MEDICAL TUESDAY . NET
Community For Better Health Care
Vol V, No 13,
In This Issue:
The Annual World Health Care Congress, co-sponsored by The Wall Street Journal, is
the most prestigious meeting of chief and senior executives from all sectors of
health care. Renowned authorities and practitioners assemble to present recent
results and to develop innovative strategies that foster the creation of a
cost-effective and accountable
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1. Featured Article: Peacekeepers of the IMMUNE SYSTEM, By Zoltan Fehervari and Shimon Sakaguchi, Scientific American
Regulatory T cells, only recently proven to exist, keep the body's defenses from attacking the body itself. Manipulations of these cells could offer new treatments for conditions ranging from diabetes to organ rejection
"H o r r o r a u t o t o x i c u s."
A century ago the visionary bacteriologist Paul Ehrlich aptly coined that term to describe an immune system attack against a person's own tissues. Ehrlich thought such autoimmunity - another term he coined - was biologically possible yet was somehow kept in check, but the medical community misconstrued his two-sided idea, believing instead that autoimmunity had to be inherently impossible. . .
Slowly, though, a number of mysterious ailments came to be recognized as examples of horror autotoxicus - among them multiple sclerosis, insulin-dependent diabetes (the form that commonly strikes in youth) and rheumatoid arthritis. Investigators learned, too, that these diseases usually stem from the renegade actions of white blood cells known as CD4+ T lymphocytes (so named because they display a molecule called CD4 and mature in the thymus). Normal versions of these cells serve as officers in the immune system's armed forces, responsible for unleashing the system's combat troops against disease-causing microorganisms. But sometimes the cells turn against components of the body. Ehrlich was correct in another way as well.
Recent work has identified cells that apparently exist specifically to block aberrant immune behavior. Called regulatory T cells, they are a subpopulation of CD4+ T cells, and they are vital for maintaining an immune system in harmony with its host. Increasingly, immunologists are also realizing that these cells do much more than quash autoimmunity; they also influence the immune system's responses to infectious agents, cancer, organ transplants and pregnancy. We and others are working to understand exactly how these remarkable cells carry out their responsibilities and why they sometimes function imperfectly. The findings should reveal ways to regulate the regulators and thus to depress or enhance immune activity as needed and, in so doing, to better address some of today's foremost medical challenges. . .
Like the immunologists of Ehrlich's time, many people today would be dismayed to know that no matter how healthy they may be, their bodies harbor potentially destructive immune system cells quite capable of triggering autoimmune disease. Yet this immunological sword of Damocles can be easily demonstrated. If a mouse, for example, is injected with proteins from its own central nervous system, along with an adjuvant (a generalized immune system stimulus), a destructive immune reaction ensues. Much as in multiple sclerosis, T cells launch an attack on the animal's brain and spinal cord. By varying the source of the injected selfprotein, researchers can provoke other autoimmune diseases in laboratory animals - which indicates that potentially harmful immune system cells can mount self-attacks on a wide variety of tissues. The risk appears to hold true in humans, too, because autoreactive immune system cells can be captured readily from the blood of a healthy person. In a test tube, they react strongly to samples of that person's tissues. Given such demonstrations of clear and imminent danger, investigators naturally wondered how it is that most animals and humans are untroubled by autoimmune disease. Put another way, they wanted to know how the immune system distinguishes threats such as microbes from a person's own tissues. They found that to achieve self-tolerance - the ability to refrain from attacking one's own organs - the immune system enlists numerous safeguards. The first defense, at least where T cells are concerned, occurs in the thymus, which lies inconspicuously in front of the heart. In the thymus, immature T cells undergo a strict "education" in which they are programmed to not react strongly (and therefore harmfully) to any bodily tissues. Disobedient cells are destroyed. No system is perfect, though, and in fact a small number of autoaggressive T cells slip through. Escaping into the bloodstream and into lymph vessels, they create the immune system's potential for unleashing autoimmune disease.
