Community For Better Health Care

Vol V, No 9, August 8, 2006


In This Issue:

1.                  Featured Article: Freedom vs. Unlimited Majority Rule

2.                  In the News: Insurance Winner

3.                  International Medicine: Kill Two Birds with One Stone: Government Efficiency?

4.                  Medicare: Keep P4P Out of Traditional Medicare

5.                  Medical Gluttony: Liability Avoidance

6.                  Medical Myths: More Rules and Regulations Make Medicine Safer

7.                  Overheard in the Medical Staff Lounge: The Wealthy Become Wealthier

8.                  Voices of Medicine: Healthy Doctor-Patient Relationships

9.                  From the Physician Patient Bookshelf: DOWN FROM TROY: A Doctor Comes of Age

10.              Hippocrates & His Kin: Just a Notch Above Lawyers

11.              Related Organizations: Restoring Accountability in HealthCare, Government and Society

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The Association of American Physicians & Surgeons (, The Voice for Private Physicians since 1943, represents 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. The AAPS is having their 63rd Annual Meeting at the Embassy Suites Hotel in Phoenix, AZ, September 13-16, 2006. Craig Cantoni will present: Confessions of a Corporate Insider: Why American Business Opposes Market-Based Medical Care; Gerry Smedinghoff, an actuary, will present: Criminals, Victims, and Innocent Bystanders: The Prisoner's Dilemma of Health Insurance; Richard Dolinar, MD, of the Heartland Institute will present:  Pay for Performance or Pay for Compliance;  Andrew Schlafly, the legal counsel will present: The American Health Information Community and Other Threats to Private Medicine; Lawrence Huntoon, MD, PhD, Editor-in-Chief, J Am Phys Surg, will present: Scientific Integrity: the Role of the Journal; A Panel will discuss: Cash Based Practices; and there will be a Debate: How Should Medical Care Be Financed: Government v Free Market.  For more info, please go to the website, your gateway to a vast amount of important information. 

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1.      Featured Article: Freedom vs. Unlimited Majority Rule, by Peter Schwartz, Ayn Rand Institute

America helped empower Hezbollah, by confusing the idea of freedom, which rests on the principle of inalienable individual rights, with the idea of democracy, which rests on the principle of unlimited majority rule.

Hezbollah, which has been waging war on Israel, and America, for years, is the immediate cause of the current fighting in the Middle East. The broader cause, though, is the United States government.

When Washington declared that freedom could be advanced by elections in which Hezbollah participated, and by which it became part of Lebanon's government, we granted that terrorist entity something it could never achieve on its own: moral legitimacy.

We gave legitimacy to Hezbollah--just as we did to such enemies as Hamas in the Palestinian Authority and the budding theocrats in Iraq and Afghanistan. These people all came to power through democratic elections promoted by the U.S. But a murderer does not gain legitimacy by getting elected to the ruling clique of his criminal gang--nor does anyone gain it by becoming an elected official of an anti-freedom state.

The premise behind the Bush administration's policy is the hopeless view that tyranny is reversed by the holding of elections--a premise stemming from the widespread confusion between freedom and democracy. . . .

The essence of democracy is unlimited majority rule. It is the notion that the government should not be constrained, as long as its behavior is sanctioned by majority vote. It is the notion that the very function of government is to implement the "will of the people." It is the notion espoused whenever we tell the Lebanese, the Iraqis, the Palestinians and the Afghanis that the legitimacy of a new government flows from its being democratically approved.

And it is the notion that was categorically repudiated by the founding of the United States.

America's defining characteristic is freedom. Freedom exists when there are limitations on government, imposed by the principle of individual rights. America was established as a republic, under which the state is restricted to protecting our rights. This is not a system of "democracy." Thus, you are free to criticize your neighbors, your society, your government--no matter how many people wish to pass a law censoring you. You are free to own your property--no matter how large a mob wants to take it from you. The rights of the individual are inalienable. But if "popular will" were the standard, the individual would have no rights--only temporary privileges, granted or withdrawn according to the mass mood of the moment. The tyranny of the majority, as the Founders understood, is just as evil as the tyranny of an absolute monarch.

Yes, we have the ability to vote, but that is not the yardstick by which freedom is measured. After all, even dictatorships hold official elections. It is only the existence of liberty that justifies, and gives meaning to, the ballot box. In a genuinely free country, voting pertains only to the means of safeguarding individual rights. There can be no moral "right" to vote to destroy rights.

Unfortunately, like President Bush, most Americans use the antithetical concepts of "freedom" and "democracy" interchangeably. Sometimes our government upholds the primacy of individual rights . . . More often, however, it negates rights by upholding the primacy of the majority's wishes . . .

