1.
Featured
Article: How Not to Be Deceived by Politicians.
2.
In
the News: Medical Whistle Blowers Demand Reform, by
James Murtagh, MD
3.
International Medicine: Canada's health care system -
poor value for your tax dollars
4.
Medicare: What Universal Health Care Can Do For You!
5.
Medical Gluttony: Stopped in its tracks.
6.
Medical
Myths: It's easy to get hooked on heroin.
7.
Overheard
in the Medical Staff Lounge: Practice Issues: Unnecessary Laboratory Costs
8. Voices of Medicine: Ruminations by a Climber
Anesthesiologist, by David Larson, M.D.
9.
From
the Physician Patient Bookshelf: Musicophilia,
by Oliver Sacks, MD
10. Hippocrates & His Kin: Allergy
pills dropped from $120 a month to $1 a month!
11. Physicians Restoring
Accountability in Medical Practice, Government and Society
MOVIE EXPLAINING SOCIALIZED
MEDICINE TO COUNTER MICHAEL MOORE's SiCKO
Logan Clements, a
pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the
truth about socialized medicine. Clements is the former publisher of
"American Venture" magazine who made news in 2005 for a property
rights project against eminent domain called the "Lost Liberty
Hotel."
For more information visit www.sickandsickermovie.com or email logan@freestarmovie.com.
* * * * *
1.
Featured Article:
How Not to Be Deceived by Politicians
Peripatetics ~
Health-Care Cons By
Sheldon Richman
Economist Joan Robinson (1903–1983) wrote, "The
purpose of studying economics is not to acquire a set of readymade answers to economic
questions, but to learn how to avoid being deceived by economists."
A better reason to study economics is to avoid being
deceived by politicians; they are the far greater threat to life, liberty, and
the pursuit of happiness. When you consider that the typical political
campaign is little more than a series of confidence games, understanding basic
economics is a matter of survival. Without such an understanding one is an easy
mark.
Case in point: How would one see through the flimflam
served up as health-care policy without a working knowledge of economic
principles? When politicians promise "universal and affordable"
medical care and insurance, how else are we to know that those promises can't
be kept. Indeed, attempting to keep them would gravely damage our medical care
(even more), our prosperity, our liberty.
What we call medical care/insurance is a bundle of
goods and services that have to be produced. They aren't found superabundant in
nature. Production of those things entails real opportunity costs in terms of
resources (labor, intellectual capital, machinery, and more, which could be
used in alternative ways. The people engaged in this production are (so far)
free to do other things if they choose. They can't be compelled to practice
medicine, run hospitals, invent medicines, or offer insurance policies. This
sobering thought should be kept in mind when analyzing politicians' plans for
medical "reform." Any proposal that would drive medical service
providers and resources into other lines of work could hardly be said to be in
the general interest.
However, one group can be compelled to participate in
a government plan: the American people in their dual capacities as taxpayers
and consumers of medical services. This is the key to any political "solution."
That's why Hillary Clinton insists against Barack Obama that any program must
be mandatory. Given the premises both candidates share, Clinton has logic on
her side. Without compulsion, any government program must fail even on its own
terms. You might think that's a good argument against government programs, but
politicians and most other people don't believe physical force perpetrated by
government is objectionable. Go figure.
Candidates who promise universal and affordable
medical care don't really believe they can lower the true costs of the relevant
goods and services. Instead, their plans contain methods, overt and covert, to
shift some people's expenses to others. The overall price tag won't shrink -
indeed, it can be expected to grow - but the money price to selected
individuals would diminish. (Nonmonetary costs, such as waiting times, would
increase.)
The problem for those who promise universal and
affordable health care is that medically we are not all created equal. Because
of genetics and lifestyle, some people are more likely to get sick than others,
and some people are already sick. This upsets the politicians' plans, and they
must do something about it. Clinton declares, "I want to stop the
health-insurance companies from discriminating against people because they're
sick."
One doesn't know whether to laugh or cry at a
statement like that. Is it ignorance, stupidity, or demagoguery? Real insurance
lets people hedge against financial ruin by pooling their risk of misfortune
with others. For reasons that shouldn't need explaining, people who present a
low risk for whatever is being insured against would reasonably be charged less
for coverage than people who present a high risk. For one thing, low-risk
customers would be unwilling to pay premiums that overstated their perceived
risk. I recall reading that the fire-insurance company founded by Benjamin
Franklin set premiums according to how fire-resistant a building was. Was that
a reasonable or outrageous thing to do?
The depth of the lack of understanding about insurance
is on stark display whenever someone demands that the terms of coverage for a
sick person be the same as those for a healthy person. Risk grows out of
uncertainty. But if someone is already sick, there is no uncertainty about his
need for medical care. "Insurance" in this case would not be real
insurance but rather a subsidy provided by others or prepayment for future
expenses.
The Real Story
To be actuarially sound, insurance must discriminate
on the basis of risk. If the government bars insurers from such
price-discrimination, they really wouldn't be in the insurance business at all.
It would be more accurate to call their activity a forced subsidy. We should at
least call a thing what it is.
Where would the Clinton principle of nondiscrimination
lead if the government seriously enforced it? If an "insurer" is
allowed to charge only one price regardless of risk, it would have to set the
price high in order to be able to cover the riskiest customers. But that would
not honor the politicians' promise of affordable coverage. Moreover, young,
healthy people would opt out, preferring to spend their money otherwise or to
save it in order to self-insure. So the government could not let this stand. To
"fix" things, it would compel everyone to participate and force the
taxpayers to subsidize low-income people.
Even with subsidies the politicians wouldn't let
insurers charge market prices for long because this would anger voters and
break the budget. So inevitably, the Clinton principle must lead to price
controls.
We know what price ceilings bring: shortages. Why
would a company that cannot charge enough to cover its costs and earn a
competitive profit continue in business? Thus the principle of
nondiscrimination combined with price controls would inevitably dry up the
supply of private "insurance." At that point, the politicians would
declare that the "free market" failed and that government must step
in to be the sole health insurer. Then government could have full control over
who gets what kind of medical attention. It would be in the triage business, a
terrifying prospect for sure. It would also dictate prices to doctors,
hospitals, and drug companies, speeding up the exodus from that profession and
those industries. As supply withered and demand inflated (because of the
illusion of low prices), government would impose more and more draconian
controls.
There's a lesson here. When the
government seeks to enforce a counterfeit right - such as the "right"
to medical care - no expansion of freedom results. Instead, government power
expands - to everyone's detriment. . .
To read the
entire OpEd, go to www.fee.org/Publications/the-Freeman/article.asp?aid=8263.
Sheldon Richman is the
editor of The Freeman and a contributor to The Concise Encyclopedia
of Economics.