Blood and lymph vessels are where a second line of defense comes into play. This layer of protection against autoimmunity has several facets. Certain tissues, including those of the brain and spinal cord, are concealed from immune cell patrols simply by having a paucity of blood and lymph vessels that penetrate deep into the tissue. Their isolation, however, is not absolute, and at times, such as when the tissues are injured, self-reactive immune cells can find a way in. Additional modes of protection are more proactive. Immune cells showing an inappropriate interest in the body's own tissues can be targeted for destruction or rendered quiescent by other immune system components.
Among the immune cells that carry out these proactive roles, regulatory T cells may well be the most crucial. The majority, if not all of them, learn their "adult" roles within the thymus, as other T cells do, then go forth and persist throughout the body as a specialized T cell subpopulation. . .
To read the entire article, please go to (Subscription Required) www.sciam.com/print_version.cfm?articleID=0005AFFE-A2F0-150E-A26183414B7F0000.
ZOLTAN FEHERVARI and SHIMON SAKAGUCHI began
collaborating in 2002, when Fehervari took a postdoctoral position in
Sakaguchi's laboratory at the Institute for Frontier Medical Sciences of Kyoto
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End of the week launch planned; new prescriptions
added, significant savings projected for
BENTONVILLE, Ark. - Oct. 5, 2006 - Responding to customer demand and requests from Florida state officials, Wal-Mart Stores, Inc. (NYSE: WMT) announced today that it is rolling out its $4 generic prescription program in Florida beginning Friday, October 6, 2006 - nearly four months earlier than expected. The program was originally planned to be rolled out statewide in January 2007.
"This program makes everyone at Wal-Mart proud. It enables us to respond to the needs of our customers who have struggled far too long with the high cost of prescriptions," said Wal-Mart President and CEO Lee Scott. "Part of this is about saving these customers money, but even more importantly, it's about making sure they get the medicines they need to live healthier lives."
The $4 generics program has been expanded to include
314 generic prescriptions available for up to a 30-day supply at commonly
prescribed dosages. The list of 314 generic prescriptions is made up of as many
as 143 compounds in 24 therapeutic categories. Since launching the program in
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3. International Medicine: German HealthCare Reform, Collapsing Again? Can There Ever Be A Common Sense Approach Once Government Takes Over?
Merkel forced to rethink healthcare reforms, By Bertrand Benoit in Berlin , FT, Sept 22 2006
Angela Merkel, the German chancellor, on Friday sought to reclaim control of her conflict-ridden grand coalition, taking her ambitious and controversial healthcare reform plans back to the drawing board.
In what appeared to be a calculated concession to her Christian Democratic Union's unruly regional grandees, she said the most contentious aspect of a reform blueprint agreed between the two governing coalition parties in July would now be renegotiated.
"Thoroughness comes before speed," she said after a hastily convened meeting with Kurt Beck, chairman of the Social Democratic Party, the CDU's junior coalition partners, suggesting the timetable for introducing the reform may not be met.
The overhaul of the 123-year old health scheme is the coalition's most ambitious undertaking since Ms Merkel took office 10 months ago. Its collapse would be a devastating blow and raise doubts about her ability to head her national-unity government for its four-year term.
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Wal-Mart Discounts Politics,
Wall Street Journal,
. . . Chicago Mayor Richard Daley issued his first
veto ever, striking down a living-wage bill that would require "big
box" retailers like Wal-Mart and Office Depot to pay a super-minimum wage
of $10 an hour plus $3 in benefits to all employees by 2010. The national
minimum is $5.15, and in
In his veto message, Mayor Daley, a pro-union Democrat, declared that the wage law would "drive jobs and businesses from our city, penalizing neighborhoods that need additional economic activity the most."
Wal-Mart and Target have announced plans to cease
expansions in the city if the law is enacted. The city already loses $300
million a year in sales tax revenues when
It turns out that the wage bill's chief sponsor, Alderman Joe Moore, shops at suburban big-box retail stores, for the usual reason. His campaign committee has purchased $30,589 worth of supplies at big-box retailers outside the city, according to disclosure forms. Alderman Moore isn't alone out there with a cart among the high stacks. A review of Illinois State Board of Elections disclosure forms finds that the 35 aldermen who voted to stick it to the "big box" retailers have spent $114,000 patronizing these non-Chicago stores.
