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MEDICAL TUESDAY . NET |
NEWSLETTER |
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Community For Better
Health Care |
Vol VIII, No 13, Nov 10, 2009 |
In This Issue:
1.
Featured Article:
Why Intelligent People Do Foolish Things
2.
In
the News: Obesity will cause more liver damage than alcohol by Anushka Asthana
3.
International Medicine: The UK's NHS is unable to provide care - Authorizes
Private Care
4.
Medicare: Here's
another prescription to cut health care costs.
5.
Medical Gluttony:
Intrusiveness by HMOs and CMS adds to medical gluttony
6.
Medical Myths: A
"Public Option" will bring down health care costs.
7.
Overheard in the Medical Staff Lounge: Massive changes in the Health Care System are
Foolish
8.
Voices
of Medicine: We Should Be Thankful for What We Have: Access
9.
The Bookshelf: How People
Prevail in the Face of Illness
10.
Hippocrates
& His Kin:
Empathetic Doctors heal you faster
11.
Related Organizations: Restoring Accountability in HealthCare, Government and Society
Words of Wisdom, Recent
Postings, In Memoriam . . .
*
* * * *
The Annual World
Health Care Congress, a market of
ideas, co-sponsored by The Wall Street Journal, is the most prestigious
meeting of chief and senior executives from all sectors of health care.
Renowned authorities and practitioners assemble to present recent results and
to develop innovative strategies that foster the creation of a cost-effective
and accountable U.S. health-care system. The extraordinary conference agenda
includes compelling keynote panel discussions, authoritative industry speakers,
international best practices, and recently released case-study data. The 3rd
annual conference was held April 17-19, 2006, in Washington, D.C. One of the
regular attendees told me that the first Congress was approximately 90 percent
pro-government medicine. The third year it was about half, indicating open
forums such as these are critically important. The 4th
Annual World Health Congress was held April 22-24, 2007, in
Washington, D.C. That year many of the world leaders in healthcare concluded
that top down reforming of health care, whether by government or insurance
carrier, is not and will not work. We have to get the physicians out of the
trenches because reform will require physician involvement. The
5th Annual World Health Care Congress was held April 21-23, 2008,
in Washington, D.C. Physicians were present on almost all the platforms and
panels. However, it was the industry leaders that gave the most innovated
mechanisms to bring health care spending under control. The
6th Annual World Health Care Congress was held April 14-16, 2009,
in Washington, D.C. The solution to our
health care problems is emerging at this ambitious Congress. The
5th Annual World Health Care Congress – Europe 2009, met in Brussels, May 23-15, 2009. The 7th
Annual World Health Care Congress will be held April 12-14, 2010 in
Washington D.C. For more information, visit www.worldcongress.com.
The future is occurring NOW. You should become involved.
To
read our reports of the 2008 Congress, please go to the archives at www.medicaltuesday.net/archives.asp
and click on June 10, 2008 and July 15, 2008 Newsletters.
*
* * * *
1.
Featured Article:
Why Intelligent People Do Foolish Things
[I am sure we all know of someone who has all the
necessary data and stats about health care but who is completely unable to
cognitively apply that information in a dynamic, real-world health care
environment. They know all the ins and outs of what they think doctors do, but
are totally clueless in the consultation room or at the bedside. It sounds like
this concept of dysrationalia is a rational explanation for the current health
care debate.]
By Keith E. Stanovich
Scientific American Mind - October
30, 2009
No doubt you know several folks with
perfectly respectable IQs who just don't seem all that sharp. The behavior of
such people tells us that we are missing something important by treating
intelligence as if it encompassed all cognitive abilities. I coined the term
"dysrationalia" (analogous to "dyslexia"), meaning the
inability to think and behave rationally despite having adequate intelligence,
to draw attention to a large domain of cognitive life that intelligence tests
fail to assess. Although most people recognize that IQ tests do not measure important
mental faculties, we behave as if they do. We have an implicit assumption that
intelligence and rationality go together - or else why would we be so surprised
when smart people do foolish things?
It is useful to get a handle on
dysrationalia and its causes because we are beset by problems that require
increasingly more accurate, rational responses. In the 21st century, shallow
processing can lead physicians to choose less effective medical treatments, can
cause people to fail to adequately assess risks in their environment, can lead
to the misuse of information in legal proceedings, and can make parents resist
vaccinating their children. Millions of dollars are spent on unneeded projects
by government and private industry when decision makers are dysrationalic,
billions are wasted on quack remedies, unnecessary surgery is performed and
costly financial misjudgments are made. . .
www.scientificamerican.com/article.cfm?id=rational-and-irrational-thought
*
* * * *
2.
In the News: Obesity will cause more liver damage than alcohol by Anushka Asthana
Senior doctor says few understand
that excess weight is linked to cirrhosis, diabetes and hypertension.
One of the country's
most senior doctors has warned that obesity will overtake
alcohol as the main cause of liver cirrhosis in the "not too distant
future".
Professor
Christopher Hawkey's comments come as a new poll shows that more than five out
of six people are unaware the disease is linked to excess weight. "Obesity
is the biggest health problem we face this century," said Hawkey,
president of the British Society of Gastroenterology.
