|
MEDICAL TUESDAY . |
NEWSLETTER |
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Community For Better Health Care |
Vol IX, No IX,
August 9, 2011 |
In This Issue:
1.
Featured Article:
A Dearth of New Meds
to treat neuropsychiatric disorders
2.
In
the News: What Happened to Obama? .
. In London? . . In Iowa? . . In the Courts?
3.
International Medicine: That
intergenerational sleight of hand worked for a while
4.
Medicare: Political Interference
with Health Care increases Costs
5.
Medical Gluttony:
This time it
started on a Rapid Transit Bus
6.
Medical Myths: Losing consciousness in
a ball room is always an emergency.
7.
Overheard in the Medical Staff Lounge: A different crop
of patients in the health care field.
8.
Voices
of Medicine: The Caterpillar
Syndrome by SCOTT SATTLER, M.D.
9.
The Bookshelf: The 9/11 Wars Is
The West Any Wiser, Ten Years On?
10.
Hippocrates
& His Kin: The Eyes of Texas are
Upon Us
11.
Related Organizations: Restoring Accountability in HealthCare, Government and Society
Words
of Wisdom, Recent Postings, In Memoriam, Today in History . . .
*
* * * *Brazil
Announcing
The 1st Annual World Health Care Congress
The World Health Care Congress (WHCC)
convenes the most prestigious forum of global health industry executives and
public policy makers. Building on the 8th annual event in the
This prominent international forum is the
only conference in which over 500 leaders from all regions of Latin America
will convene to address access, quality and cost issues, including Latin
American health ministers, government officials, hospital/health system
executives, insurance executives, health technology innovators, pharmaceutical,
medical device, and supplier executives.
World Health Care Congress Latin America will address escalating challenges such
as improving access to quality care, financing and insurance models for health
care, driving innovation in health IT, promoting evidence-based medicine and
clinical best practices. World Health Care Congress Latin America will
feature a series of plenary keynotes, invitational executive Summits, in-depth
working group sessions on emerging issues, as well as substantial business
development and networking opportunities.
For
more information on the World Health Care Congress Latin America . . .
For information on the 9th
Annual World Health Care Congress on April 16-18, 2012 . . .
*
* * * *
1.
Featured
Article: A Dearth of New Meds
to treat neuropsychiatric disorders
Drugs to treat neuropsychiatric
disorders have become too risky for Big Pharma
| Scientific
American | August 9, 2011
Schizophrenia, depression, addiction and other mental
disorders cause suffering and cost billions of dollars every year in lost
productivity. Neurological and psychiatric conditions account for 13 percent of
the global burden of disease, a measure of years of life lost because of
premature mortality and living in a state of less than full health, according
to the World Health Organization. Read more . . .
Despite the critical need for newer and better
medications to treat a range of psychiatric and neurodegenerative diseases,
including Alzheimer’s and Parkinson’s, drugs to treat these diseases are just
too complex and costly for big pharmaceutical companies to develop. The risk of
spending millions on new drugs only to have them fail in the pipeline is too
great. That’s why many big drug companies are pulling the plug on R&D for
neuropsychiatric and other central nervous system (
Our team at the Tufts Center for the Study of Drug
Development has arrived at this conclusion after conducting surveys of
pharmaceutical and biotechnology companies about the drug development process.
These surveys allow us to generate reliable estimates of the time, cost and
risk of designing new drugs. Our analyses show that central nervous system
agents are far more difficult to develop than most other types.
One of the problems with neuropsychiatric drugs is that
they take so long to develop. A
Few compounds survive this gauntlet. Only 8.2 percent of
What makes these drugs so risky? Assessing whether or not
a candidate for, say, a new antibiotic works is relatively
straightforward—either it kills the bacterium or it doesn’t—and a course of
treatment typically lasts a few days, which obviates the need for long-term
testing for safety and efficacy.
Disclosure: The Tufts Center for the Study
of Drug Development is funded in part by unrestricted grants from
pharmaceutical and biotechnology firms.
Read
the entire article on Scientific American
– Subscription required . . .
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*
* * * *
2.
In the
News: What Happened to Obama? .
. In London? . . In Iowa? . . In the Courts?
We can no
longer remain politically neutral if we want to salvage our healthcare from Government
Control. We are going the way of Bismarck’s & Napoleon’s entitlements of
two centuries ago.
That is why
my own answer to the question, "What Happened to Obama?" is that
nothing happened to him. He is still the same anti-American leftist he was
before becoming our president, and it is this rather than inexperience or
incompetence or weakness or stupidity that accounts for the richly deserved
failure both at home and abroad of the policies stemming from that
reprehensible cast of mind.
Mr. Podhoretz was the editor of Commentary from 1960 to 1995. His most recent book is "Why Are
Jews Liberals?"
Read
the entire OpEd in the WSJ – Subscription required
Read
the entire report in the WSJ – Subscription required
Health
Overhaul Is Dealt Setback By BRENT KENDALL
A U.S.
appeals court in Atlanta handed the Obama administration its biggest defeat to
date in the battle over the health-care overhaul passed last year, ruling the
law's mandate on Americans to carry health insurance was unconstitutional. . .
.
Read
the entire report in the WSJ –
Subscription required
The riots in
Britain left some Americans shaken. In the affluence of the past 40 years, and
with the rise of the jumbo jet, we became a nation of travelers. We have been
to England, visited a lot of those neighborhoods. They were peaceful; now
they're in flames. But something else raised our unease as we followed the
story on TV and on the Net. I think there was a ping on the national radar. We
saw something over there that in smaller ways we're starting to see over here.
The British
press, left, right and center, was largely united in a refusal to make
political excuses for the violence. Almost all agreed on the cause and nature
of what happened. The cause was not injustice; this was not a revolt of the
downtrodden masses, breaking into stores looking for food. The causes were
greed, selfishness, a respect and even lust for violence, and a lack of moral
grounding. Conscienceless predators preyed upon the weak. The weak were anyone
who happened to be passing by . . .
Read the entire OpEd in
the WSJ – Subscription required
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*
* * * *
3.
