MEDICAL TUESDAY . NET
Community For Better Health Care
Vol IX, No 4, May 25, 2010
In This Issue:
1. Featured Article: Developing Drugs for Cancer
2. In the News: Infectious personalities
3. International Medicine: Didn't we escape from Europe more than two centuries ago?
4. Medicare: Health Alert: Early Retirees
5. Medical Gluttony: Free Health Care for the Universe
6. Medical Myths: Health Care Reform is a Moral Imperative
7. Overheard in the Medical Staff Lounge: Medical Grand Rounds
8. Voices of Medicine: How health care became expensive
9. The Bookshelf: A new way of winning elections
10. Hippocrates & His Kin: America's most celebrated tramp
11. Related Organizations: Restoring Accountability in Medical Practice and Society
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Always remember that Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single payer initiative, was born for the benefit of the state and of a contemptuous disregard for people's welfare.
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ANNALS OF INNOVATION | The New Yorker, May 17, 2010
Why is it so difficult to develop drugs for cancer? By Malcolm Gladwell
In the world of cancer research, there is something called a Kaplan-Meier curve, which tracks the survival of patients in the trial of an experimental drug. In its simplest form, it consists of two lines. The first follows the patients in the "control arm," the second the patients in the "treatment arm." In most cases, those two lines are virtually identical. That sad fact of cancer research: nine times out of ten, there is no difference in survival between those who were given the new drug and those who were not. But every now and again—after millions of dollars have been spent, and tens of thousands of pages of data collected, and patients followed, and toxicological issues examined, and safety issues resolved, and manufacturing processes fine-tuned—the patients in the treatment arm will live longer than the patients in the control arm, and the two lines on the Kaplan-Meier will diverge.
Seven years ago, for example, a team from Genetech presented the results of a colorectal-cancer drug trial at the annual meeting of the American Society of Clinical Oncology—a conference attended by virtually every major cancer researcher in the world. The lead Genentech researcher took the audience through one slide after another—click, click,click—laying out the design and scope of the study, until he came to the crucial moment: the Kaplan—Meier. At that point, what he said became irrelevant. The members of the audience saw daylight between the two lines, for a ptient population in which that almost never happeded, and theyleaped to their feet and gave him an ovation. Every drug researcher in the world dreams of standing in front of thousands of people at ASCO and clicking on a Kaplan—Meier like that. "It is why we are in this business," Safi Bahcall says. Once he thought that this dream would come true of him. It was the late summer of 2006, and is among the greatest moments of his life.
Bahcall is the C.E.O. of Synta Pharmaceuticals, a small biotechnology company. It occupies a one-story brick nineteen-seventies building outside Boston, just off Route 128, where many of the region's high-tech companies have congregated, and that summer Synta had two compounds in development. . .
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Social networks catch an early glimpse of disease outbreaks
CHANCES are your friends are more popular than you are. It is a basic feature of social networks that has been known about for some time. Consider both an avid cocktail party hostess with hundreds of acquaintances and a grumpy misanthrope, who may have one or two friends. Statistically speaking, the average person is much more likely to know the hostess simply because she has so many more friends. This, in essence, is what is called the "friendship paradox": the friends of any random individual are likely to be more central to the social web than the individual himself.
Now researchers think this seemingly depressing fact can be made to work as an early warning system to detect outbreaks of contagious diseases. By studying the friends of a randomly selected group of individuals, epidemiologists can isolate those people who are more connected to one another and are therefore more likely to catch diseases like the flu early. This could allow health authorities to spot outbreaks weeks in advance of current surveillance methods.
In a report just posted on arXiv, an online repository of research papers, and which has been submitted to the Proceedings of the National Academy of Sciences, Nicholas Christakis from Harvard University and James Fowler from the University of California, San Diego put the friendship paradox to good use. In a trial carried out last autumn, they monitored the spread of both seasonal flu and H1N1, popularly known as swine flu, through students and their friends at Harvard University.
