MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VII, No 20, Jan 27, 2009
In This Issue:
1. Featured Article: Can you imagine your Cell Phone, PDA, and Laptop with no cords?
2. In the News: AARP rakes in cash from Seniors' Insurance
3. International Medicine: NHS Constitution Ends Era Of 'Doctor Knows Best'
4. Medicare: A Lesson from Industry Magnates
5. Medical Gluttony: It Is Only Possible With Government And Other Third Party Programs
6. Medical Myths: Concierge Medicine is all about Money?
7. Overheard in the Medical Staff Lounge: Quality Health Care versus Quantity Health Care
8. Voices of Medicine: Take Two Sugar Pills and Call Me in the Morning
9. The Bookshelf: Inside the AARP by Dale Van Atta
10. Hippocrates & His Kin: Russian Comrade Says the End is Near!
11. Related Organizations: Restoring Accountability in Medical Practice and Society
* * * * *
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
For more information visit www.sickandsickermovie.com or email email@example.com.
* * * * *
Wireless Electricity Is Here (Seriously) By: Paul Hochman, Fast Company, Wed Jan 14, 2009
I'm standing next to a Croatian-born American genius in a half-empty office in Watertown, Massachusetts, and I'm about to be fried to a crisp. Or I'm about to witness the greatest advance in electrical science in a hundred years. Maybe both.
Either way, all I can think of is my electrician, Billy Sullivan. Sullivan has 11 tattoos and a voice marinated in Jack Daniels. During my recent home renovation, he roared at me when I got too close to his open electrical panel: "I'm the Juice Man!" he shouted. "Stay the hell away from my juice!"
He was right. Only gods mess with electrons. Only a fool would shoot them into the air. And yet, I'm in a conference room with a scientist who is going to let 120 volts fly out of the wall, on purpose.
"Don't worry," says the MIT assistant professor and a 2008 MacArthur genius-grant winner, Marin Soljacic (pronounced SOLE-ya-cheech), who designed the box he's about to turn on. "You will be okay."
We both shift our gaze to an
unplugged Toshiba television set sitting 5 feet away on a folding table. He's
got to be kidding: There is no power cord attached to it. It's off. Dark.
Silent. "You ready?" he asks.
If Soljacic is correct -- if his free-range electrons can power up this untethered TV from across a room -- he will have performed a feat of physics so subtle and so profound it could change the world. It could also make him a billionaire. I hold my breath and cover my crotch. Soljacic flips the switch.
Soljacic isn't the first man to try to power distant electronic devices by sending electrons through the air. He isn't even the first man from the Balkans to try. Most agree that Serbian inventor Nikola Tesla, who went on to father many of the inventions that define the modern electronic era, was the first to let electrons off their leash, in 1890.
Tesla based his wireless electricity idea on a concept known as electromagnetic induction, which was discovered by Michael Faraday in 1831 and holds that electric current flowing through one wire can induce current to flow in another wire, nearby. To illustrate that principle, Tesla built two huge "World Power" towers that would broadcast current into the American air, to be received remotely by electrical devices around the globe.
Few believed it could work. And to be fair to the doubters, it didn't, exactly. When Tesla first switched on his 200-foot-tall, 1,000,000-volt Colorado Springs tower, 130-foot-long bolts of electricity shot out of it, sparks leaped up at the toes of passersby, and the grass around the lab glowed blue. It was too much, too soon.
But strap on your rubber boots; Tesla's dream has come true. After more than 100 years of dashed hopes, several companies are coming to market with technologies that can safely transmit power through the air -- a breakthrough that portends the literal and figurative untethering of our electronic age. Until this development, after all, the phrase "mobile electronics" has been a lie: How portable is your laptop if it has to feed every four hours, like an embryo, through a cord? How mobile is your phone if it shuts down after too long away from a plug? And how flexible is your business if your production area can't shift because you can't move the ceiling lights?
The world is about to be cured of its attachment disorder.
WIRELESS JUICE: A PRIMER; Inductive Coupling. Read the entire article . . .
* * * * *
Seniors may think they save money when they buy AARP insurance, but if they take the trouble to compare competing products, they may be paying twice as much.
AARP brought in nearly half a billion dollars in 2007 from fees insurers pay for AARP endorsement. It also gained about $40 million from holding the clients' premiums for a month and investing them.
The revenue helps pay down the $200 million bond debt that funded the organization's brass and marble headquarters in Washington, D.C. - which is closed to visitors, purportedly so staff can work.
Royalties and fees now constitute about 43% of AARP's revenue, up from 11% in 1999.
According to a 2007 Harris poll, AARP ranks third behind Consumer Reports and the American Red Cross as a trusted large advocacy group influencing U.S. politics. AARP is considered the most powerful interest group in the United States.
"They don't even have to give any campaign contributions," observes James Thurber, director of the Center for Congressional and Presidential Studies at American University in Washington. "AARP's enormous clout comes from the threat that they could defeat people in Congress who don't do what they want."
AARP lobbied against Bush's proposed overhaul of Social Security, and for the Medicare prescription drug benefit. When Part D passed, AARP was able to expand its contract with UnitedHealth Group, which underwrites its Medicare supplemental insurance plan.
"I was kind of shocked," said one member, who found out he was paying $1,079 more for his AARP auto insurance than he would have paid for a Mutual of Omaha policy. "They're making money on the backs of old people" (Gary Cohn and Darrell Preston, Bloomberg.com 12/4/08). Source . . .
* * * * *
In a Guardian interview, he said patients will gain a new legal right to information about the options available for free treatment on the NHS in England.
It will no longer be enough for a doctor to recommend painkillers for chronic backache without informing the patient of the benefits and risks of physiotherapy or surgery, if these are medically appropriate alternatives.
The constitution will for the first time set out the rights and responsibilities of patients, NHS staff and the organisations that deliver services, including private hospitals and voluntary bodies that provide care for NHS patients.
A draft version, published for consultation last year, said patients should have the right to make choices about the type of treatment that may be appropriate. Johnson said the public thought the right to choose was meaningless if it was not accompanied by a right to information about the choices available.
The constitution will say: "You have the right to choice about your NHS care and to information to support these choices. The options available to you will develop over time and depend on your needs."
A senior Department of Health source said: "Gone will be the paternalistic days of being told by the doctor that you can't have physiotherapy for your back pain, or referral to an orthopaedic consultant. If you have prostate cancer, you will get the information you need to choose whether to go for an operation or opt for a period of watchful waiting. If you need a hysterectomy, you will be told about the benefits and risks of minimally invasive surgery."
The constitution will
give patients limited rights to be treated in other EU countries. Other rights
• Choice of GP practice and preference for using a particular doctor;
• Access to drugs and treatments that have been recommended by the National Institute for Health and Clinical Excellence (Nice);
• Access to vaccinations that have been recommended by the Joint Committee on Vaccination and Immunisation;
• Privacy, confidentiality and an expectation that the NHS will keep confidential information secure;
Patients will have a
• Register with a GP practice;
• Treat NHS staff and other patients with respect;
• Follow the agreed course of treatment and talk to the clinician if this is difficult;
• Keep appointments or cancel within reasonable time.
The document says people failing to keep appointments may no longer be entitled to be treated within the maximum waiting times. But there will be no financial penalties on patients who fail to meet their responsibilities. Ministers have ruled out withdrawal of treatment from people who smoke, drink excessive amount of alcohol or are obese. . .
"Some people have said this is Tory-proofing the NHS [making it harder for a future government to take away services or require people to pay for them.] The only way to Tory-proof the NHS is by electing Labour governments. But much of this constitution would make it more difficult to change the NHS.
"It says NHS services should be free of charge, except in limited circumstances sanctioned by parliament. It says the right of access to NHS services should not be refused on unreasonable grounds. It should be a comprehensive service available to all, with a duty to each and every individual it serves."
Haven't Americans accomplished about the same with informed consent?
Does one need a constitution to be able to talk to your own doctor?
Are they still practicing medieval medicine?
The more regimented medicine becomes, the greater are the hurdles to obtaining care.
The National Health Service does not give timely access to health care, it only gives access to a waiting list.
* * * * *
When Congress was cutting payment of physician fees for Medicare Patients last year, the American Medical Association (AMA) was advocating for a reversal and increase in payments. Otherwise, physicians would stop seeing Medicare Patients. The other physician's organization, the Association of American Physicians and Surgeons was advocating to allow Congress to do what they want and experience the Market Forces in Medicine. The AMA won and Medicare continues to micromanage health care and, in the process, harass doctors. If Congress had not succumbed to advocacy, which is following the leadership of an organization rather than the rank and file, the Medicare Patients may have arose in arms against Congress. In the AMA scenario, physicians received a black eye of gauging the taxpayers and ability to manipulate Congress. Congress and the AMA won. In the AAPS scenario, physicians would have looked like winners standing straight and tall and the Medicare Patients would have given Congress a bad time. In the first scenario, Congress learned nothing about market forces and just hated physicians more for their power. In the latter scenario, Congress would have learned that to manipulate market forces is rather naïve and childish and 37 million Medicare Patients would threaten to vote them out of office because they no longer could find a doctor.
We have received a recent exchange between General Motors and one of its suppliers that shows similar fortitude to the AAPS, sent in by a MedicalTuesday member and Science Writer.
Very good answer to GM's request for help from their suppliers!!!
As a supplier for the Big 3 Mr. Knox received a letter from the President of GM North America requesting support for the bail-out program and he responds below the letter. (Verified by SNOPES)
Dear Employees & Suppliers,
Congress and the current Administration will soon determine whether to provide immediate support to the domestic auto industry to help it through one of the most difficult economic times in our nation's history. Your elected officials must hear from all of us now on why this support is critical to our continuing the progress we began prior to the global financial crisis. . . As an employee or supplier, you have a lot at stake and continue to be one of our most effective and passionate voices. I know GM can count on you to have your voice heard. Thank you for your urgent action and ongoing support.
Signed: Troy Clarke, President General Motors North America
Response from: Gregory Knox, Pres. Knox Machinery Company Franklin, Ohio
Gentlemen: In response to your request to contact legislators and ask for a bailout for the Big Three automakers please consider the following, and please pass my thoughts on to Troy Clark, President of General Motors North America.
Politicians and Management of the Big 3 are both infected with the same entitlement mentality that has spread like cancerous germs in UAW halls for the last countless decades, and whose plague is now sweeping this nation, awaiting our new "messiah," Pres-elect Obama, to wave his magic wand and make all our problems go away, while at the same time allowing our once great nation to keep "living the dream"
Believe me folks, the dream is over! This dream where we can ignore the consumer for years while management myopically focuses on its personal rewards packages at the same time that our factories have been filled with the worlds most overpaid, arrogant, ignorant and laziest entitlement minded "laborers" without paying the price for these atrocities . . . this dream where you still think the masses will line up to buy our products for ever and ever. Don't even think about telling me I'm wrong. Don't accuse me of not knowing of what I speak. I have called on Ford, GM, Chrysler, TRW, Delphi, Kelsey Hayes, American Axle and countless other automotive OEM's throughout the Midwest during the past 30 years and what I've seen over those years in these union shops can only be described as disgusting.
Troy Clarke, President of General Motors North America, states: "There is widespread sentiment throughout this country, and our government, and especially via the news media, that the current crisis is completely the result of bad management which it certainly is not."
You're right Mr. Clarke, it's not JUST management...how about the electricians who walk around the plants like lords in feudal times, making people wait on them for countless hours while they drag ass...so they can come in on the weekend and make double and triple time...for a job they easily could have done within their normal 40 hour work week. How about the line workers who threaten newbies with all kinds of scare tactics...for putting out too many parts on a shift...and for being too productive (We certainly must not expose those lazy bums who have been getting overpaid for decades for their horrific underproduction, must we?!?) Do you folks really not know about this stuff?!? How about this great sentiment abridged from Mr. Clarke's sad plea: "over the last few years 20...we have closed the quality and efficiency gaps with our competitors." What the hell has Detroit been doing for the last 40 years?!? Did we really JUST wake up to the gaps in quality and efficiency between us and them? The K car vs. the Accord? The Pinto vs. the Civic?!? Do I need to go on? What a joke! We are living through the inevitable outcome of the actions of the United States auto industry for decades. It's time to pay for your sins, Detroit.
I attended an economic summit last week where brilliant economist, Alan Beaulieu, from the Institute of Trend Research, surprised the crowd when he said he would not have given the banks a penny of "bail-out money." "Yes, he said, this would cause short term problems," but despite what people like politicians and corporate magnates would have us believe, the sun would in fact rise the next day... and the following very important thing would happen...where there had been greedy and sloppy banks, new efficient ones would pop up...that is how a free market system works...it does work...if we would only let it work..."
But for some nondescript reason we are now deciding that the rest of the world is right and that capitalism doesn't work -- that we need the government to step in and "save us"...
Save us, Hell! -- we're nationalizing...and unfortunately too many of our once fine nation's citizens don't even have a clue that this is what is really happening...
But, they sure can tell you the stats on their favorite sports teams...yeah -- THAT'S really important, isn't it...
Does it ever occur to ANYONE that the "competition" has been producing vehicles, EXTREMELY PROFITABLY, for decades in this country? ...
How can that be??? Let's see... Fuel efficient... Listening to customers... Investing in the proper tooling and automation for the long haul... Not being too complacent or arrogant to listen to Dr. W. Edwards Deming four decades ago when he taught that by adopting appropriate principles of management, organizations could increase quality and simultaneously reduce costs. Ever increased productivity through quality and intelligent planning... Treating vendors like strategic partners, rather than like "the enemy"... Efficient front and back offices... Non-union environment...
Again, I could go on and on, but I really wouldn't be telling anyone anything they really don't already know down deep in their hearts. I have six children, so I am not unfamiliar with the concept of wanting someone to bail you out of a mess that you have gotten yourself into -- my children do this on a weekly, if not daily basis, as I did when I was their age. I do for them what my parents did for me (one of their greatest gifts, by the way) -- I make them stand on their own two feet and accept the consequences of their actions and work through it. Radical concept, huh... Am I there for them in the wings? Of course -- but only until such time as they need to be fully on their own as adults. I don't want to oversimplify a complex situation, but there certainly are unmistakable parallels here between the proper role of parenting and government. Detroit and the United States need to pay for their sins.
Bad news, people -- it's coming whether we like it or not. The newly elected Messiah really doesn't have a magic wand big enough to "make it all go away." I laughed as I heard Obama "reeling it back in" almost immediately after the final vote count was tallied..."we really might not do it in a year...or in four..."
Where the Hell was that kind of talk when he was RUNNING for office? Stop trying to put off the inevitable, folks ... That house in Florida really isn't worth $750,000... People who jump across a border really don't deserve free health care benefits... That job driving that forklift for the Big 3 really isn't worth $85,000 a year... We really shouldn't allow Wal-Mart to stock their shelves with products acquired from a country that unfairly manipulates their currency and has the most atrocious human rights infractions on the face of the globe... That couple whose combined income is less than $50,000 really shouldn't be living in that $485,000 home... Let the market correct itself, folks -- it will. Yes, it will be painful, but it's gonna' be painful either way, and the bright side of my proposal is that on the other side of it all, is a nation that appreciates what it has...and doesn't live beyond its means...and gets back to basics...and redevelops the patriotic work ethic that made it the greatest nation in the history of the world...and probably turns back to God.
Sorry -- don't cut my head off, I'm just the messenger sharing with you the "bad news." I hope you take it to heart.
Gregory J. Knox, President
Knox Machinery, Inc.
Franklin, Ohio 45005
The above letter has been verified by SNOPES.
Do any of us have the fortitude to tell Congress to get out of micromanaging the health care business and after a few painful years find that health care corrected it? The next time the AMA tells us to write our Representatives and Senators, do we have the courage to write the above letter to the AMA? The worst word in any AMA promotion is advocacy. But the advocacy recommended is hardly ever in the best interest of our country or our patients. Now that we've nationalize the investment banking, retail banking, auto industries, does anyone really think they are better off? Remember Congress' involvement in the electronics industry and how the American Companies all disappeared. Now we have Sony, Panasonic, Toshiba, etc., et. al, who took over. Will the auto industry now disappear? Then we'll have Toyota, Nissan, Honda and Fiat. With our government having a $99 trillion entitlement debt that a 200 percent mortgage on our entire country would still be unable to cover, does anyone have the courage to reduce or eliminate any of the entitlements, Social Security, Medicare, Medicaid, and SCHIPS, that continue to enslave not only us, but also our children?
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
In this section, we give examples of excessive health care utilization, which should be avoided. Although this may seem like a broken record, we hope the variety of examples will illustrate to different people how they, themselves, may have unnecessarily increased health care cost while feeling good about the care they received not realizing that it was gluttonous.
Mary came in today on the advice of the hospital for follow up after her recent hospital admission. She couldn't remember exactly why she was admitted and finally said she had become more short of breath. I then remembered she had called my office on Thursday and was given an appointment the next day, Friday. She did not show for that appointment because it was inconvenient for her family. They took her the next day on Saturday to the hospital emergency room. She got the full cardiac evaluation, which according to staff members in the ER is about $9,000. In view of possible slight increase in her congestive heart failure and advanced age, she was then admitted overnight for further observation, diuresis and discharged. She wasn't sure, but thinks she felt better this week when I saw her. The $9,000 worth of tests were normal or unchanged from previous determinations.
This scenario is seen about once or perhaps twice a week in my practice. At $9,000 of gluttony per week, that adds up to nearly a half million dollars of gluttony from a one-physician practice out of several hundred thousand practices. That adds up to $billions for one symptom of one organ system.
Congress and Medicare are focusing on micromanaging the practice of medicine, trying to save $10 here and $100 there. They are unable to control these huge $billions of unnecessary costs that do not improve health care or well-being. If Congress and Medicare ever controlled the other 200+ million Americans' health care, there would have to be severe rationing and elimination of health care - the exact reversal of what liberals in Congress and the country think would happen.
If Mary had to pay even ten percent at the ER desk, this gluttony would have stopped at the desk and she would have gone home and rested. And she would have gotten better, also.
Medical Gluttony thrives in Government and Health Insurance Programs.
Gluttony Disappears with Appropriate Deductibles and Co-payments on Every Service.
* * * * *
Money and the Changing Culture of Medicine
A recent Perspective article in the NEJM, written by Drs. Hartzband and Groopman, addressed a very interesting dynamic that relates to the "application of business practices to medicine." The authors' claim, with supported evidence, that quantifying, in monetary terms, every aspect of a physician's responsibility and actions has led to a degradation of professional pride and collegiality. Concierge medicine, described in the second to last paragraph, has a somewhat counterintuitive effect. One would think, and the general media would have you believe, that it is all about the money. However, by removing the volume-based incentive and reverting to the quality-based incentive in the concierge model, increased social interaction occurs and a better patient/physician relationship is fostered. In reality, it is all about the relationship and time. Happy reading.
Dr. Doucette, President and CEO, ModernMed
Pamela Hartzband, M.D., and Jerome Groopman, M.D. New England Journal of Medicine Volume 360 - January 8, 2009 - Number 2 (Subscription required)
Rapidly rising health care costs over recent decades have prompted the application of business practices to medicine, with the goals of improving efficiency, restraining expenses, and increasing quality. In the wake of the current economic crisis and the advent of a new presidential administration, even more attention will be focused on containing costs in the health care system. Price tags are being applied to every aspect of a doctor's day, creating an acute awareness of costs and reimbursement. Physicians are now routinely provided with profit-and-loss reports reflecting their activity, and metrics are calculated to measure the cost-effectiveness of their work . . . Read more . . .
Medical Myths Originate When Someone Else Pays The Medical Bills.
Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service.
Or as in Concierge Medicine, Patients Pay the Entire Bill.
* * * * *
Dr. Harold: I'm Dr. Harold and have recently obtained hospital privileges here. My practice is about a half mile from here. I'm an internist and have decided not to accept any health insurance or Medicare patients.
Dr. Dave: That's very interesting. Are you making it?
Dr. Harold: Yes, I think so. I was in practice with a small group and they took any insurance plan. Every year or even twice a year we were notified that the reimbursement rates were changed and they gave us the new RBRVS numbers and the payment. It was difficult to follow the changes, but in general, our checks from each company after these notices seem to gradually get smaller.
Dr. Rosen: So what else is new?
Dr. Harold: The group had an administrator who was following the bottom line and he was constantly on our tail to work harder, which meant to see more patients faster. We were seeing three patients an hour and then we were told to see four an hour. Last year he said we'd have to see five patients an hour if we wanted to keep our present salary.
Dr. Milton: We have groups here that are routinely at fifteen-minute appointments or four patients an hour and one group is now at twelve-minute appointments or five patients an hour.
Dr. Edwards: My clinic has given us all a little timer we wear on our belts. We squeeze it when we go in for a patient and in 14 minutes, the vibrator goes off. We then have 60 seconds to get the patient out of the room and get started on the next one.
Dr. Rosen: I have received three patients that have changed from your health plan to ours.
Dr. Edwards: Were they unhappy with the care?
Dr. Rosen: One was a 60-year-old lady who had three medical issues and she was at your clinic for her first appointment. She was nearly through being diagnosed for her first problem, when she was told her time was up and the other two issues would have to wait for the next appointment.
Dr. Edwards: Well, I guess that seems logical. We are on a fast pace to maintain our income.
Dr. Harold: Have you figured out just what is your hourly wage?
Dr. Edwards: The administrator, who leaves at five PM, thinks we should get paid for a 40-hour week but we work at least 50 hours. So at $12,000 a month, we make about $60 an hour for our 200-hour month.
Dr. Rosen: That's only $15 an hour less that a forklift driver makes at the Big Three.
Dr. Edwards: But we have a clean air-conditioned job and we're not out in the heat or snow.
Dr. Rosen: I guess that's one way of looking at it. But it doesn't measure up professionally. Why should lawyers with four to eight years less training than doctors, have no difficulty charging $250 to $400 an hour?
Dr. Ruth: But who could stand being on everybody's "S" list.
Dr. Yancy: For $400 an hour, or $16,000 a week or $800,000 a year, I wouldn't mind being on anybody's "S" list. That's more every week than I make every month as a surgeon.
Dr. Harold: You are all making me feel very good that I forsook your kind of life.
Dr. Dave: So you're making more than when you were part of a group?
Dr. Harold: I figured that we had a 50 percent markdown by some of the best insurance companies and Medicare, and even more by HMOs and Medicaid. By not billing insurance and accepting cash, checks or plastic at the time of service, I would save the $36,000 that our insurance biller was getting paid. So I figured if only one-third as many patients would continue with me, I would make the same income as I did with my group. If I were to get half as busy, I would make considerable more.
Dr. Edwards: You make a very compelling case for going out on your own.
Dr. Harold: The other aspect that insurers don't want you to think about, is if you spend more time with patients, you make less mistakes, the patients are happier, and your children want to play with you an extra eight hours a week. That was becoming more important to me.
Dr. Rosen: More time with patients is never looked at with quality of care in mind. Reminds me of the time when I was recruited by Houston Diagnostic Clinic when I finished my residency, they allowed one hour for each new patient and one hour for each follow=up patient. They felt their doctors probably weren't smarter than the other doctors on the hospital staff, but they would give them more time to make better decisions since they were a consulting group and most of their patients had other personal physicians.
Dr. Edwards: I just have a hard time believing that very many patients would follow me if I charged them $125 an office visit and $200 for a new-patient consultation.
Dr. Harold: Remember, only one-third have to do that to continue your same standard of living and when half of them do, you will have 50 percent more time for your personal life than you have now.
Dr. Michelle: Thank you. You've shed a whole new light on personalized health care.
Dr. Rosen: I hope we will continue to see you here in the hospital staff luncheon lounge.
Dr. Harold: Thanks for the invitation. I think you will.
The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.
* * * * *
San Mateo County Medical Association Bulletin May-June 2008
Take Two Sugar Pills and Call Me in the Morning, By Philip R. Alper, M.D.
Suppose a group of medications were dirt cheap to produce, had virtually no side effects, and provided relief to 30 percent of those taking them. And further suppose that these benefits required no long, costly scientific studies to validate the medications' effectiveness. Should doctors be allowed to use them?
The miracle drugs I am describing are placebos—sham medicines—whose efficacy across a wide range of symptoms and conditions seems to rest on mobilizing a belief that their use will prove beneficial. Until a century ago, relatively few commonly used drugs had scientifically provable utility. Most achieved whatever benefit they provided through the placebo effect (sometimes called the "healing power of the mind"), which, while not a panacea, is by any name a surprisingly powerful force for good.
The prescriber must believe in what is being prescribed to boost the effectiveness of any medication, whether it is intrinsically "worthless" or not. Likewise, the patient must believe in what is being prescribed. The color, shape, and size of pills and capsules may influence their effectiveness. Administration by injection may convey an extra measure of potency that cannot be explained by blood levels or rates of absorption alone.
This is murky territory. Is it acceptable for physicians to deceive patients by prescribing something they know has no intrinsic merit? But where is the actual harm in harnessing a 30-percent placebo benefit, provided patients do not forgo a more effective treatment? Patients are always free to choose; when the patient's choice is unwise, how is the physician to respond? Medical ethicists have tended to avoid these conundrums ever since Harvard anesthesiologist Henry K. Beecher published "The Powerful Placebo" in the Journal of the American Medical Association in 1955. His opening words frame the dilemma:
"Placebos have doubtless been used for centuries by wise physicians as well as by quacks." What is one to make of that proposition?
The placebo effect touches on many common medical issues. Some analyses suggest that widely-used cough medicines may help nobody at all. Why, then, have people been taking them for so long? A recent article in the New England Journal of Medicine asserts that the selective publication of antidepressant studies (the most favorable ones were most likely to be printed) exaggerated the effectiveness of some drugs, thus distorting doctors' and patients' expectations of their effectiveness. Another recent report, in the Journal of General Internal Medicine, indicated that almost half of Chicago physicians surveyed offer placebos to their patients—and just 4 percent let patients know they're doing it. (Placebos in this case include not only sugar pills but also drugs that the provider doesn't think are necessary, such as antibiotics for a viral infection.)
I recently asked two freshmen medical students what they thought of placebos. The only legitimate use they knew of was in placebo-controlled drug trials, which compare an actual medication with an identical-looking sham medication.
Within my own career in internal medicine, the function of placebos was far broader. In the 1950s, when I went to medical school, their use was common. Several manufacturers sold placebo tablets to physicians and pharmacies; patients were not told that the ingredients were inert. The famed "Kings County Hospital mix" (in Brooklyn) consisted of powdered charcoal and black pepper in a bitter red liquid. It sparkled in the light and went straight to the top of your head. One teaspoon was said to cure anything, probably because nobody wanted another one. I can attest to its effectiveness in the clinics. I fled from an offer to practice in the 1960s when I discovered that the office was full of patients getting mostly placebo shots with no doctor present. This struck me as unsafe, unnecessary, and primarily financially motivated (interestingly, such practices are found in China today).
Read the entire article.
To peruse the Bulletin.
This article originally appeared in the Spring 2008 Hoover Digest.
Philip R. Alper, M.D., is a clinical professor of medicine at the University of California, San Francisco, and was the Robert Wesson Fellow in Scientific Philosophy and Public Policy at the Hoover Institution.
VOM Is Where Doctors' Thinking is Crystallized into Writing.
* * * * *
Dale Van Atta wrote a syndicated column with Jack Anderson that ran in more than 800 newspapers for over seven years. Today, he is a freelance author and journalist. He dedicates this volume to his aging mother, Vera Van Atta. We should alert our aging parents, even those under age 50, about this volume and the highly charged promotional campaign of the AARP.
The AARP is the second-largest organization in the United States, after the Catholic Church. It has thirty-three million members. Ethel Percy Andrus, a retired schoolteacher, was its founder. Steeped in the American ethos of God, country, and self-reliance, she explicitly stated that the "AARP is not a pressure group, petitioning for special privileges and exemptions because of age and numbers."
Today, the AARP supports higher taxes, disastrous health care legislation that threatens seniors, and other political causes such as attempting to defeat property tax reductions, the very thing that allows many retired seniors to keep their homes. The AARP has numerous business enterprises, including insurance and pharmaceuticals, that it claims are nonprofit services for seniors, but which are revenue engines for AARP causes and profit its business partners. Colonial Penn derives 80% of its profits from the AARP monopoly.
The AARP, with an income of more than $400 million a year, spent $83 million for salaries and benefits in 1994. Nineteen of the AARP's 1,732 employees earn more than $100,000 a year. The executive director, Horace Deets, is headlined in a 1997 Fortune magazine profile as Washington's Second Most Powerful Man, making $357,000 a year in salary and benefits ($157,000 more than Washington's Most Powerful Man!) plus $49,000 in expenses. The block-long office building in DC, which some of its members call a Taj Mahal, reputedly cost $117 million. And in 1990, the AARP spent more than twice as much furnishing its posh headquarters than it spent on programs assisting the elderly.
Dr Ethel Percy Andrus, the founder, first spoke out against age discrimination in employment more than 30 years ago. The AARP was instrumental in securing passage of the landmark Age Discrimination in Employment act in 1967, and its attorneys have initiated or participated in high-profile class action age discrimination suits. However, this organization, once run entirely by retired persons, now employs a staff of which 80% are below the age of 50. Even its own members consider this a shameful practice that betrays their true commitment.
Not only is there age discrimination in its employment practices, but there is ethnic discrimination in its membership as well. Only 2% of AARP's members are black, 2% are Hispanic, and 2% are other minorities. With its members being mostly white, better educated, and richer than the average, the AARP explains "It's much more expensive to recruit ethnic groups than it is just your average population."
The AARP is the only lobby so powerful than it can secure legislation, such as the Medicare catastrophic coverage act, and when its own membership rebels, secure its repeal. To maintain such clout, each month the AARP solicits an estimated 40,000 individuals who are too young to join. To maintain their political and business perspective, AARP can remove chapter leaders with or without cause, even for taking a stand on a local political issue without the AARP's approval.
A day of reckoning may be on the horizon. Membership is dropping at such an embarrassing rate that in a closed-door session in July 1995, the Board agreed that they would multiply the number of households by 1.6, which increased membership by more than 2 million in a single day.
For the innocent elderly who look to the AARP to defend seniors' interests, Van Atta has a simple message: Your trust has been betrayed.
This book review is found at TRUST BETRAYED - Inside the AARP by Dale Van Atta.
To read more book reviews . . .
To read book reviews topically . . .
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For a decade, Russian academic Igor Panarin has been predicting the U.S. will fall apart in 2010. Around the end of June 2010, or early July, he says, the U.S. will break into six pieces -- with Alaska reverting to Russian control . . . When the going gets tough, he says, wealthier states will withhold funds from the federal government and effectively secede from the union . . . The U.S. will then split along ethnic lines, and foreign powers will move in . . . "The Californian Republic," will be part of China or under Chinese influence. . . "The Central North American Republic" will become part of Canada, and Washington, D.C., and New York will be part of an "Atlantic America" that may join the European Union. http://online.wsj.com/article/SB123051100709638419.html?mod=todays_us_page_one
Wishful Thinking, Comrade!
The New Deal Failed and Prolonged the Depression
In 1939 Franklin D. Roosevelt's Treasure Secretary, realized that the New Deal economic policies had failed and stated in his diary: "We have tried spending money. We are spending more than we have ever spent before and it does not work . . . After eight years of this Administration we have just as much unemployment as when we started. . . And an enormous debt to boot!"
Leave the New Deal in the History Books
Cut Corporate Taxes To Zero And Create Real Jobs
. . . the New Deal forced the allocation of money away from the private sector. As economist Henry Hazlitt wrote back in 1946, New Deal programs prevented the creation of the types of jobs which have the multiplier effect of successful businesses. Creating "work" prevented innovation and new jobs that would create other jobs.
The quickest way to strengthen the credit system and begin the end of this crisis is to get money into the economy for true job creation, and not into government work programs. The way to do this is to slash taxes. The U.S. corporate tax rate, currently the highest in the world, should be cut to 0% (corporate income would still be taxed, of course, when distributed to shareholders as dividends).
[The Corporate Income Tax was promised to be a temporary stopgap measure in 1913 until the 16th Income Tax Amendment was ratified. However, with Congress and Government, nothing is ever temporary. Greed knows no Restraints.]
The End of "Freedom of the Press."
The total number of layoffs in American newspapers alone has topped 15,000 this year, according to Paper Cuts. Columnists and industry analysts alike now suggest a federal bailout of the press.
Will America have its own Pravda?
The Cost of Placebos
Patient: (handing the pharmacist a prescription) "How much is it?" Pharmacist: "That will be $139.50."
Patient: "How much is the generic?" Pharmacist: "That would be $39.50."
Patient: "Let me have the placebo. I understand they are almost as good as the generics."
Read Dr. Alper in Section 8 as to why they cannot be prescribed any more.
To read more HHK . . .
To read more HMC . . .
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• 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 . . .
• 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.emergiclinic.com. To read more on Dr Berry, please click on the various topics at his website.
• PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. (http://home.earthlink.net/~doctorlrhuntoon/) Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.
• FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder, www.westandfirm.org, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance.
• 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 . . .
• 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.
• David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. 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.
• 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 . . .
• 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 . . .
• 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 . . .
• 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: Queues cost Canadians more than $750 million in 2008; more than 30,000 seek treatment abroad. Read more . . . 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 National Health BLITZKRIEG at . . . Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles and book reviews that can be accessed from the Table of Contents.
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Words of Wisdom
We contend that for a nation to try to tax itself into prosperity is like a man standing in a bucket and trying to lift himself up by the handle. -Winston Churchill.
The inherent vice of capitalism is the unequal sharing of the blessings. The inherent blessing of socialism is the equal sharing of misery. -Winston Churchill.
Some Recent Postings
Why Sister Aloysius "Doubts" By James J. Murtagh, M.D, www.healthcarecom.net/JM_Doubts.htm
A Time for Freedom, by Lynne Cheney: www.delmeyer.net/bkrev_ATimeForFreedom.htm
We The People - The Story of Our Constitution, by Lynne Cheney www.delmeyer.net/bkrev_WeThePeople.htm
It was with great sadness when I saw in The Economist last week that Dr. Neuhaus had died. I was referred to him by his Concordia Seminary classmate for assistance in my Medical Ethics Courses. We have enjoyed and learned much from his Journal, FIRST THINGS, and perusing his 12,000 word Public Square each month.
Richard John Neuhaus, a turbulent American priest, died on January 8th, aged 72
WHILE the rest of the world fawned on Barack Obama, Richard Neuhaus took no joy in him. If Mr Obama truly meant, as he said, to liberalise abortion rules from his first day in office, Father Neuhaus foresaw an intensification of the culture wars at every level of American life. But he was ready to fight his side. For 30 years he had done so in books, manifestos, studies for the American Enterprise Institute and 12,000-word columns in First Things, the journal of his own Institute on Religion and Public Life. He fought his conservative corner in fluent, fervent, gossipy conversations, smoothed with bourbon and cigars and interrupted by immersion in Bach. George Bush, among many others, found talking to "Father Richard" on cloning, or same-sex marriage, superb for clearing the head. And he made his point even as, day by day, he raised Christ's body at his church on the lower East Side of Manhattan. For the Eucharist, too, was a "call to commitment", an "evangelistic" act.
Without Father Neuhaus, the religious right might still have enjoyed its 20-odd years of ascendancy in American politics. But it would have lacked much of its intellectual spine. Father Neuhaus, a Lutheran-turned-Catholic fearsomely well read in both the Church Fathers and the Protestant dissenters, encouraged evangelicals and Catholics to join forces to fill, with a new moral philosophy, the empty space at the core of modern American public life. There was, he wrote in 1984, a "naked public square" from which religion had been banished, and which "seven demons", all secular, now competed to control.
The separation of church and state might be enshrined in the constitution. But Father Neuhaus saw it as impossible in a fundamentally religious country, whose history had been driven since the Mayflower by a dynamic conviction of the usefulness of America to the purposes of God. And by ignoring religion when people were mostly believers, it threatened the legitimacy of American democracy itself. "Judicial usurpation", was Father Neuhaus's term for it. He had the Supreme Court in his sights, and much else. . .
Read the entire obituary . . .
On This Date in History - January 23
On this date in 1849, Dr. Elizabeth Blackwell received the first M.D. awarded to a woman in the United States.
On this date in 1964, the poll tax was barred in Federal elections in the United States. The Twenty-fourth Amendment to the Constitution recognized voting as a right, not simply a privilege.
After Leonard and Thelma Spinrad
The 6th Annual World Health Care Congress
Advancing solutions for business and health care CEOs to
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