1. Featured Article: Why Are Asthma Rates Soaring?

Researchers once blamed a cleaner world. Now they are not so sure.

By Veronique Greenwood | Scientific American | April 14, 2011 | 25

Asthma rates have been surging around the globe over the past three decades, and for a long time researchers thought they had a good idea of what might be fueling the increase: the world we live in is just a little too clean. According to this notion—known as the hygiene hypothesis—exposure in early childhood to infectious agents programs the immune system to mount differing highly effective defenses against disease-causing viruses, bacteria and parasites. Better sanitary conditions deprive the immune system of this training, so that for reasons that are still unclear, the body pounces on harmless particles—such as dust and ragweed—as if they were deadly threats. The resulting allergic reaction leads to the classic signs of asthma: chronic inflammation or swelling of the airways and acute spasms of those passageways.

Or so the thinking went. Although a lot of data support the hygiene hypothesis for allergies, the same cannot be said for asthma. Contrary to expectations, asthma rates have skyrocketed in urban areas in the U.S. that are not particularly clean. Moreover, the big increase in asthma rates in developed countries did not kick off until the 1980s—well after general sanitary conditions in the richer parts of the world had improved. And some studies are beginning to show that far from protecting children from asthma, respiratory infections in early childhood may actually be a risk factor for it.

The collapse of the hygiene hypothesis as a general explanation for the startling jump in asthma rates has led physicians and scientists to a new realization: asthma is a much more complex condition than anyone had truly appreciated. Indeed, it may not be even be a single disease. Studies now suggest that only half of asthma cases have an allergic component.

The prevention and treatment implications are significant. If, for instance, it is true that allergy is not a fundamental cause of asthma in many people, then an alternative mix of treatments may be more effective for those individuals. To root out asthma’s cause (or causes) and properly treat the burgeoning number of people who are affected—300 million globally at last count—scientists will have to come to grips with the biology of its various forms.

Balancing Act
The hygiene hypothesis was first described in 1989 by David P. Strachan, a British epidemiologist who was studying hay fever. The more children in a family, he noticed, the lower the rates of hay fever and eczema, an allergic skin condition. Children in large families tend to swap colds and other infections more often than children with fewer siblings. Could it be that increased exposure to pathogens from their many siblings was protecting children from large families against allergies?

That same year Erika von Mutius, an epidemiologist at Munich University, was looking into the effect of air pollution on asthma in what was then East and West Germany. Children from dirtier East Germany, she was shocked to find, had dramatically less asthma than their West German counterparts living in cleaner, more modern circumstances. The East German children, unlike their Western counterparts, had spent more time in day care and thus had likely been exposed to many more viruses and bacteria. “That was astonishing,” she recalls, and led to “a major shift” in thinking.

These findings sparked intense debate among scientists. What is it about unhygienic living that might protect against asthma? One of the more popular explanations in the following decades entailed a balance between the immune cells that are involved in the body’s reaction to most viruses and bacteria and those that are involved in the reaction to most parasites and allergens. These two groups of cells produce chemicals that inhibit each other. Early-childhood exposure to bacteria and viruses would cause the infection-related cells to become active, keeping the allergy- and parasite-related cells in check. Without that interplay, the allergy-related cells would later become overreactive, starting an allergic chain reaction that became chronic and ended in constricted airways, asthmatic spasms and labored breathing. . .

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2. In the News: Would a 25 percent education budget cut affect classroom education?

How Much Do Public Schools Spend on Teaching?

Brief Analyses | Education | NCPA | No. 745

by Michael Barba

Public education now costs federal, state and local governments upward of $500 billion annually. This total is up from $354 billion 15 years ago and currently represents the largest state and local government expenditure. While spending increased nearly 50 percent, enrollment increased by just over 10 percent, reading and science scores held steady and on-time graduation hovered at 70 percent.

School districts claim that funding cuts would require them to close schools and drastically increase class sizes, but states have little choice: K-12 schools take an average of 36 percent of general funds annually. Detroit, for example, proposed eliminating a $327 million deficit by closing half its schools and doubling average class sizes to 62 students. However, school district budgets can be cut without touching classroom spending.

Money in the Classroom? School districts very often define spending categories in unexpected ways, making it difficult to distinguish classroom spending from operational costs. While schools annually spend an average of about $10,000 per student, the National Center for Education Statistics (NCES) reports that only 60 percent of these expenditures are instructional. Instructional spending includes teacher and staff salaries, extracurricular activities such as sports or clubs, and classroom supplies. However, instructional expenses are often unrelated to the classroom. In Texas, for example, vehicle, equipment and computer maintenance, as well as food service, property insurance and refreshments for meetings are considered instructional expenditures.

Even if instructional expenses were clearly defined, lengthy regulations make it nearly impossible to determine how much money actually ends up in the classroom. For example, California mandates an instructional spending level of 85 percent of the total, but exceptions in the education code allow certain funds to be diverted to nearly any program administrators see fit. Such ineffective mandates make it impossible for teachers, parents and legislators to understand what share of tax dollars reach the classroom.

