Community For Better HealthCare

Vol V, No 2, Apr 25, 2006


In This Issue:


1.      Featured Article: Privatize the Welfare State By HOWARD HUSOCK, WSJ, March 9, 2006.

No matter whose priorities prevail in this year's budget debate, it is a certainty that the federal government will continue to devote billions to activities known as "social services." These include support for everything from foster care to drug abuse prevention; indeed, the Administration for Children and Families alone supports no less than 60 such programs at an annual cost of nearly $13 billion, in addition to the cash welfare payments it handles. Billions more are spent on such purposes by state and local governments, often through contracts with private "providers." Robust public debate has developed as to whether other parts of the New Deal legacy still make sense, but the central role of government in providing or paying for social services appears settled -- with the only question being how best to achieve efficiency and effectiveness.

But should this role be considered beyond debate? It is a question worth pondering today because of a historic confluence of circumstances: an impending wave of charitable giving at an unprecedented level; long-term projections of federal deficits, undermining the assumption that social programs can best be funded by government; and a new generation of so-called social entrepreneurs, looking to try creative approaches to help those in need, and to do so on a large scale. These circumstances, moreover, emerge in the context of heightened, post-Katrina public dissatisfaction with the quality of government-provided public services. Together, they suggest the possibility of imagining a modern society where major social service efforts are provided on a large scale outside the government, through privately funded, not-for-profit charitable organizations.

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In the era before passage of the Social Security Act in 1935, whose Title V provided for such spending, privately funded agencies yielded the bulk of U.S. social services, augmented by such local public institutions as poorhouses, asylums and orphanages. Nevertheless, such agencies -- and groups like the Child Welfare League of America -- assumed that government services would be at least as good as their private, often religiously inspired predecessors, as well as more universal in reach and standardized in approach, and thus preferable. They did not oppose government social-service spending, and, indeed, were often among its leading advocates.

In any event, greater government social service spending was certainly achieved. In terms of quality, however, it is hard to argue that things have worked out the way reformers intended. Consider services for children. Over the past 10 years, 22 to 36 children have died each year under the watch of New York City's Administration for Children and Families. A recent federal review of state child welfare agencies found that not a single state complied fully with federal standards. Then there's Head Start, whose potent name, and the fact that it provides grants to local organizations in every state, has made it immune to budget cuts. Yet a 2005 federal study involving 383 sites and 4,600 children found it led to no gains in math learning, oral comprehension or motivation to learn.

This record of government-provided services plays out today in a dramatically changing environment for philanthropy. In recognition of the wealth of soon-to-retire boomers, the Boston College Center on Wealth and Philanthropy estimates that philanthropic giving will total some $6 trillion between 2003 and 2050. Already, over the past 10 years, there's been an 88% increase in the number of foundations. Over the last decade there has been a 67% growth in the overall number of U.S. nonprofits.

Meanwhile, a wave of capable persons has come forward to establish effective new social service organizations, based on new ideas and with little or no government support. Indeed, it can be argued that we are now in an unprecedented period for the emergence of such people, who have started new types of job training, mentoring and immigrant-assistance efforts. The term "social entrepreneur" -- for those who establish such organizations -- has entered the language and become current on college campuses, where courses and research centers (Harvard, Duke, Stanford) on the topic have been established.

Thus the stars are aligned for nongovernmental organizations to play a much larger role in assisting those in need. . . . 

What's more, service organizations, which rely on private donations -- whether from individuals or foundations -- might actually prove to be more accountable for their performance than their public or publicly funded counterparts. . . .

The transition to a diminished government role in social services would be complex, as Americans have been conditioned for several generations to view government as the provider of first resort. . . . 

Such tools might include a stock market equivalent for major service-providing nonprofits. This is not as odd as it sounds; serious people are already considering such an idea. . . .

Such a system would, to be sure, have to emerge gradually -- after all, the general replacement of private with public sector social services did not occur overnight. But the question of whether and how to do so should be part of any discussion about the present and future of the welfare state.

Mr. Husock is director of the Manhattan Institute's Social Entrepreneurship Initiative and a research fellow at Harvard University's Hauser Center for Nonprofit Organizations.

To read the entire article (subscription required), go to      

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2.      In the News: After Initial Rejection, Scientists Back Work On Cure for Diabetes by Sharon Begley, Science Journal, WSJ, March 24, 2006.

When Denise Faustman announced that she had cured mice of diabetes, funders didn't exactly beat a path to her door, and colleagues didn't shower her with hosannas.

To the contrary. After her 2001 breakthrough, Dr. Faustman, an associate professor of medicine at Harvard Medical School, couldn't interest drug companies or the Juvenile Diabetes Research Foundation in supporting the bold next step she proposed: testing in people a version of what cured the mice.