And why not? The virtue of superstores isn't just that
they're prodigious creators of jobs -- Wal-Mart alone has hired 240,000 workers
since 2001 -- but that they hold down costs and pass on the savings to
consumers, even to
http://online.wsj.com/article/SB115802354054560149.html (Subscription required)
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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Government became involved in health care for those over age 65 in 1965. Since then, its involvement has mushroomed. Costs have escalated, not by five or 10 percent over budget, but by hundreds of percent. As if that isn't enough, new benefits are frequently added. The kidney lobby was most successful in getting coverage for anyone, including those not yet 65. The county hospital system for the poor was supplanted by a federal monstrosity called Medicaid, which now covers more people than Medicare. Many are no longer poor. I have Medicaid patients in my practice with household incomes approaching $50,000 annually. The Medicare recipients have a vast network. Knowledge of benefits received in one locality are quickly known in new locations and thus new benefits grow at an unbelievable rate. Likewise, the Medicaid network. The current status symbol is the electric wheelchair. Certainly this has improved the lot of many disabled, but many are able to function rather well without one.
Traditionally, pulmonary rehabilitation programs advised against patients with pulmonary disabilities obtaining disabled parking stickers or electronic wheelchairs, and instead advised them to park at the far end of the parking lot and walk to the store or their church or their club. These activities themselves would be "pulmonary rehabilitations." Once the disabled placard and the electronic wheelchair became readily available as coverage by Medicare and Medicaid mushroomed, doctors no longer had the clout to prevent what they knew inherently was bad for their patient's welfare. Medicare and Medicaid Services blamed the doctors for over utilization despite the fact it was their programs that caused the stampede into the doctors' offices.
Recently, I observed two electric wheelchairs collide at a cross street. Both individuals simply got up and walked quite ably to disentangle their motorized vehicles. Many are in fact using their electric vehicles as their primary mode of transportation - going to the grocery store, shopping centers, and to visit friends. This frees up their own cars to give to their other relatives. Central planners can never foresee all the instances of providing what can become an additional non-medical benefit - another mode of transportation. Government programs were never designed to replace cars.
Similarly, I see many who reside in nursing facilities at Medicaid (taxpayer's) expense who are quite mobile, ambulating to the day rooms and to the dining rooms, which they could also do in the homes of their families. But freeing up their home to sell at today's market prices does add large sums to their children's wealth. Government programs were never designed to replace homes.
Government, despite thousands of new laws each year, is unable to control costs, over utilization, or inappropriate utilization. Frequently the onus is put upon another scapegoat, such as the doctor, making costs seem like an overcharge, an inappropriate charge, or some other trumped-up fraud. All government programs create fraud by what seems initially as a slight variation in utilization, which mushrooms out of control.
Government medicine will always spiral upward in cost and downward in quality of care.
Only private competitive individualized health care will decrease costs to the absolute minimum and increase quality of care without any laws being invoked.
The healthcare professions, doctors and nurses, should awaken to this deception before it's too late.
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Multitasking, by Jared Sandberg, Wall Street Journal,
"Yes, Sell All My Stocks. No, the From JFK. And Get Me Mr. Sister."
A few months ago, Victor Grillo, the chief executive of a marketing company, was in his office doing two things at once -- neither of them very well.
He was on the phone booking a vacation in
His "Sent" messages folder revealed he had
inadvertently sent the message to the person on the block. In a panic, Mr.
Grillo hastily told the travel agent to finish booking the trip. He then made a
mayday call to IT. Too late; an angry R-rated email soon arrived from the
canned employee. And when he got to
Multitasking, a term cribbed from computers, is an information age creed that, while almost universally sworn by, is more rooted in blind faith than fact. It's the wellspring of office gaffes, as well as the stock answer to how we do more with less when in fact we're usually doing less with more. What now passes for multitasking was once called not paying attention.
Today's workers typically have to do three things while arguing on the phone with a spouse. David Gardner, who writes instructional material for trainers, now knows better than to try. He once worked for a marketing company stretched so thin it sent 4,000 nuns direct mail offers addressed "Dear Mr. Sister."
Employers continue to seek out jugglers despite decades of research showing that humans aren't great multitaskers. (And in the case of distracted driving, we're downright dangerous.)
