MEDICAL TUESDAY . NET
Community For Better Health Care
Vol VII, No 1, April 15, 2008
In This Issue:
* * * * *
The Annual World Health Care Congress, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. The third year it was 50 percent, indicating open forums such as these are critically important. The 4th Annual World Health Congress was held April 22-24, 2007 in Washington, D.C. That year many of the world leaders in healthcare concluded that top down reforming of health care, whether by government or insurance carrier, is not and will not work. We have to get the physicians out of the trenches because reform will require physician involvement. The 5th Annual World Health Care Congress was held April 21-23, 2008 in Washington, D.C. Physicians were present on almost all the platforms and panels. This year it was the industry leaders that gave the most innovated mechanisms to bring health care spending under control. The solution to our health care problems is emerging at this ambitious congress. Plan to participate: The 6th Annual World Health Care Congress will be held April 14-16, 2009 in Washington, D.C. The World Health Care Congress - Asia will be held in Singapore on May 21-23, 2008. The 5th Annual World Health Care Congress – Europe 2009 will meet in Brussels, May 23-15, 2009. For more information, visit www.worldcongress.com. The future is occurring NOW.
* * * * *
The Truth About Autism: Scientists Reconsider What They Think They Know
By David Wolman, WIRED, 02.25.08
The YouTube clip opens with a woman facing away from the camera, rocking back and forth, flapping her hands awkwardly, and emitting an eerie hum. She then performs strange repetitive behaviors: slapping a piece of paper against a window, running a hand lengthwise over a computer keyboard, twisting the knob of a drawer. She bats a necklace with her hand and nuzzles her face against the pages of a book. And you find yourself thinking: Who's shooting this footage of the handicapped lady, and why do I always get sucked into watching the latest viral video?
But then the words "A Translation" appear on a black screen, and for the next five minutes, 27-year-old Amanda Baggs — who is autistic and doesn't speak — describes in vivid and articulate terms what's going on inside her head as she carries out these seemingly bizarre actions. In a synthesized voice generated by a software application, she explains that touching, tasting, and smelling allow her to have a "constant conversation" with her surroundings. These forms of nonverbal stimuli constitute her "native language," Baggs explains, and are no better or worse than spoken language. Yet her failure to speak is seen as a deficit, she says, while other people's failure to learn her language is seen as natural and acceptable.
And you find yourself thinking: She might have a point.
In My Language
Baggs lives in a public housing project for the elderly and handicapped near downtown Burlington, Vermont. She has short black hair, a pointy nose, and round glasses. She usually wears a T-shirt and baggy pants, and she spends a scary amount of time — day and night — on the Internet: blogging, hanging out in Second Life, and corresponding with her autie and aspie friends. (For the uninitiated, that's autistic and Asperger's.)
On a blustery afternoon, Baggs reclines on a red futon in the apartment of her neighbor (and best friend). She has a gray travel pillow wrapped around her neck, a keyboard resting on her lap, and a DynaVox VMax computer propped against her legs.
Like many people with autism, Baggs doesn't like to look you in the eye and needs help with tasks like preparing a meal and taking a shower. In conversation she'll occasionally grunt or sigh, but she stopped speaking altogether in her early twenties. Instead, she types 120 words a minute, which the DynaVox then translates into a synthesized female voice that sounds like a deadpan British schoolteacher.
The YouTube post, she says, was a political statement, designed to call attention to people's tendency to underestimate autistics. It wasn't her first video post, but this one took off. "When the number of viewers began to climb, I got scared out of my mind," Baggs says. As the hit count neared 100,000, her blog was flooded. At 200,000, scientists were inviting her to visit their labs. By 300,000, the TV people came calling, hearts warmed by the story of a young woman's fiery spirit and the rare glimpse into what has long been regarded as the solitary imprisonment of the autistic mind. "I've said a million times that I'm not trapped in my own world,'" Baggs says. "Yet what do most of these news stories lead with? Saying exactly that."
I tell her that I asked one of the world's leading authorities on autism to check out the video. The expert's opinion: Baggs must have had outside help creating it, perhaps from one of her caregivers. Her inability to talk, coupled with repetitive behaviors, lack of eye contact, and the need for assistance with everyday tasks are telltale signs of severe autism. Among all autistics, 75 percent are expected to score in the mentally retarded range on standard intelligence tests — that's an IQ of 70 or less.
People like Baggs fall at one end of an array of developmental syndromes known as autism spectrum disorders. The spectrum ranges from someone with severe disability and cognitive impairment to the socially awkward eccentric with Asperger's syndrome.
After I explain the scientist's doubts, Baggs grunts, and her mouth forms just a hint of a smirk as she lets loose a salvo on the keyboard. No one helped her shoot the video, edit it, and upload it to YouTube. She used a Sony Cybershot DSC-T1, a digital camera that can record up to 90 seconds of video (she has since upgraded). She then patched the footage together using the editing programs RAD Video Tools, VirtualDub, and DivXLand Media Subtitler. "My care provider wouldn't even know how to work the software," she says.
Baggs is part of an increasingly visible and highly networked community of autistics. Over the past decade, this group has benefited enormously from the Internet as well as innovations like type-to-speech software. Baggs may never have considered herself trapped in her own world, but thanks to technology, she can communicate with the same speed and specificity as someone using spoken language.
Autistics like Baggs are now leading a nascent civil rights movement. "I remember in '99," she says, "seeing a number of gay pride Web sites. I envied how many there were and wished there was something like that for autism. Now there is." The message: We're here. We're weird. Get used to it.
This movement is being fueled by a small but growing cadre of neuropsychological researchers who are taking a fresh look at the nature of autism itself. The condition, they say, shouldn't be thought of as a disease to be eradicated. It may be that the autistic brain is not defective but simply different — an example of the variety of human development. These researchers assert that the focus on finding a cure for autism — the disease model — has kept science from asking fundamental questions about how autistic brains function.
A cornerstone of this new approach — call it the difference model — is that past research about autistic intelligence is flawed, perhaps catastrophically so, because the instruments used to measure intelligence are bogus. "If Amanda Baggs had walked into my clinic five years ago," says Massachusetts General Hospital neuroscientist Thomas Zeffiro, one of the leading proponents of the difference model, "I would have said she was a low-functioning autistic with significant cognitive impairment. And I would have been totally wrong."
Seventy years ago, a Baltimore psychiatrist named Leo Kanner began recording observations about children in his clinic who exhibited "fascinating peculiarities." Just as Kanner's landmark paper was about to be published, a pediatrician in Vienna named Hans Asperger was putting the finishing touches on a report about a similar patient population. Both men, independently, used the same word to describe and define the condition: autist, or autism, from the Greek autos, meaning self.
The children had very real deficits, especially when it came to the "failure to be integrated in a social group" (Asperger) or the inborn inability to form "affective contact" with other people (Kanner). The two doctors' other observations about language impairment, repetitive behaviors, and the desire for sameness still form much of the basis of autism diagnoses in the 21st century. . .
On the outskirts of Montreal sits a brick monolith, the Hôpital Rivière-des-Prairies. Once one of Canada's most notorious asylums, it now has a small number of resident psychiatric patients, but most of the space has been converted into clinics and research facilities.
