1. Featured Article: Back from the Dead By Gary Greenberg, Wired Magazine, Sept 2006
A small but passionate group of doctors say that
electricity applied deep in the brain can jolt patients out of irreversible comas.
That's when the real problems begin.
For someone left for dead 12 years ago, Candice Ivey
seems to be doing pretty well. She's still got her homecoming queen looks and
A-student smarts. She has earned a college degree and holds a job as a
recreational therapist in a retirement community. She has, however, lost her
ballerina grace and now walks a bit like her feet are asleep. She slurs her
words a little, too, which sometimes leads to trouble. "One time I got
pulled over," she says in her
In November 1994, when Ivey was 17, a log truck
T-boned her Chevy Blazer. She remembers nothing of the next two months. But
it's all seared into the memory of her mother, Elaine, especially the part
where the doctors told her that Candice, who was in a coma and breathing by
respirator, should be pronounced dead. Her brain, they said, was entirely and
irreversibly destroyed by a week of swelling and bleeding and being pushed up
against the inside of her skull like a ship scuttled on a reef.
A few days later, however, Candice proved the doctors
wrong. Unhooked from the respirator, she continued to breathe on her own -
something she couldn't have done if she were truly brain-dead. Now Elaine faced
the horrible decision of whether or not to feed her child. The doctors warned
her that Candice would probably never wake up, and if she did, she almost
certainly would be unable to live independently. In the worst case, she would
enter the permanent twilight known as a persistent vegetative state, in which
she might sleep and wake and move her limbs, yawn and sneeze and utter sounds,
but not in a way that was purposeful. Elaine decided to keep the feeding tube
in place, which, she recalls, made the neurosurgeon furious. "He thought I
was just prolonging her agony and that I would have a vegetable on my
hands," she says. "But when it's your child lying there, you'll do
anything."
In this case, anything included letting an orthopedic
surgeon named Edwin Cooper try an experimental treatment. He approached Elaine
out of the blue soon after the accident and urged her to let him put an
electrified cuff on Candice's wrist. It sent a 20-milliampere charge - enough
to make her hand clench and her arm tremble a little - into her median nerve, a
major pathway to the brain. It might rouse her from her coma, he said.
"I thought it was hokey, if you want to know the
truth," Elaine says. She agreed nonetheless - she was, she says,
"drunk as a coot" from a combination of "nerve pills and a full
glass of whisky" - and the cuff went on. Within a week, Elaine was sure
that Candice was stirring. Her doctors doubted it. "They kept telling me
it was just reflexes, but a momma knows." Then, just before New Year's
Day, a month after the accident, Cooper asked Candice how many little pigs there
were. She held up three fingers.
Now 29, Candice Ivey is thrilled to see the
64-year-old Cooper when he shows up at her door. She gives him a big, warm hug
and sits close to him on the couch. They chat about the presentation on
traumatic brain injury that she recently gave to nurses at Cooper's hospital,
and how hearing the story of her ordeal again brought him to tears. As she
tells me of her injury and its aftermath, she comes back time and again to her
gratitude. "The wreck was my fault," she says. "But getting
better, that was God's doing. He sent Dr. Cooper to my momma, didn't he?"
Edwin Cooper has been sent, or has sent himself, to
about 60 severely brain-injured people since the mid-1980s, when he first made
the accidental discovery that electrical stimulation had effects on arousal. He
was using a neuro-stimulator to relieve spasticity in the limbs of
microcephalics, people with abnormally small skulls who often have reduced
mental capacity and poor muscle control. During the treatment, he recalls, one
patient started looking around his room and smiling when people walked in,
instead of staring blankly. Cooper had already observed that when he placed the
stimulator on one arm of a quadriplegic patient to strengthen the muscles
there, the opposite arm also got stronger. He concluded that the electricity
was making its way to the brain, crossing to the opposite hemisphere, and
stimulating arousal centers in the process. He began to wonder about the effect
this might have on unconscious people. "I thought, if someone were normal
and able-bodied but in a coma, maybe this would make a difference, maybe help
wake them up," Cooper says. "It was like maybe we could reboot the
brain."
Cooper
started testing this hypothesis in 1993. Candice Ivey was one of his first
research subjects, and her recovery remains the most spectacular. But Cooper
has gathered data on 37 other patients in two studies (at the
To
read the rest of the article, please go to www.wired.com/wired/archive/14.09/brainshock.html.
Gary Greenberg (ggmail@sbcglobal.net) is a Connecticut-based writer and psychotherapist.
* * * * *
2.
