MEDICAL TUESDAY . NET	NEWSLETTER
Community For Better Health Care	Vol VIII, No 12, Sept 22, 2009

In This Issue:

1. Featured Article: Breasts in Mourning: How Bottle-Feeding Mimics Child Loss

2. In the News: Edwards Hospital - For People who don’t like hospitals

3. International Medicine: America’s lesson for the NHS

4. Medicare: Contradictions worthy of the Marx Brothers

5. Medical Gluttony: Gluttony may not be the patient’s doing but his undoing

6. Medical Myths: Life Expectancy is longer in countries with socialized medicine

7. Overheard in the Medical Staff Lounge: Patients are becoming agitated

8. Voices of Medicine: I have been sitting quietly on the sidelines watching

9. The Bookshelf: What’s NEXT in Michael Crichton’s Future?

10. Hippocrates & His Kin: Medicine is ready to go from a vertical to an horizontal industry

11. Related Organizations: Restoring Accountability in Medical Practice and Society

Words of Wisdom, Recent Postings, In Memoriam . . .

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MOVIE EXPLAINING SOCIALIZED MEDICINE TO COUNTER MICHAEL MOORE's SiCKO

Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the truth about socialized medicine. Clements is the former publisher of "American Venture" magazine who made news in 2005 for a property rights project against eminent domain called the "Lost Liberty Hotel."
For more information visit www.sickandsickermovie.com or email logan@freestarmovie.com.

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1. Featured Article: Breasts in Mourning: How Bottle-Feeding Mimics Child Loss in Mothers' Brains

After a successful birth, opting not to breast-feed may trigger evolved mourning behaviors
By Jesse Bering

Discussions of breastfeeding versus bottle-feeding usually focus on the baby: What’s best in terms of nutrition? Or an infant’s future mental health?

But we’re going to take a different route. Let’s talk about the mother, and more specifically, the changes in her body as it readies itself to nourish a hungry newborn. With her breasts enlarged and hormones flowing, what happens if no newborn appears to suckle? How will her body—and brain—react?

First, a little background. The obvious physical changes in the pregnant human body (including swelling breasts) occur in response to escalating levels of the hormones prolactin, lactogen, estrogen, progesterone, adrenocorticotropic hormone (ACTH) and growth hormone. Placental birth serves as a sort of trigger event signaling to the mother’s body that it’s time to begin releasing milk. The baby’s physical suckling behavior—that is to say, lips tugging on teats—stimulates the first ejections, but eventually milk flow can start up by simply thinking about the baby, smelling it, or hearing it cry. “Involution,” the physiological process by which women’s breasts revert back to those dormant objects that give so much pleasure to adult human males, coincides with slowly weaning the growing infant away from breast milk and onto regular foods.

So what happens when, for whatever reason, mothers do not breastfeed their healthy infants? According to a new theory being proposed by University of Albany evolutionary psychologist Gordon Gallup and his colleagues, the decision to bottle-feed is tantamount, in the mother’s psyche, to mourning the loss of the child. At least, that’s how a woman’s body seems to respond to the absence of a suckling infant at its breasts in the wake of a successful childbirth. In a soon-to-be-published article in Medical Hypotheses, the authors argue that bottle-feeding simulates the unsettling ancestral condition of an infant’s death:

Opting not to breastfeed precludes and/or brings all of the processes involved in lactation to a halt. For most of human evolution the absence or early cessation of breastfeeding would have been occasioned by miscarriage, loss, or death of a child. We contend, therefore, that at the level of her basic biology a mother’s decision to bottle feed unknowingly simulates child loss.

There is at least correlational evidence to support this evolutionary claim, too. For example, in a paper presented earlier this year at the annual meeting of the Northeastern Evolutionary Psychology Society, Gallup and his colleagues reported their findings that, among a sample of 50 mothers recruited from local pediatric clinics and who had given birth in the previous 4-6 months, those who bottle fed scored significantly higher on the Edinburgh Postnatal Depression Scale than breastfeeders did. This effect panned out even after controlling for the mother’s age, education, income and relationship status with her current partner.

Another telling finding to emerge was that the bottle-feeding mothers reported wanting to hold their babies significantly more than the breastfeeders did, which the authors believe:

...parallels findings among nonhuman primates where in response to the death of an infant, mothers of some species have been known to tenaciously hold, cling to, and carry their infants for prolonged periods after they die.

It’s an interesting (if morbid) idea that bottle-feeders are implicitly conceptualizing their babies as corpses, but there are plenty of alternative interpretations. For example, these women may simply want to make up for lost bonding time that would otherwise occur during breastfeeding. In any event, if Gallup’s theory about the “unnaturalness” of bottle-feeding simulating child loss holds up in future studies, it would have obvious, and important, clinical applications. This would also be an excellent example of how evolutionary psychological explanations of human behavior can improve the quality of human life. Of course the reasons for bottle-feeding are complex and many, and not all women have the luxury of a choice in this regard. But for those who do, the present logic may give new meaning to the expression “breast is best”—if not for infants, then at least for their mothers.

In this column presented by Scientific American Mind magazine, research psychologist Jesse Bering of Queen's University Belfast ponders some of the more obscure aspects of everyday human behavior. Ever wonder why yawning is contagious, why we point with our index fingers instead of our thumbs or whether being breastfed as an infant influences your sexual preferences as an adult? Get a closer look at the latest data as “Bering in Mind“ tackles these and other quirky questions about human nature. Sign up for the RSS feed or friend Dr. Bering on Facebook and never miss an installment again.

We in Britain think US healthcare favours those who can pay for it, but that’s a serious misdiagnosis of a smart system

The political class in the United Kingdom has taken a good deal of umbrage at the unkind comments about the National Health Service made in the context of the American healthcare debate. Please accept my apologies on behalf of my countrymen, who are looking at the NHS through the prism of the American experience and without the historical context of British health before the NHS.

That said, there is also a tremendous amount of misinformation in Britain about the American healthcare system. The fact is, both America and Britain are going to have to change the way they provide healthcare but through evolution, not sudden or drastic reform.

The root of the misunderstanding on both sides of the Atlantic involves the way that healthcare is rationed. “Rationed” is a dirty word in some quarters, but we economists have it drilled into our thinking from the first week of our freshman year in college. Goods are scarce. Societies can ration scarce goods by price, or by regulation, or by queueing, or can choose not to ration by making them almost free and thereby drive ever increasing amounts of resources into massive consumption of the free goods.

The negative view of the NHS being circulated by some in America highlights the adverse effects of rationing by regulation and queueing that occurs in Britain without giving the whole picture. It also ignores the enormous benefits the NHS has brought to British healthcare in the six decades of its existence and just how scarce access to even basic healthcare was in Britain before the NHS.

The negative view of American healthcare held in Britain also comes from a misperception of the American choice on rationing. It is widely assumed that America rations healthcare by price and that to be uninsured means not to have access to healthcare. The fact is that of all the options mentioned above, America has by and large chosen not to ration healthcare by either price or regulation or queueing, thereby driving enormous resources into the basically unrationed healthcare sector.

