MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VIII, No 14, Nov 24, 2009
In This Issue:
1. Featured Article: Stroke Rehabilitation with Robotics
2. In the News: CEO, ReflectiveMedical, Leaves Organized Medicine
3. International Medicine: The NHS gets a Bad Bill of Health
4. Medicare: The Single-Payer Health Care Debate, The American Thoracic Society
5. Medical Gluttony: When I heard "chest pain," I called 911.
6. Medical Myths: Don't worry about losing your favorite doctor under socialized medicine.
7. Overheard in the Medical Staff Meeting: Answer to the Obama Health Plan Disaster
8. Voices of Medicine: "Renewing the Covenant with Patients and Society"
9. The Bookshelf: TRUST BETRAYED - Inside the AARP
10. Hippocrates & His Kin: Is government money as valuable as patient money?
11. Related Organizations: Restoring Accountability in Medical Practice and Society
* * * * *
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
For more information visit www.sickandsickermovie.com or email firstname.lastname@example.org.
* * * * *
Born in Belgrade, in what was then Yugoslavia, Maja Matarić originally wanted to study languages and art. After she and her mother moved to the United States, in 1981, her uncle, who had immigrated some years earlier, pressed her to concentrate on computers. As a graduate student at the Massachusetts Institute of Technology, Matarić wrote software that helped robots to independently navigate around obstacles placed randomly in a room. For her doctoral dissertation, she developed a robotic shepherd capable of corralling a herd of twenty robots.
the end of her graduate training, Matarić, influenced by her knowledge of
cognitive science, became interested in how people could benefit from
interacting with robots. Now forty-four and a professor of computer science at
the University of Southern California, she has begun working with stroke and
Alzheimer's patients and autistic children, searching for a way to make
machines that can engage directly with them, encouraging both physical and
more . . .
"We wanted to do something entirely different," Matarić told me. She assembled a team of experts in several disciplines: psychology, mechanical engineering, kinesiology, rehabilitation medicine, and neurology. The team members observed Isaac Asimov's First Law of Robotics: the robot must not injure the patient. They also had to determine what tone of voice was optimal, what type of language the robot should use, how close it should get to the patient - essentially, what kinds of personality and temperament were most effective, and for what kind of patient. The robot would coach the patients orally, rather than physically. (One that physically touched a patient might require approval by the Food and Drug Administration as a device, given the potential safety issues.)
In 2003, Matarić initiated a pilot trial for stroke patients with Carolee Winstein, a professor of biokinesiology and physical therapy at U.S.C. Matarić and Winstein set out to build a robot that would attend a stroke victim in her home, persuading her to employ a weakened limb in her daily activities. Every year, some eight hundred thousand Americans suffer strokes. Currently, Medicare provides limited benefits for rehabilitation, and funding for supervised therapy is especially meagre. A socially assistive robot would be a one-time investment and could be recycled once the person had recovered strength and mobility. (Matarić's research is still in the early stages of testing, and commercial application is years away.)
Winstein believed that people who have a motor disability, like the loss of strength in an arm after a stroke, pursue a path of least resistance. For example, if they want to reach for a cereal box on a shelf after losing force and mobility in their right arm they will simply use their left arm. Such shortcuts undermine the critical period after a stroke when the brain is most plastic and offers the best chance for recovery. And rehabilitative robots tend to retrain the limb in only one motion. "It's as if I wanted to show you how to swing a racquet in tennis," Matarić explained. "I stand behind you and grab your arm and put you through it. But you have to learn to generalize on your own. If you keep doing it with me holding you, you are not actually going to learn. You have to learn how to reach for the cereal on your own, based on your own motivation and your own mode of guiding." . . .
In a pilot trial involving six stroke patients, Matarić's team found that a patient was more apt to take up the task at hand when encouraged by the robot than when he was alone and unprompted. Related studies have also shown that the patient is more responsive when the robot is in the room, rather than when it is shown to the patient on a computer screen or presented in a simulated way, using a three-dimensional virtual robot.
A woman I will call Mary, a schoolteacher in Los Angeles, suffered a stroke in 2001, when she was forty-six. She spent six months working with a physical therapist at the U.S.C. Medical Center to regain strength in her weakened right arm and leg, before taking part in Matarić's study. I watched a videotape of her session with Matarić. Mary, who was dressed in a white blouse and dark slacks, shuffled slowly to a desk stacked with magazines. There was a shelf nearby, set above shoulder level. She looked at the robot, several feet away, and waved to it. "Come over here," she said warmly.
The robot, which was three feet high and looked a little like R2-D2, in "Star Wars," scooted close to her and stopped. "Very good," Mary said.
Set on a mobile base with rotary wheels, the robot could turn in any direction and move around the room, guided by sonar. It tracked Mary's movement with a scanning laser range finder; a pan-tilt-zoom camera allowed it to look at Mary, turn away, or shake its head. A speaker, embedded in the robot's side, produced prerecorded speech and sound effects.
Glancing at the robot, Mary lifted a magazine from the top of the pile and guided it into a rack on top of the shelf. As soon as the magazine was in place, the robot emitted a beep. During the next few minutes, Mary moved each magazine, one by one, to the rack. Gradually, she increased her pace, and the beeps from the robot came faster. Mary began to laugh.
