MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VII, No 24, Mar 24, 2009
In This Issue:
1. Featured Article: The Pros and Cons of Electronic Medical Records
2. In the News: Stem Cells Are Not Just About Science, Reason Magazine
3. International Medicine: Canadian government's intervention in prescription drugs
4. Medicare: The Problems and the Solutions
5. Medical Gluttony: Designer Babies at $18,000
6. Medical Myths: Successful people are mentally healthy
7. Overheard in the Medical Staff Lounge: A Medicaid Practice
9. The Bookshelf: Code Blue: Health Care in Crisis by Edward R. Annis, MD
10. Hippocrates & His Kin: Where is the largest concentration of criminals in the U.S.?
11. Related Organizations: Restoring Accountability in Medical Practice and Society
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MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE's SiCKO
Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks
funding for a movie exposing the truth about socialized medicine. 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
For more information visit www.sickandsickermovie.com or email firstname.lastname@example.org.
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Obama's $80 Billion Exaggeration, WSJ, March 12, 2009,
Last week, President Barack Obama convened a health-care summit in Washington to identify programs that would improve quality and restrain burgeoning costs. He stated that all his policies would be based on rigorous scientific evidence of benefit. The flagship proposal presented by the president at this gathering was the national adoption of electronic medical records -- a computer-based system that would contain every patient's clinical history, laboratory results, and treatments. This, he said, would save some $80 billion a year, safeguard against medical errors, reduce malpractice lawsuits, and greatly facilitate both preventive care and ongoing therapy of the chronically ill.
Following his announcement, we spoke with fellow physicians at the Harvard teaching hospitals, where electronic medical records have been in use for years. All of us were dumbfounded, wondering how such dramatic claims of cost-saving and quality improvement could be true.
The basis for the president's proposal is a theoretical study published in 2005 by the RAND Corporation, funded by companies including Hewlett-Packard and Xerox that stand to financially benefit from such an electronic system. And, as the RAND policy analysts readily admit in their report, there was no compelling evidence at the time to support their theoretical claims. Moreover, in the four years since the report, considerable data have been obtained that undermine their claims. The RAND study and the Obama proposal it spawned appear to be an elegant exercise in wishful thinking.
To be sure, there are real benefits from electronic medical records. Physicians and nurses can readily access all the information on their patients from a single site. Particularly helpful are alerts in the system that warn of potential dangers in the prescribing of a certain drug for a patient on other therapies that could result in toxicity. But do these benefits translate into $80 billion annually in cost-savings? The cost-savings from avoiding medication errors are relatively small, amounting at most to a few billion dollars yearly, as the RAND consultants admit.
Other potential cost-savings are far from certain. The impact of medication errors on malpractice costs is likely to be minimal, since the vast majority of lawsuits arise not from technical mistakes like incorrect prescriptions but from diagnostic errors, where the physician makes a misdiagnosis and the correct therapy is delayed or never delivered. There is no evidence that electronic medical records lower the chances of diagnostic error.
All of us are conditioned to respect the printed word, particularly when it appears repeatedly on a hospital computer screen, and once a misdiagnosis enters into the electronic record, it is rapidly and virally propagated. A study of orthopedic surgeons, comparing handheld PDA electronic records to paper records, showed an increase in wrong and redundant diagnoses using the computer -- 48 compared to seven in the paper-based cohort.
But the propagation of mistakes is not restricted to misdiagnoses. Once data are keyed in, they are rarely rechecked with respect to accuracy. For example, entering a patient's weight incorrectly will result in a drug dose that is too low or too high, and the computer has no way to respond to such human error.
Throughout their report, the RAND researchers essentially ignore downsides to electronic medical records. Rather, they base their cost calculations on 100% compliance with the computer programs "adopted widely and used effectively." The real-world use of electronic medical records is quite different from such an idealized vision.
Where do the RAND policy analysts posit major cost-savings? They imagine that the computer will guide doctors to deliver higher quality care, and that patients will better adhere to quality recommendations embedded in the computer programs. This would apply to both preventive interventions like vaccines and weight reduction, and to therapy of costly chronic maladies like diabetes and congestive heart failure. Over 15 years, the RAND analysts assert, more than $350 billion would be saved on inpatient care and nearly $150 billion on outpatient care. Unfortunately, data to support such an appealing scenario are lacking.
A 2008 study published in Circulation, a premier cardiology journal, assessed the influence of electronic medical records on the quality of care of more than 15,000 patients with heart failure. It concluded that "current use of electronic health records results in little improvement in the quality of heart failure care compared with paper-based systems." Similarly, researchers from the Brigham and Women's Hospital and Harvard Medical School, with colleagues from Stanford University, published an analysis in 2007 of some 1.8 billion ambulatory care visits. These experts concluded, "As implemented, electronic health records were not associated with better quality ambulatory care." And just this past January, a group of Canadian researchers reviewed more than 3,700 published papers on the use of electronic medical records in primary care delivered in seven countries. They found no solid evidence of either benefits or drawbacks accruing to patients. This gap in knowledge, they concluded, "should be of concern to adopters, payers, and jurisdictions."
