Community For Better Health Care

Vol VIII, No 16, Dec 22, 2009


In This Issue:

1.                  Featured Article: New Predictors of Disease

2.                  In the News: Doctors' boos show Obama's tough road 

3.                  International Medicine: The persecution of NHS whistleblowers

4.                  Medicare: Telling Doctors How to Practice Medicine

5.                  Medical Gluttony: Emergency Care is the most Gluttonous of all Health Care

6.                  Medical Myths: The uninsured cause overcrowding in emergency rooms, and increase costs

7.                  Overheard in the Medical Staff Lounge: The National Health Care Debate

8.                  Voices of Medicine: Do we still need the Ban on the Corporate Practice of Medicine?

9.                  The Bookshelf: Health Care in Crisis - Has it Changed?

10.              Hippocrates & His Kin: Government Health Care Costs More than Private Health Care

11.              Related Organizations: Restoring Accountability in Medical Practice and Society

Words of Wisdom, Recent Postings, In Memoriam . . .

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                          Merry Christmas 2009                  

Thursday night, December 24, 1776, marks the anniversary of George Washington leading his troops across the Delaware to attack the British the next day in New Jersey. Thus began the greatest experiment in human freedom the world has ever experienced. The history of governments for millennia has been one of oppression and servitude. Freedom of this magnitude was never previously sought nor enjoyed by a nation. This freedom lasted for 150 years. It has been gradually restricting for the past 75 years. We must be forever on guard that our government does not repeat history. Government has found a new access to our most personal and private lives - our medical records. This last invasion now makes control over our very lives absolute. Let's make our final stand against the Reid-Pelosi bill our battle of Appomattox, which on April 9, 1865, preserved our nation in the Civil War. To that end, MedicalTuesday is dedicated to restoring freedom in health care - the only assurance of privacy in our personal health matters and in our lives. After this battle is won in 2010, we will continue the battle for the Freedom we won in 1776, lost in 1933, to eliminate the intrusion of government into our personal and private lives.  

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1.      Featured Article: New Predictors of Disease                                                                             

NOVEL CRYSTAL BALL: One day Y-shaped molecules called autoantibodies in a patient's blood may tell doctors whether a patient is "brewing" certain diseases and may even indicate roughly how soon the individual will begin to feel symptoms.
By Abner Louis Notkins
Scientific American

Overview/Predictive Antibodies
In autoimmune diseases, such as type 1 diabetes, the immune system mistakenly manufactures antibodies that target the body's tissues.

Certain of these "autoantibodies" appear many years before overt symptoms of disease, suggesting that screening for these molecules could be used to predict who is at risk of falling ill.

Autoantibodies might also serve as guides to disease severity and progression and might even warn of risk for some nonimmune disorders.

Screening for predictive autoantibodies could one day become routine, although a dearth of preventive treatments currently stands in the way.

A middle-aged woman—call her Anne—was taken aback when one day her right hand refused to hold a pen. A few weeks later her right foot began to drag reluctantly behind her left. Af­ter her symptoms worsened over months, she con­sulted a neurologist. Anne, it turned out, was suf­fering from multiple sclerosis, a potentially dis­abling type of autoimmune disease. The immune system normally jumps into action in response to bacteria and viruses, deploying antibodies, other molecules and various white blood cells to recog­nize and destroy trespassers. But in autoimmune disorders, components of the body's immune sys­tem target one or more of the person's own tis­sues. In Anne's case, her defensive system had be­gun to turn against her nerves, eroding her abil­ity to move.

Every story of autoimmune disease is sad—but collectively the impact of these illnesses is staggering. More than 40 autoimmune condi­tions have been identified, including such com­mon examples as type 1 (insulin-dependent) dia­betes, rheumatoid arthritis and celiac disease. Together they constitute the third leading cause of sickness and death after heart disease and can­cer. And they afflict between 5 and 8 percent of the U.S. population, racking up an annual medical bill in the tens of billions of dollars.

Recent findings offer a way to brighten this gloomy picture. In the past 10 years a growing number of studies have revealed that the body makes certain antibodies directed against itself—otherwise known as autoantibodies—years, and sometimes a decade, before autoimmunity causes clinical disease, damaging tissues so much that people begin showing symptoms. This profound insight is changing the way that doctors and re­searchers think about autoimmune conditions and how long they take to arise. It suggests that physicians might one day screen a healthy per­son's blood for certain autoantibodies and fore­tell whether a specific disease is likely to develop years down the line. Armed with such predic­tions, patients could start fighting the ailment with drugs or other available interventions, there­by preventing or delaying symptoms. . . .