* * * * *
2. In the News: Medical Whistle Blowers Demand Reform, by James Murtagh, MD
American Medicine is at a crossroads. The International
Association of Whistleblowers (IAW) spotlighted the incredible danger to the
public at its annual meeting May 11- 18, 2008. At the center of the conference
were repeated findings that sham peer review is harming patients, and leading
to cost increases, decreased quality, and in many cases excess deaths. Peer
review is supposed to be the safeguard of the public, but instead has been used
to suppress doctors who stand up for their patients.
The IAW teamed up with Government Accountability
Project (GAP), led by legal director Tom Devine Esq, and with the Semmelweis
society, named after the Hungarian physician Ignaz Semmelweis who
revolutionized global health by showing that simple hand washing saves
lives.
Victims of "sham" or "bad faith"
peer review rarely gain access to any independent due process to challenge this
unique form of retaliation, which in many cases results in the end of their
careers as physicians. Bad faith peer review against one physician can and does
persuade others to remain silent rather than advocate on behalf of their
patients. Speakers at the conference urging integrity in medicine, and an end
to sham peer reviews included:
o Patrick Campbell MD - Provided evidence to the FBI
that lead to the successful raid at Tenet's Redding Hospital, where 83% of
cardiovascular surgeries were found to be unnecessary. Unfortunately, the
Justice Department failed to reward him. Dr. Campbell sued and prevailed
through a landmark court of appeal decision.
o Roland Chalifoux DO - Neurosurgeon, President of the
Semmelweis Society, who blew the whistle on competitors in Fort Worth Texas.
o Michael Bennett - President of the Coalition for
Patients' Rights (CPR). Mr. Bennett lost his father due to an infection
he received at the hospital. Mr. Bennett is a nationally recognized patient
safety advocate.
Alan Dershowitz, the Counsel of Record for an amicus
brief in a "sham" peer review case, wrote: the goals of the HCQIA and
peer review are undermined, not promoted, when "qualified physicians are punished
and excluded from practice because they have chosen to stand up for a patient.
Whenever fewer physicians are willing to criticize the medical community out of
fear of the dire consequences of a fundamentally unfair, bad faith peer review,
an essential prong in the checks and balances integral to a successful health
care program will be silenced."
Without structural accountability, any structure is
vulnerable to being exploited for unacceptable hidden agendas. That is what has
happened with peer review.
The IAW unanimously adopted the GAP-Semmelweis plan
for reform, and urged Congress to explore ways to prevent the misuse of peer
review, including:
1. Launch a Government Accountability Office investigation
to assess the vulnerability and extent of hospitals abusing the peer review
process to retaliate against physician whistleblowers.
2. Conduct oversight hearings for a public forum
on any significant GAO findings. Collectively with our partners in this area,
we have heard the stories of hundreds of physician whistleblowers whose careers
have been ruined because they chose to advocate for patient safety or
challenged inadequate care at hospitals. These individuals are ready and willing
to bear witness with first-hand accounts of their experiences.
3. Amend the HCQIA to help curb abuses of the
peer review process. One possibility would be to add an affirmative defense of
"whistleblower retaliation" to the HCQIA. A physician could then take
this claim to an outside body, which could make a ruling as to whether
whistleblower retaliation was a contributing factor in any employment decision.
This type of independent review is necessary, and is similar to steps Congress
is on the verge of taking to reform the security clearance process for national
security employees.
4. Pass H.R. 4047, the Private Sector
Whistleblower Protection Streamlining Act of 2007. Introduced by Reps. Lynn
Woolsey and Education and Labor Committee Chairman George Miller, this
legislation would streamline protections for all private sector employees, and
protect physicians who are retaliated against for blowing the whistle on
inadequate health care.
5. Pass H.R. 4650, the Congressional Disclosures
Act of 2007. The legislation, introduced by Rep. Al Wynn, would give federal
workers, contractors, and any other employee of an organization that receive
payments from the federal government, including hospitals, access to court when
they are prosecuted or otherwise harassed for blowing the whistle directly to
Congress.
GAP is also pushing for this expansive definition of
employee to be included in congressional efforts to overhaul protections for
contractors in H.R. 985, Rep. Waxman's whistleblower legislation, which passed
the House in March, and is soon to be reconciled with Senate whistleblower
legislation.
Patients, citizens and taxpayers all have a stake in
protecting the nation's health system. The inspiration of Ignaz Semmelweis was alive
at this expanding annual event.
The joint task force of International Association of
Whistleblowers (IAW) urges you to write your congressman, your senator, the
media, and your friends to support the goal of a safer, freer American health
system.
James J. Murtagh Jr. MD, Atlanta GA 30329
www.internationalassociationofwhistleblowers.net/
www.opednews.com/articles/genera_internat_080508_whistleblowers_annou.htm
http://makeitsafecampaign.org/index.php?option=com_frontpage&Itemid=1
www.bizjournals.com/atlanta/prnewswire/press_releases/Georgia/2008/05/14/DC22457
* * * * *
3. International Medicine: Canada's health care system - poor value for your
tax dollars
By Nadeem Esmail, Director, Health System Performance
Studies, The Fraser Institute
The beginning of May marks the end of income tax
season in Canada. While the task of completing our personal tax returns and the
size of those tax bills slowly fades from our memories, some Canadians may find
themselves taking solace in a belief that the taxes they pay - about one-third
of which are income taxes (Veldhuis and Palacios, 2008) - at least purchase a
high quality, universal access health care program. Specifically, over one-half
of the personal income taxes Canadians just paid in aggregate are required to
cover the cost of our taxpayer-funded health care program (Statistics Canada,
2007; calculations by author).
Unfortunately, as the following data clearly shows,
Canada's taxpayers are not receiving the same sort of value that their
counterparts in other nations are when it comes to universally accessible
health care insurance.
To begin with, Canadians are funding the developed world's
third most expensive universal access health insurance system. On an
age-adjusted basis (older people require more care) in the most recent year for
which comparable data are available, only Iceland and Switzerland spent more
(as a share of GDP) on their universal access health insurance systems than
Canada did. The other 25 developed nations who maintain universal health
insurance programs spent less than we did - as much as 38% less (as a
percentage of GDP) in the case of Japan (Esmail and Walker, 2007).
Given this level of expenditure, you might expect that
Canadians receive world-class access to health care. But the evidence
demonstrates that this is not so.
