1. Featured Article: Cancer Testing? There’s an App for That

Physicians are using smartphones to diagnose diseases, check blood cell counts and identify pathogens in drinking water; Cancer Testing? There’s an App for That

Scientific American Magazine; | by Melinda Wenner Moyer | May 2011;

Many people already use their smartphones as far more than mere telephones—as gadgets for Web surfing, e-mailing or listening to music. Some scientists are now turning them into handheld tools to diagnose cancer or infectious disease, track treatment progress or check water safety. Given that the handsets are so common, they could bring cutting-edge health care technology to the developing world.

Diagnosing cancer is a challenge because it requires expensive, time-consuming assays. But in a recent study published in Science Translational Medicine, Ralph Weissleder and his colleagues at Harvard Medical School used a cell phone and a lunch box–size machine to diagnose cancer from tiny pieces of tissue, taken via needle from the abdomens of patients with suspected metastatic cancers. Read more . . . Researchers mixed the samples with antibodies that bound to four known cancer-related proteins. The machine analyzed the samples using nuclear magnetic resonance—measuring levels of the antibody-bound proteins based on their magnetic properties. It then sent the results to the smartphone, which, using an app that the researchers designed, displayed the data. Because doctors don’t need a laptop or desktop, it would be easier for them to assess patients outside the clinic. In comparison, results from more traditional diagnostic methods are typically not available for three days and require more invasive tissue sampling.

By using different antibodies, doctors could use the device to diagnose any form of cancer, says Harvard systems biologist and co-author Hakho Lee. They could also track treatment progress. “If there is a decrease in either the number of cancer cells or the expression levels of certain disease markers, then that means the treatment might be working,” he says. He expects a product within five years.

Other researchers are taking advantage of smartphone cameras to create diagnostic microscopes. Electrical engineer Aydogan Ozcan and his colleagues at the University of California, Los Angeles, have developed a 4.5-centimeter-long phone attachment that shines LED light on biological samples, producing holograms of each cell based on how the light scatters. The phone’s camera then snaps a photograph, compresses the image and sends it to a clinic for evaluation. With the ability to decipher details as small as 1/1,000th of a meter, the microscope could identify sickle-cell disease or malaria from blood samples and perform blood cell counts. The devices could bring an elegant simplicity to nations that struggle with infectious diseases. —Melinda Wenner Moyer

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2. In the News: An Economic Time Bomb

Even if Congress does nothing, tax hikes will hit hard a year from now.

Commentary by Pete du Pont

Source: Wall Street Journal, January 26, 2010

Weather-wise it has been a very cold January, and politically the Scott Brown Senate victory has chilled Washington even further. . .

Government spending has already hugely increased, and so has the size and scope of government, but next year there will also be substantial tax increases for a great many Americans. The first reason will be the expiration of the Bush tax cuts. The top personal income tax rate will rise next Jan. 1 to 39.6% from 35%, a hike of nearly one-eighth. The dividend tax rate will rise to 39.6%, more than 2½ times the current 15%. And the capital gains tax rate will rise by a third, to 20% from 15%. If the House health care bill had passed, all three of these rates would have risen to 45%. Read more. . .

The estate tax, which fell to zero this year under the Bush tax cuts, will return in 2011--or sooner, if Congress acts to restore it. Another likely tax increase will be on the income of private equity and hedge-fund managers, from the capital gains rate of 15% to the new higher income tax rates. It has already been passed by the House and is supported by the Obama administration, as is an additional 10-year, $90 billion tax on banks aimed at "rolling back bonuses for top earners." It would affect some 50 banks, insurance companies, and large broker-dealers.

Meanwhile a number of last year's tax deductions have disappeared . . .

Add on to all of these increases the biggest government deficits and spending increases (to 26.5% of gross domestic product from 21%) in half a century, the protectionism of free trade downsizing through the "buy American" requirements, China import restrictions, and the administration limitations of Columbia, South Korea, and Panama free trade agreements, and we have a very different, and not very prosperous, America ahead of us.

Or as economist Arthur Laffer wrote in his January Economic Outlook, we "cannot have a prosperous economy when government is overspending, raising tax rates, printing too much money, over-regulating and restricting the free flow of goods and services across national boundaries." We are, in his words, simply "moving in the wrong direction."

But what Mr. Laffer sees as most important is a substantial American economic collapse coming to us in 2011. His reasoning is simple and sensible: the impending 2011 tax increases will lead Americans to get their incomes into this year and pay the current lower tax rates. That will mean a 2010 GDP growth 3% to 4% higher than it otherwise would have been, and that will look very good.