Today, our foreign policy endorses this latter position. We declare that our overriding goal in the Mideast is that people vote--regardless of whether they value freedom. But then, if a religious majority imposes its theology on Iraq, or if Palestinian suicide-bombers execute their popular mandate by blowing up Israeli schoolchildren, on what basis can we object, since democracy--"the will of the people"--is being faithfully served? As a spokesman for Hamas, following its electoral victory, correctly noted: "I thank the United States that they have given us this weapon of democracy. . . . It's not possible for the U.S. . . . to turn its back on an elected democracy." All these enemies of America--Hamas, Hezbollah, the Iranian-backed Shiites--abhor freedom, while adopting the procedure of democratic voting.

If we are going to try to replace tyrannies, we must stop confusing democracy with freedom. We must make clear that the principle we support is not the unlimited rule of the majority, but the inalienable rights of the individual. Empowering killers who happen to be democratically elected does not advance the cause of freedom--it destroys it.

To read the entire Op-Ed article, please go to

Peter Schwartz is a Distinguished Fellow at the Ayn Rand Institute ( in Irvine, California. The Institute promotes Objectivism, the philosophy of Ayn Rand--author of Atlas Shrugged and The Fountainhead.

Copyright © 2006 Ayn Rand® Institute. All rights reserved.

Op-Eds, press releases and letters to the editor produced by the Ayn Rand Institute are submitted to hundreds of newspapers, radio stations and Web sites across the United States and abroad, and are made possible thanks to voluntary contributions.

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2.      In the News:  Health Insurance Winner By Scott W. Atlas, The Washington Times

As politicians and bureaucrats debate the role of government in our health-care system, and as concerns by U.S. citizens and employers about rising health-care costs and lack of control and satisfaction are raised, millions of American health-care consumers -- without big government mandates -- are taking control of their health-care dollar and bringing about changes in the health insurance marketplace.

The latest data from the leading nationwide online marketplace for health insurance,, reveal the success of patient empowerment when choice and price transparency are offered and when competitive markets are allowed to operate in response to consumer demand. High-deductible health insurance plans (HDHPs) eligible for health savings accounts (HSAs), are attractive because they shift authority and control of the health care dollar to the patient, eliminate the administrative burden from small claims, and reintroduce the patient as the customer -- all positive steps toward improving our health care system.

Although the entire consumer spectrum is making these value-conscious decisions when purchasing health insurance, more than 40 percent of 2005 purchasers were uninsured before buying their new plan and almost 60 percent were less than 40 years of age. The most significant growth in purchases of these plans is in the same 20-39 years old group -- the age group previous studies have shown to make up the segment in the ranks of the uninsured.

Also striking is that nearly half of the purchasers of these insurance plans in 2005 had annual incomes of less than $50,000 a year. Indeed, in 2005, a full 25 percent of HSA-eligible health insurance plan buyers earned $35,000 or less -- increasing that group by more than a third compared to just a year ago.

Sixty percent of these empowered consumers, using price comparisons and informed choices, chose plans with deductibles of $3,000 or more, a 20 percent increase over 2004. Extensive coverage of office visits, prescription drugs, emergency room visits, as well as the full array of lab and radiology services were featured in the vast majority of plans purchased, despite the higher deductible. Suffice it to say the coverage options in these plans were quite comprehensive. . . .

In sum, the evidence continues to build for the power of the consumer in health care. During the last two years, 3 million Americans have elected high-deductible plans with HSAs, and predictions are that 12 million will make this choice in 2007.

Once consumers with purchasing power were been given access to choice and prices presented clearly, lo and behold, the price of health insurance rapidly decreased. Improved affordability of health insurance has resulted from a competitive marketplace -- just as expected big government mandates interfere with the market and interrupt the control that empowered consumers wield. . . . To read the entire article, please go to
Scott W. Atlas, M.D., is a senior fellow at Stanford University's Hoover Institution and a professor of radiology and chief of neuroradiology at Stanford University School of Medicine. He is the author of "Power to the Patient: Selected Health Care Issues and Policy Solutions" (Hoover Institution Press, 2005).

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3.      International Medicine: Killing Two Birds with One Stone: Government Efficiency?

A local Canadian physician who states he escaped Canadian medicine tells me he got a phone call from a former patient asking for his advice. The patient had cancer of the liver and was given less than six months to live. He was advised to go on the liver transplant waiting list where the waiting time exceeds six months. It does solve two problems--kills two birds with one stone. The patient dies and you save the cost of the transplant with a single decision. Some call it government efficiency.