The contrast is clear in the numbers. America spends 16% of its GDP on healthcare. Britain spends 8%. The difference springs from the historical contexts in which each system evolved. The NHS grew up in an atmosphere of severe scarcity. Britain had been historically underserved in a whole variety of medical measures: doctors, hospital beds, technology and the country itself faced a severe budget constraint, rationing of a wide variety of goods and destruction of much of the industrial base.

Making do was the watchword of the NHS in the beginning and, as a competitor for the scarce resources of the state, still is today.

By contrast, additional healthcare spending in America was always viewed as a way around scarcity. The initial provision of health insurance occurred during the second world war to avoid wage and price controls. Firms found they could abide by the government-imposed wage limits and still attract the workers they wanted by offering health insurance on the side as a “fringe benefit” that for some unknown reason the wage control bureaucracy didn’t count as pay.

Lyndon Johnson added Medicare — government health insurance for those over 65. Today Medicare is an entitlement. This means it isn’t subject to an appropriation by Congress — the spending is automatic and unconstrained. Whatever bills Medicare’s beneficiaries run up, the government will pay without so much as a by-your-leave by Congress.

We have now added Medicaid — which covers medical insurance for those who are classified as poor or near poor. The scheme covers a family of four with an income of up to $65,000 (£39,000), depending on the state. That is roughly twice the median family income in the UK. There is also SCHIP, the State Children’s Health Insurance Program, which has grown eightfold since its inception 12 years ago, covering children in families earning up to $65,000 who have no family-based insurance.

All told, 85% of the American population has medical insurance coverage and often it is quite generous. For example, the average health insurance premium for a state employee with a family is $10,000 per year to cover relatively healthy middle-aged workers and their children. Average spending for all Americans is roughly $8,000 per year per person. By contrast, per capita spending in the United Kingdom is about $3,500 per year.

Moreover, being uninsured does not close the door to receiving healthcare. The Washington Post recently estimated that the average healthcare spending by the uninsured was 50%-70% of that of the insured population, meaning the average uninsured person in America consumes more healthcare spending than the average resident of the UK, especially when one adjusts for age.

Some of the uninsured simply pay out of pocket. But, if you are uninsured and indigent, you show up at the emergency room. It is illegal to refuse treatment in all 50 states. This creates an enormous crosssubsidy issue as hospitals and other medical service providers must push this unreimbursed cost onto their insured customers.

Ending this cross-subsidy is one reason why doctors, drug companies, hospitals and the insurance industry are all advocates of “universal coverage”. Cross-subsidisation is inefficient, but it also means that everyone in America gets cared for, whether insured or not.

So the real issue in America is not that we ration by price — by and large we do not. Our bigger long-term problem is that we effectively do not ration at all. Healthcare spending in America is growing between two and four percentage points faster than GDP. Washington views this as a long-term political challenge. As an economist, I view it as a long-term mathematical impossibility. One cannot have a component of GDP growing faster than GDP indefinitely.

With this as a backdrop, the basic idea for Obama-Care was like the adage of the businessman who was losing money on every unit he produced and proposed making it up on volume. . . .

This is where all that talk about the NHS came in. To cut costs, the administration and its congressional supporters proposed doing some real, but fairly modest, non-price rationing. The biggest losers, since they are also the biggest consumers, were the elderly. And, relative to America, the NHS does quite a bit of queueing and regulatory denial of healthcare procedures for the elderly. So it became a natural target.

This does not mean the NHS is not “cost-effective”. That is a judgment call, to be discussed below. But, if you have grown up in a system that in effect has no rationing and you are told that some non-price rationing is on its way, it really doesn’t matter whether it is cost-effective or not for the government budget. It means you are going to get less late-in-life care than you thought, whether you like it or not.

A fair question is what we Americans get by spending twice the share of GDP on healthcare than does the United Kingdom. Your politicians, your NHS and American politicians who admire your system would like us to believe that the answer is “nothing at all”. That may provide political comfort, but it is simply not credible. Nor does it comport with the facts. Again, that is different from saying: “We’ve made the right choice and you haven’t.” An 8% of GDP gap in spending is a huge sum, the equivalent of 10 Iraq wars, if you like, or roughly the total collections from the personal income tax. So we ought to get quite a bit of extra healthcare for that kind of money. In many areas the systems are equivalent but there are three standouts.

First, there is much less queueing. Any insured American can get an appointment with his or her physician at a mutually agreed time with almost no waiting. Perhaps not on Sunday or at 3am (then you have to go to the emergency room). But you don’t spend hours sitting around a waiting room and we Americans are a very impatient people. In addition there is no bending of the rules by keeping ambulances outside hospitals to meet the average wait time between being admitted and getting service or running a “waiting time” version of triage to meet bureaucratic goals. Again, the value of this is a matter of judgment and we may have culturally different answers. Contrast getting a cab at busy times in Manhattan with the nice neat queues you have in London.

Second, and this is going to be painful for the NHS’s supporters to admit, we Americans have much better cancer survival rates. A study of cancer survival rates in 31 countries published last year in The Lancet bears this out. America was consistently in the top three for both men and women in the four different kinds of cancer studied. Britain tended to rank about 20th.

For example, a woman with breast cancer is 88% more likely to die within five years of diagnosis in Britain than in America. A man with prostate cancer is six times as likely to die within five years in Britain than in America. For various types of colon and rectal cancers, both men and women are 40% more likely to die in Britain than in America within five years of diagnosis. . .

American medical practice does tend to prolong life at its end in a way that would strike anyone operating in a system with resource constraints (such as the NHS) as somewhat bizarre. Unless otherwise instructed, medical personnel will resuscitate a terminally ill person who has stopped breathing, defibrillate them if their heart has stopped and even operate on an individual who is infirm if it might “help”.

We are developing legal means in America of having the elderly and their families make decisions about these issues before the need arises. Because America has shown that a healthcare system left to its own devices in the absence of rationing will do almost everything it can to extend life. . .

Politicians in both parties in Britain have chosen to make the NHS sacrosanct lest it become “American”. For budgetary reasons they are probably wise to perpetuate the delusion in the media about people not getting care on my side of the Atlantic.

The irony is that this will lead to less equal provision of health services in Britain than in America. When nearly everyone gets generous coverage through insurance as in America, the extra “buying power” available to the rich or well connected is quite small. But when the public gets a highly rationed set of services determined by bureaucratic rules, the ability for the elite to buy their way around the queue or obtain a lifesaving medicine that the NHS does not provide is enormously valuable.

One of the big questions angry constituents have been asking their congressmen about the new “government option” that will substitute for many people’s private insurance under Obama-Care is whether the congressmen will put themselves on the government plan. So far there have been no takers.

Lawrence B Lindsey is a former board member of the Federal Reserve and served as chief economic adviser to George W Bush. He is currently president and chief executive of the Lindsey Group

www.timesonline.co.uk/tol/news/uk/health/article6806274.ece

Feedback . . .

The NHS does not give timely access to healthcare, but it gives access as much as Britain can afford.