"Multitasking doesn't look to be one of the great
strengths of human cognition," says James C. Johnston, a research
psychologist at NASA's
Researchers say analytical thinking can happen in parallel, as long as the tasks have been practiced. But the amount of practice is "too high for the practical world," says Dr. Johnston. And that wouldn't include, say, responding to emails, which requires "fantastically more cognition" than the much simpler tasks often included in multitasking research. . .
Pamela Johnston, president of her own communications company, often dials clients, then begins other work while waiting for them to pick up. When they finally do, she sometimes forgets who she's called. So she'll either come clean, or just hang up.
Something else left out of the multitasking calculations -- beside the fact that we don't do it very well -- are "resumption costs." These are the seconds it takes your brain to say "Where was I?" when resuming an interrupted task. Depending on the tasks, those resumption costs can be high enough to make it faster to unitask, which researchers say produces better performance in the first place. . .
To read the entire article, go to http://online.wsj.com/article/SB115801096324259803.html (Subscription required).
[Doctors are expected to multitask or sequential task at a rapid rate. They frequently are involved in patient care and a well-meaning nurse will ask about another patient, a social worker will come by to obtain permission to order an electric wheelchair on a third patient, a physical therapist will come up to obtain an order for treatment on a fourth patient, and another doctor will briefly mention a follow-up evaluation on a fifth patient. It really is impossible for even a physician to keep five different medical records revolving around in his brain and not occasionally get an order on the wrong patient.
[Rapid sequential tasking is not much different. HMOs expect a doctor to recall a patient's entire medical history, obtain new medical information since his last evaluation, examine the patient for any new findings, assess all the data, come to a new updated diagnostic conclusion, write new lab or x-ray orders to confirm the new diagnosis, record a complete record of the event, and be able to greet the next patient with a great smile and a pleasant "I've been expecting you all afternoon" greeting – all within 12 minutes.
[Why do doctors continue to allow these medical bureaucrats to jeopardize our patient's health?]
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Dr Sam: Did you see that the Feds are instituting a sliding premium schedule for Medicare? For a couple where each make $50 an hour, the premium will be $400 a month in three years. That's $5,000 per year or about a 450 percent increase in just three years.
Speaking of sliding fees, as a medical student, I spent an afternoon in a
Dr Sam: The Feds are unconscionable in their raping the public for their ineptitude. Why do people put up with this?
Dr Michele: Because only the government can regulate fees fairly.
Dr Sam: That's a bunch of Bull.
Dr Rosen: In 1965, my father had Blue Cross-Blue Shield for our family which had a premium of about $100 a month. If health care had remained on the open Medical MarketPlace where providers bring their fees down to meet any competition, that premium would probably have gone up to about $400, about fourfold or 400 percent in four decades, but it would have covered hospital, outpatient laboratory, x-rays, physician fees just like it did in 1965. Now that $400 a month that Medicare will charge for Part B only covers outpatient benefits and doesn't even touch hospital care. And it covers outpatient medicine very poorly.
Dr Michele: Come on guys, you'll never get the government out of healthcare. Get real.
Dr Rosen: With
the doctors in
Dr Sam: I think I'll get one of those cheap HSA plans, give up my Medicare, and have all my big stuff done off shore. Not only will I save Big Bucks on health care, I'll also save $5,000 in Medicare taxes.
Dr Rosen: If all of those high premium Americans did that, Medicare would collapse, wouldn't it Michele?
Dr Michele: I'm beginning to dislike all of you anti-Americans. I think I'll cool off by seeing some patients.
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8. Voices of Medicine:
1965 Intel cofounder Gordon Moore observed
that the number of transistors per square inch (data density in its current
iteration) on an integrated circuit had been doubling every 18 months. Known as
Since the first third of the twentieth century, there has been a similar proliferation of medical technology, broader in scope (and therefore less obviously definable) than the elegant simplicity of data density on a chip. The total knowledge base of medically associated pursuits is doubling at least every couple of years, but less visibly because the advances, like single stalks of bamboo in a hedge, shoot up at different times from different related disciplines. . .
In technical endeavors (surgery, cardiology, radiology, gastroenterology), we have seen the endoscope and the catheter revolutionize the traditional concept of surgery. All kinds of medical devices (diagnostic and therapeutic, invasive and noninvasive) are more specific and effective. Pharmacological interventions are exploding, perhaps more in cost than effect, but significantly in both.