International
Medicine: That
intergenerational sleight of hand worked for a while
Author: Mark
Milke
Appeared in the Calgary Herald
The latest deals to “save”
American and Greek public finances—allowing those countries to put themselves
into even deeper debt—should puncture the illusion the welfare state was ever a
success. The fact is, it was always built on borrowed time and borrowed money. Read more . . .
That intergenerational sleight of hand worked for a while. Successive post-war
generations went to the doctor, availed themselves of government services,
built roads and enjoyed other partially debt-financed benefits.
Problematically, they handed part of the bill for the same to future
generations. It’s akin to buying an expensive home and handing the delayed
mortgage payments to your kids when they turn eighteen.
Greece is merely the most dramatic example of this intergenerational public
finance “con job.” The recent European Union deal for
In 1995, Greece’s net liabilities
already amounted to 81 per cent of
Fast forward to 2011 and all the countries on that list are deeper in debt as a
percentage of
In
For the record, the fault for the ramped-up public debt cannot be placed on
“too low” taxes. A variety of countries with widely differing tax levels all
continued to borrow massively over that period.
For example, since 1995, and as a percentage of its economy, Greece’s total tax
take has been about one-eighth to one-fifth higher than the United States
(depending on the year). But high-tax Greece put itself into more debt as did
the (relatively) low-tax U.S. Or consider the UK; its tax rates rose steadily
since 1995 but so too its red ink problem.
In other words, the assumption that higher tax revenues will save a country
from its spending and borrowing addiction is mistaken. That’s not any more
likely than a modest raise for a consumer maxed out on her credit cards whose
real problem is overspending.
Besides, higher tax rates do not necessarily equal higher revenues when
compared with a moderately taxed nation. A high-tax, inefficient tax
regime can slow economic growth and encourage tax cheating and depress tax
receipts—another one of Greece’s many problems, actually.
In Canada, despite our relatively low net debt-to-
Looking back over post-war years, there were always alternative policy options
to the welfare state, ones that would still have provided security to citizens
in Europe, the U.S. and Canada. For starters, options included mandated private
savings accounts for health and pensions. Had such accounts been started
decades ago, each generation would have been forced to finance its own major
social benefits through pre-funding. This would have been superior to the
intergenerational transfer of wealth through the politicized tax-and-spend
system.
Instead, for decades, government borrowed massively to finance current social
programs out of future tax revenues and handed the bill to future generations.
It led to the illusion that the welfare state was sustainable.
Mark
Milke is the Director of Alberta Policy Studies at the Fraser Institute. He
also manages the Fraser Institute’s Centre for the Study of Property Rights
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Canadian
Medicare does not give timely access to healthcare, it only gives access to a
waiting list.
--Canadian Supreme Court Decision 2005
http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
*
* * * *
4.
Medicare: Political Interference
with Health Care increases Costs
ObamaCare
threatens solvency of Colorado health plans
By: John R. Graham, Director, Health Care
Studies, Pacific Research Institute
The Pueblo Chieftan
ObamaCare
encourages state politicians to increase their interference with
health-insurance premiums.
In 2008 Colorado passed a law giving the Division of Insurance the power to
deny premium hikes. To enhance this power, known as "prior approval,"
ObamaCare gave Colorado a $1 million grant last year to hire more insurance
analysts to review rates.
There is no evidence, however, that such power reduces the growth of premiums
below those observed in states where insurance divisions wield no such power.
And the future wave of political interference threatens the solvency of health
plans in Colorado and other states. Read more . . .
Health plans pay medical claims from providers whose charges have been
rocketing skyward. ObamaCare doesn't give politicians control of fees that
providers charge to private health plans — nor should it. But simply imposing
political control over health plans' premiums does not keep a lid on health
costs.
In Massachusetts, the 2006 health reform ("Romneycare") led to
draconian limits on premium hikes. Using the power that his Colorado
counterpart received in 2008, the state's insurance commissioner refused 235 of
274 requested rate hikes for April 2010, and demanded that plans rebate premiums
that had already been paid. But medical costs in Massachusetts increased faster
after the new regulations than before.
Now Massachusetts' health plans are hemorrhaging cash, and a senior regulator
has described the mess as a "train wreck." [Romney was the Governor who engineered this train wreck. We must keep
him out of Washington, DC or the whole country will be in a train wreck.]
Suppose the increased resources and power flowing from ObamaCare cause the
Colorado Division of Insurance to "go rogue," as in the Bay State.
In a new study, “Bust or Bailout? The Future of Private Health Plans Under
ObamaCare,” I model Colorado health plans' future solvency under these
conditions — where government control causes health costs to increase, while
premiums are kept artificially low.
Although Colorado health plans are currently actuarially sound, the simulation
shows that five of the top 10 health plans (none involved in the study) would
be threatened with insolvency by 2017. The Kaiser Foundation Health Plan of
Colorado, largest in the state, would experience an underwriting loss as soon
as 2013, and face insolvency as soon as 2015. Of course, national carriers
might easily choose to exit Colorado. Aetna has already announced such a move.
Nor is there evidence that prior approval of premium increases has protected
consumers from unreasonable rate hikes. My study examines data on premiums and
premium-review laws for small-group premiums in 43 states in 2006 and 2008.
Nineteen states were "file-and-use," which means that health plans
must submit premium increases to the insurance commissioner, but he has no
power to reject them.
Twenty states required prior approvals of rate changes by the insurance
department, and four were unregulated. No connection is evident between prior
approval and a lower change in rates from 2006 to 2008, nor the absolute value
of rates in 2008. . .
The notion that politicians can control health costs is a conceit of the ruling
class. Health costs will only decline when patients, not politicians, directly
control more of our health spending. This cannot happen until President Obama's
health law is repealed. In the meantime, Colorado should reject politicized
control of insurance premiums.
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Government is not the solution to our
problems, government is the problem.
-
Ronald Reagan
* * * * *
5.