She turned and looked squarely at the robot. With a sly smile, she moved her weak arm toward the remaining magazines on the desk and mimed putting one into the rack. She then stuck her tongue out at the machine.
Matarić said, "She is cheating. She is totally thrilled, because she thinks she cheated the robot." The robot, though, was on to the game. A reflective white band that Mary wore on her leg allowed the robot to follow her movements. A thin motion sensor attached to her sleeve transmitted Mary's gestures to the robot, so that it knew almost instantly whether she was raising her arm and in what motion. A sensor in the rack signalled the robot when a magazine was properly placed, and the robot communicated with Mary only when she performed the task correctly.
Although the task lasted about an hour, the novelty of the interaction did not seem to wane. In a debriefing after the study, Mary said, "When I'm at home, my husband is useless. He just says, Do it.' I much prefer the robot to my husband."
* * * * *
In the White House briefing room yesterday, President Obama trumpeted the American Medical Association's endorsement of the House health-care plan. "These are men and women who know our health-care system best and have been watching this debate closely," he said of the doctors lobby.
J. Gibson, M.D.
Carmichael, CA 95608,
November 6, 2009
Mr. William A. Sandberg, Executive Director
Sierra Sacramento Valley Medical Society
5380 Elvas Avenue, Sacramento, CA 95819-2396
Via Regular Mail & E-mail: www.ssvms.org
Subject: Resignation from SSVMS
After years of deliberation and progressive alarm, I am tendering my resignation from SSVMS and the CMA. The reason, I simply cannot stand the progressive devolution of both the CMA and the AMA into partisan, special-interest, political organizations. I have concluded that both organizations have lost their way and are accelerating their move away from their primary missions, that being the representing of the professional rather than the pecuniary interests of physicians.
I have both verbally and in
print expressed my dismay at the progressively partisan nature of these two
organizations over the past several years. I based my objections on two primary
Read more . . .
As you know, I am not opposed to physician participation in the public forum. In fact, I have published several articles supporting this activity. What I am opposed to is an organization that purports to represent the profession using that honored platform for partisan and pecuniary interests as discussed above. If remaining active in SSVMS, without being required to join the CMA were an option, I would, without hesitation, elect that option. I have and continue to hold SSVMS in the highest regard. I work with numerous medical organizations across the country and have observed the leadership you and the Board provide to be of top tier quality. I have particularly appreciated the courageous support the Board has provided in the past for SSVMedicine.
I will stay in-touch into the future. However, I have given my best effort to realign the accelerating direction of the CMA and the AMA from within. It is time to step aside, stop being an internal irritant and speak in the public forum as to the future of health care delivery in this country.
Please give my best wishes and appreciation to the Board for the opportunity to serve.
David J. Gibson, M.D.
NOVEMBER 6, 2009
In a cameo in the White House briefing room yesterday, President Obama trumpeted the American Medical Association's endorsement of the House health-care plan. "These are men and women who know our health-care system best and have been watching this debate closely," he said of the doctors lobby.
Actually, what they've been watching is a formula that automatically cuts Medicare reimbursements to physicians - by 21.5% next year - and have made it clear that they'll endorse virtually anything, no matter how damaging to medicine, as a quid pro quo for eliminating this cut. They didn't get even that. Democrats amputated the "doc fix" from ObamaCare because preventing the cuts will cost more than $200 billion and pushes the price tag well above $1 trillion. They claim they'll instead pass a separate bill with the fix, adding all of that to the deficit.
President J. James Rohack was careful to note that the AMA was endorsing both bills as a package, and on a conference call with reporters he wouldn't say if he would pull support if ObamaCare passes and the doc fix doesn't. Yet that's what his political gullibility is likely to get his members. A Democratic revolt last month already killed the two-bill deception in the Senate in a sudden onset of fiscal sanity. In the stampede to pass ObamaCare, Democrats won't give even a passing thought to leaving the AMA behind - especially now, given that the group has shown how cheaply it can be bought. Unmentioned by Mr. Obama was that 20 other physician groups came out against his health-care takeover yesterday, which they wrote "will threaten patient access and harm quality." Led by the American College of Surgeons, these doctors argued the Senate's bill "will do little to fix" health care's "underlying problems, and may make them worse." The letter was signed by groups representing neurological and orthopaedic surgeons, urologists, anesthesiologists, gynecological oncologists and others. Mr. Rohack will also face an uprising among his own members at a meeting in Houston this weekend. But presumably Mr. Obama would say that all these men and women don't know our health-care system "best."
* * * * *
Since McKinsey and Co, the consultancy company, is
not a registered charity, I presume it cost the taxpayer a substantial amount
for the firm to conduct an efficiency review into the National Health Service.
Having commissioned the report, the Department of Health took one look at its
main finding that 10 per cent of NHS staff should go in order to achieve
efficiency savings and rejected it. If you seek an example of how superbly
the Government spends money, this is a magnificent one.
Read more . . .
Any fool knows that the NHS is overmanned: perhaps not with doctors and nurses, but certainly with bureaucrats and support staff. Even the fools who run the Department of Health must have realised that if they asked McKinsey to do this job, it would find there were too many people on the payroll. To order this review and then to reject it immediately is completely obtuse.
