MEDICAL TUESDAY . NET
Community For Better Health Care
Vol V, No 18, Dec 26, 2006
In This Issue:
1. Featured Article: The Race to Ban What's Bad for Us, Reason Magazine
Trans fat, smoking, foie gras--what's next? By Nick Gillespie December 11, 2006
Is there any doubt that the infantilization of adults is one of the defining characteristics of contemporary politics?
Last week alone, New York City banned the use of trans fats in restaurant meals, and an Ohio law passed in November that bans smoking in virtually all business establishments (even in company-owned vehicles such as trailer-truck cabs) went into effect. However different the actions may seem on the surface, they share something all too common in today's America: They rob us of the right to make decisions--however stupid, unwise or repugnant to refined sensibilities--about how we want to live, work and eat.
Although "give me partially hydrogenated vegetable oil or give me death!" is not likely to become a rallying cry anytime soon, it's worth pausing a minute to consider the country's headlong rush to prohibit just about anything that bureaucrats--or simple majorities of voters--find offensive.
New York used to pride itself on being the toughest
city in the world. After passing the first municipal ban on trans fat in the
Trans fats, which are made by adding hydrogen to vegetable oils, are the flavor-enhancing substances that make many commercially prepared baked goods and fast foods so predictably yummy--and, alas, so predictably artery clogging. They are reviled by physicians, nutritionists and exercise gurus--everyone, in short, except for cooks and their customers.
So now New York City restaurants face a fine of at least $200 per infraction come next July. For good measure, the Board of Health also dictated that restaurants already posting nutritional information must post calorie counts for their meals.
"We are just trying to make food safer," said Mayor Michael Bloomberg, who in 2002 pushed through one of the toughest smoking bans in the country.
It's not as tough, though, as the statewide ban that 58 percent of Ohio voters approved and that now is in effect . . .
When Ohio--a bellwether state that once billed itself as "The Heart of It All" on its license plates--mimics policies found in New York and California (which passed the first statewide smoking ban in 1995), it's a given that no unwise, unhealthy or just unseemly choice is safe from regulation.
Indeed, how else to explain, say, Chicago's decision in April to ban the sale of foie gras out of concern for the geese who give their lives--and their livers--for diners' pleasure? Observers say it's likely that Illinois and Minnesota will be the 19th and 20th states to ban smoking in bars and restaurants, even as cities in California and elsewhere mull the idea of banning all smoking outside of private, single-family dwellings.
Such bans often are, by turns, mendacious, redundant and likely to be ineffective. The trans fat ban, averred Bloomberg, is "not going to take away anybody's ability to go out and have the kind of food they want," even as it limits what ingredients can be used.
Fast food chains such as Wendy's and KFC had already
committed to ridding their menus of trans fats, as had various high-end
It's probable that smoking bans in the workplace encourage employees to quit or cut back. The CDC, for instance, notes that "a 2002 review of 26 studies concluded that a complete smoking ban in the workplace reduces smoking prevalence among employees by 3.8 percent and daily cigarette consumption by 3.1 cigarettes among employees who continue to smoke." And there's no doubt that not smoking clears the air.
But even when bans do have an impact that most of us would agree is positive, one-size-fits-all actions leave no place for individuals to make some intensely personal choices.
They ignore the evolving social arrangements--such as
non-smoking sections, not to mention smoke-free businesses--that give people,
especially the 20 percent of adults who still light up regularly, more options
rather than fewer. By the time
Most important, these bans reduce all of us to the status of children, incapable of making informed choices. Is it quaint to suggest that there's something wrong with that in a country founded on the idea of the individual's rights to life, liberty and the pursuit of happiness?
To read the entire article, go to www.reason.com/news/show/117171.html.
[Nick Gillespie, PhD, strikes a responsive chord we can relate to in medicine also being swept into the same category as children. Doctors who spend their life taking care of people in pain, where the sine qua non is to relieve pain, have Assembly women in our legislature spear-heading requirements for how many hours of pain CME (continuing medical education) each doctor should be forced to take and how frequently. Doctors have for millennia helped people navigate their end-of-life care, and these legislators dictate the hours of terminal care we should be forced to take. Similar efforts are being waged for CME in HIV, geriatric, and who knows what else.