But when the huge tax-increase agenda arrives a year from now, the economy will begin to decline. . .

He also points out that there is a four- to eight-month gap between market performance and economic performance. Indeed, the market has often reflected good or bad tax news four to eight months ahead of their impact on the economy. We historically saw that after the Harding tax cuts (1922), the Smoot-Hawley tariff bill (1929), the Kennedy tax cuts (1963) and the Reagan tax cuts of 1983. If this pattern repeats, we could see the market begin to deteriorate sometime in the summer or fall of this year.

In modern times the Kennedy, Reagan and George W. Bush tax rate reductions helped spur economic growth; the Obama tax rate increases will have the opposite effect. Americans headed to the polls this fall, worried about the increasing size and spending of the federal government, possibly a falling market, and next year's looming tax increases, may reproduce next November the voter revolt we saw in the 1994 congressional elections. That led to a Democratic presidency and a Republican Congress, which together were better for the American people than the full-scale liberalism we see in the current administration.

www.ncpa.org/commentaries/an-economic-time-bomb

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3. International Medicine: The Road to Privatization is a hard and bumpy but necessary journey

How to make prescription medicines less available: A national pharmacare plan

Author: Mark Rovere

There has been much discussion in the past 10 years about whether Canada needs a national Pharmacare plan. While the idea might appeal to some, the plan is driven by ideology as opposed to common sense.

Undoubtedly, it is clear that reform of provincial drug plans is necessary. However a national government plan is a step in the wrong direction and will only exacerbate the current situation where leaves millions of Canadians don’t have access to the medicines they need. Read more . . .

Merging Canada’s provincial drug programs into one mega government-run program via Ottawa will only increase the politicization of drug availability. All the existing budget constraints and arbitrary decisions on which drugs are made available will only multiply. Consequently, Canadians will have less, not more, access to the latest ground-breaking drugs.

If Canadians want quick access to the newest prescription drugs approved by Health Canada, the optimal solution is to get governments out of the drug insurance business and allow the private sector to provide this service. . .

The proof that more of the same--another government program-- will lead to less access and not more is borne out by the facts. For example, our most recent study on access to new drugs in Canada shows that compared to private insurance plans, provincial public drug plans refuse to pay for most new drugs certified by Health Canada. Of the new drugs approved by Health Canada each year from 2004 to 2009, the average coverage rate across provincial public drug programs was less than 23 per cent as of June 9, 2011. That compares to almost 83 per cent under private drug plans over the same period.

Furthermore, when drug coverage between public and private drug plans was compared, private plans cover new drugs far more rapidly. . .

Under these circumstances, it is clear that private drug plans in Canada are far more generous than public plans. This should come as no surprise since provinces are faced with political pressures and budget constraints due to unsustainable health care costs. Cost containment policies such as denying coverage for the newest prescription drugs are common among all provincial drug plans. Importantly, there is no reason to assume that a national drug plan administered by the federal government would be any different.

Another false assumption that cannot be overlooked is the fact that most people do not require public assistance to pay for their prescription drugs. Research shows that between 1997 and 2002, only three per cent of Canadian households spent more than five per cent of their annual income on prescription drugs.

There is also a common misconception that all seniors require financial assistance to help pay for their medicine. However, most seniors use a small amount of their after-tax income on drugs costs. It is therefore unreasonable to provide public drug coverage based on age alone, which is common among a number of provincial plans. Instead, government subsidies should be provided to those with catastrophic drug costs relative to their income regardless of age. After all, it makes no sense to subsidize seniors with several million dollars in assets, while low-income families struggle to pay for their prescription drugs.

Most Canadians likely agree that our public drug plans are in need of serious reform. But instead of wasting time and money trying to improve government drug plans, it’s time for governments to re-think their role: get out of the business of drug insurance, target subsidies to those who need help to pay their drug costs, and allow a competitive private sector to quickly introduce new drugs, and thus rapidly respond to patient need.

Mark Rovere is Associate Director of the Health Policy Research Centre at the Fraser Institute. He holds an Honours Bachelor's degree and a Master's Degree in Political Science from the University of Windsor. Since joining the Institute, Mr. Rovere has contributed research and co-authored numerous studies on a range of health and pharmaceutical policy issues including Canadian pharmaceutical pricing, access to new medicines, government drug expenditures, Canadian and American prescription drug spending, and the sustainability of public health care in Canada.

