MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VI, No 4, May 22, 2007
In This Issue:
MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE
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. 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
* * * * *
A new light-activated therapy could make skin cancer treatment painless, inexpensive and portable.
Scottish company Lumicure has developed a portable device that combines a tiny light, a photosensitizing cream and a bandage that, if approved by the Food and Drug Administration, could treat skin cancer conveniently with molecular precision.
"It can be worn by the patient in a (Band-Aid), while the battery is carried like an iPod," said professor Ifor Samuel of the Organic Semiconductor Centre at Scotland's University of St. Andrews, who helped develop the technology, in a statement.
which typically requires painful or invasive treatments, affects 40 percent of
all Americans at some point during their lives. The Lumicure treatment would
cost between $200 and $300, compared with roughly $15,000 to $20,000 for the
standard therapy. It could also eliminate the need for chemotherapy in some
To read more, please go to www.medicaltuesday.net/index.asp .
Lumicure's treatment is a new twist on an existing treatment called photodynamic therapy. It starts with a cream containing aminolevulinic acid, which becomes photosensitive when it comes in contact with a cancer lesion. When exposed to light, the cream interacts with only the cancerous cells, making it a very selective skin treatment. . .
Photodynamic therapy available today requires treatment at a hospital using heavy equipment. It's also uncomfortable for patients because they must stay very still under extremely intense light; the treatment also can leave painful skin lesions. The new treatment takes longer than the standard therapy, but there's almost no discomfort and no scarring.
"As traditional photodynamic therapy is delivered in a physician's office, this new technology, if proven effective in clinical trials, may offer the possibility of increased access and ease of use for many patients," said Dr. Isaac Neuhaus, assistant professor at University of California at San Francisco Dermatologic Surgery and Laser Center. . . To read the entire article, go to www.wired.com/medtech/health/news/2007/05/cancer_led_therapy.
[To keep the price of the procedure at an office rate of $200 rather than the current hospital cost of $20,000, it is important that it remain a doctor's office procedure where every practice competes with every other practice. This drives costs downward, which has kept cosmetic and Lasik surgery costs down.
When doctors devised laparoscopic gallbladder operation as a one-day hospitalization, they thought the cost should come down from the $8500 five-day hospital charge to perhaps half that. However, hospitals were able to charge $15,000 for this one-day procedure because it required a sophisticate hospital surgery suite since doctors couldn't do this in their offices or their surgi-center suites.
If hospitals control this new skin cancer treatment, they would have no problem in increasing the charge from the current $20,000 rate to $40,000 just like they did for laparoscopic surgery. Hospitals don't see a problem in charging $40,000 for this unique "band aid", even if it's done in their outpatient suite where their charges know no limits and the insurance carriers pay them more than the doctors doing the same procedure in their own office.
As many experts at the World Health Care Congress stated last month, doctors have to come out of their trenches and again be involved in the health care agenda and reform.]
* * * * *
2. In the News: Customer Health Care, By GRACE-MARIE TURNER, WSJ, May 14, 2007
It's Friday evening and you suspect that your child might have strep throat or a worsening ear infection. Do you bundle him up and wait half the night in an emergency room? Or do you suffer through the weekend and hope that you can get an appointment with your pediatrician on Monday -- taking time off your job to drive across town for another wait in the doctor's office?
Every parent has faced this dilemma. But now there are new options, courtesy of the competitive marketplace. You might instead be able to take a quick trip on Friday night to a RediClinic in the nearby Wal-Mart or a MinuteClinic at CVS, where you will be seen by a nurse practitioner within 15 minutes, most likely getting a prescription that you can have filled right there. Cost of the visit? Generally between $40 and $60.
These new retail health clinics are opening in big box
stores and local pharmacies around the country to treat common maladies at
prices lower than a typical doctor's visit and much lower than the emergency
room. No appointment necessary. Open daytime, evenings and weekends. Most take
. . To read more,
please go to www.medicaltuesday.net/news.asp .
Thousands of free-standing primary care clinics have been operating for years in malls and main streets around the country, often staffed by physicians and many offering a broad range of health services. The retail health clinics are creating a new model with more limited services at lower prices and almost always staffed by nurses. The Convenient Care Association estimates there are about 325 of these retail clinics operating nationwide today. Seventy-six of them are in Wal-Marts in 12 states, but the company announced last month it will expand to 400 clinics by the end of the decade and 2,000 in five to seven years. They will be run by outside firms, including for-profit ventures like RediClinic as well as local and regional health plans and hospitals.
The industry is rapidly expanding. You can find a MinuteClinic in the CVS on the Strip in Las Vegas. But you also will find many locally-run clinics in pharmacies and food stores across America, such as the Express Clinic in Miami, MediMin in Phoenix, and Curaquick in Sioux City, whose motto is "Get well soon."
Prices vary for services from flu shots ($15-$30), to care for allergies, poison ivy and pink eye ($50-$60), and tests for cholesterol, diabetes and pregnancy (less than $50). Competition already is starting to drive prices down.
Of all patients who have visited the clinics, almost half went there for a vaccination, and one-third received treatment for ear infections, colds, strep throat, skin rashes or sinus infections. Ninety percent said they were satisfied with the care they received. The nurses staffing the clinics are under physician supervision and follow strict protocols to refer patients to physicians or emergency rooms if problems are more serious. . .