When she published a similar study two years later, reaction from colleagues wasn't much better. Two fellow Harvard diabetes experts sent a letter to the New York Times, which had run an article describing Dr. Faustman's work, calling the claim that she was the first scientist to cure diabetes in mice "patently false." They also apologized to people with diabetes "on behalf of Dr. Faustman" for "having their expectations cruelly raised." JDRF, getting flak for not funding her, circulated the (unpublished) letter to show that the scientific verdict on her results was far from unanimous, explains spokesman William Ahearn.

But JDRF did approve grants to three competing teams, including one led by an author of the critical letter, to attempt to replicate Dr. Faustman's work. Now all three are announcing they have confirmed the aspect of her study that is the basis for a clinical trial planned at Harvard. By keeping the mice's immune system from destroying their insulin-making beta cells, the three report in today's issue of the journal Science, they got beta cells in some (but not all) of the animals essentially to come back from the dead, curing their diabetes.

In the three studies -- from the University of Chicago, Harvard and Washington University -- about one-third of diabetic mice were cured . . .

In the 2003 study that the three labs tried to confirm, Dr. Faustman and colleagues gave diabetic mice a compound that destroys killer T-cells. They also transplanted cells from the spleens of healthy mice into diabetic mice. The transplants bloomed into beta cells, they reported. . . .

With the T-cells gone, they hope, surviving or regenerated beta cells will yield enough insulin to reverse diabetes. . . .

Harvard's Diane Mathis and her colleagues discovered that even in mice with long-established diabetes, there is "substantial beta-cell mass, which can be rejuvenated/regenerated to reverse disease." If so, then cell transplants, from cadavers or embryonic stem cells, wouldn't be necessary. . . .

"The good news is that all three groups cured mice as we did," says Dr. Faustman. "They showed that it was due to regeneration in the pancreas, and that's the beauty of it: The animals' own pancreas did this."

She still thinks transplanted cells from the spleen might produce beta cells. "The pancreas is too smart to cure itself in only one way," she says. "I think there will be many sources of regeneration, and we're only at the beginning of understanding what they are."

To read the entire column, please go to (subscription required)

•  You can email [Sharon Begley] at sciencejournal@wsj.com1.

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3.      International Medicine: Private Health Insurance in Developing Countries

NCPA Daily Policy Digest: HEALTH ISSUES, Thursday, April 06, 2006

Private health insurance may be a good solution for the poor inhabitants of developing countries, say researchers from the University of Pennsylvania.

Government-run health programs, adopted by most developing nations, have inefficiencies that force many people to pay over half of their medical expenses out of pocket. For example:

  • In virtually all developing countries, out-of-pocket expenses exceed the U.S. percentage of 13 percent. For instance, Bangladeshis paid 64 percent of their medical expenditures in 2002 out of pocket.
  • Out of pocket expenses paid by poor people constitute a large share of family income for those who make them.
  • Countries' insurance programs -- which profess to have free, universal and comprehensive provision of medical services -- fail, largely due to poverty.
  • From Ghana to the Philippines, poor countries train doctors and nurses who then alleviate shortages in Australia, North America and Europe, where they make more money.

Private health insurance could help reduce these burdens and alleviate some of the health expenses governments experience. Furthermore, poor families would save money because of the redistributed costs associated with private heath insurance, say the researchers.


Countries and regions currently using private insurance include:

  • Populations of the Caribbean, the Arabian Peninsula and parts of Latin America.
  • Zimbabweans and South Africans; these countries have private insurance that cover more than a quarter of private spending on medical care.

Despite the benefits private health insurance offer to families and governments, policy makers continually opt for social insurance programs and take preventative measures against private insurance companies, such as passing restrictive laws.


Source: Mark Pauly et al., "Private Health Insurance In Developing Countries," Health Affairs, March/April 2006.

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Governments Restrict Access to Health Care (NCPA Daily Policy Digest: HEALTH ISSUES, April 06, 2006)

Nearly 50 percent of people in parts of Africa and Asia have no access to medicines due to harmful government policies including weak health infrastructure, taxes and tariffs, price controls and bureaucratic drug registration, says the International Policy Network (IPN).

Many examples of such interventions exist, says IPN:

  • Taxes and tariffs of up to 55 percent on imported medicines price people out of treatment, and costly registration requirements restrict the approval of American, European and Japanese medicines in most poor countries because manufacturers cannot justify the investment in registration.
  • Health insurance is hampered by government regulations, so the poor are unable to obtain insurance and are only able to pay for treatments if they have sufficient savings, or must rely on charity or meager government healthcare provision.
  • Price controls -- which proponents claim benefit the poor -- actually reduce the availability of drugs, especially in distant rural regions, by making it uneconomic for pharmacies to stock them; even in relatively wealthy South Africa, price controls have led to the closure of scores of rural pharmacies -- leaving thousands of poor people without any access to medicines at all.
  • Inadequate protection for intellectual property in poor countries undermines incentives to invest in R&D for the diseases of poverty by making it more difficult to recover costs.