"It is almost
certainly going to reverse the rise in life expectancy – so we start living
shorter lives than before. It will increase the risks of a number of cancers;
hip and knee surgery requirement is going to be vast; and it is now projected
to overtake alcohol as the biggest cause of liver cirrhosis within two
decades."
Obesity has already
become the main cause of less serious forms of liver disease, but cirrhosis is
the end stage – an irreversible scarring that causes the organ to deteriorate.
A BSG poll of 1,959
people released today found that while the majority understood that obesity
could cause diabetes, high blood pressure and infertility, few understood its
link to certain cancers or liver problems.
New figures from the
organisation show a huge spike in the number of people under the age of 65
dying of liver disease, while deaths linked to other problems – such as
diabetes, cancers and stroke – have fallen for that age group.
The average age of
death from liver disease is 59 compared with between 82 and 84 for heart and
lung disease and strokes. It is the fifth largest cause of death in the UK, and
in the past 10 years there has been a five-fold increase in cirrhosis for those
aged between 35 and 55.
Hawkey said today's
poll also showed that people don't realise other complications are related to
obesity. "People don't know there is an epidemic of cancer of the
oesophagus, for example, which is very hard to treat."
He said Britain had
become a "nation of grazers" seeking instant gratification. The poll,
he said, highlights a number of worrying trends. For example, it found that
half of those questioned considered themselves overweight, and of these one in
five women and more than one in six men admitted to binge-eating. Experts say
bingeing is a disorder where suffers can consume 10,000 calories in one go.
"It is comfort
eating – just like comfort drinking," said Hawkey, adding that bingeing
could lead to many health risks beyond excess weight. The NHS defines binge-
eating as a disorder where the sufferer feels "compelled to overeat".
"Binge eaters
usually eat large quantities, including when they're not hungry, in a short
period of time and in private. They feel they have no control over their
overeating," the NHS information sheet says. . .
"Binge-eating
is not about people eating large portions – it is almost a ritual. They plan
it, buy high-fat and sugary foods, find a time they can be alone, and lock the
door. It is comfort eating – but way beyond having an extra chocolate biscuit
because you feel down.
"People can
take 10,000 calories in one go – four times what you would expect to eat in a
day. They could, for example, eat a whole pack of butter." Ringwood said
treatment includes cognitive behavioural therapy.
Hawkey said the
healthiest option is for people to eat small portions of foods that release
carbohydrates slowly. He also advocates vegetarianism, or
"semi-vegetarianism" for those who can't give up meat entirely.
www.guardian.co.uk/lifeandstyle/2009/nov/01/obesity-liver-cirrhosis-diabetes-link/print
*
* * * *
3. International Medicine: The NHS is
unable to provide care in the UK- Authorizes Private Care
Patients left waiting by NHS win
right to private care
Cabinet agrees to enforce
maximum waiting time of 18 weeks…
David Batty and agencies, guardian.co.uk,
Saturday 31 October 2009
Patients who wait longer
than the target of 18 weeks for NHS treatment are to be given the
legal right to get free private healthcare.
The move will place
maximum waiting times for treatment on the statute book for the first time and
should be rushed into law before the next general election after being agreed
by the cabinet earlier this week, the Times reports today.
It will be coupled with
a further legal right for cancer patients to receive private treatment if they
have not been seen by an NHS specialist within two weeks of referral by their
GP.
The measures will be
unveiled in next month's Queen's speech, the last of the parliament, and are
intended as part of a Labour challenge to the Conservatives on the future of
the NHS and public services. . .
"It will provide
ordinary people with the right and the power to ensure that they get the
service that they deserve and that their illness is treated in time.
"And if the
standards are not being met they will have the right to have them provided by
the medical resources that have always been available to those who are well off
or well connected."
The Conservatives'
shadow health secretary, Andrew Lansley, said the plan had "more to do
with electioneering than improving the NHS".
He said: "They
claim that these will be legally enforceable new rights, but are Labour really
planning to put the lawyer in the operating theatre? Do they trust the doctors
to do their job or do they want judges telling surgeons who they should operate
on first?
"Putting the
18-week target in legislation will further distort priorities and will lead to
many more patients waiting for treatment for 18 weeks even when they could and
should have got it sooner."
The director of the
Patients Association, Katherine Murphy, questioned whether the legal right
should be a priority for the NHS.
She said: "Targets
are still perverting care in too many cases. Elderly patients admitted through
A and E don't tick any of the target boxes when they're admitted to wards. It's
no surprise they can end up being neglected.
"Until this problem
is addressed targets can still have a detrimental effect on patient care.
Fixing this problem should be the priority-not coming up with vote winning
initiatives.
guardian.co.uk ©
Guardian News and Media Limited 2009
www.guardian.co.uk/politics/2009/oct/31/nhs-waiting-times-private-health
The same
problem exists in Canada. Their next step is to follow the UK's admission of
defeat.
Canadian
Medicare does not give timely access to healthcare, it only gives access to a
waiting list.
--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R.
791
http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
*
* * * *
4. Medicare: Here's another prescription to cut health
care costs.
This type of model embodies the characteristics of
the "accountable-care organizations," or ACOs, proposed in the House
bill unveiled last week and the Senate Finance bill approved in committee in
early October. Accountable-care organizations are networks of doctors and
hospitals that together would receive a lump-sum payment for coordinating the
care of their patients and for taking accountability for both the quality and
the value of the care and service delivered.