[It would seem more appropriate that these novices in the legislatures be required to take courses in pain, geriatrics, end-of-life and HIV problems to give them some minimalist understanding of the issues involved. Their action confirms that they are the children in need of parenting since they have so little comprehension and understanding of the issues involved. Because they also have little understanding of the basic principles of liberty on which our country was founded, they cannot conceivably be the parents of physicians telling them what they must learn.]
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2. In the News: States Struggle to Cover Retirees, By Dennis Cauchon, USA TODAY
Medical liabilities exceed $1 trillion Medicare unfunded liabilities rose to $32.3 trillion in 2006
State and local governments are starting to take aggressive steps to reduce the enormous cost of providing health care benefits to retired teachers, police officers, firefighters and other public workers.
As 43 state legislatures prepare to convene next month, governments are cutting benefits, setting aside money to cover future costs and shifting expenses to the federal Medicare program. The efforts are the first to address a liability of more than $1 trillion for providing medical care promised to about 25 million current and future retired state and local civil servants.
The changes are being driven by a new accounting rule, which took effect Friday and forces states and large local governments to report how much they owe for medical benefits promised to retirees.
"The numbers make your jaw
The retirement of baby boomers - 79 million born from 1946 to 1964 - will make it hard for state and local governments to keep up with the cost of medical benefits for retirees. What governments are doing now:
West Virginia. The state pension board is to vote Wednesday on shifting prescription-drug coverage for retirees to Medicare, a federal program. The change, along with making retirees pay more, would slash the state's $8 billion unfunded liability to $5 billion.
North Carolina. Civil servants hired after Oct. 1 will have to work 20 years before qualifying for 100% state-paid medical coverage. Previously, workers had to wait only five years.
San Diego. The City Council this month eliminated retiree health coverage for some workers who got big pension hikes in 2002.
South Carolina. Republican Gov. Mark Sanford's next budget will propose putting $245 million in a new trust fund dedicated to retiree medical benefits. Georgia, Vermont, Virginia and New York City also have started trust funds or plan to create them. . .
Because of soaring revenue, states haven't had to cut other spending or raise taxes to cover retiree medical care. State and local government attempts to shed retiree medical costs could be bad news for Medicare because many now pay retiree health care costs that would otherwise be paid by the federal government.
Medicare's financial situation already is deteriorating. The government's audited financial statement, released Friday, reported that Medicare's unfunded liability rose $2.4 trillion in 2006 to $32.3 trillion.
Unlike pension benefits, medical benefits usually are not protected by law and can be discontinued by state legislatures. "These benefits are affordable as long as we do something now," says Charles Agerstrand, a retirement consultant for the Michigan Education Association, which represents teachers. "If not, we're heading for a major collision."
To read the original, go to www.usatoday.com/printedition/news/20061218/1a_lede18.art.htm.
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3. International Medicine: The Treasure of Mumbai, (Bombay) WIRED Magazine, December 2006
To Big Pharma, Indian drug maker Cipla is a pirate operation. To the developing world, it's a vital medicine chest. And now its cheap pills are coming to a pharmacy near you. By Erika Check
FORTY YEARS AGO, A BRITISH COMPANY called ICI Pharmaceuticals developed a potent high blood pressure medication called propranolol. It was the first beta blocker, a class of drugs that inhibits fight-or-flight hormones like adrenaline. But it was expensive. So Yusuf Hamied, a 34-year-old chemist at an Indian drugmaker, got his company to start manufacturing a cheaper version. ICI protested to the Indian government, and Hamied found himself face to face with prime minister Indira Gandhi. "Should millions of Indians be denied the use of a lifesaving drug just because the originator doesn't like the color of our skin?" he asked her.
It was a specious argument ICI was worried about profits, not skin color but Gandhi was persuaded. She urged parliament to change the laws governing drug patents, making them apply not to the chemical compounds themselves but to the processes used to manufacture them. If a company like Hamied's could come up with a different way to make the same beta blocker (or whatever), it could sell its own version in India free and clear.