Rick Kellerman, president of the American Academy of Family Physicians, concedes, "The retail clinics are sending physicians a message that our current model of care is not always easy to access." The threat of competition from the in-store clinics means some doctors are keeping their practices open later and on Saturdays and holding an hour open for same-day appointments. Competition works.
And competition also worked to force prescription drug prices down: When Wal-Mart announced last year that it was dropping the price of several hundred generic medicines to $4 for a month's supply, other pharmacies, from Target to corner drug stores, followed suit. Wal-Mart now says that a third of all prescriptions filled at its pharmacies are for the $4 generics, and 30% of them are filled by people without insurance.
Take note, Congress: The market is providing cheaper medicines, more affordable care -- and it is also helping the uninsured. A Harris Interactive poll conducted in March for The Wall Street Journal said that 22% of those visiting the clinics were uninsured. Wal-Mart says that half of its clinic visitors are uninsured. . .
And the clinics are working to solve another problem that is vexing Washington -- creation of electronic medical records. Most retail clinics create computerized patient records, with the goal of making the records accessible throughout the chain. The records also can be emailed to a hospital or to the patient's regular doctor -- or sent by fax if necessary. . .
Because health care is largely regulated and licensed at the state level, some states are more friendly than others at having non-physicians deliver care. California requires that clinics be a medical corporation owned by a physician. In Arizona, each site must be licensed, but in most other states, a single license will serve multiple clinics. Illinois is considering legislation to limit the number of nurses a doctor could supervise to two and restrict the clinics' right to advertise.
This industry is in its infancy and will hardly register in our nation's $2 trillion-plus health care bill. But just as Nucor overturned the steelmaking industry with a faster-better-cheaper way of making low-end rebar, these limited service clinics could be the disruptive innovator in our health-care system. Package pricing for more complex treatments, like knee replacement surgery, may not be far behind.
Government can get in the way, of course, with protectionist policies that throw up more regulatory barriers to entry. But retail clinics could be just the beginning of consumer-friendly innovations, if Congress were to change tax policies in a way that would allow people to have more control over their health spending, as President Bush has proposed.
The linchpin is giving people the same tax benefits whether they get their health insurance at work or on their own, or buy coverage through groups like churches, labor unions and professional or trade associations. Allowing people to buy health insurance across state lines would inject another dose of healthy competition into the system.
With many congressional leaders hostile to free-market solutions, these policy changes are unlikely in the next two years. But as consumers get a taste of what consumer-friendly health care is like, they may well demand that the top-down, centralized health-care delivery of the 20th century give way to a system more in tune with the demands of 21st-century consumers seeking greater value and efficiency.
Ms. Turner is president of the Galen Institute: www.galen.org/
To read the entire article, go to http://online.wsj.com/article_print/SB117911344481901660.html. (subscription required)
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3. International Medicine: Appointment of Controversial Former U.S. Health Executive to the NHS
US health boss joins NHS team By Nicholas Timmins, Public Policy Editor, May 10, 2007
The appointment of a controversial former US health executive to be the National Health Service's commercial director was confirmed yesterday by David Nicholson, the chief executive. . .
In a letter to key staff, Mr Nicholson announced that Chan Wheeler, a former chief executive of Uniprise, a division of UnitedHealth, the US health giant, was to be the new commercial director, helping negotiate contracts with the private sector for the treatment of patients and the commissioning of their care.
Mr Wheeler earned an
average of almost $1.4m (£701,000) a year in his past three years as chief
executive of Uniprise, and made $8m from the sale of stock options, according
to Security and Exchange Commission filings.
To read more,
please go to www.medicaltuesday.net/intlnews.asp .
The SEC is investigating allegations that a range of executives at UnitedHealth, including Mr Wheeler, received improperly backdated share options between 1998 and 2002. Mr Wheeler is "co-operating with all the regulators" and denies any wrongdoing, according to his US attorney.
Mr Nicholson confirmed his appointment to a new "NHS leadership team", which will include a director for commissioning and system management, a medical director and a new finance and operations director, all separate from the Department of Health existing posts.
The appointment of a single "director-general for commissioning and system management", as opposed to one for commissioning and one for NHS providers, will be seen by some - ahead of Gordon Brown's arrival as prime minister - as a rolling back of the Thatcher-Blair "purchaser/provider split" in the NHS. That has seen hospitals and other organisations become free-standing foundation trusts and social enterprises, with primary care trusts intended to become chiefly commissioners of care. . .
Mr Nicholson and the health department see the appointment of Mr Wheeler as commercial director as evidence that outsiders see a commercially oriented job worth doing in the NHS.
To read more, go to www.ft.com/cms/s/75425bd8-fe92-11db-bdc7-000b5df10621.html.
The NHS does not give timely access to healthcare, it only gives access to a waiting list.
* * * * *
. . . More than 260,000 women will be diagnosed with some form of breast cancer this year. This is always awful news; yet thanks to earlier detection and clinical research, survival rates have never been higher.
Between 1990 and 2002, deaths from breast cancer declined 2.3% annually. Today nearly 98% of women with early-stage breast cancer survive at least five years. Many will live long, full lives.