. . . it has long been apparent that the NHS is an organisation that exists as much for the benefit of many of those who work in it, as for those it purports to treat. It is also apparent that, despite numerous reforms since it began in 1948, it is shaped by an immediate post-war ideology that has about as much relevance today as Bile Beans and Craven "A"s. No private-sector health concern would begin to think of running itself as the NHS does: it would be bankrupt within weeks. But then no private-sector health concern has as its mission in life the provision of jobs for Mr Brown's client state . . .
The bold move for a government to take would be to contract out the management of the NHS. Hospitals, then possibly even whole health authorities, should be franchised out to the private sector, to break the culture of jobbery and self-serving trade unionism that has handicapped the development of the NHS . . .
Of course, all our politicians can carry on claiming that value doesn't matter, and believing that there is a bottomless pit of money to run our health-care service. In the suffering this will inflict on patients in the long term, it reveals an utter unfitness to govern . . .
The NHS does not give timely access to healthcare; it only gives access to a waiting list
Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.
--Canadian Supreme Court Decision 2005 SCC 35,  1 S.C.R. 791
* * * * *
Michael A. Diamond, M.D. Allergy, Asthma, Arthritis, and Lung Center
Daytona Beach, Florida
In the United States, medical costs have been increasing inexorably for many years, as have the numbers of the uninsured; the latter is currently estimated to be as high as 47 million persons. A single-payer system has long been suggested by some as the most logical solution to the current crisis in health care access and affordability (1). Under a single-payer health system, the federal government would ultimately be responsible for reimbursement of most medical services provided by clinicians and hospitals. The hope is that a single-payer system will both improve access to health care and reduce health care costs. By definition, under a single-payer system no one would be without health insurance, and cost savings might be achieved through a reduction in administrative expenses coupled with an emphasis on preventive medicine and the universal adoption of electronic medical records. However, I have substantial concerns over whether these potential benefits can actually be accomplished. It is the history of government bureaus to become large and complex rather than lean and efficient. Furthermore, access to preventive care does not equate to individual adherence to the precepts of such care. Finally, I fear that the ultimate toll of a single-payer system will be a reduction in the quality of health care that Americans may be unwilling to bear. Read more . . .
Proponents of a single-payer system argue that government-sponsored insurance would save money by reducing wasteful administrative costs. Yet comparisons of administrative expenditures between private and government-run insurance programs are misleading (2). For instance, the cost of administering a private insurance plan includes the expense of collecting premium dollars, which also applies to government insurance programs such as Medicare. However, this expense does not register on Medicare's budget insofar as a separate government agency (the Internal Revenue Service) performs this function. Furthermore, many states tax premiums paid to private insurers, and also tax their profits; government programs are not so encumbered. Finally, Medicare spends approximately twice as much on claims than most private insurers (older patients consume more services), and administrative expense is expressed as a percent of claims paid. Thus, Medicare looks more thrifty than it really is (2). Estimates of the bureaucratic cost savings under a single-payer system do not account for the expense of administering a greatly expanded Medicare-like program or the price of collecting new employer and individual taxes.
Additionally, administrative costs are only a small portion of health care costs in this country. The main problem is overuse of health care, particularly that involving expensive new technologies and drugs (3). Even within Medicare, which functions as a single-payer health system for elderly Americans, there are wide variations in health care spending across regions, with little or no gains in quality in regions with greater expenditures (4). Over-attention to administrative costs distracts us from the real problem of wasteful spending due to the overuse of health care services.
A single-payer system will subject physicians to unwanted and unnecessary oversight by government in health care decisions. With the newfound power to benchmark physicians and regulate payments, the government will inevitably restrict the use of potentially beneficial therapies and pay differentially for perceived differences in quality, with potential unintended consequences such as increased health care disparities (5). Without price competition from private insurers, the government will be free to pay whatever it wants for health services. Physicians are already inadequately reimbursed for services provided under Medicaid (6), and reductions in Medicare reimbursement over the years have demonstrably affected access and quality of care in a variety of health care venues (710). Even lower physician payments under single payer will drive many physicians out of business, further restricting access to care. Decreased reimbursement will also prevent hospitals from investing in new health care technologies or trying innovative new therapies (11). Allowing government, rather than the free market, to set health care prices is a dangerous proposition.
Despite the general perception, health insurance alone will not overcome the problem of access to health care in this country. Many patients with adequate insurance do not come to their appointments or do not adhere to recommended therapies. Part of what we perceive to be medical problems can actually be traced to societal conditions. How can we ensure, for example, that all pregnant women receive prenatal care? How can we force patients with asthma to use their prescribed inhalers regularly? How can we stop patients from smoking and eating an unhealthy diet? Health coverage and medical advice would yield little or nothing unless patients do their part.
Single-payer health insurance would also lead to rationing and long waiting times for medical services. The adverse consequences of waiting for health services in countries with single-payer insurance are well documented (12, 13). Access to a waiting list for health care does not equate with access to health care, which is one reason why patients from abroad often prefer to come to the U.S. for treatment. It is unlikely that Americans would welcome these changes.