Moreover, low pay and poor conditions at government run hospitals and clinics mean that a large number of trained medical professionals have immigrated to wealthier countries with better healthcare systems, says IPN.

Furthermore, governments in Africa and Asia must remove these taxes, tariffs and regulations, says IPN; this is the only way to alleviate the problems and help the sick receive the much needed treatments.

To read the original article, go to

Source: Editorial, "Governments Restrict Access to Healthcare and Prevent Medicine Development: major new report," International Policy Network, March 28, 2006: based upon: Barun Mitra et al., "Civil Society Report on Intellectual Property, Innovation and Health," International Policy Network, March 28, 2006.

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Governments are not the solution to healthcare problems; governments decrease access, worsen quality, and destroy personalized healthcare for purely fiscal reasons.

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4.      Medicare: The Long Arm of Government Medicine in Massachusetts

Big Health In Massachusetts, (NCPA Daily Policy Digest: HEALTH ISSUES, April 06, 2006)

A plan introduced this week in the Massachusetts state legislature would impose tax penalties, expand government-insurance programs and impose unfunded mandates to achieve universal health coverage, says the Washington Times.

Although Gov. Mitt Romney (R) had a dream of universal consumer-driven health care, this bill isn't "consumer-driven" at all, says the Times. It relies on third-party payers and employers and existing government-insurance programs. Furthermore:

  • The plan would impose "fees" -- actually, giving up existing tax breaks -- in the amount of $295 (per employee) for employers and $150 for individuals who fail to comply.
  • Companies that employ insurance-less "free riders" who run up big hospital bills must pay anywhere between 10 percent and 100 percent of bills over $50,000.
  • These fees -- sure to make people and employers take the law seriously -- will distort the state's economy and do little or nothing to harness market forces, says the Times.

Equally bad, it imposes an unfunded mandate. One health specialist speaking to the Wall Street Journal predicted that the plan would require a subsidy of about $700 million -- about four times what the plan provides.

According to Regina Herzlinger, a professor at the Harvard Business School and a fellow at the Manhattan Institute:

  • The plan will hurt businesses, especially small ones; it will force employers to favor capital improvements over labor, and compel outsourcing of jobs overseas.
  • In Hawaii, a similar plan applying only to full- or near-full-time workers set off a proliferation of part-time vs. full-time jobs.

Source: Editorial, "Big health in Massachusetts," Washington Times, April 6, 2006.

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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: We Haven't Seen Anything Yet - Just Wait for P4P

According to recent reports, Adults receive about half of recommended care:

54.9% = Overall care

54.9% = Preventive care

53.5% = Acute care

56.1% = Chronic care

It looks like if everyone received the recommended care, Payment for Performance (or Quality of Care) would double adult health care costs in this country.

Are we really ready to accept a $3 trillion health care bill in this country? The rest of the world already thinks our $1.8 trillion is excessive.

How would it improve healthcare quality in a patient with known cholesterol and triglycerides twice normal for the past three years, to proceed with another lipid profile to determine LDL cholesterol when he has no intention to change his diet or take statin drugs?

How would it improve healthcare quality in an elderly noncompliant adult onset type II diabetic who has never been in ketosis, who takes his medications sporadically, doesn't measure his glucose regularly, and states he's not going to do so in the future, to obtain a glycohemoglobin when all the previous year's determinations have been high?

How would it improve healthcare quality in an 80-year-old man with cancer of the prostate, who declined surgery, radiation and hormonal therapy, to obtain another PSA when the last one was four times normal and the previous one was five times normal?

How would it improve healthcare quality to obtain a yearly pap smear on a 60-year-old virginal nun when the incidence of cancer of the uterus approaches zero?

These are the type of grading systems that the Pay for Performance (P4P) advocates are using to reduce payment to physicians.

What's wrong with just letting the physicians work these things out with patients and their families so everyone gets the quality and type of personalized healthcare that he or she desires? We've spent the first 32 years of our lives getting the training for this challenge.

To read another perspective on what P4P really means (payment for compliance or punishment for noncompliance) and how it trivializes and corrupts the medical profession, please review Robert P Gervais, MD's, article: Payment for Performance in Perspective, (With Bob being an ophthalmologist, please excuse his calculations of physicians income by inadvertently adding three zeros.)

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6.      Medical Myths: Everyone Should Retire at Age 65?

A fixed retirement age rejects a young spirit and old skill By John Browne, Published: April 7 2006

Several decades ago, Michael Young [the British thinker and social entrepreneur] coined the term "chronologism" for society's tendency to pigeon-hole people according to their physical age. He wrote about the bureaucratisation of age which ignores ability and choice, and creates a linear process driven by the ticking of the clock.