That one law transformed India's pharmaceutical industry. Today, Hamied's company, Cipla, is the third-largest in India, with sales of $651 million in 2005. That's not much compared to multibillion-dollar concerns like GlaxoSmithKline, but Cipla is still the medicine cabinet to the developing world. As much as 40 percent of the AIDS patients in poor countries who take medications take Cipla drugs.
What Hamied does is legal in India and the countries where Cipla sells drugs. But the company is still making copies largely without permission of the people who hold the patents on the compounds. So to most of the international pharmaceutical industry, Hamied is a pirate.
He is 70, portly, with white hair and wire-frame glasses. But his rhetoric is still inflammatory. Pacing around the Cipla boardroom, he tells the story behind every drug the company makes, punctuating each anecdote by pulling a box of samples from the floor-to-ceiling cabinets and throwing it on the table. These are the copied drugs that earned Cipla its outlaw reputation: anti-cholesterol pills, antibiotics, AIDS treatments. He tosses in an asthma inhaler and a box of ciprofloxacin, the powerful antibiotic popular with bioweapon-fearing Americans.
Hamied made the greatest waves last year, when global fears of a bird flu pandemic inflated demand for oseltamivir, the only drug thought to be effective against the disease. Its maker, Switzerland-based Roche Pharmaceuticals, said it couldn't produce enough. Hamied stepped in, without a license from Roche, and started manufacturing the drug with the intention of selling it in countries where Roche didn't hold the patent and, though he won't acknowledge it overtly, anywhere else. As is his style, Hamied made a lot of noise about his planned defiance. He has built his business on challenging the companies and patent structures that dominate the global drug market, because it's a worthy cause and because it's good for his bottom line. Now the Indian laws that let Hamied get away with all that are changing. In 2005, the Indian government brought its patent laws in line with those of the developed world. Indian companies can keep making certain knockoffs, but they can't copy drugs patented after 1995 without a license. So Cipla needs a new business model: It's going to sell legal generics to rich Americans. . .
HAMIED'S FATHER, A CHEMIST and an Indian nationalist, founded Cipla in 1935, when there wasn't a single pharmaceutical company in the country. It was a nation-building project; Hamied the elder wanted to do everything he could to make India self-sufficient. His timing was perfect. Embroiled in World War II, Great Britain asked its colonies for help, and Cipla gladly began churning out medicines for the war effort. . .
And it's as a businessman that Hamied feels the lopsidedness of the way drug patents work around the world. In the US and many other countries, new drugs are patent-protected for 20 years. When a company wants intellectual property protection in a new country, it needs a patent there, too. After 20 years, any company can start making its own version, called a generic.
In practice, makers like Cipla often manufacture and sell drugs owned by other companies in countries where the patents aren't enforced. Pharmaceutical giants like Roche or GlaxoSmithKline see that as pirate behavior, arguing that if you start messing around with the patent system, you take away their profit incentive to invent new medicines. According to a 2003 study in the Journal of Health Economics, it can take 12 years and $800 million to discover one novel drug. . .
Hamied doesn't consider himself a pirate. "Cipla never breaks the law," he says. "It lives by the law of the land it is working with." But he doesn't deny that he feels the system favors the rich and the Western. "The third world cannot afford the prices of medications that are prevailing in the first world," Hamied says. "So don't talk about patents in isolation. Talk about access to medicine at affordable prices."
. . . Rich nations the ones responsible for propping up the current patent system came to see the risks of the legal monopolies. In May, the member states of the World Health Organization passed a resolution expressing concern about the "impact of high prices of medicines on access to treatment." The resolution also declared that patents aren't helping poor patients get new medicines. . .
Hamied's competitors in India have vowed to expand their R&D to compete with Big Pharma. But Hamied doesn't think it'll work. Western drug companies feed off massive federal research grants that the Indian government couldn't possibly match. The future, Hamied says, is legal, licensed drugs.