The strongest argument against a single-payer system may well be the outcomes in states that have attempted to expand health care access through the use of government programs and mandates. TennCare was a widely touted managed-care Medicaid program adopted by Tennessee in 1994 that was characterized as the solution to providing health insurance to most uncovered residents while simultaneously controlling costs (14). TennCare's subsequent collapse has been attributed to mismanagement and unrealistic fiscal planning, a perhaps predictable consequence of government administration of health care (15). Massachusetts enacted legislation in 2006 that was intended to move that state to near-universal health care coverage. Indeed, by 2008 some 165,000 more residents were insured through a combination of employer mandates and government subsidized insurance, and overall, almost 93% of nonelderly adults had coverage by late 2007 (16). However, because inadequate (or no) provision was made to expand the provider workforce, many of these patients had no access to care (16), and costs have escalated so far beyond estimates that additional financial support is required (17). . .
Personally, I would welcome a system that can provide health care for all, and the current health reform movement appears to be headed toward the desirable goal of universal coverage. Yet a government-controlled system is not the answer insofar as recent history tells us the government is not best equipped to do that job. Once the government wrests control and dictates the practice of medicine, it would mean the death knell for the medical profession as we know it and the end of what many consider to be the best medical care in the world.
Read the entire Pro/Con article and the references supporting this view in the American Journal of Respiratory and Critical Care Medicine. . .
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
Eli, an 80-year-old lady with asthmatic bronchitis, told her daughter she was
having chest pain. Her daughter called 911 before going into Ms Eli's room to
see how her mom was doing. She told her daughter and the EMT who arrived that
she thought it was her costochondritis or her acid reflux (GERD) that was
causing this because her chest bone was very tender and she had not taken her
antacid and acidreducer
pills. But the daughter and EMT agreed that it was best to take mother to the
. Read more . . .
They did not give the suffering patient any of her missed pain relievers,
antacids or acid reducer pills before they left.
During her six-hour stay and evaluation, she had x-rays, ECGs, CT scans, cardiac studies and no heart disease was found. She was sent home in the same condition that she arrived in chest pain with a tender breast bone and tender stomach. These were not treated in the Emergency Department. Who was evaluating the whole patient?
When she arrived in the office the next day, she was still hurting and had an exquisitely tender costochondral junction and epigastric (upper abdomen the ulcer zone) tenderness. She was immediately given two extra-strength Tylenol tablets, antacids and acid reducers while continuing the interview and exam. She felt much better within 20 minutes when we were concluding our evaluation.
The daughter was cautiously advised that if she had done these things the night before, she could have saved her mother considerable suffering over the past 24 hours as well as the stress and discomfort of six hours in the Emergency Department. That, in and of itself, could more likely cause a coronary than staying in bed at home.
The daughter asked how was she to know this wasn't a coronary.
Your mother told you her diagnosis, feeling it was her costochondritis or her GERD. The reasonable thing to do would be to give her exactly what we did on your arrival in the office that she had missed for several days. The Tylenol, antacid pills and acid reducers would have made her feel better within 15 minutes, as it has here in the office. Her mother's suffering would have been reduced from 24 hours to about 15 minutes, she would not have been inconvenienced for a six-hour exhausting Emergency Room stay, and she would probably have saved about $5-9,000 of health care expenses. Who's thinking about the patient's welfare in avoiding stress and pain? Greater concern for the patient will frequently lower health care costs also.
It should be noted that such unnecessary expenses will not be avoided with the Obama Health Care Disaster that is now brewing. It may make it far worse. The entitlement mentality will entrench immediate care at all costs. It can only be avoided with a co-payment on every health care charge. From our own practice research, a 20 percent co-payment on ER charges would stop 80 percent of these unnecessary costs at the registration desk. When the patient and family understand that the 20 percent co-payment of the ER costs will be expected to be paid on discharge from the ER, and the minimum charge will be at least $600 (patient pays $120 on leaving), even though it frequently is ten times that amount, Ms Eli would have turned to her daughter and told her that she didn't feel that sick, that she thinks her own assessment is probably correct, and "Let's go home and take those pills that I've missed for a few days."
We've had personal experience since our Intern days when we always carried a bottle of Tylenol and Antacids in our white coat pocket when on duty in the ER. As we triaged the county hospital emergency ward, a high stress and anxiety center, we would freely give out these pills and move on with our triage. Frequently, the spouse or parent would go down the row of gurneys to find us and ask us what those marvelous pills were that we gave the patient. She is free of pain and hasn't felt better in days. We could then discharge that patient on the spot before we came around to her gurney again.
In the 1960s in the County Hospitals, we weren't concerned with health care costs. We were just trying to manage the 50 or 100 patients who thought they were desperately ill. Usually we would find four or five that really were. It was important to clear 20 or 30 gurneys as fast as we could so that we could focus our attention on the four or five that were sick - or even had an emergency.
Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on Every Service.
* * * * *
The reason that the President needs to promise that he
won't take away your health plan or your doctor is that he believes that he could.
After all, there is no right to choose a doctor or form of payment enshrined in
the Constitution. And as to the right to contract privately - that has been
whittled away by statute and precedent to almost nothing.
Read more . . .
The President and other advocates of radical health "reform" do say they believe that health care should be a right - that can "never be taken away." However, since this "right" is to be conferred by government, it is by definition an entitlement - a privilege. And even if it couldn't actually be "taken away" - unless the political situation changes, of course - it can and certainly will be limited, subject to the societal goal of improving the overall health of the collective. How will we reduce the number of tests or procedures, or the amount of GDP spent on medical care, without taking something away?