Since not all medical providers are ready to accept
this type of payment, new approaches to care delivery and financing already
under way in some states and health systems are also included
in legislation. This includes "medical homes" in which practices are
paid to guide a patient's care. It also includes "bundled payment"
for certain acute episodes of care and chronic conditions.
In this model, providers receive a fee for an entire
episode of a patient's care – rather than for individual procedures – and then
determine the best use of medical resources to deliver the best care for that
patient. The Integrated Healthcare Association
is developing a plan for bundled payment for total knee replacement and
coronary artery bypass graft in partnership with several Southern California hospitals including Cedars-Sinai Medical Center and health plans including Blue Shield of California.
Administrative burdens must go
There is also a great deal of administrative
inefficiency in the health care system. According to a
study in the New England Journal of Medicine,
almost one-fourth of hospital costs are related to administration and billing,
and doctors spend more than eight hours a week on paperwork rather than on
patient care. The administrative burden on those who run and participate in
public programs is also very high. . .
Address social disparities
Real health care reform must address the reasons we
fall ill in the first place. In California, there are large disparities in
health outcomes among different economic, geographic and cultural communities.
The difference in life expectancies of people living in neighborhoods just a
few miles apart is striking. The Bay Area Regional Health Inequities Initiative
reports that "people who live in West Oakland … can expect to live on
average 10 years less than those who live in the Berkeley Hills."
Redressing the "social determinants" of
poor health is not only a moral obligation, it is also an economic imperative.
The California Center for Public Health Advocacy estimates that a 5 percent
reduction in the prevalence of obesity and physical inactivity will save the
state nearly $2.4 billion a year. This is because obesity and physical
inactivity are associated with the five chronic conditions that account for as
much as 75 percent of our health care spending in the United States: diabetes,
asthma, depression, congestive heart failure and congestive arterial disease.
The environments in which people live can have a
positive impact on their health outcomes even in the face of persistent
economic inequality. A local ordinance limits the development of fast food
restaurants in south Los Angeles where the prevalence of obesity is higher. And
ultimately it is the availability of affordable healthy foods that is the key
to lowering rates of obesity. It is 10 times more expensive to get 200 calories
from carrots than from donuts.
All components must collaborate
In the end, it will take a broad range of different
strategies to control rising health care costs. And the solutions that are
developed must be informed by what works in doctors' offices, hospitals and
community clinics and for real patients and consumers. . .
It is possible to dramatically improve the value we
get for our medical spending while improving the high quality of care we
receive. California's experiences create a road map we can use to successfully
implement federal reform and control rising medical costs.
Do you think health care reform can succeed without
a public option? To comment on this issue, please use our forum.
www.sacbee.com/opinion/story/2295481-p2.html
Government is not the solution to our
problems, government is the problem.
-
Ronald Reagan
* * * * *
5. Medical Gluttony: Intrusiveness by HMOs and CMS adds
to medical gluttony.
We have been pointing out
the gluttony caused by patients, and on occasion by our colleagues, in their
demands for unnecessary tests and procedures. Recently, a patient demanded
quarterly checks on his lipids. Review of the lipids from his previous
physician revealed they had been stable for the past several years. However,
with a history of elevations in the past, a return to yearly checks would be
more than adequate.
Patients with elevated
lipids, who promise to change their dietary habits and get their lipids in
line, have a success rate on the order of losing weight - perhaps 10 percent.
As physicians, we shouldn't be supporting fantasies that seldom happen.
Patients who have a body mass index of 40 (morbid obesity) want their weight
recorded to the nearest one-half pound after removing their soft shoes,
handkerchief and phone. Putting these back on the scale seldom budges the
balance, and I have to remind them that their fantasy behavior adds another
line to their list of diagnoses.
For the past several years,
the insurance companies have been getting more intrusive in telling physicians
how to practice, what tests to order and how frequently. By monitoring the
claims, they see diagnosis such as hyperlipidemia with no charge for a lipid
panel. Physician's efforts to reduce cost by no longer measuring a patient's
dietary failure after five or ten years is now being monitored and letters of a
quiet reprimand are being sent to the doctor. Sometimes it takes longer to read
all these letters from the insurance companies about a variety of tests than to
read the accompanying stack of patient charts with new reports. Ordering the
tests does increase health care costs by 500 percent if done yearly rather than
every five years. This excess cost, or gluttonous behavior on the part of
insurance companies, will eventually result in large increased insurance
premiums in the name of quality and prevention, when there has actually been no
improvement in quality.
These divergent forces in
health care will neither reduce health care costs nor improve quality. But they
could be achieved by the simple mechanism of having a co-payment on every test
and procedure the physician or patient desires. The co-payment reduces the
appetite for excesses and thus controls health care costs and will be more
effective than the various oversight programs that are not inexpensive in and
of themselves. The co-payment also provides motivation for patients to follow
diets that lower cholesterol or weight. This would be a more effective weight-loss
or cholesterol-lowering program than dietary instructions from dieticians,
which are seldom followed.
Medical Gluttony thrives in Government and Health
Insurance Programs.
It Disappears with Appropriate Deductibles and
Co-payments on Every Service.
*
* * * *
6. Medical Myths: A "Public Option" will bring
down health care costs.
