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MEDICAL TUESDAY . NET |
NEWSLETTER |
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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
Words of Wisdom,
Recent Postings, In Memoriam . . .
* * * * *
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.
* * * * *
1. Featured Article: Stroke Rehabilitation with Robotics
Robots
That Care
Advances in technological therapy.
by Jerome
Groopman, The New Yorker, November 2, 2009
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.
At
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
cognitive rehabilitation. Read
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."
* * * * *
2.
In the News: Sacramento Physician, CEO,
ReflectiveMedical, Leaves Organized Medicine
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.
David
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
Bill:
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
points. Read more . . . The
first relates to my view that the public holds medicine in high regard in that
it belongs to our society at large and not a political party. The second is my view that organized
medicine at both the state and the federal level is out of its depth when doing
business with professional politicians. The attached article from today's WSJ
summarizes my view as to the AMA's naivetι as it relates to the current
health care bills now before Congress. The evident self-serving behind the
AMA's endorsement of ObamaCare is an embarrassment and, in my opinion,
impeaches the profession in the court of public opinion
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.
Sincerely,
David J. Gibson, M.D.
REVIEW
& OUTLOOK
NOVEMBER 6, 2009
The AMA Wants a Unicorn, Too
Contrary to the President, most doctors oppose his reforms.
http://online.wsj.com/article/SB10001424052748704013004574518013218640066.html
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."
* * * * *
3. International Medicine: The NHS gets a Bad Bill
of Health
The Government could make
the NHS more efficient by contracting out the management of its care, says
Simon Heffer.
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 . . .
Read
the entire Simon Heffer report in the Daily
Telegraph . . .
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, [2005] 1 S.C.R.
791
http://scc.lexum.umontreal.ca/en/2005/2005scc35/2005scc35.html
* * * * *
4.
Medicare: The Single-Payer
Health Care Debate, American Thoracic Society
Pro/Con Editorials: Con: Why It's Not the
Best Answer, ATS, American Journal of RCCM
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
* * * * *
5.
Medical Gluttony:
When I heard "chest pain," I called 911 before I even went into her
room.
Ms
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 acid reducer
pills. But the daughter and EMT agreed that it was best to take mother to the
emergency room. 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.
* * * * *
6.
Medical Myths:
Don't worry about losing your favorite doctor under socialized medicine.
Myth 10. If you like your health plan and your doctor, you can keep
them. AAPS, July 20th, 2009
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.
Additional information:
·
Lessons from Canadian
medicare, and other topics from the Sioux Falls Tea Party, July 2, 2009.
·
"Saying No to
Medical Care," AAPS News, March 2006.
·
"Time to Draw the
Line," AAPS News, November 1993.
Medical Myths Originate When Someone Else Pays The Medical Bills.
Myths Disappear When Patients Pay Appropriate Deductibles and
Co-Payments on Every Service.
* * * * *
7.
Overheard in the
Medical Staff Meeting: Answer to the Obama Health Plan Disaster
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.
* * * * *
8.
Voices of
Medicine: A Review of Local and Regional Medical Journals
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. . .
What
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.
* * * * *
9. Book Review: TRUST BETRAYED - Inside the
AARP by Dale Van Atta.
Regenery Publishing, Inc. Washington, DC: 1998, 208 pp, $25, ISBN
0-89526-485-4.
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 . . . It has thirty-three million members. Ethel
Percy Andrus, a retired schoolteacher, was its founder. Steeped in the American
ethos of God, country, and self-reliance, she explicitly stated that the "AARP
is not a pressure group, petitioning for special privileges and exemptions
because of age and numbers."
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.
To read more
book reviews . . .
To read book reviews
topically . . .
* * * * *
10. Hippocrates & His Kin:
Is government money as valuable as patient money?
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.
* * * * *
11.
Professionals Restoring Accountability in Medical Practice, Government
and Society:
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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Del Meyer, MD, Editor & Founder
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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
It's
Time for Fundamental Health Care Reform . . .
Health
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In Memoriam
Alan Peters, furniture-maker,
died on October 11th, aged 76
From
The Economist print edition, Nov 5th 2009
REACHING
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. Read
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. . .
Read
the entire obiturary . . .
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
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