Medical
Gluttony: This
time it started on a Rapid Transit Bus
Mrs. Pinkerton, an 85-years-old lady had a
full day of shopping. She got on the rapid transit bus to go home. She leaned
against the window and dozed off. The lady behind her felt she had passed out
(don’t we all when we doze off?) and told the driver there was a lady slumped
over in a coma. He stopped the bus and called Emergency 911. Mrs. Pinkerton
awoke, noted all the commotion, and observed the activities. She was surprised
when the
She was wheeled into the Emergency Room
and was greeted by the nurse who took her vital signs. Her BP, pulse, respiratory rate, and body
temperature were all normal. She asked the nurse why she was here. The nurse
looked a little surprised and told her she had passed out and they would be
checking her out to make sure she was fine. In her fine British accent, noting
that her hat and veil were removed as well as her long gloves, hose and heels,
“I beg to differ with you.” The nurse, not wanting to challenge an elderly lady,
proceeded to establish an intravenous line, get saline running, and waited for
the doctor.
The doctor was there within minutes,
checked her over briefly by reading the nurse’s vital signs, noting that the
patient had a history of hypertension, gastro-esophageal-reflux disease (GERD),
irritable bowel syndrome (IBS) and asthma. He advised the RN to proceed with the
standard coma protocol, signed the standing orders, and she was whisked off to
the x-ray room and a brain CT was done. By this time, the ECG tech had finished
an electrocardiogram which was normal and the lab tech had drawn half dozen
tubes of blood. The brain CT scan was completed and sent to the home of the radiologist
on call while the Chest X-ray was being done. This was also transferred by Tele-Med.
Mrs. Pinkerton was then taken to the cardiac lab and an
She was then returned to the ER gurney to await
the results of all the test. Over the next two hours all the reports drifted in
and were normal.
When she was advised that she could go
home, she reminded them that she was out shopping, didn’t have a car, and was
riding the bus back to her house. So, since she was now stranded with no bus to
board, would they be so kind as to call that nice limousine with a nurse in the
back to take her home? They offered to call a cab but she declined stating the
hospital was so far out from her home that she couldn’t afford it. Although it
was near midnight, she asked them to call her daughter and awaken her and see
if she could come and take her home.
She was given the discharge papers with a
note to call her personal physician and be seen the next day.
When she came in, we obtained the entire
ER records by fax and went over them with the patient.
The history was as noted by the nurse. The
ER report was correct and corresponded to ours. The vital signs were again
normal. Our physical examination of the head, heart, lungs, abdomen, and
neurological exam of the cranial nerves, motor, sensory, reflexes and
coordination were all normal.
Reviewing the hospital record indicated that
their physical examination was also entirely normal.
The laboratory exam revealed a normal
complete blood count, normal electrolytes, normal prothrombin time, normal
kidney function, normal liver function, essentially normal urinalysis except
for 10-20 white and epithelial cells which would be normal for a lady this age.
(She probably was of the vintage that when she washed her vulva and urethra in
the shower or tub, she would close her eyes in a sense of propriety.)
Of the expensive studies we noted a normal
chest x-ray, normal electrocardiogram, normal Computerized Tomography scan of
her brain, a normal
The only recommendation was to have her
personal physician order a gastro-esophageal-duodenoscopy to evaluate her GERD
vs Peptic ulcer.
Of course, we wouldn’t think of subjecting
an 85-year-old female in excellent health to this procedure that was so well
and easily controlled with acid reducers and acid neutralizers.
We were unable to get the cost of this ER
visit, but it was certainly on the order of the $6,000 to $9,000 bills we’ve
seen for the past two or three years. The cost should have been zero if the
hysterical lady on the bus would just have let her doze for another 15 minutes
until she was home.
In
this case not one of the tests was necessary. And the final recommendation out
of the ER door for a $5,000 endoscopy procedure was totally illogical and
unnecessary.
Medical Gluttony, par excellante.
Editor’s Comment: We don’t wish to be critical of our ER physician colleagues who are
always in a difficult position with what walks through the door. They can’t
make a clinical decision based on a hysterical spouse, daughter or friend who
takes them to the emergency because of their hysteria. But this is a system
failure. May I indulge you in another similar case with a different outcome?
See Myths below . . .
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Medical Gluttony thrives in irresponsible Government
and Health Insurance Programs.
It Disappears with Appropriate Deductibles and
Co-payments on Every Service.
If this lady
had been told there was a 20% co-payment when she arrived and been asked for a
check or credit card for $120 co-payment, she was alert and oriented enough that
she would have demanded to be taken home immediately. This Gluttony would have
been stopped at the ER registration desk. This would be such a simple and easy
solution to the health care over-utilization problem. But it’s too simple for
lawyers in Congress who prefer 100 page laws over a one paragraph registration
protocol.
*
* * * *
6.
Medical
Myths: Losing
consciousness in a ball room is always an emergency.
I was a
guest at a Ball at the Sutter Club in Sacramento. In the foyer, a lady sitting
in a straight back chair, was slumping forward and sideways. The screaming
ladies got my attention and when I saw what was happening, I helped her to the
floor.
“Don’t
you want to get her back up in the chair?” someone shouted. I said no. That
would put her in a coma for sure. Her pulse was strong and her breathing was
steady on the floor. Read
more . . . The crowd gasped as the elderly lady was starting to move and
raise her head slightly. I told her to lie there for a few more minutes to let
her circulation stabilize. The circulation to her brain had probably been
somewhat diminished because of heat from the crowd, plus some alcohol, and
sitting bolt upright in a straight back chair which allowed the blood to her
brain to descend to the lower portions of her body much like edema of the legs.
By this time she started talking to some of her lady friends who were standing
and sitting next to her.
I
started to move back to my family, when I heard a lady say, “I still think we
should call an ambulance.”
So I
quickly moved back and sat down on the floor next to the lady who was now very
alert and somewhat jovial. She thanked me and I sat there a few more minutes
speaking with her to make sure I didn’t miss some important medical history
until much of the crowd vanished. I then
helped the lady to her chair. She made it easily. She maintained a good pulse
and strong breathing and I assured the ladies near by that she would be just
fine.