Defining Total Spending. While the NCES reports that instruction is 60 percent of expenditures in the 100 largest districts, a closer analysis reveals that the instructional category only takes an average of 51 percent. The discrepancy arises because the percent of instructional spending is calculated after excluding capital expenditures — including land purchases, construction projects and long-term debt payments — and other spending, such as for leased equipment and adult education. Excluding these expenditures allows districts to report spending a higher percentage on instruction.

Including all dollars spent reduces instruction’s share and gives a clearer picture of the total bill. The figure compares instruction’s reported percentage to its percentage of total spending in a few large school districts. For instance, during the 2008-2009 school year:

· The Philadelphia, Pa., schools reported that instruction was 54 percent of its expenditures, but including capital costs and other expenses, only 31 percent of its spending was instructional.

· Similarly, Washington, D.C., public schools reported spending 53 percent on instruction, when it took only 35 percent of total expenditures.

· By contrast, Arlington, Texas, devoted 61 percent of its total expenditures to instruction, very near its reported 64 percent. . .

School Accountability Requires Transparency. Confusion surrounding K-12 spending is caused by not limiting the expenses classified as instructional to the classroom and not considering all spending when calculating instruction’s share. Determining how many dollars end up in classrooms would allow parents, teachers and legislators to hold administrators accountable, but this cannot be done until classroom spending is distinguished from all other spending. Districts could then measure what percent of expenditures are devoted to the classroom in proportion to every dollar spent, regardless of its budget category.

Instead of cutting dollars spent in the classroom, state legislators should require clear accounting for how education tax dollars are spent, cap noninstructional expenditures as a percentage of spending and limit the growth of spending outside the classroom.

Michael Barba is a graduate student fellow with the National Center for Policy Analysis.

Back to: Brief Analyses | Education

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3. International Medicine: The international rankings of healthcare-Commentary Magazine-Blog

The Worst Study Ever?

Abe Greenwald | Commentary Magazine | 04.26.2011

COMMENTARY has just made available to all online readers Scott W. Atlas’s “The Worst Study Ever?” from their April issue. Atlas is a professor of radiology and chief of neuroradiology at the Stanford University Medical Center and a senior fellow at the Hoover Institution. His article is a comprehensive and devastating indictment of the World Health Organization’s World Health Report 2000, which has been cited far and wide as the go-to reference on America’s health-care failings. As Atlas demonstrates, the report is actually an insult to objective research and a milestone in successful leftist activism: Read more. . .

In fact, World Health Report 2000 was an intellectual fraud of historic consequence—a profoundly deceptive document that is only marginally a measure of health-care performance at all. The report’s true achievement was to rank countries according to their alignment with a specific political and economic ideal—socialized medicine—and then claim it was an objective measure of “quality.”

www.commentarymagazine.com/2011/04/26/the-worst-study-ever/

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Would you really go to Bolivia to have your heart or brain operation?

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4. Medicare: RomneyCare could put the US on the Road to Single-Payer Socialized Medicine

Bay State On Road to Single-Payer

Your editorial's criticism of Mitt Romney's 2006 Massachusetts health law is correct in that taxes, costs and political interference in medical decisions have all gone up while access to medical care has deteriorated ("Obama's Running Mate," May 12*). The Massachusetts law also jeopardizes the very solvency of private health plans in the Bay State.

Because it was politically intolerable to allow premiums to rise in line with the costs of RomneyCare, the state's insurance commissioner denied 235 of 276 rate increases in April 2010. For a short time, no new policies were offered and plans suffered significant losses. Read more… The next month, Blue Cross Blue Shield of Massachusetts, the state's largest carrier, announced a $55 million provision for anticipated losses in the second quarter alone. Of the 12 largest carriers, five were already operating at a loss. At this point, even if the state allows Blue Cross Blue Shield of Massachusetts to increase rates in line with medical costs, my analysis concludes that the carrier will become insolvent somewhere around 2017.

Gov. Romney did not give Massachusetts "universal" private health coverage. He put it on a glide-path to a single-payer, government-monopoly health system.

John R. Graham

Pacific Research Institute Read more on the Blame Game . . .

San Francisco

http://online.wsj.com/article/SB10001424052748703730804576319642832207056.html?mod=ITP_opinion_1

*The Romney camp blames all this on a failure of execution, not of design. But by this cause-and-effect standard, Mr. Romney could push someone out of an airplane and blame the ground for killing him. Once government takes on the direct or implicit liability of paying for health care for everyone, the only way to afford it is through raw political control of all medical decisions.