The difference between
New technology has the burden of demonstrating the importance of its superiority over its predecessor. Of the big four incentives—emotional, political, social, economic—the price of new nonmedical technology is determined more by economics than anything else (with a not insignificant, but really optional, advertising emotional/social boost), and the cost of acquisition has regularly come down.
When applied to medicine and its seemingly
We who manage health services should have a broader view of the effects of what we do and what we use to do it. It is not sufficient just to control our own contribution to resource mismanagement. We must seek to constrain political and business behaviors that wantonly succumb to or exploit human narcissism in expensive Pyrrhic battles that ignore reality. A good physician gives patients what they need rather than what they want, and we owe the same tough love to the society that depends on us.
To read the entire article, please go to www.smcma.org/Bulletin/BulletinIssues/June06issue/Moore's%20Law.html.
Dr. Zacharia is an orthopaedic surgeon in
To the spectator, the practice of medicine is a bit like visiting a foreign country. A trip to either is often magical, mysterious and expensive.
In both cases, the locals wear costumes (lab coats, etc.), speak an unusual language (medicalese), and have their own rituals (autopsies) and ceremonies (grand rounds).
Beginning this week, it is my distinct pleasure to be your medical docent on a weekly adventure through clinics, hospital corridors, laboratories and medical school classrooms. Each week, I have been asked to dispense with jargon, cronyism and hype to give you a look from the inside at doctoring. I will call it as I see it, and share real stories of health, disease, and science.
The world of medicine is changing - rapidly. Sometimes these changes are for the better. We have a new, powerful antibiotic they can eradicate entire categories of bugs. We have vaccines that have wiped out infectious diseases and new vaccines that may prevent certain types of cancer, such as cervical cancer. We have probes and lasers and scanners and robotic arms that can reach the inner premises of the human body. We can take whole pieces of people and swap down for defective pieces in other people.
But these advances have brought with them ethical, policy and financial controversies.
There are tough questions. What do we value more, the latest and greatest chemotherapy that cost $45,000 and offers one person a five percent chance of surviving an additional 12 months, or an immunization program that also cost, but has the potential of providing 34 people -- most of them poor -- with an additional 10 years of life?
Sometimes, medical changes are for the worst. Today our doctor spend far less time with us one-on-one. There are new deadly viruses that did not exist before, and new diseases, some which are caused by the medical profession itself. There are people on street corners pushing illegal, dangerous and expensive drugs that come to us from distant lands, and there are people on our TV screens and in our magazines pushing legal, expensive and dangerous drugs that come to us from corporate boardrooms.
I will show you a side of medicine very similar to what we teach our medical students. I worked as a dean at the UC Davis School of Medicine, a professor of medicine, a clinic director, a volunteer physician at free clinics, a researcher, a doctor in foreign countries and a ship's doctor. But that's only half the story. I have also worked as a journalist covering the health beat for newspapers, TV and public radio. I have seen firsthand the various snafus in the system that result in you receiving misinformation -sometimes from the news, your doctor, your health plan or the Web. . .
To read the rest of the story, please go do www.sacbee.com/296/story/28096.html.
Michael Wilkes, M.D. is a professor of medicine at the
To read more Voices of Medicine, please go to www.healthcarecom.net/vom2003.htm.
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9. Book Review: Lord of the Flies by William Golding
At the dawn of the next world, a plane crashes on an uncharted island, stranding a group of schoolboys. At first, with no adult supervision, their freedom is something to Celebrate. This far from Civilization they can do anything they want. Anything. But as order collapses, as strange howls echo in the night, when terror begins its reign, the hope of adventure seems as far removed from reality as the hope of being rescued…
This brilliant work is a frightening parody on man's return to that state of darkness from which it took him thousands of year to emerge. (NYT)
Lord of the Flies was recently released in a new
edition with new notes from the author.
William Golding (born
The theme of Lord of the Flies is described by Golding as an attempt to trace the defects of society back to the defects of human nature. The moral is that the shape of the Society must depend on the ethical nature of the individual and not on any political system however apparently logical or respectable.