So I
took this opportunity to discuss what I did to those in attendance. The room
was stuffy and the lady had a few drinks and her blood pressure probably
dropping causing her to slump out of the chair. By putting her on the floor,
her head was level with her heart and the heart could basically loaf and still
get fresh blood to her brain even with a blood pressure that my have dropped to
90 or 80 or even less. It didn’t matter in the supine position since a blood
pressure of “even less” would still pump the blood loaded with oxygen to her
brain. After lying there for a few moments, she regained her cardiac output and
pressure very likely returned to normal despite not having any medical
equipment there to measure it. She did just fine.
It was
after the patient in the afore mention section came to the office (after her dozing
on the bus) that I realized that this lady could have had the same ER
experience. If a doctor happened to ride the rapid transit bus, then my Mrs.
Pinkerton could also have avoided the unnecessary hospitalization. The ultimate
health care cost savers depend on an intelligent, composed laity with a large
number of Allied Health specialists from
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Medical Myths originate when someone else pays the
medical bills and allow a trip to the ER.
Myths disappear when Patients pay Appropriate
Deductibles and Co-payments on Every Service and stop at the registration desk
when asked for the payment beforehand.
*
* * * *
7.
Overheard
in the Medical Staff Lounge: A different crop
of patients in the health care field.
Dr. Rosen: Has the nature of
your patients changed recently?
Dr. Sam: Those that are
assigned to us by the Independent Practice Associations change every month.
Dr. Dave: Isn’t that the
truth. Just after we got 300 welfare Medicaid patients dumped into our
practice, we are finding it difficult to find consulting physicians. Read more . . .
Dr. Rosen: Are you having
difficulty in finding just a few specialties uncovered?
Dr. Edwards: We’ve found a
number of specialties with hardly anyone taking referrals. This week we
couldn’t find a dermatologist for a patient with a difficult rash which was not
responding to the usual steroid creams.
Dr. Milton: The HMOs are
telling our patients they need a colonoscopy at age 50. We’re having difficulty
finding enough Gastroenterologists to see these patients. Some of our loyal
consultants who have seen our colon patients for decades are no longer taking
new GI patients with a combination HMO/Medicaid insurance profile.
Dr. Edwards: Just wait until
the ObamaCare dumps another 35 million patients into the Medicaid trenches
which are fast becoming cesspools as they succumb to ruptured appendices and
gall bladders and bowel obstructions with no one to care for them.
Dr. Milton: That’s how the
socialists got ObamaCare approved. When PEW did their stats on people with no
health insurance, the welfare/Medicaid people generally answered the poll as
not having health insurance. They did not see Medicaid as insurance. Ultimately
logical if you can’t find a doctor that is willing to see twice as many
patients per hour to break even, despite giving inferior care at seven minutes
a patient and increasing your risk for malpractice.
Dr. Rosen: Well, it’s
beginning to look like many of the new crop of patients in the field are no
longer worth harvesting. A farmer will plough his rice under if the cost of
harvesting exceeds the rewards of the crop. It looks like medicine has reached
this equinox. The financial rewards of seeing patients is beginning to exceed
the cost of seeing, evaluating, and spending hours on the phone to try to get
someone to do a procedure that the HMO demands being done. And if the procedure
doesn’t get done, the HMOs review your charts and do not return in their
quarterly distribution what they withheld from your reimbursement because of
what they perceive as poor clinical care when it was their unreasonable demands
that caused it.
Dr. Edwards: We are in the
Business-Professional world of commerce where lean marketing and lean health
care reigns supreme. We can’t spend so much time on the MUDDA of health care
that doesn’t facilitate quality.
Dr. Milton: We need more
business men in Congress and fewer attorneys as the first step in turning
health care around. Otherwise medicine will be place into increasing
restrictive legal straight jackets.
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The Staff Lounge Is Where Unfiltered Opinions Are
Heard.
*
* * * *
8.
Voices of Medicine:
A Review of Local and Regional Medical Journals
IN MY OPINION From the Humboldt-Del
Norte Medical Society
The Caterpillar
Syndrome by SCOTT SATTLER, M.D.
As a family practice doc for the past
thirty-odd years, I’ve had the opportunity to follow the births, lives and
deaths of many Humboldt County residents. One of the most humbling and rewarding
aspects of my practice has been its involvement with the intricacies of the
dying process and the medical and family dynamics involved. As a profession, we
don’t talk about this very much; not that it’s secret per se, but perhaps it’s
that we hold it as sacred. Most of us are shy when it comes to sharing these
things. Yet we can gain a great deal from looking in this direction, as it is
such an integral part of our practices and of our personal lives. Read more . . .
There is an aspect of the dying process
that I have observed on many occasions that begs for discussion and
contemplation. I wonder whether others
who are working with the dying have observed this phenomenon, and I wonder
whether, as you read this article, you might nod your head in recognition. Then again you might consider these musings
merely the dodderings of a chronologically gifted, eccentric airhead. I look
forward to your impressions and invite you to share them with me.
There is a Sufi saying that there is but
one major sacred book—the sacred manuscript of nature. The perception in this
editorial comes from observing one of nature’s wonders—caterpillars. After
hatching from its egg and devouring its eggshell, the caterpillar spends its
life exploring its favorite vegetation, eating, and growing. Then, at a given
point, it is as if it knows that it is time for its caterpillar life to end,
and there emerges an irresistible desire to prepare for its caterpillar demise.
“Been there. Done that. Got the fuzzy t-shirt. Time to move on…” might be its
driving motive. An internal switch is thrown; the desire to eat wanes and then
disappears, supplanted by a desire to find a secluded protected environment
where it will conclude its caterpillar life in relative safety. It finds the
underside of a twig on its favorite bush, wraps itself in its security-blanket
cocoon and surrenders to the overwhelming urge to release all aspects of its
caterpillar life, simply trusting that all is well and as it should be. And
then it dies to being a caterpillar.