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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 SCC 35, [2005] 1 S.C.R. 791

http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html

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4. Medicare: Medicaid Efficiency is Poor Health Care and Extremely Costly

Ms. Brown, a state worker, had a productive career for more than 20 years. She was persuaded by a former friend to move in with him. In 2000, he severely abused her, both mentally and emotionally. She did not feel safe with him nor could she leave since her sole parent was ill and destitute. Her former “friend” belittled her when out shopping with her, made her seem helpless, withdrawn, socially inept, and appear to be a pathetic and dependent creature. He gave her $20 a week for her food, clothing and makeup. Read more . . .

When seen in our office, she was having rather severe intrusive thoughts and reactions from the trauma of the past ten years. She described an incident when she saw a male across the park wearing white socks, the same as her “landlord” wore, and she became hysterical. The surrounding crowd looked at her as if she were a crazy woman. She saw a man wearing a belt buckle with the name of her abuser on it and she froze and couldn’t move for several minutes.

She met with a counselor three times a week for three years. She felt her counselor (three hours per week for 150 weeks) had a good understanding of her problems and was working with the patient to become independent and self-reliant.

In an austerity move, she was transferred to the local Mental Health Clinic from the Mental Health Clinic in the adjacent county. She became further depressed when she realized that the near 500 hours which had been invested in her mental well being would essentially be tossed out, so to speak, and she would have to start with a new counselor in our county. This made her feel even more hopeless.

Social security agreed that she would never be able to return to work and provided her with disability benefits.

When the government takes over all of our health care, these types of financial efficiencies will be medically inefficient and very cruel to suffering people in need of mental care.

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Government is not the solution to our problems, government is the problem.

- Ronald Reagan

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5. Medical Gluttony: Hospital measures the home BP and Weight every week

A Medicare patient we’ve previously discussed had left the Emergency Room when she felt the treatment she received was adequate. Sue saved $6,000 of a potential $9,000 ER bill; however, the hospital nurse was visiting her every week for BP and weight monitoring under the illusion of preventing further episodes of shortness of breath. After about six months, she asked me if this was helpful to her care. We looked at the graph and confirmed her BP was stable and so was her weight. She then proceeded to dismiss the home visits stating she no longer felt their need. The nurse tried to talk her out of it but the patient persisted insisting they would not need to see her again. Read more . . . .

Having experienced that Medicare pays hospital home visits at twice the rate of physician’s home visits, the costs would be staggering with no physician oversight that was apparent. In the hospital practice of health care, gluttony reigns supreme.

Her quarterly physician visits were adequate medical care at a fraction of the costs.

This type of gluttony will become more common as the faceless government takes over a very private profession where care should be confidential and necessary.

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Medical Gluttony thrives in Government and Health Insurance Programs.

It Disappears with Appropriate Deductibles and Co-payments on Every Service.

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6. Medical Myths: Patients should be allowed to do their own medical testing to save money.

Mrs. Roman called for an appointment to get a battery of tests—not just any battery—but a complete battery that would show any abnormality in her body. She was informed that she needed to see the doctor to obtain tests. She asked, “Why?” Read more . . .

When she came in, she said that no doctor had been able to explain why she was tired, stressed out, couldn’t sleep, and generally not feeling well. It all started a year earlier for what she felt were unexplained reasons. She believed there must be something wrong with her metabolism. There was also numbness on the top of her head.

During the review of her personal history, it became apparent that her problems started when her husband left her and moved to Chicago.

This being Friday, she said this had to happen fast since she was also moving to Chicago on Wednesday. She was informed that laboratory tests and x-rays ordered today would take three to five days to be completed and another three to five days to be reported. She didn’t see this as a problem that couldn’t be handled by leaving a forwarding address; she would read the results when she settled in Chicago.

She was on Medicaid and was recently assigned to an HMO that she understood to be the country’s finest insurance plan—the one with which the president would insure everyone. In anticipation of the Obama plan of placing the 30-50 million welfare recipients into HMOs, California is slowly transferring all their indigent people like her to HMO coverage.

After spending the next 45 minutes doing an entire medical history and physical examination, no serious medical problem was unearthed except her anxiety and depression related to her living alone and feeling abandoned by her husband. She asked for a prescription for some herbs that she believed would resolve her anxieties. We reminded her that herbs were sold OTC at the natural food stores, which she would have to purchase on her own.

With the examination not justifying any tests, and after considerable discussion, we gave her a prescription for Xanax, should she later decide to take to help her make the transition to her new residence in Chicago.