Dr Christakis and Dr Fowler selected a random group of 319 undergraduates and asked each to nominate up to three friends. Using these names, they collected another group of 425 friends. As the friend paradox predicts, the second group were both more popular (named more times by the random group) and more central to the connections among Harvard students. Flu infections were monitored from September 1st 2009 to the end of December by identifying those diagnosed by the university's health services and by e-mail responses to a twice-weekly health survey. Overall, 8% of the students were formally diagnosed with the flu and 32% were self-diagnosed. But the infection rate peaked two weeks earlier among the group of more-connected friends. Their social links were indeed causing them to get infected sooner.
As this result came with the benefit of hindsight, the researchers tried to come up with a real-time measure that could potentially provide an early warning sign of an outbreak as it began to spread. To do this they went back to the beginning and compared diagnoses between the two groups on a daily basis for each of the 122 days of the study. A significant difference between the two groups was first detectable a full 46 days before visits to health services peaked for the random group. For those with self-reported symptoms, there was a noticeable difference 83 days before the peak in self-reported symptoms.
These early results are impressive. Currently, the methods used to assess an infection by America's Centres for Disease Control and Prevention lag an outbreak by a week or two. Google's Flu Trends, which monitors millions of queries submitted to the giant search engine for the occurrence of flu-related keywords, is at best contemporaneous with an outbreak. Dr Christakis and Dr Fowler suggest that a hybrid method might be developed in which the search queries of a group of highly connected (ie, popular) individuals could be scanned for signs of the flu. . .
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OPINION: WONDER LAND, WSJ, MAY 13, 2010
One of the constant criticisms of Barack Obama's first year is that he's making us "more like Europe." But that's hard to define and lacks broad political appeal. Until now.
Any U.S. politician purporting to run the presidency of the United States should be asked why the economic policies he or she is proposing won't take us where Europe arrived this week.
In an astounding moment, to avoid the failure of little, indulgent, profligate Greece, the European Union this week pledged nearly $1 trillion to inject green blood into Europe's economic vampires.
For Americans, this has been a two-week cram course in what not to be if you hope to have a vibrant future. What was once an unfocused criticism of Mr. Obama and the Democrats, that they are nudging America toward a European-style social-market economy, came to awful life in the panicked, stricken faces of Europe's leadership: Merkel, Sarkozy, Brown, Papandreou. They look like that because Europe has just seen the bond-market devil.
In the German legend, Faust was a scholar who sold his soul to the devil many years hence in return for a life now of intellectual brilliance and physical comfort. In our version of the legend, Europe's governments told the devil that, more than anything, they wanted a life of social protection and income fairness no matter the cost. Life was good. A fortnight ago, the bond devil arrived and asked for his money . . .
The Social Security Program Only Gives Temporary Social Security.
The Devil is lurking around our American neighborhood, also.
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4. Medicare: Health Alert: Early Retirees by John Goodman, PhD
There are 78 million baby boomers and a very large number of them have retirement on their minds. If the past is a guide, more than 80% of them will retire before they become eligible for Medicare (at age 65). Although about one-third of U.S. workers have a promise of post-retirement health care from an employer, almost none of these promises are funded and, as is the case of the automobile companies, are likely to be broken in whole or in part.
As a result, millions of retirees will find themselves buying their own insurance in the individual market. There they will face some unpleasant realities, which for many of them may come as a shock:
Unwise public policies will make these problems even worse. And far from correcting these mistakes, ObamaCare promises to pile new problems on top of existing ones.
In general, tax law, labor law and employee benefits law favor the active employee and discriminate against the retiree. For example, here are three public policy barriers that will stand between early retirees and affordable health insurance:
As for employer promises of post-retirement health care, it tends to be an all-or-nothing proposition. That is, employers can keep their retirees in their group insurance plan — paying with pretax dollars — or they can do nothing. It's hard to be in between. If an employer cannot afford, say, $12,000 family coverage for a retiree, the employer cannot split the difference and contribute $6,000 to the employee's individually-owned insurance. Such a contribution would be treated as taxable income.
The obvious solutions to these problems are: (1) allow employers to contribute (say, to a retiree's Health Savings Account) any contribution the employer can afford to make; (2) allow the retiree to pay his share of premiums with pretax dollars and (3) allow active employees and their employers to save tax-free — knowing that they will face the problem of post-retirement care. (For an additional solution, see . . .)
