MEDICAL TUESDAY . NET

NEWSLETTER

Community For Better Health Care

Vol V, No 13, Oct 10, 2006

 

In This Issue:


1.                  Featured Article: Peacekeepers of the IMMUNE SYSTEM, Scientific American

2.                  In the News: Wal-Mart and Sam's Clubs $4 Generic Prescription Program

3.                  International Medicine: German HealthCare Reform, Collapsing Again?

4.                  Medicare: Bureaucratic Injury of Citizens Doesn't Stop with the Feds

5.                  Medical Gluttony: Government Benefits Just Keep on Getting More Gluttonous.

6.                  Medical Myths: Doctors Can Do Several Things at Once.

7.                  Overheard in the Medical Staff Lounge: Only the Government Can Legally Do the Illegal.

8.                  Voices of Medicine: Moore's Law and Medicine By Alan G. Zacharia, M.D

9.                  From the Physician Patient Bookshelf: Lord of the Flies by William Golding

10.              Hippocrates & His Kin: Blenderized Stool

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

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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 U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. This year it was 50 percent, indicating open forums such as these are critically important. The 4th Annual World Health Congress has been scheduled for April 22-24, 2007, also in Washington, D.C. The World Health Care Congress - Asia will be held in Singapore on May 21-23, 2007. The World Health Care Congress - Middle East will be held in Dubai, United Arab Emirates, on November 12-14, 2007. The World Health Care Congress - Europe 2007 will meet in Barcelona on March 26-28, 2007. For more information, visit www.worldcongress.com. 

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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. . .

Imperfect Defenses

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 University in Japan. Fehervari is now a research associate in the department of pathology at the University of Cambridge, where he earned a Ph.D. in immunology. Sakaguchi is professor and chair of the department of experimental pathology at Kyoto. He began searching for regulatory T cells in the early 1980s and has studied them ever since.

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2.      In the News: WAL-MART AND SAM'S CLUBS ACCELERATE FLORIDA ROLLOUT OF $4 GENERIC PRESCRIPTION PROGRAM

End of the week launch planned; new prescriptions added, significant savings projected for Florida Wal-Mart and Sam's Club customers

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 the Tampa Bay market two weeks ago, the list has been expanded to include medicines such as the oncology drug Megestrol and Lovastatin, which is used to treat cholesterol. The list of $4 prescription medications now represents nearly 30 percent of prescriptions currently dispensed in the 235 Wal-Mart, Neighborhood Market and Sam's Club pharmacies throughout Florida. . . 

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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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4.      Medicare: Bureaucratic Injury of Citizens Doesn't Stop With The Feds, It Goes Down To All Levels of Political Power, Even The City Council

Wal-Mart Discounts Politics, Wall Street Journal, September 12, 2006

. . . 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 Illinois the minimum is $6.50. So you ask: What else is new? Well this is Chicago, so follow us back through the big-box bill's politics, and even the most politically jaundiced reader might find a surprise.

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 Windy City residents go bargain hunting in the suburbs. And of course if Wal-Mart, Home Depot and the others were to abandon the city, Chicago residents would be paying a great many millions more a year in higher prices. Still, the City Council has vowed a veto override vote later this week. What then? Well, the poor get stuck while those with the financial means will drive out to the suburbs to do some Wal-Mart shopping.

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 Windy City pols.

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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5.      Medical Gluttony: Government Benefits Just Keep on Getting More Gluttonous.

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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6.      Medical Myths: Doctors Can Do Several Things at Once?

Multitasking, by Jared Sandberg, Wall Street Journal, Sept 12, 2006

"Yes, Sell All My Stocks. No, the 3:15 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 Mexico while also composing an email to four of his lieutenants about the need to fire a fifth. He sent the email, and was continuing with his travel agent. All of a sudden, he "got the nagging feeling that something wasn't right."

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 Mexico, Mr. Grillo learned he'd been booked into a presidential suite at $3,000 a night. . .

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 Ames Research Center. "It's almost inevitable that each individual task will be slower and of lower quality."

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).

Email Jared.Sandberg@wsj.com. To see past columns, go to CareerJournal.com.

[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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7.      Overheard in the Medical Staff Lounge: Only the Government Can Legally Do the Illegal.

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.

Dr Rosen: Speaking of sliding fees, as a medical student, I spent an afternoon in a Colon and Rectal Surgeon's office. There was an elderly woman brought in by her son for rectal bleeding. The surgeon was only able to insert his finger partway and immediately made the diagnosis of rectal cancer. The son asked how much it would cost to have the surgery. The surgeon stated that his fees vary from zero to $500 for the operation. In the 1970s shortly after the implementation, Medicare made it illegal to charge a sliding scale for our patients.

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 India, the Caribbean, and Thailand being American trained, more people are seeing that they can afford to take a trip half way around the world, have their surgery, and still save considerably over charges in this country.

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: Moore's Law and Medicine By Alan G. Zacharia, M.D

SAN MATEO COUNTY MEDICAL ASSOCIATION BULLETIN

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 "Moore's Law," this trend has been reliable and is predicted to continue in the near term.

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 Moore's Law applied to medicine and Moore's Law applied to chips is that chips are obligate denizens of free-market capitalism. Everyone understands that improved computing power is beneficial, but not mandatory or even necessary. People lived before computers and will live after them. Sales of new technology can be and are driven by marketing more than need, and this creates an economic elasticity that drives down price.