Consider Canada's waiting lists. In 2007, waiting
lists for access to health care in Canada reached a new all-time high of 18.3
weeks from general practitioner referral to treatment by a specialist. Despite
substantial increases in both health spending and federal cash transfers to the
provinces for health care over the last decade or so, this wait time is 54%
longer than the overall median wait time of 11.9 weeks back in 1997 (Esmail and
Walker with Bank, 2007; Esmail et al.,
2007) Canada's waiting lists are also, according to available evidence,
among the longest in the developed world. For example, a 2007 survey of
individuals in seven nations, six of which maintain universal access health
insurance programs, published in the journal Health Affairs found that:
■ Canadians were more
likely to experience waiting times of more than six months for elective surgery
than
Australians, Germans, the
Dutch, and New Zealanders, but slightly less likely than patients in the United
Kingdom;
■ Canadians were least
likely among the six nations to wait less than one month for elective surgery;
■ Canadians were most
likely to wait six days or longer to see a doctor when ill, and were least
likely among the
six universal access nations
surveyed to receive an appointment the same day or the next day; and,
■ Canadians were least
likely to wait less than one hour and most likely to wait two hours or more for
access to
an emergency room among the
six universal access nations surveyed (Schoen et al., 2007).
That is hardly the sort of access you might expect
from the developed world's third most expensive universal access health
insurance system. It is also worth noting that there are seven developed
nations - Austria, Belgium, France, Germany, Japan, Luxembourg, and Switzerland
- which maintain universal access health insurance programs that deliver access
to health care without queues for treatment (Esmail, 2004). . .
Governmental restrictions on medical training, along
with a number of other policies that affect the practices of medical
practitioners, have also taken their toll on Canadians' access to care. Among 28
developed nations that maintain universal approaches to health insurance, a
recent comparison found Canada ranked 24th in the age-adjusted
number of physicians per thousand population (Esmail and Walker, 2007). It
should come as no surprise that Statistics Canada determined in 2005 that more
than 1.3 million Canadians could not find a regular physician, while a recent
estimate suggested that the number of Canadians without a regular physician was
around five million (Statistics Canada, 2008; CFPC, 2007). . .
To access the entire article and a number of
references, go to www.fraserinstitute.org/Commerce.Web/product_files/CanadasHealthCareSystemPoorValueforTaxDollars.pdf.
Canadian Medicare does not
give timely access to healthcare, it only gives access to a waiting list.
--Canadian Supreme Court
Decision 2005 SCC 35, [2005] 1 S.C.R. 791
http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
* * * * *
4. Medicare: What Universal Health Care Can Do For You! by Ralph
R. Reiland (February 19, 2008)
There's automatic cheering at her political
rallies when Hillary Clinton tells the faithful that she'll deliver
"universal health care." Her plan will "rein in costs"
while simultaneously "improving quality," she says, thereby insuring
that "all Americans will have affordable, quality health
insurance." To hold down costs, the plan will run "without
any new bureaucracy," insurance companies will be required to provide
"high value for every premium dollar," and drug companies will be
required to "offer fair prices." And somewhere troubles melt like
lemon drops and bluebirds fly above the chimney tops.
We'll be allowed to stick with our current coverage,
says Mrs. Clinton, or switch to a plan with the "same health benefits that
members of Congress receive." The latter will "provide benefits at
least as good as the typical plan offered to members of Congress, which
includes mental health and dental coverage." And along with producing
better teeth and fewer crazies, the Clinton plan promises to do its share in
delivering some economic leveling: "The Bush tax cuts for those making
over $250,000 will be discontinued" and "the government will ensure
that health insurance is always affordable and never a crushing burden on any
family."
As Hillary Clinton is fond of saying to Barack Obama,
it might be "time for a reality check."
In Britain, for instance, Colette Mills, a 58-year-old
former nurse, found out the hard way that there's a huge difference between
rhetoric and reality, between what the politicians promise and the system
delivers, when it comes to "universal health care." Struggling with
breast cancer, Mills "has run out of time to benefit from a potentially
life-extending drug that the National Health Service (NHS) has denied her, even
though she was prepared to pay for it," reported Sarah-Kate Templeton in
the Sunday Times of London on January 27.
"Mills is the victim of a ruling which states
that any patient who wants to pay for additional drugs not prescribed by the
NHS should lose their entitlement to their basic NHS cancer care and pay for
all their treatment," explains Templeton, health editor at the Times.
"She was prepared to pay for the drug but not her whole treatment."
Being treated with NHS-prescribed Taxol, Mills sought to add Avastin to her
treatment, based on medical reports that showed an increased effectiveness of
Taxol when used in concert with Avastin. "An American trial has shown that
taking the drugs in combination doubles the chance of preventing the disease
from spreading compared to taking Taxol on its own," explains Templeton.
"Taking Avastin in addition to Taxol is also likely to keep the disease
under control for twice as long." Mills sued to try to force the NHS to
allow her to pay for the Avastin. During her four-month legal battle with the
government, the cancer had spread to her liver and other parts of her body and
doctors have now advised Mills that it's too late for her to benefit from the
combination of Avastin and Taxol.
"It wasn't going to cost them," says Mills,
sentenced to death, in effect, by the state bureaucracy. "I was going to
pay for it. How can they say this policy is far more important than somebody's
life? I am just absolutely gutted. I just cannot believe people make these
decisions about other people's lives. The NHS has taken this opportunity away
from me and, if they are doing it to me, they are doing it to a lot of other
women as well."
The Department of Health in Britain argues that
individual payments for supplemental treatment can't be permitted alongside the
one-size-fits-all system because that would "undermine" the
"fundamental principle of the NHS, now supported by all the main political
parties, that treatment should be free at the point of need."
In the case of Colette Mills, that means
"free" but unavailable -- "free at the point of need," but
disallowed by the central planners. Also playing a role in making Avastin unavailable to
Mills was the ideology of egalitarianism, the idea that all inequalities are
inherently malicious and immoral. As Templeton explains: "The government
claims that to allow some patients to pay for additional drugs on top of their
NHS treatment creates a two-tier system between those who can and cannot afford
them." In other words, better dead than unequal. . .
To read the entire
article, go to www.capmag.com/article.asp?ID=5118.
Ralph R. Reiland is the B. Kenneth Simon professor of
free enterprise at Robert Morris University in Pittsburgh.
Government is not the solution to our problems,
government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Stopped in its tracks.
Ms Margie, a 78-year-old WS Female, was seen after an emergency
room visit. The ER record indicated that she had chest pain and congestive
heart failure. She responded to intravenous diuretics with prompt diuresis of a
liter of urine and resolution of her shortness of breath. She was told her
electrocardiogram revealed an atrial fibrillation but did not reveal a heart
attack. She had no previous ECGs. Her blood tests were negative for an acute
heart attack. She was told that they would like to do more procedures on her
heart. When told the cost of the next series of tests, she stated that she felt
fine and would proceed home to convalesce for a few days to see how she felt..
Since she had Medicare without any additional
insurance, Ms Margie knew she would have to pay 20 percent of the next few
thousand dollars. She felt she could make the decision later after further
reflection on her age and how she was doing.