Mr. Romney's refusal to appreciate this, then and now, reveals a troubling failure of political understanding and principle. The raucous national debate over health care isn't about this or that technocratic detail, but about basic differences over the role of government. In the current debate over Medicare, Paul Ryan wants to reduce costs by encouraging private competition while Mr. Obama wants the cost-cutting done by a body of unelected experts like the one emerging in Massachusetts.

Mr. Romney's fundamental error was assuming that such differences could be parsed by his own group of experts, as if government can be run by management consultants. He still seems to believe he somehow squared the views of Jonathan Gruber, the MIT evangelist for ObamaCare, with those of the Heritage Foundation.

In reality, his ostensible liberal allies like the late Ted Kennedy saw an opening to advance their own priorities, and in Mr. Romney they took advantage of a politician who still doesn't seem to understand how government works. It's no accident that RomneyCare's most vociferous defenders now are in the White House and left-wing media and think tanks. They know what happened, even if he doesn't

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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: The Hospital Bill

Mr George brought in the hospital bill for his two-days admission for alleged pneumonia.

Amount Billed: $47,366 (In for 48 hours-$1,000 per hour)

Amount Pd by Medicare: $12,148 ($250 per hour allowed)

Amount Not Allowed: $34,085 (Listed as savings for the patient)

Deductible Amount: $ 0

Co-Payment: $ 0

Amount Paid by Insurance $ 1,132

On receiving the hospital records, the x-ray report said Normal; the working diagnosis in the ER was pneumonia. The final diagnosis on the hospital summary: Probable pneumonia.

The diagnosis more likely than not would be “An acute febrile illness, probably self limited. Treatment with bed rest, analgesics and antipyretics (OTC or in most people's medicine cabinet) would very likely have produced the same result at virtually no significant medical costs.

The above statement would scare any human being without the health insurance firewall.

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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: You should drink at least eight glasses of water a day.

The origin of this myth is most likely the fact that a 1945 government agency said that the human body needed around 8 glasses of fluid a day. This included the fluid from all of the foods we eat and drinks like tea and coffee. Somehow over time “fluid” turned to “water” and the modern water myth arose. This also lead to silly slogans like “if you are thirsty it is too late” – a concept that would seem to have been invented by water bottlers who have something to gain from excess water consumption by the general population. So, in reality, if you are thirsty, drink some water. If you are not, don’t.

It is not uncommon in medical practice to find over hydration. This is usually at the behest of some well meaning nurse, wife, mother, daughter telling the patient that they need to drink eight to 10 glasses of water a day. They are also frequently told not to wait until they’re thirsty.

If one drinks more fluids than the heart and circulatory system can manage, the body stores the excess fluid in the legs as edema. As the legs fill up with fluid, the knees then and thighs, hips and even the back develop edema. Of course as the water level in our bodies rise further, it begins to fill up our lungs. At this stage if you don’t get to a physician in time to reverse this and drive two to four glasses away from your body rapidly by diuresis through your kidneys, you will proceed to die in congestive heart failure.

Some times the battlefield will become a winner versus loser struggle. The doctor managing the case will explain to the well-meaning nurse, wife, mother, daughter that the patient is dying in his own excess fluid. On occasion, they may listen. On other occasions, the well meaning nurse, wife, mother, daughter feel they have an incompetent physician who doesn’t appreciate this simple “medical rule” and will continue to give the patient excessive fluids during the evening, night and morning when no one can monitor their misunderstanding and the physician loses the battle to save his patient’s life.

Ignorance will sometimes reign supreme.

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Old Wives’ tales are sometimes difficult to manage.

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7. Overheard in the Medical Staff Lounge: Is Mitt Romney Presidential?

Dr. Rosen: Last week we were discussing why Newt Gingrich wasn’t fit to be president. I believe that Ruth took issue, not because the marriage was over, but that he chose to tell his wife while she was in the hospital in the midst of her critical cancer time that he was divorcing her. He couldn’t even wait until she was home to do it privately. Meanwhile, Michelle felt that his arrogant behavior was really unbelievably, crude, inhumane, insensitive and so undignified that he should never be the leader of our country. I think she even referred to him as a scumbag. Maybe the events of his staff deserting him were well deserved. I don’t think we can even imagine that Governor Mitt Romney would ever be subject to such behavior. But is he Presidential?

Dr, Ruth: I agree, he will never have an adverse moral issue.

Dr. Sam: He’s a far greater threat to freedom than Gingrich ever thought of being.

Dr. Dave: He’s a socialist of the first order. And he won’t admit it.

Dr. Paul: How do you figure?

Dr. Dave: He did in Massachusetts what Obama is doing in the nation. He socialized an entire industry - one of the largest in our country.

Dr. Paul: I know some doctors who feel health care has improved under Mitt Romney in Massachusetts.

Dr. Dave: I think if you read the accolades closely, the ones that like Mitt Romney’s brand of government medicine are more committed to government control than to patient’s medical welfare.

Dr. Paul: Don’t you think that reading your interpretation into what Mitt Romney says is your own bias?