In the News:
Welcome to Club Fed, WSJ,
The closest thing to a lifetime sinecure in
New data from the U.S. Bureau of Economic Analysis
confirm that the average federal civilian worker earns $106,579 a year in total
compensation, or twice the $53,289 in wages and benefits for the typical
private worker. This federal pay premium costs taxpayers big bucks because
Uncle Sam's annual payroll is now $200 billion a year. No wonder that, with a
per capita income of $46,782 a year,
And this pay disparity keeps widening. The Cato
Institute's Chris Edwards tracks government compensation, and he finds that in
1950 the average federal bureaucrat received $1.19 for every dollar that a
private employee earned. By 1990 that ratio had risen to $1.51 and is now $2.
In 2005 federal wages rose 5.8% compared to 3.3% in the private sector.
Since 2000 only one major industry, the booming oil
and gas sector, has kept pace with the automatic pay increases for employees of
"Club Fed." Federal pay has risen by 38%, double the 15% pay increase
in private pay from 2000-2005. This is roughly double the rate for private
workers in manufacturing, retail, finance, health care and construction.
![[Good Work If You Can Get It]](./Sept2606_files/image002.gif)
It's true that
many federal employees are in white collar occupations that often command high
pay, but studies find that public sector workers enjoy a 20-30% pay bonus above
comparably skilled private workers. And this differential does not account for
one of the biggest benefits of a government job: civil service rules giving
virtual lifetime job security. Airline mechanics, auto workers and software
designers must all worry about business-cycle downturns or changes in
technology or outsourcing, but Uncle Sam's 1.8 million civilian employees live
in a recession-proof bubble.
As for performance, Mr. Edwards reports that only one
in 5,000 federal non-defense employees is fired for cause each year. One
federal manager recently told us of an administrative assistant who missed work
"about half the time" thanks to an assortment of ailments, sick
children and funerals for a mother who died on three separate occasions. When
the agency heads finally fired her, they were slapped with an anti-discrimination
lawsuit and the half-time worker pulling down a full-time salary was
reinstated. . . To read the entire article, please go to http://online.wsj.com/article_print/SB115560164971035701.html
For an alternate point of view, go to http://online.wsj.com/article_print/SB115707704297451445.html.
Club
Gov. Arnold Schwarzenegger
signed a bill Wednesday that includes a provision added in the waning days of
the legislative session allowing his administration to nearly double the pay of
50 top state bosses.
Under Assembly Bill 2936,
the workers -- mostly heads of agencies and departments -- could get as much as
125 percent of the governor's salary, although the governor says he intends to
extend the raise to only one or two officials.
Schwarzenegger doesn't take
his pay. But in 2007, the salary assigned to his office is scheduled to
increase to $206,500. That would mean the top administrators would qualify for
as much as $258,125. Under current law, the salaries of the top supervisors are
set in state law and top out at about 138,000. . .
To read more about
purchasing votes and the rape of the public till, please go to http://nl.newsbank.com/nl-search/we/Archives?p_product=SB&p_theme=sb&p_action=search&p_maxdocs=200&s_dispstring=(bosses%20could%20get%20big%20raises)%20AND%20date()&p_field_advanced-0=&p_text_advanced-0=("bosses%20could%20get%20big%20raises")&p_perpage=10&p_sort=YMD_date:D&xcal_useweights=no.
* * * * *
Privatisation
by stealth is bad for your health, James Johnson, head of the
BMA, says the reforms don't work.
I have been a doctor for over 36 years. As a vascular surgeon in
Of course the NHS has changed tremendously
since I qualified and many of those changes are for the better. With the help
of new medical technologies, powerful drugs and new surgical techniques, people
are living longer and their expectations from doctors have never been higher.
I doubt that Aneurin Bevan would recognise
today's health service: it is a huge, monolithic body that employs more than 1m
people and on average about 48m patients have contact with the NHS every year.
The government has invested unprecedented funds in the NHS and some parts of
the service are getting better. Waiting lists are a good example and - it is
important to say so - it is not all doom and gloom.
However, all over the country, doctors are
seriously worried about where the NHS is going. This was very clear last week
at the British Medical Association's annual meeting in
News emerged on Friday that the government
had been quietly encouraging tenders from the private sector for a wide range
of roles in the management and support of primary care trusts: I am concerned
that it only seems to be a short step to move from there to clinical services.
The NHS is struggling to manage deficits.
Many healthcare professionals are losing their jobs and even some doctors face
the risk of redundancy. Given that the
Last week in
These centres really worry me. When a GP
refers a patient to a certain consultant now, a bureaucrat at a management
centre - often not even a trained doctor - reviews the case and has the power
to redirect the patient to another consultant's list. This is ostensibly to
make sure patients go to specialists with shorter waiting lists.