What is clear is that electronic medical records facilitate documentation of services rendered by physicians and hospitals, which is used to justify billing. Doctors in particular are burdened with checking off scores of boxes on the computer screen to satisfy insurance requirements, so called "pay for performance." But again, there are no compelling data to demonstrate that such voluminous documentation translates into better outcomes for their sick patients. . .
Some have speculated that the patient data collected by the Obama administration in national electronic health records will be mined for research purposes to assess the cost effectiveness of different treatments. This analysis will then be used to dictate which drugs and devices doctors can provide to their patients in federally funded programs like Medicare. Private insurers often follow the lead of the government in such payments. If this is part of the administration's agenda, then it needs to be frankly stated as such. And Americans should decide whether they want to participate in such a national experiment only after learning about the nature of the analysis of their records and who will apply the results to their health care. . .
The president and his health-care team have yet to address these difficult and pressing issues. Our culture adores technology, so it is not surprising that the electronic medical record has been touted as the first important step in curing the ills of our health-care system. But it is an overly simplistic and unsubstantiated part of the solution. . .
Drs. Groopman and Hartzband are on the staff of Beth Israel Deaconess Medical Center in Boston and on the faculty of Harvard Medical School.
Off the Record — Avoiding the Pitfalls of Going Electronic By Pamela Hartzband, M.D., and Jerome Groopman, M.D. http://content.nejm.org/cgi/content/short/358/16/1656
Our Firstborn Son: "I'm Dr. Jerry Groopman, and this is my wife, Dr. Pam Hartzband," http://22.214.171.124/search?q=cache:1_Ss0C4Wn0oJ:www.nytimes.com/books/first/g/groopman-second.html+Pamela+Hartzband,+MD&cd=10&hl=en&ct=clnk&gl=us
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Not many of us would want the federal government to leave military procurement to defense contractors, Medicare reimbursement to doctors, or banking regulation to Citigroup. But President Obama says when it comes to allocating federal funds for scientific studies, we should defer to scientists . . .
"This order," said the president, "is an important step in advancing the cause of science in America" and "protecting free and open inquiry." Harold Varmus, co-chairman of the president's scientific advisory council, said it showed the president would rely on "sound scientific practice ... instead of dogma in developing federal policy."
But one person's dogma is another one's ethical imperative or moral principle. Science can tell us how to build a nuclear weapon. But science can't tell us whether we should use it.
Just because research may be useful in combating disease doesn't mean it's ethically acceptable. The infamous Tuskegee syphilis experiment—in which the federal Public Health Service secretly withheld treatment from infected black men to learn more about the disease—might have yielded valuable data. But no scientific discovery could possibly have justified it.
Research on embryonic stem cells is controversial because it requires the destruction of live human embryos. Supporters find it easy to minimize the significance of this fact because the embryos are only a few days old—nothing more than "blastocysts."
But if it's OK to destroy 5-day-old embryos to further scientific inquiry, is it OK to destroy embryos that are five weeks old? Five months? Eight months? Science can't answer that question.
You don't have to be part of the pro-life movement to have qualms about this kind of scientific inquiry. James Thomson, the University of Wisconsin biologist who pioneered the field, has said, "If human embryonic stem cell research does not make you at least a little bit uncomfortable, you have not thought about it enough." The president's new order suggests we shouldn't think too much. . .
He did, however, reject another option. "We will ensure," he said, "that our government never opens the door to the use of cloning for human reproduction. It is dangerous, profoundly wrong and has no place in our society, or any society."
Is that a scientific judgment? No, it's a philosophical one, reflecting Obama's moral values. Apparently, the folks in the white lab coats can't be relied on to answer all questions.
But this position is hard to square with his professed approach. On one hand, the president says his policy is "about letting scientists like those here today do their jobs, free from manipulation or coercion." On the other, he will use coercion to keep them from doing reproductive cloning.
What this mandate means is simple: It may be permissible for scientists to create cloned embryos and kill them. It's not permissible to create cloned embryos and let them live. Their cells may be used for our benefit, but not for their own.
There lies the reality of embryonic stem cell research: It turns incipient human beings into commodities to be exploited for the sake of people who are safely past that defenseless stage of their lives.
It's a change that poses risks not just to days-old human embryos. The rest of us may one day reap important medical benefits from this research. But we may lose something even more vital.
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Canadian prescription drug policies do not result in lower drug costs for Canadians, according to a new study by the Fraser Institute.