Yet precisely because these solutions are obvious, direct, simple and workable, they are nowhere to be found in ObamaCare.
Instead, the new law creates subsidies for employer-provided insurance for retirees between now and 2014. However, these subsidies go not to individuals but to employers. And because higher-income employees are more likely to have an employer promise of post-retirement care, the subsidies will go to those who least need them.
These subsidies end in 2014, by which time insurers — selling in a newly created health insurance exchange — will have to accept all applicants regardless of health condition. Since the difference in premiums in this artificial market cannot exceed 3 to 1 (rather than the actual cost ratio of 6 to 1), the idea is to overcharge young people so that 50- and 60-year olds can be undercharged. . .
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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By Alieta Eck, MD
We do not have "universal health care." We have mandatory free "health care for the universe."
A middle-aged woman came to our local emergency room, suitcase in tow, complaining of a severe headache and diminished vision. A CT scan of the head showed a brain tumor. The neurosurgeon on call was summoned and within days the patient had surgery to preserve her vision. An inspiring story giving tribute to the wonderful ingenuity, generosity, and high standards in our country?
This woman knew about her brain tumor and had already had an unsuccessful attempt at surgery in her home country. She booked a flight as a tourist, and her extended family took her directly from the airport to the emergency room. None of them had the slightest intention of paying any part of her bill. American patients, insurance subscribers, and taxpayers will subsidize the hospital, albeit inadequately. The neurosurgeon will not get paid, but will still be fully liable for any adverse outcome in our medical malpractice environment.
For foreigners, it appears that dishonesty pays. But those who are completely honest have a harder time. The headmaster of a Christian grammar school in Liberia had an abdominal tumor the size of a football. No one in Liberia felt capable of handling such surgery so our church arranged for him to come to that same hospital in New Jersey. Since US government officials knew this man needed medical attention, he was asked to supply letters from the church guaranteeing payment for his surgery. Only then, would the US embassy give him a visa. The church, here, will fulfill its promise and pay a fair price as this is the honorable thing to do. The surgeon will be paid unless he voluntarily chooses to perform the procedure for free, and everyone is uplifted.
There will be those who say they would do anything to get medical care for a loved one. Does this mean they would steal for it? And does their need make stealing right?
Charity is a noble thing, but it cannot be mandated. Our government's requiring physicians and hospitals to provide free services to whomever walks into the ER does not represent true charity, but a taking of the services from those with valuable skills. The more that is taken, the less charity can be freely given, and all patients suffer as services become less available. Many hospitals now lack neurosurgery coverage for any patient, insured or not.
The proper channels would be for the needy to appeal to those in a position to provide charity, with a culture of generosity arising to meet the need. We learned quickly that we could not provide access to the United States for every Haitian that needed help. Instead, armies of volunteers have traveled there to help.
While illegal immigrants are not the only ones taking advantage of the "free" services here in the US, the situation attracts those who are willing lie to get something for nothing. Hospitals near the border are especially hard hit, especially by women who forgo prenatal care and show up at the ER in the second stage of labor. An added attraction is automatic American citizenship for the child. Births to illegal alien mothers constitute nearly 40% of all births paid for by Medi-Cal. Dozens of hospitals along the border in California, Arizona, New Mexico, and Texas have been forced to close or go bankrupt because of the unfunded federal mandate to provide free care to Illegals. . .
Our forefathers came to this country with only the shirts on their backs, expecting nothing but an opportunity to work in freedom. They did not demand free services but worked alongside hardworking Americans to build their own American dream. That was always the promise of America and we need to be vigilant lest we lose it.
Medical Gluttony thrives in Government Programs.
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"Inaugurating Britain's National Health Service on July 5th 1948, the Health Minister Nye Bevan crowed, ‘We now have the moral leadership of the world.'"
In a telephone call to clergymen, also broadcast over the internet, Obama dismissed the concerns of opponents of his health agenda as "fabrications." Dissenters were making up allegations about death panels, government funding of abortions, and a government takeover of medicine, he said, because they want to "discourage people from meeting…a core ethical and moral obligation…that we look out for one another…that I am my brother's keeper" (Commentary by Star Parker 8/25/09).