I can almost imagine younger, more
energetic caterpillar friends urging it to eat, eat just a little, and perhaps
wanting it to stay involved with caterpillar community life. And in completion of this fantasy, I hear the
cocoon-spinner’s final plea to its more active companions: “If you really want
to help me, just keep the birds away.”
I think many humans do this, too. Over
the years I’ve noticed a similar pattern, especially in elders who have
recently survived the death of their lifelong mate. Quite often the surviving
spouse would unexpectedly die within six to eighteen months after their loved
one passed. When I talked with their families, I often heard a similar story,
namely that the surviving spouse had proceeded to wrap up the family business
after the funeral of their mate, had often mended any personal issues that
needed tending, and then simply withdrawn from societal obligations, reduced
their food and fluid intake, gotten the dwindles and simply died. It was as if
a switch in the core of their being had been triggered, and they knew that
their life as a human was drawing to its natural end. They were fully ready to move on, and all family
entreaties to “eat just a little more” were kindly ignored. They did not meet
the formal medical criteria for depression. They were not, on the whole, nearly
as unhappy as their families. I have seen this pattern of end-of-life behavior
time and time again. Sometimes the
triggering scenario is different. I often saw a similar pattern of behavior in
those diagnosed with end stage malignancies. When confronted with the reality
that long-term quality survival was no longer a realistic option, this pattern
often emerged. The gift of cancer, it seems, is that of Time. Unlike sudden
cardiovascular death, the incurable cancer patient is given a window of time
within which to do the necessary homework on the physical, mental and spiritual
planes if they so desire and if they are given the freedom and the opportunity
to do so. Read: “Keep the birds away.” Frequently this end-of-life-pattern
mimics the pattern described above, namely, that of the Caterpillar Syndrome.
I do not feel that this condition is
pathologic. There is little, if any disease on the part of the patient, unless
those caring for them induce this condition out of their own frustration,
anger, fear or greed. I have felt no
sense at all of suicidal ideation in these patients. Is the caterpillar being
suicidal when it attaches its silk purchase to the twig and starts to spin its
cocoon? To the contrary, my sense is
that this syndrome is a part of the ‘Death with dignity’ that we espouse so
repeatedly at the theoretic and institutional levels. As physicians we have a
hard time dealing with this. We have a
hard time remembering that our obligation of caring for patients begins and
ends with actual caring for our patients. This includes inquiring as to their
most heartfelt desires at this stage of life, and honoring them, supporting
them, and indeed protecting them from ‘the birds,’ namely those who would
impose a different scenario upon them for their own personal needs and
desires. We owe this to our patients,
for who can provide this service to them if not us?
www.sonic.net/~medsoc/images/bulletins/2010-06%20JUNE%20BULLETIN%20-%20WEB%20POST.pdf
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Is an Insider's View of What Doctors are Thinking, Saying and Writing about
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9.
Book
Review: The 9/11 Wars Is
The West Any Wiser, Ten Years On?
The Rise and Fall of Al-Qaeda. By Fawaz Gerges. Oxford
University Press USA; 272 pages; $24.95. To be published in Britain in
November; £12.99. Buy from Amazon.com, Amazon.co.uk
Rock the Casbah: Rage and
Rebellion Across the Islamic World. By Robin Wright. Simon &
Schuster; 307 pages; $26.99 and £17.99. Buy from Amazon.com, Amazon.co.uk
Cables from Kabul: The Inside
Story of the West’s Afghanistan Campaign. By Sherard Cowper-Coles. Harper
Press; 312 pages; £25. Buy from Amazon.co.uk
The 9/11 Wars. By Jason Burke. Penguin
Global; 709 pages; $16. Allen Lane; £30. Buy from Amazon.com, Amazon.co.uk
IS THE West any wiser, ten years on? Policymakers
certainly know more than they did on September 11th 2001—about the nature of
al-Qaeda, for example, and what drives young Muslims to emulate it—and have
shed at least some of their illusions about the West’s ability to shape the
Muslim world to its liking. But as these four very different books show,
salutary lessons have yet to be learned.
Anniversaries of the attacks on the twin towers prompt
the question: who’s winning? In the first and shortest of these books Fawaz
Gerges, a professor at the London School of Economics and author of several
studies of jihadism, argues that the West has won, but doesn’t realise it.
Al-Qaeda, he suggests, was never the monster many imagined it to be, and is now
a virtually spent force. The only thing that keeps it alive is fear stoked by
self-serving politicians and ignorant media. “A decade after September 11”, he
writes, “over-reaction is still the hallmark of the US War on Terror.” He has a
point, but is a little too quick to brush aside those experts who think
al-Qaeda still has some kick in it.
In “Rock the Casbah” Robin Wright goes further, arguing
that Islamist extremism has been thoroughly discredited and that a vibrant
counter-jihad is sweeping the Muslim world, exemplified most recently
in the Arab spring. Her book serves as a corrective. Commentators have spent a
decade bewailing the absence of tolerant, peace-loving Muslims ready to stand
up and be counted. But they were there all along, struggling to be heard. Now
Islam’s assorted bloggers, rappers, feminists and reformers have found in Ms
Wright, a former Washington Post journalist, a worthy chronicler. They
are so lively and likeable it seems churlish to suggest that she overrates
their importance.
Professor Gerges and Ms Wright both argue that the West
has done a poor job of understanding the Muslim countries where they have
intervened. Their case is powerfully reinforced by Sherard Cowper-Coles in
“Cables from Kabul”, published earlier this year. Sir Sherard, a former British
ambassador to Afghanistan, exposes the group-think—the belief that sufficient
military effort would bring success—that has blighted Western efforts there
over the past decade. Witty, urbane and shrewdly observed, his book is a
withering critique of Anglo-American delusions—and of official Afghan shortcomings.
It is also a vivid picture of the life of a British diplomat in a uniquely
challenging post.
In “The 9/11 Wars”, the biggest and most ambitious of
these books, Jason Burke says his aim is to provide “a grubby view from below”:
to focus on the ordinary people affected by conflict rather than on
decision-makers in far-off capitals. But his book does much more. Its 700-odd
pages attempt to knit together into a coherent whole the vast sprawling fabric
of the global “war on terror”.