In "Cost Burden of Prescription Drug Spending in Canada and the United States: 2008 Edition," researchers compared average per-capita drug spending in Canada and the United States in order to determine whether Canada's prescription drug policies result in lower drug costs for Canadians. They found:
· In both 2006 and 2007, Canadians spent approximately 2.5 percent of their Personal Disposable Income (PDI) per capita on prescription drugs.
· Americans spent less than Canadians did in both years and averaged 2.2 percent of their after-tax income on prescription drugs in 2006 and 2.3 percent in 2007.
This information is especially pertinent because Canada and America average a very similar amount of prescriptions per person (13.7 for Canadians and 12.6 for Americans). However, in GDP calculations, Canadians spent slightly less than Americans, say the researchers:
· Canadians averaged 1.5 percent of their per capita gross domestic product (GDP) on prescriptions in both 2006 and 2007.
· Americans averaged 1.6 percent in 2006 and 1.7 percent in 2007.
The researchers concluded that the Canadian government's intervention in the prescription drug market does not produce a lower drug cost burden for Canadians relative to the cost burden for Americans, who enjoy much freer markets.
Source: Brett J. Skinner and Mark Rovere, "The problem with central planning: How successful are Canada's drug policies?" Fraser Institute, February 2009.
Canadian Medicare does not give lower cost drugs, it only gives access to a waiting list.
--Canadian Supreme Court Decision 2005 SCC 35,  1 S.C.R. 791
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Reforming Medicare by John C. Goodman, NCPA, Thursday, February 26, 2009
How can we control the rising cost of Medicare? Fortunately, there are an enormous number of people who have answers. These include most of the 44 million enrollees, 650,000 doctors and 30,000 facilities participating in Medicare. In fact, almost everyone who has contact with the system can produce examples of waste and inefficiency that could be eliminated.
However, none of these people can do much to bring about the improvements needed. Perversely, people who try to improve the system are often financially penalized for doing so. This should change. Every doctor, patient and hospital administrator must be unleashed to use their intelligence and creativity to make the changes necessary to produce low-cost, high-quality health care.
I. Free the Provider
Doctors participating in Medicare are forced to practice medicine under an outmoded, wasteful payment system designed for a different century. They should instead be allowed access to 21st century alternatives.
Problem: Typically, doctors receive no financial reward for talking to patients by telephone, communicating with them by e-mail, teaching them to manage their own care or helping them be better consumers in the market for drugs. In fact, doctors who help patients in these ways will end up with less take-home pay. To make matters worse, as Medicare suppresses reimbursement fees, doctors are increasingly unable to perform any task that is not reimbursed. Hospitals face the same perverse incentives. Facilities that figure out how to lower patient costs, raise quality and offer warranties and other guaranties are penalized for doing so. Unfortunately, high-cost, low-quality care is reimbursed at a higher rate than the alternative.
Solution: New Payment Opportunities. It should be as easy as possible for Medicare providers to get paid in better ways. What is needed is not pay-for-performance, but performance for pay - with ideas and proposals coming from the supply side of the market (which is more knowledgeable about potential improvements than the demand side).
Accordingly, any provider should be able to propose and obtain a different reimbursement arrangement, provided that (1) the total cost to government does not increase, (2) patient quality of care does not decrease and (3) the provider proposes a method of measuring and assuring that (1) and (2) have been satisfied.
Case Study: Surgery with a Warranty in Pennsylvania. According to a RAND Corporation study, patients receive recommended hospital care - such as an aspirin after a heart attack or antibiotics before hip surgery - only about half the time, on the average. There is also a lot of variation in quality. In Pennsylvania alone, the mortality rate for heart surgery among hospitals varies from zero to 10 percent. Even more surprising, hospitals usually profit from their mistakes: When patients have to be readmitted to deal with complications from the initial surgery, the hospital can bill them again.
Geisinger Health System in central Pennsylvania has discovered a better way for patients and insurers. It offers a 90-day warranty, similar to the type of warranties found in consumer product markets. Specifically, Geisinger charges a flat fee for three months of follow-up treatment. If the patient returns with complications in that period, Geisinger promises not to send the patient or the insurer another bill.
The problem is that Geisinger would lose money on the proposition even as it saved money for Medicare and Medicaid - because those programs do not pay for such guarantees. Medicare should pay more to hospitals that save taxpayers money.
Implementation: Streamline Approvals. Paperwork and time delays are the enemy of entrepreneurship. Workable performance for pay reforms require transactions that are easy to negotiate and consummate. However, given a willing Medicare administration, the process of reform should not take long. There are already low-cost, high-quality pockets of excellence just waiting to be replicated.