Early Insight from Diabetes

People familiar with advances in genetics might wonder why researchers would want to develop tests for predictive autoantibodies when doctors might soon be able to scan a person's genes for those that put the individual at risk of various disorders. The answer is that most chron­ic diseases arise from a complex interplay between environ­mental influences and multiple genes (each of which makes but a small contribution to a disease). So detection of susceptibil­ity genes would not necessarily reveal with any certainty whether or when an individual will come down with a particu­lar autoimmune condition. In contrast, detection of specific autoantibodies would signal that a disease-causing process was already under way. Eventually, genetic screening for those with an inherited predisposition to a disease may help reveal those who need early au­toantibody screening.

Studies of patients with type 1 dia­betes provided the first clues that auto­antibodies could be valuable for predict­ing later illness. In this condition, which typically arises in children or teenagers, the immune system ambushes the beta cells in the pancreas. These cells are the manufacturers of insulin, a hormone that enables cells to take up vital glucose from the blood for energy. When the body lacks insulin, cells starve and blood glucose levels soar, potentially leading to blindness, kidney failure, and a host of other complications. . .

More important, these studies also raised the prospect that doctors might forecast whether a child is at risk for type 1 dia­betes by testing blood for the presence of these autoantibodies. Clinical researchers found that an individual with one auto­antibody has a 10 percent risk of showing symptoms within five years. With two autoantibodies, the chance of disease jumps to 50 percent; with three autoantibodies, the threat rockets to between 60 and 80 percent. . .

The discovery that autoantibodies frequently herald the onset of type 1 diabetes prompted scien­tists to examine whether the same might be true in other au­toimmune diseases. One that has been the focus of especially intense research is rheumatoid arthritis, a debilitating condi­tion that is highly prevalent, afflicting about 1 percent of the world's population. In those affected, the immune system at­tacks and destroys the lining of the joints, causing swelling, chronic pain and eventual loss of movement.

Predicting Other Diseases

Immunologists have recently unearthed an auto­antibody that is present in 30 to 70 percent of patients diag­nosed with rheumatoid arthritis . . .

To read the rest of this remarkable research. . .

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2.      In the News: Analysis: Doctors' boos show Obama's tough road

Barack Obama isn't used to hearing boos.

[But with the lack of political sophistication of the AMA, it really does not matter. Politicians cannot be too concerned about one-half of one percent of America. Their votes are not even a blip on the vote tally.]

For all the young president's popularity, the response he got Monday from doctors at an American Medical Association meeting was a sign his road is only going to get rockier as he tries to sell his plan to overhaul the nation's health care system.

The boos erupted when Obama told the doctors in Chicago he wouldn't try to help them win their top legislative priority — limits on jury damages in medical malpractice cases.

But what could they expect? If Obama announced support for malpractice limits, that would set trial lawyers and unions — major supporters of Democratic candidates — on the attack. Not to mention consumer groups.

Every other group in the health care debate has a wish list and a top priority. Insurers don't want competition from the government. Employers don't want to be told they have to offer medical coverage to their workers. Hospitals want to stave off Medicare cuts. Drug companies want to charge what the market will bear.

Obama can't give all of them what they want. . .

AMA insiders shouldn't have been surprised by Obama's upfront refusal to consider malpractice caps.

The group couldn't get that idea passed by a Republican Congress and president a few years ago. Some states have such curbs, but anyone who can count votes knows the chances for national limits are slim to none with Democrats in charge of Congress. . .

Read the entire analysis:

EDITOR'S NOTE - Ricardo Alonso-Zaldivar reports on health care policy for The Associated Press.

Feedback . . .

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3.      International Medicine: The persecution of NHS whistleblowers

The government says it supports whistleblowing, yet excuses are still being made when they are sacked and humiliated by Beatrix Campbell, The  

"The government supports whistleblowing," said culture secretary Ben Bradshaw in May. "And the NHS is expected to support it too." Well, Dr Kim Holt certainly didn't get any support from the NHS in London for warning in 2006 that child protection had become unsafe in Haringey's St Ann's hospital – before the brutal death of Peter Connelly (also known as Baby P) in August 2007. Nor was she supported by her employer, the celebrated Great Ormond Street hospital trust.