Myth 9. A "public option" is needed to
spur competition, keep private plans honest, and bring down costs. AAPS, July 15th, 2009
The
White House claims that the choice of a public plan operating alongside private
plans would spur private plans to improve. It also promises that all plans
would be playing by the same rules.
According
to a July 2
letter from the Congressional Budget Office (CBO), the addition of a
government-run plan provision to the Dodd/Kennedy bill, the Affordable Health
Choices Act, "did not have any substantial effect on the cost or
enrollment projections, largely because the public plan would pay providers of
health care at rates comparable to privately negotiated rates - and thus was
not projected to have premiums lower than those charged by private insurance in
the exchanges."
In
other words, the government either keeps its word about competing on a level
playing field, in which case the plan is pointless, or the government plan gets
unfair advantages, notes Andy Chasin in a memo to Republican Health Policy
Staff.
Advocates
for the public option, such as former Secretary of Labor Robert Reich, say it
is the "lynchpin of health-care cost containment" - because without
it, "the other parties that comprise America's non-system of health care -
private insurers, doctors, hospitals, drug companies, and medical suppliers - have
little or no incentive to supply high-quality care at a lower cost…." (Wall St J
6/24/09).
In
other words, the public plan is expected to use its monopsony power to squeeze
providers.
Economist
Paul Krugman agrees: A public plan would have the "bargaining power needed
to bring down costs" (NY
Times 6/22/09).
Gregory
Mankiw points out that it wouldn't really bring down costs, just shift them
from consumer to provider. The same thing could be accomplished by taxing
providers and using the proceeds to subsidize consumer purchases (NY
Times 6/28/09).
Cost-shifting
from the big public plans called Medicare and Medicaid already adds an
estimated $89 billion to private insurance costs. Crowd-out is amply
demonstrated: up to one-half of children newly enrolled in the State Children's
Health Insurance Program (SCHIP) previously had private coverage. A Robert Wood
Johnson survey of 22 studies concluded that substitution of government for
private coverage "seems inevitable" (Michael Tanner,
"Obamacare to Come: Seven Bad Ideas for Health Care Reform, Cato Policy
Analysis No. 638, May 21, 2009).
Bargaining
power is not the only potential source of lower prices charged by government,
notes John Calfee: just look at Fannie Mae and Freddie Mac. They were viewed as
less risky because the government was expected to bail them out if they failed
(Wall St
J 6/26/09).
The
other advantage of the government is that it can always change the rules,
observes Michael Tanner.
"Let's
get this straight: 1300 insurance companies aren't enough to have competition?
We need 1301 to suddenly make it all OK?" asks
Rossputin.
And
if the government wanted more competition among insurers, why not repeal the
McCarran-Ferguson exemption that shields the business of insurance from
antitrust law?
One
enormous advantage the federal plan will almost certainly have is exemption
from 50 sets of state mandates that make health insurance unaffordable for so
many.
Additional information:
"Repeal of the
McCarran-Ferguson Act," Resolutions Adopted at the 49th Annual Meeting of
AAPS, 1992.
"Congress Moves
Toward Repeal of McCarran Ferguson," AAPS News, August 1990.
This
entry . . . is filed under health care reform, mythbusters. You can follow any
responses to this entry through the RSS 2.0 feed. You
can leave
a response, or trackback
from your own site.
www.aapsonline.org/newsoftheday/00340
Medical Myths originate when someone else pays the
medical bills.
Myths disappear when Patients pay Appropriate
Deductibles and Co-payments on Every Service.
*
* * * *
7. Overheard in the Medical Staff Lounge: Massive changes
in the Health Care System are Foolhardy
Dr. Sam: The Congress is considering massive changes in how
we practice. They have no idea what the unintended consequences will be.
Dr. Dave: The infrastructure of health care is so intricate,
that even small changes are very disruptive.
Dr. Rosen: And this disruption is not in the innovative sense of
the term. Instead of a change towards efficiency, it will create confusion. And
the players, primarily physicians and nurses, will get the blame.
Dr. Paul: But in the long run, things will work out and the
centralized government control will standardize medicine.
Dr. Ruth: I'm not convinced that standardizing health care will
ever be in the best interest of our patients' health.
Dr. Edwards: Also, monopolies are never efficient. They become
more insensitive to the people they are supposed to serve, and without
effective feedback they become very costly.
Dr. Rosen: Dennis Prager made an interesting observation in his
show this morning. He argues we are
in a civil war in America far worse than our Civil War of 1861. In that Civil
War, the people of the North and the people of the South were generally alike
with the same desires for freedom. In the present Civil War of the Liberals and
the Conservatives, there will never be a meeting of the minds. The Liberals
have lost the concept or the idea upon which America was built. And there is no
indication that they will ever accept the original tenant of our country. They
want to make us more like Europe.
Dr. Milton: Now that's a loaded statement. It's tragic to think
there are now members of our own profession that have lost sight of what was
wrought in America. We have made the world a much better place. To even think
that they want to accept the government control of Bismarck's Germany of two
centuries ago is dividing our profession.
Dr. Rosen: Prager also quoted the Pew study of citizens in a
number of countries. Would they look inside themselves or outside themselves
for their future direction?
Dr. Edwards:
Well, did we make it?
Dr. Rosen: Yes we did. Only in America did the majority of
people still look within themselves for their future. All the other countries
interviewed looked outside themselves, primarily to their government for
directing their lives.
