MEDICAL TUESDAY . NET

NEWSLETTER

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 . . .

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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.

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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.]

Rational and Irrational Thought: The Thinking That IQ Tests Miss

We assume intelligence and rationality go together. But we shouldn't be surprised when smart people do foolish things.

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          

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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

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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 weeksComments (…)

Digg it

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

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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

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4.      Medicare: Here's another prescription to cut health care costs.

The Conversation: Cut health costs? Here's a prescription By Micah Weinberg
Sacramento Bee: Saturday, Oct. 31, 2009

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

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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: 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.

Feedback . . .

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: 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:

"White Paper on Medical Financing," by Andrew Schlafly and Jane M. Orient, M.D., J Am Phys Surg, Fall 2006.

"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

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Medical Myths originate when someone else pays the medical bills.

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

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7.      Overheard in the Medical Staff Lounge: 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 . . .

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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

From: Vital Signs, the official publication of the Fresno-Madera Medical Society

Global Health Care: We Should be Thankful for What We Have: Access

by Gaurang Pandya, MD, Director, Secretary, Pandya Family Foundation Inc.

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

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VOM Is Where Doctors' Thinking is Crystallized into Writing.

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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.

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The entire book review is found at  . . .

To read more book reviews . . .

To read book reviews topically . . .  

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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.


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11.  Organizations Restoring Accountability in HealthCare, Government and Society:

•                      The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports. This month, read 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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Words of Wisdom

"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 throughout the USA. These are dangerous times. Stay tuned to the current issues, which we bring quarterly and will increase as staffing permits. Why not sign up now at www.healthplanusa.net/newsletter.asp?

In Memoriam

Richard Sonnenfeldt, chief interpreter at Nuremberg, died on October 9th, aged 86

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 Stόrmer. 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.