Dr. Dave: It’s not only what Mitt Romney says, but also that he was able to pull it off in Massachusetts. It was a fait accompli.

Dr. Sam: Prejudice is sometimes difficult to overcome.

Dr. Paul: I don’t think it’s prejudice. I think these are well-meaning physicians who truly believe that Romney care has improved healthcare in Massachusetts.

Dr. Sam: I think if you look at all the stats, what people are covered, how well they’re covered, the costs overruns that have reduced benefits in their second year; there is nothing but a downside. Like Medicare, the cost overruns measure into catastrophic numbers. And still people call it a success—it will work if we do some fine-tuning. We’ve been fine-tuning Medicare for fifty years, and it is still out of tune. Even with the government contracting most of the program out to insurance companies in the various states.

Dr. Dave: We can look at every government healthcare program throughout the world. UK has been fine-tuning the NHS for more than fifty years and they are starting to contract work out to private hospitals. Sweden, the granddaddy of modern socialized medicine, has privatized their largest hospital. Why would we even think about going down this road to failure when it has always failed? Are we not mature enough to learn from other countries’ experiences? Or is government medicine so ingrained in the Socialists that they have a total Biased Block?

Dr. Edwards: We formerly had a socialist at the county medical society journal and we would go through the same arguments. He would simply brush them all off and tell us “Socialized Medicine has never been done right. It has always allowed too much freedom for people to choose. We have to have enough power to force the people to toe the line, monitor every medical decision to see what is most cost effective, and not allow any variation from the best of care.”

Dr. Milton: He didn’t have enough understanding of finances to even begin to understand the cost of monitoring healthcare with RNs behind every nurse’s station monitoring the orders as written, RNs reviewing every doctor’s private charts, RNs reviewing every lab order, RN’s reviewing every x-ray order, etc, et. al. Every two or three RNs would equal one physician’s entire income.

Dr. Rosen: One insurance man from a large medical insurance firm once admitted to me, after a meeting when everyone was gathering in the lounge, that they could problem dispense with their army of nurse reviewers, pay the usual and customary fees from doctors and other providers, and probably save money. But, don’t think we’ll ever give up our control over doctors and hospitals.

Dr. Dave: The WSJ stated that Romney was to the left of Obama. It would seem that Obama should choose Romney as his running mate in 2012.

Dr. Rosen: That’s an excellent idea. At least they are two birds of same feather. If Romney ran against Obama, I would be unable to vote.

Dr. Ruth: I agree. I wouldn’t be able to vote in 2012 either if Obama ran against Romney. After the elections were over, no one would know the will of the people.

Dr. Dave: That would be the height of confusion and misdirection and misinterpretation. The politicians could lead us by the nose and say it was the will of the people.

Dr, Rosen: How did we ever get into this political mess? There would be no front door of leadership to a known future. Politics would reign supreme. Politicians enjoy keeping people confused and misdirected. That’s how the re-enslavement revolution will come about—without firing a shot. Humankind will have wasted 300 years in their search for freedom. Everything could be lost in one administration. What a human tragedy—of Shakespearian dimension.

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The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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8. Voices of Medicine: A Review of Local and Regional Medical Journals: Sonoma Medicine

COMMENTARY: Saying Goodbye to Dr. Marcus Welby

By Herb Brosbe, MD

The title of this article tells you that you are dealing with an elder physician. You’ll have to Google Marcus Welby. There are no references in this article. It is one of those close-to-home pieces. I feel an overwhelming need to express myself. If I offend anyone, I apologize.

I feel like the last of the Mohicans. My culture is dying. Everywhere I look medicine is changing. I cannot stop it, but I need not applaud.

The current model of primary care (the gatekeepers have left, right?) appears to be a clinic. A place where the doctors triage and treat. You have a short time to diagnose the problem. Patients are often interrupted as you try to get to the point. You can’t get too far behind.

When I grew up in medicine, the commonest model was private practice. A small office of one to three physicians. This model is now considered inefficient. I simply do not believe this to be true. Read more . .

I was classically trained that taking the history was the most important part of the interaction. The exam, laying on of hands, provided more clues to reinforce the information you gleaned from the patient’s story.

Recently I had a man follow up from a visit to the ER for severe chest pain (case details have been changed throughout this article). As my office staff once again scrambled to gather whatever information was available, I could not help but wonder why in the 21st century communication between the ER and the community physician is so abysmal. Apparently the young doctor (the patient’s description) ordered the usual cardiac evaluation: CT chest and angiogram. The patient was sent home with hydrocodone and omeprazole. I asked him about his day before the chest pain. He had spent the day pruning trees. Hard repetitive work for hours. When I examined him, I pressed upon his chest wall muscles and reproduced the severe pain. This does not make me a better doctor, it just means I make time to take the history.