Even if he doesn't force you to change, the President cannot promise that the health plan or doctor of your choice will still be available under new rules.
And if the "reform" leads inexorably to single payer, that means no choice of plan.
The President denies that he is aiming to end up where he thinks the system should have begun: single (government) payer. "When you hear the naysayers claim that I'm trying to bring about government-run health care," he said in one speech, "know this: They're not telling the truth." He said it is "illegitimate" to argue that his program is a Trojan horse for single payer.
"It's not a Trojan horse," said Professor Jacob Hacker of the University of California at Berkeley, who developed the intellectual architecture for the public option in the 1990s. "It's just right there."
Economist Paul Krugman notes that single payer may not be feasible to accomplish politically, but once people have the option of a public plan, it can evolve into single payer.
In other words, the public option is single payer by stealth, writes Conn Carrell.
Medical Myths Originate When Someone Else Pays The Medical Bills.
Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service.
* * * * *
The Medical Staff Meeting had just heard a presentation by the Sisters who own our hospital on how the Obama Health Care Reform would be good for their organization in providing care to the poor and down trodden who have been so long neglected:
Thank you Sister for a complete presentation of those whom you feel have fallen through the cracks in our health care delivery system and are without care. I believe your speech may have been valid in the early 1960s. But we're now in the 21st century.
Since 1965, we have Medicare that covers all people
and patients over the age of 65. So the older folks or seniors can no longer
fall through the cracks. That's better than any other country in the world
. Read more . . .
Since 1965, we have Medicaid that covers all poor people and patients of any age in our country. So the poor can no longer fall through the cracks unless you feel more than the bottom 12 or 15 percent of our society are poor. But we can't use those who are more than two standard deviations from the mean in the Bell Shaped Curve. That doesn't make sense. So we cover more poor people better than any other country in the world.
Since 1965, we have had Medicare disability that covers all the disabled Americans of any age for life or length of disability. Unfortunately, many who no longer are disabled and can work continue to collect benefits for years because a massive government program cannot manage individual variations. The disabled Americans get better care than any other country in the world.
We also have the retired, injured and disabled veterans who are covered by the VA system.
Thus we have a triple net through which virtually no one can fall.
There are no 47 million Americans without insurance. That's a myth which should have stopped being repeated in 1965. Those who repeat that number have no interest in health care or helping people, but only want power over our private lives. Can you imagine that every medical decision we make can be reviewed by our government to see if appropriate or can be reimbursed? What a total and complete loss of privacy for a country built of freedom and privacy from government oversight and interference.
The uninsured are primarily from those making over $25,000, $50,000, $75,000 and now even $100,000 who have chosen on their own not to buy insurance. There is no need to enslave us under the illusion that those need to be covered.
Further review of the Pew study of uninsured Americans reveals that most Medicaid people when ask if they had insurance coverage, stated no. They don't consider Medicaid as real insurance. And you just mentioned in your address that Obama was going to put another 25 million Americans in that slough that doesn't feel insured.
And you mentioned that there might be as high as a $30 million decrease in Medicare reimbursements. Your own administrators have said that Medicare currently only covers about 90 percent or less of hospital costs. What will you do with less that 80 percent of costs covered?
Sister, you should not align yourself with what Dinesh D'Souza calls the party of death. They tried to cover abortions, or what you and I call prenatal killing, which we don't believe in.
You should not align yourself with a party that believes like the Nazi's did, that there are some lives not worth living and should be euthanized or more accurately killed in the same manner that we execute real killers.
I hope you are not so naοve to think that you temporarily won the elimination of those lines in the current 2,000 page law written by an estimated 1,000 attorneys who have not fully read the other 999 items. And the politicians voting on it admit freely they haven't read it all yet.
There is never a need to rush such a large law that massively changes everything so dramatically through congress in one or two sessions. Such things should evolve over decades as they have with Medicare and Medicaid, with room still for improvement.
There is one provision in the massive proposal that eliminates any cap on attorney's contingency fees in malpractice cases.
There is one provision in the massive proposal that eliminates any cap on malpractice awards.
Many in this room have been working on MICRA, which limited malpractice awards and contingency fees over the last 30 to 40 years and have made our yearly contribution to the effort. This has decreased our malpractice insurance premiums, where mine is only twice my auto premium.
Eliminating those two caps will see malpractice premiums double within the year. This will not only hurt our profession, but it will also hurt yours and our hospital's financial health.
Sister, I don't think we are able to play politics and lie effectively with the seasoned politicians. We should stick to our mission in life, caring for patients, before all of us get hurt and our patients get even less care. They now get the best care of any place in the world.
Thank you for allowing me to respond to your message.
The Staff Meeting Is Where Unfiltered Medical Opinions Can Be Heard.
* * * * *
Stephen Jackson, Editor of The Bulletin of The California Society of Anesthesiology, reaches back to his work on the ASA's Ethics committee on how we have lost our historical roots in an address to the AMA in 1995. Read the editors introduction at www.csahq.org/pdf/bulletin/covenant_58_2.pdf
These are turbulent times for medicine and health care, especially for physicians. As a pastor, perhaps I can give some comfort to you who daily navigate these powerful currents of change. I am not sure how much comfort I can offer, but I can offer some observations that may help guide your own conduct and that of the medical profession as the pace of change accelerates in the coming years.