"Forgive me if sermons about morality are a little hard to swallow from a man who supports partial birth abortion," Parker writes.
She also notes that reform proposals would outlaw the voluntary Christian sharing communities through which 100,000 Americans take care of their own medical expenses, independently of government and insurance companies.
In contrast, government compelling taxpayer A to pay provider B for care of patient C is not the same thing as "looking out for one another."
There are in fact core moral issues involved in "health care reform": a radical change in the physician's code of ethics. The New Ethics transforms the physician from a healer, who places his individual patient's welfare first, to a tool of the state, sacrificing individuals for the good of the collective.
Rationer-in-chief Ezekiel Emanuel describes his ethics as "communitarian." He blames the Oath of Hippocrates for the "overuse" of medical care, regardless of cost of the effect on others, and he favors the "complete lives" concept for allocating scarce resources. Those resources (including people's earnings) are assumed to belong to the collective, to be appropriated and redistributed as the rulers think best.
The existence of "disparities" or of profits is taken as evidence of immorality. Disparities of concern are those based on "invidious" discrimination, as by race or gender. Allocation by age can be just and rational. See: Persad G, Wertheimer A, Emanuel EJ. Principles for allocation of scarce medical interventions. (Lancet 2009;373:423-431).
Disparities have not been eliminated by nationalized health systems; quite the contrary. Thirty years into the British National Health Service (NHS), an official task force (the Black Report) found little evidence that access to care was any more equal than when the NHS began. Almost 20 years later, a second task force (the Acheson Report) found that access had become even less equal. There is also pervasive inequality in Canada, with differences in per capita spending as great as seven-fold between urban and rural areas ( John Goodman, Cato Policy Analysis 1/27/05).
One of the features of the NHS that has persuaded the British of its social justice is "the difficulty and unpleasantness it throws in the way of patients, rich and poor alike," writes Theodore Dalrymple. "For equality has the connotation not only of justice but of hardship and suffering" (Wall St J 8/8/09).
Additionally, the differences in health between the rich and poor in Britain are not only among the greatest in the western world, but they are as great as they were in 1948, "when health care was de facto nationalized precisely to bring about equalization," Dalrymple continues.
The whole population has been pauperized in the name of an inalienable right to health care—in the dirtiest, most broken-down hospitals in Europe, writes Dalrymple in an earlier article (Wall St J 7/29/09).
"Morality is always the justification," writes Mark Steyn. "Inaugurating Britain's National Health Service on July 5th 1948, the Health Minister Nye Bevan crowed, ‘We now have the moral leadership of the world.'"
Roy Romanow, the Canadian politician who headed the most recent of numerous inquiries into problems with the Canadian system, defends the state's monopoly on medical care by saying that "Canadians view medicare as a moral enterprise, not a business venture." But Steyn asks, "What's so moral about relieving the citizen of responsibility for his own health care?" . . .
Medical Myths Originate When Someone Else Pays The Medical Bills.
Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service.
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Dr. Dave: That was a great conference you had last Friday, Yancy.
Dr. Yancy: Thank you Dave. Did the Power Point Slides keep the thing together?
Dr. Dave: I thought they were very professional.
Dr. Rosen: It's good for us medical folks to hear a good surgeon talk about how he makes the decision on a breast mass. Hadn't realized it was that involved. Do all the surgeons do the sentinel node thing?
Dr. Yancy: I'm not sure. But I think there would be medical liability if one didn't.
Dr. Sam: We sure have a lot of opportunity to obtain CME (Continuing Med Education credits) these days, don't we?
Dr. Ruth: And they are so much more convenient. The Friday Grand Rounds from Labor Day to Memorial Day gives us more than 30 hours of CME a year.
Dr. Rosen: And with the University of California at Davis here in Sacramento, those of us in Medicine have weekly grand rounds every Thursday. That's 50 hours of CME a year if you can make most of them.
Dr. Ruth: I don't get over there on Thursday. It's too early for me.