I want to approach the same subject from a different perspective - that of a businessman running an international company that is based in London but works in more than 100 countries and employs around 100,000 staff worldwide. Why do we care about discrimination on grounds of age and why do we think that the concept of retirement needs to be redefined?

When first Bismarck in Germany in 1889 and then Lloyd George in Britain in 1908 introduced the idea that people should stop work at a particular age and receive a small but secure pension, they were acting in a spirit of decency and humanity. But the world of work has changed. So has medical science. We live in a different world and we live in that world for much longer.

The nature of the economy has also changed. More than 70 per cent of the European economy is now based on services rather than manufacturing. Many of the jobs in both private and public services are based on knowledge gathered through experience. How can we afford to say to someone, just because they have reached 60 or 65: "You are too old to make a contribution any more"?

In the US, people commonly work on beyond 60. There is no formal retirement age. Alan Greenspan retired only two months ago at the age of 80 and even then does not seem to have quite grasped the concept of "retirement". . .

These are the practical, economic reasons why we need to rethink the idea of a rigid age of retirement. But there is another reason: the need for a civilised society to overcome prejudice. Slowly and imperfectly we have stopped judging people simply on the basis of their gender, religion or skin colour. As with many forms of prejudice, attitudes to age run very deep. And they are reinforced by a culture in which the word "young" is synonymous with vitality and the future, and "old" is synonymous with the past - the slow and the failed . . .

Business cannot change social attitudes alone but we can show what can be done. The key must be flexibility. People should have the chance to stay on, either on a full-time basis or, where practicable, to work part time, combining paid income with some income from their pension. They should be able to phase out of work or to change their role, becoming advisers rather than managers, for instance . . .

Lord Browne of Madingley is group chief executive of BP; this is an edited extract of his Young Foundation lecture "Beyond Retirement", delivered yesterday in London

To read the entire edited extract, please go to (Subscription required)

Medical Truth: Retirement Age Should Be Flexible and Consistent with Mental and Physical Capabilities

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7.      Overheard in the Medical Staff Lounge: Has the Geography of the Female Chest Changed?

Last week, after I went through the buffet line in the medical staff lounge, I joined a table with a cardiologist, radiation oncologist, and plastic surgeon. The cardiologist was pointing out some of the modern challenges in obtaining routine electrocardiograms and echocardiograms in an increasing number of women - especially in the age group in which cardiac disease begins to occur. Technicians can easily map out the chest of women in the sixth and seventh decade of life. This is when they begin to have heart disease that plagues men a decade earlier. The breasts are beginning to atrophy and are freely mobile so that ECG leads and ultrasound sensors can be placed with great accuracy. With more women having implants, the accuracy of lead placement is more elusive as saline water bags raised an atrophic breast into the adolescent conical shape.

The radiation oncologist mentioned that they had a couple of patients with lung cancer receiving radiation therapy to the hilum of the lung. The radiation oncologist places black marks on the chest to either side of the sternum to delineate the radiation field, on which the radiation technician can focus the cancer-killing beam with great accuracy. These black marks stay on for the entire multi-month treatment period and can't be washed off. The oncologists also normally deal with elderly women, the age when lung cancer normally occurs, with atrophic breasts that could be easily moved so that these indelible marks were placed directly on the chest wall. He's had two female patients with lung cancer where it was difficult to accurately place the radiation field. In fact, now that he had a chance to think about it, he began to wonder if the delivered dose of radiation might be diminished enough going through a water interface so that the calculated lethal dose did not reach the cancer and thus there might be a greater recurrence rate.

The plastic surgeon was asked if the size of the saline water bags inserted was getting larger in recent years. He had the impression that the usual size of the implants (240 to 300 cc or the equivalent of an eight to 10 ounce water glass) was indeed increasing as seen on the breast implant website, which shows the before and after photos with the size of the implant listed.  There now are more women opting for the 360 cc to more than 600 cc (12 to 20 ounces) implants. He said that he was still using the eight-ounce to ten-ounce implants most frequently, these being the type that the more mature women would want.

As the chest physician at the table, I remarked that it has had little effect on our practice, although I've seen physicians in the chest conference setting who missed the double contour breast shadow and were criticized by the chief for not reading a CXR thoroughly.

Looking around as to who was listening in on our lunch table talk, a family doctor at the next table looked surprised and said, "Gosh with two to three pounds of water weight outside of the center of gravity on these women, maybe that's why some of my patients seem to be running after their center of gravity, much like a Parkinson's patient. Has anybody assessed the risk of falling and broken hips in such patients?"