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4. Medicare: Contradictions worthy of the Marx Brothers

Medicare for Dummies

The thing about the bully pulpit is that Presidents can make the most fantastic claims and it takes days to sort the reality from the myths. So as a public service, let's try to navigate the, er, remarkable Medicare discussion that President Obama delivered on Wednesday. It isn't easy.

Mr. Obama began by depicting a crisis in the entitlement state, noting that "our health-care system is placing an unsustainable burden on taxpayers," especially Medicare. Unless we find a way to cauterize this fiscal hemorrhage, "we will eventually be spending more on Medicare than every other government program combined. Put simply, our health-care program is our deficit problem. Nothing else even comes close."

On this score he's right. Medicare's unfunded liability—the gap between revenues and promised benefits—is currently some $37 trillion over the next 75 years. Yet the President uses this insolvency as an argument to justify the creation of another health-care entitlement, this time for most everyone under age 65. It's like a variation on the old Marx Brothers routine: "The soup is terrible and the portions are too small."

As astonishing, Mr. Obama claimed he can finance universal health care without adding "one dime to the deficit, now or in the future, period," in large part by pumping money out of Medicare. The $880 billion Senate plan he all but blessed this week would cut Medicare by as much as $500 billion, mainly by cutting what Mr. Obama called "waste and abuse." Perhaps this is related to the "waste and abuse" that Congresses of both parties have targeted dozens of times without ever cutting it.

Apparently this time Mr. Obama means it, though he said this doesn't mean seniors should listen to "demagoguery and distortion" about Medicare cuts. That's because Medicare is a "sacred trust," and the President swore to "ensure that you—America's seniors—get the benefits you've been promised."

So no cuts, for anyone—except, that is, for the 24% of senior beneficiaries who are enrolled in the Medicare Advantage program, which Democrats want to slash by $177 billion or more because it is run by private companies. Mr. Obama called that money "unwarranted subsidies in Medicare that go to insurance companies—subsidies that do everything to pad their profits but don't improve the care of seniors."

In fact, Advantage does provide better care, which is one reason that enrollment has doubled since 2003. It's true that the program could be better designed, with more competitive bidding and quality bonuses. But Advantage's private insurers today provide the kind of care that Mr. Obama said he would mandate that private insurers provide for the nonelderly—"to cover, with no extra charge, routine checkups and preventative care."

Advantage plans have excelled at filling in the gaps of the a la carte medicine of traditional Medicare, contracting with doctors and hospitals to coordinate care and improve quality and covering items such as vision, hearing and management of chronic illness. If seniors in Advantage lose this coverage because of the 14% or 15% budget cut that Mr. Obama favors, well, that's "waste and abuse."

Mr. Obama did also promise to create "an independent commission of doctors and medical experts charged with identifying more waste in the years ahead." That kind of board is precisely what has many of the elderly worried about government rationing of treatment: As ever-more health costs are financed by taxpayers, something will eventually have to give on care the way it has in every other state-run system.

But Mr. Obama told seniors not to pay attention to "those scary stories about how your benefits will be cut, especially since some of the folks who are spreading these tall tales have fought against Medicare in the past and just this year supported a budget that would essentially have turned Medicare into a privatized voucher program."

This is a partisan swipe at one of the best GOP ideas to rationalize the federal budget, despite Mr. Obama's accusations that his opponents want to do "nothing." This reform would get Medicare out of the business of spending one out of five U.S. health dollars, and instead give the money directly to seniors to buy insurance to encourage them to be more conscious of cost and value within a limited budget. Democrats would rather have seniors dance to decisions made by his unelected "commission of doctors and medical experts."

Mr. Obama also called for "civility" in debate even as he calls the arguments of his critics "lies." So in the spirit of civility, we won't accuse the President of lying about Medicare. We'll just say his claims bear little relation to anything true.

Printed in The Wall Street Journal, Sept 11, 2009, page A18

http://online.wsj.com/article/SB10001424052970203440104574404893691325078.html

Feedback . . .

Government is not the solution to our problems, government is the problem.

- Ronald Reagan

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5. Medical Gluttony: Gluttony may not be the patient’s doing but his undoing

Mr. Green was a farmer from the Midwest who got lost in California when his cigarettes caught up with him and he developed emphysema. He became progressively more short of breath as the years went along but always remained cheerful and upbeat. He was glad to be free of his 60-year cigarette habit when he first came in. He was looking forward to retirement in California with his wife, doing the things they wanted to do despite his shortness of breath.

Then he developed another complication of cigarette smoking, a stroke that paralyzed one side of his body. He regained some use of his paralyzed leg after a month in physical therapy and could hobble around with the help of a cane and even make it into my office to manage his emphysema or COPD. After a couple more years of struggling along, he had a third complication of cigarette smoking, a heart attack after which he nearly died. But he survived and was able to hobble around again with his cane on his good arm. After about another year or so he developed hoarseness.

Vocal cord paralysis as a cause of hoarseness can sometimes be due to cancer involving the nerve that goes into the chest and back up to the voice box, called the recurrent laryngeal nerve. A bronchoscopy revealed a growth on Mr. Green’s larynx or voice box. It was about one centimeter in size and undoubtedly was cancer of the throat, the fourth complication of cigarette smoking,

He was referred to the Otorhinolaryngologist (ENT surgeon) for evaluation and treatment. Introducing him to the ENT surgeon, I suggested because of major disease in his heart, lungs and brain, that a spot of radiation therapy or surgical removal of the cancer by a partial laryngectomy was reasonable since his life expectancy was very short, on the order of a couple of years. The ENT surgeon noted that he was on welfare and instead of proceeding as discussed, referred him to the University ENT department.

When I saw him two months later, he showed evidence of a radical neck surgery, his entire voice box was removed, and he had a tracheostomy through which he breathed. He no longer could talk without a voice box. He looked depressed and seemed to have lost the will to live. Being unable to talk to his wife or his doctor brought tears to his eyes.

His wife explained that they got overwhelmed at the University where they told him what he needed and what they were going to do. They scheduled him for removal of the cancer with the entire larynx or the voice box. Mr. Green did not understand that he would never talk again. The surgeon assured him that he could purchase a device to hold against his neck that would allow him to speak.

Mr. Green did not have the energy to try or make any attempts to learn to use the device. I saw it lying on his beside table, as he sometimes would look at it tearfully.

As his emphysema progressed, after about two years of sadness, even though he gave me a warm smile and a handshake every time, never uttering a word for those two years, crying at times, he went home, gave up and died.

I now wished I had referred him directly to the radiation oncologist to give the localized radiation therapy that would probably have kept the cancer under control for a few years and he would have had a reasonably comfortable retirement instead of trying to raise his phlegm through a tracheostomy tube and wiping the phlegm off with a wash cloth, with progressive shortness of breath and respiratory failure.

I would have saved Mr. Green two years of suffering and probably saved $50,000 of health care costs.

Feedback . . .

Medical Gluttony thrives in Government and Health Insurance Programs where doctors don’t have to explain things to patients.

Gluttony Disappears with Appropriate Deductibles and Co-payments on Every Service, which gets the patient’s immediate attention.