When seen, she had stable atrial fibrillation, no
congestive heart failure and wanted to continue on the prescribed regimen for a
month or two. She would come in sooner if she experienced shortness of breath.
The Medicare co-payment was a major control in health
care costs without any loss in quality of care. In this instance, it saved more
than half the projected costs of an Emergency Visit. If all Medicare patients,
before becoming eligible for Medicare benefits, had to sign an agreement
relinquishing Medicare benefits if they obtain MediGap insurance, Medicare
costs would have remained under control and patients would have obtained
quality care, at a reasonable cost, without any oversight.
* * * * *
6.
Medical Myths:
It's easy to get hooked on heroin.
Junk
Medicine: Doctors, Lies and the Addiction Bureaucracy, by Theodore Dalrymple
Addiction is a moral and spiritual problem demanding deliberate
changes in behavior, not an illness demanding treatment, says Theodore
Dalrymple, who has encountered many heroin addicts in his work as a
psychiatrist and prison doctor.
In his latest book, "Junk Medicine: Doctors, Lies
and the Addiction Bureaucracy," Dalrymple debunks the disease model of
addiction. According to the conventional view, people who try heroin are
quickly "hooked," compelled to continue taking it by the unbearable
agony of withdrawal. Dalrymple offers one example after another that
contradicts the official account. For example:
·
He describes histrionic
addicts, writhing in apparent pain, who complain of horrible discomfort in the
presence of doctors from whom they hope to obtain narcotics but act normally
both before the visit and after.
·
He notes experiments in
which withdrawal symptoms were eliminated with placebo injections of saline
solution.
·
He cites the experiences
of patients who repeatedly receive large doses of narcotics for pain yet rarely
become addicted.
Medical texts agree that the physical symptoms caused
by abrupt withdrawal of opiates are not life-threatening and at their worst
resemble the flu. Just as the difficulty of giving up a heroin habit is
routinely exaggerated, so is the ease of acquiring one. You have to work quite
hard to become a bona fide heroin addict, says Dalrymple:
·
In fact, to judge by the
U.S. government's own survey data, the vast majority of people who try heroin
either never use it again, use it just a few times, or only use it
intermittently.
·
Even among heroin users,
the heroin addict is the exception.
·
Heroin is a minority
taste even among users of illegal drugs, who prefer marijuana by a factor of
about 50 to 1.
Source: Jacob Sullum, "Junk Medicine: Doctors,
Lies and the Addiction Bureaucracy," Economic Affairs, March 2008; based
upon: Theodore Dalrymple, "Junk Medicine: Doctors, Lies and the Addiction
Bureaucracy," Harriman House Publishing, August 27, 2008.
For more on Health Issues: www.ncpa.org/sub/dpd/index.php?Article_Category=16
* * * * *
7.
Overheard in the
Medical Staff Lounge: Practice Issues: Unnecessary Laboratory Costs
Dr. Edwards: I had
a patient who asked for all kinds of unnecessary tests. She couldn't understand
why she couldn't have every test that she wanted.
Dr. Milton: I
just show them the lab requisition with three columns of tests and ask which
ones they would like since it would cost more than $10,000 to get all of them.
I have my pen ready to start checking off the little boxes and wait for them to
answer. After a brief pause, they begin to realize that it's best to have a
physician navigate the waters for them.
Dr. Dave: I did
the same with a patient who wanted a number of x-rays and specialized body
scans without any symptoms or findings in any organs. With my pen ready, I
asked her to start. She replied, "My whole body."
Dr. Edwards: Good
idea that backfired. It's really such a simple solution. But it does put us in
a slightly adversarial relationship with our patient.
Dr. Milton: It's
just temporary and it actually improves the Doctor - Patient relationship
overall. If it doesn't, it's time to move on to another physician.
Dr. Michelle: That
sounds so cruel.
Dr. Milton: No,
it's more like tough love. You're doing the patient a favor not letting him be
his own physician, and driving up his insurance costs; you're doing the health
care system a great service by infusing some responsibility for costs; and
you're maintaining your physician ethics.
Dr. Ruth: I had
a patient where none of those tricks worked. She got very upset and assertive.
Said she will report me to her HMO if I didn't order them.
Dr. Sam: I
would then acquiesce and order every and any test her heart desired and let her
fight her own battles with her health insurers, HMOs, laboratory, and x-ray
facility.
Dr. Rosen: When
those places then call you for the justification, how do you get out of that
sticky wicket?
Dr. Sam: I
just tell the lab or whoever, there is none. This is what she wanted or she'd
report me.
Dr. Rosen: Have
you ever been reported?
Dr. Sam: Once.
And by the time I submitted all the paper work to the Medical Practice
Association and the HMO, I had five hours of work at no pay. Never again.
Dr. Rosen: And
if it goes to the Medical Board, that involves having an attorney handle it for
you. Most health care attorneys state, "Never respond personally to the
Medical Board, they are not your friends. Always let an attorney do that for
you."
Dr. Sam: But
isn't that expensive at $300 an hour?
Dr. Rosen: I
expect to spend at least a $2500 every time I interface with the Medical Board.
But that's better than losing the medical license that allows one to practice
and make a living.
Dr. Michelle: Wow!
You frighten me.
Dr. Rosen: It's
amazing that so many patients don't understand their relationship with their
insurers is a sticky wicket. They act as if the insurance carrier is their
parent and will cater to their whim. They don't understand that the insurance
company is doing their best to control costs. The Insurance carrier will bend
over backwards looking like they are helping their patients, whom they now call
members (as if part of a family), but are actually very hard nosed and will
maneuver out of doing them the best they can. Just look at the lawsuits in this
area.
Dr. Milton: And
few really appreciate the adversarial relationship of all members of the health
care team and establishment.
Dr. Sam: Why
are we all still practicing medicine?
Dr. Ruth:
Prestige. I no longer can make what my husband makes as an engineer.
Dr. Rosen: I
don't even make $40 an hour for my 3,000-hour work year.
Dr. Ruth: It's
one o'clock. I think it's time to get back to work at the office.
* * * * *
8.
Voices of
Medicine: A Review of Local and Regional Medical Journals
Bulletin of the California
Society of Anesthesiologists, Winter, 2008
www.csahq.org/pdf/bulletin/pres_57_1.pdf
Everest and Oxygen - Ruminations by
a Climber Anesthesiologist By David Larson,
M.D.
Gaining Altitude and Losing Partial Pressure with Dave and Samantha Larson
Dr. Dave Larson is an obstetric anesthesiologist who
practices at Long Beach Memorial Medical Center, and his daughter Samantha is a
freshman at Stanford University. Together they have successfully ascended the
Seven Summits, the tallest peaks on each of the seven continents, a feat of
mountaineering postulated in the 1980s by Richard Bass, owner of the Snowbird
Ski Resort in Utah. Bass accomplished it first in 1985. Samantha Larson, who
scaled Everest in May 2007 (the youngest non-Sherpa to do so) and the Carstensz
Pyramid in August 2007, is at age 18 the youngest ever to have achieved this
feat. . . .