Making these health gains possible are also new drugs, many of them launched over the last few decades. Among them are taxanes, a drug called Herceptin which hones in on a specific receptor expressed by some breast cancers, and advanced hormone therapies such as the aromatase inhibitors. Other innovative therapies, including one that cuts off tumor blood supply called Anti-VEGF and more recently a targeted drug called Tykerb, have been approved.
This progress should continue well into the future.
More than 500 compounds are currently in clinical trials for all cancers, four
times more than in any other disease area. People with colon cancer now also
live much longer, owing partly to a spurt of effective new drugs in recent
years -- among the newest are Anti-VEGF and Erbitux. In 2004, total U.S. cancer
deaths were down by more than 3,000 after years of increases -- evidence of a
. . To read more,
please go to www.medicaltuesday.net/medicare.asp .
Yet these improvements are not being realized around the world. Europe should be sharing in the progress against cancer, but large bureaucracies have been erected to contain costs, by slowing the introduction of new drugs and restricting how doctors can use them.
Unfortunately, some people want to import the European model here into the U.S. -- and in some cases it has already arrived. One current bill on "sole-source" or very unique drugs would make Medicare more like Europe, tying access to decisions on pricing.
Since European drug regulators do not allow new medicines to reach patients until government negotiators have extracted a favorable price from sponsors, cancer drugs are often available in the U.S. months if not years earlier. In 2003, when 31 new drugs were launched worldwide, about 60% were available here months before Europe. Between 1995 and 2001 the 15 cancer drugs approved in Europe and the U.S. took 468 days to reach patients in Europe versus 273 days in America. Herceptin was tangled up in a 550-day approval process as the Europeans fought for a lower price, while the U.S. approved it in fewer than 120 days. . .
There is a price for these policies. A study done in 2003 for Britain's National Health Service found that, long after its approval, more than 1,000 eligible British women with breast cancer were still not receiving Herceptin. Five-year survival for breast cancer caught early in England is 78%, compared to 98% in the U.S. In Germany, a study found that 41% of German physicians were treating early breast cancer with taxanes, compared to 60% in America at the time. German breast cancer mortality decreased by 9% from 1990 to 1998, while mortality in the U.S. dropped more than twice as much. Overall, between 2004 and 2006 European deaths from breast cancer increased about 1.5% while the number of deaths from colorectal cancer increased 1.8%. New research by Columbia University economist Frank Lichtenberg, looking at cancer statistics in Europe, found use of newer cancer drugs correlates closely with improvements in survival.
Even in the U.S., public payers are increasingly resistant to paying for effective new uses of cancer drugs. A large trial of Herceptin, approved for late-stage breast cancer, showed that it reduced recurrence in early-stage patients by a robust 50%. But many Medicare patients in the Northwest could not access the medicine for about five months because Medicare's local insurer would not pay for it. Increasingly, Medicare wants more flexibility to limit or deny payment for new uses of cancer drugs -- and some in Congress want to give it to them. . .
The larger problem is our orientation to how we pay for health care. Most people believe insurance is there for when they get sniffles, when it is really there to provide comprehensive care for catastrophic episodes like cancer. So long as insurers are expected to cover the full costs of everyone's routine expenses, they will increasingly eye the high costs of the extraordinary care experienced by the few. When it comes to expensive drugs to treat cancer, we need to make sure that prices reflect the real value drugs provide in how they are being used, but the prices should not be arbitrarily set under government payment programs. . .
Dr. Gottlieb, a physician and resident fellow at the American Enterprise Institute, has served recently in senior roles at the Food and Drug Administration and the Center for Medicare and Medicaid Services.
To read the entire article, (subscription required) go to http://online.wsj.com/article_print/SB117486373440048427.html.
[This is TUESDAY. Before the above article could be imported, its predictions were already being incorporated into the U.S. Health Care Bureaucracy. Black Wednesday has arrived.]
May 9, 2007, should be cited in the annals of cancer immunotherapy as Black Wednesday. Within an eight-hour period that day, the FDA succeeded in killing not one but two safe, promising therapies designed and developed to act by stimulating a patient's immune system against cancer. The FDA's hubris will affect the lives and possibly the life spans of cancer patients from nearly every demographic, from elderly men with prostate cancer to young children with the rarest of bone cancers. . .
In the span of eight hours, the dawn of a new era in cancer immunotherapy was driven back into the night. It will be years before we know the full impact of these decisions and how many cancer patients, young and old, have had their lives cut short as a result. For now, however, one thing is clear: While our lawmakers obsess over FDA "safety reforms," no one is holding this government agency accountable for its complicity in stalling therapies for life-threatening diseases.
To read the entire editorial, go to http://online.wsj.com/article_print/SB117911315709601659.html.
Dr. Thornton, a former medical officer in the FDA Office of Oncology Products, volunteers as president of the Sarcoma Foundation of America.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
Costly Medicine: Billions spent on medical research have yielded few cures. Time to rethink our approach. By Crispin Littlehales, Red Herring, April 30, 3007, www.Redherring.com
Hundreds of billions of dollars and 30
years of biotech research have done little to stop humankind's biggest killers.