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6. Medical Myths: Life Expectancy is longer in countries with socialized medicine

Myth 6: Life expectancy is longer in other countries because they have universal tax-funded medical coverage, and the U.S. does not.

The longest-lived people are probably the Japanese. They have good genes, are seldom overweight, and eat lots of fish. They have had a government-funded medical system since 1927—and they also have a robust private medical sector. Japanese, like all people except Canadians and North Koreans, are not restricted to a “single” (government) payer. How do we know they wouldn’t live even longer without their government medicine?

International comparisons are tricky because of ethnic diversity in the U.S. While Japanese men in Japan live longer (mean 78.4 years) than the “average” American man (74.8 years), Asian-American men live still longer (80.9 years). (Bureau of the Census, cited by John Goodman)

If we look at illnesses in which aggressive, timely medical care makes a difference, Americans live longer. For example, American women have a 63% chance of living five years or more with cancer, compared with only 56% for Europeans. For men, the figures are 66% for Americans, and 47% for Europeans, writes Betsy McCaughey.

Some European countries with universal coverage have better life expectancies than the U.S. They also have less gang warfare, less racial diversity, fewer traffic deaths, and a different diet. Americans who don’t die from homicide or car crashes outlive people in every Western country (David Gratzer, IBD 7/26/07).

Problems like gangland wars, drug abuse, and unhealthy lifestyles are not caused by lack of universal tax-funded health coverage, and would not be eliminated by enacting it. The suggestion that U.S. life expectancy would increase with universal coverage is faith-based or hope-based, not evidence-based or logic-based. In fact, such an increase is neither sought nor expected by advocates of radical reform such as Tom Daschle, who urge Americans to accept the infirmities of old age and the inevitability of death.

Universal access to a ticket in a waiting line is not a way to improve life expectancy; quite the contrary.

Additional information:

· “Health Care in a Free Society: Rebutting the Myths of National Health Insurance,” by John C. Goodman, Policy Analysis No. 532, Cato Institute; Jan 27, 2005.

· Lives at Risk: Single-Payer National Health Insurance Around the World, by John C. Goodman, Gerald L. Musgrave, and Devon M. Herrick, Rowman and Littlefield, 2004.

· Review of Critical: What We Can Do About the Health-care Crisis by Tom “Daschle,” by Jane M. Orient, M.D., J Am Phys Surg, spring 2009.

The AAPS Mythbusters: www.aapsonline.org/newsoftheday/00321

Feedback . . .

Medical Myths Originate When Someone Else Pays The Medical Bills.

Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service.

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7. Overheard in the Medical Staff Lounge: Patients are becoming agitated

Dr. Rosen: Have you noticed your patients becoming more concerned about the direction of American Health Care?

Dr. Edwards: They are becoming confused. They were confident that President Obama would increase Medicare benefits and were shocked that Schwarzenegger might decrease Medicaid benefits.

Dr. Dave: My state employee patients say they are hurting and are trying to get much of their health care by phone because of the three furlough days a month.

Dr. Rosen: And that puts physicians again in an uncomfortable middle.

Dr. Sam: Another no win situation—patients unwittingly demanding bad practice while physicians are trying not to compromise care.

Dr. Dave: Or losing income.

Dr. Edwards: But they are still getting their lucrative health benefits.

Dr. Dave: It’s the 14 percent decrease in income which they feel doesn’t allow them to make the $20 to $50 co-payments.

Dr. Sam: You can say that again—last week I had eight patient requests for antibiotics for an infection and they didn’t want to come in for an examination.

Dr. Rosen: Patients frequently think of antibiotics as a single solution—doctor, just give me some antibiotics.

Dr. Sam: Any ole antibiotic will do.

Dr. Rosen: On the other hand, many patients think a pain pill is specific for a pain.

Dr. Edwards: That really is amazing isn’t it? ‘I’m taking a pain pill for my shoulder pain and now I have a backache. Can you give me a pain pill for a backache?’

Dr. Sam: It’s sometimes hard not to talk down to such medical ignorance.

Dr. Rosen: That’s because insurance companies and their HMOs are running our practice. It’s very easy, if one has the time, to point out to a patient that the Motrin doesn’t go to the shoulder or the back but works primarily in the brain for pain relief, in addition to the anti-inflammatory action at the site of injury. Meanwhile, the narcotics they may be requesting have no effect on the back or shoulder pain. Narcotics, in effect, are just slicing off the brain from the site of injury so you don’t feel it. It does nothing to decrease the injury or affect the diseased area itself. All of these quality measures take time and because of the demand, those are the first things to go.

Dr. Edwards: That’s a very difficult argument to make or to win when everyone else is controlling our practice. Physicians need to resist any control that reduces quality.

Dr. Sam: But it’s the very thing that politicians cannot or do not want to understand.

Dr. Dave: That’s another thing that’s doing us in. As the quality is going down through no fault of our own, the insurance companies, Congress, and the President are all blaming us, which is totally unwarranted. American physicians provide the highest quality of care that is found anywhere.

Dr. Edwards: Have you heard the new Obama rap music putting the World Health Organization saying we are 37^th in the world in quality of care to a beat? Can you imagine anyone going to Bolivia for sophisticated surgery like heart or brain?

Dr. Rosen: That’s because the WHO can’t conceive of quality existing in any non-socialized health care system. So we drop to number 37 out of prejudice. But there’s no dispute among the population that we’re No. One.

Dr. Paul: But look at all the offshore medical centers springing up around the world from Bangkok to New Delhi with good outcomes.

Dr. Rosen: Anybody can do good hernia or orthopedic surgery. But the best cardiac and neurosurgery is done in this country. I’ve never heard of anyone going from the United States to any foreign country for this type of critical surgery.

Dr. Edwards: But people flee other countries to have surgery in the United States.

Dr. Rosen: I was once in the Paris airport when a man with an eye patch was being rolled on a stretcher to a plane. His wife told the bystanders he would take the risk of delaying an emergency with a 10-hour flight home rather than the risk of a European surgeon.

Dr. Edwards: If all of Europe had higher quality health care than the USA as the WHO suggests, we would not see such brazen attempts at escape at great risk of bodily harm.

Dr. Milton: But who’s putting all of this together for the people who vote and need help?

Dr. Edwards: That’s where we have all fallen down. Physicians have been beaten and denigrated for so long, they’ve given up. We have to rise above the fray and save our profession. Which will probably also save the nation.

Dr. Sam: Looks like the grassroots are rising up and saving our profession for us.

Dr. Edwards: But have you noticed that the physicians that are supporting our current Obama Health Care albatross are all on the government side? The rest of us are too quiet and are not speaking up. That gives support to the socialists who point out the few doctors on their team.

Dr. Sam: What makes it even worse - members of the medical society who are running for congress are far enough to the left to be labeled socialist.

Dr. Rosen: We need not fear that. The government will never be efficient enough to regulate or reform anything including healthcare. It has to come from the outside. We will be far more useful in saving medicine for our patients by using effective dialog within our organization as within other organizations as well as with presentations and lectures.

Dr. Paul: Good luck. The tides are against you. The government will take over the health care establishment and you will learn to live with it.