From Our Archives

Rising medical costs are a worldwide problem, but nowhere are they higher than in the United States. Roger Doyle reports in Scientific American that the major reason for high US costs is over-investment in technology and personnel. America leads the world in expensive diagnostic and therapeutic procedures such as organ transplants, coronary artery bypass surgery and magnetic resonance imaging. Orange County, he states, has more MRI machines than all of Canada. According to political scientist Lawrence R. Jacobs of the University of Minnesota, universal access is the strategy other countries use to impose fiscal controls. In other words, one must have universal access to control access so that social planners and government can control our health. There would not be 48-hour waits in the ERs of Canada without universal access. There would not be 18-month surgical waiting lists without universal access. And when the United States gets universal access, there will be no escaping from other countries' controlled universal limited access to our unlimited access. So beware of organizations that propose universal access. They are not acting in either our patients or our own professional interest. They may have outlived their usefulness. Without any value, they will continue to lose members.

Canadian Medicare does not give timely access to healthcare, it only gives access to a waiting list.

--Canada's Supreme Court

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4.      Medicare: Keep P4P out of Traditional Medicare

WASHINGTON – In response to growing concern over the quality of medical care in the U.S., Medicare is experimenting with "pay-for-performance" (P4P), a financial incentive that rewards health care providers for recommended care. A new Cato Institute working paper to be published in the Yale Journal of Health Policy Law & Ethics, however, finds that P4P is an unproven tool for improving quality and carries significant potential for harm.

In the study "Pay-for-Performance: Is Medicare a Good Candidate?" Michael Cannon, director of health policy studies at the Cato Institute, warns policymakers to take a cautious approach to P4P, especially when applying it to Medicare: "Given Medicare's patient population, size, and sensitivity to interest group lobbying, any harm that could result from a P4P scheme would be more likely to occur within traditional Medicare than elsewhere in the health care system."

Cannon explains that the high incidence of chronic illness among Medicare beneficiaries "increases the likelihood that a P4P scheme would create incentives to mistreat such patients and turn them into 'medical hot potatoes' that providers make an effort to avoid."

Furthermore, Medicare is a creature of the political process. This, the study asserts, not only increases the potential for error at each stage of designing, implementing, and maintaining a P4P scheme, but guarantees congressional and administrative lobbying by providers who seek to protect their own interests in shaping a P4P initiative.

According to Cannon, Congress can harness the potential of provider-focused P4P incentives while reducing the likelihood of harm by confining P4P to private Medicare Advantage plans and by encouraging greater participation in those plans.

In addition, P4P financial incentives can be targeted to patients as well as providers to allow greater transparency. "A weakness of provider-focused financial incentives," Cannon explains, "is that it can affect the quality of care, or even a patient's access to care, without the patients' knowledge. In contrast, patient-focused financial incentives would engage patients in the pursuit of quality, while allowing them to deviate from 'best practices' if doing so fits their needs."

Policy Analysis no. 575:
here to receive Cato's Daily Dispatch, news releases and event notices.

From the HBR: I could not believe how pernicious government could be. I always looked at government as the good guy and our government IS the good guy, but when you give it a little too much you incent the government to change for the worse. When the Godfather mandates something those under him know to do it even if there is competition.  He is a kindly old gentleman that really doesn't know what you are doing, but cross him and you are dead. Mandates are bad, pure and simple. Every mandate from government that I have seen has had terrible unintended consequences. It means government wants things done the government's way . . . –Allen. 

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

- Ronald Reagan

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5.      Medical Gluttony: Liability Avoidance

Because of government oversight, new drugs must undergo an unusual amount of suggested or required monitoring. A large majority of drugs have a one to five percent liver effect. Isoniazide was used for millions of people with tuberculosis when several patients developed hepatic side effects. Some could be rather serious, such as fulminate hepatic necrosis. Liver function tests were then suggested/required when starting a patient on INH (Isoniazide). The monitoring revealed that a large number of patients developed elevated liver enzymes. It was also found that in many cases the enzymes increased to two or three times normal - not a hundred times normal as in hepatitis. A few brave souls decided the benefits exceeded these risks and continued the INH cautiously. They found that liver enzymes did not increase further. Hence, a lot of TB patients that would have been taken off of the drug continued treatment. Health care improved.

In most instances, if the new drug has significant liver toxicity, it will show up in the first few months. If it doesn't, it is generally safe to continue it. Follow-up monitoring becomes the physician's clinical judgment call.

We see patients daily from other reputable practices and institutions that are on drugs that have not undergone monitoring for liver function for five or more years after the initial check. Then there are patients who read the drug company's entire circular stating that liver function tests are necessary every three months. Today I had one of those patients. She had been on Lovastatin for about five years. Her previous physician had monitored her liver function every three months. The record reflected about 20 normal liver function tests. At about $100 for a liver screen, the patient in the first instance had a monitoring cost of about $100. Today's patient had a monitoring cost of about $2,000. That is a 20 fold or 2,000 percent increase in health care costs. Estimating that there may be 10 million people on statin drugs, that is an extra $20 billion in health care costs. What is the answer?