Her sin was to draw attention to the effects of shortages compounded by cuts. This popular and successful doctor says she felt doomed after she and the three other consultants with questions about £400,000 cuts in an already shaky service wrote a joint letter airing their concerns. . By February 2007 she was no longer working at St Ann's. By the August when Connelly died there were no experienced consultant paediatricians there.

Holt has been subjected to the rage of a managerial machine that tolerates no dissent. Codes of conduct sanctioned by the General Medical Council (GMC) oblige doctors to raise concerns. But when they do doctors can rely neither on their managers, nor the GMC, nor the government?

In 1998 Dr Rita Pal tried to expose the frightening conditions at a Staffordshire hospital. The GMC turned its gaze to her rather than the hospital management. Uniquely, she sued the GMC. Judge Charles Harris concluded on 27 May 2004 that there were "clearly triable" issues raised by Pal against the GMC and that "cross-examination might be very revealing". The GMC settled.

But Pal was no longer working in the health service by the time her critique was vindicated earlier this year by the Healthcare Commission. The trust was imposing £10m million cuts and between 400 and 1200 more patients were dying than would normally have been expected. . .

Whistleblowers do what they do because the system silences them. It humiliates them, scares them and often sacks them. These whistleblowers have lost money, time, sleep and self-esteem; they endured nightmares not only about their own future but the safety of patients who needed on them. . . Read the entire report . . .

Feedback . . .

The NHS does not give timely access to healthcare; it only gives access to a waiting list.

Government medicine is the same the world over.

Any Doctor that tries to improve it gets Sacked and Humiliated.

Let's preserve what we have before it's too late.

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4.      Medicare: Telling Doctors How to Practice Medicine by John Goodman, PhD

In Redefining Health Care, Michael Porter and Elizabeth Olmsted Teisberg explained that the key to efficient health care is doctors' repackaging and repricing the services they provide. In The Innovator's Prescription, Clay Christensen showed that doctors need different payment structures, depending on the types of activities they engage in. In Market-Driven Health Care and in other books Regina Herzlinger argued for delivering health care in specialized, focused factories. In reviewing these publications [here, here and here], I argued that the desired reforms would be natural and normal in an unfettered medical marketplace.

Our system of third-party payment, however, stands in the way of high-quality, low-cost care. To see how health care could be different, we can look to those markets where the third-party payers are absent. Concierge doctors, for example, consult with their patients by phone and e-mail, keep medical records electronically, prescribe electronically and provide other services that insurance normally doesn't pay for. Walk-in clinics post their prices and strive to lower the time cost as well as the money cost of care. In the medical tourism market, there is not only transparency, but price and quality competition are the norm.

Yet, third-party payment isn't going away. Given that, how can we get from where we are now to where we need to be? The dominant view is that buyers of care should use the power of the purse to force doctors to do what they probably would have done anyway if the third-party payers had not been there in the first place. In a previous Alert, I called this the "demand-side" approach to changing medical practice and there isn't a chance in the world that it's going to succeed. . . Read the entire report. . .

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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: Just as in People Gluttony, Medical Gluttony never sees itself as Gluttonous

Last month, a patient bemoaned the excesses of health care in general and Medicare in particular. With 40 percent of health care over-utilized or excessive, as my patient stated, he felt we should easily afford giving everyone A-Number-1 health care by eliminating these excesses. He felt that Obama care was good for the country and would make health care available to all.

This week, he came in because his nose was congested and he had been to the Emergency Department where he had a rather complete evaluation, including CT scans of his nasal sinuses. He came in because his $4,000 ER visit was not helpful. No treatment was provided. We provided him complimentary nasal steroids and suggested some OTC antihistamines. He responded and was well in two days.

Another patient came in last month having been to the ER the night before with pain in his right leg. He had a venous Doppler of his right leg, along with chest x-rays, ECGs and a variety of lab studies. He was told he did not have thrombophlebitis or pulmonary embolization, but they were not entirely sure. So he was told to have me order another venous Doppler of his right leg since this one was normal, just in case. No treatment was provided. His exam in the office revealed three plus ankle edema to his knees, orthopnea to the extent he could not lie in bed and had to sleep in his Lazy Boy Recliner, with neck veins distended to 45 degrees indicating rather significant right heart failure. He responded nicely with intravenous furosemide with a five-pound (five pints of fluid or ten glasses) diuresis overnight. He asked if he should have the repeat studies that the ER had recommended. He was told the ER evaluation was not directed to his primary rather acute problem, congestive heart failure, and so they would not be necessary. He was better after a $125 office call than the ER call which was at least 20 times as expensive.