Editor’s note: Be sure to read the Crichton book review, NEXT, in this issue where in he describes the Master Gene which is associated with social dominance and strong control over other people. “We have isolated it in sports leaders, CEOs, and heads of state. We believe the gene is found in all dictators throughout history.” . . .

“Our study shows that the gene not only produces a bossy person, but also a person willing to be bossed. They have a distinct attraction to totalitarian states.” He noted that these people are especially responsive to fashions of all kinds, and suppress opinions and preferences not shared by their group.

[It’s unfortunate that Dr. Michael Crichton died last year before he could give us his opinion on whether our current leader has this gene. Are we going to be a totalitarian state without a revolution? Without anyone even firing a single shot?]

Feedback . . .

The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

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8. Voices of Medicine: The voice of physicians in the trenches

I have been sitting quietly on the sidelines watching

By Zane F Pollard, MD

I have been sitting quietly on the sidelines watching all of this national debate on healthcare. It is time for me to bring some clarity to the table by explaining many of the problems from the perspective of a doctor.

First off the government has involved very few of us physicians in the healthcare debate. While the American Medical Association has come out in favor of the plan, it is vital to remember that the AMA only represents 17% of the American physician workforce.

I have taken care of Medicaid patients for 35 years while representing the only pediatric ophthalmology group left in Atlanta, Georgia that accepts Medicaid.

For example, in the past 6 months I have cared for three young children on Medicaid who had corneal ulcers. This is a potentially blinding situation because if the cornea perforates from the infection, almost surely blindness will occur. In all three cases the antibiotic needed for the eradication of the infection was not on the approved Medicaid list.

Each time I was told to fax Medicaid for the approval forms, which I did. Within 48 hours the form came back to me which was sent in immediately via fax, and I was told that I would have my answer in 10 days. Of course by then each child would have been blind in the eye.

Each time the request came back denied. All three times I personally provided the antibiotic for each patient which was not on the Medicaid approved list.

Get the point -- rationing of care.

Over the past 35 years I have cared for over 1000 children born with congenital cataracts. In older children and in adults the vision is rehabilitated with an intraocular lens. In newborns we use contact lenses which are very expensive. It takes Medicaid over one year to approve a contact lens post cataract surgery. By that time a successful anatomical operation is wasted as the child will be close to blind from a lack of focusing for so long a period of time.

Again, extreme rationing. Solution: I have a foundation here in Atlanta supported 100% by private funds which supplies all of these contact lenses for my Medicaid and illegal immigrants children for free.

Again, waiting for the government would be disastrous.

Last week I had a lady bring her child to me. They are Americans but live in Sweden, as the father has a job with a big corporation. The child had the onset of double vision 3 months ago and has been unable to function normally because of this. They are people of means but are waiting 8 months to see the ophthalmologist in Sweden. Then if the child needed surgery they would be put on a 6-month waiting list. She called me and I saw her that day. It turned out that the child had accommodative esotropia (crossing of the eyes treated with glasses that correct for farsightedness) and responded to glasses within 4 days and so no surgery was needed. Again, rationing of care.

Last month I operated on a 70 year old lady with double vision present for 3 years. She responded quite nicely to her surgery and now is symptom free. I also operated on a 69 year old judge with vertical double vision. His surgery went very well and now he is happy as a lark. I have been told -- but of course there is no healthcare bill that has been passed yet -- that these 2 people because of their age would have been denied surgery and just told to wear a patch over one eye to alleviate the symptoms of double vision. Obviously cheaper than surgery.

I spent two year in the US Navy during the Viet Nam war and was well treated by the military. There was tremendous rationing of care and we were told specifically what things the military personnel and their dependents could have and which things they could not have. While I was in Viet Nam, my wife Nancy got sick and got essentially no care at the Naval Hospital in Oakland, California. She went home and went to her family's private internist in Beverly Hills. While it was expensive, she received an immediate work up. Again rationing of care.

For those of you who are over 65, this bill in its present form might be lethal for you. People in Britain face rationing of care in that there is an eight month wait for cataract surgery, 11 for hernia and the same for disc and total hip The government wants to mimic the British plan. For those of you younger, it will still mean restriction of the care that you and your children receive.

While 99% of physicians went into medicine because of the love of medicine and the challenge of helping our fellow man, economics are still important. My rent goes up 2% each year and the salaries of my employees go up 2% each year. Twenty years ago, ophthalmologists were paid $1800 for a cataract surgery and today $500. This is a 73% decrease in our fees. I do not know of many jobs in America that have seen this sort of lowering of fees.

But there is more to the story than just the lower fees. When I came to Atlanta, there was a well known ophthalmologist that charged $2500 for a cataract surgery as he felt they was the best. He had a terrific reputation and in fact I had my mother's bilateral cataracts operated on by him with a wonderful result. She is now 94 and has 20/20 vision in both eyes. People would pay his $2500 fee.

However, then the government came in and said that any doctor that does Medicare work cannot accept more than the going rate (now $500) or he or she would be severely fined. This put an end to his charging $2500. The government said it was illegal to accept more than the government-allowed rate. What I am driving at is that those of you well off will NOT be able to go to the head of the line under this new healthcare plan, just because you have money, as no physician will be willing to go against the law to treat you.

I am a pediatric ophthalmologist and trained for 10 years post-college to become a pediatric ophthalmologist (add two years of my service in the Navy and that comes to 12 years). A neurosurgeon spends 14 years post -college, and if he or she has to do the military that would be 16 years. I am not entitled to make what a neurosurgeon makes, but the new plan calls for all physicians to make the same amount of payment. I assure you that medical students will not go into neurosurgery and we will have a tremendous shortage of neurosurgeons. Already, the top neurosurgeon at my hospital who is in good health and only 52 years old has just quit because he can't stand working with the government anymore. Forty-nine percent of children under the age of 16 in the state of Georgia are on Medicaid, so he felt he just could not stand working with the bureaucracy anymore.

We are being lied to about the uninsured. They are getting care. I operate on at least 2 illegal immigrants each month who pay me nothing, and the children's hospital at which I operate charges them nothing also. This is true not only of Atlanta, but of every community in America.

The bottom line is that I urge all of you to contact your congresswomen and congressmen and senators to defeat this bill. I promise you that you will not like rationing of your own health care.

Furthermore, how can you trust a physician that works under these conditions knowing that he is controlled by the state. I certainly could not trust any doctor that would work under these draconian conditions.

One last thing: with this new healthcare plan there will be a tremendous shortage of physicians. It has been estimated that approximately 5% of the current physician work force will quit under this new system. Also it is estimated that another 5% shortage will occur because of the decreased number of men and women wanting to go into medicine. At the present time the US government has mandated gender equity in admissions to medical schools. That means that for the past 15 years somewhere between 49 and 51% of each entering class are females. This is true of private schools also, because all private schools receive federal funding.

The average career of a woman in medicine now is only 8-10 years and the average work week for a female in medicine is only 3-4 days. I have now trained 35 fellows in pediatric ophthalmology. Hands down the best was a female that I trained 4 years ago -- she was head and heels above all others I have trained. She now practices only 3 days a week.