With a thirty percent co-payment, as presented in the HealthPlanUSA Business Plan, she would have understood that the few hundred tests for diagnosing anxieties was not only totally mythical, but also very expensive and she would personally have decided not to go forward. Percentage co-payments control healthcare costs effectively and completely.

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Medical Myths originate when someone else pays the medical bills.

Myths disappear when Patients pay Appropriate Deductibles and Co-payments on Every Service.

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7. Overheard in the Medical Staff Lounge: Should Physicians become more political to survive?

Dr. Rosen: With Britain, Europe, Sweden, South Africa, Canada and other countries trying to privatize their socialized health care systems, why is America going in the opposite direction?

Dr. Sam: Because we have a very astute socialist president who, during one term, is conniving to change our semiprivate healthcare system into a totally government-controlled socialistic health care system.

Dr. Edwards: He is very astute in getting people hooked on welfare but making the taxes mostly go up during his next administration. Read more . . .

Dr. Kaleb: He knows that once people are used to entitlements, it is too risky to give them up.

Dr. Dave: So it is extremely urgent that physicians and surgeons and podiatrists and dentists get very involved in the current election process. By 2014 it will be too late. Then we’ll be like Britain. After 55 years of the National Health Service, there are no physicians that have experience or can remember private practice. The very concept of going out on your own frightens them.

Dr. Rosen: That’s why socialists have been incremental for a long time. Logic would never arrive at government-controlled medicine or healthcare. It has to be an emotional or illogical approach. The very idea of having government know everything about your most personal life is a threat against liberty.

Dr. Kaleb: Many of us that came to this country because of the two centuries of proven freedom and unbelievable growth just can’t imagine your country and now mine reversing directions. Don’t they teach economics in your schools? Don’t they teach history in your schools? Don’t school children see that all governments until the American experiment were oppressive and restricted freedom? Can’t they see that in many of the backward Muslim countries, women are definitely not free and many men aren’t free? Why do Americans even think of turning this country around and going back to roots that many of us escaped from?

Dr. Paul: There are a lot of people that can’t fight the system and thus depend on the government to protect them.

Dr. Milton: There you said the magic word, Paul - protect. Governments aren’t there to take care of us, they are there to protect us. People and their families and their communities are there to help take care of them.

Dr. Paul: I meant protect and take care of them. Why can’t government do both?

Dr. Milton: Once you start taking care of people, giving them money they don’t have to work for, you can never give them enough. Every one of my Social Security patients thinks that their checks should be at least twice as high. Every one of my Medicare and Medicaid patients thinks their health benefits should be unlimited when they are already twice as high as patients paying their own health insurance. In those three unsustainable programs that are bankrupting our country and giving us insurmountable debt, the wishes of the beneficiaries would immediately bankrupt our entire nation. That would then terminate Social Security, Medicare and Medicaid overnight.

Dr. Kaleb: So why can’t you start making Social Security, Medicare, and Medicaid financially sound? When benefits started in the Roosevelt era, life expectancy was only 62 years. Life expectance is now 15 more years. The old formulas can’t pay for everyone loafing for an extra 15 years sitting in the gravy line. People are healthier now at 75 or even at 80 than they were at 65 in Roosevelt’s time. The benefits should have been indexed to life expectancy and then we wouldn’t have these crises.

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The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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8. Voices of Medicine: A Review of Regional Medical Journals: Drug Expiration Dates: Part III

Bulletin of the Humboldt-Del Norte County Medical Society, April 2011

IN MY OPINION BY SCOTT SATTLER, MD

The Drug Expiration Date: Part III: A Costly Illusion

This is the third article of a series investigating misrepresentation of the expiration dates by the pharmaceutical industry (PhRMA). Please refer to the previous two issues of the Bulletin for details and documentation of the following: (In the VOM, the two June issues at www.MedicalTuesday.net)

1. The U.S. Food and Drug Administration

(FDA) regulations of 1979 required that drug manufacturers determine the expiration date for all drug products through extensive stability testing, and label each product accordingly. For decades PhRMA has failed to do so. Instead, for marketing purposes, drug manufacturers project an arbitrary date 1-5 years into the future and document that the drug will remain safe and potent up to this date. They continue to label this arbitrary quality assurance date as the drug’s expiration date. Read more . . . .