The Larsons
have ascended Kilimanjaro, Elbrus, McKinley, Aconcagua, Kosciuszko, Everest,
Vinson, and Carstensz - eight peaks to qualify unequivocally for the Seven Summits
list of climbers. As of March 2007, 198 climbers have climbed all seven in
either the Bass or Messner lists, and a mere 30 percent climbed the eight peaks
required to complete both lists, as have the Larsons. What follows is a
personal account from Dr. Larson, a CSA member.
By Kenneth Y. Pauker, M.D., Associate Editor
Anesthesiologists, unique amongst all physicians, have
a special relationship to oxygen. We measure it obsessively in our patients,
and know from the tone of the pulse oximeter with every heartbeat just how
"full" of oxygen our patient's blood is. If it drops, we react
quickly to diagnose and treat the change. We are keen on 100 percent oxygen
saturation.
As an anesthesiologist and climber, my own personal
relationship with oxygen changed when I started climbing 8,000-meter peaks,
culminating with my summiting Mount Everest on May 17, 2007. At Everest's
29,032 foot summit - the highest point on earth - there is merely a third of
the partial pressure of oxygen that exists at sea level, and therefore just a
third of the amount of oxygen available for respiration. Alveolar pO2
is about 35 mm Hg and arterial pO2 is about 30 mmHg! While tackling
Everest requires a concatenation of incredible physical and mental stamina,
good weather, two months in the Himalayas, and luck, it is the body's process
of acclimatization to hypoxia that is fundamentally critical for success.
Anyone magically transported from sea level to 29,000 feet without
acclimatization would die from hypoxia within minutes. Time is required to
allow the body to adapt with physical processes that enable humans to survive
above 25,000 feet, the so-called "death zone." Even when fully
acclimatized, life above 25,000 feet is tenuous - you lose your appetite, your
weight plummets, you become lethargic, and muscle wasting ensues.
A rule of thumb is to ascend no more than 1,000 feet
per day, and then to take a rest day every other day to allow time for
acclimatization. The trek to Everest starts at about 9,000 feet, and hence
requires at least 30 days to reach 29,000 feet.
The first and most important compensatory change is an
increase in respiratory rate, which, by presenting an increased opportunity for
oxygen uptake in the pulmonary capillaries, increases oxygen delivery. Minute
ventilation increases in response to (a) stimulation of the peripheral
chemoreceptors (carotid bodies) by hypoxia and (b) a change in the central
chemical control of breathing, wherein hypoxia causes a reduction in CSF
bicarbonate, which of itself stimulates ventilation. Full respiratory
acclimatization requires about 45 days.
The second compensatory change is an increase in red
cell mass. Since oxygen is carried by red blood cells, the more the merrier.
Having more red blood cells increases oxygen-carrying capacity. Hypoxia induces
release of erythropoietin, which stimulates bone marrow to increase red blood
cell production. A significant increase in red cell mass takes weeks and
hemoglobin levels can increase from 14.5 g/dl to 20 g/dl.
A third physiologic compensation is the marked
leftward shift of the oxyhemoglobin dissociation curve. This increases the
affinity of hemoglobin for oxygen, which in turn enhances diffusion across the
blood-gas barrier and enhances oxygen loading in the pulmonary capillaries. The
curve is also shifted to the left by a marked respiratory alkalosis. On the
summit of Everest, minute alveolar ventilation is at least 40 liters per
minutes, arterial pH is about 7.7, and alveolar PCO2 is around 14.
KP: What about
increased 2,3-DPG? Doesn't this shift the curve to the right to facilitate
off-loading of oxygen in the tissues? Does this contribute to conditioning at
altitude or only at sea level? Is the curve left shifted in the lungs to pick
up oxygen and right shifted in the tissue to facilitate delivery?
DL: Animals that live in oxygen-deprived environments have
hemoglobins with high oxygen affinities. For example, fetal hemoglobin has a
p50 of 19 mm Hg, compared with a p50 of 27 in normal adult hemoglobin. 2,3-DPG
is a product of red cell metabolism. Increased 2,3-DPG in the red cell reduces
oxygen affinity of hemoglobin by increasing the chemical binding of the
subunits and converting more hemoglobin to the low affinity T form. The effect
of the profound respiratory alkalosis at extreme altitude overwhelms the small
decrease in oxygen affinity caused by the increased concentration of 2,3-DPG in
the red cells.
An increased oxygen affinity is advantageous at high
altitude because it assists in the loading of oxygen at the level of the
pulmonary capillaries. Moreover, at extreme altitude, metabolic compensation
for the respiratory alkalosis is slow, possibly because of chronic volume
depletion caused by dehydration.
The reality is that, at extreme altitudes, the blood
oxygen dissociation curve shifts progressively leftward (increasing oxygen
affinity of hemoglobin) primarily because of respiratory alkalosis. This effect
completely overwhelms the relatively small tendency for the curve to shift to
the right because of the increase in red cell 2,3-DPG. The oxygen gradient
between the blood and tissues must be so great that a small right shift in the
curve caused by increased 2,3-DPG is not particularly helpful in supplying
oxygen. The key is to facilitate oxygen loading in the pulmonary capillaries,
and this is dramatically enhanced by the marked left shift of the oxygen
dissociation curve caused by the extreme respiratory alkalosis.
Twenty-nine thousand feet is at the cusp of human
physiological ability to survive. I wanted all the help I could get. I breathed
oxygen through a recently developed high altitude climbers' mask called
"Top Out." This mask is designed with a 500 cc reservoir so that
although the flow rate is just two liters per minute, the first 500 cc of
intake is enriched with oxygen and is delivered to the most distal alveoli.
These new masks have been used for about four years and are a great improvement
over the old reservoir-less Russian climbing masks.
High altitude climbers have long used acetazolamide
(Diamox) to enhance and speed up acclimatization. Diamox is a carbonic
anhydrase inhibitor. Interference with CO2 transport is thought to
result in intracellular acidosis of cells of the central medullary
chemoreceptor. In this way, it acts as a respiratory stimulant. It also changes
CSF pH and causes a left shift of the O2 dissociation curve. It also
increases cerebral blood flow and cerebral pO2. Studies have shown
that it can reduce altitude deterioration. Acetazolamide also effectively eliminates
the disturbing Cheyne-Stokes or periodic respiration that frequently affects
climbers at high altitude and makes it easier to get a good night's sleep. Side
effects include paresthesias in the hands and feet, and mild diuresis. These side effects diminish with continued
use and are reduced by using a dose of 125 mg p.o. BID. Unfortunately,
inhibition of carbonic anhydrase in the tongue prevents the conversion of
carbon dioxide to carbonic acid (in fizzy drinks like beer), and the
acid-sensing taste buds are not activated. This makes beer taste awful.