This is a book worth rereading as our political system, thinking it is acting in a logical and respectable fashion, is destroying the moral nature of individuals since all repercussions come from the government and the individual is no longer sacrosanct, a constitutional guarantee. Physicians can no longer act in the patient's best interest, but must look first to government rules and regulations before ministering to the patient's needs. We must daily make this point to our patients. They, not we, have the power to change government to restore freedom.
A Perigee Book, published by the Penguin Group, May 2006. Copyright by William Golding, 1954
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In a recent lecture on C. difficile diarrhea, which occurs when patients are on prolonged antibiotics, it was pointed out that in many instances it has been difficult to re-establish normal flora or bacterial population in the human gut. In one instance, when nothing else worked, doctors took the stool of a normal person with the appropriate bacteria in the bowel and fed it to the sick patient through a naso-gastric tube. Apparently the procedure worked.
But will they be able to keep nurses on the job who will have to blendarize stool from one patient and feed it to another? How will they camouflage the smell?
Speaking of smells, have you ever walked into a restroom and been greeted with a floral odor? Ever wonder what inhalants or fumes were being camouflaged?
To read more medical vignettes, please go to www.healthcarecom.net/hhk2000.htm.
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• The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports. This month, read The Rationale For A Statewide Health Insurance Exchange at www.ncpa.org/sub/dpd/index.php?page=article&Article_ID=13219.
• Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may subscribe at www.pacificresearch.org/pub/hpp/index.html or access their health page at www.pacificresearch.org/centers/hcs/index.html. This month, read Medical Tourism: Why Americans Take Medical Vacations Abroad by Diana M. Ernst at www.pacificresearch.org/pub/hpp/2006/hpp_09-06.html.
The Mercatus Center at
• The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. www.nahu.org/publications/hiu/index.htm. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business. Be sure to review the current articles listed on their table of contents at hiu.nahu.org/paper.asp?paper=1. To see my recent column, go to http://hiu.nahu.org/article.asp?article=1328&paper=0&cat=137.
• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. This month, be sure to read about Two Studies on Consumer-Directed Health Care at www.galen.org/ccbdocs.asp?docID=922.
• Greg Scandlen, an expert in Health Savings Accounts (HSAs) has embarked on a new mission: Consumers for Health Care Choices (CHCC). To read the initial series of his newsletter, Consumers Power Reports, go to www.chcchoices.org/publications.html. To join, go to www.chcchoices.org/join.html. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn at www.chcchoices.org/publications/cpr9.pdf This month's newsletter is found at www.chcchoices.org/publications.html.
• The Heartland Institute, www.heartland.org, publishes the Health Care News. Read the late Conrad F Meier on What is Free-Market Health Care? at www.heartland.org/Article.cfm?artId=10333. You may sign up for their health care email newsletter at www.heartland.org/Article.cfm?artId=10478. To keep up with emerging issues, go to www.heartland.org/Article.cfm?artId=19607.
• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling, PhD, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. This month, be sure to read Dr Ebeling's current column Not Losing Sight of the Best in the Pursuit of Liberty at www.fee.org/publications/the-freeman/article.asp?aid=5598.
The Council for
Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as
CEO for five years, is an association of insurance companies, actuarial firms,
legislative consultants, physicians and insurance agents. Their mission is to
develop and promote free-market solutions to
• The Health Policy Fact Checkers is a great resource to check the facts for accuracy in reporting and can be accessed from the preceding CAHI site or directly at www.factcheckers.org/. This week, read about consumer-driven plans at a Commonewealth Fund Survey.
Independence Institute, www.i2i.org, is a free-market think-tank in Golden,
• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read Virtuous Leaders Or War Criminals at www.quebecoislibre.org/06/061008-2.htm.
• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section at www.fraserinstitute.ca/health/index.asp?snav=he.
• The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission is to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site. This month, read More Evidence for Free Markets in Health Coverage at http://policy.heritageblogs.org/2006/09/more_evidence_for_free_markets.html.
• The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. You may also log on to Lew's premier free-market site at www.lewrockwell.com to read some of his lectures to medical groups. To learn how state medicine subsidizes illness, see www.lewrockwell.com/rockwell/sickness.html; or to find out why anyone would want to be an MD today, see www.lewrockwell.com/klassen/klassen46.html.