Well, mostly legal. At Hamied's factory, a full ton of powdered oseltamivir is stashed in plastic drums. A Cipla manager proudly brandishes the tangible proof behind his boss's bluster: a plastic baggie heavy with the stuff. He says he watches the news daily for updates. If a pandemic hits, what does he think the Americans will do? "We are waiting," the manager says with a smile.
To read the entire article, go to www.wired.com/wired/archive/14.12/indiadrug_pr.html.
Erika Check (firstname.lastname@example.org) is a reporter for Nature in San Francisco.
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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In an editorial a month ago, we warned that "Blinding Medicaid waste and abuse" had created a $22.3 million hole in D.C. coffers. Now comes word that the failure to file the proper reimbursement paperwork for Medicaid and Medicare services has already caused overruns in the current budget. With the fiscal year having only started on Oct. 1, this is a red flag neither Mayor Tony Williams nor his successor can ignore.
D.C. Chief Financial Officer Nat Gandhi has warned Mayor-elect Adrian Fenty that the city already has overspent by $87 million, The Washington Post reported yesterday. That figure could rise to $300 million next year if spending reins aren't gripped immediately. Most of the potential shortfall is attributed to rising costs for health care, and The Post cited higher-than-expected health-care enrollments as creating part of pressure. But much of the fault lies with an inefficient bureaucracy.
As The Washington Times reported and editorialized last month, an audit by the D.C. Inspector General found the city's Medicaid program is in "serious breach of basic internal controls," with D.C. officials spending $22.3 million on non emergency transportation for Medicaid recipients. Problem is, they cannot determine whether the money should have been paid or not because transportation firms filed dozens of claims for Medicaid patients who were actually dead.
A health-insurance program for the poor, Medicaid transportation costs have been pushing skyward for some years now. The costs are of such concern to the 109th Congress, that as part of the Deficit Reduction Act, it also created the Medicaid Integrity Program, granting open-ended authority to the federal Department of Health and Human Services to tackle Medicaid waste, fraud and abuse -- authority that was relegated previously to the states. The District, amid its spending frenzy on nonemergency transportation, didn't catch on. As we said in our Oct. 27 editorial, "We could point fingers at City Hall... This time, though, we are just grateful that the feds are looking in the right direction."
Indeed, while federal and local auditors scrutinize the District's Medicaid spending habits, Congress has put City Hall on notice, too. Sens. Charles Grassley and Max Baucus, the chairman and ranking member of the Senate Finance Committee, said in a Nov. 17 letter to the D.C. inspector general that they want details on "all ongoing audits, evaluations and investigations that examine the Medicaid program in the District of Columbia." And well they should: National nonemergency Medicaid transportation costs have reached $1.5 billion -- a 48 percent increase since the 1999-2003 period.
This isn't the first time the District has been warned about its egregious Medicaid offenses. As the senators say in their letter, previous probes have cited "unnecessary trips and excessive claims as well as billing Medicaid for trips never provided."
The D.C. lawmaker chiefly responsible for Medicaid oversight, David Catania, told reporter Jim McElhatton that he was "delighted" with the steps City Hall has taken to reform the Medicaid. We do not share Mr. Catania's enthusiasm. Neither the District nor the several states that are wasting tax dollars should be let off the hook. We thank the senators for their ongoing inquiry, and hope they continue with the knowledge that bureaucracies like the District's don't quickly reform themselves.
Government is not the solution to our problems, government is the problem.
- Ronald Reagan
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PEER REVIEW, the protected legal milieu that allowed doctors to review each other to improve their practice without fear of retribution, was corrupted some twenty years ago. Doctors were supposed to be the most objective in their judgments of any profession. But it turned out that doctors are some of the most opinionated people of any profession.
Hospitals began having their doctors on payroll review charts of the doctors they wished to remove from their staff for various economic reasons. Essentially all medical records are at variance with what other doctor's think is the best of care. We have all experienced national medical conferences where professors from one institution may be 180 degrees in opposition to a specific mode of diagnosis or treatment. By having their own selected physicians be on the reviewing committee, the hospitals were able to remove physicians they felt undesirable for a variety of reasons. The courts were reticent to interfere with hospital internal matters. So, this destruction of physicians has been able to proceed relatively unchallenged for decades.