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 mandatory entitlements, Moore's Law creates a disastrous situation. In making medical decisions, people operate on an emotional/social level and do everything they can to avoid the reality of the cost. Politics complicates policy, and insurance companies and the government, as the "payers" of the cost, become the ever-burgeoning "them." Thus, the cost of entitlement is severely buffered and obscured. This creates an economically inelastic situation in which price is no object; and unlike a single transistor, the societal toll, financial and otherwise, of each additional medical improvement is accelerating. . . .

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 Daly City.


There's A New Doctor In The House, by Michael Wilkes, MD, Sacramento Bee, October 7, 2006

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 University of California, Davis. Dr. Wilkes can be reached at DrWilkes@sacbee.com.

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 Cornwall, 1911) declared that he was brought up to be a scientist, and revolted; after two years at Oxford he changed educational emphasis from science to English Literature, and became devoted to Anglo-Saxon.

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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10.  Hippocrates & His Kin: Blenderized Feces

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


 

                      The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports. This month, read The 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 George Mason University (www.mercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Recently he has been working on secretive pork-barrel spending that is inserted into major budget bills with no debate, and without even having a legislators' name attached. This month, read Licensing Occupations: Ensuring Quality or Restricting Competition? at www.mercatus.org/Events/eventID.385/event_detail.asp. Why do 30 percent of Californians need a license to work? Please join the Mercatus Center for Excellence and Accountability in Government.

                      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 America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care-and may even make things worse." Be sure to read what Americans want at www.cahi.org/cahi_contents/newsroom/article.asp?id=795.

                      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.

                      The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter at www.i2i.org/healthcarecenter.aspx. This month, read Minimum Wage Often Transfers Wealth Away From Poor at www.i2i.org/main/article.php?article_id=1328.

                      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 Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio at www.cato.org/people/cannon.html. Visit their new The Center for Global Liberty and Prosperity at www.cato.org/economicliberty/.

                      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.]

                      Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. You may join them to explore the Roots of American Republicanism on a British Isles cruise on July 10-21, 2006. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Read President Arnn's comments at www.hillsdale.edu/arnn/usnews.asp. Also read his comments on Ronald Reagan, RIP, at www.hillsdale.edu/newimprimis/default.htm. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read Daniel L. Dreisbach "Origins and Dangers of the ‘Wall of Separation' Between Church and State at www.hillsdale.edu/imprimis/2006/10/. The last ten years of Imprimis are archived at www.hillsdale.edu/imprimis/archives.htm.

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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. - Walpole

In Memoriam 

[Tower of Records, Books and Video died last Friday. Although it collected the rock star imitators with rings in their lips, tongues, navels, and private areas seen only in the exam room, tattoos on faces, scalps, torsos and extremities, I never felt out of place in my coat and tie. It started a few years earlier than my arrival in Sacramento in 1966. It always felt like a bit of Sacramento when I visited TOWER in London or TOWER in Tokyo. Many of my books were autographed by their authors at TOWER. But TOWER continued opening new stores and failed to adapt to the electronic age. This did them in. That's the way businesses go under and should go under when they no longer become efficient. Unfortunately Government medicine is slow to adapt and instead of becoming more efficient, is becoming more costly. Government medicine should go the way of TOWER. But being slaves to the system is too comforting for some. Just as when slaves were set free, some couldn't leave the comfort of slavery. Can we learn? Or will there have to be another American Experiment of 1776 hundreds of years from now to make another stab at freedom? Why don't we just move forward to our roots and regain our freedom?]

 

Sacramento fans recall the glory days, by Chris Macias - Sac Bee Pop Music Critic, Saturday, October 7, 2006

Tower Records was Sacramento's icon of sound, and all over the city, hearts are breaking.

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.

"Tower was Sacramento's gift to the world," said blues musician and radio personality Mick Martin, who worked at Tower from 1967 to 1969. "It was the place to be, everyone hung out there."

For scores of Sacramento musicians and music fans, the loss of Tower Records is like the breakup of a legendary band.

"I guess I speak a bit from nostalgia and (as a) bit of a baby boomer," said Marty DeAnda, owner of the Sacramento record label DIG Music. "There will no longer be the smell of cardboard when you peel the shrink-wrap off an album."

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 Sacramento from Cameron Park just to shop at Tower.

"We would go to the Tower on Sunrise, and I used to go down there all the time and browse the racks," he said. "That was back when they had tapes, too, 'cas-singles,' cassette singles, like INXS, 'Devil Inside' -- that was one of the first things I ever bought."   . . .

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 West Sacramento to buy Beatles albums during the height of the British Invasion.

"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 Watt Avenue parking lot on a flatbed truck. That was in 1996. The same parking lot doubled as a mosh pit when the Deftones, the Grammy-winning hard rock band from Sacramento, performed a free show in 1997.

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 San Francisco, worked at Tower Records on Florin Road in 1991. . .

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. . .

Singer-songwriter Greene, 25, said he celebrates Tower hanging on as long as it did, but the end was inevitable for the Sacramento landmark.

"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

About the writer: The Bee's Chris Macias can be reached at (916) 321-1253 or cmacias@sacbee.com. Bee staff writers Jonathan Pinkerton, Lisa Heyamoto and Gina Kim contributed to this report.

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 Tuxedo Park, New York, which was a very swanky retreat for the rich. Some of the men wore a new garment as a dinner jacket and the garment took its name, or at least its nickname, from the setting. 

Speaker's Lifetime Library, © 1979, Leonard and Thelma Spinrad