CATO. The Cato Institute (www.cato.org) was founded in 1977 by Edward H. Crane,
with Charles Koch of Koch Industries. It is a nonprofit public policy research
foundation headquartered in
• The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.
• The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]
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Del Meyer, MD, Editor & Founder
Words of Wisdom
The greatest harm is done by people who think they are doing the greatest good. -John Locke
Government Medicine's Prejudice Against Innovation. -Edward Hudgins
Deceivers are the most dangerous members of society.- They trifle with the best affections of our nature, and violate the most sacred obligations. -Crabbe.
O, what a tangled web we weave, when first we practice to deceive. -Walter Scott
Mankind, in the gross, is a gaping monster, that loves to be deceived, and has seldom been disappointed. -Mackenzie
All deception in the course of life is indeed nothing else but a lie reduced to practice, and falsehood passing from words into things. -South
Government Medicine is our societies' greatest deception in thinking we're doing good. HHK
There are three persons you should never
deceive: your physician, your confessor, and your lawyer. -
Tower Records was
For 46 years, Tower was a second home for local music fanatics, a mixture of young and old, rock and classical, spoken word and blues.
Tower was once the hippest place in town, where employees were like rock stars and music culture was manufactured.
For scores of
"I guess I speak a bit
from nostalgia and (as a) bit of a baby boomer," said Marty DeAnda, owner
As Tower Records' obituary was being written on Friday, popular local singer-songwriter Jackie Greene was feeling the blues.
Greene remembers coming all
the way to
"We would go to the Tower
Tower Records was a school of sorts for local DJ Larry Rodriguez. The 37-year-old worked at Tower Records on Broadway as a teenager, when his job was to wipe down the plastic cards that displayed album titles. And then he'd spend some of his paycheck on music, especially the array of sounds from the bargain section.
"I was able to really experience jazz and metal music and international music and all sorts of stuff, just by being able to pick up a record for a couple of bucks because it looked interesting," Rodriguez said. "I really got turned on to a lot of great music from Tower, so I've got to give it up to them for that."
At Tower Records, you could literally feel the music with your fingers. Whether it was browsing CD jewel cases, vinyl album covers or tape cassettes, shopping at Tower Records was a tactile experience lost in the digital age.
Local media producer Dennis
Newhall used to drive to the Broadway store from
"You have to use the phrase 'used to,' " Newhall said, "because it used to be the place you would go when you wanted to see what was new. Now, you just sit down at your computer."
Tower Records will also go
down in the history books as the place where Metallica performed in a
And if you worked at Tower
Records, every day was casual Friday and a lip piercing or pink hair was de
rigueur. Jonah Matranga, a nationally renowned singer-songwriter who now lives in
Mike Farrace remembers when a job at Tower was the hippest gig in town. He started as a store clerk in 1997 and eventually became senior vice president of digital business.
"In the '70s and '80s and even the '90s, Tower was the coolest place to work," said Farrace, who oversaw the 1995 launch of the Tower Web site, the first American record store to sell music online.
"Everybody wanted to work there. People would come in and beg for jobs. You'd get concert tickets and promo (albums), artists would come by and sign autographs. It was just exciting."
Rob Fauble, owner of the midtown record store The Beat, said no one -- not even Tower's competitors -- hoped for this finale. . .
25, said he celebrates Tower hanging on as long as it did, but the end was
inevitable for the
"From a nostalgic standpoint," he said, "it's heartbreaking."
To read the entire article, please go to www.sacbee.com/150/v-print/story/35242.html
On This Date in History - October 10
On this date in 1813, Giuseppe Verdi, the great Italian composer, was born. Somehow, if his name had been translated into the English equivalent, Joseph Green, not only would the name sound less impressive, but the Opera Aida would probably not have sounded the same.
On this date in 1865, John Hyatts patented the billiard ball. Some of us feel like we have been standing behind one of Mr. Hyatts' inventions for sometime now.
On this date in 1886, the tuxedo was born
at the autumn ball at
Speaker's Lifetime Library, © 1979, Leonard and Thelma Spinrad