Don't get us wrong. There has been some progress with rising life expectancies
(at least in rich countries) and treatments for cancer and HIV patients. But 25
million people worldwide have died of AIDS-related illnesses; the reduction in
U.S. deaths from cancer is minute; and two-thirds of the 30,000 diseases known
to man remain without treatments. What's going wrong?
To read more,
please go to www.medicaltuesday.net/gluttony.asp .
Our cover story, "Costly Medicine," available on newsstands, takes
stock of money spent on new therapies in the $643-billion global market for
drugs and where it has gotten us. Year-on-year cancer deaths began to fall in
2003, when 369 few Americans died, according to U.S. government data. In 2004,
there were 3,014 fewer deaths
development, but hardly a sea change. In 1990, heart disease was the
fifth-leading cause of co-called "disability adjusted life-years" worldwide,
and it's projected to rise to No. 1 by 2020. To read more, you'll have to go to
* * * * *
I recently wrote a column about cholesterol-lowering medications. I stated that if 67 healthy men with elevated cholesterol took a cholesterol-lowering drug (from a class of drugs called statins) for five years, only one would benefit. The other 66 would not benefit, and it would cost about $5,500 over the five-year period.
. . . Most people commented on the usefulness of that number. They claimed that it was helpful in deciding whether to take the medicine. Many readers wrote that after knowing this number, they did not feel taking the drug was worth the effort or expense. Others took the opposite view: If one person in 67 would benefit, they wanted to have a shot at being that one. There is no right interpretation; both interpretations are valid, depending on the person's values.
This number -- the 1 in 67 -- is a term doctors call
"the number needed to treat," or NNT. It is a relatively new concept
-- it can be calculated for most treatments -- and it is grossly underused in
sharing information with the public.
To read more,
please go to www.medicaltuesday.net/myths.asp .
The NNT allows doctors and patients to understand the bang that they'll get for their investment -- in other words, what is the chance that a treatment such as a pill or surgery will result in the desired outcome. . .
Many people will derive little or no benefit from their medicines, but they are never told this. Others are not taking medicine because they believe their prescribed pills will offer no benefit when in fact they could derive substantial benefit. The key is for doctors and patients to understand the NNT and to talk about it. . .
. . . let's say you came to me with a bladder infection. When I offered you an antibiotic that when taken for three days would cure one out of two people (NNT is 2), you might not care as much about the cost of the medicine given the large expected benefit.
The only way you can make good decisions about what treatment is best for you is when you're provided useful, understandable information about the drugs or surgery we are offering you.
Information you might find important includes:
an explanation of exactly what we are hoping to accomplish by the treatment
a ballpark estimate of the cost of treatment
honest explanations of the risks or side effects
Just for comparison, here are some estimates of NNT:
1 in 2,550: The number of breast cancer deaths prevented in women between the ages of 50 and 59 screened annually for five years with mammograms.
1 in 2,000: The number of women ages 60-64 without risk factors who would prevent a hip fracture by taking medicine for osteoporosis for five years.
1 in 700: The number of people with mild high blood pressure who would prevent a stroke or heart attack by taking blood pressure medicine for one year.
1 in 16: The number of infections prevented by treating a victim of a dog bite with a week of antibiotics.
1 in 7: The number of children (otherwise healthy children) who benefit from treatment with an antibiotic for an ordinary ear infection.
To read Prof Wilkes entire article, go to www.sacbee.com/107/v-print/story/166505.html.
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Dr. Rosen: Have you noticed the number of people wanting durable medical equipment like hospital beds, wheelchairs, motorized wheelchairs, when it's hard to justify?
Dr. Milton: Yes, it seems to be getting worse.
Dr. Rosen: Many figure if their friend at the senior citizen's residence has one, why shouldn't he.
Dr. Dave: Once
something's free, greed takes over.
To read more,
please go to www.medicaltuesday.net/lounge.asp .
Dr. Rosen: And some of the expensive items don't have much co-pay. So that makes it even harder. The patient doesn't have any skin into it and even becomes more demanding.
Dr. Michelle: I had a patient with severe crippling rheumatoid arthritis several months ago who I thought really needed a motorized wheelchair in order to get around. I must have spent the equivalent of several 20-minute appointments on this and still it was denied.
Dr. Ruth: Maybe they thought she couldn't navigate it?
Dr. Michelle: She had enough residual function in her right hand to maneuver the driving knob. So she really was the ideal disabled patient that could utilize it well.
Dr. Yancy: So what else is new? In government medicine, those that really need the medical care or service can't get it, and those that could easily live without it somehow navigate the system and get it.
Dr. Dave: But you can't really analyze a bureaucrat's mind or the logic of their thinking. Frequently it is unrelated to health care. It might be something so simple that will never be recorded like your patient with rheumatoid arthritis will probably be dead in two or three years. And the patient with emphysema who is not disabled will have his wheelchair for a decade or more.
Dr. Yancy: Don't kid yourself. A bureaucrat is incapable of backward logic like that.
Dr. Milton: Neither are they capable of forward logic like Michelle and her patient.
Dr. Ruth: So what's the answer?
Dr. Rosen: I think Professor Yunus, who won the Nobel Prize for his micro credit which evolved into health insurance plans, has the answer. The patient should never receive any free health care. He should always have to pay a portion of it. When people are so poor and the daily wage is less than one dollar, and Dr. Yunus thinks that free health care is bad, he is really onto something important and basic.