2. In 1985 the U.S. Food and Drug Administration

(FDA) tested the stability of expiring stockpiled medications at the request of the U.S. military. They discovered that 88% of the drugs they tested remained stable for an average of 66 months longer than their labeled expiration dates. Some, like Cipro, were shown to be stable for up to 13 years. They extended the drugs’ shelf life accordingly on a lot-by-lot basis. The head of this testing program concluded that labeled expiration dates had essentially no bearing on whether or not a drug was usable for a longer period, and that the stated expiration date did not mean or even imply that a given drug would stop being effective or become harmful after that date.

3. The U.S. Department of Defense

(DoD) and the FDA subsequently created the Shelf Life Extension Program (SLEP) to provide ongoing drug stability testing for the military and other select federal entities. It continues to this day. SLEP currently contains the most extensive source of pharmaceutical stability data in the world. This program saves its participating federal organizations, and hence the taxpayers, many millions of dollars yearly by not destroying perfectly good medicines such as tetracycline, aspirin, atropine, doxycycline, penicillin, Lasix, Tagamet, Dilantin, potassium iodide, cefoxitin and captopril, just to name a few.

4. In 1985 the pharmaceutical industry via the United States Pharmacopeia (USP) took a major step that expanded this costly illusion. The USP unilaterally declared that once the manufacturer’s original shipping container was opened and the drug product was transferred to another container for dispensing or repackaging, the expiration date no longer applied. They urged that all secondarily dispensed medications be relabeled with a one-year maximum “Beyond Use” date stating, “Do not use after ___.” In 1997 the USP made this a requirement for participating pharmacists and by 2000, 17 states had passed laws mandating that their pharmacists comply. According to the AMA, there is little scientific basis for this action.

Questions that must be asked:

1. Why the costly secrecy surrounding the SLEP database?

Not only is participation in SLEP restricted to a limited number of federal organizations, but also access to SLEP’s drug stability database is severely restricted by the DoD. My attempts to review this data online were met with popup notices threatening confiscation of my computer and storage media as well as criminal prosecution should I persist. Why are only these few participating federal organizations allowed to share this information or submit drugs for testing? As of 2009 the list of SLEP participants included only the Army, Navy, Air Force, Marines, the U.S. Department of Veterans Affairs (the VA), the CDC’s Strategic National Stockpile (SNS), the U.S. Postal Service and the Defense Supply Center-Philadelphia (DSCP). The U.S. Public Health Service and U.S. Coast Guard are excluded. State and local emergency response centers are not permitted to participate. No similar shelf life extension program exists for these organizations that are required to stockpile many of these same medications1. As a consequence some states have abandoned their emergency medical stockpiles because they cannot afford to replace them when they outdate. Ironically the federal government has subsidized such states to allow them to keep their medicine stockpiles current authorizing our tax dollars to be used for the destruction and replacement of drugs that the FDA knows are safe and effective. . .

2. What are the costs of the discarded usable medicines?

The CDC reported that in 2008 the USA spent $234.1B on prescription drugs. This figure had doubled since 1999. This equates to $670 per person per year, or about $2,700 for a family of four. 48% of us took at least one prescription drug within the last month.

Over a third of Americans 60 years or older take 5 or more prescription drugs a day. Over 75% of this age group takes 2 or more meds regularly. It’s a big market. . .

We throw away a lot of money when we discard perfectly good medications.

3. Why were the FDA regulations changed in April of 2010, bypassing the requirement to establishing a valid expiration date?

In April 2010, FDA regulation 21CFR 211.166 was changed to allow verification of a ‘tentative expiration date’ to suffice for labeling as the expiration date, preempting any requirement to determine drug stability or efficacy after that date. Thus the previous FDA regulation requiring a scientific determination of a true expiration date after which a drug has been demonstrated to no longer be safe or effective is now history. But the disingenuous label “Expiration Date” lives on. How was this allowed to happen?

5. How often is PhRMA utilizing the FDAregulation that allows drug manufacturers to reprocess expired medications?

The current FDA regulation 21CFR211.204 allows pharmaceutical manufacturers to retest outdated drugs returned to them and, if they meet quality standards, they may be reprocessed and re-sold. For example this would allow Cipro, given the SLEP findings, to be resold 3 or 4 times.

Conclusion:

For decades multinational corporate drug manufacturers have been allowed to label medications sold in the U.S. with expiration dates that do not reflect their true stability. This comes at a considerable cost to people and to the state and federal budgets. Congress has the ability to change this process through its role as regulator of the FDA. I urge that you let your colleagues and your congressmen know of this costly and unjustified illusion.