Dr. Abraham Verghese, author of Cutting for Stone, is professor for the theory and practice of medicine at Stanford. He spends hours teaching his students the art of taking a history and doing a physical before ordering tests. When I was a medical student at UCSF in the 1970s, this was not a novel idea.

Only a dozen or so primary care doctors in our community still admit their own patients. I am in awe of the young hospitalists. So talented, so competent. I have worked in countries in which the best and the brightest work in hospitals and the rest are in community clinics. Often a veil of disdain grows between these physicians over the years.

Our hospitalists appear to be overworked. They do not have time to communicate with the patient’s primary care doctor, and often tests are repeated that were taken recently elsewhere. I have seen a hospitalist admit one of my cardiac patients, change her medications and discharge her, never telling her cardiologist that she had been admitted. . .

Care gets compromised when my specialist’s office staff is too busy to ask the patient, “Who referred you? Who is your primary care doctor?” Case in point. My patient gets sent to the orthopedist. Orthopedist without communicating with me sends her on to neurologist. Neurologist without communicating with orthopedist sends her on to medical center. Later I get an email asking, “What am I supposed to do now?” I have to respond, “What are you trying to say?” Stunned, I read the reply: “I was diagnosed with ALS. I don’t know what to do.“ She was not talking about how to make a follow-up appointment with the ALS clinic. She was talking about how to tell her elderly parents and her 11-year-old son.

Colleagues, why can’t we treat each other with a little respect and communicate with each other?

In my small office, I have the privilege of being able to spend more time with patients if I choose. Case in point. “Carlos” is 19. He is dressed in typical rapper fashion. He wants to discuss how to get rid of multiple warts on his fingers and hands. I explain what a wart is and the various ways they can be treated. I know Carlos. I delivered Carlos.

I ask him, “How’s work with your uncle going?”

“Didn’t work out,” he states simply.

“Too bad,” I respond. “What’s next?”

“That’s the problem,” he says, “I don’t know.”

We talk for a while about the possibilities. I encourage him to seek an appointment with a guidance counselor at the JC. He agrees. He stands up to leave. I extend my hand. He gives me a hug. “Thanks, doc,” he says.

And that, ladies and gentleman, is what it’s all about. Caring. . .

It is true that I do not see 30 patients a day. I see 15 usually. I do not believe that makes my style of medicine obsolete or inefficient. Caring for patients is different from treating them. Competency and caring are the skills that lead to better outcomes with less expense. This I know.

Dr. Brosbe is a Santa Rosa family physician.

Email: Herbert.Brosbe@stjoe.org

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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: CLONING OF THE AMERICAN MIND

CLONING OF THE AMERICAN MIND - Eradicating Morality Through Education, by B. K. Eakman; Huntington House Publishers, Lafayette, LA, 1998, 606 pp, ISBN: 1-56384-147-9

"The educational system should be a sieve, through which all the children of the country are passed. . . It is very desirable that no child escape inspection. . ."

Paul Popenoe, behavioral eugenicist
American Eugenics Society; Editor, 1926

With this quotation, B K Eakman, educator, speech and technical writer, and researcher, sets the tone and the caution of a well-researched "call to alarms." She previously wrote the first publication to warn of individually identifiable psychological assessments being given under cover of academic (achievement) testing. That 1991 book, Educating for the "New World Order," was a surprise hit. It revealed that "corrective" curricula were being brought into classrooms under the umbrella of remediation. Youngsters' beliefs and viewpoints were being remediated, not their skills in academic disciplines.

Eakman does a masterful job chronicling three parallel efforts dating over a century--information gathering methodologies, behavioral science, and legislation--and places these in context to provide insight, not only into the times and circumstances surrounding each event, but the ramifications for our present era.

Cloning of the American Mind centers on America's "illiteracy cartel," a term Eakman coined to describe an out-of-control psychographic consulting industry. Psychographics is a relatively new field that combines elements of demographic and marketing research, where personal, student, and family records assume a commodity that with recent advances in computer technology can be acquired by almost anyone. Psychographics means "the study of social class based upon the demographics . . . income, race, color, religion, and personality traits. . . which can be measured to predict behavior." Their use in persons in captive, compulsory settings like elementary and secondary schools is of serious ethical and civil rights concerns.

This book explores today's behemoth psychographic consulting/information brokerage industry, focusing in particular on state-of-the-art computer technologies and advertising strategies to illustrate how behavioral scientists are combining these with psychiatry to reform education. In the process, Eakman shows us two factions of behavioral science as they evolve, clash, and then come together to accomplish what no extremist group or power elite has been able to do in the history of the world: hold an entire population hostage to a set of quasi-political, psychological criteria by predicating children's job prospects on whether they hold "acceptable" worldviews and opinions. These social engineers, by obtaining personal information about youngsters and their families, also get into the belief system of the students and correct any viewpoints they find distasteful.