Such an offer may sound
presumptuous, coming as it does from a priest rather than a physician. So,
before going further, let me share some of the experience that led me to this
seemingly brash venture.
Read more . . .
I have the opportunity to converse and consult with some of the best minds in medicine and health care administration. And I have had the chance to write and speak frequently on the nature of health care and its significance in human life, with a particular focus on the importance of not-for-profit institutions. In all of this I have seen access to health care as a fundamental human right and discussed the ethical dimensions of health care within the framework of the Consistent Ethic of Life, which I have articulated and developed over the past 12 years. . .
Your profession and mine have much in common - the universal human need for healing and wholeness. What special qualities do ministry and medicine share?
First, we both are engaged in something more than a profession - a vocation. In its truest sense, it means a life to which we are called. In my own case I was called to both professions. As an undergraduate, I had decided to become a doctor and followed a premed curriculum. But long before I graduated, I heard a stronger call to the priesthood.
Second, we both are centered on promoting and restoring wholeness of life. The key words in our professions - heal, health, holy, and whole - share common roots in Old English.
Third, and most fundamentally, we both are engaged in a moral enterprise. We both respond to those who are in need, who ask us for help, who expose to us their vulnerabilities, and who place their trust in us.
As someone who has cared for others and who has been cared for by you and your colleagues, I hope you will allow me to speak frankly about the moral crisis that I believe currently grips the medical profession generally and physicians individually. . .
do I mean when I speak of a "moral crisis" in medicine? I mean that
more and more members of the community of medicine no longer agree on the
universal moral principles of medicine or on the appropriate means to realize
those principles. Conscientious practitioners are often perplexed as to how
they should act when they are caught up in a web of economics, politics, business practice, and social responsibility. The result is that the practice of medicine no longer has the surety of an accurate compass to guide it through these challenging and difficult times. In other words, medicine, along with other professions, including my own, is in need of a moral renewal. . .
How did we arrive at this situation? Medicine, like other professions, does not exist in a vacuum. The upheavals in our society, especially those of the past 30 years, have left their imprint on the practice and organization of medicine. Each of us has his or her own list of such upheavals. My list includes the shift from family and community to the individual as the primary unit of society, an overemphasis on individual self-interest to the neglect of the common good, the loss of a sense of personal responsibility and the unseemly flight to the refuge of "victimhood," the loss of confidence in established institutions, the decline in religious faith, the commercialization of our national existence, the growing reliance on the legal system to redress personal conflicts. . .
Physicians have too often succumbed to the siren songs of scientific triumph, financial success, and political power. In the process, medicine has grown increasingly mechanistic, commercial, and soulless. The age-old covenants between doctors and patient, between the profession and society, have been ignored or violated. . .
The change I have in mind is "renewing the covenant with patients and society." That covenant is grounded in the moral obligations that arise from the nature of the doctor-patient relationship. They are moral obligations - as opposed to legal or contractual obligations - because they are based on fundamental human concepts of right and wrong. While, as I noted earlier, it is not currently fashionable to think of medicine in terms of morality, morality is, in fact, the core of the doctor-patient relationship and the foundation of the medical profession. Why do I insist on a moral model as opposed to the economic and contractual models now in vogue?
Allow me to describe four key aspects of medicine that give it a moral status and establish a covenantal relationship: . . . Read these keys at www.csahq.org/pdf/bulletin/covenant_58_2.pdf
This moral center of the doctor/patient relationship is the very essence of being a doctor. It also defines the outlines of the covenant that exists between physicians and their patients, their profession, and their society. The covenant is a promise that the profession makes - a solemn promise - that it is and will remain true to its moral center. In individual terms, the covenant is the basis on which patients trust their doctors. In social terms, the covenant is the grounds for the public's continued respect and reliance on the profession of medicine. . . .
The responsibilities I just noted are not new to the practice of medicine. Almost 2,500 years ago, Plato summed up the differences between good and bad medicine in a way that illuminates many of the issues physicians face today in our increasingly bureaucratized medical system. In his description of bad medicine, which he called "slave medicine," Plato said,
The physician never gives the slave any account of his problem, nor asks for any. He gives some empiric treatment with an air of knowledge in the brusque fashion of a dictator, and then rushes off to the next ailing slave.
Plato contrasted this bad medicine with the treatment of free men and women:
the physician treats the patient's disease by going into things thoroughly from the beginning in a scientific way and takes the patient and the family into confidence. In this way he learns something from the patient. The physician never gives prescriptions until he has won the patient's support, and when he has done so, he aims to produce complete restoration to health by persuading the patient to participate.
Similar ideas are reflected in the Hippocratic Oath attributed to an ancient Greek physician. This oath is still used at some medical school graduations. Its second section includes a pledge to use only beneficial treatments and procedures and not to harm or hurt a patient. It includes promises not to break confidentiality, not to engage in sexual relations with patients or to dispense deadly drugs. It specifically says: "I will never give a deadly drug to anybody if asked for it, nor will I make a suggestion to this effect."
There are plenty of pressures, some self-imposed and some externally imposed, that make it easy to practice bad medicine, just as there were two and one-half millennia ago. Sustaining your covenants requires a willingness to affirm and incorporate into your lives the ancient virtues of benevolence, compassion, competence, intellectual honesty, humility, and suspension of self-interest - virtues by which many of you live quite admirably. . .