Dr. Rosen: The disappointing thing is that with 3500 physicians in our Medical Society, of which probably more than a thousand are primary or personal physicians, only about a dozen or two make the Medical Grand Rounds. These are always the best conferences with faculty from the great Medical Centers throughout the world presenting. We are truly fortunate.
Dr. Paul: The pediatric department has monthly Grand Rounds. They are also very good.
Dr. Michelle: The OBG department also has monthly Grand Rounds. It's always instructive to hear about the most challenging cases in the hospital every month. It keeps us all on our toes.
Dr. Sam: All of the journals now seem to give CME. The New England Journal of Medicine is the most ambitious. I didn't think that I would have time to read each issue thoroughly, then take the test and do a good job. But that alone would be more than 50 CME hours.
Dr. Ruth: I like the Medical Letter. It comes every two weeks and the quiz is right in the issue. You just answer the questions each time on the website, and you see your score immediately.
Dr. Sam: I do the same. That's 13 CME each half year or 26 per year.
Dr. Edwards: I'm sure most of us attend our specialty meetings every year. I enjoy seeing my colleagues every year. And that's usually 20 or 30 CME units.
Dr. Sam: Looks like we all get about 100 CME units a year instead of the 25 units required by the Medical Board.
The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
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The last generation of physicians were raised in an era before government involvement. All people received medical care; universal health care was a reality. Those who did not pay out-of-pocket for their care were able to receive care at the county hospital, the charity hospital and the medical school. All medical schools had residency programs, most major hospitals had affiliations with medical schools. These institutions had residency programs. The chief resident had a "free clinic" where patients with limited ability to pay and those who refused to pay were cared for. These clinics were manned by the residents and a volunteer physician or surgeon. The volunteer physician or surgeon was usually from the community. The volunteer physician was not paid. They received the title of assistant or associate clinical professor from the medical school.
Volunteer physicians attended academic programs, grand rounds, radiology conferences, morbidity and mortality conferences and other programs. These activities were part of the continuing medical education which most physicians were involved before CME (continuing medical education) became mandated for licensure. The interaction with medical students and residents was part of the continuing medical education. Essentially all physicians were involved in affiliations with medical schools and/or county hospitals.
Difficult cases and unusual cases were discussed and critiqued at the weekly conferences. Referrals were made to known individuals at the medical school when that doctor's expertise exceeded that of the referring doctor. The interactions were intimate between the community physician and the academic physician.
The growth of government involvement changed the climate. The intimate interaction was reduced or eliminated. Conference times were changed for the convenience of the institution. This resulted in inconvenience to the community physician, thus reducing the interactions.
Government policies encouraged physicians and surgeons to join multispecialty groups. It became more difficult to practice in a small group or independently. Economics and the blizzard of government forms meant that small groups and independent physicians had to hire people to fill out paper-work. Insurance companies and government agencies set fees. Physicians were paid progressively lower amounts. To receive the maximum payment for a particular activity required a billing expert. The billing event was the tool to achieve maximum compensation. The art of the billing event became relentlessly more prominent.
Success in achieving reasonable compensation became dependent on gaming the system. Success prior to government involvement was dependent on efficiency and a good result. The patient was the former payer. The reputation of the surgeon was most important. The patient was in charge. Now the government was the payer. The third party, insurance company or government, was now as important, or to some, more important, than the patient
Surgeons were individuals. Now surgeons are part of a department. In the HMO the referring physician has never seen the surgeon operate. The referring primary care person has no idea what happens to the patient. She may not know if the patient is alive or dead.
The involvement of government in Medicare and Medicaid was to make medical care "more equal". The federal propaganda in 1965 was to improve "equality of care". In reality, it allowed the camel's nose into the tent. Healthcare has been used as a tool to bring the philosophy of the left into the constitutional limitations of government.
In the last generation of physicians and surgeons, the physician or surgeon set the fee. This was based on the prevailing fees in the community. Fees varied but patients were aware and if a fee was out-of-line a patient would not be happy. Patients were aware. Co-pays did not exist. Patients were expected to pay for care. As the world changed the Relative Value Scale (RVS) and the Current Procedural Terminology (CPT) replaced the physician determined fee . . .