Dr. Dave: Even our founders said, "We have given you a
republic, if you can keep it."
Dr. Milton: We have freedom that people in other countries dare
only dream about.
Dr. Rosen: We have to become more articulate. Otherwise, we too
will only be able to dream about the freedom we once had. Has the American
Dream run its course and is it ready for the dustbin of history?
Dr. Kaleb: I certainly hope not. That's why we came here.
Dr. Paul: I don't see us losing freedom if the government takes
over health care.
Dr. Kaleb: What else could you call it?
Dr. Paul: But won't our patients benefit from Universal Access?
Dr. Kaleb: Our patients will die or suffer in pain waiting to be
seen.
Dr. Paul: And all medical records will be available to every
doctor and hospital treating the patient.
Dr. Kaleb: And there are tens of millions of others that will
have access to the Medicare Computers with every habit, indiscretion and
disease also being transparent.
Dr. Paul: But we have the Health Insurance Portability and
Accountability Act (HIPAA) that assures confidentiality of medical records.
Dr. Kaleb: On the contrary, it opens up every medical chart to
any government agency and health insurance company that allegedly has a need
for medical information.
Dr. Paul: Sounds like these are the people that need to know.
Dr. Kaleb: I think if we survive the current assault on health
care, people will be ready to close their charts from government intrusion and then maybe we'll get back to
rational and private health care.
Dennis Prager: A Society that Venerates Lawyers More than Doctors
If the 1,990-page House Health Care Bill becomes law,
the average American will receive worse health care, American physicians will
decline in status and income, American medical innovation will dramatically
slow down and pharmaceutical discoveries will decline in number and quality.
And, of course, the economy of the United States will deteriorate, perhaps
permanently.
However, we are also certain that there is one American
group that will thrive - trial lawyers. The very existence of a 1,990-page law
guarantees years of, if not more or less permanent, lawsuits. And the law
actually specifies that states that do not limit attorneys' fees in cases of
medical malpractice shall be financially rewarded . . . Read
his column . . .
The Staff Lounge Is Where Unfiltered Opinions Are
Heard.
*
* * * *
8. Voices of Medicine: A Review of Local and Regional
Medical Journals
From: Vital Signs, the official publication of the Fresno-Madera Medical
Society
In 2004 two years after diagnosis,
my mother-in-law passed away in India due to advanced breast cancer. She never
had a screening examination. Looking more into it we realized that in
Ahmedabad/Gujarat, there is no system for deployment of resources for people's
education, early detection and management of breast cancer. The reasons for
this are many. Thereafter we established a charitable Pandya Family Foundation
with a mission to increase awareness of value of early detection of breast
cancer. We decided that in an unscreened population with lack of access to
physicians, mammography and education regarding early detection of breast
cancer, the best initial screening should be awareness and breast self
examination. We then set up a simple plan to go to women who are the biggest
stakeholders and beneficiaries of early detection.
Looking for a
potential opportunity to pass on our message, in 2008 and 2009 some of us
visited India three times. We looked for opportunities to collaborate with
Government Department of Health and local NGOs. In June and November 2008,
armed with multiple silicone breast models with hidden small to medium size
lumps and method of teaching women, we set up camps in city of Patan. The women
from ages 14 to 60 attended the camps. After going through the training we gave
them pink ribbons to put on and to talk about it and teach and encourage other
women who were not present. We felt
good when the women leaders of this group asked about how to buy the silicone
breast models to carry this on. We gave them our models that we had. In the summer of 2009, we took this effort a
notch higher. We partnered with two different nonprofit organizations doing
clinical work in Gujarat, India. This time our team also included four female
medical students from Philadelphia.
Our first partner was Trust
for Reaching the Unreached (TRU). We helped them survey and screen the tribal
population around the remote town of Shivrajpur. With this NGO we traveled to a
different village for five consecutive days. We interviewed patients, we took
their blood pressure and checked finger stick blood sugar, asked them to stop
smoking, counseled them on other complaints, and taught women selfbreast exam
on the silicone models and gave them a screening clinical breast exam. We found
several biopsiable lesions. This time I had taken a laptop-based ultrasound
system with me, and I was able to do ultrasound guided FNAs at the base camp
for those who followed up. We taught the NGO employed outreach female workers
how to teach the technique of self-examination with the use of breast models
that we gave them. Hopefully they will carry this effort forwards. . .
Read the entire article at www.fmms.org/index.php?c=16
Dr. Pandya practices General Surgery in Porterville,
California
VOM
Is Where Doctors' Thinking is Crystallized into Writing.
*
* * * *
9. Book Review: How
People Prevail in the Face of Illness
THE ANATOMY OF HOPE- How
People Prevail in the Face of Illness by Jerome Groopman, MD,
Jerome
Groopman in his first book in 1997, THE
MEASURE OF OUR DAYS - New Beginnings at Life's End, focused on "End of Life"
issues after losing his father to what he considered incompetent medical care. http://healthcarecom.net/bkrev_MeasureOfOurDays.htm In this, his third book, he tries to understand why some
people find hope despite facing severe illness, while others do not. And can
hope actually change the course of a malady, helping patients prevail?