Zane F Pollard, MD
Eye Consultants of Atlanta
3225 Cumberland Blvd., SE
Suite 900
Atlanta, GA 30339
404-351-2220

www.eyeconsultants.net/pollard.html

Feedback . . .

VOM Is Where Doctors' Thinking is Crystallized into Writing.

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9. Book Review: What’s NEXT in Michael Crichton’s Future?

NEXT by Michael Crichton, MD, Harper, New York, 10022, © 2006, by Michael Crichton, $9.95;
Five Compact Discs, six hours, performed by Erik Singer, Harper Audio, $14.95.

This novel is fiction, except for the parts that aren’t.
BioGen Research Inc, a company featured in this novel, is a product of the author’s imagination and should not be understood to refer to any actual company.

The more the universe seems comprehensible, the more it also seems pointless.–Steven Weinberg

Dr. Crichton welcomes us to our genetic world, which is fast, furious, and out of control. He warns us he’s not writing of the world in the future, but the world as he sees it right now. This is one of Dr. Crichton’s final novels, but may well be his most important. He is the author of Jurassic Park and State of Fear; and he is also the creator of the television series ER.

Crichton informs us there are only four hundred genes that are different in humans compared to the chimpanzee. Transgenic creatures (animals with injected human genes) are a possible occurrence in our time. What these creatures can do is obviously a figment of Crichton’s imagination, but he makes it very realistic and believable.

We are introduced to BioGen Research Inc, which is housed in a titanium-skinned cube in an industrial park outside Westview Village in Southern California. Majestically situated above the traffic on the 101 freeway, the cube had been the idea of BioGen’s president, Rick Diehl, who insisted on calling it a hexahedron. The cube looked impressive and high-tech while revealing absolutely nothing about what went on inside—which is exactly how Diehl wanted it.

In addition, BioGen maintained forty thousand square feet of nondescript shed space in an industrial park two miles away. It was there that the animal storage facilities were located, along with the more dangerous labs. Josh Winkler, an up-and-coming young researcher, preparing to enter the quarters, noticed that his assistant, Tom Weller, was reading a newspaper clipping from the Wall Street Journal taped to the wall saying, “Diehl must be crapping in his pants.” We learn the reason as he reads. . .

Toulouse, France—a team of French biologists isolated the gene that drives certain people to attempt to control others. Geneticists at the Biochemical Institute of Toulouse University headed by Dr. Michel Narcejac-Boileau, announce the “discovery of the ‘Master’ gene which is associated with social dominance and strong control over other people. We have isolated it in sports leaders, CEOs, and heads of state. We believe the gene is found in all dictators throughout history.”

Dr. Narcejac-Boileau explained that while the strong form of the gene produced dictators, the milder heterozygous form produced a “moderate, quasi-totalitarian urge” to tell other people how to run their lives, generally for their own good or for their own safety.

“Significantly, on psychological testing, individuals with the mild form will express the view that other people need their insights, and are unable to manage their own lives without their guidance. This form of the gene exists among politicians, policy advocates, religious fundamentalists, and celebrities. The belief complex is manifested by a strong feeling of certainty, coupled with a powerful sense of entitlement—and a carefully nurtured sense of resentment toward those who don’t listen to them.”

At the same time, he urged caution in interpreting the results. “Many people who are driven to control others merely want everybody to be the same as they are. They can’t tolerate difference.”

This explained the team’s paradoxical finding that individuals with the mild form of the gene were also the most tolerant of authoritarian environments with strict and invasive social rules. “Our study shows that the gene not only produces a bossy person, but also a person willing to be bossed. They have a distinct attraction to totalitarian states.” He noted that these people are especially responsive to fashions of all kinds, and suppress opinions and preferences not shared by their group.

“Unbelievable,” Josh said. “These guys in Toulouse hold a press conference and the whole world runs their story about the ‘master gene’? Have they published in a journal anywhere?”

“Nope, they just held a press conference. No publication and no mention of publication.” “What’s next, the slave gene? Looks like crap to me,” Josh replied. “You mean, we hope it’s crap,” as Josh and Tom begin their routine of taking the compressed-air cylinder, attaching a vial of retrovirus and having the preselected set of six rats do a 10-second inhalation of the retrovirus.

The retrovirus had been bioengineered to carry a gene in the family of genes controlling aminocarboxymuconate paraldehyde decarboxylase. Within BioGen they called it the maturity gene. When activated, it seemed to modify responses of the amygdala and cingulate gyrus in the brain. The result was an acceleration of maturational behavior—at least in rats. Infant female rats, for example, would show precursors of maternal behavior, such as rolling feces in their cages, far earlier than usual. And BioGen had preliminary evidence for the maturational gene action in rhesus monkeys, as well.

Interest in the gene centered on a potential link to neurodegenerative disease. One school of thought argued that neurodegenerative illnesses were a result of disruptions of maturational pathways in the brain.

If that were true in Alzheimer’s disease or another form of senility—then the commercial value of the gene would be enormous.

As the story line progresses, Josh has to pick up his druggie brother at the courthouse to bring him home after their attorney sprung him from jail. When he arrives at home, he notices the cylinder in his back seat is empty. He looks at his brother he had brought home and asks him what he did. “I just thought I’d get a whiff of what I presume was nitrous oxide. Did I do something wrong?” “You just inhaled virus for a rat.”

In another plot, the cell line that BioGen used was obtained by UCLA from Frank Barnett. As the cell line ages, it is replenished and thus Mr Barnett comes face to face with the law. BioGen owns the cell line and they can replenish it any time they need to. Mr. Barnett has no rights to stop them from taking punch biopsies from six of his organ systems. Barnett becomes a fugitive. He doesn’t want to give UCLA and BioGen samples. He doesn’t realize their worth—three billion dollars. He hides from the BioGen bounty hunters. In court, the hunters are named “Professional fugitive recovery agents” with the purpose of obtaining cells from Mr. Barnett. When it is difficult to make a citizen’s arrest on Barnett, an ambulance, with a man in a white coat operating out of a small room in the back, go after his daughter, Tracy. When she manages to escape, they pursue her son, Jamie. They pick up a boy who says his name is Jamie, but just before the punch biopsy, they discover they have taken the wrong “Jamie.” The “fugitive recovery” has just become a kidnapping. The boy has to be reunited with his mother before it’s too late.

Meanwhile in France, a parrot that has been given some human genes begins to speak with an extraordinary vocabulary. “Gerard” is able to originate a sentence, rather than just repeat it, and learns math, enabling him to help his new owner’s son do well in school.

Back in America, a chimpanzee named “Dave,” who a researcher injected with some of his own genes, begins to talk. He doesn’t look entirely like other chimpanzees and the scientist takes him home to his family as his “son.” When he enrolls him in school, it causes a stir until the father convinces authorities that he has a rare genetic disorder. The chimp-son is allowed to remain in class.

Crichton skillfully weaves several ethical stories into very complicated, sometimes hilarious, plots with a surprise ending with far-reaching implications and human complications.