One of the leading researchers here is Laurent Mottron, 55, a psychiatrist specializing in autism. Mottron, who grew up in postwar France, had a tough childhood. His family had a history of schizophrenia and Tourette syndrome, and he probably has what today would be diagnosed as attention deficit and hyperactivity disorder. Naturally, he went into psychiatry. By the early '80s, Mottron was doing clinical work at a school in Tours that catered to children with sensory impairment, including autism. "The view then," Mottron says, "was that these children could be reeled back to normalcy with play therapy and work on the parents' relationships" — a gentle way of saying that the parents, especially the mother, were to blame. (The theory that emotionally distant "refrigerator mothers" caused autism had by then been rejected in the US, but in France and many other countries, the view lingered.)
After only a few weeks on the job, Mottron decided the theories were crap. "These children were just of another kind," he says. "You couldn't turn someone autistic or make someone not autistic. It was hardwired." In 1986, Mottron began working with an autistic man who would later become known in the scientific literature as "E.C." A draftsman who specialized in mechanical drawings, E.C. had incredible savant skills in 3-D drawing. He could rotate objects in his mind and make technical drawings without the need for a single revision. After two years of working with E.C., Mottron made his second breakthrough — not about autistics this time but about the rest of us: People with standard-issue brains — so-called neurotypicals — don't have the perceptual abilities to do what E.C. could do. "It's just inconsistent with how our brains work," Mottron says.
From that day forward, he decided to challenge the disease model underlying most autism research. "I wanted to go as far as I could to show that their perception — their brains — are totally different." Not damaged. Not dysfunctional. Just different. . .
By the mid-1990s, Mottron was a faculty member at the University of Montreal, where he began publishing papers on "atypicalities of perception" in autistic subjects. When performing certain mental tasks — especially when tapping visual, spatial, and auditory functions — autistics have shown superior performance compared with neurotypicals. Call it the upside of autism. Dozens of studies — Mottron's and others — have demonstrated that people with autism spectrum disorder have a number of strengths: a higher prevalence of perfect pitch, enhanced ability with 3-D drawing and pattern recognition, more accurate graphic recall, and various superior memory skills. . .
Back in Burlington, Baggs is cueing up another YouTube clip. She angles her computer screen so I can see it. Set to the soundtrack of Queen's "Under Pressure," it's a montage of close-up videos showing behaviors like pen clicking, thumb twiddling, and finger tapping. The message: Why are some stress-related behaviors socially permissible, while others — like the rocking bodies and flapping arms commonly associated with autism — are not? Hit count for the video at last check: 80,000 and climbing.
Should autism be treated? Yes, says Baggs, it should be treated with respect. "People aren't interested in us functioning with the brains we have," she says, because autism is considered to be outside the range of normal variability. "I don't fit the stereotype of autism. But who does?" she asks, hammering especially hard on the keyboard. "The definition of autism is so fluid and changing every few years." What's exciting, she says, is that Mottron and other scientists have "found universal strengths where others usually look for universal deficits." Neuro-cognitive science, she says, is finally catching up to what she and many other adults with autism have been saying all along.
Baggs is working on some new videos. One project is tentatively titled "Am I a Person Yet?" She'll explore communication, empathy, self-reflection — core elements of the human experience that have at times been used to define personhood itself. And at various points during the clip, she'll ask: "Am I a person yet?" It's a provocative idea, and you might find yourself thinking: She has a point.
David Wolman (firstname.lastname@example.org) wrote about a terrorist attack response drill in issue 16.02.
* * * * *
2. In the News: Flu Economy – The Business Side of the Health Equation
The Illness's Unusual Course This Year Has Mixed Results For Health-Care Companies,
By THEO FRANCIS and ELLEN BYRON, WSJ, April 3, 2008
The surprising course of the latest flu season -- one of the most unpredictable in years -- has been a headache for companies from tissue makers to hospital owners.
In recent seasons, the flu has generally hit hard in December and peaked in February before petering out in March. But this year it followed a different pattern, getting off to a tamer start than usual and then roaring back in late February with the strongest surge in years. One reason: Vaccine planners failed to accurately predict the strains of the virus that would emerge this winter, making the flu shots most people got less effective than usual.
This has created a scramble at companies that count on Americans to sniffle and sneeze. Kimberly-Clark Corp., maker of Kleenex, blamed the cold-and-flu season's initial weakness for a 12% reduction in facial-tissue shipments in the quarter ended Dec. 31, compared with a year earlier.
In January, Walgreen Co. CEO Jeffrey Rein told a shareholder gathering that December marked the first time in his 25-year career at the company that cough- and cold-medicine sales fell during the month. If attendees of the meeting needed to cough, he joked, they should leave the room and "go to a movie theater or on a bus" to spread their germs. "We're really hoping for a very strong flu season," Mr. Rein told the crowd, according to a transcript of his presentation.
Procter & Gamble Co. said on a conference call in January that quarterly sales of its Vicks cold medicine had been weak. "Unfortunately, people have not been getting sick at a rate that we would all like yet," P&G CEO A.G. Lafley said on the call, with a chuckle.
Of course, each year, influenza, with its chills, aches and fever, takes a serious toll, killing about 36,000 Americans and hospitalizing more than 200,000; one government study pegs lost earnings at $16.3 billion a year. For most people, the flu season means having to get through a couple of days of fever, achiness and coughing. Americans bought $4.1 billion worth of cold, flu and allergy remedies last year, according to market-research firm Mintel International.
However, the flu economy encompasses more than just the makers and sellers of cold medicines. Even car insurers can get a financial boost when more drivers get the flu, because at least some stay off the roads. . .
The surge in flu cases that began in February probably saved HandClens, a fledgling hand sanitizer made by Woodward Laboratories Inc., of Aliso Viejo, Calif. It won a big order from Costco Wholesale Corp. last year only to see crowds of healthy shoppers ignore the product in January. "We were absolutely in panic mode," says CEO Kenneth Gerenraich. "We were borrowing from our credit line to pay the bills and keep ourselves afloat."
As the flu flourished in February, so did sales. "Now we're paying our bills, and the checks are flowing in," Mr. Gerenraich says. "Business is good."
Hospitals also rode the roller coaster of this flu season. Sicker patients often bring higher reimbursement from insurers or the government, and the flu can cause pneumonia and other complications. "You have a strong flu season, and the ancillary business is very profitable," David Dill, chief financial officer of LifePoint Hospitals Inc., explained to investors at a conference in January. If an elderly flu sufferer in intensive care needs a tracheotomy, "that turns into higher acuity business for us," he said. "Or, on the pediatric side, young kids coming into the hospital, that's a nice margin for us, as well."
LifePoint, a publicly traded chain based in Brentwood, Tenn., with 49 hospitals in 18 states, reported a 4.2% drop in year-over-year admissions in the fourth quarter of last year, which analysts and the company said was in large part because of the lack of flu cases. A LifePoint spokeswoman said admissions rose as flu cases soared in February and again in late March. . .
