move into more modest premises, or to live by candlelight in his existing mansion.
And so it goes on. Show me a global warming zealot and I will very often show you a hypocrite.
A WWII veteran was seen and showed his Tri-Care card. He said it took 57 yeas for Congress to authorize what was promised him in 1945—TriCare for life—which actually came about in 2002.
[There are still medical societies that argue "government advocacy" as an inducement to membership. But isn't 57 years longer than the average working lifetime?]
To read more HHK from our archives, please go to www.healthcarecom.net/hhk2000.htm#Top.
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• The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports. This week, be sure to read about U.S. Cutting Greenhouse Gases Better Than Europe at http://eteam.ncpa.org/news/us-cutting-greenhouse-gases-better-than-europe.
• Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may subscribe at www.pacificresearch.org/pub/hpp/index.html or access their health page at www.pacificresearch.org/centers/hcs/index.html. Be sure to read Sally Pipes' current research on mandates: Eliminating government mandates would lower cost of health insurance.
• The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government. Be sure to read about Director Tyler Cowen and a summary of his new book, In Praise of Commercial.
• The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace: www.nahu.org/media/index.cfm. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business. Be sure to review the current articles listed on their table of contents at hiu.nahu.org/paper.asp?paper=1. To read the Provider's Perspective, go to http://hiu.nahu.org/article.asp?article=1328&paper=0&cat=137.
• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org.
• Greg Scandlen, an expert in Health Savings Accounts (HSAs) has embarked on a new mission: Consumers for Health Care Choices (CHCC). To read the initial series of his newsletter, Consumers Power Reports, go to www.chcchoices.org/publications.html. To join, go to www.chcchoices.org/join.html. Be sure to read the current newsletter on how the Massachusetts Plan is falling apart already, at www.chcchoices.org/publications.html. Click on report 67.
• The Heartland Institute, www.heartland.org, publishes the Health Care News. Read the late Conrad F Meier on What is Free-Market Health Care? at www.heartland.org/Article.cfm?artId=10333. Read about Medicare Part D costs under-run at www.heartland.org/Article.cfm?artId=20743. You may sign up for their health care email newsletter at www.heartland.org/Article.cfm?artId=10478.
• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling, PhD, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. Read another classic - Features: The Welfare State: Promising Protection in an Age of Anxiety.
• The Council for Affordable Health Insurance, www.cahi.org/, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse." Be sure to read about Health Care Reform proposed by President Bush.
• The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to signup for the monthly Health Care Policy Center Newsletter at https://lincoln.i2i.org/elert/listinfo/healthcare/. Once you become a member, you will have access to the Healthcare Private Archives.
• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read The Illusion Of Success Through Luck.
• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section at www.fraserinstitute.ca/health/index.asp?snav=he. This month, be sure to read The Misguided War Against Medicines.
• The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission is to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site. This month, be sure to read After Walter Reed: How to Fix Military Medicine.
• The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. Be sure to read this month's report, Government Laws Are Not Contracts at www.mises.org/story/2484. You may also log on to Lew's premier free-market site at www.lewrockwell.com to read some of his lectures to medical groups. To learn how state medicine subsidizes illness, see www.lewrockwell.com/rockwell/sickness.html; or to find out why anyone would want to be an MD today, see www.lewrockwell.com/klassen/klassen46.html.
• CATO. The Cato Institute (www.cato.org) was founded in 1977 by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio at www.cato.org/people/cannon.html. This month, be sure to read Libertarians in an Unlibertarian World.
• The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor. This month, be sure to read Rescue The Constitution from the Court at www.ethanallen.org/index2.html.
• The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.] There's no better place for freedom-loving Americans than New Hampshire...
• The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, war time allows the federal government grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in war time we have to push for limited government—while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to www.stcroixreview.com. Be sure to read Angus MacDonald's Editorial on Democracy.
• Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. You may join them to explore the Roots of American Republicanism on a British Isles cruise on July 10-21, 2006. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Read President Arnn's comments at www.hillsdale.edu/arnn/usnews.asp. Also, read his comments on Ronald Reagan, RIP, at www.hillsdale.edu/imprimis/2004/07/. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read John Marini on Roosevelt's or Reagan's America. The last ten years of Imprimis are archived at www.hillsdale.edu/imprimis/archives.htm.