Finally, I would emphasize among medicine's professional obligations the setting and enforcing of the highest standards of behavior and competence. . . Your own Code of Medical Ethics speaks directly to this point. . . .
It is my hope that today will mark the beginning of a conversation among all of us concerned with the moral framework of health care in the United States, but especially among those of you within the medical profession. If current trends continue, the moral authority at the basis of medicine is in danger of being lost, perhaps irrevocably. You are closest to these issues, and, in the end, your choices will determine our course as a nation and community. Recommitting yourselves to medicine's inherent moral center will give you the strength and wisdom to renew the covenant and provide the leadership your patients, your profession, and your nation need and expect from you.
Read the entire important address at www.csahq.org/pdf/bulletin/covenant_58_2.pdf
VOM Is Where Doctors' Thinking is Crystallized into Writing.
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Dale Van Atta wrote a syndicated column with Jack Anderson that ran in more than 800 newspapers for over seven years. Today, he is a freelance author and journalist. He dedicates this volume to his aging mother, Vera Van Atta. We should alert our aging parents, even those under age 50, about this volume and the highly charged promotional campaign of the AARP.
The AARP is the second-largest organization in the
United States, after the Catholic Church.
Read more . . .
Today, the AARP supports higher taxes, disastrous health care legislation that threatens seniors, and other political causes such as attempting to defeat property tax reductions, the very thing that allows many retired seniors to keep their homes. The AARP has numerous business enterprises, including insurance and pharmaceuticals, that it claims are nonprofit services for seniors, but which are revenue engines for AARP causes and profit its business partners. Colonial Penn derives 80% of its profits from the AARP monopoly.
The AARP, with an income of more than $400 million a year, spent $83 million for salaries and benefits in 1994. Nineteen of the AARP's 1,732 employees earn more than $100,000 a year. The executive director, Horace Deets, headlined in a 1997 Fortune magazine profile as Washington's Second Most Powerful Man, making $357,000 a year in salary and benefits ($157,000 more than Washington's Most Powerful Man!) plus $49,000 in expenses. The block-long office building in DC, which some of its members call a Taj Mahal, reputedly cost $117 million. And in 1990, the AARP spent more than twice as much furnishing its posh headquarters than it spent on programs assisting the elderly.
Dr Ethel Percy Andrus, the founder, first spoke out against age discrimination in employment more than 30 years ago. The AARP was instrumental in securing passage of the landmark Age Discrimination in Employment act in 1967, and its attorneys have initiated or participated in high-profile class action age discrimination suits. However, this organization, once run entirely by retired persons, now employs a staff of which 80% are below the age of 50. Even its own members consider this a shameful practice that betrays their true commitment.
Not only is there age discrimination in its employment practices, but there is ethnic discrimination in its membership as well. Only 2% of AARP's members are black, 2% are Hispanic, and 2% are other minorities. With its members being mostly white, better educated, and richer than the average, the AARP explains "It's much more expensive to recruit ethnic groups than it is just your average population."
The AARP is the only lobby so powerful than it can secure legislation, such as the Medicare catastrophic coverage act, and when its own membership rebels, secure its repeal. To maintain such clout, each month the AARP solicits an estimated 40,000 individuals who are too young to join. To maintain their political and business perspective, AARP can remove chapter leaders with or without cause, even for taking a stand on a local political issue without the AARP's approval.
A day of reckoning may be on the horizon. Membership is dropping at such an embarrassing rate that in a closed-door session in July 1995, the Board agreed that they would multiply the number of households by 1.6, which increased membership by more than 2 million in a single day.
For the innocent elderly who look to the AARP to defend seniors' interests, Van Atta has a simple message: Your trust has been betrayed.
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When the human genome was first sequenced nearly a decade ago, the world lit up with talk about how new gene-specific drugs would help us cheat death.
Well the verdict is in; keep eating those greens. David H. Freeman in Fast Company, Nov 2009.
"People were very optimistic about DNA studies," says one prominent biotech venture capitalist, "but would I put money into them? Philanthropic and government money, yes; investor money, no."
It is sad that charitable or government money has little value compared to investor or real money.
When MRIs became readily available, patients became optimistic of having one done on them. Would patients put their own money into purchasing one? Insurance and Medicare money, yes; personal money, no.
It is sad that insurance or Medicare money has so little value compared to patient or real money.
People shop around for the best deal in purchasing a car. Assuming 60 month financing, it's a financial decision whether to buy a $200 a month compact, a $400 a month intermediate size car, or a $600 a month luxury sedan with up front down payments of $800, $1200 or $1600. Health Care has become more expensive than the purchase of cars. But it should still be possible to purchase a $300 a month basic policy to cover emergencies and hospitals with a $300 deductible, or a $600 a month policy to cover emergencies, hospitals, and outpatient with a $600 deductible or a $900 a month total coverage policy with a $900 deductible?
Each dollar of deductible or co-pay reduces premiums by two to three dollars a month on average.
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John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.
Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .
PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.patmosemergiclinic.com/. To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .
PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.
FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.WeStandFirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser's view on today's health care problem: In today's proposals for sweeping changes in the field of medicine, the term "socialized medicine" is never used. Instead we hear demands for "universal," "mandatory," "singlepayer," and/or "comprehensive" systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this "nationalized financing" or "nationalized health insurance." In a more honest day, it was called socialized medicine.