Reference: Maximizing State and Local Medical Countermeasure Stockpile Investments through the Shelf-Life Extension Program. Brooke Courtney, Joshua Easton, Thomas V. Inglesby, and Christine SooHoo. Biosecurity and Bioterrorism: Volume 7, Number 1, 2009

© Mary Ann Liebert, Inc. DOI: 10.1089/bsp.2009.0011
http://www.upmc-biosecurity.org/website/resources/publications/2009/2009-03-27-max_st_local_med_cntr.html §

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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about

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9. Book Review: "Harry Potter and the Deathly Hallows" by J K Rowling

Harry Potter: Magic and Spycraft

By James J. Murtagh, M.D.

(Ed. Note: Dr. James Murtagh is Medical Director of the Eastgate Sleepcare Center in Cincinnati Ohio)

"Harry Potter and the Deathly Hallows" by J K Rowling
Reveals Snape as the True Double Master SpyMaster Triumphant
Spoiler alert: Consider seeing the movie and reading the entire Harry Potter series
before reading this Op Ed

Magic and Spycraft: both are Faustian bargains, and both are front and center in the final conclusion of Harry Potter's story. Along with ancient ethical dilemmas and dangers of double agents.

Just as he prepares to lead his forces into a final battle that appears hopeless, Harry discovers he is being helped by a double Spymaster. Read more . . .

Severus Snape has been the puppet master, deep under cover for decades, exercising incredible self-control, pretending to torment Harry, when in fact he was all along the guardian angel. In a flash, we now understand how Harry and friends escaped so many impossible situations- Snape was protecting them.

And now we know: the entire seven part series belonged as much to Snape as it did to Harry. No other literary character in history, as far as I can tell, ever maintained a secret double-agent cover for seven books (thick books, too) spanning more than 19 years under the most intense scrutiny, fooling the most powerful wizards of all, even those able to read his mind. Truly, Snape became an extraordinary mixture of good and evil.

Confused? Naturally. None of this could work without the maximal confusion. That makes Snape by far the most interesting character of the Hogwarts world.

Sun Tzu and Niccolo Machiavelli, John le Carré and Shakespeare all would applaud. Who is the double Snape really working for? Can he tell a hawk from a handsaw? Really good double agents don't even know. Snape is an anti-hero that must integrate every level of his story double story, and present himself as monster even to their closest friend to avoid detection. The divided double-agent consciousness often drives them to believe themselves mad.

Snape (and by extension the puppet's puppet master Dumbledore) was directing both sides of the wizarding civil war! Snape becomes Voldemort's consigliere, and effectively decapitates the leadership of the renegades.

Snape's secret is as shocking as Darth Vader revealing he is Luke's father! Snape effectively became a stand in for Harry's father, to protect Harry for the sake of Harry's mother Lilly, the love of Snape's life.

A love triangle leading to a torn conscience and a double spy? That worked in Hamlet, in Casablanca, and the Odyssey. It seems many of the best deep-cover double agents have Oedipal conflicts very directly linked to disintegrating psyches.

To maintain his cover, Snape must not hesitate to do horrible deeds. Just one example: Dumbledore actually orders Snape to kill Dumbledore to absolutely remove any doubt of Snape's apparent evilness.

Incredibly effective, but at a huge cost! Dumbledore rationalizes that he is dying anyway. But Harry doesn't know, and blind rage almost cripples Harry and his friends. Did they deserve to be in the dark? What did effect did all of this manipulation have on the souls of the allies? What mark did decades of a double life leave on Snape? His soul surly in the end was a fragmented as Voldemort's after decades of a double life.

How is it that the so-called good magicians such as Merlin, Gandalf, Prospero and Dumbledore are called wise, when they routinely use such Machiavellian tactics?

Raising the question: were the tactics of the good side of the force and the evil side any different here?
Do the ends justify the means? Magic or spy craft? Both are Faustian bargains. Clearly, the ethical loose ends left by Snape will be debated for many years.

Snape resigns himself to a life of duplicity in order to further "the greater good." But Harry grasps the danger of the ultimate powers, and after winning the battle, abjures further duplicity, scatters his powerful weapons, the Hallows, and bury the ultimate weapon- the elder wand. Just as Prospero, after accomplishing his mission, broke his magic staff, drowned his magic books are ten thousand fathoms deep. His Brave New World was over.

On a different level, Rowling understands that she herself has a magic power over her audience, and that she, like Harry, must break her magic stick, abjure power, and vows to end her series. Rowling herself has been a kind of double agent, and now she must come in from the cold.