Crichton gives us a generous bibliography on Genetics, Human Tissue in the Biotechnology Age, New World Reproductive Technology and the Biotech Revolution, all resources for the information in this book.

At the end of his research for the book, Crichton arrived at the following conclusions, which he exemplifies in NEXT: Read the conclusions . . .

Michael Crichton died unexpectedly in Los Angeles Tuesday, November 4, 2008, after a courageous and private battle against cancer.

In Memoriam
Through his books, Michael Crichton served as an inspiration to students of all ages, challenged scientists in many fields, and illuminated the mysteries of the world in a way we could all understand . . . he leaves behind the greatest gifts of a thirst for knowledge, the desire to understand, and the wisdom to use our minds to better our world.
www.michaelcrichton.net/aboutmichaelcrichton-inmemoriam.html

Biography
CRICHTON, (John) Michael. American. Born in Chicago, Illinois, October 23, 1942. Died in Los Angeles, November 4, 2008. Educated at Harvard University, Cambridge, Massachusetts, A.B. (summa cum laude) 1964 (Phi Beta Kappa). Henry Russell Shaw Traveling Fellow, 1964-65. Visiting Lecturer in Anthropology at Cambridge University, England, 1965. Graduated Harvard Medical School, M.D. 1969; post-doctoral fellow at the Salk Institute for Biological Sciences, La Jolla, California 1969-1970. Visiting Writer, Massachusetts Institute of Technology, 1988.

Awards: Recipient of Mystery Writers of America's Edgar Allan Poe Award, 1968 ("A Case of Need", written under pseudonym Jeffery Hudson); and 1980 ("The Great Train Robbery"). Association of American Medical Writers Award, 1970 ("Five Patients"); Academy of Motion Picture Arts and Sciences Technical Achievement Award, 1995 ("for pioneering computerized motion picture budgeting and scheduling"); George Foster Peabody Award (for "ER"); Writer's Guild of America Award, Best Long Form Television Script of 1995 (for "ER") Emmy, Best Dramatic Series, 1996 (for "ER"). Ankylosaur named Crichtonsaurus bohlini, 2002.
www.michaelcrichton.net/aboutmichaelcrichton-biography.html

What I Have Learned From Reactions To My Books.
Conference on the "Legal and Social Issues in Michael Crichton's NEXT" Chicago, IL
Lesson 1: People Live In The Past: Twenty-year-old technology was considered "a dazzling vision of tomorrow" but modern technology was "simply unbelievable."
Lesson 2: Media Authorities Also Live in the Past
Lesson 3: Not All Fields Are Equally Rigorous
Lesson 4: Who's Writing the Fiction? Crichton maintains his fiction is labeled as such. The media make claims of truth when they are reporting pure fiction.
www.michaelcrichton.net/speech-learned.html

Books and Movies Including the Ones Coming Out Post Hummus.
www.michaelcrichton.net/books.html

Michael Crichton Book Reviews:
DISCLOSURE by Michael Crichton, MD . . .
STATE OF FEAR - by Michael Crichton, MD . . .
NEXT - by Michael Crichton, MD . . .

DelMeyer@MedicalTuesday.net

Feedback . . .

This book review is found at . . .

To read more book reviews, go . . .

To read book reviews topically, go . . .

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10. Hippocrates & His Kin: Medicine is ready to go from a vertical to an horizontal industry

Rupert Murdock (Head of News Corporation) Musings at a conference:
Devices such as the Amazon Kindle and Sony Reader may take 20 years to displace newsprint. But I do certainly see the day when more people will be buying their newspapers on portable reading panels than on crushed trees. Then we’re going to have no paper, no printing plants, no unions. It’s going to be great.

Murdock is an innovative thinker who looks forward to his industry going horizontal from vertical.

Medicine is ready to go horizontal from vertical:
The computer industry went from Mainframes to Personal Computers in the early 1980s. Thus anyone could make chips, hard drives, flat screens and the $5 million dollar mainframe was replaced by the $500 PC. Wouldn’t it have been tragic if President Reagan had poured hard working American’s tax money to save Burroughs and other mainframe companies? Only IBM survived by making the transition to PCs quickly and efficiently and was ready when mainframes again became necessary for the digital internet expansion into huge search engines processing gigabytes in milliseconds.

The auto industry could have gone from vertical to horizontal if President Obama had not tried to save the United Auto Workers’ jobs. Major companies have electric autos that can travel 200 miles on one charge. In Sacramento, that would allow any family to go to San Francisco and back or to Lake Tahoe and Reno and back or to Yosemite. Thus, every two-car family would have gotten rid of one internal combustion vehicle, which would have cut admissions in half without any government interference or mandates. The internal combustion engine has essentially reached its maximum efficiency. Only an uninformed Congress can keep forcing more gas mileage at the expense of safe protective bodies—it’s like they are beating a dead horse to do better. Of course, Congress is known for subsidizing dead horses. China is already perfecting the battery and electric cars will have an even greater range shortly. Competition allows anyone to make batteries, electric motors, chassis, bodies and the price would drop like the mainframe becoming a series of PCs.

Medicine would have gone from vertical hospital palaces to horizontal 800,000 private practices had not the government interfered. Mandates prevented doctors from purchasing diagnostic equipment that would have lowered their cost at least like the PC did to the mainframe. With 800,000 private practices each competing with each other, there would be great incentives for efficiencies with a rush to efficient electronic ordering, prescriptions, reports, requisitions, medical records without the government mandates for EMR which will cause great confusion, similar to when the DMV in California had to abandon their electronic endeavors through failed computerization at great costs. The majority of surgeries can now be done in freestanding surgical clinics with facility charges only 20 percent of hospital facility charges. Horizontal health care would reduce health care costs by at least 50 percent according to some estimates we’ve received. We don’t anticipate a 99 percent drop in costs like from the mainframe to the personal computer.

But who knows how much efficiency the doctors could produce? It may never happen only because the government will not eliminate the thousands of mandates on health care, health insurance and the profession. If we revert to the Bismarck Socialized Medicine of 19^th century Germany, we may have lost our one chance in this millennium for truly efficient, personalized, cost-effective economical and safe healthcare.

Feedback . . .

To read more HHK…

To read more HMC…

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11. Professionals Restoring Accountability in Medical Practice, Government and Society:

• John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.

• David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings and in his role as assistant Editor of Sacramento Medicine. His series of articles in Sacramento Medicine can be found at www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm.

• ReflectiveMedical Information Systems (RMIS), delivering information that empowers patients, is a new venture by Dr. Gibson, one of our regular contributors, and his research group which will go far in making health care costs transparent. This site provides access to information related to medical costs as an informational and educational service to users of the website. This site contains general information regarding the historical, estimates, actual and Medicare range of amounts paid to providers and billed by providers to treat the procedures listed. These amounts were calculated based on actual claims paid. These amounts are not estimates of costs that may be incurred in the future. Although national or regional representations and estimates may be displayed, data from certain areas may not be included. You may want to follow this development at www.ReflectiveMedical.com. During your visit you may wish to enroll your own data to attract patients to your practice. This is truly innovative and has been needed for a long time. Congratulations to Dr. Gibson and staff for being at the cutting edge of healthcare reform with transparency.

• PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.

• PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to www.patmosemergiclinic.com/. To read more on Dr Berry, please click on the various topics at his website.

• FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance.

• Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."

• Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25–50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to www.simplecare.com.

• Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.

• Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at www.healthcarecom.net/OpEd.htm.

• Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at www.peerreview.org.

• Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848, no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment. Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.

To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to www.semmelweissociety.net.

• Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to www.sepp.net.

• Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives. Dr. Cihak now has a new column with Richard Dolinar, MD, worth reading at www.thenewstribune.com/opinion/othervoices/story/835508.html.

• The Association of American Physicians & Surgeons (www.AAPSonline.org), The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: Read Dr. Orient’s Analysis of Pres Obama Address to Congress. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read INQUISITOR ENDORSES OBAMACARE. Browse the archives of the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.

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Words of Wisdom

Government’s view of the economy could be summed up in a few short phrases:
If it moves, tax it.
If it keeps moving, regulate it.
And if it stops moving, subsidize it. -Ronald Reagan

"There is a time to let things happen and a time to make things happen." -Hugh Prather: author, minister, and counselor

"The most powerful weapon on earth is the human soul on fire." -Ferdinand Foch: Commander in Chief of Allied armies during WWI

“A computer will allow you to make a mistake faster and with greater magnitude than a paper system.” -Fran Griffin, Director of the Institute of Healthcare Improvement

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HealthPlanUSA.net for April 2009 . . .

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NEXT by Michael Crichton . . .

HealthPlanUSA is now a separate Newsletter devoted to the rapidly evolving field of health plans being promoted throughout the USA. These are dangerous times. Stay tuned to the current issues, which we bring quarterly and will increase as staffing permits. Why not sign up now at www.healthplanusa.net/newsletter.asp?

In Memoriam

Ted Kennedy Dies of Brain Cancer at Age 77

Ted Kennedy's Soviet Gambit by Peter Robinson, Forbes, 08.28.09,

Picking his way through the Soviet archives that Boris Yeltsin had just thrown open, in 1991 Tim Sebastian, a reporter for the London Times, came across an arresting memorandum. Composed in 1983 by Victor Chebrikov, the top man at the KGB, the memorandum was addressed to Yuri Andropov, the top man in the entire USSR. The subject: Sen. Edward Kennedy.

"On 9-10 May of this year," the May 14 memorandum explained, "Sen. Edward Kennedy's close friend and trusted confidant [John] Tunney was in Moscow." (Tunney was Kennedy's law school roommate and a former Democratic senator from California.) "The senator charged Tunney to convey the following message, through confidential contacts, to the General Secretary of the Central Committee of the Communist Party of the Soviet Union, Y. Andropov."

Kennedy's message was simple. He proposed an unabashed quid pro quo. Kennedy would lend Andropov a hand in dealing with President Reagan. In return, the Soviet leader would lend the Democratic Party a hand in challenging Reagan in the 1984 presidential election. "The only real potential threats to Reagan are problems of war and peace and Soviet-American relations," the memorandum stated. "These issues, according to the senator, will without a doubt become the most important of the election campaign."

Kennedy made Andropov a couple of specific offers.

First he offered to visit Moscow. "The main purpose of the meeting, according to the senator, would be to arm Soviet officials with explanations regarding problems of nuclear disarmament so they may be better prepared and more convincing during appearances in the USA." Kennedy would help the Soviets deal with Reagan by telling them how to brush up their propaganda.

Then he offered to make it possible for Andropov to sit down for a few interviews on American television. "A direct appeal ... to the American people will, without a doubt, attract a great deal of attention and interest in the country. ... If the proposal is recognized as worthy, then Kennedy and his friends will bring about suitable steps to have representatives of the largest television companies in the USA contact Y.V. Andropov for an invitation to Moscow for the interviews. ... The senator underlined the importance that this initiative should be seen as coming from the American side."

Kennedy would make certain the networks gave Andropov air time--and that they rigged the arrangement to look like honest journalism.

Kennedy's motives? "Like other rational people," the memorandum explained, "[Kennedy] is very troubled by the current state of Soviet-American relations." But that high-minded concern represented only one of Kennedy's motives. . .

In 1992, Tim Sebastian published a story about the memorandum in the London Times. Here in the U.S., Sebastian's story received no attention. In his 2006 book, The Crusader: Ronald Reagan and the Fall of Communism, historian Paul Kengor reprinted the memorandum in full. "The media," Kengor says, "ignored the revelation."

"The document," Kengor continues, "has stood the test of time. I scrutinized it more carefully than anything I've ever dealt with as a scholar. I showed the document to numerous authorities who deal with Soviet archival material. No one has debunked the memorandum or shown it to be a forgery. Kennedy's office did not deny it."

Why bring all this up now? No evidence exists that Andropov ever acted on the memorandum--within eight months, the Soviet leader would be dead--and now that Kennedy himself has died even many of the former senator's opponents find themselves grieving. Yet precisely because Kennedy represented such a commanding figure--perhaps the most compelling liberal of our day--we need to consider his record in full. . .

When President Reagan chose to confront the Soviet Union, calling it the evil empire that it was, Sen. Edward Kennedy chose to offer aid and comfort to General Secretary Andropov. On the Cold War, the greatest issue of his lifetime, Kennedy got it wrong.

www.forbes.com/2009/08/27/ted-kennedy-soviet-union-ronald-reagan-opinions-columnists-peter-robinson.html

Peter Robinson, a research fellow at the Hoover Institution at Stanford University and a former White House speechwriter, writes a weekly column for Forbes.

On This Date in History - September 22

On this date in 1776, Nathan Hale at 21-years-old was hanged as a spy by the British, during the American Revolutionary War. On his way to the gallows, he said his last words, ending with the line, “I only regret that I have but one life to give for my country.” How many of us are willing to dedicate our lives, while still living them, to what this country stands for?

On this date in 1789, the U.S. Post Office was established. What was once an arduous and uncertain task of horse and buggy, through rain, sleet or snow, delivering mail has now largely been replaced by technology as the Post Office gasps in its death throes of negative finances.

After Leonard and Thelma Spinrad

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The 7th Annual World Health Care Congress

Advancing solutions for business and health care CEOs to implement new models for health care affordability, coverage and quality.

The 7^th Annual World Health Care Congress will be held April 12-14, 2010
Washington, DC
www.worldhealthcarecongress.com
Toll Free: 800-767-9499

In partnership with MedicalTuesday.net, the 7th Annual World Health Care Congress is the most prestigious meeting of chief and senior executives from all sectors of health care. The 2010 conference will convene 2,000 CEOs, senior executives and government officials from the nation's largest employers, hospitals, health systems, health plans, pharmaceutical and biotech companies, and leading government agencies.

Further Reading

We in Britain think US healthcare favours those who can pay for it, but that’s a serious misdiagnosis of a smart system

Medicare for Dummies

Myth 6: Life expectancy is longer in other countries because they have universal tax-funded medical coverage, and the U.S. does not.

In Memoriam