Implementation: Relax Stark Restrictions. Another essential ingredient is allowing doctors and facilities to work together as a team - making needed improvements and profiting from them. To facilitate this change, regulations that prohibit profitable provider arrangements must be repealed or relaxed.
II. Free the Patient
Patients also suffer when payments to doctors and hospitals are based on outmoded formulas. Whereas suppliers compete to meet customer needs in almost every other market, this rarely happens in health care.
Problem: Many patients have difficulty seeing primary care physicians. They often turn to hospital emergency rooms where there may be long waits and where the cost of care is much higher. When they do see doctors, patients often get inadequate information.
Studies show that diabetics, asthmatics and other chronic patients can manage their own care as well as or better than conventional physician care and at lower costs. Yet to do this patients need training, easier access to information and the ability to purchase and use in-home monitors. This is not happening under the current system.
Solution: Patient Power. New ways should be explored to empower patients - especially the chronically ill, allowing them to manage more of their own care and more of their own health care dollars.
For example, almost all the states have "Cash and Counsel" programs for homebound, disabled Medicaid patients - allowing them to manage their own health care dollars and hire and fire their caretakers, instead of having these decisions made by an impersonal bureaucracy. Patient satisfaction in these programs is almost 100 percent. Medicare should build on this highly successful program by giving chronically ill patients some of the same opportunities.
Implementation: Flexible Health Savings Accounts. Within both traditional Medicare and Medicare private insurance plans (Medicare Advantage), insurers should be able to make risk-adjusted deposits to the HSAs of chronic patients. Unlike the accounts under current law, these HSAs should be flexible - allowing patients to exercise discretion where it is possible and desirable . . .
John C. Goodman is president and CEO and Kellye Wright Fellow at the National Center for Policy Analysis.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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Now a California clinic, already enjoying a reputation for helping parents pick the gender of their next bundle of DNA, claims it can do even more. Want blue eyes? How about curly hair?
Jeff Steinberg, director of Fertility Institutes, said he plans to use the technology — designed to detect diseases and defects in the unborn — to make cosmetic alterations.
Hype or help, the medical ethics community and other fertility specialists are aghast at this brave new world.
"It's an outrage to my sense of justice that people would rather waste resources on something like this rather than things that really matter," said John Lantos of Kansas City's Center for Practical Bioethics. "It's frivolous, not necessarily unethical. It's a vast waste of resources at a time health-care resources are scarce."
Mark Hughes, a pioneer of pre-implantation genetic diagnosis, the technology that could make trait selection possible, calls the whole idea "absurd."
"I went into science and medicine to diagnose and treat and hopefully cure disease," Hughes said. "The last time I checked, eye color and gender wasn't a disease. There's no pathology, no pain or suffering and no reason for doctors to be involved."
Steinberg, whose publicist didn't return calls to The Star, has said his clinic isn't deterred by criticism. Science is moving forward, he said, and so is he.
"Genetic health is the wave of the future," he told the New York Daily News. "It's already happening and it's not going to go away. It's going to expand. So if they have major problems with it, they need to sit down and really examine their own consciences because there's nothing that's going to stop it."
His clinic announced in December that it would be offering services that would "greatly increase" the odds of a certain hair color, eye color and complexion. The clinic, with offices in California and New York, plans to offer trait selection beginning in early fall. The cost for the process will be about $18,000.
"Not all patients will qualify for these tests and we make NO guarantees as to ‘perfect prediction' of things such as eye color or hair color," said the clinic's news release. . .
But many fertility clinics, such as Reproductive Resource Center of Greater Kansas City, only use the procedure for medical purposes. The center has no plans to go further.
"We like to spend time focusing on bad diseases that create havoc and we're fine with that," said Rodney Lyles of the center. "We just see people who so badly want to have a baby, a healthy baby. That's what we try to get them."
In every industry there are people who operate on the edge, who do things others don't or won't, Lyles said. But that doesn't mean more people will join in.
"It could get out there, where you order your baby like you want it, but I don't see that happening in large scale," Lyles said. "If this doctor feels like he can do it, I guess people may go do that. … We wouldn't have an interest."
Hughes also doesn't see a market for selecting the color of a baby's skin, hair or eyes. . .
"Right now, it's a marketing hype," she said. "But we need to take it seriously." . . .
What worries Darnovsky is trait selection is just another road to new discrimination.
"It could create a brave new world that we would not want to live in," she said. "Just now in society we're working to get away from social prejudices that have to do with appearance, especially skin color.
"And this guy wants to choose the skin tone of future babies. Not a good idea."
Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on Every Service.
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Wall Street Warriors By: Carin Gorrell
Successful stockbrokers may be skilled at managing assets, but not all are so good at managing stress. A study finds many are unhappy, sleep deprived, even clinically depressed.