He looked for the answers in the lives of several extraordinary
patients that he cared for over thirty years. They led him "on a journey
of discovery from a point where hope was absent to a place where it could not
be lost." In the process, he learned the difference between true hope and
false hope and describes times when he foolishly thought the later was
justified. He also describes instances where patients asserted their right to
hope and he wrongly believed that they had no reason to do so. He felt that
because they held on to hope, even when he felt that there was none, the
patients survived.
In a number of examples, he explores his patients' religious
beliefs. He describes one woman of deep faith who showed him that even when
there is no longer hope for the body, there is always hope for the soul. He
credits his patients for helping him see another dimension in the anatomy of
hope.
Groopman thinks that many of us confuse hope with optimism, a
prevailing attitude that "things turn out for the best." But he
thinks that hope differs from optimism. Hope does not arise from being told to
"think positively" or from hearing an overly rosy forecast. Hope,
unlike optimism, is rooted in unalloyed reality. Without a uniform definition
of hope, his patients taught him that "hope is the elevating feeling we
experience when we see - in the mind's eye - a path to a better future. Hope
acknowledges the significant obstacles and deep pitfalls along that path. True
hope has no room for delusion."
Groopman believes that hope gives us the courage to confront our
circumstances and the capacity to surmount them. He was well into his career
when he came to realize this. He states that for all his patients, hope, true
hope, has proved as important as any medication he might prescribe or any
procedure he might perform. Making a diagnosis and finding the optimal therapy
were essentially detective work. Solving a complex case and identifying the
best treatment is indeed an exhilarating intellectual exercise. But the
background and stories of patients' lives give doctors the opportunity to probe
another mystery: How do hope and despair factor into the equation of healing? . . .
As a patient for some nineteen years after failed spine surgery,
Groopman lived in a labyrinth of relapsing pain and debility. It was rekindled
hope that gave him the courage to embark on an arduous and contrarian treatment
program and the resilience to endure it. "Without hope, I would have been
locked forever in that prison of pain. . .
It seems to exert potent and palpable effects not only on my psychology
but on my physiology." . . .
Pick up a copy of this book and join Dr.
Groopman as he takes you on a journey through his final years of medical
training and practice experiences. He will introduce you to patients that
showed him how true hope differs from false hope leading you through a
labyrinth of pain to undying hope, the biology of hope and deconstructing hope.
This journey can benefit both physician and patient. It will not only be the
most inexpensive trip you could take, but also the most valuable and rewarding
one you might experience.
The entire book review is
found at . . .
To read more book
reviews . . .
To read book
reviews topically . . .
*
* * * *
10. Hippocrates & His Kin: Rich Countries' Kids likely
to reach age 100
London – Most babies born in rich
countries this century will eventually make it to their 100th
birthday, new research says. Danish experts say that since the 20th
century, people in developed countries are living about three decades longer
than in the past. Surprisingly, the trend shows little sign of slowing.
In an article published in the
medical journal Lancet, the researchers write that the process of aging may be
"modifiable."
James Vaupel of the Max Planek
Institutes in Germany and colleagues in Denmark examined studies published
globally in 2004-05 on issues related to aging. They found life expectancy
increasing in most countries, even beyond the limits of what scientists thought
possible.
In the battle between the increasing numbers of
retirees versus the number of workers, who will win the Social Security War? As
the working years are extended by 10 and 20 years due to good health, how long
will the workers support retirees still in their prime working years, such as
those in their seventies who will live into their 90s?
Nice Doctors Heal You Faster By Harvey Black
Empathy
Heals: Patients whose doctors show concern recover from colds faster.
It feels good when someone pays attention to our
concerns and our feelings - and it turns out such empathy is good for our
health, too. Researchers at the University of Wisconsin School of Medicine and
Public Health report in Family Medicine that patients of doctors who expressed
such concern had a cold for one day fewer than patients whose physicians
focused on just the facts. In randomized controlled trials, the colds of
patients assigned to empathetic doctors lasted an average of seven days; those
with low empathy docs endured an extra day of cold misery. The doctors' empathy
also boosted the patients' immune systems. There was a direct corelation
between a physician's empathy level and his or her patient's level of IL-8, a
chemical that summons immune system cells to fight microbial bad guys.
ObamaCare,
BismarckCare, NHS or any government health care cannot deliver empathetic care.
All government health care will deteriorate quality private health care.
*
* * * *
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 the
report: The Congressional
Budget Office (CBO) Wednesday night released its cost analysis of the
Republican health care plan and found that it would reduce health care premiums
and cut the deficit by $68 billion over ten years. The Republican plan does not
call for a government insurance plan but rather attempts to reform the system
by creating high-risk insurance pools, allowing people to purchase health
insurance policies across state lines and instituting medical malpractice
reforms.
•
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. John
Graham notes that Speaker Pelosi repeated the well-worn mantra that
politicians of all stripes, of both parties, had been trying to
"reform" health care for a century, since Teddy Roosevelt was
president. Wow: Health care as we know it didn't even exist then. There was no
penicillin, no medical devices, and only one drug - Aspirin. And even then they
were trying to take it over? Imagine where we'd be if politicians of all
stripes had simply ignored health care for a century. We probably would have
achieved "health care for all" without their help.
•
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. The question posed this month: In the public sector, no tool
adjusts spending to changing conditions. In the current recession, many states
have decreased revenues, but little decreased spending has been seen. This
pattern raises a difficult question: How do states correct for the inflexibility
in spending cuts?