Although dexamethasone has been shown to improve
acclimatization in combination with acetazolamide, most climbers view Decadron®
or "DEX" as a rescue drug, to be used only after one develops high
altitude pulmonary edema (HAPE) or high altitude cerebral edema (HACE).
Assiduous compliance with a thorough acclimatization strategy gives the highest
chance of success in reaching Everest's summit, as well as making the two-month
Himalayan sojourn considerably more pleasant.
I acclimatized well and suffered very few of the
symptoms of acute mountain sickness (AMS), which include headache, nausea,
insomnia, lethargy, loss of appetite, and dizziness. AMS portends the
potentially life-threatening conditions HAPE and HACE, and should be treated
with rest and analgesics. If symptoms do not resolve or progress, descent,
supplemental oxygen, and dexamethasone are necessary.
In spite of thorough acclimatization, I was still
hypoxic - for many weeks. I carried a portable aviation-type pulse oximeter
with me and measured my oxygen saturation until it became psychologically
uncomfortable - I did not want to know just how low it could go. At base camp,
17,500 feet, with one-half the partial pressure of oxygen compared to sea
level, my maximum oxygen saturation was 91 to 92 percent; and that was achieved
by hyperventilation in a standing position. At rest in a supine position
(sleeping), it was 84 to 88 percent. At camp 3 (24,000 feet), it was in the low
80 percent range at best. We breathed oxygen by facemask above 24,000 feet, but
the oxygen saturation was not greatly improved.
My "summit day" was 20 hours long and
started at 11 p.m. after a fitful four-hour rest at the South Col (camp 4) at
26,000 feet. I had only been able to drink about a liter of fluid and brought
1.5 liters of liquid with me. We had a good weather window, which means high
barometric pressure and hence more oxygen availability. I headed out in
darkness for the summit. Despite using supplemental oxygen at two liters per
minute via "Top Out" mask, I occasionally experienced hypoxic panic
after finishing an especially vigorous move such as climbing the Hillary step
just before the final summit ridge. After struggling up the Hillary step, I
laid down in the snow, breathing 60 times per minute and with a horrible
sensation of absolute suffocation. I reached deep into my mind and was able to
hear my voice saying, "Slow down. Take it easy," and I fully regained
my equilibrium.
I recovered and made my way to the summit, avoiding
the precipitous 6,000-foot drop into Tibet. It is here where you take 10 deep
breaths for every step, and rest after every step. I do not know what my oxygen
saturation was, but I do know that I was on the edge of viability and critically
dependent on my oxygen canister. A sudden failure of an oxygen delivery system
can cause hypoxic panic, extreme hyperventilation, limb paresthesias, and
urinary incontinence. Supplemental oxygen clearly increases the chance of
success and survival by increasing endurance and climbing speed. When I finally
reached the summit, I sat down and rested, and I felt great - figuratively and
literally on top of the world. However, with any exertion my body would
immediately react with hyperventilation. In spite of the high altitude hypoxia,
and save for my few episodes of utter hypoxic panic, I felt fantastic - truly
high as a kite. I knew where I was at each moment and can remember each step,
although many were indistinguishable from their predecessors. It was a thrill
and an honor to be on the top of Everest. . .
To continue this physiologic discussion, find out what
it's like being back in the OR, answer the question, "Why climb?,"
and read the references, go to www.csahq.org/pdf/bulletin/everest_57_1.pdf.
To read more VOM, go to www.healthcarecom.net/voicemed.htm.
* * * * *
9. Book Review: Current Books: Rapturous Lightning by
Colleen Foy Sterling, MD
SONOMA MEDICINE, the
Magazine of the Sonoma County Medical Association, Spring 2008
Musicophilia, by Oliver Sacks, MD, 400 pages, Knopf, $26.
Dr. Oliver
Sacks has been writing about the wonderful world of neurology for many years. Before
I went into medicine, I enjoyed one of his early books, The Man Who Mistook
His Wife for a Hat. The title alone tickled me, and I still enjoy seeing
the book on my bookshelf. So when I opened his latest creation, Musicophilia,
I settled in for an enjoyable performance. What I found was more like an
invitation to an intimate conversation with a sage and experienced colleague in
the medical arts. . .
In the first chapter of Musicophilia, "A
Bolt from the Blue," Sacks playfully muses about the lucky people who are
suddenly overcome with musical passion. Most impressive is the case of an
orthopedic surgeon who is struck by lightning and reborn, via this near-death
experience, with an all-consuming "craving for piano music." The
craving starts with simply buying CDs by the pianist Vladimir Ashkenazy; it
ends with the orthopedist's new ability to hear and learn by ear almost any
classical music he wants. I tried to replicate this effect by setting my
Internet radio to Chopin, Janácek and Mendelssohn. Suddenly workmates were
stopping by and inquiring as to the source of my inspirational soundtrack. I
even started playing music in my exam rooms. The patient response was
overwhelmingly positive.
Sacks loves to relate anecdotes about life-altering
experiences, and these made me realize how blocked our brains are from taking
in new things, new ways of seeing, of hearing. Daily we work with patients who
feel it is "too late to change their ways, too late to modify a life-long
habit, too late to pick up a new skill or to recover from a neurologic
event." As Sacks observes, the acquisition of a sudden passion, "a
rapture," could make anyone want to be struck by lightning.
The benefit of reading Sacks's work, rather than inviting
him over for an afternoon of conversation, was that I could put the book down,
savor passages, and let them sink in. I also could leaf through some of the
more tedious sections and move on to the next. "A Strangely Familiar
Feeling," "Musical Seizures" and "Fear of Music:
Musicogenic Epilepsy" are the obvious result of years of collecting
correspondence and case reports (from his own mother, his practice and
historical sources) of epileptic phenomena manifesting in any form related to
music. Epilepsy is one of Sacks's clinical specialties, and perhaps this
collection of cases was originally even the inspiration for the book. . .
Musicophilia will
reawaken and rekindle an appreciation for the ways in which music floods and
flows through our brains. The implications for patient care and symptom interpretation
are many. Hope springs forth, and it is mind-bending to contemplate the
possible role of music for rehabilitation, recovery and remodeling of behaviors
in ourselves and in our patients.
As a musician, physician and philosopher, Sacks has
written a book that stimulates and reinvigorates how we see our patients and
their potential for life, change and growth.
To read the entire review, go to www.scma.org/magazine/scp/SP08/foy-sterling.html.
Dr. Foy Sterling, a family physician
at Kaiser Santa Rosa, serves on the SCMA Editorial Board.