Another doctor who always feels that the government is the answer to all medical challenges stated that he would alert his congressman to get a law passed. What kind of law? He didn't know, but he did know that there should be a law.

On discussing this with my London correspondent, I was told that these challenges are very simple in the National Health Service. In fact, there are two options. One is to not cover breast implants after a certain age much like renal dialysis. The other is keeping women with such requests on the waiting list for enough years that they develop cataracts. When they want to see their vision restored with cataract surgery, they have to go on another list for two years. By that time, they should be fighting more serious diseases.

Socialized Medicine Gets Right to the Source of the Problem in a Hurry, Doesn't It!

But then again, the NHS may not be entirely successful. This week, I had a 68-year-old lady who, while I was bringing her annual medical history up-to-date, remarked that the only medical occurrence in the previous year was that she finally had her "breast lift." She had wanted one since age 22 after her second child when the hormonal surge after her first child was flattening out. She was happy that she could finally afford to have this done even after a 46-year wait. The result was not apparent on examination in the recumbent position except for retracting scars. But then she had no intimate relationship going and didn't think she ever would again. The result was apparently for her own self-image and the public in full attire.

Looks Like Some Patients Could Out Wait Socialized Medicine, Should Such a Catastrophe Occur.

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8.      Voices of Medicine: From Local and Regional Medical Journals

Current Books: Sonoma Medicine, the Magazine of the Sonoma County Medical Association.

Sex, Time, and Power: How Women's Sexuality Shaped Human Evolution, by Leonard Shlain, MD

Is That All There Is? A review by Allen Gruber, MD

Dr. Leonard Shlain, a Marin County surgeon, has written a speculative but erudite book that grapples with an age-old conundrum, namely: What caused the two human sexes to become what they are today? With this book, Shlain has thrown a large hat into a ring occupied by the hundreds of authors who have recently re-examined traditional sex roles. Many pundits have developed plausible rationales for either maintaining the status quo or upsetting it under the rubric of progress, equality, or liberation.

Shlain takes a middle ground. Although Sex, Time, and Power is not a scientific work, Shlain does bring the benefits of scientific training and rigorous analysis when formulating his hypotheses and conclusions. His book is encyclopedic in its development of a theory of human sexual adaptations as predecessors to certain traits that set us apart from all other species. In his effort to understand archaic processes that cannot be tested by controlled scientific investigation, Shlain integrates diverse fields of knowledge, including anthropology, linguistics, paleobiology, evolutionary theory, ethology, archaeology, anatomy, physiology, and medicine. By doing so, he creates an impressive (but not unassailable) set of explanations for understanding the bio-psycho-social constructs that are male and female human beings.

Shlain's analysis has one unifying methodology. All the evidence and rationales that he brings to the plate are tested against the known rules of natural selection. He makes genuine and intellectually honest efforts to ground his logic in this genetic winnowing process, although some readers may take him to task for stretching concepts at crucial points and for a sprinkling of factual errors and a few instances of perspective bias.

Throughout the book, Shlain uses evolutionary principles to explain misogyny and patriarchy, bipedalism, menstruation, linear time-sense, foresight, iron-deficiency anemia, rampant encephalization, the bio-selective perils of childbirth, sexual power imbalances, pornography, the social evolution of crones, and the helpless neoteny of human infants. He dubs the primordial female and her descendents Gyna sapiens both to underscore how close the human sexes are to being different subspecies and to honor females' crucial evolutionary role in developing the unique and powerful traits that make the human species so dominant . . .
According to Shlain, women developed the potential for continuous sexual receptivity and, in the interest of self-preservation, simultaneously evolved the ability to remain sexually unavailable unless men met certain requirements. Central to these was the need for continuous dietary iron replenishment and for protection and support during pregnancy and child-rearing. Thus was born women's power to say "No!" to sex and, with it, the birth of a continuous tension between the sexes that continues to the present.

One of Shlain's most important insights is that human females spend the bulk of their lives slowly bleeding to death. With a few minor exceptions, this is a uniquely human trait and, in Shlain's view, must have an evolutionary purpose. From all causes combined, the proclivity of human females to lose blood runs into the impressive total of 15 gallons of iron-rich fluid during the course of a woman's reproductive years. Shlain exhaustively details the many routes of female iron loss. Leading the list in terms of short-term loss are labor, delivery, and the hemoglobin content of the placenta. (The human female is thought to be the only mammal that does not routinely eat the placenta following labor.) The bulk of female blood loss, however, occurs during menstruation: typically 10 gallons of iron-rich blood through the completion of menopause . . .
Shlain is impressively erudite when he expounds upon subjects that fall within his expertise as a physician, and he is an excellent storyteller. Having directed his book primarily to an educated lay audience, and having blithely admitted to his lack of credentials in many of the fields he draws from (evolutionary biology, anthropology, ethology, sociology), he goes to frequently overlong length in explaining phenomena familiar to physicians. For this reason, doctors may find much of his book somewhat tedious in its basic medical detail, even though those details are important in the building of Shlain's arguments.