A confluence of factors seem to have contributed to this year's flu season. The strains of flu that have predominated in the U.S. in recent years are known as H1N1. Health officials predicted last year that that trend would continue, so pharmaceutical companies pumped out vaccines to target those strains. But H3N2 strains proved more prevalent this year. To make matters worse, H3N2 is a particularly nasty variety of the flu. . .
To read the entire article, go to http://online.wsj.com/article_print/SB120719135290885495.html.
* * * * *
3. International Medicine: What is Single-Payer Government Medicine really like?
Lessons from Sweden's Universal Health System: Tales
from the Health-care Crypt
by Sven R. Larson, Ph.D., JAPS, volume 13, No 1, 2008.
You cannot buy a new Lexus for $20,000. Small budgets cannot buy first-class medical care either. Yet one of the most persistent arguments for single-payer health insurance is that it will somehow give everyone gold-plated care at little or no cost.
There are a lot of dry statistics to prove just how wrong this notion is. But there is a side of this issue that rarely is told, especially not by advocates of a government medical monopoly. It is the story of those who pay the price for the serious rationing in a single-payer system.
Rationing of care is a reality under universal health insurance. Yet, its advocates seem universally oblivious to it. In an effort to unmask the reality of “universal coverage,” here are some actual case histories of real people with real experiences. They were reported by Swedish news media, in some instances numerous times. Sweden has longer experience with socialized medicine than almost any other country in the world.
In October 2003 Mrs. A., who lives in Malmo, Sweden, gave birth to a baby boy. She was signed out from the hospital after delivering the baby. There are not enough beds, so delivering a baby “without complications” is an outpatient procedure. Budget cuts have eliminated beds and medical staff. The next day Mr. and Mrs. A. noticed that their baby was weak and did not want to eat. As is common in Sweden, they did not call a doctor. Instead they called the tax-paid “TeleMedicine” service. Nobody advised them to go see a doctor right away. The following day their baby died of pneumonia.
In May 2006 another couple lost their three-year-old son to the budget-starved medical system. When Mr. and Mrs. B.'s son suffered from diarrhea and had been vomiting for almost two days, they took him to the emergency room at the nearby university hospital. A doctor ordered a supply of intravenous fluids, and the boy was sent on to the pediatric clinic to have them administered. When he arrived, the nurses had no time for him. Mr. and Mrs. B. repeatedly called on the medical staff to ask why nobody was coming to give their son the intravenous fluids he so desperately needed. Every time they got the same answer: nobody has time. They have too many patients and too little staff. Six hours later the three-year-old boy died of heart failure. You do not have to be a child to die from denial of care in Sweden.
In April 2005 Mr. C., 61 years old, became concerned about an unusual feeling of fatigue. He went to see a doctor at the local government-run clinic. The doctor sent him home with some encouraging words. Mr. C. came back a while later with worsened symptoms. Again he was sent home after a superficial examination and with more reassurance. Over the next year and a half Mr. C. visited this tax-paid local clinic a total of 14 times. He had no choice—all Swedes have to go through a government-run primary care physician at a tax-paid clinic in order to see a specialist. He developed blood in his urine. But the doctors refused even to take a blood test. They told Mr. C. and his son that they were denying him the blood test because of budget restrictions imposed by government bureaucrats. When, finally, Mr. C.'s son convinced the doctors to do one blood test, they found out that Mr. C. had cancer. He was referred to a regional hospital. There they established that his cancer, originally curable, had spread throughout his body. There was nothing left to do. He died shortly after.
Even those who do not die from encountering denials of care suffer considerably under Sweden's universal coverage. Mr. D., a multiple sclerosis patient, lives in Gothenburg, a city of 500,000. His doctor told him about a new medicine that is considered a breakthrough in MS treatment. But, when the doctor put in a request to have Mr. D. treated with it, the request was denied. Reason: it would cost 33 percent more than the old medicine, and that was more than the government was willing to pay. For most Swedes there are no longer any subsidies for prescription drugs. People with exceptionally high pharmaceutical costs get some subsidies, but they have to pay the greater share themselves. When the government denied Mr. D. the new medicine on the grounds that the subsidies would cost too much, he offered to pay the full cost of the medicine himself. He was denied the option to pay full cost out of his own pocket because, the bureaucrats said, it would set a bad precedent and lead to unequal access to medicine. In Sweden, there is no way to obtain access to medication outside the government-run system.
There are other absurd examples. How many times have you gone to see your doctor only to find security guards posted in the waiting room?
This is reality in Malmo, Sweden's third largest city. To see a physician the 280,000 residents of Malmo have to go to one of two local clinics before they can see a specialist. Except during business hours, only one of the two clinics is open to serve all the city's residents. As a result the clinic is severely overcrowded. The security guards serve two functions. They keep patients from becoming unruly as they sit and wait for hours to see a doctor, and they keep new patients from entering the center when the waiting room is considered full.
Opening the second clinic during off-business hours is considered too costly.
Government control over medicine also leads to government arrogance. In Gothenburg, a hospital was blessed with having a talented orthopedist on its staff. Dr. Leif Sward worked part time for the government-run hospital, part time for a local soccer club at its private orthopedic clinic, and part time for the British national soccer team.
You would expect a man with such credentials and experience to be considered a prized asset in a tax-supported hospital. But the government bureaucrats were unhappy with the fact that Dr. Sward was not working full time for them. They considered his work for the private health clinic “competing employment”—the soccer players should come to the tax-supported hospitals instead so as to increase their revenues. So they gave Dr. Sward an ultimatum: quit the private sector or leave us.
Dr. Sward chose the latter.
By giving Dr. Sward this ultimatum, the medical bureaucrats showed that their priority was to control and stifle competition and choice, an action contrary to the interests of patients. . .
If we implement a universal, single-payer model in America today, the negative effects will reliably occur about a generation from now. The question that we need to ask ourselves as we enter the election season is this: Are we willing to send that bill down the road for our children to pay?
To read more about Sweden's Health Care and the taxes required to pay for it, go to www.jpands.org/vol13no1/larson.pdf.
Single-payer medicine does not give Access to Healthcare, it gives access to a Denial of Service.
* * * * *
4. Medicare: The Economics of Entitlements
Horrors of a 'Crisis' By George F. Will, Washington Post, Sunday, April 13, 2008
During presidential elections, when candidates postulate this or that "crisis" for which each is the indispensable and sufficient cure, economic hypochondria is encouraged, so a sense of suffering is rampant. Recently the Wall Street Journal, like Joseph Conrad contemplating the Congo, surveyed today's economic jungle and cried, "The horror! The horror!"
Declines in housing values and the stock market are causing some Americans to delay retirement. A Kansas City man had been eager to retire to Arizona, but now, the Journal says, "figures he'll stay put for another couple of years." He is 59.
So, this is a facet of today's hydra-headed "crisis" -- the man must linger in the labor force until, say, 62. That is the earliest age at which a person can, and most recipients do, begin collecting Social Security.
The proportion of people aged 55 to 64 who are working rose 1.5 percentage points from April 2007 to February 2008, during which the percentage of working Americans older than 65 rose two-tenths of one percentage point. The Journal grimly reported, "The prospect of millions of grandparents toiling away in their golden years doesn't square with the American dream."