To read more book reviews, go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
To read book reviews topically, go to www.healthcarecom.net/bookrevs.htm.
* * * * *
10. Hippocrates & His Kin: The Medical MarketPlace
Allergy Medications
Claritin, a modern non-sedating antihistamine, was
about $4 a pill two years ago or $120 for a 30-day, one-month supply. Recently,
I noticed that it was OTC at Sam's Club and 300 pills or a 10-month supply was
$12. In case you missed the math: it has gone to one-tenth as much for a
10-month supply as previously for a one-month supply. Isn't the Medical
MarketPlace the best thing that has happened in health care?
Now, how do we get the government out of the
pharmaceutical business and let the marketplace bring the costs down to where
we can afford it? Every member of Congress spends $4.5 million a year on
running their office and staff. Each member of Congress could have spent $1
million dollars worth of staff time per year to try to bring about a 10 percent
reduction. Free enterprise brought about more than a 99 percent reduction in
the first year of generic Rx. ($120 per month to $1 per month).
The answer to the health care dilemma is obvious: Get
the government out of it.
Telling it like it is.
State Senator Dave Cox was
asked about the Democrats tax proposal to raise revenue. Senator Cox said the
State of California had no revenue problem since state revenue has increased
from $50 billion to $100 billion just during the 10 years he's been in office.
We have a spending problem.
Every tax increase has moved
the economy in exactly the opposite direction, according to Cox.
Government Hallucinations
Political Columnist, Dan Walters, says perusing the
state budget is not unlike Alice on her plunge down a rabbit hole into
Wonderland, a world where up is down, down is up and what appears to be true is
often false. We are routinely force-fed numbers from those who have a political
interest in making them add up a certain way. And the more they assure us that
they're not using any gimmicks, the more suspicious we become.
Borrowed money is counted as revenue, payments due in
one fiscal year are magically transported into another year, income is
inflated, liabilities are minimized, increases in spending are characterized as
cuts, and accounting is constantly shifted between cash and accrual basis.
He had to go to the state controller's office to see
the actual cash reports of real money coming in and what was paid out and found
the $7 billion short fall. The state legislature's budget office projects what
they think should happen but seldom does.
We should know we cannot trust Government. They would
also destroy health, if they controlled it.
To read more HHK, go to www.healthcarecom.net/hhk2001.htm.
To read more HMC, go to www.delmeyer.net/hmc2005.htm.
* * * * *
11. Physicians 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.
•
PATMOS EmergiClinic - where Robert Berry, MD, an emergency
physician and internist practices. To read his story and the background for
naming his clinic PATMOS EmergiClinic - the island where John was exiled and an
acronym for "payment at time of service," go to www.emergiclinic.com. To read more on
Dr Berry, please click on the various topics at his website.
•
PRIVATE
NEUROLOGY is a Third-Party-Free
Practice in Derby, NY with
Larry Huntoon, MD, PhD, FANN. http://home.earthlink.net/~doctorlrhuntoon/.
Dr Huntoon does not allow any HMO or government interference in your medical
care. "Since I am not forced to use CPT codes and ICD-9 codes (coding
numbers required on claim forms) in our practice, I have been able to keep our
fee structure very simple." I have no interest in "playing
games" so as to "run up the bill." My goal is to provide
competent, compassionate, ethical care at a price that patients can afford. I
also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT
THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept
totally private and confidential - in accordance with the Oath of Hippocrates.
Since I am a non-covered entity under HIPAA, your medical records are safe from
the increased risk of disclosure under HIPAA law.
•
Michael J. Harris, MD - www.northernurology.com - an active member in the
American Urological Association, Association of American Physicians and
Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry
practice in urology in Traverse City, Michigan. He has no contracts, no
Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally
recognized for his medical care system reform initiatives. To understand that
Medical Bureaucrats and Administrators are basically Medical Illiterates
telling the experts how to practice medicine, be sure to savor his article on
"Administrativectomy:
The Cure For Toxic Bureaucratosis."
•
Dr Vern Cherewatenko concerning success in restoring private-based
medical practice which has grown internationally through the SimpleCare model
network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service,
the "Cash-Based Revolution." The patient pays in full before leaving.
Because doctor charges are anywhere from 25–50 percent inflated due to
administrative costs caused by the health insurance industry, you'll be paying
drastically reduced rates for your medical expenses. In conjunction with a
regular catastrophic health insurance policy to cover extremely costly
procedures, PIFATOS can save the average healthy adult and/or family up to
$5000/year! To read the rest of the story, go to www.simplecare.com.
•
Dr David MacDonald started Liberty Health Group. To compare the
traditional health insurance model with the Liberty high-deductible model, go
to www.libertyhealthgroup.com/Liberty_Solutions.htm.
There is extensive data available for your study. Dr Dave is available to speak
to your group on a consultative basis.
•
Madeleine
Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in
health care, has died (1937-2006).
Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html.
She will be remembered for her
important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the
government's efforts in criminalizing medicine. For other OpEd articles that
are important to the practice of medicine and health care in general, click on
her name at www.healthcarecom.net/OpEd.htm.
•
David J
Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the
free Medical MarketPlace in speeches and writings. His series of articles in Sacramento
Medicine can be found at www.ssvms.org. Read his "Lessons from the Past."
For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.
•
Dr
Richard B Willner,
President, Center Peer Review Justice Inc, states: We are a group of
healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have
experienced and/or witnessed the tragedy of the perversion of medical peer review
by malice and bad faith. We have seen the statutory immunity, which is provided
to our "peers" for the purposes of quality assurance and
credentialing, used as cover to allow those "peers" to ruin careers
and reputations to further their own, usually monetary agenda of destroying the
competition. We are dedicated to the exposure, conviction, and sanction of any
and all doctors, and affiliated hospitals, HMOs, medical boards, and other such
institutions, which would use peer review as a weapon to unfairly destroy other
professionals. Read the rest of the story, as well as a wealth of information,
at www.peerreview.org.
•
Semmelweis
Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD,
FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD,
Secretary-Treasurer; is
named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician
who has been hailed as the savior of mothers. He noted maternal mortality of
25-30 percent in the obstetrical clinic in Vienna. He also noted that the first
division of the clinic run by medical students had a death rate 2-3 times as
high as the second division run by midwives. He also noticed that medical
students came from the dissecting room to the maternity ward. He ordered the
students to wash their hands in a solution of chlorinated lime before each
examination. The maternal mortality dropped, and by 1848, no women died in
childbirth in his division. He lost his appointment the following year and was
unable to obtain a teaching appointment Although ahead of his peers, he was not
accepted by them. When Dr Verner Waite received similar treatment from a
hospital, he organized the Semmelweis Society with his own funds using Dr
Semmelweis as a model: To read the article he wrote at my request for
Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the
California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some
very interesting letters to the editor from the Medical Board of California,
from a member of the MBC, and from Deane Hillsman, MD.