Another patient came in having been to the Emergency Room with shortness of breath. A CXR, lung V/Q scan was unremarkable as was his ECG, cardiac studies and a variety of other tests. The shortness of breath occurred some months earlier and was associated with severe pleuritic chest pain. He had been on a trip to Los Angeles, the classic finding for pulmonary embolus. He was told he definitely did not have a pulmonary embolus, a blood clot to his lung. However, being several months later, all the acute tests for that diagnosis were no longer positive and would no longer be expected to be diagnostic. This would be a clinical diagnosis, no longer accepted by medical protocols, and he was given no explanation for his persistent three months of shortness of breath. This shortness of breath did resolve after three months of anticoagulation treatment for the clinical diagnosis.

What did all these three cases have in common? Unnecessary emergency evaluation, with poorly directed diagnostic and costly testing.

The billing costs of these three cases as compared with similar known costs (since hospital charges are confidential) was estimated at $20,000 to $30,000, even though only about three to five thousand dollars would be collected by the hospital using comparative figures.

The office cost to correct these errors was about $300, which could have been the entire cost if the ER visits had been avoided.

This information unfortunately will never be highlighted nor understood in the current health care cost-cutting debate, even though the magnitude of this Health Care Gluttony is major. These three patients were initially seen in the same week, and this was an ordinary week. Even considering $20,000 of excess charges, this would amount to $One million in one year of excess Medical Gluttony seen in one practice during the course of one year.

One of these three had stated that by eliminating this over-utilization, we could provide free health care for all. When this was presented to these patients, not one of them saw themselves as over-utilizing or involved in excessive or unnecessary health care costs, much less as being gluttonous.

Oh, that God the gift would give us, To see ourselves as others see us -Robert Burns

[This should not be read as criticism for how emergency rooms work. They have to attend to whatever patients bring to them and treat them in the ER milieu, which is different than the office milieu. The answer as usual is more citizen- or patient-responsible behavior. We should not expect our doctors to be medical cops. To prevent this adversary arrangement, patients should have a percentage co-payment on every test so they would be their own cops. They will be more effective cost containers than any oversight or government agency.]

The Health Care Debate in our Nation this year has not even touched this basic health care problem.

Feedback . . .

Medical Gluttony thrives in Government and Health Insurance Programs.

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

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6.      Medical Myths: The uninsured cause overcrowding in emergency rooms

Myth 12. The uninsured cause overcrowding in emergency rooms, and increase costs for the "rest of us" through cost-shifting. AAPS July 29, 2009

The uninsured are frequently vilified as "free riders" who receive care but shift the cost onto others—when they are not being portrayed as victims who don't get as much medical care as some think they should.

Thus they deserve punishment by higher taxes if they don't accept their "individual responsibility" to buy costly insurance—or else public subsidies to buy "coverage" (instead of public payment for care actually received).

The problem is purportedly magnified by overuse of the more costly emergency room by uninsured patients who delayed care they should have gotten sooner from a lower-cost primary physician.

In fact, the Congressional Budget Office (CBO) finds that "uncompensated care is less significant than many people assume." Citing a study by Jack Hadley and others in a Health Affairs web exclusive for Aug 25, 2008, the CBO noted that the $35 billion in uncompensated care provided by hospitals in 2008 constituted less than 2% of total expenditures, and the estimates are much smaller for other providers. The amount potentially associated with cost-shifting from the uninsured is at most 1.7% of private health insurance costs, conclude Hadley et al.

The amount supposedly lost because of uncompensated care is, moreover, likely calculated from grossly inflated "chargemaster" prices.

The uninsured paid $30 billion out of pocket for medical care in 2007. According to a California HealthCare Foundation study, 50% of uninsured residents with incomes at least twice the federal poverty level obtained some medical care in the past year for which they were charged; 80% paid in full, and 10% were paying in installments. About 8% received pro bono care (Wall St J 11/21/08).

A much more serious cause of cost-shifting is underpayment by government programs, Medicare and Medicaid. The "leech therapy" that these programs use to hold down their own costs by sucking about $90 billion from the private sector adds some 11% (or $1,800 for the average family) to the cost of private plans, writes Shikha Dalmia (Forbes 6/17/09).

Additionally, two-thirds of all medical bad debt is caused by insured patients, who decline to pay their copayments and deductibles, leaving thousands of uncollected balances averaging $500 to $1,000 (WSJ Market Watch 9/9/08).

As to the burden on emergency rooms, uninsured patients are underrepresented there (JAMA 2008;300:1914-1924)—after all, they worry about the cost. In Massachusetts, despite the decrease in the number of the uninsured, there has been little change in ER use for routine problems (Kevin Sack, NY Times 5/28/09). One reason might be that expanded insurance coverage leads to expanded demand, and nothing was done to increase available supply.

Hadley et al. estimated the increased demand that would come from insuring all the uninsured: an increase of some $112 billion in medical spending.

The experiment has already been done north of the border. An ER physician in Thunder Bay, Ontario, estimated that nearly half of the residents of his town could not find a family physician and thus flocked to the ER for every medical need, reports Dave Racer.

Additional information:

This entry was posted on Wednesday, July 29th, 2009 at 7:56 am and is filed under health care reform, mythbusters, uninsured. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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Medical Myths Originate When Someone Else Pays The Medical Bills.

Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service.

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7.      Overheard in the Medical Staff Lounge: The National Health Care Debate

Dr. Rosen: The national health care debate seems to be heating up.

Dr. Milton: There is a lot of heat, but not much luminescence.

Dr. Edwards: Not even in the health care dungeon?

Dr. Yancy: Don't you mean the hospital?

Dr. Milton: No I really mean Washington.

Dr. Ruth: But don't you think these issues are now receiving media attention? Isn't that good?

Dr. Rosen: Yes, that would be good if the national attention span were a bit longer than a 9-second blip.

Dr. Yancy: The national attention span gets shorter every year. Some can't even say the name of the current health reform bill in 9 seconds.

Dr. Edwards: That does make the case that a national debate would be non-productive.

Dr. Rosen: Greg Scandlen points out that all the arguments that we're hearing are carryovers from the 1960s debates when a case could be made for the poor and disabled, the seniors and the veterans. But these are all covered now by entitlements.

Dr. Milton: Yes. But those for government medicine, who think there never is enough of government involvement as long as independent citizens are making their own choices, will never be satisfied until they think all doctors are under their thumb.

Dr. Paul: Your paranoia is showing through, Milton.

Dr. Milton: You can't tell me that the members of Congress don't really dislike us?

Dr. Paul: I've never heard one to make such an assertion. Maybe it's your paranoia index on the rise?

Dr. Edwards: I think it's a valid suspicion. Sure, when they're speaking with you one gets the impression that they're working in your court. But it shouldn't take too many press conferences to realize that they are avowed socialists and as such are anti-private practice, anti-capitalist, and thus against professions that they think have public favor.

Dr. Rosen: Getting back to the issues in the health care debate, the real issues are whom the uninsured are and what can be done to keep those insured from over-utilizing expensive health care. It seems to me that the uninsured today is a totally different population from the uninsured of the 1960s.

Dr. Milton: I agree with Scandlen that people are led to believe the 1960s and that the poor, the seniors, the disabled, and the vets are now covered. So the uninsured are those who are working and don't want to spend their money on health insurance.

Dr. Edwards: In last week's Bee, there was an extensive article on a physician's son who couldn't afford health insurance. How sad. Doesn't that make you weep?

Dr. Milton: The uninsured are primarily those by choice who have other priorities, and the bureaucrats utilize their status as part of the argument. Except for the current recession with increased unemployment, the uninsured are making $50,000 to $75,000 per year and choose other priorities. A basic hospital and surgical plan for large liabilities can still be purchased for $400 a month, which should be affordable by those making $4,000 to $6,000 per month.

Dr. Edwards: People should get use to paying for the usual basic health care costs such as office calls, basic labs and x-rays. But most want their health insurance to be pre-payment plans for everything rather than a plan for costs that otherwise are difficult to afford.

Dr. Rosen: The Obama-Pelosi-Reid plan does not solve any health care problems, is not really about health, and will make health care less affordable than it is already.

Dr. Edwards: And will increase your taxes astronomically.

Dr. Milton: How can any reasonable doctor be for it?

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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

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

The San Mateo County Medical Association July-August 2009 Bulletin discusses the efforts to allow Hospitals to Practice Medicine.

There are Multiple Legislative Efforts to Erode the Ban on the Corporate Practice of Medicine

By Sue U. Malone, SMCMA Executive Director

You may not be following efforts in the current state legislative session to erode the corporate bar that prevents hospitals from directly employing physicians, but you should be aware of these efforts and contact our legislators to oppose these efforts. Three bills related to this topic were introduced this legislative session, two Assembly bills (AB 646 and 648) and one Senate bill (SB 726).

Modifying or eliminating the corporate medicine bar allows certain hospitals to hire physicians. Under current law, hospitals are barred from hiring doctors as employees. This important law was created to prevent corporations or other entities from unduly influencing the professional judgment and practice of medicine by licensed physicians.

The California Hospital Association (CHA) supports these legislative efforts and at least one of the bills (AB 648) is backed by a powerful labor union—the American Federation of State, County and Municipal Employees (AFSCME) — the largest public employee and health care workers' union in the United States.

The proponents argue that allowing certain hospitals and health care districts to hire doctors will increase access in underserved areas. On the other hand, organized medicine believes and has argued that there are more effective ways to increase access in the underserved areas and that the interests of patient protection served by the corporate bar are too important to be pushed aside. . .

You need to communicate with our legislators that SB 726would eliminate important legal protections for patients by allowing hospitals to directly employ physicians. It is important for the integrity of patient care that physicians remain independent from the corporate influence of the hospital administration, which must answer to priorities other than patient care. An erosion would eliminate important legal protections for patients, diminishing the equality of care that patients receive in California hospitals. . .

Read more . . .

The corruption of personalized health care by corporations will pale in comparison to how government medicine will essentially eliminate all individualized care.

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VOM Is Where Doctors' Thinking is Crystallized into Writing.

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9.      Book Review:  Health Care in Crisis - Has it Changed?

Code Blue: Health Care in Crisis
by Edward R. Annis. Regnery Gateway Press, Washington, D.C. 1993, 278 pages.
Reviewed by Del Meyer, MD

Doctor Annis opens his introduction describing the two worlds that physicians live in:  The wonderland of modern medicine, a gratifying and challenging world of achievement in research, education, and clinical practice; and the faltering American health care world, which is on the verge of collapse. Not unlike Charles Dickens in the opening to this Tale of Two Cities:  "It was the best of times. It was the worst of times."

Annis gives us many anecdotal insights into the history of American medicine:  Fleming's discovery of penicillin in England in 1928, that sat on the shelf until American drug companies developed methods of production in 1943, making it available to patients; sick England in the postwar era to healthy America; the high death rate of Europe to increased life expectancy to 68 years in America in 1949. The high cost of living is only exceeded by the higher cost of dying. His chapter on health insurance ("Call the Plumber, We're Insured!") is a parody on why health insurance is not insurance and, therefore, cannot work in its current format.

Edward Annis, who never chaired a meeting or held an organized medicine office, was elected president of the AMA at a young age in an attempt to counter a cunning band of political sophists in Washington, D.C. He champions the fight to head off government intrusion between doctor and patient and dispels the myth that a "managed" health care system would solve America's problems. He feels the problems in health care have a "Made in Washington" label. Health care already is the most regulated industry in America, strangling doctors and hospitals by senseless paper work, counterproductive bureaucracy, an abusive civil court system, and price controls that are actually driving prices up. He feels it should be labeled a crisis in government that can only be solved by less government interference.

In his final chapter, "What's the Solution?," Annis gives us his analysis of why third-party systems aren't working.  Clinton's health plan; and two well-thought-out plans which he feels put the patient back in the driver's seat - in charge of his or her own money. He favors "An Agenda for Solving America's Health Care Crisis," by the National Center for Policy Analysis, which can be reached at 214-386-6272. . .

Dr. Annis quotes Tom Paine's 1976 Revolutionary Era treatise, Common Sense, decrying excessive government, Time makes more converts than reason.

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This book review is found at . . .  

To read more book reviews . . .

To read book reviews topically . . . 

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10.  Hippocrates & His Kin: When is a tax not really a tax?

Telephone Bill
I was looking over the charges on my telephone bill and noticed 8 lines of taxes. There was another line that intrigued me: Monthly Regulatory Cost Recover Charge $1.25 to help defray costs incurred in complying with State and Federal telecom regulations; State and Federal Universal Service Charges, and surcharges for customer-based and revenue-based state and local assessments on AT&T. These are not taxes or government-required charges.

Is there anyone out there that would like to tack on a Regulatory Cost Recovery Charge for Physicians and see if we can get paid for what everyone else gets paid?

Car Service Bill
I was looking over my car statement for the last service job. There was an environment charge for oil drain disposal.

Suppose we could add an environment charge for needle and syringe disposal?

Sacramento thanks the taxpayers who had $25,000 taken from them forcibly under threat of incarceration to pay our symphony for concerts in the neighborhood.

The Philharmonic is able to once again bring the classical music to neighborhoods because of $25,000 in federal stimulus package funds approved by Congress earlier this year. Seven musicians, a conductor, a singer and narrator will present free performances of Igor Stravinsky's "The Soldier's Tale" and other works, from Del Paso Heights to Orangevale to Natomas. Sac Bee . . .

How Sad that Charity is no longer Voluntary.

Government Health Care Simply Costs More than Private Health Care

Just looking at the gross numbers: the total cost of the bill Sen. Reid presented to the Senate was estimated to be $848 billion. It was said to extend insurance coverage to 31 million Americans (maybe, in a few years). That would be about $27,000 per additional insured person.

Can't we just give these people a $12,000 gold-plated Blue Cross policy and save $15,000?

Karl Rove

Democrats began the year as masters of the political universe, winning the White House and increasing their majorities in Congress. But the year is ending badly for them. Their top initiative, health care, is deeply unpopular. Congress's approval rating is 26%, Speaker Nancy Pelosi's is 28%, and Senate Majority Leader Harry Reid's is an anemic 14%.

Would Congress really try to redo one fifth of our ecomomy by a majority of one that represents such a small fraction of who America really trusts?

If they do, it spells the end of American Freedom - at least until the next election.

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To read more HHK . . .

To read more HMC . . .

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11.  Professionals Restoring Accountability in Medical Practice, 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

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

                      PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .

                      PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. ( Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work. Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE. Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law. 

                      FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder,, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser's view on today's health care problem:  In today's proposals for sweeping changes in the field of medicine, the term "socialized medicine" is never used. Instead we hear demands for "universal," "mandatory," "singlepayer," and/or "comprehensive" systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this "nationalized financing" or "nationalized health insurance." In a more honest day, it was called socialized medicine.

                      Michael J. Harris, MD - - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis."

                      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

                      ReflectiveMedical Information Systems (RMIS), delivering information that empowers patients, is a new venture by Dr. David Gibson, one of our regular contributors, and his research group which will go far in making health care costs transparent. This site provides access to information related to medical costs as an informational and educational service to users of the website. This site contains general information regarding the historical, estimates, actual and Medicare range of amounts paid to providers and billed by providers to treat the procedures listed. These amounts were calculated based on actual claims paid. These amounts are not estimates of costs that may be incurred in the future. Although national or regional representations and estimates may be displayed, data from certain areas may not be included. You may want to follow this development at During your visit you may wish to enroll your own data to attract patients to your practice. This is truly innovative and has been needed for a long time. Congratulations to Dr. Gibson and staff for being at the cutting edge of healthcare reform with transparency. 

                      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

                      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, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives. He now has a new column with Richard Dolinar, MD, worth reading at

                      The Association of American Physicians & Surgeons (, The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: AMA favors some of worst features of Senate bill. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read The Power Of The Minority. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.

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Del Meyer, MD, Editor & Founder

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Feedback . . .

Words of Wisdom

John 3:16 For God so loved the world that he gave his only Son for our transgressions that whoever believes in him, shall not perish but have eternal life.

 "The essence of optimism is that it takes no account of the present, but it is a source of inspiration, of vitality and hope where others have resigned; it enables a man to hold his head high, to claim the future for himself and not to abandon it to his enemy." - Dietrich Bonhoeffer, a Lutheran pastor and man of conscience, who was martyred for his opposition to Hitler in 1945.

Some Recent Postings

The Case Against the Electronic Medical Record by David Gibson, MD & Jennifer Shaw Gibson

Primary Care - It is a Tough Business by David Gibson, MD & Jennifer Shaw Gibson

Stay Current with the HealthPlan Debate . . .

In Memoriam

Charis Wilson, model and writer, died on November 20th, aged 95

From The Economist print edition Dec 10th 2009

THE first time she modelled for Edward Weston, in March 1934, Charis Wilson knew she didn't look good. At 20 she was "a piece of jailbait", a mere child, especially with the stumpy plaits into which she sometimes twisted her hair. She was a drifter, moving in a miasma of angry despair in and out of speakeasies and other people's beds because her father had refused to let her go to college, even though she'd won a full scholarship to Sarah Lawrence, and even though he would certainly have let her brother go. There was nothing to do but work in her mother's dress shop, sleep around in San Francisco, get pregnant, have an abortion. She had taken a solemn vow of chastity since then, like one of her made-up childhood rituals of lying in freezing cold water, but to someone with her natural generosity it was a heartless, bitter thing. She looked pale, her chin jutting out in defiance and her whole face needing something—like warts on her nose, her mother told her—to make it remotely interesting. . . .

She was not an exhibitionist, or not much of one, though she had scandalised her Aunt Allie by sunbathing naked on the deck of the big family house at Carmel, and it had been easy to take off her clothes for Edward. He didn't direct her, or put her in a pose—she hated those anyway, couldn't hold them, preferred to lie down comfortably with a book. He just let her move as she liked, in a sort of slow motion until he stopped her; and she waited, almost floating, as when she used to swim out from Carmel to the kelp beds and tie her bathing suit to a stalk and lie there, her white arms—as Edward now saw them—as sinuous and exquisite as the kelp itself.

The lines of Nature

He could be brutally direct about his nudes, who were also always his lovers, talking about "doing" backs, buttocks, heads as though they were lifeless bits of stone. It seemed that he could feel as much passion for a pepper, in the dimpled line of its spine and its cushioned, fleshy base, as for any young woman. Charis he found different, both more beautiful than the others and perhaps "the great love of my life". His finest nudes, he thought, were done with her. He had achieved "certain heights reached with no other love".

He had also met his match in her. Both of them wanted sex as much as photography, and said so candidly. Everything they did in the 11 burning years they were together was good collaborative work, at least as far as she was concerned. The notion of a muse was nonsense to her, a passive thing. She knew exactly what she was doing—how furniture framed her or shadows fell, how her knee or shoulder would look turned just so, or what a good idea it would be to run and roll naked down the giant sand dunes at Oceano, a small part of that infinite, flowing unity of all forms that he was always looking for.

Soon she knew his ideas well enough to write the text for his photographs, his applications for grants and his articles for photographic magazines, for words came easily to her as they never did to him. She took the notes, on her clackety Royal typewriter, and also drove their puttering Ford on the giant western trips they made in the late 1930s; the books that resulted, notably "California and the West", were as much hers as his, but she was seldom credited. In the end, this rankled. Though she felt she had pulled even with him, he never saw her that way or gave her writing equal space with his pictures. The grand romance cooled and in 1946 died, giving way to ordinary life. . . .

Read the entire obituary. . .

Charis Wilson


On This Date in History - December 22

Near this date in about 6 BC, God so loved the world that he gave his only begotten Son to die for our transgressions, that whosoever will believe in Him, will not perish, but have Eternal Life. -John  3:16.

On this date in 1944, Germany demanded the surrender of American troops at Bastogne, Belgium. Brigadier General Anthony C. McAuliffe didn't negotiate. He didn't capitulate. His memorable reply was "Nuts!" And he went on fighting the Battle of the Bulge and won.

After Leonard and Thelma Spinrad


The 7th Annual World Health Care Congress

Advancing solutions for business and health care CEOs to implement new models for health care affordability, coverage and quality.

The 7th Annual World Health Care Congress will be held April 12-14, 2010
Washington, DC
Toll Free: 800-767-9499

In partnership with, the 6th Annual World Health Care Congress was the most prestigious meeting of chief and senior executives from all sectors of health care. The 2010 conference will convene 2,000 CEOs, senior executives and government officials from the nation's largest employers, hospitals, health systems, health plans, pharmaceutical and biotech companies, and leading government agencies.