Just as Shakespeare ultimately decided to put his artistry aside. I can just imagine Rowling, standing in the Globe, vowing as Shakespeare did:

'Our revels now are ended'
Our revels now are ended. These our actors,
As I foretold you, were all spirits and
Are melted into air, into thin air:
And, like the baseless fabric of this vision,
The cloud-capp'd towers, the gorgeous palaces,
The solemn temples, the great globe itself,
Yea, all which it inherit, shall dissolve
And, like this insubstantial pageant faded,
Leave not a rack behind. We are such stuff
As dreams are made on, and our little life
Is rounded with a sleep.

—William Shakespeare
From The Tempest, Act 4 Scene 1

Farewell Harry Potter! We will miss you. We always knew you would do well!

This book review is found at www.healthcarecom.net/JM_HarryPotterReview2.htm.

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10. Hippocrates & His Kin: Do We Really Need to Spend More on Schools?

Property Rights and Environmental Quality

Where property rights can be well defined and enforced, as with property rights pertaining to land and water, increases in the security of property rights lead to improved environmental quality—Cato.org

No one takes as good a care of property than its owner.

Read more . . .

Do We Really Need to Spend More on Schools?

Americans think so, until they hear that we spend $13,000 per student already. –Paul Peterson, PhD, Prof of Government at Harvard, WSJ 8-5-11

Author & Presenter: Block Grants: Intensifying the Race to the Bottom,

presented before the National Academy on Aging, National Press Club, Washington, D.C., July 1995.

Americans is used loosely in this context. In this instance it typifies the Socialists.
The Constitutional “Party” knows this innately.
Both are present in each political party making partisan politics in the US confusing.

Battered Britain takes stock.

In London, a handful of looters who spoke out talked of a lack of respect for the young and the poor, raging against an increasingly affluent city that had left them behind. Yet the vast majority of the austerity measures—which the government will now face new challenges in seeing through—have yet to come into effect, leading some to question whether they truly played a role. And just as many voices blamed a weak police response and a breakdown of family values years in the making for giving rise to a class of directionless youth. –Anthony Faiola, Washington Post, Aug 9, 2011.

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow

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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 Health care is the number one domestic policy issue of our time. The three biggest problems in health care are rising costs, inadequate quality and incomplete access to care. To address these problems, the NCPA has developed private sector, free enterprise solutions to empower patients, liberate doctors and encourage competition in the medical marketplace.

• 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. Just released Sally Pipes on Medicaid failure: By any objective measure, Medicaid is a failure. It provides substandard care at an ever increasing cost to taxpayers. When a Republican Congress and a Democrat president worked together to end another failing program – welfare as we knew it — we achieved something rare in public policy: success.

• 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, treat yourself to an article on Tax rates do not equate with tax revenue.

• 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 ObamaCare a Factor in Bleak Jobs Report.

• 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, be sure to read Price Competition can Lead to Quality Competition.

• 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.

• 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. Read her Patient Power Blog.

• 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 The Keys to Economic Growth.

• 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.

• 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 (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.

• 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 17^th 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, read The Right to Work: A Fundamental Freedom Choose recent issues. The last ten years of Imprimis are archived.

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Words of Wisdom

Individual Responsibility

The belief in individual responsibility, which has always been strong when people firmly believe in individual freedom, has markedly declined, together with the esteem for freedom . . . Responsibility . . . often evokes the outright hostility of men who have been taught that it is nothing but circumstances over which they have no control that has determined their position in life or even their actions. This denial of responsibility is, however, commonly due to fear of responsibility, a fear that necessarily becomes a fear of freedom. –Friedrich August von Hayek, 1899-1992, Austrian-born economist, The Road to Serfdom (1944) and The Constitution of Liberty (1960) and Nobel Laureate (1974).

The “private sector” of the economy is, in fact, the voluntary sector, and . . . the “public sector” is, in fact, the coercive sector. The voluntary sector is made up of the goods and services for which people voluntarily spend the money they have earned. The coercive sector is made up of the goods and services that are provided, regardless of the wishes of the individual, out of the taxes that are seized from him. –The Wisdom of Henry Hazlitt, 1993.