The pharmaceutical companies will not bear the wrath of the FDA in reducing their recommendations, which they admit informally is excessive; but "Why should we take the risk?" The doctor is hesitant to instill common sense with many giving the same answer, "Why should we take the risk?" The insurance companies will dare not cover this excess for fear of adverse publicity. The groups writing the rules for the highest quality of care will certainly not be caught dead recommending anything less that a liver screen every three months. So, the answer returns to the patient who must be offered a financial incentive or at risk to do so. The only solution is a percentage copayment by the patient. A $10 or $20 copayment will not alter the $2,000. Only a 10 or 20 percent copayment will instill responsible behavior in the patient. No one else in the medical hierarchy can possibly achieve this avoidance of medical gluttonous behavior.

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6.      Medical Myths: More Rules and Regulations Make Medicine Safer

Adam Smith, in his Inquiry into the Wealth of Nations, drew an analogy between London and Paris in the eighteenth century. Was Paris with four volumes of laws safer than London, which had only a few pages? Most people believe more laws make us toe the mark. However, Professor Smith pointed out that murders and robberies were committed in Paris daily. Meanwhile, London, a larger city with only a few laws, had only three or four robberies or murders per year. Increased laws only worsened society and increased lawlessness and crime.

Doctors Practicing Medicine Based On Their Own Integrity and Moral Values With Less Rules and Regulations Will Make Medicine Safer.

And Then It Really Did Happen.

I remember a cartoon as a child picturing a family taking their vacation pulling an Airstream Trailer behind the car. The father looked out of his side window and remarked, "There goes an Airstream all by itself." The son in the back seat quickly looked behind him and said, "But dad that is OUR Airstream!"

Well, this week a patient came in for a follow up to an Emergency Room visit. She stated that she was a passenger in front with her husband heading for Lake Tahoe. As they were climbing, they noted a jeep coming around a large truck and there was not enough room on the mountainside to swerve to avoid it. As it got closer, they noticed there was no driver. After a head on collision with their car and jeep totaled, and all passengers still alive, it was found that the jeep was being towed by the truck and the hitch had come undone.

I had thought the cartoon was a funny story. But then it really did happen. It no longer seemed funny.

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7.      Overheard in the Medical Staff Lounge: The Wealthy Become Wealthier at Taxpayer's Expense

The wealthy class in Sacramento, which includes the Kings Players and their owners, who live in some of the largest homes in the area and drive expensive cars, was the subject of the discussion last week when the new Kings Arena was announced.

"It has taken six years of false starts, recriminations and damaged political careers to come up with a financing plan to build a new arena for the Sacramento Kings. But in the end, the deal hinged on a single, do-or-die round of late-night talks.

"Negotiators for the city and county of Sacramento, and for the Kings, announced in a briefing Thursday at The Bee that they had struck a deal to build an 18,000-seat arena with an estimated price tag of between $470 million and $542 million. Move-in date: 2010."

Dr. Hoyt, the jock of the medical staff, supported the effort to tax the city and county to pay for the new Arena for the Sacramento Kings. The sales tax increase for 15 years would produce $1.2 billion in revenue. The Arena would cost a half billion. Dr Hoyt shells out his $1600 for two season tickets every year. 

Dr. Sam: But the team owners would operate the arena and receive all revenues from events, parking and concessions. They also would get to keep the lucrative naming rights, likely worth millions. "They are talking about half a billion dollars to fund an arena, and the owners, the Maloofs, would reap the revenues -- that's a massive subsidy," said Dave Tamayo, president of People United for a Better Sacramento, a grass-roots organization opposing the plan.

Dr. Rosen: I just have a hard time understanding how subsidizing a huge money making machine in which guys in shorts make more money in one game than our professional colleagues who make daily life/death decisions earn all month is even ethical. Are they adding more value to society in one night than our work all month?

Dr Hoyt was wondering how the People's Magazine got into the Medical Staff Lounge. It was sporting a young male announcing that he was Gay. "Why should that be newsworthy?" he asked.

Dr Jay retorted, "I think I will have a coming out party announcing that I'm hetero sexual. But the nurses would treat that with a yawn."

Dr Hoyt: "But why would one announce to the world that he prefers placing his phallus inside his partner's rectum instead of his wife's vagina?"

Dr Jay: "Why is it polite conversation to admit that you prefer feces for your lubricant rather that the thin highly sensitizing vaginal secretions?"

Dr Hoyt: "I guess different strokes for different folks."

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8.      Voices of Medicine: A Voice from the Past, Sacramento Medicine, October 1999

Healthy Doctor-Patient Relationships

When I was a summer extern in a Kansas City hospital some years ago, the hospital employed Danish interns. As an idealistic third year medical student, I was struck by their comparison of American medicine with the practice of medicine in Denmark. American doctors, they said, try too hard to please their patients. In their country, physicians work for the government; the patients come to their designated doctor, who works from 8:30 to 5. Physicians make decisions without any deference to patients' feelings; there is no need to entice the patients to come back since they have no other choice.