But the GP may have chosen a particular
consultant for a good reason. Nobody should be able to second-guess the GP. . .
.
No wonder the clinical workforce is up in
arms. The BMA is a broad church with doctors from every part of the political
spectrum and widely differing views on what to do to save the NHS. What unites
us is the will and determination to keep the NHS comprehensive and free to
patients, ethically rationed by clinical priority, equitably resourced and
funded out of general taxation.
These fundamental values cannot be
maintained if the NHS is broken up and tendered to private corporations. This
is my vision for the NHS and I'm worried the government is taking us away from
that.
The government's favoured method of
raising quality and keeping prices down is to do what they do in supermarkets
and offer choice and competition. There is no doubt it works in supermarkets -
plenty of choice, good quality and low prices. But will it work in a health
service where more "customers" - we doctors are old- fashioned enough
to call them patients - do not mean more profit but more cost. . . .
The very last thing the
My plea to government - one I shall make
very clearly at the health summit - is to involve doctors in decisions at all
levels. Many doctors are natural innovators but have become distanced from the
running of the health service. I believe the only way to stop the rot is by
clinicians becoming involved in every aspect of managing, running and shaping
the NHS.
To read the entire article, please go to www.timesonline.co.uk/article/0,,2092-2252273_1,00.html.
James Johnson is chairman of the British
Medical Association
Since Kaiser Permanente already has
clinicians involved in every aspect of managing, running, and shaping KP, they
should have no problem in running the NHS.
* * * * *
4. Medicare: Free Health Care Is A Fatal Notion, by Amy Ridenour,
NCPA
www.ncpa.org/sub/dpd/index.php?page=article&Article_ID=11226
Although national health care may be the Holy Grail of
American liberalism, Amy Ridenour of the
It would be bad enough if national health care merely
offered patients low-quality treatment. Even worse, Ridenour finds, it kills
them:
- Breast
cancer is fatal to 25 percent of its American victims; in
- Prostate
cancer proves fatal to 19 percent of its American sufferers; in
single-payer
- After
major surgery, a 2003 British study found, 2.5 percent of American
patients died in the hospital versus nearly 10 percent of similar Britons;
seriously ill
In addition, medicrats often distribute resources
based on politics rather than science, leaving a disorganized and inefficient
system for many patients, says Ridenour:
- In
usual circumstances, people over age 75 should not be accepted for
treatment of end-state renal failure, according to
- According
to a Populus survey, 98 percent of Britons want to reduce the time between
diagnosis and treatment.
For all its problems, says Ridenour, the United
States' more market-friendly health system offers patients better care and
would deliver greater advancements if government adopted liability reform,
interstate medical insurance sales, unhindered health savings accounts and
other pro-market improvements, says columnist Deroy Murdock.
Source: Deroy Murdock, "Free health care is a
fatal notion," DailyBreeze.com,
For text: www.dailybreeze.com/opinion/articles/3747821.html
For more on Health Issues: www.ncpa.org/sub/dpd/index.php?Article_Category=16
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical Gluttony:
Maybe if We Just Repeated Everything, the Answers Would Appear.
This week, I saw a cardiac patient who had an
emergency coronary artery bypass as he was returning from an overseas tour.
When he got back, he developed a wound infection and they had to reopen his
chest to debride the wound. He had lost 20 pounds in the process with his
weight having gone from 185 to 165. He was trying to recover ten pounds by
eating more, doing exercise, and playing golf. He was trying to find out what
was keeping him so light. He also had
back pain and thought this might somehow be the result of some malignancy.
I pointed out that his current weight calculated to a
body mass index (BMI) of 24, which is at the upper limits of normal. (Looking
at the appropriate weight for each height produces a body mass index. A BMI of
19-24 is normal, 25-29 is overweight, 30-34 is obesity, 35-39 is marked obesity
and over 40 is morbid obesity. To calculate your BMI, go to www.nhlbisupport.com/bmi/.)
Our examination included a careful check on possible
lymph nodes, liver enlargement, abdominal masses, prostate nodules, stool check
on the rectal glove which was negative. (President Reagan's colon cancer was
found on his prostate examination when the stool on the doctor's exam glove was
positive for blood. Hence, the double importance of men over 55 having prostate
and stool hematest checks yearly.) All were negative.
We reviewed his medical record and found an
unbelievable number of laboratory tests and x-rays. He wanted more MRIs and CT exams.
He had a number of both, all of which were negative for any abnormal masses. He
wanted them repeated. These were all current within the last three months. He
wanted more blood panels. He had every conceivable panel and these were all
recent. The liver tests were slightly abnormal but not in the hepatitis ranges.