As a society we are getting desensitized to divulging personal information. We're no longer sure what "personal" means. Certainly our children don't know. When they're asked questions about the family's medicine cabinet, mental problems, drinking habits, sexual practices, they are only too eager to impress, divulge and exaggerate information to please the teacher, and sound impressive misinterpreting what they see and hear. False information is thereby interspersed with accuracy being of little or no concern to those collecting information. The media, of course, has no stake whatsoever in other people's privacy.

The critical point is that there is a computer model available to predict behavior, simply by deriving a pattern of one's past activities. These activities can include anything from long-distance telephone usage to spending, recreation, and health. These are increasingly available, not only as part of any security background check, but also can now be added to a routine background check. If this is not enough, there is the ever-lurking "information underground' to which even government officials turn when they cannot get their data on us through legitimate channels.

Eakman points out that Jeffrey Rothfeder in his 1992 volume, Privacy For Sale, decided to show just how much information he could obtain about a prominent public figure. He selected former Vice-President Dan Quayle, someone he held in mild contempt. By using his personal computer and telephone, Rothfeder found he could easily gain access to information he wasn't supposed to be able to get. He found more than he bargained for and started sounding alarms. However, Rothfeder was blissfully unaware that techniques identical to those he was describing were being used in the nation's elementary and secondary schools. A database exists that not only has the capability to track and cross-reference generic information about people, their beliefs, family ties, friends' and associates' names, addresses, phone numbers and aliases; political/civic clubs and associations joined; magazine subscriptions; frequent shopping places; political campaigns and causes contributed to; how important a person is by region, state, or city; what potentially embarrassing information one may harbor; but can also predict a person's future action.

Education policy--indeed, all of social policy today--is aimed at dysfunctional people, not toward the backbone of society. When ordinary folk use the term "parents," we mean the majority of upstanding, decent people who care about their children. Statistics show that about one-half of one percent of American youngsters have no responsible adult to care for them. Yet, over the past 30 years, social and domestic policy has focused almost exclusively upon this irresponsible, negligent and abusive element. So when education policy makers hear the term "parents," they're thinking of negligent, abusive, and irresponsible people, or at the very least, of "rank amateurs." . . .

By the late 1970s, day care was a booming business. Awash in unworkable philosophies of child management for over a decade, parents could scarcely get rid of their youngsters fast enough or for long enough periods. Psychiatrists touted the day care concept as beneficial not only to parents, but a boon to a child's socialization and school-readiness. Reality, however, was less positive. Daycare overstimulated toddlers, transmitted diseases like hepatitis, and weakened the bonds between parent and child. Institutions of learning had now taken on a new function: that of substitute parent.

Eakman's behind-the-scenes objective look at our bureaucratic education system makes Cloning of the American Mind an indispensable book for parents, educators, physicians, or anyone involved with our children. One can open up this volume to almost any of its 600 pages and find alarming news. In these two pages I have just touch the tip of the iceberg of what Eakman is telling us is happening to our children and the future of our society. We should all purchase our own volume for careful reading and tell all our friends about this book. We should even consider an extra volume for a concerned friend, and one for a member of our local school board. Our country's future is at stake--and our children won't be able to save it unless we take drastic action now.

The epitaph of the 20th century should be: "Here lie the victims of open-mindedness." --Joseph Sobran, syndicated columnist.

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The Book Review Section Is an Insider’s View of What Doctors are Reading about.

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10. Hippocrates & His Kin: In Vino Veritas

P. J. O’Rourke with a modest proposal for a more honest politics.

Mitt Romney (with apologies for making him violate his religious principles by taking a drink): “I’m a technocrat. I fix problems. I fix a problem whether the problem exists or not. Like health care in Massachusetts. It wasn’t a problem. I fixed that.”

Newt Gingrich: "The thing is I'm brilliant—dazzlingly brilliant. I'm dazzled by my own brilliance. I'm so dazzled sometimes I can't see where I'm going. I bumped right into Paul Ryan's budget proposal. I'm a deer in my own headlights."

Mr. O’Rourke’s many books include “Don’t Vote—It Just Encourages the Bastards.” WSJ

Dear President Obama:

I am writing today with a somewhat unusual request. I am asking that you return America to its August 20th, 1959, borders so that Hawaii is no longer a state and you are no longer a citizen.

Prime Minister Benjamin Netanyahu

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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. NCPA HealthCare Policy: We have a health care crisis because doctors, patients, employers and employees are trapped in a wasteful, broken system that is too bureaucratic and far too unresponsive to patient needs and market forces. To solve our problems, your doctor needs the opportunity to produce higher-quality, less-costly care. As a patient, you need access to services you are not now getting. At the workplace, you need access to health insurance that costs less and gives you more. At the NCPA, we believe sensible reforms, based on the innovative and competitive nature of the free-market, would help us build a more sustainable health care system.

• 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. Vol.9 No.4, April 2011, Key Points

•The Medicare part of the Ryan budget is superior to Obamacare but needs more definition.