This is a daunting task, yet Mr Burke largely
accomplishes it. His book is the best overview of the 9/11 decade so far in
print. It is also the summation of the career of a fine journalist (he works
for the Guardian and the Observer), a writer who, crucially
for his subject, knows South Asia as well as he knows the Middle East.
More than most authors (and for that matter most
politicians) Mr Burke is alert to the complex, multi-dimensional nature of what
he dubs the “9/11 wars”. He sees them as a messy, protracted conflict or series
of conflicts, spread over a wide geographical canvas, and possessing no clear
beginning or end. He has no time for ideological narratives, whether from
George Bush or Osama bin Laden, that reduce these wars to a neat slogan.
Equally nuanced is his characterisation of al-Qaeda and its ilk. He does not
see the group as some unified “axis of evil”, but as an “amorphous, dynamic and
fragmented movement based more on personal relations and a shared world view
than on formal membership of an organisation.”
Mr Burke agrees that al-Qaeda is weaker than it was a
decade ago and that its ideology has lost much of its appeal. But he is
unwilling to write its obituary just
yet. Having spent much time in the wilder parts of Afghanistan and
Pakistan—today the centre of the global struggle—he takes seriously the threat
al-Qaeda and its allies still pose to the governments of both countries. And,
like Sir Sherard, he is sceptical that the West is pursuing the right policies.
. .
If there is a seed of optimism in “The 9/11 Wars”,
however, it is in its diagnosis of the weakening, though markedly not the
demise, of al-Qaeda. The movement and its allies have not merely discredited
themselves through resorting to indiscriminate violence. With their Utopian
global agenda, far removed from everyday needs and grievances, they have in the
end alienated the very populations (in Iraq, Saudi Arabia, Jordan and
elsewhere) whose support they counted on. All politics is local: a banal
lesson, perhaps, but one that could have a significant bearing on the outcome
of this long twilight struggle.
Read
the entire book review at The Economist . . .
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more book reviews . . .
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The Book Review Section Is an Insider’s View of What
Doctors are Reading about.
*
* * * *
10. Hippocrates & His Kin: The Eyes of Texas are
Upon Us
With a Texan possibly becoming our next president,
we need to look what Law & Order looks like.
Sign on a Texas Ranch:
NO TRESPASSING:
TRESPASSERS WILL BE SHOT.
THOSE THAT SURVIVE WILL BE SHOT AGAIN.
Now That
Sounds Like a Very Effective NO TRESPASSING SIGN, Don’t you think?
Sign in a Texas Restaurant:
KEEP YOUR CHILDREN AT YOUR TABLE
IF THEY
WE WILL ALSO GIVE THEM A
Now That Should Give Every Mother a Grave Concern for Behavior, Don’t
you think?
Sign in a Ford Truck Dealership:
IF YOU
YOU SHOULD GO BACK TO WHERE YOU CAME
FROM.
Now that’s a welcome you won’t soon forget!
To read more HHK
. . .
To
read more HMC . . .
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Hippocrates
and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow
*
* * * *
11. Organizations Restoring Accountability in HealthCare,
Government and Society:
•
The National
Center for Policy Analysis, John C
Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick
wrote Lives at Risk, issues a
weekly Health Policy Digest, a health summary of the full NCPA
daily report. You may log on at www.ncpa.org and register to receive one or more
of these reports. This month, read about consumer directed health care . . .
•
Pacific
Research Institute, (www.pacificresearch.org) Sally
C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription
newsletter, which is very timely to our current health care situation. You may
signup to receive their newsletters via email by clicking on the email tab or directly access their health
care blog. This month read
about: Big Government and Health-Care Stocks . . .
•
The Mercatus
Center at George Mason University (www.mercatus.org)
is a strong advocate for accountability in government. Maurice McTigue, QSO,
a Distinguished Visiting Scholar, a former member of Parliament and cabinet
minister in New Zealand, is now director of the Mercatus Center's Government
Accountability Project. Join
the Mercatus Center for Excellence in Government. This month, read their
research: No
Correlation Between State Unemployment and Stimulus Funds Received . . .
•
To read the rest of this column, please go to www.medicaltuesday.net/org.asp.
•
The
National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision
Statement: Every American will have access to private sector solutions for
health, financial and retirement security and the services of insurance
professionals. There are numerous important issues listed on the opening page.
Be sure to scan their professional journal, Health Insurance Underwriters
(HIU), for articles of importance in the Health Insurance MarketPlace. The HIU magazine, with Jim
Hostetler as the executive editor, covers technology, legislation and product
news - everything that affects how health insurance professionals do business.
•
The Galen
Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent
every Friday to which you may subscribe by logging on at www.galen.org.
A study of purchasers of Health Savings Accounts shows that the new health care
financing arrangements are appealing to those who previously were shut out of
the insurance market, to families, to older Americans, and to workers of all
income levels. This month, you might focus on the Rough Week that ObamaCare had . . .
•
Greg Scandlen, an expert in Health Savings Accounts (HSAs), has
embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the
initial series of his newsletter, Consumers Power Reports.
Become a member of CHCC, The
voice of the health care consumer. Be sure to read Prescription for change:
Employers, insurers, providers, and the government have all taken their turn at
trying to fix American Health Care. Now it's the Consumers turn. Greg has
joined the Heartland Institute, where current newsletters can be found.
•
The Heartland
Institute, www.heartland.org,
Joseph Bast, President, publishes the Health Care News and the Heartlander. You
may sign up for their
health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?. This month take an overview of recent months of Health Care News . .
.