To view
some horror stories of atrocities against physicians and how organized medicine
still treats this problem, please go to www.semmelweissociety.net.
•
Dennis
Gabos, MD, President of
the Society for the Education of Physicians and Patients (SEPP), is
making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms
and Responsibilities of Patients and Health Care Professionals. For more
information, go to www.sepp.net.
•
Robert J
Cihak, MD, former
president of the AAPS, and Michael Arnold Glueck, M.D, write an
informative Medicine Men
column at NewsMax. Please log on to review the last five weeks' topics or click
on archives to
access the last two years' topics.
•
The Association of
American Physicians & Surgeons (www.AAPSonline.org)
The Voice for Private Physicians since 1943, representing physicians in their
struggles against bureaucratic medicine, loss of medical privacy, and intrusion
by the government into the personal and confidential relationship between
patients and their physicians. Be sure to read News of the Day in
Perspective: 32,000
scientists dissent from global-warming "consensus." Don't
miss the "AAPS News," written by
Jane Orient, MD, and archived on this site which provides valuable information
on a monthly basis. Be sure to read Electronic Panacea,
about the perils of electronic medical records. Scroll further to the official
organ, the Journal of American Physicians
and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York,
as the Editor-in-Chief. There are a
number of important articles that can be accessed from the Table of Contents page of the
current issue. Don't miss the excellent articles from Sweden's Health Care
Crypt by 0Sven Larson, PhD or the extensive book review section which covers
eight great books in this issue.
* * * * *
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Del Meyer
Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Words of Wisdom
Most people would rather be certain they're miserable, than
risk being happy. -Robert Anthony
In the confrontation between the
stream and the rock, the stream always wins - not through strength but by
perseverance. -H. Jackson Brown,
Jr.
There is nothing impossible to him who will try. -Alexander the
Great, 356-323
B.C., King of Macedonia.
Some Recent or
Relevant Postings
Bill Coda: www.healthcarecom.net/BillCoda.DHM.htm
Restaurants for the Hearing Impaired: medicaltuesday.blogs.com/
In Memoriam
Albert Hofmann, chemist, died on April 29th, aged 102, From The Economist, May 8th 2008
HIS first experience was "rather agreeable". As he
worked in the Sandoz research laboratory in Basel in Switzerland on April 16th
1943, isolating and synthesising the unstable alkaloids of the ergot fungus,
Albert Hofmann began to feel a slight lightheadedness. He could not think why.
His lab was shared with two other chemists; frugality and company had taught
him careful habits. And this was a man whose doctoral thesis had revolved
around the gastrointestinal juices of the vineyard snail.
Perhaps, he supposed, he had inhaled the fumes of the solvent he
was using. In any event, he took himself home and lay down on the sofa. There
the world exploded, dissolving into a kaleidoscope of colours, shapes, spirals
and light. It seemed to have something to do with lysergic acid diethylamide,
LSD-25, the substance he had been working on. He had synthesised it five years
before, but had found it "uninteresting" and stopped. Now, like some
prince in faery, he had got the stuff on his fingertips, rubbed it into his
eyes and seen the secrets of the universe.
The next Monday, ever the good scientist, he deliberately took
0.25 milligrams of LSD diluted with 10cc of water. It tasted of nothing. But by
5 o'clock the lab was distorting, and his limbs were stiffening. The last words
he managed to scrawl in his lab journal were "desire to laugh". That
desire soon left him. As he cycled home with a companion, perhaps the most
famous bike ride in history, he had no idea he was moving. But in his house the
furniture was ghoulishly mutating and spinning, and the neighbour who brought
him milk as an antidote was "a witch with a coloured mask". He
realised now that LSD was the devil he couldn't shake off, though in his
senseless body he screamed and writhed on the sofa, certain that he was dying.
After six hours it left him. The last hour was wonderful again,
with images "opening and then closing themselves in circles and spirals,
exploding in coloured fountains." Each sound made colours. His doctor
found nothing physically wrong with him, except for extremely dilated pupils.
The substance evidently left the body quickly, and caused no hangover. But the
mind it flung apart, reassembled and profoundly changed, leaving him the next
morning as fresh as a newborn child.
Over the next decades, Mr Hofmann took an awful lot of LSD. . .
It proved disastrous for him that Timothy Leary at Harvard had the
same idea. When the professor told his students in the 1960s that LSD was the
route to the divine, the true self and (not least) great sex, use of the drug
became an epidemic. People ingested it, in impure forms, from sugar cubes and
blotting paper. They blamed it for accidents, murders and wild attempts to fly.
The media flowered in psychedelic shades of orange, purple, yellow and green,
and in the melting shapes and dizzying circles of a world gone almost mad. Mr
Hofmann in 1971 met Leary in the snack bar at Lausanne station; he found him a
charmer, but because of his carelessness LSD had by then been banned in most
countries, and production and research had been stopped. They never resumed. .
.
Without it, however, Mr Hofmann knew it was still possible to get to
the same place. As a child, wandering in May on a forest path above Baden in a
year he had forgotten, he had suddenly been filled with such a sense of the
radiance and oneness of creation that he thought the vision would last for
ever. "Miraculous, powerful, unfathomable reality" had ambushed him
elsewhere, too: the wind in a field of yellow chrysanthemums, leaves in the
sunlit garden after a shower of rain. When he had drunk LSD in solution on that
fateful April afternoon he had recovered those insights, but had not surpassed
them. His advice to would-be trippers, therefore, was simple. "Go to the
meadow, go to the garden, go to the woods. Open your eyes!"
Albert
Hofmann
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www.economist.com/obituary/PrinterFriendly.cfm?story_id=11328656
On This Date in
History - May 27
On this date in 1923, Henry Kissinger was
born in Furth, Germany. If
he had stayed in Germany, history would have taken a different turn. But,
thanks to the need to flee from Nazi oppression, he and his family came to the
United States as refugees, and Henry Kissinger grew up to be one of the most
celebrated American Secretaries of State. He made history just by becoming
Secretary of State, the first of his faith - and the first to speak with a
German accent.
On this date in 1647, Achsah Young hanged
as witch in Massachusetts. She
became the first person inscribed in the annals of America for being executed
as a witch. Today we sanitize the name as witchcraft, organize cults around
some of them and suggest sanity tests for others.
On this date in 1818, Amelia Bloomer was
born in Hiram, New York.
Remembered in history mainly for an article of feminine clothing, now long out
of fashion, Amelia Bloomer was one of the early crusaders for women's rights,
feeling that the way women dressed handicapped them. She began wearing
trousers.
After Leonard and
Thelma Spinrad