•
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 read Breaking
Promises: How can President Obama
possibly endorse the bill that Speaker Pelosi unveiled to such great fanfare on
Thursday? The House bill breaks major promises he has made to the American
people about his goals for health reform. To name just a few...Cost: The
president has assured us that health reform would lower health costs. But the
House bill would bend the federal cost curve UP, not down, according to the
Congressional Budget Office's preliminary
analysis.
•
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?. Greg Scandlen: I'll just note that this is
the 200th issue of Consumer
Power Report. It's a milestone of sorts, though I have been doing
similar newsletters since launching the Health Benefits Letter in 1991.
Interesting how the technology has changed over that time, going from mail-out
hard copy, to fax-out, and now e-mail. . . While the technology has changed,
the issues never seem to. We are still rebutting the same empty rhetoric we did
when we first started. It is not encouraging. The statists just never seem to
be able to learn from experience. They get their policies adopted. The policies
fail and are repealed. And they try yet again to adopt the same policies all
over. It is like there is a health reform industry that simply doesn't know how
to do anything else. They are eternally blind to what actually works and keep
promoting what has been proven to fail. Alas.
•
The Foundation for
Economic Education, www.fee.org, has
been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for
over 50 years, with Richard M Ebeling, PhD, 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: The "stimulus"
has not "saved" anything. It has been a huge misdirection of
resources from things that would meet real-live individual needs to those
things that meet the "needs" of politicians to be reelected. As I
noted in an earlier column, where I live almost half a million dollars was
spent rolling sod onto a narrow median strip on I-68 near my home, an
unnecessary and wasteful project if ever one existed. Our economy is moribund
because for many years the government and the Federal Reserve misdirected
resources into lines of production that never could be sustained. While the
boom lasted, things seemed to be great, but it now is time to pay the piper.
Unfortunately, the politicians and intellectuals seem to believe that the
"solution" is even more wasteful spending.
•
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. Paul
Hsieh, M.D. has an excellent op-ed in the
Christian Science Monitor about the harms of mandatory insurance. It begins: In
his recent speech to Congress, President Obama could have promoted healthcare
reforms that tapped the power of a truly free market to lower costs and improve
access. Instead, he chose to offer a national version of the failing
"Massachusetts plan" based on mandatory health insurance. This is a
recipe for disaster. Three years ago, Massachusetts adopted a plan requiring
all residents to purchase health insurance, with state subsidies for
lower-income residents. But rather than creating a utopia of high-quality
affordable healthcare, the result has been the exact opposite - skyrocketing
costs, worsened access, and lower quality care…
•
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: Commonly Misunderstood Concepts:
Health Care by
Gennady Stolyarov II: It is an odd society indeed where such a seemingly simple
idea as health care is so severely misunderstood. Health care, as the
constituents of the term suggest, is simply caring for one's health, where
health - of course - is the physical integrity and unobstructed functioning of
one's body. A healthy person is one whose body is not breaking down, one who is
not in constant pain, one who is going to live for a long time unless some
unforeseen external peril - such as an accident or an assault - violates the
integrity of one's body from without. Most people will recognize that doctors
play an important and sometimes necessary role in the provision of health care.
What many people today fail to recognize, however, is that doctors are never a sufficient
part of genuinely effective health care. . . What are other crucial components
of health care? They are not esoteric, and they do not require specialized
knowledge. They include eating in moderation, exercising regularly, avoiding
harmful substances, practicing at most monogamy, keeping one's surroundings
clean, and avoiding risks to life and limb as much as possible. There are also
numerous over-the-counter medications and first aid practices, that, if used
intelligently, can enable individuals to recover from many minor and even some
major perils. These habits are not just little frills added on to the body of
health care; they are that body, and without them, one will be quite dead quite
soon - but not before racking up absurd amounts of medical expenses. I will
note that in the 20th century, human life expectancy in the West surged from
the mid-to-late forties to the late seventies. Although medical advances were
phenomenal during that time, the vast majority of the increase can be
attributed to improvements in overall cleanliness of infrastructure and
healthier habits. With the advent of sanitation, regular dental hygiene,
automatic washers and dryers, and efficient household cleaning supplies, a lot
of infectious diseases that formerly wiped out millions were kept at bay - mostly
not by doctors, but by ordinary laypersons living their lives in a superior
manner to that of their ancestors. New technologies motivated new behaviors,
and these everyday behaviors are our first and so far our best line of defense
against disease and decay. . .
•
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 now is being emulated
by BO, they have lost site of their mission and we will no longer feature them
as a freedom loving institution and have canceled our contributions.
•
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 17th or lose federal funds, Hillsdale
students take a semester-long course on the Constitution restoring civics
education and developing a civics textbook, a Constitution Reader. Congratulations on having nearly reached their $500 Million
goal which allows them to replace all loans and grants to students who
otherwise would obtain government loans and support. You may log on
at www.hillsdale.edu
to register for the annual von Mises Seminars, or their famous Shavano
Institute. Congratulations to Hillsdale for its national rankings: No 68 on
Forbes list of the Top 100 Private Colleges and Universities; US News placed
Hillsdale at No 89 on its list of America's Best Liberal Arts Colleges; and the
Princeton Review included Hillsdale in its new guide, The Best 371 Colleges. Please log on and register to receive Imprimis,
their national speech digest that reaches more than one million readers each
month. This month, read John Bolton, Former U.S. Ambassador to the United Nations,
President Obama's
Foreign Policy: An Assessment at www.hillsdale.edu/news/imprimis.asp.