The freedom to choose, a hallmark of a free society, has been important in our country. However, it has begun to erode even among professionals. There is diminishing hope for patient freedom of choice. They will be locked into a regimentation that is normally associated with a totalitarian or socialistic society.

An estimated 2/3 to 3/4 of physicians believe in limited government and personal liberty, and that humans behave for the betterment of their status, not because of any innate altruism. This becomes noblest under a system of economic and political freedom where we have to provide a wanted service before we can benefit from our endeavors. Any disruption of this process, e.g., by government intrusion, creates more problems than solutions; this holds true, by extension, to the ills we face in medicine.

Adam Smith in his Inquiry into the Wealth of Nations drew an analogy between London and Paris in the eighteenth century. Was Paris with four volumes of laws safer than London, which had only a few pages? Most people believe more laws make us toe the mark. However, Professor Smith pointed out that murders and robberies were committed in Paris daily. Meanwhile, London, a larger city with only a few laws, had only three or four robberies or murders per year. Increased laws only worsened society and increased lawlessness and crime.

In discussions with colleagues over the past decade in the staff rooms of our community's hospitals, I would guess that a large majority agrees with the premise that more laws are not the answers to our problems. Yet, many who agree in private will not admit the same if the staff lounge is filled with physicians for fear of antagonizing those physicians that believe in State Medicine. Also, many give examples in which they feel the government is the answer to malpractice, gas price inflation, the cost of health care, HMOs, and other problems.

Andrew I. Cohen of the University of Oklahoma defines a "free society" by three key features: 1) private property (which includes our medical license) is protected as inviolable; 2) the government's role, at most, is to prevent and punish the violation of individual rights; and 3) all human relationships (such as the doctor--patient relationship) are voluntary. To the extent that a society is free, it will provide the best opportunities to nurture and sustain deep friendships or lasting relationships.

Considering what is necessary for a deep relationship, two persons must share some form of good will. This sincere good nurtures a sense of trust and healthy interdependence. If, however, you find yourself in an institutional environment or an alliance that allows no choice, this involuntary relationship will restrict the development of any healthy relationship, including a healthy doctor-patient relationship. A free society will always try to minimize the extent to which human relationships are involuntary.

The practice of medicine has, in a significant way, become an involuntary relationship. The doctor-patient relationship is frequently forced. For twenty years, patients sought my medical advice or opinion and gladly waited for it. If I gave that medical advice at 6:45 pm when the appointment was at 4:45 pm, they thanked me for staying late to see them and some even asked if they could pay me extra for working late. Now we have administrators who tell doctors that a 15-30 minute wait for patients is unreasonable. Since they know nothing of quality of care, this superficial measuring stick gives them a reason for existence. The record of that professional opinion was held inviolable by the doctor in trust for the patient. Seldom was that relationship terminated.

Now, patients frequently come because they are directed by their insurance carrier into an involuntary relationship, making the doctor-patient relationship suspect. Patients don't completely trust what the physician records if they believe what is recorded may prevent the care they want.

Occasionally doctors sell their practices for $25 a chart. An administrator who bought the charts, now his organization's property, may not readily release a patient's chart to a new doctor. Thereby, the most confidential of all records has been auctioned off to the highest bidder, who considers a patient who has to wait for 30 minutes for an appointment as merely two or three units of lost revenue.

Patients who leave one hospital HMO because the appointment terminates at exactly 15 minutes sometimes find that the doctor in the next HMO presses a time clock when he walks in and a beep goes off after 9 minutes alerting the doctor that he has 60 seconds to bring the medical evaluation to a close and start his/her next appointment. Doctor, medical group, administration, insurance carrier, and patient are all now adversaries in a forced relationship.

Doctors see no hope in solving this problem voluntarily. The profession that in the past looked to the law and lawyers as the ultimate losing game now is actually looking to lawyers and laws to solve their problems. If we considered ourselves as the protector of our patient's health, we would never have sold a chart at any price. If we controlled the patient's medical file, we could never be asked to compromise care or to be held hostage. We would continue to have a trusting, healthy interdependent relationship. And none of this has any relationship to laws or lawyers. It's us, a profession based on principles, simply being professional.

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9.      Book Review: DOWN FROM TROY: A Doctor Comes of Age by Richard Selzer, Reviewed by Del Meyer, MD

[This rerun of the review of Dr Selzer's book, which I did for Sacramento Medicine in 1992, was precipitated by an email from Richard Herrick who would like help in locating Dr. Richard Selzer. If you know of his where-abouts, please feel free to communicate directly with Richard Herrick. See email at the end.]

