MEDICAL TUESDAY . NET

NEWSLETTER

Community For Better Health Care

Vol VII, No 4, May 27, 2008

 

In This Issue:


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

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MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE's SiCKO

Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the truth about socialized medicine. Clements is the former publisher of "American Venture" magazine who made news in 2005 for a property rights project against eminent domain called the "Lost Liberty Hotel."
For more information visit
www.sickandsickermovie.com or email logan@freestarmovie.com.

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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.

 

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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

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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

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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

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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.

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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 text: www.blackwell-synergy.com/action/showFullText?submitFullText=Full+Text+HTML&doi=10.1111%2Fj.1468-0270.2008.00813_5.x&cookieSet=1 

For more on Health Issues: www.ncpa.org/sub/dpd/index.php?Article_Category=16

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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.

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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 Decadronฎ 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.

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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, Janแcek 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.

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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.

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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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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

Reuters

 

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