Oh? The idea that protracted golden years of idleness are a universal right is a delusion of recent vintage. Deranged by the entitlement mentality fostered by a metastasizing welfare state, Americans now have such low pain thresholds that suffering is defined as a slight delay in beginning a subsidized retirement often lasting one-third of the retiree's adult lifetime.
In 1935, when Congress enacted Social Security, protracted retirement was a luxury enjoyed by a tiny sliver of the population. Back then, Congress did its arithmetic ruthlessly: When it set the retirement age at 65, the life expectancy of an adult American male was 65. If in 1935 Congress had indexed the retirement age to life expectancy, today's retirement age would be 75. . .
Yes, in January single-family homes in major metropolitan areas lost 10.7 percent of their value from last January. To find such a large decline in a year you must peer back into the mists of prehistory, all the way back to . . . the 1990s. Furthermore, the vast majority of homeowners will remain well ahead, even after the market corrects for housing inflation.
By one measure, between the beginning of 2000 and the middle of 2006, as the consumer price index was rising 21 percent, average housing prices rose 93 percent -- and much more in some markets Miami, 180 percent; Los Angeles, 175 percent; Washington, D.C., 150 percent).
Not long ago there was broad agreement that too much of Americans' wealth was tied up in the nation's housing stock and that the principal impediment to homeownership was not a scarcity of cheap mortgages but the prevalence of high housing prices. Hence deflation of housing prices would be desirable. . .
Subprime mortgages are a small minority of mortgages, and only a minority of subprime borrowers are not making their payments. Casting this minority of a minority as victims of "predatory" lending fits the liberal narrative that most Americans are victims of this or that sinister elite or impersonal force and are not competent to cope with life's complexities without government supervision. . .
What next? Adults still burdened with student loans have not yet announced their entitlement to relief, but as they watch this subprime drama, they might.
To read the entire OpEd column, go to
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5. Medical Gluttony: Homeless Living Standards Are Improving
This week, I saw a Medicaid patient who rolled into the office on a motorized wheelchair (MWC). But this was no ordinary wheelchair. It had large tires, could go down the corridors dangerously fast, noiselessly, and could turn in a circle. Despite this mobility, it was a few inches wider than my office door, which accommodates standard wheelchairs, including MWC. He had obtained the MWC from Medicaid because of his back disability. The disability wasn't apparent since he easily got out of the MWC, walked through the waiting room, down the corridor, and into the office where I was working. Examination failed to reveal any significant disability of the back, which had full range of motion (ROM). He stated that he was able to walk several blocks without difficulty. The MWC allowed him to go shopping down the street without a car, go to the grocery store to buy food with his food stamps, and drive to the river for lodging. I noticed a large backpack on the back of the MWC. He said it carried his sleeping bag, groceries, drinking water and personal items.
The MWC also provided transportation to visit the 26 homeless food shelters in the various churches and organizations in Sacramento. He had visited them all and chose a different one each day which provided a variety of warm meals on essentially a monthly rotational basis. He was never asked for his ID or a disability card.
In addition, the MWC provided transportation to visit his parent's home since they were both retired and away during frequent world travels. This allowed him a nice warm bath and a place to keep his wardrobe and sleep most weekends, especially during the inclement winter months. His cell phone kept him in touch with family and friends.
On a daily basis, he got his MWC batteries charged at the light rail stops, where there is always an electric outlet. This gave him a great range of travel. It also allowed him to recharge his cell phone so he was never out of communication with friends or relatives.
He stated he could always move indoors if he wished, but he enjoyed his lifestyle for the present. Since he was in his early 40s, he thought he might keep this up for at least another five, if not ten years.
* * * * *
6. Medical Myths: Scary Forecasts are Medicare's Little Secrets
Scary Forecasts by John Goodman, PhD, The Expert Who Explodes Medical Myths.
Today I'm going to let you in on a little secret about forecasting health care costs: All the forecasters cheat. Cheat? Yes, cheat.
There is nothing underhanded about it. For people who read footnotes and appendices, the information is all there. But for ordinary mortals, the projections you see are not what you think they are.
But let's back up. Why do you even care about forecasts of future health care spending? The rational reasons are: (1) to figure out what path we are currently on, (2) to decide whether the path is acceptable, and (3) if it is not acceptable, to figure out how to get off of it.
Turns out, however, that the estimators at the Congressional Budget Office (CBO), the Centers for Medicare and Medicaid Services (CMS) and the Social Security/Medicare Trustees have already done tasks (1) and (2) and decided that the future is so terribly awful, they cannot possibly wait for you or anyone else to do task number (3).
So what we get out of these agencies is not a real projection of the past into the future but one that has been tempered by ...the hope? ...the wish? ...the refusal to accept reality? ...or the fanciful belief that somehow, somewhere, in some totally unexplained way we will ...we must ...we have to ...get off the path we are on.
For example, the Medicare Trustees, after acknowledging that health spending has been growing at a rate that is 2 to 3 percentage points above GDP growth, assume that the growth rate will decline to the GDP growth rate over the next 75 years. The CBO, after acknowledging that health care spending per capita has been growing at a rate that is 2.1 percentage points faster than GDP per capita for the past 30 years, assumes much slower rates of growth for Medicare and Medicaid beginning in 2018 and thereafter.
Will those changes occur? Maybe. Maybe not. It still begs the question: What path are we really on? Note: even after tempering, all the projections are bad. However, a new CBO www.cbo.gov/ftpdocs/87xx/doc8758/11-13-LT-Health.pdf contains an untempered projection that implies that:
• Within the next 50 years, by the time today's teenagers reach the retirement age, health care spending will crowd out every other program of the federal government.
• Well before that occurs, Medicaid spending at the state level will crowd out every other function of state government.
To avoid this unpleasant outcome and keep all other programs in place, we will have to double the size of government! A previous www.cbo.gov/ftpdocs/82xx/doc8295/07-09-Financing_Spending.pdf estimates the needed tax rates at 66% for middle-income families and 92% for high-income families - assuming no increase in taxpayer resistance.
That is the path we are on. We will not get off of it with pen and ink. We will get off of it only with real reform. . .
Goodman, President, National Center for Policy Analysis
12770 Coit Rd., Suite 800, Dallas, Texas 75251 www.ncpa.org
Subscribe to this digest: www.ncpa.org/sub/#cdhc
NCPA is a service mark of the National Center for Policy Analysis. We are an independent public policy institute and are not affiliated with any other organization, trade association or corporation.
Copyright 2003-2008 National Center for Policy Analysis - All rights reserved
* * * * *
7. Overheard in the Medical Staff Lounge: The Candidates can't get it Right.
Dr Sam: Looks like all the candidates will sell American Health Care down the river.
Dr. Dave: You're probably right. But McCain is the least harmful to our patients.
Dr. Yancy: I'm not fighting it any more. Government medicine will come by fiat or incrementally. We just look like losers trying to fight it. Just let the people experience it and rebel.
Dr. Rosen: But then it will be too late. Look at all the anecdotes we have from England, Sweden, Canada and Europe about patients dying from lack of health care, and they are rebelling loudly. But the bureaucrats aren't going to let go.
Dr. Sam: You have that right. I'm beginning to think the bureaucrats take great pleasure in the whole process. They don't think of death or dying.