Dr. Richard Selzer, a surgeon from Yale, recounts his childhood memories of Troy, NY, as the son of one of the town's doctor. His mother, an artist, wanted him become a writer. His father, however, continually reminded his mother of the boy's fine surgical hands. Every evening at bedtime, his mother, a self taught soprano, sang an ecumenical litany to her sons, Dickie, as Richard was called, and his brother Billie. She would sing "Shema Yisroel" alternated with "Ave Maria" and "Keep Me, O Keep Me, King of Kings, Beneath Thine Own Almighty Wings," which was Dickie's favorite. His father accused his mother of religious inconsistency. She defended herself: "With prayers, there is no harm in being especially sure." Mother said she was glad she had an untrained voice and had never learned to read music. This way she wasn't a slave to the rules. It was all done by ear and by instinct. If she heard a song once, it belonged to her ever afterward. Dickie never missed her performances at the Troy Music Hall which had the most perfect acoustics in North America. It still does. No one knows how this accident happened.

Mother was also the "doctor's wife" a position of no small importance in those days. Not a day went by that she wasn't stopped on the street and asked for medical advice, which she ladled out as if it were bounty. She didn't always get it right and a portion of Father's time had to be spent countermanding her suggestions.

Once Father received two tickets to Havana, Cuba, from a Mame Faye. The prostitute was unable to take a vacation and so gave them to Father "for services rendered." Billie, being an infant at the time, was left behind with friends. On his twenty-first birthday, mother not only explained to Dickie that Havana was the site of his conception, but she took him there.

Father & Mother frequently argued. Mother did not share Father's love for Troy. Born and raised in Montreal, albeit in the ghetto of St. Urbain Street, she considered Troy a geographical come-down. Dickie learned from his parent's marriage that there is no need to clear up misunderstandings. It is mainly by them that one day advances into the next and that people continue to relate to one another. The "discussion" between Dickie's parents concerning his becoming a writer versus a surgeon continued.

"When I was 12, and it appeared to Father that he might be losing, he committed the supreme act of seduction," Dr. Selzer writes. "He died. . . Since I could not find him in the flesh, I would find him through the work he did." He became a surgeon. When he turned 40, however, his mother's wish was fulfilled. He also became a writer.

Dr. Selzer returns to his native Troy after 50 years in this is his seventh book. A town with an extraordinary assortment of hookers, (Dr. Selzer did not find out until he was 50, that many of the prostitutes his father treated in his surgery had had him as a client as well as a physician) merciful nuns, spinster schoolteachers, hard-drinking working men, retired professors, and voraciously hungry fat ladies. His insights, humor, humanity, all come to life in this narrative, an art he states he learned from the Bard of Troy, a one-eyed veteran of World War I, named Duffy. . .

Dr. Meyer: I am working with Penny Lane and Anne Marie Lanesey on this project and we would like your help in locating Dr. Richard Selzer. 


We read your review of "DOWN FROM TROY: A Doctor Comes of Age" which lead to this e-mail to you.

Any and all help, which you can offer, including permission to use the anecdotes from your book review, to make this project a success is appreciated.  

Project overview: Troy's House of the Rising Sun: Recording oral histories of Mame Faye's Life and Times in Troy

Troy past is rich in history.  It was a town with an extraordinary assortment of hookers, including best known and Troy's own Mame Faye.

Independent filmmaker and RPI graduates Penny Lane and Anne Marie Lanesey want to build a link to Mame Faye's past and her long departed Brothels which were on Sixth Street.  As you may know Brothel Row was the home to Mame Faye and her ladies who enjoyed a great notoriety it is said for their famous clients.

Penny is collecting oral histories of Mame Faye's life and plans to convert the work into a video documentary to tell those tales.  Interviews with people who know of Mame Faye's many stories and heard of or lived in Faye's heyday will follow shortly. Also needed for the project are photos, old newspaper articles, and songs. It is said that some of RPI's old fraternity song books from the early part of this century have songs about Mame.     

Right now we are in the initial stages of the oral history phase of the project.  We need to talk with people from a lot of different eras and collect as much historical data as we can.  Penny views this effort and subsequent video documentary as a compelling way to share a slice of Troy's rich history. Penny may be contacted at 518-527-9521.  

As an aside my Great Great Grandfather: 

On the 17 March 1872, at Argusville, New York, John Sherburne Herrick, M.D. died at age 49 years.  Dr Herrick was one of the early graduates of the Albany Medical College (graduated 1847) and up to his death was engaged in a large practice in rural Schoharie County, NY.  Albany Med is of the nation's oldest private medical school., The institution was founded in 1839 with an initial enrollment of 57 students.


Dr. Herrick has been difficult to obtain info on, including his date of birth and a picture.  I am still researching him for my Family Tree. I may be reached at 518-312-6078. Richard Herrick  

To read the entire review, as well as some of the letters he wrote, please go to

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10.  Hippocrates & His Kin: Just a Notch Above Lawyers

Lawyer: Trying to explain to his doctor client how the "Law of the Deep Pockets" might affect the litigation, "By way of the converse, A Bum is Judgment Proof."