•The current proposal would limit future Medicare beneficiaries’ choices to those selected from a federal exchange.

•Medicare beneficiaries would benefit more from Republicans’ clear commitment to restore Medicare Advantage, a popular alternative to the traditional Medicare monopoly that half of current beneficiaries will lose due to Obamacare.

•Republicans should advance Medicare reforms in a way that makes their benefits more clear to the public, by building on the popularity of Medicare Advantage and Medigap, rather than appropriating the language of “exchanges” from Obamacare.

• 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 by Veronique de Rugy | Mar 19, 2010: Breakdown of Medicare Expenditures: This chart by Mercatus Center senior research fellow Veronique de Rugy uses data from the Social Security Administration to illustrate long-term projections of Medicare revenues from premiums and payroll taxes (blue) along with projected transfers into Medicare from the federal government (red) and the projected deficits in Medicare’s Hospital Insurance Fund (orange); when summed, these components add up to total long-term Medicare expenditures.

Throughout the time period examined, the portion of Medicare that is funded by our tax dollars is slated to remain roughly constant at 40%. As a percentage of GDP, these general revenue transfers are projected to increase from 1.3% in 2010 to 3.6% in 2050. In addition, growing deficits in the Hospital Insurance Trust Fund will need to be proactively addressed by new legislation to avoid a future interruption of service. Medicare funding must be cut; these cuts must be deliberate, not due to a legislative loophole.

• 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 what’s happening to Medicare: Without a serious course adjustment, Medicare will become a third-rate, price-controlled program that rations a lower quality of care through waiting lines and other restrictions. If the antiquated, open-ended, fee-for-service model isn’t reformed, then we will continue to pour deficit-funded dollars into the program or raise taxes to levels that would topple the economy as millions of baby boomers hit retirement. The only way to save Medicare is to change it.

• 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?. On November 2, millions of Americans voted to take back their country. Now the real work begins: to hold those elected officials accountable to their promises of lower taxes and smaller government. To support their efforts, The Heartland Institute is making available free copies of a new 260-page book, The Patriot's Toolbox, and nearly a dozen booklets that present in plain English what needs to be done to reform health care, state budgets, schools, environmental policy, and more. You can read these publications online, download, them, or ask for free copies. (read more)

• 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 the current lesson on Economic Education: Economist James M. Buchanan used to ask his Ph.D. students the following question, “It is said that a fly that grew 9 times its size could no longer fly. What does that imply for the fiscal dimensionality of the state?” This question is one of scale in relation to the size of government.

• 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. By Linda Gorman: ObamaCare is unpopular, unwieldy, expensive, arguably unconstitutional, and a prime target for repeal. It requires the states to do much of the federal government’s dirty work. Right now, the federal government is paying states $1 million to plan health insurance exchanges designed limit the kinds of health insurance policies available to state residents.

• 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. "No one would accept the argument that a mugger or a burglar is entitled to someone’s property if he’s walking down a given street or living in a given neighbourhood. So what entitles the state to make that identical claim?"

• 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 (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 Humanitarians v. Economists at www.hillsdale.edu/hctools/ImprimisTool/archives/2011_03_Imprimis.pdf The last ten years of Imprimis are archived.

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Words of Wisdom by Eric Hoffer (1902-1983)

A San Francisco longshoreman-turned-author, achieved immediate fame for his book True Believer (1951), in which he described the underlying logic of mass movements, such as Nazism and Communism, and the characteristics of their followers. He also wrote The Passionate State of Mind (1955) and The Ordeal of Change (1963).

We clamor for equality chiefly in matters in which we ourselves cannot hope to obtain excellence. –The Passionate State of Mind

No matter how noble the objectives of a government, if it blurs decency and kindness, cheapens human life, and breeds ill will and suspicion—it is an evil government. –The Passionate State of Mind

We cannot win the weak by sharing our wealth with them. They feel our generosity as oppression. –The Ordeal of Change

There can be no freedom without the freedom to fail. –The Ordeal of Change

I doubt if the oppressed ever fight for freedom. They fight for pride and power—the power to oppress others. The oppressed want above all to imitate their oppressors; they want to retaliate. –The True Believer

It is to escape the responsibility for failure that the weak so eagerly throw themselves into grandiose undertakings. –The True Believer

Some Recent Postings

In The April 26 Issue:

1. Featured Article: Ayn Rand on tax day

2. In the News: ObamaCare Opt Outs

3. International Medicine: Intellectual Dishonesty On Health-Care Issues

4. Medicare: ObamaCare

5. Medical Gluttony: Tossing Drugs into the Toilet.

6. Medical Myths: Information technology will improve efficiency and safety

7. Overheard in the Medical Staff Lounge: Is Newt Gingrich Presidential?

8. Voices of Medicine: The Social Security trust fund is an Empty Lockbox

9. The Bookshelf: No one can fully appreciate the great fortune we have to be Americans . . .

10. Hippocrates & His Kin: The modern Squatters

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

In Memoriam

Baruch (Barry) Blumberg, defeater of hepatitis B, died on April 5th, aged 85

The Economist | Apr 28th 2011 | from the print edition

ALTHOUGH it was medicine for which he won his Nobel prize, Barry Blumberg was really an explorer. Growing up in Brooklyn, he dreamed of being Shackleton at the South Pole or Darwin on board the Beagle. His heroes were Lewis and Clark, the intrepid explorers of the new American continent, and the field-trip grants he founded in later life were named after them. Invited to China in 1977 to talk about his great discovery, a virus that caused hepatitis, and his greater invention, a vaccine to prevent it, he would slip out in the early mornings to run for hours through fields, farmyards or the just-stirring streets of Beijing. As master of Balliol College, Oxford from 1989-94—the first American to hold the post, and the first scientist—he would pedal out eagerly into the countryside, his burly frame well waterproofed against the English weather, to see what he might see.

On these trips he would have a vague plan A, a goal in view, for he had learned to appreciate planning during a wartime spell in the navy; but plans B and C might be good, too. Like Tristram Shandy, he preferred the apparently random and open-minded route. His scientific method was to gather huge amounts of data, with exuberant curiosity, in order to let some discovery surprise him. “Goal-oriented” institutions, such as the National Institutes of Health, found it hard to work with him, and he with them, but he would cheerfully decamp to freer places, such as the Institute for Cancer Research, which let him roam until relevance emerged from his roamings. “Expect the unexpected” was his motto—after Heraclitus, who said you could never step into the same river twice.

His career in medicine (itself unexpected, since he had wandered towards maths, in the steps of his Uncle Henry, and then physics, all within the reach of his omnivorous intelligence, before ending up, at his father’s stray suggestion, at Columbia University’s medical school) was animated not by a goal, but by a question. Why did some people fall sick, when others did not? As a young doctor on the hellish, Hogarthian wards of the Bellevue Hospital in lower Manhattan, he noticed that some among his poor, desperate patients contracted TB, while others stayed healthy. A field trip in 1950 to Suriname, to a remote township reachable only by river, reinforced the puzzle: native Creole workers in the sugar plantations often developed elephantiasis, but Javanese did not. Dr Blumberg became fascinated by polymorphism, the study of inherited variations in human beings. Round the world he went, to Nigeria, Australia, the Arctic, India, taking thousands of blood samples, hoping something would show up.

What showed up one day in 1964, quite unexpectedly, as he was studying yellow jaundice, was a mysterious protein in the blood of an Australian aborigine. It turned out to be the surface antigen, or immune-response trigger, for hepatitis B—a principal killer among the world’s diseases, and a chief precursor of liver cancer. Once the virus and its antigen were found, Dr Blumberg and his team devised tests for it, so that donors could be screened before giving the blood that often transmitted the infection. They also made a vaccine for it, the first “cancer vaccine” ever invented.

Deep past to distant future

The scientific establishment was reluctant to accept his work, and pharmaceutical companies were slower to develop it; Dr Blumberg felt like a usurper battering at the palace gates. Defiantly, and with typical generosity, he shared his findings with the world, sending out reagent kits and copies of his patent to anyone who wanted to carry forward his research. At last, in 1982, Merck put the vaccine on the market. Its effects were dramatic. In China the chronic hepatitis B infection rate among children fell from 15% to around 1% in a decade; in the United States and many other countries, post-transfusion hepatitis B was almost eradicated within a few years. Public immunisation programmes, urged on by Dr Blumberg in private chats with the high-and-mighty, saved and are still saving millions of lives. . .

Read the entire Obituary in The Economist, subscription required . . .

On This Date in History – May 10

On this date in 1869, the first transcontinental railroad link was completed at Promontory, Utah. They drove a golden spike to complete the first full railroad connection across the American continent. We may not be too impressed, in the age of jet planes, by railroads; but it was the railroad that sparked the industrial revolution of the nation. Is the clock turning back? Confronted with the mass transportation problems of big cities, many are urging not merely the continuance but the expansion of commuter rail service. Will we see more celebrations for the driving of a few more golden spikes?

On this date in 1940, Winston Churchill became Prime Minister of Great Britain. He had been a brilliantly successful author and lecturer, but more of a gadfly than a success as a political figure. He was 66 when his nation’s highest office came to him. Did the times, the challenge, make Winston Churchill? Great men do not merely rise to an occasion, they make an occasion. Would England have fought so gallantly in World War II against such overwhelming odds—until America entered the fray—without the eloquence and the bulldog determination of Winston Churchill? What we do know is that, in his democracy and in ours, whenever the times have called for that kind of leadership, that kind of leadership, sooner or later, has emerged. Do we have it now?

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.

MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol X, No 3, May 10, 2011