Stockbrokers may be trading more than they realize—research suggests they're swapping their health for success.
In a study of 26 men ages 22 to 32, all prestigious Wall Street brokers, researchers at Florida's Nova Southeastern University examined how work stress affects brokers' physical and mental health. Led by John Lewis, Ph.D., a psychology professor at NSU, the study found that a broker's average workday was 10 to 12 hours long, and that those earning the most also slept the least. The participants rarely missed work, calling in sick an average of twice a year but suffering from the flu or a virus at least twice as often. And despite being wealthy, the brokers were unhappy. Thirty-eight percent met the criteria for subclinical major depression, while 23 percent were clinically diagnosed with major depression—shocking, considering only 7 percent of men are currently depressed in the U.S., according to the National Institutes of Mental Health.
These findings carry implications for both brokers and their clients. "If employers don't make stress management seminars mandatory, these guys are going to burn out," explains Alden M. Cass, M.S., study co-author and a Ph.D. candidate in psychology at NSU. "One of the symptoms of depression is inability to make decisions and sound judgments—and if the public becomes aware of this, they're going to be reluctant to invest."
Psychology Today Magazine . . . Last Reviewed 3 Mar 2009
Mental Health and Sound Judgment require a balanced life.
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Dr. Dave: Looks like our Independent Practice Association (IPA, the MCO [managed care organization] that manages the contracting HMO) has been putting a lot of Medicaid patients on our lists to see. Is this the 1970s all over again?
Dr. Paul: In Pediatrics, we have over half our practice devoted to Medicaid.
Dr. Dave: But the poor only comprises about 15 percent of the population. Why the 50 percent?
Dr. Paul: Many of our children are raised by a single mother who doesn't work or can't work because she has a brood of children to raise.
Dr. Dave: How have we become a nation of irresponsible fathers siring all these children and then disappearing?
Dr. Paul: Isn't that what happens in a free society?
Dr. Dave: In a free society, people are responsible. If free people desire to have children, they get married and establish a family as the unit in which to have and raise them.
Dr. Paul: I think the mothers of my children think they should have the freedom to have children.
Dr. Ruth: Aren't many of these children all half brother and sisters with a variety of fathers?
Dr. Paul: Isn't that the freedom that conservatives always talk about?
Dr. Dave: No that is what socialism is all about. Socialism breaks down the family structure and breeds irresponsibility. Freedom can only occur in a society where every one is responsible for his actions.
Dr. Paul: But that sort of freedom will never occur again. We will all be dependent on the government to manage health care.
Dr. Dave: I guess the government is the real provider in these cases—the real father; these are basically government babies you're taking care of.
Dr. Paul: Interesting. Never thought of it that way.
Dr. Dave: Today's paper mentioned that 40 percent of newborn children don't have a father in the picture. How can that be healthy?
Dr. Paul: They seem fairly well adjusted to me.
Dr. Dave: Maybe while they're in a doctor's office. But there's much more to life that that.
Dr. Paul: What are you trying to do? Shake my faith in government?
Dr. Dave: Maybe that's just part of growing up. For doctors, it's delayed sometimes up to a decade after the MD degree. Before long you'll realize that government cannot do anything right. The feds should stick with defense, justice, treasury, and state and get out of the rest of their endeavors.
The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
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According to a September 2006 report in the New York Times, Afghanistan's opium harvest has increased almost 50 percent from the year before and reached the highest levels ever recorded. Antonio Maria Costa, head of the United Nations Office on Drugs and Crime (sic) explained: "It is indeed very bad, you can say it is out of control. . . . The Taliban had distributed leaflets at night, inviting farmers to increase their poppy cultivation in exchange for protection. . . . I am pleading with the government to be much tougher. A new high-security prison block would be inaugurated in a few weeks. We have place for 100 people and I am asking the government to fill it within six months."
History is a chronicle of people clinging to erroneous ideas authenticated as religious or scientific truths. Max Planck (1858–1947), one of the greatest physicists of all time, observed: "A new scientific truth does not triumph by convincing its opponents and making them see the light, but rather because its opponents eventually die, and a new generation grows up that is familiar with it."
In the natural sciences the lifetime of belief in false truths tends to be brief. In contrast, beliefs in false truths in human affairs—in custom, religion, politics, and law—typically linger for decades, centuries, even millennia. "[H]ow can we agree," declared Mikhail Gorbachev, "that 1917 was a mistake and all the seventy years of our life, work, effort and battles were also a complete mistake, that we were going in the ‘wrong direction'? No . . . it is the socialist option that has brought formerly backward Russia to the ‘right place.' "
Gorbachev sought to put a human face on the inhuman visage of communism, and the more he failed, the more he insisted that he was on the right track. American drug prohibitionists—Democrats and Republicans alike—seek to cast the ignoble war on drugs into a noble, therapeutic rhetoric, and the more they fail, the more they insist that they are on the right track.