•
The Foundation
for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty,
Freedom's Magazine, for over 50 years, with Lawrence W Reed, President, and Sheldon
Richman as editor. Having bound copies of this running treatise on
free-market economics for over 40 years, I still take pleasure in the relevant
articles by Leonard Read and others who have devoted their lives to the cause
of liberty. I have a patient who has read this journal since it was a
mimeographed newsletter fifty years ago. Be sure to read about Freedom University
offers an introductory, interdisciplinary, comprehensive overview of the
workings of a free society
•
The Council
for Affordable Health Insurance, www.cahi.org/index.asp, founded by
Greg Scandlen in 1991, where he served as CEO for five years, is an association
of insurance companies, actuarial firms, legislative consultants, physicians
and insurance agents. Their mission is to develop and promote free-market
solutions to America's health-care challenges by enabling a robust and
competitive health insurance market that will achieve and maintain access to
affordable, high-quality health care for all Americans. "The belief that
more medical care means better medical care is deeply entrenched . . . Our
study suggests that perhaps a third of medical spending is now devoted to
services that don't appear to improve health or the quality of care–and may
even make things worse."
•
The
Independence Institute, www.i2i.org, is a
free-market think-tank in Golden, Colorado, that has a Health Care Policy
Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy
Center Newsletter. This month read about the crises we’re in: America is in
crisis: The constitutional system of checks and balances is failing to keep
government within its proper bounds. Read more . . .
•
Martin
Masse, Director of
Publications at the Montreal Economic Institute, is the publisher of the
webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which
will allow you to brush up on your French. You may also register to receive
copies of their webzine on a regular basis. This month, read Mr Masse’s Review:
Statism and the Decline
of the Roman Empire . . . or the Soviet Union . . . Or Quebec.
•
The
Fraser Institute, an
independent public policy organization, focuses on the role competitive markets
play in providing for the economic and social well being of all Canadians.
Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying
taxes and started working for themselves. Log on at www.fraserinstitute.ca
for an overview of the extensive research articles that are available. You may
want to go directly to their health
research section.
•
The
Heritage Foundation, www.heritage.org/,
founded in 1973, is a research and educational institute whose mission was to
formulate and promote public policies based on the principles of free
enterprise, limited government, individual freedom, traditional American values
and a strong national defense. -- However,
since they supported the socialistic health plan instituted by Mitt Romney in
Massachusetts, which is replaying the Medicare excessive increases in its first
two years, and was used by some as a justification for the Obama plan, they
have lost sight of their mission and we will no longer feature them as a
freedom loving institution and have canceled our contributions. We would
also caution that should Mitt Romney ever run for National office again, he
would be dangerous in the cause of freedom in health care. The WSJ paints him
as being to the left of Barrack Hussein Obama. We would also advise Steve
Forbes to disassociate himself from this institution.
•
The
Ludwig von Mises Institute,
Lew Rockwell, President, is a rich source of free-market materials,
probably the best daily course in economics we've seen. If you read these
essays on a daily basis, it would probably be equivalent to taking Economics 11
and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. You may also log
on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to
be an MD today.
•
CATO. The Cato Institute (www.cato.org) was
founded in 1977, by Edward H. Crane, with Charles Koch of Koch Industries. It
is a nonprofit public policy research foundation headquartered in Washington,
D.C. The Institute is named for Cato's Letters, a series of pamphlets that
helped lay the philosophical foundation for the American Revolution. The
Mission: The Cato Institute seeks to broaden the parameters of public policy
debate to allow consideration of the traditional American principles of limited
government, individual liberty, free markets and peace. Ed Crane reminds us
that the framers of the Constitution designed to protect our liberty through a
system of federalism and divided powers so that most of the governance would be
at the state level where abuse of power would be limited by the citizens'
ability to choose among 13 (and now 50) different systems of state government.
Thus, we could all seek our favorite moral turpitude and live in our comfort
zone recognizing our differences and still be proud of our unity as Americans. Michael
F. Cannon is the Cato Institute's Director of Health Policy Studies. Read
his bio, articles and books at www.cato.org/people/cannon.html.
•
The
Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state
organizations associated with the State Policy Network (
•
The Free State Project, with a goal of Liberty in Our
Lifetime, http://freestateproject.org/,
is an agreement among 20,000 pro-liberty activists to
move to New Hampshire, where they will
exert the fullest practical effort toward the creation of a society in which
the maximum role of government is the protection of life, liberty, and
property. The success of the Project would likely entail reductions in taxation
and regulation, reforms at all levels of government to expand individual rights
and free markets, and a restoration of constitutional federalism, demonstrating
the benefits of liberty to the rest of the nation and the world. [It is indeed
a tragedy that the burden of government in the U.S., a freedom society for its
first 150 years, is so great that people want to escape to a state solely for
the purpose of reducing that oppression. We hope this gives each of us an
impetus to restore freedom from government intrusion in our own state.]
•
The
St. Croix Review, a
bimonthly journal of ideas, recognizes that the world is very dangerous.
Conservatives are staunch defenders of the homeland. But as Russell Kirk
believed, wartime allows the federal government to grow at a frightful pace. We
expect government to win the wars we engage, and we expect that our borders be
guarded. But St. Croix feels the impulses of the Administration and Congress
are often misguided. The politicians of both parties in Washington overreach so
that we see with disgust the explosion of earmarks and perpetually increasing
spending on programs that have nothing to do with winning the war. There
is too much power given to Washington. Even in wartime, we have to push for
limited government - while giving the government the necessary tools to win the
war. To read a variety of articles in this arena, please go to www.stcroixreview.com.
•
Hillsdale
College, the premier small liberal
arts college in southern Michigan with about 1,200 students, was founded in
1844 with the mission of "educating for liberty." It is proud of its
principled refusal to accept any federal funds, even in the form of student
grants and loans, and of its historic policy of non-discrimination and equal
opportunity. The price of freedom is never cheap. While schools throughout the
nation are bowing to an unconstitutional federal mandate that schools must
adopt a Constitution Day curriculum each September 17th or lose
federal funds, Hillsdale students take a semester-long course on the
Constitution restoring civics education and developing a civics textbook, a
Constitution Reader. You may log on at www.hillsdale.edu
to register for the annual weeklong von Mises Seminars, held every February, or
their famous Shavano Institute. Congratulations to Hillsdale for its national
rankings in the USNews College rankings. Changes in the Carnegie
classifications, along with Hillsdale's continuing rise to national prominence,
prompted the Foundation to move the College from the regional to the national
liberal arts college classification. Please log on and register to receive Imprimis,
their national speech digest that reaches more than one million readers each
month. This month Choose recent
issues. The last ten years of Imprimis are
archived.