Doctor: So by treating this BUM, I get sued. But if he had struck me and paralyzed me that would just be too bad?

Lawyer: So you're beginning to see how we attorneys win no matter who loses.

Will Rogers said, "I never met a man I didn't like."

Attorney: "I never met a man in a neck brace I didn't like." (After Parker)

"I would like to see the time come when the massive hemorrhage of some of our best talents into the law will cease. . . Our country is already sufficiently litigation-prone and legalistic. The over-supply of lawyers not only helps create its own demand but can get in the way of solving problems. –Jess Brallier: LAWYERS and Other Reptiles II

Attorney to client who had just fired him: "You can't act as your own attorney. This kind of trickery and duplicity is best left to professionals." WSJ

Bureaucrat to doctor: Don't you feel bad taking money from sick people?

Doctor: Not really. . . I just keep them alive so you can get their taxes.

Bureaucrat to himself: I guess doctors give me job security.

Remember: For every doctor in prison, there is an attorney out there who represented him.

Doctors should never talk to patients about anything but medicine. When doctors talk politics, economics or sports, they reveal themselves to be ordinary mortals--you know, idiots like the rest of us. --Andy Rooney

Attorney Jill Demmel reporting in our local newspaper about the unending assault on her profession, "I think it was maybe five or six years ago that we ranked right above used-car salesmen in respect and it's gone downhill from there..." Well don't worry Jill. Our administrative and professional leadership feels that your efforts and more laws are the answer to medicine's problems. So we'll be right down there with you shortly.

To read more archived HHK Vignettes, go to To read more about attorneys and summertime fun, scroll down to the July-August issue.

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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 and register to receive one or more of these reports. The Single-Payer Government proponents complain about the patchwork in US healthcare and that we need one government single-payer system to have a uniform and smooth running health care system. For reality, be sure to read the current posting: If Washington were truly interested in knowing why Americans cheat or try to avoid taxes, it wouldn't have to look any further than the more than 65,000 pages that make up the federal tax code and the 582 tax forms, says Investor's Business Daily (IBD). The tax code is a patchwork of needless complexity, filled with loopholes, exceptions and rules that confound the Internal Revenue Service's own agents, who give out the wrong information about half the time when taxpayers call with questions. To understand how government health care would look if we had single-payer government control, please go to

                      Pacific Research Institute, ( Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may subscribe at or access their health page at This month, be sure to look over the press release on a new book that addresses: What States Can Do To Reform Health Care at

                      The Mercatus Center at George Mason University ( is a strong advocate for accountability in government and oversight. 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: Mercatus Center research seeks to understand the consequences – both intended and unintended – of public sector management processes, such as funding and management decisions by state and federal governments, and improve the state of knowledge to which these processes refer, thereby fostering solutions that promote a freer, more prosperous, and civil society.  Research focus includes: tax and fiscal policy, government accountability, the contracting process, government reform, and congressional oversight. To review recent publications, please go to

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

                      The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at A 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. When you buy any big-ticket item, whether a house, a car, or a big-screen television, you compare prices. So isn't it astounding that last year Americans laid out nearly $2 trillion for health care with only the vaguest inkling of the price for individual products and services? For Americans today, comparison shopping in medical services is next to impossible. To read Grace-Marie Turners entire Op-Ed piece in the New York Sun, please go to

                      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 To join, go to 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 at To read the latest in Consumer Health Updates, go to

                      The Heartland Institute,, publishes the Health Care News. Read the late Conrad F Meier on What is Free-Market Health Care? at You may sign up for their health care email newsletter at To read another failed attempt to have the US Senate address the health care needs of small business, please go to

                      The Foundation for Economic Education,, 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. Read another classic about the roller coaster ride of a government bureaucracy and the power to manipulate: Ninety Years of Monetary Central Planning in the United States by Richard M  Ebeling, PhD, please go to

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

                      The Health Policy Fact Checkers is a great resource to check the facts for accuracy in reporting and can be accessed from the preceding CAHI site or directly at This week, read the Daily Medical Follies: "Woeful Tales from the World of Nationalized Health Care" at

                      The Independence Institute,, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter at Read her latest newsletter at, which includes a section on PC Medicine and Euthanasia. Read Joanna Conder's latest Op-Ed piece, Medicare Cap Makes Physician Supply Fall Short at  

                      Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read Sowing Socialist Seeds And Expecting A Harvest Of Free Enterprise by Randy Hillier. Years from now when the last family farm is bankrupt and corporate factory farms have finished monopolizing the industry, people will look back and wonder if the destruction was avoidable. For farmers, this is the critical moment when they must ask themselves the tough questions and be prepared to accept the painful answers. What went wrong? Who is responsible? Can the problems be fixed? These questions have been willfully avoided but necessity demands answers. Read about Beggars on Tractors at Martin Masse's recent editorial at www.quebecoislibre.orgr/04/040615-2.htm.