An Internet search reveals many reviews of Sex, Time and Power. A preponderance of the reviewers are female, often with a feminist orientation. Their reception of Shlain's book is clearly divided. Some critiques are of the damned-both-ways variety, in which Shlain's condemnation of misogyny is viewed as "condescending" while his elevation of females' key role in human evolution is labeled as "demeaning" and "baseless flattery that [he] uses to worm into the good graces of his female audience." Others comment with delight or dismay that the book has been incorporated into many women's studies courses. One reviewer writes that Shlain represents a threat to feminist progress in that "while patting women on the head, he employs the facade of empowering language to codify women's oppression as natural, inevitable, and, most of all, a product of our very efforts to exert control over our sexuality."

My own reading is that Shlain has done as good a job as possible to present an encyclopedic and thoughtful treatise on the evolutionary sociobiology of humankind . . .

For all its good points, I have to confess to experiencing some negative feelings from Shlain's book, mainly from the repeated subtextual message that humans are the product of an oppressively mechanical evolutionary process. While I can intellectually accept the evolutionary mechanisms that promote species adaptation, reproduction, and survival, it can be horrifying to contemplate how little the individual person amounts to in all of this. As individual men and women, we are left with biologically programmed sexual-emotional needs that are not especially "user-friendly" in terms of inter-sex compatibility or individual fulfillment. Having the sexual evolutionary process meticulously explained runs the risk of arriving at a cynical and mechanistic view of male-female relations. It is dispiriting to contemplate that, at the level of the lone individual, our sexuality is basically an elaborate system of bartering meat (or the modern equivalent of meat) for sex. The cultural and emotional part of me feels there has to be more to male-female relations than that. Perhaps Dr. Shlain should be challenged to take up this thread as the nucleus of his next book.

Dr. Gruber, an anesthesiologist and pain medicine specialist, serves on the SCMA Editorial Board.  To read the entire review, go to

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9.      Book/Cinematic Op-Ed Review: "Tsotsi"

Is Free Will Possible Even in Cycle of Global Gang Violence? By James J Murtagh, M.D. 

Warning: movie spoiler alert. If you have not seen "Tsotsi", consider seeing the film before reading further.

[Note: James Murtagh has spent 20 years as an Intensive Care Unit physician at a major Southeast hospital.]

At first, the South African film "Tsotsi", looks like a re-shoot of the Brazilian masterpiece, the "City of God." The City of God, in turn, is "The Godfather" on speed. It reminded me of Goodfellows, Sopranos, and Scarface. Horrible circumstances, leading to unavoidable crime, leading to bloodbaths.

        But then I realized. "Tsotsi" is the answer to all of these films, not the extension.

        Tsotsi, like "City of God," shows ruthless killers born to crushing poverty. Children are abandoned, growing up in pipes and in garbage dumps. No hope exists, so escalating butchery builds to a fevered pitch of kinetic violence until a final orgy of death appears inevitable.

        Except in "Tsotsi," where the bath of blood is stopped, and the gangland leader reforms, transformed by the innocence of a child. The hardened criminal surrenders himself, arms spread wide and high, as if he were forming a kind of cross, tears of remorse and redemption streaming down his cheeks. The power of the heart and his empathy for a helpless child reformed even one of the most hardened killers in film history.

        Free will entering into an International gangland story is shocking and exhilarating.  In all other mobster movie in memory, the Killers, Godfathers and Macbeths were pawns of fate. Fate tricks each gangster-leader into believing he is supremely powerful and wise, an Uberman above the laws of good or evil, the Master of the Universe, holding all power and all the puppet strings. But ultimately, each realized he was deluded. In fact, each supposed villain puppet master was in fact himself only a puppet, dangling ironically on the strings of the corrupt violent system. Those that lived by the gun die by the gun, and those who put heads on pikes end up with their own head on a pike.

        Macbeth and Brutus showed how conditions turn good men into villains, as surely as fate turned Darth Vader from the good side to the evil side of the force. But for the grace of God, in the theme of these stories, any of us could be born or made into killing machines.

        Vito Corleone's criminal fate appeared sealed as he stepped as an orphan refugee child, into the shadow of the statute of liberty, stripped of his name, and thrown friendless into quarantine. Later, fate made his son Michael reluctantly into the next criminal genius. Neither father or son apologized, as crime appeared as the least bad choice option. Even the police were conniving with rival gangs to finish both Corleones off. Who could the Corleones have turned to, even if they wanted to go straight? Not the police. Not the media. Not the church.