Coercive world-savers have always been blinded by their reformist zeal. Communists denied the importance of man's need for private possessions, a propensity they perceived as "property abuse," and called individuals and institutions that catered to that need "capitalist exploiters." Drug prohibitionists deny the importance of man's need for mind-altering chemicals, a propensity they perceive as "drug abuse," and call individuals and institutions that cater to that need "narco-terrorists" and "narco-states."
The opium trade is said to constitute one-third or more of Afghanistan's gross domestic product. People who grow and sell opium, like people who grow and sell olives, are engaged in agriculture and trade not terrorism. Using explosives and herbicides to destroy crops—especially the crops of faraway people with different traditions and religions—is terrorism.
The story of the trade in alcohol in America and the West is familiar, and so also are the medical and social effects of drinking. In the United States alone, intoxicated drivers cause an estimated 17,000 traffic deaths per year, one every 30 minutes. Twenty percent of all traffic fatalities are due to driving while under the influence. The same day that the New York Times ran its report on opium cultivation in Afghanistan, it also ran a story about the use of alcohol in the United States.
The entire state of Wyoming, said the writer, is like "a small town with long streets. . . . The open space means room to roam and a sense of frontier freedom. It also means that on any given night, an unusually high percentage of young people here are drinking alcohol until they vomit, pass out or do something that lands them in jail or nearly gets them killed." Rosie Buzzas, a Montana state legislator and part-time alcohol counselor, tells the reporter:
We're a frontier culture, and people say, "I work hard and I'll be damned if I'm not going to have a beer or two on the way home.". . . There's a church, a school, and 10 bars in every town. It has never been hard for young people to get alcohol in Montana, Ms. Buzzas said, in part because many parents think it is a rite of passage for children to drink. "There are plenty of adults who tell me, ‘What's the big deal? Kids just have to learn to drink.' " . . . Not long ago, three children, ages 9, 11 and 12, died of alcohol poisoning in an isolated town in Montana, but the deaths did little to change attitudes.
Customs and traditions are more powerful than laws, guns, and herbicides. We have our customs, other people have theirs. "Why," asks an unidentified Afghan, "does the government tell us to stop growing opium when it's doing nothing about alcohol use and prostitution? Opium is not mentioned in the Koran, but alcohol and prostitution are."
A scholar on Iranian culture reminds us that before Qajar's period (which began in the late eighteenth century), "opium was deeply integrated into Iranian social and daily life. People consumed opium each morning in order to be in a good mood to go to work. . . . Opium functioned in Iranian society the way that wine does in French society."
We define certain goods, in particular opium and cocaine, as presenting irresistible temptations, especially to Americans; persecute the tempters and regard their oppression as the protection and promotion of public health; call the people who justify and promote the persecution "medical scientists" and "lawmakers"; and honor the individuals who engage in the mayhem and murder integral to the enterprise as heroes in a noble "war on drugs."
Could all this deception, self-deception, effort, and expense be the practical consequence of a simple conceptual error consecrated as truth?
Thomas Szasz (email@example.com) is professor of psychiatry emeritus at SUNY Upstate Medical University in Syracuse. His latest books, both from Syracuse University Press, are The Medicalization of Everyday Life: Selected Essays and Psychiatry: The Science of Lies. His forthcoming book is Coercion as Cure: A Critical History of Psychiatry (Transaction).
Article printed from The Freeman | Ideas On Liberty: www.thefreemanonline.org
VOM Is Where Doctors' Thinking is Crystallized into Writing.
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Code Blue: Health Care in Crisis by Edward R. Annis. Regnery Gateway Press, Washington, D.C. 1993, 278 pages.
Doctor Annis opens his introduction describing the two worlds in which physicians live: The wonderland of modern medicine, a gratifying and challenging world of achievement in research, education, and clinical practice; and the faltering American health care world, which is on the verge of collapse. Not unlike Charles Dickens in the opening to this Tale of Two Cities: "It was the best of times. It was the worst of times."
Annis gives us many anecdotal insights into the history of American medicine: Fleming's discovery of penicillin in England in 1928, that sat on the shelf until American drug companies developed methods of production in 1943, making it available to patients; sick England in the postwar era to healthy America; the high death rate of Europe to increased life expectancy to 68 years in America in 1949. The high cost of living is only exceeded by the higher cost of dying. His chapter on health insurance ("Call the Plumber, We're Insured!") is a parody on why health insurance is not insurance and, therefore, cannot work in its current format.