Dr. Milton: Why haven't American insurance companies latched onto this?
Dr. Yancy: They just want to stick it to doctors. They just love to deny a legitimate request a doctor makes. They don't care about the patient.
Dr. Michelle: Come, now Yancy. That's a pretty strong statement.
Dr. Dave: No, I think that is a valid statement. They are in it to make a profit and the patient is the source of the profit. Even a dead patient may be profitable if it cuts their losses that exceed the premium.
Dr. Milton: One thing that has never been factored in with Durable Medical Equipment (DME) is the item that is being replaced with insurance dollars. A motorized wheelchair that replaces a car should have a significant deductible or co-pay on the order of 40 to 50 percent. Otherwise, the family makes a profit selling the patient's car. The same can be said for a hospital bed replacing a regular bed.
Dr. Rosen: I
think what we're saying here is that the insurance carriers are holding a sword
over our heads expecting us to control costs
which is at
their non-medical economic direction when the most
effective cost control mechanism would be the patient at risk whether 10
percent of hospital costs or 20 percent of ER costs or 30 percent of other
outpatient costs or 40 percent of DME so that each
patient would make a judgment call on whether the ER visit, office evaluation,
test, x-ray, consultation, motorized wheelchair, or hospitalization is of any
value to him/her. Current consumer-directed health care data suggests this
would be a 30 to 50 percent reduction in health care costs. However, anecdotal
information suggests that insurance carriers are unwilling to give up this
control of physicians even if it costs them the 30 to 50 percent.
* * * * *
Medicine: Why is
Such a Conundrum? By Alice P.
Ms. Mead served as staff counsel to the California Medical Association for 11 years, focusing on bioethics, including informed consent, confidentiality, end-of-life care, discrimination, and drug abuse treatment/control issues. Ms. Mead currently works as a consultant, specializing in regulatory law governing new drug and device development; patient confidentiality and informed consent; and domestic and international treaty issues relating to controlled drugs and drug treatment policy. Her clients include members of the pharmaceutical industry and other health-related organizations.
Cannabinoids. Many would call this the "hot new topic" in analgesic research. However, the results of clinical studies with oral tetrahydrocannabinol (THC) are uneven and confusing, and the use of crude herbal cannabis is laden with prejudice and political baggage. Is this, indeed, a promising new area of medication development?
Why Didn't Cannabinoid Medicines Develop in Parallel with the Opiates?
Why have cannabinoids only now come to the attention
of the medical and scientific communities? To address that question, we must
first take a quick tour through history. In the mid-1800s, through the writings
of British physicians such as William O'Shaughnessy and U. Russell Reynolds,
Western medicine learned of the therapeutic potential of the cannabis plant.
Initially, individual pharmacists compounded oral tinctures and extracts, but,
as pharmaceutical companies burgeoned, these manufacturers made such products
more broadly available. At a time when therapeutic options were limited,
physicians welcomed another potential tool to alleviate suffering. Earlier in that century, the active
analgesic ingredients in opium
been discovered and isolated. Standardized opiates and, later, synthetic
medicines were developed. These medications were water soluble, easy to
formulate and administer, and had a predictable onset of action. Opium was not
smoked for medical purposes; rather it was viewed strictly as an intoxicant.
There was a clear distinction between smoked opium and pharmaceutical opioid
dosage forms. To read more, please go to www.medicaltuesday.net/voicesofmedicine.asp .
What happened to cannabis medicines? Cannabinoids are sticky, highly lipophilic (not water soluble), and THC in particular is unstable unless properly stored or treated. Scientists could not identify the active ingredient(s) of cannabis medicines, and therefore pharmaceutical companies and pharmacists could not prepare adequately standardized products. Moreover, patient response was variable and unpredictable. Thus, as more "modern" medicines came on the market, cannabis tinctures and extracts began to fall out of favor with the medical profession. At that same time, smoked (recreational) cannabis entered the U.S. and rapidly became demonized by state and federal governments. During hearings on the Marijuana Tax Act of 1937, which imposed onerous administrative burdens on physicians who prescribed cannabis-based products, the AMA voiced merely a weak objection.
Although THC, the primary psychoactive cannabinoid, was discovered and synthesized in 1964, follow-up research was not extensive. Not until the 1970s, when smoked cannabis use increased, were the therapeutic properties of cannabis inadvertently rediscovered by numerous users. Hence, the use of crude, smoked cannabis as "medicine" became entwined with the form used for recreational purposes. However, had technology made it possible to analyze, research, formulate, and deliver cannabinoids as effectively as the opiates, we might not have a "medical marijuana" debate today. This vitriolic controversy is merely an artifact of the delayed development path that cannabinoid medicines have followed.
Beginning around 1990, science took a huge leap
forward. The endocannabinoid system was discovered, and several endocannabinoid
ligands were identified. With a greater understanding of the mechanism of action,
researchers rushed to explore the potential of this receptor system. A new era
of discovery was born. The resulting body of preclinical studies demonstrates
that cannabinoids have analgesic properties (alongside many other potential
therapeutic effects) and can affect a wide range of bodily processes and
systems. Three categories of cannabinoids have been established: 1)
endocannabinoids, which are produced by the body; they are quickly metabolized
to this and the difficulty in patenting endogenous biochemicals have not yet
been studied in humans; 2) phyto-cannabinoids, which are found exclusively in
the cannabis plant; and 3) synthetic cannabinoids, which may be synthetic
versions of naturally occurring cannabinoids or molecules that are quite novel
in structure. . .