* * * * *
Words
of Wisdom, Recent Postings, In Memoriam, Today in History . . .
Words of Wisdom
"Be fully aware. Be engaged. Remind yourself to live in the
present moment, The Zone."— Jim Fannin:
Nightingale-Conant author
"What's dangerous is not to evolve." — Jeff Bezos: the founder, president, and CEO of Amazon.com
"I've failed over and over and over again in my
life and that is why I succeed."
— Michael Jordan: a former professional basketball player
"Innovation distinguishes between a leader and a
follower." — Steve Jobs:
co-founder, chairman, and former CEO of Apple Inc.
Some Recent Postings
In This Issue:
1.
Featured Article: Tourette’s syndrome
2.
In the News: Our world is a much wilder
place than it looks
3.
International
Medicine: Government’s
Health Spending Crises
4.
Medicare: Who Has
Power to Stop a Rogue President?
5.
Medical Gluttony: Government Gluttony:
Insurmountable Debts
6.
Medical Myths: It’s Safe to be a
WhistleBlower? Not unless we make it safe.
7.
Overheard: If
it weren’t for Republicans in the House, I’d spend another $800 Billion
8.
Voices of Medicine: Deal With the
Patient, NOT the Computer
9.
The Bookshelf: Life After Death By
Jeff Sugarman, MD
10.
Hippocrates & His Kin: Can you really
go without Health Insurance?
11.
Related Organizations: Restoring Accountability in Medical Practice and
Society
Flesh and dust
The ECONOMIST | Jul 22nd 2011 | by E.B.
| LONDON
THROUGHOUT the history of art, nudes were idealised
templates for humanity, with rippling muscles, tidy breasts and smooth skin.
Not for Lucian Freud, who died at home in London on Wednesday, aged 88. For
him, the nude was something more naked, more real. His portraits were often
confrontational and unsettling, whether the subject was a local thief or the
Queen of England (who kept her clothes on). In his “dingy studio”, writes
William Grimes in his fine obituary for the
New York Times, Freud’s “contorted subjects, stripped bare and
therefore unidentifiable by class, submitted to the artist’s unblinking,
merciless inspection.”
This apparent mercilessness is what makes Freud’s work difficult, but also
mesmerising. Rarely is the human form captured in all its vulnerability, with
all ofits flaws. Freud’s gift to painting was to demystify the nude—to find the
beauty in the grotesque—and to do it without seeming unaffectionate. “For me
the paint is the person,” Freud explained to Lawrence Gowing, a
biographer.
A survey of tributes to the man reveals a delicious glut of adjectives. His
nudes had a “fleshiness and mass,” observes Mr Grimes, with faces that “showed
fatigue, distress, torpor.” His female subjects “seemed not just nude but
obtrusively naked.” Michael Glover in the Independent marvels at the
“gorgeous, swollen, egregious fleshiness” of his figures. Florence Waters in
the Telegraph considers Freud's
legacy of “gracelessly posed, grossly sagging” women. His work evokes thoughts
of “a face sculpted in paint that appears to fold and puff like a cauliflower
ear.”
But perhaps the finest recollection comes from Sue Tilley, the somewhat
unwieldy subject of Freud’s painting “Benefits Supervisor Sleeping”, which sold at auction in 2008 for £17.2m
($33.6m). A 280-pound (20-stone) civil servant, Ms Tilley posed for Freud for
several paintings—a physically arduous experience—and the results are often
described as remarkably unflattering. But her description of their time, as printed in the Guardian,
is enlightening for the way it captures the artist’s humanity and unhurried
discipline. . .
He wasn't cruel—he painted what he saw. What
strikes me most is, I look at my fat ankles and my fat feet every morning and I
think they look just like that painting. Even the skinny girls don't look good,
do they? He painted out of love. . .
Read the entire
obituary in The Economist: www.economist.com/blogs/prospero/2011/07/lucian-freud
On This Date in History - August 9
On this date in
1974, Gerald R. Ford succeeded Richard M Nixon, who resigned, as President.
This was the first time in our history; a man not chosen even indirectly
by the people became the President of the United States. Gerald R. Ford had
been named by Richard Nixon anad confirmed by the Congress to succeed Spiro
Agnew as Vice President when Agnew resigned; when Nixon residned in the
Watergate scandal, Ford became President. If ever the United States government
could have been brought to a paralyzed halt that, we feared, could have been
the time. But it held firm. The people held firm. The strength of any
government, in this country, lies not in those who govern but in the
electorate.
On this date in 1936,
Jesse Owens dominated the Olympics. Today, we want to remind you oof just
how much an individual can do. An American names Jesse Owens, a Black American
competing in the Olympic Games hosted by Adolf Hitler in 1936—a Black American
competing under the eyes of the world’s leading, most virulent advocate of
white Aryan superiority. On this day, Jesse Owens, already a great trac star,
became the first man to win four medals in the Olympic Games. He stood in the
winner’s platform at the Olympic Stadium, a living proof of the wrongness of
Mr. Hitler.
After Leonard and Thelma
Spinrad
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plans and our pending national challenges, please go to www.healthplanusa.net/newsletter.asp
and enter your email address. Then go to the archives to scan the last several
important HPUSA newsletters and current issues in healthcare.
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Always remember that Chancellor
Otto von Bismarck, the father of socialized medicine in Germany, recognized
in 1861 that a government gained loyalty by making its citizens
dependent on the state by social insurance. Thus socialized medicine, or any
single payer initiative, was born for the benefit of the state and of a
contemptuous disregard for people’s welfare.
Thus we must also remember that ObamaCare has nothing to do with
appropriate healthcare; it was similarly projected to gain loyalty by making
American citizens dependent on the government and eliminating their choice and
chance in improving their welfare or quality of healthcare. Socialists know
that once people are enslaved, freedom seems too risky to pursue.