To read the rest
of this section, please go to www.medicaltuesday.net/org.asp .
Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."
Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 2550 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com.
Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.
Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.
David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. Read section 2 above for the latest views of Dr. Gibson on organized medicine and a short bibliography of a dozen of his articles. We will be featuring more of his varied OpEd pieces in the future. His previous articles we featured have reached as high as Number 11 on the Google Search list.
Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.
Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.
To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.
Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.
Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives. He now has a new column with Richard Dolinar, MD, worth reading at www.thenewstribune.com/opinion/othervoices/story/835508.html.
The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: Pelosi Exposed . . . Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read Going for Broke . . . Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.
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Please note that sections 1-4, 6, 8-9 are entirely attributable quotes and editorial comments are in brackets. Permission to reprint portions has been requested and may be pending with the understanding that the reader is referred back to the author's original site. We respect copyright as exemplified by George Helprin who is the author, most recently, of "Digital Barbarism," just published by HarperCollins. We hope our highlighting articles leads to greater exposure of their work and brings more viewers to their page. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.
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"We live in an extraordinarily debauched, interesting, savage world, where things really don't come out even. The purpose of true drama is to help remind us of that. Perhaps this does have an accidental, a cumulative social effect - to remind us to be a little more humble or a little more grateful or a little more ruminative." -David Mamet, Three Uses of the Knife.
"Every generation rediscovers its own excesses and its own degradations, and they always turn out in retrospect to be the same ones that the previous generation had, just under a different name. So, what's the difference between Enron and Teapot Dome? It's the same thing." -David Mamet, The Voysey Inheritance.
"It's strange the number of people who believe you can do right by means which they know to be wrong." -Edward Voysey
"Why is it so hard for a man to see clearly beyond the letter of the law?" -Mr. Voysey
"Drama is basically about lies. Somebody lying to somebody." -David Mamet.
Drama is really about conflicting impulses within the individual. That is what all drama is about." -David Mamet.
Review these Excellent Postings of David Gibson, MD, CEO, Reflective Medical Information Systems
Alan Peters, furniture-maker, died on October 11th, aged 76
From The Economist print edition, Nov 5th 2009
blearily, in the morning, for a pair of socks, few people give a thought to the
smooth running of a drawer. But to Alan Peters, who for many years was probably
Britain's best furniture-maker, a properly fitted and functioning drawer was
the acme of his craft. A perfect drawer, he would say, had to slide in on a
cushion of air, and when pulled out had to cause the other drawers to retract,
very slightly, into the almost airtight case. It must show no hint of "slop"
from top to bottom or side to side. The front must fit into the opening like a
plug, with no light or gaps visible.
more . . .
All very well to say; but Mr Peters, true to the Arts and Crafts Movement in which he had been trained, was working with "timber rather than walking sticks", in William Morris's phrase. Solid wood moved: it faded in sunlight, swelled in humidity, dried out in central heating, in constant sympathy with its surroundings. In Mr Peters's hands it adjusted to the user, too: to sit in one of his chairs was to feel the back give a little, graciously, as if "it wants you to". Wood moved slowly, but not equally, with its mixture of springwood and summerwood, straight and wavy grain, knots, rings and imperfections. And it would always go the way it was naturally inclined.
For drawer-sides, therefore, Mr Peters liked reclaimed Victorian timber, which was "as stable as it was ever going to be". Honduras mahogany was the best, or quartersawn oak, brought into his workshop to climatise and then fitted when the weather was dry. Fitting was a matter of continuous checking and swift, soft planing; only one stroke of a plane, he would say, separated a perfect drawer from a sloppy one. Backs were fitted to sides, and sides to fronts, with immaculate dovetail joints - another Arts and Crafts trademark - that were hardly glued, but tapped in with a hammer. The drawer-bottom was solid cedar of Lebanon, for the smell. His last little touch, as he planed the top edge of the front, was to bevel it slightly, front to back, so that the inward taper perfected the fit. At that point, "so close to where I want to be", he found himself proceeding more and more slowly, almost with reverence. . .
His exquisite work made him the leader of the craft furniture revival of the 1970s and 1980s, and brought honours in both Britain and America. But how it had begun, this love-affair, was mysterious. As a boy he made a workshop in his parents' cellar, mapping out dovetails with dividers while other boys played football, and he courted his future wife with the history of tables, chairs and cupboards. He was hooked young, and stayed there. . .
On This Date in History - November 24
On this date in 1963, Lee Harvey was killed. No homicide in the history of the world has ever been witnessed by more people than the killing of Lee Harvey Oswald, accused assassin of President John F. Kennedy. Oswald was in front of the television cameras in the basement of the Dallas Jail when he was shot by Jack Ruby, on this day in 1963. The whole world saw it happen; but we have yet to fully understand how and why, even though we saw it with our own eyes.
Two days after this date in 1963, Chief Justice Earl Warren spoke some wise words at the memorial tribute to President Kennedy: If we really love this country, if we truly love justice and mercy, if we fervently want to make this nation better for those who are to follow us, we can at least abjure the hatred that consumes people, the false accusations that divide us and the bitterness that begets violence.
After Leonard and Thelma Spinrad
The 7th Annual World Health Care Congress
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