He was borderline anemic, but only 0.5 gm% down. His iron level was normal. I
told him that his weight was really high normal, that these few abnormal tests
could be repeated in another three months, or six months after the current
sampling, and he should to try to adjust to his new ideal body weight.
When he left, I don't think he was a happy man. There
was easily more than $10,000 worth of testing done in the past three months.
His insurance took care of 100 percent. An extra $10,000 would have added
nothing to his health or allayed his anxieties.
What are the answers? If this patient went to formal
review, the administrative review may have felt sorry for him and allowed the
expensive repeating of testing. However, there would have been no medical basis
for his decision. The best control of medical costs is having the physician in
charge. However, the patient must be at some financial risks to want to listen
to the physician. This patient responsibility coupled with the physician's
guidance reduces health care costs consistent with the highest level of medical
care. It cannot be duplicated by any reviewing agency or administrative
oversight. Eliminating the reviewing agencies and administrative oversight will
save $ billions.
* * * * *
6.
Medical Myths: Government has real role in providing health care
solutions for residents
Socialized
bogeyman, Editorial, Sacramento Bee, September 10, 2006
Careful, Gov. Arnold
Schwarzenegger. Your ghostwriter seems to have just made you an opponent of
Medicare.
The opinion piece in
question was designed to detail your reasons for vetoing Senate Bill 840 by
Sheila Kuehl, D-Santa Monica. SB 840 would have revolutionized the state's
health care system. Private insurers would have gone out of business. The state
would have started paying directly for the health care of millions of
Californians.
"I cannot support a
government-run health care system," you wrote (or, more accurately,
someone wrote for you).
Hmm. So what exactly is
Medicare? Or, more important, what are Republicans and Democrats really
fighting about when it comes to providing affordable health care to more
Californians, and how can anyone find the elusive political compromise?
SB 840 sought to create
one payer of health care -- the state -- for residents of California. That
would be the so-called "single-payer" solution to our health care
ills. The very term "single payer" tends to create political divides.
And along those divides, the very real role of government in health care gets
misunderstood.
"Socialized medicine
is not the solution to our state's health care problems," wrote Schwarzenegger
in vetoing SB 840. Actually, socialized medicine is as American as apple pie.
No greater example is Medicare.
Medicare is essentially a
single-payer form of health care. One payer -- the federal government --
provides the bulk of the funds to hospitals and doctors for the necessary care
of millions of senior citizens. . .
Our problem with SB 840 was how the
Democrats dangled it as veto bait from the get-go. No quest for common ground
ever appeared evident, either by Democrats or Schwarzenegger. It was all about
Democrats embracing government as the solution and Republicans denouncing it.
In vetoing SB 840, Schwarzenegger followed the script.
Real progress in lowering
health care costs and insuring more Californians will take a far more serious
effort than the theater surrounding SB 840. It will start with the recognition
that government is not the bad guy, and that government has an indispensable
role in any solution. www.sacbee.com/324/story/20346.html
[In an adjacent article,
the author says it's time to choose between Medicare and Missiles. If we forgo
missles to defend ourselves, when we are taken over, there won't be any
Medicare. Yes, the choice between Medicare and Missles is really a no-brainer.
We have to thank the editors at Sac Bee for putting government programs in such
a focused perspective.]
Government has not
provided any real health care solutions with either Medicare or Medicaid.
Disaster is looming in
both programs. In fact, they are on life support.
* * * * *
7.
Overheard in the
Medical Staff Lounge: Reading the Comics-- my Immense Ego
Joe: I need a job where my immense Ego seems normal. I've
decided to be a doctor. I will determine who lives and who dies.
How many terminal diseases do you think you'll treat
in a medical career?
Joe: Who said anything about terminal? I will find a way
to make any disease terminal. I'm going to write a book, "How to legally
commit homicide and make it look like medically assisted suicide."
What if a guy comes in with just mild hypertension?
Joe: I will devise the lethal combination of
antihypertensive drugs that the patient is already taking that will make him
glide off into
Dr Rosen: Have
you heard that Newsweek Magazine states that preventative health care is
expected to grow from $300 billion to $1 trillion in just a decade?
Dr Michelle: How
will people be able to afford that? We'll have to make preventive medicine a
covered health insurance benefit.
Dr Rosen:
You've got to be kidding. That will double insurance costs and make preventive
medicine unaffordable.
Dr Michelle: Only
the government will be able to regulate and reduce the costs of preventive
care.