To read the entire article, go to www.csahq.org/pdf/bulletin/issue_15/cannabis_064.pdf.
* * * * *
Primary care is being pushed into prominence by managed care organizations throughout the country with the gatekeeper concept. Dr Eric Cassell, a Clinical Professor of Public Health at Cornell University Medical College, begins Doctoring by pointing out how thoughtlessly rapid the restructuring of American health care has been. He contends that identifying primary care physicians as first-contact doctors, mere gatekeepers to the specialties, is a mistake. The obvious organizational advantages should not and do not make primary care medicine simple. Unless there are changes in primary care, Dr. Cassell does not feel the primary care system will prove effective in restraining costs.
Cassell traces the idea of health over 200 years as
being equated with freedom from disease. The world of medicine, from this
perspective, is a world of disease--peopled by those who have an acute disease,
are being prevented from having a disease, are being treated for their disease,
or are being rehabilitated from the effects of their disease. Organizing
medicine according to disease developed at the beginning of the nineteenth
century. The heavy hand of the past still prevails in medical science as it is
taught to students and house officers today.
To read more,
please go to www.medicaltuesday.net/bookreviews.asp .
Unlike most other branches of medicine, primary care medicine is based on the centrality of the patient rather than on an organ system or a disease. The ideas that underlie current understandings of primary care medicine have been evolving since the 1920's, gaining force in the 1960's with the family physician movement, growing rapidly after its official designation as a specialty in 1970, which decried specialty medicine's concentration on the disease and sought to refocus on the patient.
No one questions the soundness of these ideas; the problem is that after a full generation of prominence they simply have not thrived within a disease-oriented, technology-driven medical establishment. For two generations we have asked doctors to focus on the patient as a person, yet, more often than not, we still see the patient's human concerns swept away by the technological imperative. If primary care is a better medical practice, why hasn't it won the field?
Cassell feels that physicians have great difficulty entering the information of the patient as a sick person into the calculus of their medical judgments so that it has equal weight with information about disease, pathophysiology, and technology. Cassell feels it is first of all the educational problem that needs to be solved. There is a deep conflict between the measurable nature of the disease--the science of medicine--and the subjective knowing of the patients as individuals. . .
To read the entire review, please go to www.delmeyer.net/bkrev_Doctoring.htm.
To read other reviews, please scan the Physician Patient Bookshelf at www.delmeyer.net/PhysicianPatientBookshelf.htm.
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Congress has recently been busy passing Hate Crime Laws. www.cato.org/testimony/ct-tl04172007.html
Let's see if we can follow Congressional logic. It is now a crime to commit murder of someone you hate, but is it no longer a crime to murder someone you love?
Recently, a government department hired
several cannibals to increase their ethnic diversity, "You are all part of our team now," said the Human Resources rep during the welcoming briefing. "You get all the
usual benefits and you can go to the cafeteria for something to eat, but please
don't eat any employees."
The cannibals promised they would not. Four weeks later their boss remarked, "You're all working very hard and I'm satisfied with your work. We have noticed a marked increase in the whole company's performance. However, one of our secretaries has disappeared. Do any of you know what happened to her?" The cannibals all shook their heads, "No."
After the boss had left, the leader of the cannibals said to the others, "Which one of you idiots ate the secretary?" A hand rose hesitantly.
You fool!" the leader continued. "For four weeks we've been eating managers and no one noticed anything. But, NOOOooo, you had to go and eat someone who actually does something."
Anyone know where we can find some to work at the Centers for Medicare and Medicaid Services?
To read more,
please go to www.medicaltuesday.net/hhk.asp .
So what happened with free market shopping for a doctor or a hospital? Or is it more fun to send three dollars to Washington and allow Congress to give us one dollar of health care?
Gilbert Chan reports that Blue Shield wants to drop costly health coverage in many rural areas. CalPERS is in bind of trying to provide reasonable rates for all of its members. That could change this winter. Segura and her 17-year-old son face the prospect of switching doctors and a 25- to 50-minute commute for routine office visits. . . Segura and some 3,000 other El Dorado County residents are sitting in the same boat. To their health plan, these rural residents are tabbed as too expensive to cover, and Blue Shield of California wants to drop them.
drop the (Blue Shield plan), we're gone. We would have no local doctors,"
said Ted Schmidt, chief of the Garden Valley Fire Protection District, which
has eight paid firefighters on staff. Right now, he and his crew see doctors at
a local clinic four miles away.
It sure is hard to control Farmers and their Doctors.
Government bureaucrat to his supervisor: What's the promotional budget for our austerity program?
Can't government workers
think of progress without throwing taxpayer money at it?
To read more Vignettes, please go to www.healthcarecom.net/hhk1995.htm.
* * * * *
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.
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.emergiclinic.com . To read
more on Dr Berry, please click on the various topics at his website. PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry
Huntoon, MD, PhD, FANN. http://home.earthlink.net/~doctorlrhuntoon/ . Dr Huntoon
does not allow any HMO or government interference in your medical care.