Dr. Yancy: They're just following directives. Almost like my family dying in the holocaust - the soldiers turning on the gas were just following orders.
Dr. Rosen: Only this is more insidious. Like turning up the heat to boil a lobster. He doesn't feel it until he's cooked.
Dr. Dave: Look at Mrs. Clinton's plan of 1993. She won. Over the next decade, the opposition implemented nearly all her items incrementally and the public doesn't even know it. We have government medicine and people think it's still private. Even private medicine is controlled by Medicare regulations.
Dr. Rosen: It's really sad when the opposition, our friends, no longer see the problem.
Dr. Edwards: Medicare can limit your fees even if you don't participate in Medicare and patients see you privately.
Dr. Yancy: I don't think the average American can appreciate the ferocity of the federal government. If they haven't had a run in, they just think of it as a friendly Uncle Sam.
Dr. Rosen: And our friendly Uncle Sam is showing his age and loss of fight in the last half century. He is not even winning our external wars.
Dr. Patricia: Don't you think those wars have been mistakes?
Dr. Sam: Mistakes or not. It's always a greater mistake not to win the war. If we had let McArthur win the Korean War, we would not have a current North Korean problem. And then we would most likely not have had a Vietnam problem. And the current war could be won in 30 days if we just decided to do it and eliminate all the sources of the insurgents. But Congress would just have a fit.
Dr. Rosen: I guess we'll have to handle that problem in November.
Dr. Dave: I don't think the American people have the stomach to do it.
Dr. Edwards: Maybe this two-hundred year experiment in human freedom has run its course.
Dr. Rosen: It really only lasted 150 years. For the last 75 years, the government has no longer been our servant. We have been and continue to be the servants.
* * * * *
8. Voices of Medicine: A Review of Local and Regional Medical Journals
Bulletin of the California Society of Anesthesiologists, Winter, 2008
In Vino Veritas: Anesthesia & Mystical Truth, By George A. Mashour, M.D., Ph.D.
I have known Dr. George Mashour since our overlapping days at the Massachusetts General Hospital, and as I pen this introduction, I appreciate anew just why George truly is in a class of his own. Now comfortably ensconced at the University of Michigan, George is by many measures as curious a character as the famous Dr. Richard Feynman from whom I have pilfered the title of this introduction. Beginning with this issue of the Bulletin, we shall be reprinting a variety of his “writings.” I can assure you that you will not want for entertainment. I first met George when he came to the MGH for his anesthesia residency. Although that institution sports its fair share of talented souls, George stood out even within that group. He had, by the time of our first meeting, already completed a Ph.D. in Neuroscience, a residency in psychiatry, and was one of a small group of esteemed Fulbright Scholars. When he showed up in our OR and introduced himself, it was, to quote Bogie's famous old line, “the beginning of a beautiful friendship.” Although George may tell audiences that I had a substantial impact on parts of his career, I would counter that George is the one who had an impact on mine. He was one of those residents that all academic faculty dream of finding: bright, energetic, creative and ever so full of the capacity “to do.” The opportunity to call him one of my “students” validated my fundamental rationale for being in academia. I have made it my habit to sample each and every one of his writings, some dating from the earliest days of his residency, each reflecting his truly masterful fluency with classical and modern learning. It is, however, his first major anesthesia publication dating from 2004 and a recent talk he gave to my group in Santa Barbara based on a 2005 publication that best reflect the breadth of his intellectual and literary talents. . .
It is this broad talent—his ability to convey the mystery of our trade, to stir in us the emotion associated with that mystery, yet simultaneously making all of us just a bit wiser about our humble and small place in the eons-long struggle against human suffering—that makes his works worthy of our attention. Enjoy!
· Jason A. Campagna, M.D., Ph.D., Associate Editor
Gentle reader, how fortunate you are to be living in the great state of California. No, it is not because of the sunny climes, nor the vast expanses of the fair Pacific, nor even the sculpted pectoralis majors of your governor. It is, in fact, because of the editor of the CSA Bulletin: you are unequivocally blessed to have a wise soul like Dr. Stephen Jackson as the literary élan vital of your Society. Although I have never met the man personally, I became thoroughly convinced of his exquisite taste and discerning mind when he lauded a series of essays I penned during my chief residency as “most brilliantly written” and “vastly entertaining.” Here, I said to myself, is a man with vision. Here, I exulted, is a man with his finger on the pulse of the emerging field of literary anesthesiology.
Don't get me wrong, people: I previously have had the experience of submitting articles to other savvy editors in California. Yet, with no offense to them intended, it seems to me that they have an almost irrational obsession with trivialities such as “data” and “proof,” expecting me to beat upon my delicate insights with such blunt instruments as “statistics.” Indeed, I often comfortably begin my rebuttal letters with “you're just not getting it!” Dr. Jackson, on the other hand, is a man who seems to understand that the deepest truths cannot be taught, but rather are caught.
On that note, the present treatise reflects on the topic of anesthesia and mystical truth, a story that has its origins in antiquity and touches on the deepest quandaries of our field. One of the fundamental scientific questions in anesthesiology is the mechanism by which general anesthetics extinguish consciousness, a question that becomes yet more complex when we consider that—somewhere along the road to sweet oblivion—anesthetics can also produce heightened, even mystical states of consciousness.
The Temple of Apollo in Delphi was among the most sacred sites of Ancient Greece, because within those hallowed halls was perched the Oracle. The Oracle was typically a woman from Delphi who underwent a mystical initiation that transformed her into a prophetic priestess, or Pythia. These seers would induce themselves into a trance-like state, from which sprung the cosmic truths that guided the lives of the ancients. The Pythia, however, was not simply high on life. As Strabo (64 B.C.-A.D. 25) writes:
They say that the seat of the oracle is a cavern hollowed deep down in the earth, with a rather narrow mouth, from which rises a pneuma [the ancient Greek word for gas, vapor, or breath] that produces divine possession. A tripod is set above this cleft, mounting which, the Pythia inhales the vapor and prophesies.
The vapors emanating from the chasm under the Temple thus imbued the Pythia with a mystical force—or did they? Around 1900 an English classicist named Adolphe Oppe visited French archeological excavations at Delphi and found no evidence of a chasm or any source of gas. The tales of old appeared to be debunked, and the mysterious vapors of Delphi were regarded as nothing more than legend throughout the greater part of the 20th century.
A more recent investigation by John Hale and colleagues revealed that, in fact, there were hidden faults under the Delphic Temple.1 Analysis of the spring water around the site of the Oracle identified the gases methane, ethane, and ethylene. It was the sweet aroma of ethylene that fit Plutarch's ancient description of the Temple's vapors as expensive perfumes. What finally helped reveal the secret of the gases were not the records of the historian Plutarch, but rather the investigation of one of the great women in the history of anesthesiology. In 1899, Isabella Herb was an anesthetist for Charles Mayo at the Mayo Clinic and, in the 1920s, introduced the anesthetic ethylene into clinical practice.2 (Figure 1) Her publications on ethylene from the 1920s and 1930s indicate that its administration in lower doses evokes a trance-like state leading to euphoria and mystical experiences. Occasionally, however, patients under the influence of ethylene would thrash about uttering incoherent screams—descriptions like these fit ancient reports of the Oracles periodically having violent reactions instead of prophecies. The mystery of Delphi appeared to be solved.