        "The woman made me do it," was Adam's excuse. "The serpent made me do it" Eve replied. "I am not my brother's keeper," Cain continued. "The weird sisters made me," continued Macbeth. Venus "forced" Paris abduct Helen, so Agamemnon murdered daughter Iphigenia, to obtain good winds so to sack Troy. The Greeks rumbled with the Trojans, the Sharks with the Jets. And so on, and so on, and so on.

        But Tsotsi breaks this mold. Beginning as a killer more heartless than Luca Brasi, Tsotsi discovers his heart is bigger than violence. Unlike any other mob movie character, (possible excepting Samuel Jackson's "Pulp Fiction" character), Tsotsi actually breaks through his environment, and takes responsibility, to find redemption. To read the entire review, please go to

To read other movie reviews, go to

James J. Murtagh Jr., Atlanta GA 30329,

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10.  Hippocrates & His Kin: A Scheme to Kill Off 5.8 Billion Humans

A popular professor at the University of Texas at Austin tells students that human beings are turning Earth into "fat, human biomass," while leaving the planet "parched." The Planet would be better off with 90% of human beings dead, Professor Eric Pianka believes.

Pianka was named the 2006 Distinguished Texas Scientist by the Texas Academy of Science. He is a specialist in herpetology and evolutionary ecology.

"The Earth's population is growing," he said. "We will see a point when we reach the carrying capacity--there aren't enough resources." He thinks the current 6.5 billion human beings are too many, and 0.7 billion would be about the right number. Human life, he thinks, is no more valuable than other life, such as lizards or bison.

Pianka tells his student audiences, cheerfully, that each one of them will get to bury nine others. "This is really an exciting time." 

The prime candidate for achieving this massive genocide is the Ebola virus, as soon as it evolves the capacity for airborne transmission, states Pianka. . . .

"The biggest enemy we face is anthropocentrism," he said, describing the belief system in which humans are the central element of the universe. "This is that common attitude that everything on this Earth was put here for [human] use."

To Pianka, a human life is no more valuable than any other -- a lizard, a bison, a rhino.

To read the entire article, and the professors who disagree, please go to (Jamie Mobley, Seguin Gazette 4/2/06).

To read more, go to

Was Hitler's Holocaust Just A Warm Up Maneuver To The Real One?

Managed Care Organizations Treating Physicians as School Kids

The Managed Care Organization (MCO) requested a review of 44 charts and substantiation that LDL, Glycohemoglobin, Mammograms and PSAs were done on the selected patients to determine the next payment for quality, which has now been re-invented as performance. Since these were rather detailed reviews, contingent on several factors, they required about as much time as an office call. Hence, after the office closed, this required the equivalent time of 44 short office visits or follow-ups. Many were repeats from the previous year that had declined to obtain the requested lab or procedure. This, of course, required making copies of the documentation that the patient had been requested to obtain the test. If a test was obtained, the measure of distrust for physicians in the 21st century was seen in that the results of the test had to be forwarded to the MCO. The fact that the physician was going to be held strictly accountable was seen on the envelope and in the cover letter to the forms to be completed addressed that it was confidential to the physician and not his staff.

The Revolt Of Managed Care Is Eminent

[Please note: When MCO or HMO are used in MedicalTuesday, we are referring to the For Profit HMOs and MCOs, and not to Kaiser or The Permanente Medical Group, which are a unique and totally integrative health care system.]

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11.  Restoring Accountability in HealthCare, Government and Society:


•                      John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to "On March 3, 2006, we got word that the Prime Minister of Antigua and Barbuda has signed our letter giving us 90 days to come up with the means to utilize their brand new 200+ bed hospital. He has indicated that he recognizes our compassionate and comprehensive approach to health care and our desire to see the healthcare of the people of Antigua & Barbuda enhance in the process. Our mission will be to bring uninsured people to the island for high quality, low cost surgery utilizing US physicians who are willing to live there for travel there for 2-4 weeks stays. Physicians will be paid a fair price for their services, and enjoy a beautiful resort environment at the same time." You may want to start planning to take a month each year to practice in this resort environment, or even buy a medical timeshare. Their medical board includes John and Alieta Eck, MDs. To read the rest of the proposal, please go to