"Since I am not forced to use CPT codes and ICD-9 codes (coding numbers
required on claim forms) in our practice, I have been able to keep our fee
structure very simple." I have no interest in "playing games" so
as to "run up the bill." My goal is to provide competent,
compassionate, ethical care at a price that patients can afford. I also believe
in an honest day's pay for an honest day's work. Please Note that PAYMENT IS
EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office
are kept totally private and confidential - in accordance with the Oath of
Hippocrates. Since I am a non-covered entity under HIPAA, your medical records
are safe from the increased risk of disclosure under HIPAA law. Michael J. Harris, MD - www.northernurology.com - an
active member in the American Urological Association, Association of American Physicians
and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry
practice in urology in Traverse City, Michigan. He has no contracts, no
Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally
recognized for his medical care system reform initiatives. To understand that
Medical Bureaucrats and Administrators are basically Medical Illiterates
telling the experts how to practice medicine, be sure to savor his article on
"Administrativectomy: The Cure For Toxic Bureaucratosis" at www.northernurology.com/articles/healthcarereform/administrativectomy.html . To read the
rest of this section, please go to www.medicaltuesday.net/org.asp . 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 2550 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. · Dr. Elizabeth Vaughan is another
Greensboro physician who has developed some fame for not accepting any
insurance payments, including Medicare and Medicaid. She simply charges by the
hour like other professionals do. Dr. Vaughan's web site is at www.VaughanMedical.com . · 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 h er 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 . Be sure to read his article Politicians Cannot Manage a
Health Care System . Dr Richard B Willner , President, Center Peer
Review Justice Inc , states: We are a group of healthcare doctors --
physicians, podiatrists, dentists, osteopaths -- who have experienced and/or
witnessed the tragedy of the perversion of medical peer review by malice and
bad faith. We have seen the statutory immunity, which is provided to our
"peers" for the purposes of quality assurance and credentialing, used
as cover to allow those "peers" to ruin careers and reputations to
further their own, usually monetary agenda of destroying the competition. We
are dedicated to the exposure, conviction, and sanction of any and all doctors,
and affiliated hospitals, HMOs, medical boards, and other such institutions,
who would use peer review as a weapon to unfairly destroy other professionals.
Read the rest of the story, as well as a wealth of information, at www.peerreview.org . Semmelweis Society
International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS,
President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD,
Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD
(1818-1865) , an obstetrician who has been hailed as the savior
of mothers. He noted maternal mortality of 25-30 percent in the obstetrical
clinic in Vienna. He also noted that the first division of the clinic run by
medical students had a death rate 2-3 times as high as the second division run
by midwives. He also noticed that medical students came from the dissecting
room to the maternity ward. He ordered the students to wash their hands in a
solution of chlorinated lime before each examination. The maternal mortality
dropped, and by 1848, no women died in childbirth in his division. He lost his
appointment the following year and was unable to obtain a teaching appointment
Although ahead of his peers, he was not accepted by them. When Dr Verner Waite
received similar treatment from a hospital, he organized the Semmelweis Society
with his own funds using Dr Semmelweis as a model. To read the article he wrote
at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as
the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm . Scroll
down to read some very interesting letters to the editor from the Medical Board
of California, from a member of the MBC, and from Deane Hillsman, MD. To view some horror stories
of atrocities against physicians and how organized medicine still treats this
problem, please go to www.semmelweissociety.net . Dennis Gabos, MD , President of the Society
for the Education of Physicians and Patients ( SEPP ), is
making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms
and Responsibilities of Patients and Health Care Professionals. For more
information, go to www.sepp.net . Robert J Cihak, MD , former president of the
AAPS, and Michael Arnold Glueck, M.D , write an
informative Medicine Men column at NewsMax. Please
log on to review the last five weeks' topics or click on archives to see the
last two years' topics at www.newsmax.com/pundits/Medicine_Men.shtml . This week's column is Healthcare
Not a Government Tool - FDA and
Congress vs. Your Medical Care. The Association of American Physicians
& Surgeons ( www.AAPSonline.org ), The Voice for Private Physicians Since 1943,
representing physicians in their struggles against bureaucratic medicine, loss
of medical privacy, and intrusion by the government into the personal and
confidential relationship between patients and their physicians. Be sure to
scroll down on the left to departments and click on News of the
Day in Perspective: Ron Paul
introduces bill to rein in the FDA or go directly to it - www.aapsonline.org/nod/newsofday425.php . Don't
miss t he " AAPS News, "
written by Jane Orient, MD, and archived on this site which provides valuable
information on a monthly basis. This month, be sure to read about Walter
Wonderful, THE PINNACLE OF
SOCIALIZED MEDICINE . Scroll further to the
official organ, the Journal of American
Physicians and Surgeons , with Larry Huntoon, MD, PhD,
a neurologist in New York, as the Editor-in-Chief. www.jpands.org/ . There are
a number of important articles that can be accessed from the current Table of Contents . Don't
miss the excellent article by Dr.Orient: Health Information Technology: The End of Medicine
as We Know It? O r the extensive book review
section that covers six great books this month. And be sure to put a little
humor in your week by reviewing Huntoon's Lampoons . Be sure to put the AAPS 64 th Annual Meeting to be held on October 10-13, 2007,
in Cherry Hill, NJ, on your planning calendar. * * * * * Thank you
Please note that sections 1-4, 8-9 are entirely attributable quotes and editorial comments are in brackets. Permission to reprint portions has been requested and may be pending with the understanding that the reader is referred back to the author's original site. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.