The relationship of anesthesia to mystical truth has a more academic manifestation in modernity, indeed, in the Harvard of the late 19th century. Renowned psychologist William James's experiments with nitrous oxide influenced one of his greatest works, The Varieties of Religious Experience.3 (Figure 2) In the midst of a nitrous reverie, James once scribbled, “That sounds like nonsense, but it is pure on sense!” James published more formal reflections of his nitrous experiences in an 1898 article entitled “Consciousness Under Nitrous Oxide.” This treatise was inspired by the work of one who has been called “anesthesia's philosopher and mystic,” Benjamin Paul Blood.4 In 1874, Blood published a book entitled The Anaesthetic Revelation and the Gist of Philosophy, which heavily influenced the thinking of James. Blood attempted to formulate a foundation for philosophy based on his 14-year investigation into the mysteries of the mind using ether and nitrous oxide. Blood regarded the anesthetic experience as a key to resolving the typical dualistic thinking of Western philosophy. Oscar Wilde, after receiving anesthesia for a tooth removal, elegantly expressed this synthetic experience in a letter to William James:
The next experience I became aware of, who shall relate! My God! I knew everything. A vast inrush of obvious and absolutely satisfying solutions to all possible problems … an all-embracing unification of hitherto contending and apparently diverse aspects of truth took possession of my soul by force … Then, in a flash, this state of intellectual ecstasy was succeeded by one that I shall never forget … a state of moral ecstasy. I was seized with an immense yearning to take back this truth to the feeble, sorrowing, struggling world in which I had lived.
So it is that anesthesia conditioned the sense of truth in both the ancient and modern worlds. Perhaps one day the cognitive neuroscience of anesthesiology will grasp these mystical phenomena that may seem like nonsense, but in fact are a most intriguing on sense.
To read the entire article, go to www.csahq.org/pdf/bulletin/mashour_57_1.pdf.
* * * * *
9. Book Review: The Zone Diet by Barry Sears, PhD
The other day at the nursing station, I observed the ward clerk reading "Weight Watchers" as she devoured a "Babe Ruth." . . . I guess that keeps the scales balanced and the economy moving. It also contributes to the epidemic in America – 50-60% of the population are overweight with 25-33% affected with obesity. We consumed 15% more calories in 1994 than we did in 1970 and today we dine out twice as often. If obesity was an infectious disease, we would call it a national crisis.
Of all the books that cross my desk, there is at least one or two each month about dieting. The "diet industry" is flourishing. But is there really any new information? At one bookstore I counted 107 different diet books. At another there were over 200 titles. It is interesting that as this deluge of new books were filling up the shelves, some "dated" diet books that spoke of revolutionary new medical dietary evidence were now on sale at 10% of their initial listing.
There are number of diet books written by celebrities. These authors are obviously without credentials. However, some of these books are quite basic and meet a need because of a co-author with credentials, e.g., MS, PhD or MD, although the latter group may not always be as knowledgeable as the public assumes.
A brief review of some of these books will describe this self-perpetuating industry. The questions still remain. Are they of value to the overweight Americans? Are they helpful to those with other dietary problems such as hyperlipidemia, coronary artery disease, peripheral vascular disease, hypertension, or diabetes? Do they provide complete lifelong nutritional programs? Do they incorporate exercise and stress management? There are at least three that do.
www.amazon.com/exec/obidos/redirect?link_code=as2&path=ASIN/0722536925&tag=delmeyernet-20&camp=1789&creative=9325 A couple of years ago, my RN-NP introduced me to The Zone Diet by Barry Sears, PhD. Since then he has written additional volumes, including Mastering the Zone, which I received in the current package of audio tapes (Harper Audio, $25). Dr. Sears gives a very comprehensive nutritional program which is easily put into action. After a discussion of the ill effects of hyperinsulinism, he presents a system of balanced eating so one always remains "in the zone." If you're "in the zone" of normal insulin levels one should not have postprandial lethargy. The current presentation seems more complete than what I have encountered in the past. He also states that only in America can one go to a gym and find valet parking. He advises that one should park at the most remote regions of a parking lot and walk. He even suggests that we park our cars about 15 minutes from work to provide at least 15 minutes of exercise every morning and every evening. He sees no need to buy exercise equipment or join a gym or pay to exercise. As physicians we have people run in place for a two minute exercise pulse in an eight foot exam room. Americans have a hard time thinking that anything happens unless they spend money. Much of the world feels we have too much of that. I found his system very easy to follow and quite effective.
To read the others, please go to http://healthcarecom.net/Diets.htm#The%20Zone%20Diet.
Diets: Reviews by Del Meyer, MD
* * * * *
10. Hippocrates & His Kin: Health Care Reform is Just Around the Corner
Politician: Health care reform is just around the corner.
Would someone just tell me around which corner?
Employer: I know that half of my sales and promotion costs are wasted.
I just wish I knew which half.
Consumer: I'm going to start walking more and riding my bike more with gasoline at $4 a gallon.
If the Gas Prices don't slow down, America will be getting green and Americans getting healthier!
The side effects of gasoline seeking market base prices are helping the economy. But are the environmentalists happy?
The free market is more effective in the greening of America than Congress could ever hope for. Can we put Congress out on a Furlough for a few years to let problems decrease?
Naiveté Reigns Supreme: Evian water 9 oz $1.49 = 21.19 per gallon! $21.19 for WATER and the buyers don't even know the source.
Evian spelled backwards is Naive.
To read more HHK, go to www.healthcarecom.net/hhk2001.htm.
To read more HMC, go to www.delmeyer.net/hmc2002.htm.
* * * * *
11. Organizations Restoring Accountability in HealthCare, Government and Society:
• The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at www.ncpa.org and register to receive one or more of these reports. Read the real news about Medicare and Social Security.
• Pacific Research Institute, (www.pacificresearch.org) Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog. Read John Graham's Blog: San Francisco's Health Access Plan Has Raised $6 Million - Now It Only Needs $194 Million More To Achieve "Universal" Health Care.
• The Mercatus Center at George Mason University (www.mercatus.org) is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government. Read another success story on Empowering the Poor.
• The National Association of Health Underwriters, www.NAHU.org. The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page. Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. www.nahu.org/publications/hiu/index.htm. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business. Be sure to review the current articles listed on their table of contents at http://www.hiu-digital.com/hiu/200803/. To see my recent column, go to http://hiu.nahu.org/article.asp?article=1660&paper=0&cat=137
• The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at www.galen.org. A new 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. Simply browse by topic on the opening page.
• Greg Scandlen, an expert in Health Savings Accounts (HSAs) has embarked on a new mission: Consumers for Health Care Choices (CHCC). To read the initial series of his newsletter, Consumers Power Reports, go to www.chcchoices.org/publications.html. To join, go to www.chcchoices.org/join.html. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn. Read about MSAs and Medicare.
• The Heartland Institute, www.heartland.org, publishes the Health Care News. Read the late Conrad F Meier on What is Free-Market Health Care?. You may sign up for their health care email newsletter at www.heartland.org/Article.cfm?artId=10478. Read an update on HSAs.