Government, on the other hand, knows it is corrupt. Government assumes all others are corrupt. The RVS and the CPT became the standards of billing. Numbers and divisions of care replaced global fees. It was possible to game the system. Gaming became the method of HMOs to maximize payment. The patient was a conduit not the object of energy. Billing events replaced professionalism. Corruption is a virus. If spreads from the rotting head to the rest of the body.
Fraud, which had no place in the last generation of physicians and surgeons, became progressively more common. The Russian mafia relinquished extortion to create billing events to defraud Medicare and Medicaid. Hospitals in Los Angeles recruited "homeless". Admitted them to their hospitals and billed for "care" that never occurred. Fraud became the focus of special FBI units in Los Angeles and ultimately 15 other cities. This was the result of your government's involvement in health care. No matter what was done to eliminate waste and fraud the situation worsened. More and more money moved from the government programs to the criminals. The criminals were sometimes caught and imprisoned. The criminals were not deterred. They went to white collar prisons and were subjected to shorter terms than when they peddled drugs or extorted by violence. Their fellow prisoners were of a better class. . .
Physicians and surgeons in a war zone will treat enemy wounded. Will Dr. Emanuel concur that is ethical or will he simply declare the enemy combatant is mentally incompetent. In Saigon, Vietnam all that came to the Navy Station Hospital received care.
The cost of medical care will continue to rise. Government bureaucracies in the USA will increase in number and power. Care will deteriorate further. Costs will not be controlled. (The UK's National Health Service has more than 750 agencies involved in "health care".)
Eventually physicians will stop accepting payment from the government and insurance agencies. The best will move offshore. Who will care for the sick? Will the government punish and enslave doctors who object to the government mandates. We are supposed to pursue life, liberty and the pursuit of happiness. Will doctors be excluded from the mandates of the US Constitution?
The government is the direct cause of the explosion in health care costs. The elimination of the government and a return to the ethics, culture and morality of the last generation will bring under control the runaway costs and the deteriorating care of the sick.
VOM Is Where Doctors' Thinking is Crystallized into Writing.
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The Blueprint, By Adam
Schrager and Rob Witwer (Speaker's Corner, 226 pages, $15.95)
"How the Democrats Won Colorado (and Why Republicans Everywhere Should Care)."
In February 2003, Bill Owens attended the Colorado Rockies Fantasy Camp in Tucson, Ariz., an exercise in wish fulfillment that tends to be the preserve of successful middle-age men who are rewarding themselves with a week of baseball in the company of former big-league players. Mr. Owens's claim to success seemed assured. A few months earlier he had won re-election as the Republican governor of Colorado by a record margin, and his party was riding high. The state House and state Senate had solid GOP majorities, and in Washington both Colorado senators and five out of seven representatives were Republican. Mr. Owens had recently been called "America's Best Governor" in a National Review cover story, and he was even viewed as a potential 2008 presidential contender.
Just a few years later he was ex-Gov. Owens and Colorado had turned solidly Democratic.
The 2004 elections saw President Bush re-elected and the Republicans' hand in Congress strengthened, but Democrats in Colorado defied the national tide, taking control of both houses in the Legislature and one U.S. Senate seat. In 2006 they captured the governor's office, and in 2008, when Barack Obama carried the state, the Democrats' gains included adding the other U.S. Senate seat. Five out of seven congressional seats were in the party's hands.
What caused this stunning reversal? It wasn't just the vagaries of political fortune; a carefully executed Democratic plan was instrumental in the turnaround. Adam Schrager and Rob Witwer debriefed the architects of the plan and now lay out what they learned in "The Blueprint." Mr. Schrager is a political reporter and Mr. Witwer a Republican former member of the Colorado House. Their report addresses, as the book's subtitle has it, "How the Democrats Won Colorado (and Why Republicans Everywhere Should Care)." . . .
At the height of the Gang of Four's success in Colorado, former governor Bill Owens offered his bitter perspective: "They bought the state. We ought to treat this the way we treat naming rights to football stadiums—let's just put Pat Stryker's and Tim Gill's names on the gold dome of the Colorado state capitol, because that's what happened."