•                      PATMOS EmergiClinic - - where Robert Berry, MD, an emergency physician and internist practices. Here is his story: Three years ago, I left ER medicine to establish a primary care clinic in a town of about 15,000 in northeast Tennessee - primarily for the uninsured, but also for anyone willing to pay me for my care at the time of service.  I named the clinic PATMOS EmergiClinic - for the island where John was exiled and an acronym for "payment at time of service."  I have no third party contracts...not commercial, not Medicare, TennCare or worker's compensation. My practice today has over 4,000 patient charts.  My patients are typically between 5-50 years old, but I do have a significant number of Medicare patients.  A year ago, over 95 percent of the patients I saw had no insurance.  Today, that figure may be 75 percent.  But even those with insurance learn a simple lesson when they come to me: health insurance does not equal healthcare, at least not at my clinic. I clearly tell my patients how much a visit will cost.  Everything is up front and honest.  I will prepare a billing claim for my patients with insurance, for a small fee, but I expect them to pay me when I see them.  Because I need only one employee in my office, my costs are low.  For the same services, I charge about 60 percent of charges made by other local clinics, 40 percent of what the local urgent care clinic charges and less than 20 percent of what the local ER charges.  I am the best bargain in town. To read Dr Berry's article on socialized medicine, please to

•                      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. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.

•                      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" at

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

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

•                      Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at She will be remembered for her important work, Who Owns Your Body, which is reviewed at Please go to to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at

•                      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 To read his latest article on When the Public Loses Confidence in Physicians, 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, who would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at

•                      Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848 no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see 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 To read Dr Chalifoux' review of how hospitals were able to obtain absolute power to review, punish, suspend and terminate physicians using procedural due process and not substantive due process, go to

•                      To attend the annual meeting of the Semmelweis Society in Washington, DC, May 7-9, 2006, go to and click on May Meeting. To read the entire agenda on Where is it Safe to Practice, go to agenda 2006.pdf.

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

•                      Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at This week the Medicine Men discuss:  For all the talking about "the uninsured" and "access to health care" in America, you'd think that having health insurance was more important than actually seeing a doctor. As a recent study and wee bit of reflection suggests, it's the other way around. To read the entire column, see 

•                      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.  Please go to to see the latest news release and action alerts. Be sure to scroll down on the left to departments and click on News of the Day to review the latest topics. The "AAPS News," written by Jane Orient, MD, and archived on this site, provides valuable information on a monthly basis. Scroll further to the official organ, the Journal of American Physicians and Surgeons,, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents page of the current issue. Be sure to read a review of Dr Jane Orient's third edition of Sapiraνs Art & Science of Bedside Diagnosis as well as other book reviews. If you missed Dr Gervais article on Payment for Performance above, be sure to pick it up now.

•                      To Attend the 63d Annual Meeting of the AAPS, in Phoenix, AZ, September 13-16, please go to, your gateway to a vast amount of information.


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Stay Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same.

Please 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 twenty hours per week of 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.

Del Meyer       

Del Meyer, MD, Editor & Founder

6620 Coyle Avenue, Ste 122, Carmichael, CA 95608

Words of Wisdom

Albert Einstein: Not everything that can be counted counts and not everything that counts can be counted. (How did Einstein know we would be battling P4P?)

Earl Nightingale: Creativity is a natural extension of our enthusiasm.

Edward Langley, Artist 1928-1995: What this country needs are more unemployed politicians.

Some Recent Postings

HealthPlanUSA Quarterly for January 2006:

HealthPlanUSA Quarterly for April 2006:

OpEd/Cinematic Reviews:

Medicare Reform: Pharmacy Benefit Program - What Must be Done - A Clinician's Point of View:

In Memoriam

Michael Joyce: The architect. A conservative every Democrat should study carefully.

MICHAEL JOYCE, who died on February 24th at age 63, was hardly a household name, unless you happen to be called Kristol or Podhoretz. The New York Times has not yet even bothered to accord him an obituary. Yet, Mr Joyce was one of the leading architects of the conservative renaissance that reshaped America over the past 40 years.

A blue-collar Catholic Democrat by background, Mr Joyce more or less invented a new industry: conservative intellectual philanthropy. He ran two of the right's biggest treasure troves -- the John Olin Foundation (1979-85) and the Lynde and Harry Bradley Foundation (1985-2001) -- and dispensed millions to conservative thinkers.

To read the entire obituary, please go to

On This Date in History – April 25

On this date in 1864, Guglielmo Marconi, the father of wireless radio, which revolutionized worldwide communications, was born in Bologna, Italy. In 1899, he sent the first signals through the air via radio waves across the English Channel.

On this date in 1945, The US and USSR troops met in Friendship at the Elbe River.

Also on this date in 1945, a group of international dignitaries met in San Francisco at the opening of the United Nations Conference.

At this magical moment in history, the east and west joined forces on two separate fronts, despite the language barrier.

Today is Tax Freedom Day. So far this year, every dollar you’ve earned has gone for taxes and today you start working for yourself. In California, with a higher tax rate, we don’t start working for ourselves until April 28. The New Yorkers, with the highest tax rate in the United States, continue to work as slaves to the government for another two weeks and don’t start working for themselves until May 9, 2006. Do we really enjoy working for the government for one-third of our lives even though we may not even agree with how the government spends the money they forcibly take away from us?