• The Foundation for Economic Education, www.fee.org, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling, PhD, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. The Law of Unintended Consequences is a fascinating thing. You can never be entirely sure what the second-, third-, etc. -order effects of any action will be. This is especially so with government policy because centralized decision-making can do so much damage to so many people. That ought to humble the politicians and bureaucrats, but it never does.
• The Council for Affordable Health Insurance, www.cahi.org/index.asp, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse." Read the current update on the 2008 Candidates Health Care Proposals.
• The Independence Institute, www.i2i.org, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter at www.i2i.org/healthcarecenter.aspx. Read her latest newsletter at http://www.i2i.org/articles/HCPCjournal1.pdf.
• Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at www.quebecoislibre.org/apmasse.htm to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read the treatise on Market Failures And Externalities Do Not Justify Government Intervention.
• The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at www.fraserinstitute.ca for an overview of the extensive research articles that are available. You may want to go directly to their health research section at www.fraserinstitute.ca/health/index.asp?snav=he. This month, you might like to read what real progressive taxation looks and feels like: Total tax bill for average Canadian family has increased by more than 1,700 percent since 1961.
• The Heritage Foundation, www.heritage.org/, founded in 1973, is a research and educational institute whose mission is to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site. This month, be sure to read another Medicare story on Congress Must Not Ignore the Medicare Trustees' Warning.
• The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at www.mises.org to obtain the foundation's daily reports. You may also log on to Lew's premier free-market site at www.lewrockwell.com to read some of his lectures to medical groups. To learn how state medicine subsidizes illness, see www.lewrockwell.com/rockwell/sickness.html; or to find out why anyone would want to be an MD today, see www.lewrockwell.com/klassen/klassen46.html.
• CATO. The Cato Institute (www.cato.org) was founded in 1977 by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio at www.cato.org/people/cannon.html.
• The Ethan Allen Institute, www.ethanallen.org/index2.html, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.
• The Free State Project, with a goal of Liberty in Our Lifetime, http://freestateproject.org/, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]
• 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, war time allows the federal government 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 war time 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 www.stcroixreview.com.
• Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at www.hillsdale.edu to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. 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 Charles Kessler, Editor, Claremont Review of Books on “Limited Government: Are the Good Times Really Over?” The last ten years of Imprimis are archived www.hillsdale.edu/hctools/imprimis_archive/.
* * * * *
Thank you for joining the MedicalTuesday.Network and Have Your Friends Do the Same. If you receive this as an invitation, please go to www.medicaltuesday.net/Newsletter.asp and enter you email address to join the 20,000 members who read this newsletter. If you are one of the 80,000 guests that surf our web sites, we thank you and invite you to join the email network on a regular basis by subscribing at the website above.
Please note that sections 1-4, 6, 8-9 are entirely attributable quotes and editorial comments are in brackets. Permission to reprint portions has been requested and may be pending with the understanding that the reader is referred back to the author's original site. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff..
ALSO NOTE: MedicalTuesday receives no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the research and writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country.
Spammator Note: MedicalTuesday uses many standard medical terms considered forbidden by many spammators. We are not always able to avoid appropriate medical terminology in the abbreviated edition sent by e-newsletter. (The Web Edition is always complete.) As readers use new spammators with an increasing rejection rate, we are not always able to navigate around these palace guards. If you miss some editions of MedicalTuesday, you may want to check your spammator settings and make appropriate adjustments. To assure uninterrupted delivery, subscribe directly from the website rather than personal communication: www.medicaltuesday.net/newsletter.asp
Del Meyer, MD, Editor & Founder
6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608
Words of Wisdom
The Power to tax involves the power to destroy. -Chief Justice John Marshall, Supreme Court decision in McCulloch v. Maryland, March 6, 1819.
Government is an endless pursuit of new ways to tax. -Anonymous Aphorisms
Why do they couple taxes and death? Death only comes once. -Anonymous Aphorisms
Some Recent and Timely Postings
DIETS DON'T WORK, by Bob Schwartz, PhD, Breakthru Publishing, Houston, Texas, Third Revised Edition, 149 pp, $12.95 © 1996 www.delmeyer.net/bkrev_DietsDon'tWork.htm
THE CANCER WARD by Alexander Solzhenitsyn. Translated by Nicholas Bethel and David Burg, Noonday Press, New York, © 1974. (Russian edition 1968) www.healthcarecom.net/bkrev_CancerWard.htm
CAN THE HEALTH INSURANCE INDUSTRY SURVIVE? www.healthcarecom.net/OE_UniversalHealthCareDefeatedInCA.htm
Charlton Heston, who won the 1959 best actor Oscar as the chariot-racing "Ben-Hur" and portrayed Moses, Michelangelo, El Cid and other heroic figures in movie epics of the '50s and '60s, has died. He was 84.
The actor died Saturday night at his home in Beverly Hills with his wife Lydia at his side, family spokesman Bill Powers said. He declined to comment on the cause of death or provide further details.
"Charlton Heston was seen by the world as larger than life. He was known for his chiseled jaw, broad shoulders and resonating voice, and, of course, for the roles he played," Heston's family said in a statement. "No one could ask for a fuller life than his. No man could have given more to his family, to his profession, and to his country."
Heston revealed in 2002 that he had symptoms consistent with Alzheimer's disease, saying, "I must reconcile courage and surrender in equal measure."
With his large, muscular build, well-boned face and sonorous voice, Heston proved the ideal star during the period when Hollywood was filling movie screens with panoramas depicting the religious and historical past.
"I have a face that belongs in another century," he often remarked.
Publicist Michael Levine, who represented Heston for about 20 years, said the actor's passing represented the end of an iconic era for cinema. "If Hollywood had a Mt. Rushmore, Heston's face would be on it," Levine said.
The actor assumed the role of leader offscreen as well. He served as president of the Screen Actors Guild and chairman of the American Film Institute and marched in the civil rights movement of the 1950s.
With age, he grew more conservative and campaigned for conservative candidates. In June 1998, Heston was elected president of the National Rifle Association, for which he had posed for ads holding a rifle.
He delivered a jab at then-President Clinton, saying, "America doesn't trust you with our 21-year-old daughters, and we sure, Lord, don't trust you with our guns." Heston stepped down as NRA president in April 2003, telling members his five years in office were "quite a ride. ... I loved every minute of it."
Later that year, he was awarded the Presidential Medal of Freedom, the nation's highest civilian honor. "The largeness of character that comes across the screen has also been seen throughout his life," President Bush said at the time.
"America has lost a great patriot. The Second Amendment has lost a faithful friend," said Wayne LaPierre, of the National Rifle Association of America, in a statement. "So have I, and so have four million NRA members and eighty million gun owners. And so has every American who cares about the Bill of Rights, individual liberty, and Freedom.
Heston engaged in a lengthy feud with liberal Ed Asner during the latter's tenure as president of the Screen Actors Guild. His latter-day activism almost overshadowed his achievements as an actor, which were considerable.