Some Recent Postings

From The June 28 Issue:

1. Featured Article: It’s Worse Than You Think

2. In the News: What happened to Doctor—Patient Confidentiality?

3. International Medicine: Long Waits Cost Canadians Millions

4. Medicare: The Obama deficits portend a gloomy future.

5. Medical Gluttony: Non Emergency Care in Emergency Rooms

6. Medical Myths: Medicare Price Controls will save the government money

7. Overheard in the Medical Staff Lounge: Medical Practice is Changing

8. Voices of Medicine: Drug Expiration Date: Part II: A Costly Illusion

9. The Bookshelf: A Common Sense Platform for the 21^st Century

10. Hippocrates & His Kin: A World Food Crisis?

11. Related Organizations: Restoring Accountability in Medical Practice and Society

Words of Wisdom, Recent Postings, In Memoriam . . .

In Memoriam

Robert Oakeshott, champion of worker co-operatives, died on June 21st, aged 77

From the Economist | print edition | Jul 7th 2011

IN ZAMBIA, where he was helping Kenneth Kaunda run the economy, Robert Oakeshott once ran out of petrol. He decided that he and a colleague could push the car the many miles home, while the woman of the party, the writer Doris Lessing, sat behind the wheel to steer. To his cheerful shouts of “Almost there!” they reached the top of a hill from where, he had reckoned, they could easily cruise down. As they crested it, with Lessing half-in and half-out, the car rolled back over her, cracking her hip. She was confined to the sofa for some days.

An apt metaphor, some might think, for the back-and-forth progress of Mr Oakeshott’s favourite idea: workers’ co-operatives, in which workers own and run their companies. His life was devoted to pushing, in the most amiably persistent way, the notion that if workers became stakeholders, if the gap between management and labour vanished, and if effort and profit were shared for the common good, human beings would be happier, freer and, just possibly, better off. Round the world he went, inspecting foundries in Florence, care-providers in New York, coffee-shops in Dublin, to see how they were doing. In his ears, along with merry snatches of Handel, rang the words of J.S. Mill: that if production became co-operative, there would be a moral revolution.

He knew—being a realistic man as well as a crashingly impractical one, who once missed Greta Garbo’s glass by a mile when serving her at Chateau Lafite, and also drove a horse and trap through a gate only wide enough for the horse—that co-ops were hard to create. Capital was scanty. Unions were hostile. Management and worker functions clashed uneasily together. For decades, both right and left ignored co-ops (though both Gordon Brown and David Cameron have recently endorsed the ideal). Marx had mocked them as “dwarfish”, a word Mr Oakeshott ruefully relished. The Economist, for which he wrote occasionally, was cool about them. Undaunted, he pressed his case.

For most of the 1970s he ran his own building co-op, Sunderlandia, in the north-east of England. The region was in steep decline, but he liked it, dropping his Balliol accent to say “New-cassle” like a local, and finding it fertile ground for his schemes. As he ate with his fellow-workers in the greasy spoon, enjoying their competitive talk of growing leeks and selling scrap, he realised that under the industrial overalls lurked canny capitalist peasants. Sunderlandia bowled along for some time; but then a downturn came, and the worker-members would not agree to cut their own pay. In 1978 it went into liquidation. . .

Read the entire obituary at The Economist – Subscription required.

On This Date in History – July 12

On this date in 1862, the U. S. Congressional Medal of Honor was established. This is the highest form of recognition of valor in the cause of freedom.

On this date in 102 B.C., Julius Caesar was born. He built imperial Rome, created a new monarchy that lasted for hundreds of years, and in the end fell pray to the same lust for power that had led him to the top. He died in one of the most famous assassinations of all time. His story reminds us that those who use government for their own ends, those who feel that they can disregard the will of the people, often underestimate the resilience and the resistance of the people.

On this date in 1817, Henry D. Thoreau was born in Concord, Massachusetts. Almost two millennia after Caesar, Thoreau stood for all that was opposite to the ideas of a Caesar. Thoreau not only did not want government to govern him, he did not want to be part of government. Caesar wanted to rule the civilized world; Thoreau wanted to escape from it. Caesar wanted to change the world; Thoreau wanted to watch it as it existed.

The contrast between these two men born on the same day, nearly two millennia apart, illustrates the essential conflict between the two sides of human nature. The world will progress onward and upward further, albeit slower under the Thoreaus. It will strike off in any direction of a 360-degree compass under the Caesars, but progress may never come. When something “new” is discovered and thought to be “progressive,” the older and wiser will recognize it as history repeating itself again, that it is backward and downward—thus regressive.

After Leonard and Thelma Spinrad

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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 and control will become absolute.

MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol X, No 7, July 12, 2011