The last ten years of Imprimis are archived.
Last week we were pleased to be invited to the Hillsdale meeting in Sacramento
to hear President Larry Arnn speak about private education and meet with a
large reception of supporters who all believe in limited government and freedom
in education.
* * * * *
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"People, in circumstances of
stress, can behave like swine, and that this, indeed, is not only a fit
subject, but the only subject, of drama." -David Mamet
"People say we're a country
divided, but we're not a country divided, what we are is a democracy."
-David Mamet on November 02, 2009
Some Recent Postings
Read the ten-page
summary of the 2,000 page worst health care tax increase legislation before
Congress in its two century history: www.healthplanusa.net/archives/October09.htm
HealthPlanUSA is now a separate
Newsletter devoted to the rapidly evolving field of health plans being promoted
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issues, which we bring quarterly and will increase as staffing permits. Why not
sign up now at www.healthplanusa.net/newsletter.asp?
From The Economist print edition, Oct 29th 2009
. .
. For three months of evidence-gathering before the Nuremberg trials began, Mr
Sonnenfeldt's official label was chief interpreter. Less officially, but with
permission, his job was to startle, harry and trick the accused into admitting
what they had done. Translation inevitably slowed the questions, allowing the
accused to develop their denials. But Mr Sonnenfeldt's sharpness made up, in
part, for that. Was it true, he asked Hermann Goering, Reichsmarschall,
that he had boasted to Hitler that he had torched the Reichstag himself in 1933?
"Just one of my jokes," said Goering. "Tell me another joke you
told Hitler," said Mr Sonnenfeldt. Goering did not reply. . .
His German was native,
from a childhood spent in Gardelegen in north-west Germany until, at 15, his
Jewish parents sent him to England for safety. He was alert to the
"platitudinous babble" of von Ribbentrop, the star-struck love-words
of Hitler's secretary and the coarseness, laced with Franconian intonations, of
Julius Streicher, publisher of the vilely anti-Jewish Der Stürmer. He could put Goering down, in a second, by calling the flabby
ex-field-marshal Herr Gering, a little nothing.
His English, though, was
equally impressive: learned in Kent, spiced up in India (where he was dropped
after being wrongly deported to Australia, in 1940, as an enemy alien) and
polished in Baltimore, otherwise Bawlmer, where he lived for two years before
joining the American army. He had worked hard, with every motive in the world,
to scrub his German accent away, and that fluency eventually promoted him from
armoured-car-greasing to translation. Mr Sonnenfeldt was contemptuous of other
interpreters at Nuremberg who, through a thick lard of Swabian consonants or
Polish syntax, could fuddle questioner and questioned alike. He was so good
that he could deal in subtlety.
He was also a Jew,
facing - and faithfully interpreting - men who had wished to obliterate
everyone like him. He had seen the results for himself in the camp at Dachau,
which he was one of the first to enter after liberation. Among the stiff stacks
of unburied corpses and the ghostlike, disbelieving living, he had been able
only to think how lucky he was. The spectre of himself as he might have been
was sometimes beside him as he probed through obfuscations for the details of
appalling crimes. He felt it tugging at his sleeve.
He found he did not hate the Germans, who now scratched for food in
bombed-out Nuremberg and fought for the cigarette-ends he threw out of his jeep.
Nor did he hate the Nazis individually, except for Streicher. What chilled him
was the ordinariness of these men. When he served them their indictments on
October 20th 1945, going from cell to cell, he noticed how clean the hands were
that took the papers from him. These men were not evidently monsters. They also
knew good from bad, right from wrong. When he asked Rudolf Hoess, commandant of
Auschwitz, whether he was ever tempted to enrich himself from the inmates,
Hoess replied: "What kind of man do you think I am?"
. . . He did
other things in his life later; as an electrical engineer, he helped to develop
colour television and computers for the moon landings. He supposed, however,
that he would be remembered only for his Nuremberg days. And that, he always
said, was all right with him.
Read
the entire obituary . . .
On This Date in History - November 10
On this date in
1775, the Continental Congress established the U. S. Marine Corps. To read
about the world's best fighting force, please go to www.marines.mil/Pages/Default.aspx.
Whenever
a U. S. Embassy is under siege, we can always depend on the Marines to do a
"Fast Rope" rescue operation and save the day.
On this date in
1871, reporter Henry M. Stanley found David Livingstone, a missionary who had
gone into the wilds of Africa, and spoke his famous line, "Dr.
Livingstone, I presume." However, Dr. Livingstone was neither
lost nor in need of rescue and remained in Africa while Stanley returned to
civilization and glory.
After Leonard and
Thelma Spinrad
MOVIE EXPLAINING SOCIALIZED
MEDICINE TO COUNTER MICHAEL MOORE's SiCKO
Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks
funding for a movie exposing the truth about socialized medicine. Clements is
the former publisher of "American Venture" magazine who made news in
2005 for a property rights project against eminent domain called the "Lost
Liberty Hotel."
For more information visit www.sickandsickermovie.com or
email logan@freestarmovie.com.