|
MEDICAL TUESDAY . NET |
NEWSLETTER |
|
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
Words of Wisdom,
Recent Postings, In Memoriam . . .
* * * * *
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.
* * * * *
1. Featured Article: Developing Drugs for Cancer
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. . .
Feedback
. . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
* * * * *
2. In the News: Infectious personalities
Social networks catch an early glimpse of disease
outbreaks
From
The Economist print edition | May 13th 2010
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.
Early
warning
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. . .
Read the entire article . . .
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
* * * * *
3. International Medicine: Didn't we escape from Europe more than
two centuries ago?
OPINION: WONDER LAND, WSJ, MAY 13, 2010
Daniel Henninger discusses Europe's economic stagnation, noting that
President Obama's health-care and energy policies will surely make us more like
Europe.
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.
The bond market is a good bargain—if you live more or
less within your means. The Europeans, however, pushed a good bargain into a
Faustian bargain, which the world calls a sovereign debt crisis.
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 . . .
Read the entire OpEd . . .
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
The Social
Security Program Only Gives Temporary Social Security.
The Devil is lurking around our American
neighborhood, also.
* * * * *
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:
- Whereas employers
typically pay about 75% of the premium at work, these retirees will have
to pay 100% of the premium out of their own pockets.
- Whereas the share of
premium paid by employees tends to be the same — regardless of age —
individual insurance premiums for, say, a 60-year-old tends to be 5 times
higher than for a 20-year-old. . .
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:
- Although tax law
allows employers to pay premiums for group insurance for active employees
with pretax dollars, employers cannot make premium contributions to the
individually-owned insurance of their retirees with untaxed dollars. . .
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. . .
Read the entire Health
Alert . . .
Feedback
. . .
Subscribe MedicalTuesday .
. .
Subscribe HealthPlanUSA .
. .
Government is not the solution to our problems, government is
the problem.
- Ronald Reagan
* * * * *
5. Medical Gluttony: Free Health Care for the Universe
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?
There's more.
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.
Read Dr. Eck's Bio and the entire OpEd . . .
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .
Medical Gluttony thrives in Government Programs.
* * * * *
6. Medical Myths: "Morality is always the justification."
"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.'"
Myth 22. "Health care
reform" is a moral imperative.
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?" . . .
To read the entire Myth 22
and additional URLS . . .
To read
more myth busters from AAPS. . .
Feedback
. . .
Subscribe MedicalTuesday .
. .
Subscribe HealthPlanUSA .
. .
Medical Myths Originate When Someone Else Pays The Medical Bills.
Myths Disappear When Patients Pay Appropriate Deductibles and
Co-Payments on Every Service.
* * * * *
7. Overheard in the Medical Staff Lounge: Medical Grand
Rounds
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.
Feedback
. . .
Subscribe MedicalTuesday .
. .
Subscribe HealthPlanUSA .
. .
The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
* * * * *
8. Voices of Medicine: A Review of Articles by Physicians
How
health care became expensive and dangerous - II
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.
Read
the entire OpEd . . .
Read
more about Saul William Seidman, MD. . .
Feedback
. . .
Subscribe MedicalTuesday .
. .
Subscribe HealthPlanUSA .
. .
The HealthPlan that
will control costs. . .
VOM Is Where Doctors' Thinking is Crystallized into Writing.
* * * * *
9. Book Review:
To win elections today, one must bypass
the political party.
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)."
A New Way Of Playing to Win
By ERIC O'KEEFE
| BOOKSHELF | WSJ | May 13, 2010
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
Read the rest of this important book review.
. .
To read more book
reviews . . .
To read book reviews
topically . . .
Feedback
. . .
Subscribe MedicalTuesday . .
.
Subscribe HealthPlanUSA .
. .
* * * * *
10. Hippocrates & His Kin:
America's most celebrated tramp considered his life the grandest of adventures.
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.
To
read more HHK . . .
To read more HMC . . .
Feedback
. . .
Subscribe MedicalTuesday .
. .
Subscribe HealthPlanUSA .
. .
* * * * *
11.
Professionals Restoring Accountability in Medical Practice, Government
and Society:
•
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."
* * * * *
Thank you for joining the
MedicalTuesday.Network and Have Your Friends Do the Same. If you receive this
as an invitation, please go to www.medicaltuesday.net/Newsletter.asp,
enter you email address and join the 10,000 members who receive this
newsletter. If you are one of the 80,000 guests that surf our web sites, we thank
you and invite you to join the email network on a regular basis by subscribing
at the website above. To
subscribe to our companion publication concerning health plans and our pending
national challenges, please go to www.healthplanusa.net/newsletter.asp
and enter your email address. Then go to the archives to scan the last several
important HPUSA newsletters and current issues in healthcare.
Please note that sections 1-4, 6, 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.
We respect copyright as exemplified by George
Helprin who is the author, most recently, of "Digital Barbarism,"
just published by HarperCollins. We hope our highlighting articles leads to
greater exposure of their work and brings more viewers to their page. 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.
Spammator Note: MedicalTuesday uses many
standard medical terms considered forbidden by many spammators. We are not
always able to avoid appropriate medical terminology in the abbreviated edition
sent by e-newsletter. (The Web Edition is always complete.) As readers use new
spammators with an increasing rejection rate, we are not always able to
navigate around these palace guards. If you miss some editions of
MedicalTuesday, you may want to check your spammator settings and make
appropriate adjustments. To assure uninterrupted delivery, subscribe directly
from the website rather than personal communication: www.medicaltuesday.net/newsletter.asp.
Also subscribe to our companion newsletter concerning current and future health
care plans: www.healthplanusa.net/newsletter.asp
Del Meyer
Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Feedback
. . .
Subscribe MedicalTuesday .
. .
Subscribe HealthPlanUSA .
. .
"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
"Money
is for making things happen." — Richard Branson: a British business mogul and adventurer
"Priorities lead to prosperity." — Michelle Singletary: Nationally syndicated columnist for The Washington
Post
Some Recent
Postings
Health Care: A Two-Decade Blunder
by Tevi Ty . . .
The Prisoner's
Dilemma of Health Insurance by Gerry Smedinghoff. . .
Sorting Fact From
Fiction on Health Care by Jerome Groopman & Pamela Hartzband . . .
In Memoriam
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.
By STEPHEN MILLER
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."
Read
the entire Remembrance . . .
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
Washington, DC
www.worldhealthcarecongress.com
Toll Free: 800-767-9499
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.