Messrs. Schrager and Witwer are generally even-handed in "The Blueprint," though they take occasional swipes at efforts that "took message control out of the hands of candidates and handed it to 'outsiders.' " But wealthy progressives are not the only frustrated "outsiders" in America today. Indeed, the methods of "The Blueprint" can be applied by conservatives frustrated with big-spending insiders. The political parties may have to take a back seat while leaders from the private sector battle over who will provide adult supervision to our profligate politicians.
Mr. O'Keefe is chairman and chief executive of the Sam Adams Alliance, based in Chicago.
Printed in The Wall Street Journal, May 13, 2010, page A17
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Hoboes who carried their belongings in a bundle were known as "Bindle Stiffs."
Let there be no mistake - "A hobo," as one authority explained, "is a migratory worker, a tramp is a migratory non-worker, and a bum is a stationary non-worker."
Of the three, hobo was definitely the highest calling.
Peddlers were widely scorned as they carried their 60-pound pack of goods to distant settlements.
But in frontier America in the nineteenth century, where general stores were few and the most basic necessities hard to come by, a peddler loaded down with treasures was always welcomed. Never mind if his wares were overpriced or travel worn: To the isolated farm family, he was a source of news and gossip, as well as goods. Most of the early peddlers hailed from New England, particularly Connecticut, where many of their products - from tin ware to clocks - were manufactured. In the first three decades of the 1800s, at least half the men in Hartford are thought to have tried peddling. It was, after all, a job that required no apprenticeship and little investment. When European immigrants began pouring into the country at mid-century, many turned to peddling for similar reasons. These strong-legged merchants trudged into the most distant settlements, some reaching Detroit, St. Louis and New Orleans.
Peddlers were known for their quick wit and shady deals and emerged as a species of folk hero.
Merchandise by Mail
With mounting prices and limited choices at rural stores, Chicago-based Montgomery, Ward and Company introduced in 1872, the first mass-marketing catalog. The firm began with $2400 in capital and a one-page flyer listing 163 items that was mailed to members of the National Grange, America's largest farm organization. Farmers opted for the convenience, improved selection, better prices, and the company's pledge: "Satisfaction guaranteed, or your money back." Sears, Roebuck and Company opened for business in 1893 and surpassed Montgomery Ward in catalog pages and sales in seven years. Then with the institution of rural free mail delivery in 1896 and parcel post in 1913, many general stores faded into history.
And then Jeff Bezos founded Amazon.com, Inc. in 1994, and launched it online in 1995.
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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.
• Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .
• 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. To review How to Start a Third-Party Free Medical Practice . . .
• 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. Read Lin Zinser's view on today's health care problem: In today's proposals for sweeping changes in the field of medicine, the term "socialized medicine" is never used. Instead we hear demands for "universal," "mandatory," "singlepayer," and/or "comprehensive" systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this "nationalized financing" or "nationalized health insurance." In a more honest day, it was called socialized medicine.
• 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.
• 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.
• ReflectiveMedical Information Systems (RMIS), delivering information that empowers patients, is a new venture by Dr. Gibson, one of our regular contributors, and his research group which will go far in making health care costs transparent. This site provides access to information related to medical costs as an informational and educational service to users of the website. This site contains general information regarding the historical, estimates, actual and Medicare range of amounts paid to providers and billed by providers to treat the procedures listed. These amounts were calculated based on actual claims paid. These amounts are not estimates of costs that may be incurred in the future. Although national or regional representations and estimates may be displayed, data from certain areas may not be included. You may want to follow this development at www.ReflectiveMedical.com. During your visit you may wish to enroll your own data to attract patients to your practice. This is truly innovative and has been needed for a long time. Congratulations to Dr. Gibson and staff for being at the cutting edge of healthcare reform with transparency.
• 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, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives. He now has a new column with Richard Dolinar, MD, worth reading at www.thenewstribune.com/opinion/othervoices/story/835508.html.