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Words of Wisdom
You must pay the price if you wish to secure the blessing. - Andrew Jackson
The first step to becoming is to will it. - Mother Teresa
People with goals succeed because they know where they are going... It's as simple as that. - Earl Nightingale
The only thing that stands between a man and what he wants from life is often merely the will to try it and the faith to believe that it is possible. - Richard M. DeVos
Concentrate: put all your eggs in one basket, and watch that basket. - Andrew Carnegie
Some Recent or Relevant Postings
Hippocrates Modern Colleagues: www.delmeyer.net/hmc2007.htm
Physician Patient Bookshelf: www.delmeyer.net/PhysicianPatientBookshelf.htm
Med-Info Line: www.delmeyer.net/MedInfo2006.htm
Medical Practice Available Free: www.delmeyer.net/Practice_Valuation.htm
THE true American liberal is now a vague, elusive creature. Many claim to have seen it; some even claim to have been it, in some fit of youthful idealism that they have lived to regret. In the 1980s and 1990s its American habitat became so eroded, as the behemoths of conservatism overgrazed the plains, that it was on the brink of extinction. For any politician or intellectual of ambition, the L-word was woolly-headed, dangerous and naive: an interest to be indulged only in secret, and out of the way of the police.
Yet one liberal stayed defiantly in the public view. You could spot him on New York's East Side (a natural habitat), small and spry, bouncing along as if he couldn't wait to write down the ideas for human improvement that buzzed around in his head. Or you could track him, by the cool whiff of Martinis and the sizzle of steaks, to his table among the bookshelves at the Century Club, turning the pages of Emerson as he waited for dessert. He had no patience with camouflage. The horn-rimmed glasses, the bow tie and the expression of perpetual questioning proclaimed him as a liberal (American genus) to everyone who saw him.
Arthur Schlesinger junior knew that he was frozen in the past. His thought had stopped, he admitted in old age, half a century before—around 1946, the year when, at 29, he had won a Pulitzer for his book on Andrew Jackson and had been made a professor of history at Harvard. He had no particular need to revise his thinking after that, because the shape of American history was now clear to him. It moved in cycles. . .
To all appearances—and on the evidence of the book he wrote later, "A Thousand Days"—Mr Schlesinger was in love: with Jack, with Bobby, with Jackie, and most of all with the perfect brand of north-eastern Brahmin liberalism the Kennedys represented. Schlesinger liberalism was altruistic and perfectibilian, but it was also anti-Communist, pluralistic, pragmatic and tough. He saw all this in his boss. "He re-established the republic", he wrote. . . He transformed the American spirit...[and] made people look beyond nature and race to the future of humanity. . .
To read the entire obit, go to www.economist.com/obituary/displaystory.cfm?story_id=8810722.
On This Date in History -March 13
On this date in 1884, World Standard Time was established at an international conference in Washington, D.C. based on Greenwich Mean Time without a vast bureaucracy, or coalition, or hidden agendas, or regulations. For the first time, the clocks all over the world were synchronized.
On this date in 1852, the first Uncle Sam cartoon was created. Although Uncle Sam, our favorite uncle and now a figure of admiration or hate for most of the world, has been around for a long time, the lanky Yankee in the star spangled outfit was born in the issue of the New York weekly called The Lantern on this date in 1952. Uncle Sam followed Brother Jonathan as our national symbol. We are the only country in the world whose national popular symbol is everybody's relative.
SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE
Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the truth about socialized medicine. Clements' strategy is to release the documentary this summer on the same day that Michael Moore's pro-socialized medicine movie "Sicko" is released. This movie can only be made in time if Clements finds 200 doctors willing to make a tax-deductible donation of $5K each by the end of March. Clements is also seeking American doctors willing to perform operations for Canadians on wait lists. Clements is the former publisher of "American Venture" magazine who made news in 2005 for a property rights project against eminent domain called the "Lost Liberty Hotel."
For more information visit www.sickandsickermovie.com or email firstname.lastname@example.org.