Heston lent his strong presence to some of the most acclaimed and successful films of the midcentury. "Ben-Hur" won 11 Academy Awards, tying it for the record with the more recent "Titanic" (1997) and "The Lord of the Rings: The Return of the King" (2003). Heston's other hits include: "The Ten Commandments,""El Cid,""55 Days at Peking,""Planet of the Apes" and "Earthquake."
He liked to cite the number of historical figures he had portrayed:
Andrew Jackson ("The President's Lady,""The Buccaneer"), Moses ("The Ten Commandments"), title role of "El Cid," John the Baptist ("The Greatest Story Ever Told"), Michelangelo ("The Agony and the Ecstasy"), General Gordon ("Khartoum"), Marc Antony ("Julius Caesar,""Antony and Cleopatra"), Cardinal Richelieu ("The Three Musketeers"), Henry VIII ("The Prince and the Pauper").
Heston made his movie debut in the 1940s in two independent films by a college classmate, David Bradley, who later became a noted film archivist. He had the title role in "Peer Gynt" in 1942 and was Marc Antony in Bradley's 1949 version of "Julius Caesar," for which Heston was paid $50 a week.
Film producer Hal B. Wallis ("Casablanca") spotted Heston in a 1950 television production of "Wuthering Heights" and offered him a contract. When his wife reminded him that they had decided to pursue theater and television, he replied, "Well, maybe just for one film to see what it's like."
Heston earned star billing from his first Hollywood movie, "Dark City," a 1950 film noir. Cecil B. DeMille next cast him as the circus manager in the all-star "The Greatest Show On Earth," named by the Motion Picture Academy as the best picture of 1952. More movies followed.
Most were forgettable low-budget films, and Heston seemed destined to remain an undistinguished action star. His old boss DeMille rescued him.
The director had long planned a new version of "The Ten Commandments," which he had made as a silent in 1923 with a radically different approach that combined biblical and modern stories. He was struck by Heston's facial resemblance to Michelangelo's sculpture of Moses, especially the similar broken nose, and put the actor through a long series of tests before giving him the role.
The Hestons' newborn, Fraser Clarke Heston, played the role of the infant Moses in the film.
More films followed: the eccentric thriller "Touch of Evil," directed by Orson Welles; William Wyler's "The Big Country," costarring with Gregory Peck; a sea saga, "The Wreck of the Mary Deare" with Gary Cooper.
Then his greatest role: "Ben-Hur."
Heston wasn't the first to be considered for the remake of 1925 biblical epic. Marlon Brando, Burt Lancaster and Rock Hudson had declined the film. Heston plunged into the role, rehearsing two months for the furious chariot race.
He railed at suggestions the race had been shot with a double: "I couldn't drive it well, but that wasn't necessary. All I had to do was stay on board so they could shoot me there. I didn't have to worry; MGM guaranteed I would win the race."
The huge success of "Ben-Hur" and Heston's Oscar made him one of the highest-paid stars in Hollywood. He combined big-screen epics like "El Cid" and "55 Days at Peking" with lesser ones such as "Diamond Head,""Will Penny" and "Airport 1975." In his later years he played cameos in such films as "Wayne's World 2" and "Tombstone."
He often returned to the theater, appearing in such plays as "A Long Day's Journey into Night" and "A Man for All Seasons." He starred as a tycoon in the prime-time soap opera, "The Colbys," a two-season spinoff of "Dynasty."
At his birth in a Chicago suburb on Oct. 4, 1923, his name was Charles Carter. His parents moved to St. Helen, Mich., where his father, Russell Carter, operated a lumber mill. Growing up in the Michigan woods with almost no playmates, young Charles read books of adventure and devised his own games while wandering the countryside with his rifle.
Charles's parents divorced, and she married Chester Heston, a factory plant superintendent in Wilmette, Ill., an upscale north Chicago suburb. Shy and feeling displaced in the big city, the boy had trouble adjusting to the new high school. He took refuge in the drama department.
"What acting offered me was the chance to be many other people," he said in a 1986 interview. "In those days I wasn't satisfied with being me."
Calling himself Charlton Heston from his mother's maiden name and his stepfather's last name, he won an acting scholarship to Northwestern University in 1941. He excelled in campus plays and appeared on Chicago radio. In 1943, he enlisted in the Army Air Force and served as a radio-gunner in the Aleutians.
In 1944 he married another Northwestern drama student, Lydia Clarke, and after his army discharge in 1947, they moved to New York to seek acting jobs. Finding none, they hired on as codirectors and principal actors at a summer theater in Asheville, N.C.
Back in New York, both Hestons began finding work. With his strong 6-feet-2 build and craggily handsome face, Heston won roles in TV soap operas, plays ("Antony and Cleopatra" with Katherine Cornell) and live TV dramas such as "Julius Caesar,""Macbeth,""The Taming of the Shrew" and "Of Human Bondage."
Heston wrote several books: "The Actor's Life: Journals 1956-1976," published in 1978; "Beijing Diary: 1990," concerning his direction of the play "The Caine Mutiny Court Martial" in Chinese; "In the Arena: An Autobiography," 1995; and "Charlton Heston's Hollywood: 50 Years of American Filmmaking," 1998.
Besides Fraser, the Hestons had a daughter, Holly Ann, born Aug. 2, 1961. The couple celebrated their golden wedding anniversary in 1994 at a party with Hollywood and political friends. They had been married 64 years when he died.
In late years, Heston drew as much publicity for his crusades as for his performances. In addition to his NRA work, he campaigned for Republican presidential and congressional candidates and against affirmative action. . .
At a Time Warner stockholders meeting, he castigated the company for releasing an Ice-T album that purportedly encouraged cop killing.
Heston wrote in "In the Arena" that he was proud of what he did "though now I'll surely never be offered another film by Warners, nor get a good review in Time. On the other hand, I doubt I'll get a traffic ticket very soon."
For The Economist Obituary, go to www.economist.com/obituary/displaystory.cfm?story_id=11004056.
On This Date in History - April 15
On this date in 1965, the Sixteenth President of the United States died from wounds inflicted by assassin John Wilkes Booth.
On this date in 1912, the S. S. Titanic, the invincible ship, sank with loss of more than 1500 lives. It was mortally wounded by an iceberg the previous night.
On this date in 1452, Leonardo da Vinci was born in the city of Vinci in Tuscany. The world is a great deal richer for having had a versatile man of genius like Leonardo in it.
On this date, the United States Income Taxes are due for the previous year. Some years ago, a gentleman with a penchant for designating special days announced that from that point on, April 15 was to be known as National Hostility Day, a day of ill feeling for many taxpayers who feel put upon indeed. Maybe it should be a national day for mourning the huge mistake that was made in ratifying the 16th amendment on February 3, 1913, to allow Congress to tax its citizens without any limits. We need another amendment to limit Congress' greed to a 15 percent limit on income tax and a 10 percent limit on interstate excise or import taxes; to limit state legislatures to a five percent income tax and a five percent sales tax; to limit the local government to a one percent property tax and a one percent sales tax. All other taxes, including the corporate taxes, which are taxes on tax, would be outlawed. All polls, the Readers Digest as well as the liberal press, agree that no one should be taxed more than one-fourth of his earnings. The above limits are overly generous, but indeed a first step.
After Leonard and Thelma Spinrad