• The Association of American Physicians & Surgeons, 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: "We have to pass the health care bill, so you can find out what's in it," said House Speaker Nancy Pelosi. It's a good thing doctors don't practice medicine that way. Imagine sending patients to major surgery and then checking to find out what is in their medical record! This month read Miracle on Page 327 that Dr. Alieta Eck found tucked in the health care bill. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month's guest editorial is in Section Five above. 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.
The AAPS California Chapter is an unincorporated association made up of members.
The Goal of the AAPS California Chapter is to carry on the activities of the
Association of American Physicians and Surgeons (AAPS) on a statewide basis.
This is accomplished by having meetings and providing communications that
support the medical professional needs and interests of independent physicians
in private practice. To join the AAPS California Chapter, all you need to do is
join national AAPS and be a physician licensed to practice in the State of
California. There is no additional cost or fee to be a member of the AAPS
California State Chapter.
Go to California Chapter Web Page . . .
Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"
PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.
Our motto, "omnia pro aegroto" means "all for the patient."
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"The best and most beautiful things in the world cannot be seen, nor touched ... but are felt in the heart." — Helen Keller: Was a blind and deaf author and lecturer
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Some Recent Postings
Edward Uhl 1918-2010 – Sunday, May 9 | Remembrances – WSJ – May 13, 2010
Arms Maker Helped Invent the Bazooka and the Thurnderbolt II
In 1961, Mr. Uhl was named Fairchild CEO, succeeding founder Sherman Fairchild.
At the start of Edward Uhl's career as an arms manufacturer, he helped invent the bazooka to counter German Panzers during World War II.
Later, as CEO and then chairman of Fairchild Industries Inc., Mr. Uhl oversaw development of the A-10 Thunderbolt II, used to devastating effect against Iraqi heavy armor during the Gulf War.
Mr. Uhl, who died Sunday at age 92, led a turnaround at Fairchild in the early 1960s, transforming it from mainly a manufacturer of military airplanes into an aerospace giant that also built missiles, commuter planes and satellites.
Raised in Elizabeth, N.J., the son of a milkman, Mr. Uhl attended Lehigh University on an ROTC scholarship. Not long after graduating with an engineering degree in 1940, he was called to active duty and was assigned to work under Maj. Leslie Skinner, an Army rocket researcher with a laboratory at George Washington University.
Mr. Uhl made the bazooka shoulder-fired by coming up with the hollow tube firing mechanism. It got its name during a demonstration for Army generals, one of whom remarked that "it sure looks like Bob Burns's bazooka." Mr. Burns was a popular comedian who played an improvised musical instrument of that name.
After the war, Mr. Uhl helped set up test firings of German rocketeer Werner von Braun's V2 at White Sands, N.M. Mr. Uhl left the Army in 1947 and joined the Glenn L. Martin Co., where he led development of "pilotless aircraft," or missiles. Among these was the Pershing I, capable of carrying a nuclear warhead. . .
Mr. Uhl was known for his military bearing, and said that outside managers often didn't fit in with Fairchild's style. "We're a meat and potatoes company," he told Fortune in 1983. "We don't go for froufrou, lace, and things like that."
Printed in The Wall Street Journal, May 13, 2010, page A7
On This Date in History - May 25
On this date in 1787, the U. S. Constitutional Convention achieved a quorum in Philadelphia having been delayed since May 14 when only two members had arrived. Only the representatives of Virginia and Pennsylvania were there on time.
On this date in 1803, Ralph Waldo Emerson was born in Boston. It was he who sparked New England's golden age of literature. He is known for his sayings, such as "Nothing great was ever achieved without enthusiasm." We have great things to re-achieve in America and enthusiasm is growing.
After Leonard and Thelma Spinrad
The 8th Annual World Health Care Congress
Advancing solutions for business and health care CEOs to
implement new models for health care affordability, coverage and quality.
The 8th Annual World Health Care Congress will be held on April 4-6, 2011
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In partnership with MedicalTuesday.net, the Annual World Health Care Congress is the most prestigious meeting of chief and senior executives from all sectors of health care. The 2010 conference convened 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. Please watch this section, as well as www.HealthPlanUSA.net, for future reports.