Dr Rosen: Every
regulation and control that government has implemented since the advent of
Medicare in 1965, has just skyrocketed the cost unnecessarily. It has done more
to put the cost of health care out of reach than physicians, hospitals, and
high tech combined. It's time to get government out of health care.
Dr Michelle: I
can't believe you Rosen. Are you saying that Medicare isn't the best thing that
has ever happened for sick and old people?
Dr Rosen: Sick
people are now paying more than half of their heath care costs, which is more
than the 100 percent they were paying in 1965. So without Medicare, sick
seniors wouldn't be paying any more and be in control of their health care
including quality of care.
Dr Michelle:
Rosen, you make me sick. I think I'll wander across the street to my office and
see sick patients before I really get ill.
* * * * *
8.
Voices of
Medicine: What Are Doctors Writing About?
Richard B
Warner, MD, President of the
. . . Let me
share with you another little piece of my education that has a bearing on all
this planning. While I was a medical student, I took an unusual opportunity to
see the world by participating in the KU University of the
One of the most intriguing places I visited that year
was
While the rest of the
(We will be discussing with Dr Warner options to
obtain the rest of his speech, which has not been posted on the KMS.org web
site.)
* * * * *
9.
Book Review: Freakonomics, by Steven Levitt, Reviewed by Gerry Smedinghoff
In 1965, after several years of steadily increasing auto
fatalities, Ralph Nader declared that the automobile was the scourge of the
country and must be disciplined. Yet, in the two decades from 1925 to 1945, the
auto fatality rate (measured in deaths per mile traveled) had dropped by 50
percent. And in the next 20 years from 1945 to 1965 - when his landmark book Unsafe
at Any Speed was published - the auto fatality rate was reduced by another
50 percent. But instead of praising the auto industry for its unprecedented and
phenomenal safety record, in the absence of government regulation, he chose to
accuse it of criminal negligence.
Nader may have known numbers, but he was completely
ignorant of statistics. What he didn't know was that while auto fatalities were
increasing at an alarming rate, Americans were buying cars and driving at an
even more alarming rate. In other words, he never adjusted the fatality data
for exposures. But while actuaries and statisticians may have ignored or even
mocked his buffoonery, Nader became famous and built a legacy, laughing all the
way to the bank.
The mass media may now be in the process of anointing
a new Ralph Nader, a
economics professor named Steven Levitt, co-author of
the new book Freakonomics: A Rogue
Economist Explores the Hidden Side of
Everything. A more accurate subtitle would be, "A Rogue
Economist Asks the Right Questions but Gets the Wrong Answers."
In spite of the book's problems, Levitt's work and
methodology are a huge improvement on Nader's hatchet job of the auto
industry. This is why Milton Friedman
cites John Maynard Keynes as one of the most important economists of the 20th
century:
Because brave pioneers must be allowed to get
everything wrong, before more knowledgeable successors can get things right.
Thus the benefit of this book is not what Levitt says but how he teaches his
readers to think.
Levitt's primary fault is that he appears to pose his
questions only to himself, where a little peer review and insider expertise
would have saved him the trouble of writing much of the book and saved readers
from being misled by it. Levitt just can't help but believe that the first
possible explanation that comes to his mind to explain two correlating
variables must be correct. His
secondary fault is that he fearlessly dives into the most treacherous of
academic exercises, employing the discipline of economics to explain everyday
phenomena that don't appear to make sense, without realizing just how difficult
and frustrating this task can be. Which is another way of saying that most economists
find it difficult to do much better.
But to Levitt's credit, he does expose several popular media myths with
robust statistical data. . .
To read the entire review, go to
www.contingencies.org/septoct06/pdfs/Try_at_home_0906.pdf.
Gerry Smedinghoff is the director of actuarial
services for TriWest Healthcare Alliance in
* * * * *
10. Hippocrates & His Kin: Bureaucratic Doctors are
Interested in Power, not Patients
Dr James Johnson, President of BMA: The
very last thing the
Bureaucratic doctors would lose all their power if they didn't have a 12-month waiting list to manipulate.
Today's health service: it is a huge,
monolithic body that employs more than 1m people and on average about 48m
patients have contact with the NHS every year.
Are these 48m physician visits or 48m
patients in contact to get on a waiting list requiring follow-up contacts to
see how they're progressing along that list?
Dr James Johnson: In my vision for the
NHS, there needs to be more focus on emergency care and the improvement of
long-term conditions.
With one million employees of the NHS, I'm
sure there must be at least one million visions as to what's wrong - just like
any other government program.
Old doctors never die, they just lose their patience.
Sometimes they also lose their patients.
* * * * *
11.
Physicians
Restoring Accountability in Medical Practice, Government and Society: