MEDICAL TUESDAY . NET                                  NEWSLETTER

Community For Better Health Care                        Vol XIV, No 1, Jan, 2015


In This Issue:

1.                  Featured Article: America and the Barbary Pirates

2.                  In the News: Kamala Harris, AG, State of California: I will fight for . . . I will fight for . . .

3.                  International Medicine: Pot heads around the world

4.                  Medicare: Why we had to eliminate Medicare, Medicaid from our practice

5.                  Medical Gluttony: Obamacare savings require Rose Colored Glasses

6.                  Medical Myths: Healthcare is so expensive; no one except the government can pay for it.

7.                  Overheard in the Medical Staff Lounge: A Simple Way to Kill Yourself Without Assistance

8.                  Voices of Medicine: EDITORIAL: Touching the Patient by Rob Nied, MD

9.                  The Bookshelf: Extreme Medicine by Dr Kevin Fong

10.              Hippocrates & His Kin: Should doctors hold public office?

11.              Restoring Accountability in Medical Practice, Healthcare, Government and Society

12.              Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

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The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data The 12th Annual World Health Care Congress will be held March 23-25, 2015 at the Marriot Wardman Park Hotel, Washington DC.   For more information, visit The future is occurring NOW.  

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1.      Featured Article: America and the Barbary Pirates                                                                 

An International Battle Against an Unconventional Foe

by Gerard W. Gawalt

Ruthless, unconventional foes are not new to the United States of America. More than two hundred years ago the newly established United States made its first attempt to fight an overseas battle to protect its private citizens by building an international coalition against an unconventional enemy. Then the enemies were pirates and piracy. The focus of the United States and a proposed international coalition was the Barbary Pirates of North Africa.  

Pirate ships and crews from the North African states of Tripoli, Tunis, Morocco, and Algiers (the Barbary Coast) were the scourge of the Mediterranean. Capturing merchant ships and holding their crews for ransom provided the rulers of these nations with wealth and naval power. In fact, the Roman Catholic Religious Order of Mathurins had operated from France for centuries with the special mission of collecting and disbursing funds for the relief and ransom of prisoners of Mediterranean pirates.

Before the United States obtained its independence in the American Revolution, 1775-83, American merchant ships and sailors had been protected from the ravages of the North African pirates by the naval and diplomatic power of Great Britain. British naval power and the tribute or subsidies Britain paid to the piratical states protected American vessels and crews. During the Revolution, the ships of the United States were protected by the 1778 alliance with France, which required the French nation to protect "American vessels and effects against all violence, insults, attacks, or depredations, on the part of the said Princes and States of Barbary or their subjects."

After the United States won its independence in the treaty of 1783, it had to protect its own commerce against dangers such as the Barbary pirates. As early as 1784 Congress followed the tradition of the European shipping powers and appropriated $80,000 as tribute to the Barbary states, directing its ministers in Europe, Thomas Jefferson and John Adams, to begin negotiations with them. Trouble began the next year, in July 1785, when Algerians captured two American ships and the dey of Algiers held their crews of twenty-one people for a ransom of nearly $60,000.

Thomas Jefferson, United States minister to France, opposed the payment of tribute, as he later testified in words that have a particular resonance today. In his autobiography Jefferson wrote that in 1785 and 1786 he unsuccessfully "endeavored to form an association of the powers subject to habitual depredation from them. I accordingly prepared, and proposed to their ministers at Paris, for consultation with their governments, articles of a special confederation." Jefferson argued that "The object of the convention shall be to compel the piratical States to perpetual peace." Jefferson prepared a detailed plan for the interested states. "Portugal, Naples, the two Sicily’s, Venice, Malta, Denmark and Sweden were favorably disposed to such an association," Jefferson remembered, but there were "apprehensions" that England and France would follow their own paths, "and so it fell through."

Paying the ransom would only lead to further demands, Jefferson argued in letters to future presidents John Adams, then America's minister to Great Britain, and James Monroe, then a member of Congress. As Jefferson wrote to Adams in a July 11, 1786, letter, "I acknolege [sic] I very early thought it would be best to effect a peace thro' the medium of war." Paying tribute will merely invite more demands, and even if a coalition proves workable, the only solution is a strong navy that can reach the pirates, Jefferson argued in an August 18, 1786, letter to James Monroe: "The states must see the rod; perhaps it must be felt by some one of them. . . . Every national citizen must wish to see an effective instrument of coercion, and should fear to see it on any other element than the water. A naval force can never endanger our liberties, nor occasion bloodshed; a land force would do both." "From what I learn from the temper of my countrymen and their tenaciousness of their money," Jefferson added in a December 26, 1786, letter to the president of Yale College, Ezra Stiles, "it will be more easy to raise ships and men to fight these pirates into reason, than money to bribe them."

Jefferson's plan for an international coalition foundered on the shoals of indifference and a belief that it was cheaper to pay the tribute than fight a war. The United States's relations with the Barbary states continued to revolve around negotiations for ransom of American ships and sailors and the payment of annual tributes or gifts. Even though Secretary of State Jefferson declared to Thomas Barclay, American consul to Morocco, in a May 13, 1791, letter of instructions for a new treaty with Morocco that it is "lastly our determination to prefer war in all cases to tribute under any form, and to any people whatever," the United States continued to negotiate for cash settlements. In 1795 alone the United States was forced to pay nearly a million dollars in cash, naval stores, and a frigate to ransom 115 sailors from the dey of Algiers. Annual gifts were settled by treaty on Algiers, Morocco, Tunis, and Tripoli.

When Jefferson became president in 1801 he refused to accede to Tripoli's demands for an immediate payment of $225,000 and an annual payment of $25,000. The pasha of Tripoli then declared war on the United States. Although as secretary of state and vice president he had opposed developing an American navy capable of anything more than coastal defense, President Jefferson dispatched a squadron of naval vessels to the Mediterranean. As he declared in his first annual message to Congress: "To this state of general peace with which we have been blessed, one only exception exists. Tripoli, the least considerable of the Barbary States, had come forward with demands unfounded either in right or in compact, and had permitted itself to denounce war, on our failure to comply before a given day. The style of the demand admitted but one answer. I sent a small squadron of frigates into the Mediterranean. . . ."

The American show of force quickly awed Tunis and Algiers into breaking their alliance with Tripoli. The humiliating loss of the frigate Philadelphia and the capture of her captain and crew in Tripoli in 1803, criticism from his political opponents, and even opposition within his own cabinet did not deter Jefferson from his chosen course during four years of war. The aggressive action of Commodore Edward Preble (1803-4) forced Morocco out of the fight and his five bombardments of Tripoli restored some order to the Mediterranean. However, it was not until 1805, when an American fleet under Commodore John Rogers and a land force raised by an American naval agent to the Barbary powers, Captain William Eaton, threatened to capture Tripoli and install the brother of Tripoli's pasha on the throne, that a treaty brought an end to the hostilities. Negotiated by Tobias Lear, former secretary to President Washington and now consul general in Algiers, the treaty of 1805 still required the United States to pay a ransom of $60,000 for each of the sailors held by the dey of Algiers, and so it went without Senatorial consent until April 1806. Nevertheless, Jefferson was able to report in his sixth annual message to Congress in December 1806 that in addition to the successful completion of the Lewis and Clark expedition, "The states on the coast of Barbary seem generally disposed at present to respect our peace and friendship."

In fact, it was not until the second war with Algiers, in 1815, that naval victories by Commodores William Bainbridge and Stephen Decatur led to treaties ending all tribute payments by the United States. European nations continued annual payments until the 1830s. However, international piracy in Atlantic and Mediterranean waters declined during this time under pressure from the Euro-American nations, who no longer viewed pirate states as mere annoyances during peacetime and potential allies during war.

Gerard W. Gawalt is the manuscript specialist for early American history in the Manuscript Division, Library of Congress.

The Thomas Jefferson Papers

Explore the entire manuscript and others at

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2.      In the News: Kamala Harris, AG, State of California: I will fight for . . . I will fight for . . .

The Fight for Barbara Boxer’s California Senate Seat on her retirement in 2016

“Let me take just a moment to tell you what makes Kamala Harris so special,” Sen. Elizabeth Warren of Massachusetts blogged, encouraging her national donor base to give to Harris.

“She’s exactly the kind of leader we need in the Senate,” Sen. Kirsten Gillibrand of New York, another prodigious fundraiser, said in an email urging her contributors to pivot toward Harris.

“So Excited about ‪@KamalaHarris campaign for California US Senate seat,” New Jersey Sen. Cory Booker tweeted, inviting his 1.52 million followers to donate to Harris’ campaign.

By the end of the first week, Harris had become the frontrunner to replace Sen. Barbara Boxer, who is retiring in 2016. Harris’ aides worked hard to spin an air of invincibility. Enthusiastic press coverage fed into it.

“She has been dubbed the female Obama. She cooks. She goes to the gym in a hoodie,” The Guardian of the U.K. wrote. “She views lawyers as heroes and takes on mortgage companies the way Elizabeth Warren takes on Wall Street.”

There was, however, the question of issues.

Harris, sworn in for her second term as attorney general on Jan. 5, announced her Senate candidacy on Jan. 13 in a vacuous 240-word blurb in which she asked for money, and made no other public statements.

In the plea for money, Harris promised to fight crime, fight for consumers, fight for equal rights, fight for “the next generation,” fight for “middle class families who are feeling the pinch of stagnant wages,” fight “for our children,” and “fight relentlessly to protect our coast, our immigrant communities and our seniors.”

She listed many fights, but missed a few. There was no talk of fighting for the right to privacy or for national defense, or combating climate change, which many Democrats see as the defining issue of our time. Water policy evidently was not snappy enough.

Harris did her best to have a shock-and-awe opening, while Tom Steyer, the San Francisco billionaire environmentalist, toyed with entering the race by subjecting himself to an AMA, also known as an ask-me-anything, on Reddit.

Steyer was, indeed, asked all sorts of questions, from his choice of jelly with his peanut butter to his opinion of Mariah Carey, and his quirky choice of wearing the same plaid tie, day after day.

More to the point were the snarky and unscripted questions: When would he release his tax returns? How much money did he make from oil and coal when he ran Farallon Capital, the San Francisco hedge fund that made him rich? He answered some but not all the questions. It was a tough crowd, made tougher by its trollish anonymity.

Steyer gets points for engaging with whoever participates in such chats. He also got a glimpse into the flaming that awaits him if he enters the race.

Former Los Angeles Mayor Antonio Villaraigosa and Rep. Xavier Becerra, D-Los Angeles, also are contemplating a candidacy. Each could be formidable. A few Republicans have raised their hands, too, though California is Democratic territory.

Republican consultant Fred Davis, who has been involved in several presidential, Senate and gubernatorial races, said a Republican candidate would need $100 million and be able to campaign on the level of Ronald Reagan, or maybe Arnold Schwarzenegger, before he soiled his image.

Republicans won’t spend money in California in 2016, when they must defend Senate seats in several less expensive states. Whoever the Republican presidential candidate ends up being won’t spend a dime here after the primary.

“Nonstarter for Republicans,” Davis said.

Perhaps the race will turn into a free-for-all, and Harris will spend the next two years battling a half-dozen serious opponents. Certainly, many politicians would love to be one of 100 senators. But a Senate campaign is no small undertaking.

Boxer raised $29 million in her last race. A contested race in 2016 could cost $40 million, or more. It must be raised in increments of $2,600, the current federal cap on the amounts that individual donors can give.

Harris has been building toward high office for years. Making all the right friends, she presented Willie Brown with the cap that read “Da Mayor” on the night in 1995 when he was elected San Francisco mayor. She spent December 2007 knocking on doors in frigid Iowa for Sen. Barack Obama, when most political experts assumed Hillary Clinton would be the Democratic nominee.

Harris is hoping to scare off any opponents, at least those who aren’t billionaires. She’s clearly willing to ask for money, though the $14.2 million she has raised since her first run for attorney general is not nearly sufficient for a Senate race.

It doesn’t hurt that she comes from San Francisco. San Francisco is her largest source of money, $2.9 million, plus $830,000 from the Silicon Valley.

Harris, who is married to a Los Angeles lawyer, spends much of her time in Los Angeles, which pays off. Los Angeles and Beverly Hills account for $2.4 million of her money. She has friended Hollywood, taking no less than $1.4 million from entertainers and corporations involved in “The Industry,” by my count.

Issues matter, too.

Bill Carrick, who has managed U.S. Sen. Dianne Feinstein’s campaigns, noted that a candidate needs to be prepared to face questions on as many issues as a presidential candidate: defense, trade, the Middle East, the debt ceiling, climate change, the right to privacy, wealth disparity, plus complex California issues such as water delivery.

“There are a lot of people displaced by the current economy,” Carrick said. “Income inequality, middle-class challenges, I think those issues are going to be really big.”

There will be time to talk about all those issues and more between now and Election Day 2016. There should plenty of debate, but only if there is a campaign, not a coronation.

Follow Dan Morain on Twitter @danielmorain.

Dan Morain has been a columnist at The Bee since 2010 focusing on state government and politics. He previously worked for The Los Angeles Times covering the California Supreme Court when Rose Bird was chief justice, the Legislature when Willie Brown was speaker and the governor's office during Gray Davis' tenure. Dan Morain can be reached at or 916-321-1907. Twitter: @DanielMorain.

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3.      International Medicine: Pot heads around the world.

Beginning January 1, ordinary Czechs can grow up to five marijuana plants or have several marijuana cigarettes in their pockets without fear of criminal prosecution.  Previously what constituted a small amount was not specified and the police and courts loosely interpreted the penal code case by case, often resulting in incarceration of home growers, says the Wall Street Journal.

The government's approval of a table specifying what amounts of drugs are permissible is a vital part of the country's new penal code that was last year approved by both houses of parliament and in January of this year was signed into law by President Vaclav Klaus.  Without the just-approved table of amounts that will be used by Czech police, the January decriminalization of the drug would be difficult to judge by courts and investigators, says the Journal:

·                     The Cannabis plant still remains illegal, however, though from the New Year possession of five or less plants is merely a misdemeanor, and fines for possession will be on par with penalties for parking violations.

·                     The Czech decision is in sync with the country's liberal, Dutch-like social attitudes and laissez-faire approach to civil liberties.

There is also an interesting lifestyle footnote:  Czechs are Europe's biggest drinkers of hops-infused beer and are also the continent's leaders in smoking pot, says the Journal:

·                     Czechs consume 320 pints of the golden brew per person annually.

·                     Also 22 percent of Czechs between the age of 16 and 34 smoke cannabis at least once a year, according to a recent report by the European Monitoring Centre for Drugs and Drug Addiction.

     Czech decriminalization of small amounts of cannabis possession does not, however, provide greater     clarity to the country's policy on medical marijuana, an issue which is gaining momentum both in Europe, North America and elsewhere around the globe.  The murky state of medical marijuana in the Czech Republic is akin to the legal limbo of the plant's medicinal uses elsewhere in Europe, says the Journal.

Source: Sean Carney, "Czech Govt Allows 5 Cannabis Plants For Personal Use From 2010" Wall Street Journal

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4.      Medicare: Why we had to eliminate Medicare, Medicaid from our practice

Approximately in July of 2014 there were a number of new Medicare regulations that came down the pike which we had to learn second hand. We wrote the same prescriptions we’ve written for decades and our patient and pharmacists called or faxed back that those Rx were no longer covered. Medicare had changed to a different generic than the one we’ve been prescribing. The pharmacists simply asked us write a new prescription, which doubles the time for prescription writing. Or we could contest the change and go through the Prior Authorization process. We only did this once to understand the cost. Medicare intermediaries wanted to know what different drugs we had tried before they considered it. Since, the patient had been on the current ones for a number of years and the trial period was prior to that, we no longer knew which ones were used. The patients revolted when we tried to use a new generic. They frequently had already had experience that that generic and refused to fill it. So the 30 second Rx became 60 seconds (100 % increase in professional time and overhead) and then 5 minutes, 15 minutes—the prescription process could tie up my front desk for days—occasionally for weeks.

But this harassment was not confined to medicine prescriptions. As a pulmonologist, we have been in the business of treating respiratory failure patients (low oxygen levels) for more than 40 years. Ordering oxygen for a patient was simply writing a “Durable Medical Equipment” (DME) requisition, fax it to the DME Company and the oxygen would be at the patient’s home, sometimes before the patient got there from the office.

In July of 2014, this request was not honored. My front desk spent considerable time with the DME Company which stated there were a number of new Medicare rules. They needed the request completed on a new Medicare Form, a detailed medical reason (usually termed: chart notes), a printout of the oxygen determination, and appropriate time to process the request.

After we had completed the request in detail, provided a copy of the complete office visit (we don’t have written chart notes – as a consultant we have complete EMR typed up professional visits we could send to the personal physician in response to the consultation request. This included a typed up Oxygen saturation report documenting the low oxygen of respiratory failure, justifying the life-saving oxygen need. We knew they would not be able to find the oxygen portion in a two page report so we underlined the required lab evaluation with bright ink.

My front desk spent another 10 or 15 minutes with the Medicare intermediary before they interrupted me while I’m with the next patient.  She stated that they didn’t need a complete report they couldn’t understand. They just needed the answers to their questions—nothing more. Plus they needed the actually printout of the oxygen level. I pointed out we didn’t have such a fancy machine with a printer like the hospitals have. We just have the standard “pulse-ox” monitor which most physicians use in their offices. We’ve used this same type of instrument in our office for 40 years documenting respiratory failure. The Medicare lady replied, “How will we know if you’re telling us the truth? You could put down any level you wish.” I told her that I was sorry she didn’t trust our honesty. I also informed her we would not be purchasing a $1500 instrument that measures all vital signs, in addition to the oxygen level required for our type of practice, and handed the phone back to my medical assistant and proceeded seeing the patient that Medicare interrupted.

This lady who was in such severe lung failure, her arterial oxygen saturation was 78%, about the level of blue venous blood so that we had to help her to her car. She declined to go the hospital emergency room. She spent the next two months in her lounger gasping for breath before the oxygen was finally delivered. She called Medicaid, which referred her to another oxygen company that was willing to bypass Medicare’s directives to save a human life. Of note, is that the following month, she had to begin using the Medicare required oxygen company.

At this time in January 2015, after six months of this type of harassment, my front office stated that they were spending between 15 minutes to more than two hours, justifying the low cost care our patient were accustomed to receiving and doing well on it. With the front desk medical assistant being paid $30 an hour, this exceeded many of Medicaid reimbursement payments as low as $28. And with office overhead now exceeding 50%, with Medicare reimbursement of $69 for a $150 office evaluation, the cost of our practice now exceeded the joy of a professional practice for the benefit of our patients, we notified our patients on Jan 1, 2015, that we would close our practice on June 30, 2015.  This would give them six months to find a new physician and we would be happy to transfer their Medical File to whatever physician they would choose.

We regretted this intrusion and reduction in quality of care by the government into their private healthcare. We no longer were able to work for them. We were working for Medicare which is a corruption of our professional oath and journey for the last 45 years.

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

- Ronald Reagan

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5.      Medical Gluttony: Obamacare savings require Rose Colored Glasses

Medicaid savings in the January 2015 projection are due to 10 percent to 15 percent reductions in costs per beneficiary. The same holds for the $51 billion of savings due to lower subsidies to health insurers in Obamacare exchanges. CBO (Congressional Budget Office) notes that cost increases in private and government health plans have been significantly slower than anticipated in previous years, and assumes this will continue. Nobody can fully explain the slower rate of health spending in recent years, but consumer-driven health plans and the Great Recession explain much of it.

This challenges CBO’s long-term projections: CBO now projects real (inflation-adjusted) growth in Gross Domestic Product (GDP) of over two percent per annum though 2025, so it appears imprudent to expect health spending to continue to increase at a recessionary pace. Another challenge is that CBO projects that only 75 percent of enrollees will receive subsidies in 2015 and 71 percent in 2025 (p. 122). However, 87 percent received subsidies in 2014.

Beyond 2019, Obamacare’s spending explodes again. CBO projects the average exchange subsidy per covered enrollee in 2015 will be $4,330 and increase to $7,710 in 2025, an increase of 78 percent in nominal terms (p. 122). In real, inflation-adjusted terms it is an increase of 48 percent (using the CBO’s estimate of future Consumer Price Inflation).

And 2025 is only ten years in the future! We have had Medicare for fifty years, and there is little political will to get its unfunded liability under control. Don’t let the CBO’s rose-colored short-sighted vision lull us into complacency: Obamacare is a long-term spending disaster.

John R. Graham is a Senior Fellow at the National Center for Policy Analysis and Co-Organizer of the Health Technology Forum: DC. His research is collected at JRG Health Sector Analysis.

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Medical Gluttony thrives in Government and Health Insurance Programs.

It Disappears with Appropriate Deductibles and Co-payments on Every Service.

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6.      Medical Myths: Healthcare is so expensive; no one except the government can pay for it.

We hear daily about the exorbitant cost of healthcare today. We also hear that “if you think healthcare is expensive now, just wait until it’s free.” But that exemplifies it is not an expense issue. It’s an over utilization issue. In our experience, because it’s free, there is an over utilization of more than twice that needed for optimum health care. It is really an entitlement mentality that causes the excessive use and therefore the excessive cost.

Almost every day we hear patients tell us that we shouldn’t worry about the cost because Medicare pays for it. But because Medicare is paying so much of it, Medicare is scheduled to go broke in the next decade. That is why we are experience the increasing denial of medications, tests, x-rays, procedures, and even emergency surgery.

I had a patient with an acute appendicitis. Normally, in America such a patient would have an appendectomy on the same day. However, the HMO took three days to approve it. I treated him with high doses of antibiotics trying to stave off a ruptured appendix for the three day delay. Fortunately, we were able to delay a ruptured appendix which would have caused peritonitis, which was frequently fatal in the days before our current potent antibiotics. Peritonitis is still a serious complication, prolongs expensive hospitalization, can cause abdominal abscesses to form if pockets of pus aren’t cleared by the antibiotics, can cause extreme pain and suffering, resulting in abdominal adhesions and scarring. This may result in prolong abdominal pain and further suffering.

Hence, this delay to obtain Medicare or intermediary approval, was not only life threatening, but could easily have caused significant increased morbidity and increased cost. The cost increase is very significant. To go from a one day, sometimes an outpatient procedure, to a 5 or more day procedure, is a 500% or more increase in costs.

These delays, which lower the quality of health care in the United States, are a result of lack of trust by HMOs and insurance carries in physicians who are the captains in the healthcare team. A health insurance executive, at a luncheon at which wine was served, admitted to me that they could probably eliminate the army of reviewers on every hospital ward and outpatient facility throughout the country, which are a huge cost to them, and just pay the charges that doctors submitted, they more likely than not would save healthcare dollars.

“Then why don’t you do that?” I asked.

He replied, “Why would we want to give up control of the most powerful profession in the country?”

Healthcare is so expensive that we have to return it to the care of physicians and their patients, the only ones that can make it affordable again. That is the next step in Healthcare Reform that will work.

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Medical Myths originate and costs increase when someone else pays the medical bills.

Myths disappear and costs decrease when Patients pay Appropriate Deductibles and Co-payments on Every Service. Patients then manage their healthcare costs judiciously.

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7.      Overheard in the Medical Staff Lounge: A Simple Way to Kill Yourself Without Assistance

Dr. Rosen:      There is an increasing emphases of Doctors assisted killing their patients. Is it appropriate for the messenger of healing to assist patients in terminating their lives?

Dr. Milton:      That is a very disturbing question. And our professional organizations seem to be advocating this.

Dr. Ruth:        I would never have thought that when I went to medical school such a subject would ever be considered.

Dr. Michelle:   I would not and could not be involved in such a travesty. 

Dr. Sam:         It beats anything that I could have ever imagined.

Dr. Patricia:   It certainly makes me feel uneasy with my own professional colleagues.

Dr. Edwards:  Let’s think about this a moment. What do you think will be the ultimate outcome of this?

Dr. Sam:         I know a lawyer with Merkel Cell CA in his thigh that invaded his femur when it became very painful. He told his wife let’s move to our vacation home in Oregon so I can put an end to this suffering. 

Dr. Edwards:  But dying is not a painful proposition. We have plenty of drugs now to let everyone die in comfort. Why not let nature take its course?

Dr. Rosen:       I don’t think the general public believes that. It’s not been so long since many people didn’t want to be around a dying person. Some were so petrified they sent them off to the hospital to die. And after they died, they left the bed unable to even touch their loved ones.

Dr. Edwards:  Then we went through the long ethical dilemma. How to let our patients die? We couldn’t even let our terminal patients die in peace. When the heart stopped, we pounded on their chests, frequently breaking ribs. If they survived, they would really have severe pain from fractured ribs. The respiratory therapists were always nearby with their ventilators waiting for the doctors to intubate the dying patient so they could hook them up to breath for them.

Dr. Rosen:      Then we had a real ethical problem. Can we ever turn off the ventilator? Isn’t that called Mercy killing? Isn’t that criminal? A felony?

Dr: Yancy:      But the hospitals loved it, especially while the ventilators were running and collecting revenue by the minute, by the hour, by the day . . . by the month . . . by the . . .   until the court allowed the doctor to turn off the ventilator.

Dr. Rosen:      That could take a week or more after the patient had effectively died.

Dr. Yancy:      You can see why hospitals love it. At $500 an hours, the weeks, months, etc. was a gold mine for the hospitals.

Dr. Edwards:  Remember the Karen Quinlan fiasco? When they finally got the court order to turn off the ventilator, Karen kept on breathing.

Dr. Rosen:      Which goes to show you what actually happens when lawyers and courts practice medicine. Doctors no longer provide appropriate care. They are unable to make appropriate medical decisions—like checking for spontaneous breathing when making rounds.

Dr. Edwards:  Maybe Karen was able to breathe on her own six months earlier on her year-long expensive life-support ventilator care.

Dr. Milton:      Can we explore that possibility a little more? Let’s assume that without the court interference, and the doctors would have followed normal quality of care, they might have found that she could have been breathing on her own 200 days earlier without life support. Now just take the cost of daily life support in your hospital. We know it’s quite variable. To be in the ICU costs several thousand dollars a day. Then add on the charge for life support which will also be several thousand dollars a day. Looks like the 200 days could add up to more than half a million dollars saved in hospital charges. Before long, you’re talking real money.

Dr. Rosen:      Some physicians felt collecting an ICU treatment charge every day was gouging the system. And when they addressed it, the hospitals did not understand why. I remember once when I was managing a patient on life support who also had an infection, the infectious disease doctor suggested that we both continue to see the patient every day but only put a charge in every other day.

Dr. Milton:      When the hospital administrator heard this, I bet he thought you were stupid. Wasn’t the name of the game to charge whatever the traffic will bear?

Dr. Rosen:      That’s what the hospital thought and how the hospital practices. It is unfortunate that the lay public doesn’t believe that doctors are cost conscious.

Dr. Milton:      That’s because some doctors do gouge the patients.

Dr. Rosen:      How do the new staff members view this?

Dr. Ruth:        I think most of them go with the flow. They don’t want to make waves early in their careers.

Dr. Rosen:      Most of them have government sponsored debt. So they have become slaves to the government. So the next generation of physicians will no longer be independent. They will practice by whatever rule they think will prevail and get their student loans paid. They no longer will be a servant to their patients.

Dr. Michelle:   How sad.

Dr. Rosen:      But they may think they have the patient’s best interest at heart, even to the point of Mercy Killing.

Dr. Ruth:        Tragic!

Dr. Rosen:      And that’s why it’s hard to have an ethical discussion about doctors being an accomplice to the patient’s suicide vs murder.

Dr. Yancy:      I caution patients who are on Beta Blockers for their high blood pressure what could happen if they over dose on this medication. They already have low blood pressure on the medication and their heart rate goes down to the 40s. I tell them if they took 5 or 6 of these as they are about to retire, their heart rate could go down into the 30s and their BP could drop into the 60s. Then if they took twice that many when they turned off their bedside lamp, their pulse would continue downward and their blood pressure would drop even further. Then the brain and kidneys would not be perfused and they would sleep       very soundly. They may then not awaken in the morning. If that is their intent, be sure to tell your wife that you love her and that you’re not feeling well and will retire early.

Dr. Rosen:      You’ve just outlined why Doctors never have to put a needle in the patient’s vein and inject anything lethal to assist in a suicide. Let the patient do it on his own and keep your white coat on. Never wear the black coat of the executioner.

Dr. Edwards:  Yes, let’s not be an accomplice to killing.

Dr Yancy:       Beta Blockers give your patients a peaceful painless death.

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8.      Voices of Medicine: A Review of Local and Regional Medical Journals: Sonoma Medicine

EDITORIAL: Touching the Patient by Rob Nied, MD

At the 2014 Australian Open, Stan Wawrinka became the first man since 2009 to win a Grand Slam tennis tournament outside the Big Four of Federer, Djokovic, Murray and Nadal. In the championship match, he beat Nadal, who was suffering from a back injury. How much low back pain factored into the loss, only Rafa knows for sure. Certainly the 90% of us who have experienced this type of pain can imagine how limiting it might have been. In fact, low back pain is the number one cause of disability in the United States, with an estimated $100 billion annual cost for lost work and wages. For Nadal, the difference between the winner and first runner-up prize money was $1.3 million.

Does sports participation cause low back injuries? A recent study reviewing injury data from professional tennis players competing in the US Open from 1994 to 2009 did not find a significant increase in low back injuries, despite increases during those years in game intensity, higher rotational velocity serves, and longer playing seasons.1 In fact, NCAA injury surveillance has found that only 2% of all sports-related injuries in college athletes are to the low back. Some of these are traumatic injuries, such as contusions and spondylolysis, but most often athletes suffer from the same common mechanical low back pain as the rest of us.

Degenerative disc disease may be quite common in athletes. In a study of asymptomatic late adolescent elite tennis players, none of whom had a history of low back pain, 28 of 33 athletes had significant findings on MRI, including pars interarticularis lesions, facet arthropathy and bulging discs.2 Does this mean that sports are particularly hard on the spine or that a “bad back” on imaging does not necessarily correlate with symptoms or athletic limitation? Knowing how common abnormal MRI findings are in the general public, my interpretation is that athletes have the same backs as the rest of us but are better able to control their core forces and motion.

Athletes like a hands-on approach to low back pain. They are very aware of their bodies, and manual therapies tend to work well for them. Deep tissue work and massage have become a standard part of most training regimens. Beyond just “feeling good,” animal research suggests that manual therapy may actually help injured tissues recover faster. In a 2013 Consumer Reports survey, of the 14,000 subscribers who had experienced low back pain in the past year but did not have back surgery, 59% were highly satisfied by the care from their chiropractor, 55% with their physical therapist, and 53% with their acupuncturist.3 Only 34% of respondents were highly satisfied with the treatment offered by their primary care physician. Clearly our patients also appreciate the hands-on healing power of touch—it is better than prescribing a pill. . .  Read More . . .

Dr. Nied, a family and sports medicine physician at Kaiser Permanente Santa Rosa, is the immediate past president of SCMA.

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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about

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9.      Book Review: Extreme Medicine by Dr Kevin Fong

Miraculous Medical Tales by Brien A. Seeley, MD, Sonoma Medicine

My father-in-law, the late Dr. Lyle Powell Jr., taught me the axiom that “to best understand something complex, one should examine its extremes.” This examination not only clarifies the thing’s limits; it reveals what inner workings impose those limits. That revelation is precisely the result when this axiom is applied to human physiology by Dr. Kevin Fong in his engaging new book, Extreme Medicine.

Fong’s book provides the reader with a fascinating tour of the emergence of modern medicine from a brutish past in which war, disaster, epidemics and the perils of exploration all pressed pioneering physicians to try new things. Fong is a master storyteller, and his prose delivers a captivating and punchy mix that is part Discovery Channel and part Rod Serling. His writing style bespeaks of British formality, impeccably correct and at times reminding one of a dialogue in Downton Abbey. His medical training in London gives much of the book the tone of a lecture by an emeritus professor. Yet his tales have a dramatic and personalized intimacy, both from his own experiences and those of real historical figures. These stories are thrilling. They put the reader right there, as if personally confronting the acute, life-threatening medical problem and having to make the daring decisions about what should be done.

Extreme Medicine will reward both lay readers and those in the medical profession. For physicians, this book will summon again the awe and “aha” that we felt at the new insights into human physiology that were bestowed upon us during our medical training. When Fong recounts the frantic, midnight rush to respond to a code blue crash-cart experience, he instantly transports the physician reader back to those breathtaking codes that we attended as interns, where some of those insights were etched into us.

Time and again, Fong removes the reader from the immediate crisis to the comfort of a crystal-clear, academic retelling of the underlying physiology that pertains. This technique is quite effective, and it intensifies our appreciation for the importance of the miraculous cellular and molecular workings of human physiology. As such, this book will improve every physician who reads it. .

This book review is found at  

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The Book Review Section Is an Insider’s View of What Doctors are Reading about.

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10.  Hippocrates & His Kin: Should doctors hold public office?

Physicians, nurses, and other professions are never line officers in the military or other organizations. They are always advisory to the chain of command. This is as it should be. Physicians do not make good senators, or judges, administrators, executive officers, including CEO of a country. At the present time we have two physicians trying to be the president of these United States.  It’s not in their nature to be in command. There is a vast difference in being in charge of a neurosurgical or an ophthalmology suite with a clear focus on being expert in our training and specialty. There are no special skills in our training to be the Commander-in-Chief of the military or to be skillful in all endeavors in our country or the world at large. Being a governor may be a training ground, but it is not complete. Neither of the doctors running for president has had such public administrative experience. However, their entry was a pleasant diversion of the political process. There is plenty of time to allow this most interesting development to close prior to our next year’s presidential election.

How important is influenza vaccination for school children.

In the 1960 as a Medical Student, I was on the Board of Education of Immanuel Lutheran School, the largest protestant school in Kansas City with 150 students in K-8. Influenza vaccination was encouraged but only half of the children ended up being vaccinated. We decided this was good with half of the children immunized, an epidemic would not be too fierce with an average of every other child being immune. There were no epidemics within the school during those two years.

In the 1980s, I was on the Board of Education of Town & Country Lutheran School with 120 students in K-8th grade. It was the largest Lutheran School in Sacramento. Again we encourage flu vaccine for everyone. Our survey indicated that about 90% had been immunized.

In 2014 we have a medical doctor in the state legislature. He is supporting legislation and a proposition to force 100% vaccination. The Sacramento Bee reports that we have approximately a 97% immunization rate in Sacramento County. With 97% of our children immunized we cannot have a flu epidemic in our schools.

Why would a physician want to be that dictatorial by forcing 100% compliance? It has been estimated to obtain compliance of the last 5 percent in any endeavor, is not only very coercive, but also the most expensive portion of the Bell Curve. Isn’t he able to do the math? Having received the highest level of education in society, why has he given up on the education of his patients, their families and the public which is the method used in a free and voluntary civilization? This does not detract from affirming that influenza vaccination is extremely important for our children. The parents obviously agree with us.  

“Sometimes it’s best to keep your mouth shut and act like a fool, rather than open it and remove all doubt.”


Thomas Jefferson was a prolific writer. His Papers at the Library of Congress are a rich storehouse of his thoughts and ideas expressed both in official correspondence and in private letters. This brief selection suggests something of what awaits users' own online investigations into the writings of the man who was the third president of the United States, the founder of the University of Virginia, and author of the Declaration of Independence.

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Yesterday, Today & Tomorrow

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

                      The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk, issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at and register to receive one or more of these reports.

                      Pacific Research Institute, ( Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog.

                      The Mercatus Center at George Mason University ( is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government.

                      To read the rest of this column, please go to

                      The National Association of Health Underwriters, The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business.

                      The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at A study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels.

                      Greg Scandlen, an expert in Health Savings Accounts (HSAs), has embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the initial series of his newsletter, Consumers Power Reports. Become a member of CHCC, The voice of the health care consumer. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn. Greg has joined the Heartland Institute, where current newsletters can be found.

                      The Heartland Institute,, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care? This month, be sure to read ?

                      The Foundation for Economic Education,, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Lawrence W Reed, President,  and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. Be sure to read the current lesson on Economic Education.

                      The Council for Affordable Health Insurance,, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse."

                      The Independence Institute,, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter.

                      Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis.

                      The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at for an overview of the extensive research articles that are available. You may want to go directly to their health research section.

                      The Heritage Foundation,, founded in 1973, is a research and educational institute whose mission was to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. -- However, since they supported the socialistic health plan instituted by Mitt Romney in Massachusetts, which is replaying the Medicare excessive increases in its first two years, and was used by some as a justification for the Obama plan, they have lost sight of their mission and we will no longer feature them as a freedom loving institution and have canceled our contributions as thousands of physicians also have done.


Romney is a RINO – Republican In Name Only

                      The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at to obtain the foundation's daily reports. You may also log on to Lew's premier free-market site to read some of his lectures to medical groups. Learn how state medicine subsidizes illness or to find out why anyone would want to be an MD today.

                      CATO. The Cato Institute ( was founded in 1977, by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio, articles and books at

                      The Ethan Allen Institute,, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.

                      The Free State Project, with a goal of Liberty in Our Lifetime,, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]

                      The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, wartime allows the federal government to grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St. Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in wartime, we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to

                      Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read ? Choose recent issues.  The last ten years of Imprimis are archived.

                      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 and check out their history, mission statement, newsletter, and a host of other information

                      Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .

                      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 To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .

                      PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. ( 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. 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,, 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. Read Lin Zinser’s view on today’s health care problem:  In today’s proposals for sweeping changes in the field of medicine, the term “socialized medicine” is never used. Instead we hear demands for “universal,” “mandatory,” “singlepayer,” and/or “comprehensive” systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this “nationalized financing” or “nationalized health insurance.” In a more honest day, it was called socialized medicine.

                      Michael J. Harris, MD - - 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."

                      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 To read his "Lessons from the Past," go to For additional articles, such as the cost of Single Payer, go to; for Health Care Inflation, go to

                      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, which 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 To see Attorney Sharon Kime's response, as well as the California Medical Board response, see 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

                      The Association of American Physicians & Surgeons (, 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: Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. 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 that can be accessed from the Table of Contents.

                       The AAPS California Chapter is an unincorporated association made up of members. The Goal of the AAPS California Chapter is to carry on the activities of the Association of American Physicians and Surgeons (AAPS) on a statewide basis. This is accomplished by having meetings and providing communications that support the medical professional needs and interests of independent physicians in private practice. To join the AAPS California Chapter, all you need to do is join national AAPS and be a physician licensed to practice in the State of California. There is no additional cost or fee to be a member of the AAPS California State Chapter.
Go to California Chapter Web Page . . .

            Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"

                      PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.

Our motto, "omnia pro aegroto" means "all for the patient."

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12.  Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

Words of Wisdom

Thomas Jefferson’s Papers

Thomas Jefferson was a prolific writer. His Papers at the Library of Congress are a rich storehouse of his thoughts and ideas expressed both in official correspondence and in private letters. This brief selection suggests something of what awaits users' own online investigations into the writings of the man who was the third president of the United States, the founder of the University of Virginia, and author of the Declaration of Independence.

"We hold these truths to be self-evident: that all men are created equal. . . ."
Declaration of Independence, July 4, 1776

"our liberty depends on the freedom of the press, and that cannot be limited without being lost."
Thomas Jefferson to Dr. James Currie, January 28, 1786

"nothing can now be believed which is seen in a newspaper. Truth itself becomes suspicious by being put into that polluted vehicle."
Thomas Jefferson to John Norvell, June 11, 1807

"Bigotry is the disease of ignorance, of morbid minds; enthusiasm of the free and buoyant. Education & free discussion are the antidotes of both."
Thomas Jefferson to John Adams, August 1, 1816

"I agree with you that it is the duty of every good citizen to use all the opportunities, which occur to him, for preserving documents relating to the history of our country."
Thomas Jefferson to Hugh P. Taylor, October 4, 1823

"When angry, count ten before you speak; if very angry, an hundred."
Thomas Jefferson to Thomas Jefferson Smith, February 21, 1825

—Library of Congress

Some Recent Postings

In The December Issue:

1.      Featured Article: How bad is Censorship getting?

2.      In the News: Doctors will go two weeks without pay next month

3.      International Medicine/Medical Affairs: A Swiss Shot Heard 'Round the World

4.      Medicare: Medicare in Wonderland

5.      Medical Gluttony: Medical Gluttony can be hazardous to your health and well being.

6.      Medical Myths: The $64,000,000 Question?

7.      Overheard in the Medical Staff Lounge: ICD 9 is being retired. Are you staying for ICD 10?

8.      Voices of Medicine: Noble Brains, Healthy Lives

9.      The Bookshelf: Being Mortal

10.  Hippocrates & His Kin: The High Cost of Stupidity

11.  Restoring Accountability in Medicine, Government and Society

12.  Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

In Memoriam

Stéphane Charbonnier (“Charb”), cartoonist and editor of Charlie Hebdo, was murdered on January 7th, aged 47

|The Economist | From the print edition | Jan 17th 2015 |

“WHERE’S Charb? Where’s Charb?” cried the assassins as they hurtled into the offices of Charlie Hebdo. Where else should he be? At the big circular table, plotting with his fellow scribblers to draw something shocking, gross and salacious. The Virgin Mary giving birth in stirrups. The pope fondling a Swiss guard. The anarchist dog Maurice sodomising a chair or crapping in the food bowl of Patapon, the fascist cat. Marcel Keuf le flic, goofy and drunk again, punching an innocent civilian in the police station. Muhammad showing his hairy naked bum…

Ba-boom, ba-boom, ba-boom.

He didn’t look like a provocateur. A schoolboy, perhaps. Thick glasses, short hair, lorry-driver’s T-shirt, faded denim jacket. Socks well pulled up. He liked order and punctuality, even in an office so small, cosy and crazy that they were all engaged in un boulot de dingues to get the magazine out at all. Cartoons were his wild side. Copying Hergé’s Tintin had helped him escape from boring childhood in Pontoise and just-as-boring school. In interviews he was soft-spoken, almost grey, but with a gleam in his oh-so-innocent eye that said, Watch me. He would draw what he liked. Nothing and no one scared him. He wasn’t killing anyone with his black felt pen.

. . .What he was doing was perfectly legal, under French law. In 2007 Charlie’s editor had been hauled into court for reprinting cartoons of Muhammad from a Danish magazine. But the judge had said, fine.

Of course the government got jittery sometimes. In 2012, when Muslims were up in arms over a film, . . “You musn’t make fun!” they were saying. The foreign minister accused him of adding oil to the flames. Rubbish, Charb shot back; this was fair comment on a news story. On the back page was a cartoon of naked Muhammad asking, “Do you like my butt?” The proud editor posed in the office holding his masterpiece high.

. . . But there was never serious trouble from outside unless Islam was on the cover. The worst came in 2011, when the office was firebombed for running an issue called Sharia Hebdo, with Muhammad as guest editor (“100 lashes if you don’t die laughing!”). Charb stood in the ruins, holding up the magazine. After that, the police protected him 24 hours a day. How ironic, that the flics he loved to pillory now cared so much for him!


Some people thought he was obsessed with Islam. Some even said he got up Muslims’ noses just to increase sales. It often turned out that way, but it wasn’t true. As a paid-up communist, his main targets were the right and fat-cat corporations. He’d been sniping at those ever since his fascist grandfather had held forth across the dinner table in Pontoise. His dream was to be like Maurice the dog, insolent and uncontrollable; the powers-that-be wanted him to be uptight, asexual and conservative, like Patapon the cat. If any con had especially suffered the jab of his felt pen, it was Nicolas Sarkozy when he was president of France. But Islam bothered Charb because it couldn’t be laughed at. As a good atheist and anti-clericalist he had to banaliser this religion, so that like Catholicism you could mock it and no one would care.

. . . He thought smokers should be locked up. The only things he considered sacred were the human person and free expression, but his regular column in Charlie was called “Charb doesn’t like people”, and sometimes he didn’t. He couldn’t understand marriage, all that clatter of saucepans and Hoovering, or why couples wanted kids. By contrast, he could fearlessly scrawl away because he had nothing to lose.

Instead, Charlie was his family. He happily took responsibility for everything it did. It gave him the joy of working alongside his hero Cabu, with his pudding-basin haircut and loud check shirts, and with Georges Wolinski, a venerable veteran of the satire trade. And there week by week he devoted himself to laughing out loud and crudely at the absurdities of the world. “Still no attacks in France?” a Kalashnikov-toting jihadist asked in one of his last drawings. “Well, I’ve got until the end of January to present my best wishes.”

They were presented on January 7th, both to him and to the equally defiant Cabu and Wolinski. Charlie’s print run that week had been set at 60,000 copies, about half of which usually sold. The week after, the print run was more than 5m. Muhammad, again, was on the cover, this time proclaiming “Je suis Charlie”. Where else should he be?

On This Month in History - 

On this month in history, 1964, President Lyndon Baines Johnson “declares unconditional war on poverty in America.” Like all political programs in history, after 53 years, we have more poverty than we’ve ever had since the American Revolutionary War which we won. Will we have any president in the near future to raise the white flag of defeat and let Americans prosper again!

In this month in history, Amelia Earhart Putnam became the first woman to fly solo across the Pacific Ocean from Honolulu to Oakland, completing the flight on January 12, 1935. Also on this date in 1932, Mrs. Hattie Caraway became the first elected U. S. woman Senator.

The U. S. Civil Service was established as a merit system by the Pendleton Act in 1883.  Unfortunately, in the 1960s, President John F. Kennedy allowed the civil service to Unionize and destroy quality and raise wages that exceed the private industry.

After Leonard and Thelma Spinrad

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Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, any single payer initiative, Social Security was born for the benefit of the state and of a contemptuous disregard for people’s welfare.

We must also remember that ObamaCare has nothing to do with appropriate healthcare; it was similarly projected to gain loyalty by making American citizens dependent on the government and eliminating their choice and chance in improving their welfare or quality of healthcare. Socialists know that once people are enslaved, freedom seems too risky to pursue.