                      The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at for an overview of the extensive research articles that are available. You may want to go directly to their health research section at This year, Canadians start working for themselves on June 19th. According to The Fraser Institute's annual Tax Freedom Day calculations, released today, Canadians worked until June 18th to pay the total tax bill imposed on them by all levels of government. Read more at    

                      The Heritage Foundation,, 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. Recent healthcare info can be reviewed at

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

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

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

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

                      Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. You may join them to explore the Roots of American Republicanism on a British Isles cruise on July 10-21, 2006. 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. Read President Arnn's comments at Also, read his comments on Ronald Reagan, RIP, at Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read Harvey C Mansfield on A New Feminism at The last ten years of Imprimis are archived at

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Del Meyer

Del Meyer, MD, Editor & Founder

6620 Coyle Ave, Ste 122, Carmichael, CA 95608

Words of Wisdom

Let every nation know, whether it wishes us well or ill, that we shall pay any price, bear any burden, meet any hardship, support any friend, oppose any foe to assure the survival and the success of liberty. –John F. Kennedy, 1961.

Above all, we must realize that no arsenal, or no weapon in the arsenals of the world, is so formidable as the will and moral courage of free men and women. –Ronald Reagan, 1981.

Some Recent Postings

DOWN FROM TROY: A Doctor Comes of Age by Richard Selzer

"Guantánamo": Torture, Blowback, and Innocence, a Cinematic Op-Ed by James J Murtagh, M.D.

The Encyclopedia of Stress and Stress-Related Diseases by Ada P. Kahn, PhD, has now been published. To read the foreword I wrote please go to Published by Facts On File: Enter Kahn in the search box.

In Memoriam

George C. Roche III: Hillsdale College is saddened to announce the passing of its 11th president, George Charles Roche III. President Roche died Friday evening, May 5, in Louisville, Kentucky. Born in 1935 in Colorado, President Roche was a graduate of Regis College and the University of Colorado, from which he received his M.A. and Ph.D. in history. He is the author of nine books.

President Roche was appointed the 11th president of Hillsdale College in 1971. He served in that office for 28 years until November 1999. Under his leadership, the college continued and extended its policy of refusing all forms of federal government support. In 1977, efforts were made by the Department of Health Education and Welfare to subject all colleges whose students received any form of federal aid to the full range of federal regulations. This included even those colleges that refused every form of direct aid. Hillsdale College refused to agree. In 1984, it lost its case before the Supreme Court and faced the prospect of the loans of all its students and graduates being recalled. Rather than submit, the college organized a private loan fund on the guarantee of its own credit and began to supply privately-based financial aid to replace the federal support. . . .

In a tribute to President Roche written for a gathering in his honor last November, Hillsdale College President Larry Arnn spoke of the moment when the federal Department of Health Education and Welfare threatened to call in all the loans of the college if it did not submit:

"Having worked here for a while myself, I have some ability to measure the difficulty of that moment 29 years ago. It would take a strong-willed man to see the college through a moment like that. It would take shrewdness, and it would take fortitude.

"It was important for the college that those qualities were present in its leadership at that moment. Those of us who must now carry on are grateful that it was here."

To read the entire tribute, please go to

On This Date in History – August 8

On this date in 1940, the Battle of Britain began. The waging of war used to be rather selective. War was conducted by fighting men, while the civilians waited for the results. Over the years, it began to change; but total war, as we know it now, really began on this day, August 8, in 1940, during World War II, with the Battle of Britain, a sustained series of air attacks by the German Air Force against both British home territory and the Royal Air Force. It was a foretaste of what of what was to come later, when cities were to be main targets, with their civilian populations, for the bombers of both sides. Not only was the aerial blitz defeated; the British people, finding themselves, so to speak, combatants in the war, responded with a new burst of determination. When you find yourselves in a war, even if you are a civilian, you may not have too many alternatives.

On this date in 1950, President Truman issued a warning. Citizens have a double-edged relationship with their government. They regard Uncle Sam as a protector and a helping hand, but they want to keep Uncle Sam from intruding too much into their lives. And, above all, they are troubled about where the rights of the individual and the rights of the state part company. President Harry S. Truman gave us one suggestion, when he said on this date in 1950: "Once a government is committed to silencing the voice of opposition, it has only one way to go, and that is down the path of increasingly repressive measures, until it becomes a source of terror to all its citizens and creates a country where everyone lives in fear." Although we have come close once or twice, we have never gone down that path. But all around us, all the time, we see other nations going down that path. . . . We have to watch ourselves.

Speaker's Lifetime Library, © 1979, Leonard and Thelma Spinard