Edward Annis, who never chaired a meeting or held an organized medicine office, was elected president of the AMA at a young age in an attempt to counter a cunning band of political sophists in Washington, D.C. He champions the fight to head off government intrusion between doctor and patient and dispels the myth that a "managed" health care system would solve America's problems. He feels the problems in health care have a "Made in Washington" label. Health care already is the most regulated industry in America, strangling doctors and hospitals by senseless paper work, counterproductive bureaucracy, an abusive civil court system, and price controls that are actually driving prices up. He feels it should be labeled a crisis in government that can only be solved by less government interference.
In his final chapter, "What's the Solution?," Annis gives us his analysis of why third-party systems aren't working; Clinton's health plan; and two well-thought-out plans which he feels put the patient back in the driver's seat – in charge of his or her own money. He favors "An Agenda for Solving America's Health Care Crisis," by the National Center for Policy Analysis, which can be reached at 214-386-6272 . . .
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have been accused of spousal abuse
7 have been arrested for fraud
19 have been accused of writing bad checks
117 have directly or indirectly bankrupted at least 2 times
3 have done time for assault
71 cannot get a credit card due to bad credit
14 have been arrested on drug-related charges
8 have been arrested for shoplifting
21 currently are defendants in lawsuits, and
84 have been arrested for drunk driving in the last year
Can you guess which organization this is? NBA? NFL? Mafia? AMA? Wall Street? Cosa Nostra ? ? ? ?
The 535 members of the United States Congress cranking out nearly a thousand new laws a year to keep the rest of us in line while they get out of line.
Can we count on you to vote all these criminals out of office?
It has been widely noted that 2009 will have the first "trillion-dollar deficit" in American history. Actually it's the second. In fiscal 2008, the national debt increased from $9 trillion to slightly over $10 trillion. Yet the budget deficit in the last fiscal year was officially reported as being $455 billion. How could the national debt have increased by considerably more than twice the "deficit"? Simple. Just call the money borrowed from the Social Security trust fund an "intragovernmental transfer" and exclude it from the calculation of the deficit.
Mr. Gordon is the author of "Hamilton's Blessing: The Extraordinary Life and Times of Our National Debt" (Walker, 1997).
Corporate managers have gone to jail for less cook booking than that.
President's tax hikes and spending will increase the national debt by $23.1 TRILLION over the next ten years.
Isn't that more than it cost to run our country for the first 233 years?
Running out of gas making a home visit.
The Sisters of Mercy developed a home care and Hospice program to take care of their patients after they left the hospital if their personal physicians deemed it necessary.
Sister Mary was out making her rounds visiting homebound patients when she ran out of gas. As luck would have it, a gas station was just a block away.
She walked to the station to borrow a gas can and buy some gas. The attendant told her that the only gas can he owned had been lent out, but she could wait until it was returned.
Since the nun was on the way to see a patient, she decided not to wait and walked back to her car. She looked for something in her car that she could fill with gas and spotted the bedpan she was taking to the patient.
Always resourceful, she carried the bedpan to the station, filled it with gas, and carried the full bedpan back to her car.
As she was pouring the gas into her tank, two men watched from across the street. One of the them turned to the other and said, "If it starts, I'm turning Catholic."
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• John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm. Be sure to read: Muhlenberg Regional Medical Center is closing it doors after 130 years. This represents a colossal failure of government as mandates . . .
• PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.patmosemergiclinic.com. To read more on Dr Berry, please click on the various topics at his website. Dr. Berry has a very interesting dialogue with the Greeneville Sun and others about the uninsured and CoverTN.
• PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.
• FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance.
• Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."
• Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25–50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com.
• Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.
• Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.
• David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.
• Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org. Read about Hospital's Deadly Mistakes and the Cost of Courage . . .
• Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model. Read the article he wrote at my request for Sacramento Medicine when I was editor in 1994. See Attorney Sharon Kime's response, as well as the California Medical Board response. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD. View some horror stories of atrocities against physicians and how organized medicine still treats this problem. Read the issues that harass physicians on a daily basis.
• Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.
• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives.
• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.
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Words of Wisdom
Courage is going from failure to failure without losing enthusiasm. - Winston Churchill
"The mind moves in the direction of our currently dominant thoughts." - Earl Nightingale: Author, The Strangest Secret, Lead the Field
"You can resist an invading army; you cannot resist an idea whose time has come." - VICTOR HUGO
Some Recent Postings
Christopher Nolan, the voice of the crippled, died on February 20th, aged 43
YOU wouldn't have wanted to be Christy Nolan. His two arms looked normal, but they would fly out randomly, like a clockwork doll's. "Dreadful deadly spasms" of cerebral palsy shot their way from his cranium to his spine and into his feet. He needed carrying to the bath, to the toilet, to bed; his long legs were good for nothing, collapsing under him like a deck of cards. When he tried to talk, nothing came out but "dull looks, dribbles and senseless sounds". He could not even wipe the saliva from his own face.
In bed at night, when he was as able-bodied as anyone, he would rehearse what his "drunken, drooling body" could do, and what it couldn't:
Can't chew, can't swallow, so why chew? Can't call—can call, a famished moan maybe yet it suffices...can't cry—can cry, can cry, can cry wet pillows full but who cares…can't laugh—can laugh, can can can.
At birth, at the County Hospital at Mullingar in Ireland, he had been deprived of oxygen for two hours. He should have died, but instead "sagaciously he dolefully held on". People pitied him, stroked his head and said God was good, but even as a boy he was not so sure. The "closeted cossetted certainty of Christ" could always calm him, as could communion when Father Flynn was able to sneak the host between his spasming, locking jaws. But once, in St John the Baptist's, he had himself wheeled to the life-size crucifix with its grey bloodied face and threw out his left arm in a great arc to give Christ two fingers, because he was to blame.
And yet, despite it all, he could use words. At the age of 13, he could write this:
Among firs, a cone high-flown,
Hied, foraying, embalming,
Among coy, conged fir needles,
A migratory off-spring
Embarks on life's green film.
For a long time, no one knew. He could communicate: yes with upshot eyes, a neck-bow for affirmation, a drubbing of feet on his wheelchair for attention. The IQ tests always went well, well enough for him to go to "ordinary" school at Mount Temple in Dublin. His blue eyes blazed with intelligence. But no one suspected that in his head were stored millions of words, "nutshelled" and ready. They included all the songs and stories he had heard from his father, the poems recited by his teachers, the alphabet-words stuck up round the kitchen by his mother, glittering fragments of Hopkins and Joyce and Yeats. His overriding ambition was how to "best his body" and get them out.
At the age of 11 he learned how. With a rubber-tipped stick strapped like a unicorn's horn to his forehead, and dosed with a new pill that calmed his neck muscles a little, he picked out one letter, then another, on a typewriter, "by a bent, nursed, and crudely given nod of his stubborn head":
His own mother cradled his head but he mentally gadded here and there in fields of swishing grass and pursed wildness. His mind was darting under beech copper-mulled, along streams calling out his name, he hised and frolicked but his mother called it spasms. Delirious with the words plopping onto his path he made youth reel where youth was meant to stagnate. Such were [his] powers as he gimleted his words onto white sheets of life.
Sometimes one word would take 15 minutes to write. It never got faster; his last work, "The Banyan Tree", a novel based on his family's farming history in Westmeath, took a decade. But as soon as he began to get the "beautiful words" on paper, he won competitions. Weidenfeld & Nicholson published his poems and writings when he was 15. The book was called "Dam-Burst of Dreams", as it was. He could speak, and not just for himself, but for all the other, silent, damaged boys of the world. . .
Nothing could have happened without his parents. To the end, his mother gripped his chin as he wrote. They carried him on their shoulders, held him, one on each side, to let him ride a pony, steadied him in a stream to feel the icy water on the rocks beneath his feet. His mother had told him, when he was three and crying with frustration, that she liked him just as he was. From that point, "he [fanned] the only spark he saw, his being alive". . .
To read the entire Obituary, go to http://www.economist.com/obituary/displaystory.cfm?story_id=13176558.
On This Date in History - March 24
On this date in 1603, the crowns of England and Scotland were joined when Scotland's King James VI awoke to the surprising news that he was no longer King of Scotland; he was the king of both England and Scotland. He became so excited that he knighted three hundred new Scottish and English lords on his way to attend his coronation in London as King James I.
On this date in 1882, Robert Koch announced discovery of the tubercle bacillus, the bacillus that causes tuberculosis. Above all, this showed the need for applying scientific skills to isolate disease-bearing microorganisms.
On this date in 1902, Thomas E Dewey was born in Owosso, Michigan. He was a renowned criminal prosecutor, governor of New York State and two-time presidential candidate. He will probably be best remembered in history for the 1948 election night when the Chicago Tribune was so sure of the outcome that it printed an edition declaring Dewey's victory over Harry S Truman.
After Leonard and Thelma Spinrad
The 6th Annual World Health Care Congress
Advancing solutions for business and health care CEOs to
implement new models for health care affordability, coverage and quality
Tuesday, April 14 – Thursday, April 16, 2009
Marriott Wardman Park Hotel
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In partnership with MedicalTuesday.net, the 6th Annual World Health Care Congress is the most prestigious meeting of chief and senior executives from all sectors of health care. The 2009 conference will convene 2,000 CEOs, senior executives and government officials from the nation's largest employers, hospitals, health systems, health plans, pharmaceutical and biotech companies, and leading government agencies.
MedicalTuesday.net readers receive a $200 discount off the current registration rate. Mention promotional code SSF896 at time of registration.
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