ALSO NOTE: MedicalTuesday receives no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the research and writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country.
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Del Meyer, MD, Editor & Founder
6620 Coyle Avenue, Ste 122, Carmichael, CA 95608
Words of Wisdom
Milton Friedman: The government spends $3 to do a $1 job.
Peter Drucker: Managing in the post-capitalist society. Improving the productivity of service workers will demand fundamental changes in the structure of organizations. The greatest need for increased productivity is in activities that do not lead to promotion into senior management within the organization. But nobody in senior management is likely to be much interested in this kind of work, know enough about it, care greatly for it, or even consider it important. Such work does not fit the organization's value system. In the hospital, for instance, the value system is that of the doctors and nurses. They are concerned with patient care. No one therefore pays much attention to maintenance work, support work, clerical work. We should therefore expect within a fairly short period of years to find such work contracted out to independent organizations, which compete and get paid for their own effectiveness in making this kind of work more productive.
Action Point: Make your back room service activities someone else's front room.
Some Recent Postings
AMERICA ALONE, The End of the World as we Know It, by Mark Steyn www.delmeyer.net/bkrev_AmericaAlone.htm
WHO REALLY CARES - America's Charity Divide Who Gives, Who Doesn't, and Why It Matters by Arthur C. Brooks www.delmeyer.net/bkrev_WhoReallyCares.htm
HPUSA April 2007 Newsletter: www.healthplanusa.net/April07.htm
[When I came to Sacramento in 1966, I was introduced to Merlino's Orange Freeze. There was a long line up at the window and cars up and down the street. I noted some had nearly devoured their Orange Freezes by the time they return to their cars, and on a day of three digit heat, one could observe them turning around and getting in line again. When the High Schools let out on a hot day in May, one could forget about going to Merlino's until a few thousand high school kids had their cool slush.]
Bauldie L. Merlino, who co-founded Merlino's Orange Freeze in 1946 and perfected the icy-smooth icon that tamed the heat of Sacramento summers for more than a half century, died Monday. He was 98. . .
Before there was air conditioning, there was Merlino's Orange Freeze -- a frozen concoction of freshly squeezed orange juice, plain tap water and a spoonful of sugar that became a Sacramento institution. Standing in line amid triple-digit temperatures to buy the icy treat was a popular summer ritual for families and famous names, including Govs. Jerry Brown and Ronald Reagan.
Bauldie Merlino and his wife, Mary, opened their first
store in 1946 at Third Avenue and Stockton Boulevard, across from where the
California State Fair was then located. Taking the recipe his wife used to sell
an earlier version at a midtown refreshment stand with her brothers during
World War II, he adjusted a mechanical freezer until the dessert texture was
just right, the couple's son said.
. . To read more,
please go to www.medicaltuesday.net/org.asp .
Quiet and focused, Bauldie Merlino worked in the back making freezes while his wife waited on customers. They became less active in daily operations as their sons took over and added outlets in Carmichael, east Sacramento and Old Sacramento. Although financial problems forced the family to close the business in 2000 and sell the pieces in bankruptcy court, Bauldie Merlino was pleased the company had earned a place in Sacramento history, his son said.
"He was very proud of what we did and having sons to carry on," Ray Merlino said. "He wasn't real happy when the bankruptcy hit, but he just said, 'Everything has to end sometime.' "
Bauldie Merlino was born in 1908 to Italian immigrants who worked hard to support eight children in Brookside, Colo. Like his brothers, he left school after eighth grade and joined his father working in a mine. . .
Mr. Merlino took up golf when he was 65 years old and became an avid player. He enjoyed growing vegetables in his garden, belonged to the Dante Club and was an active member of Immaculate Conception Catholic Church.
"He just played 18 holes of golf a few days before he died," his son said. "He had an active life.
To read the whole obituary, go to www.sacbee.com/101/v-print/story/177224.html.
On This Date in
On this date in 1947, the "Truman Doctrine" went into effect. As outlined by President Harry S. Truman, it was to limit and contain Soviet expansion by providing U.S. aid for countries threatened by the Red giant. In the years since then, historians and revisionist historians have argued over the wisdom and effectiveness of the Truman Doctrine, but nobody has ever doubted that it made absolutely clear the position of the United States in its time. It was another one of Truman's character: "Stand up and be counted."
On this date in 1819, the steamboat Savannah, the first American-built steamboat to cross the Atlantic, started across the ocean from Savannah, Georgia. The anniversary is commemorated every year as National Maritime Day. This confirms the fact that the U.S. is still a seagoing nation while others say we found ourselves in deep water and are still there.
On this date in 1813, Richard Wagner, regarded by most as one of a few great immortals in the world of composing, was born. Wagner was a man with definite opinions in many fields besides music. Physicians with definite opinions in many fields besides medicine owe him a debt of gratitude.
After Leonard and Thelma Spinrad