For an excellent overview of Peer Review and how it has been abused, read Dr. Larry Huntoon's review of the subject by clicking on his article at www.jpands.org/jpands1102.htm.
Recently Dr. Huntoon spoke at a town hall meeting explaining the process of Peer Review and Abusive Peer Review. He was shocked when a member of the hospital board tried to justify Abusive Peer Review as being an appropriate way to remove undesirable physicians.
Anna Marie Silvas, a member of the Christus Spohn Hospital Beeville advisory board, tells those gathered at Thursday night's town hall meeting on hospital-physician relations that sham peer review is a useful tool for hospitals to remove troublesome physicians.
Local physicians replied that there is no place in the medical industry for sham peer reviews. www.bee-picayune.com/story65.shtml
The very concept that physicians who have probably spent a quarter million dollars of their parent's resources obtaining a medical education, with the institution probably investing an equal amount in providing the structure of this education, can have this investment terminated for non-medical reason without due process is a travesty of our American Judicial System. To toss a half million-dollar investment in healthcare out of the window is an extreme form of not only Medical Gluttony, but of the destruction of a human being (professional homicide) and his family. That hospitals are able to do this is a serious blight on American health care. No wonder doctors are afraid to speak out and be an effective force in shaping America's health care. Who wants to volunteer for the guillotine?
To read a series of insightful articles by attorneys and others that we published while I served as editor of Sacramento Medicine, please go to www.delmeyer.net/HMCPeerRev.htm.
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When cardiac surgeons stop the heart while working on them, the patient is under anesthesia. There is obviously no pain and it really doesn't matter how many minutes it takes to stop the heart and later to restart it. The period in between is really a cardiac arrest, which is what is trying to be obtained in the execution chambers. Of course, there are no physicians present for ethical reasons.
That a judge would think that a killer being executed and the technician after giving the anesthesia takes a bit longer to get his heart stopped and then to think the killer is suffering while unconscious, is a total disconnect with reality.
Cal Thomas reports: In California, U.S. District Judge Jeremy D. Fogel declared California's execution procedure unconstitutional and lethal injections -- the preferred execution method in 37 states -- an offense to the ban on cruel and unusual punishment.
One wishes such considerations were available to relatives of the deceased, and to the deceased themselves. Diaz spent more than two decades in prison before he was executed. That probably inflicted cruel and unusual punishment on the relatives of his victim.
According to court records, Diaz was convicted of second-degree murder in his native Puerto Rico. He escaped from prison there and also from Connecticut's Hartford Correctional Center in 1981. In Hartford, he held one guard at knifepoint while another was beaten. Diaz was responsible for three other inmates escaping with him.
As to the constitutional issue regarding cruel and unusual punishment, here too some history may be helpful. This is why "original intent" of the founders is important to consider, because what they meant by the phrase and what we think we believe about it differs considerably.
At the time the Bill of Rights was written, the authors specifically sought to ban such execution methods as burning at the stake, crucifixion and breaking on the wheel.
To understand this in perspective, read the entire OpEd by Cal Thomas: The cruel and unusual in punishment at www.sacbee.com/110/v-print/story/94627.html.
Looks like Federal Judges are more in need of End of Life and Pain Education than Physicians.
It would be appropriate if judgments were based on facts.
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Dr. Sam: I can't believe the loops we have to go through in our office in order to get paid. We sent our end-of-the-month statements and the patients were irate. They said these are bills from 2005? Why are you billing me now?
Dr. Dave: What did they say after you told them?
Dr Dave: What kind of response did she get?
Dr Sam: She said she didn't confront them. That would have gotten us into trouble with the insurance carrier. Can you believe after a year of insults, we can't be frank about reality and instead have to bend over and just take a spanking like we did in kindergarten?
Dr. Yancy: I don't bend over for anyone. When I get done with an operation, I enter the details into my Palm Pilot, and download it into my computer as soon as I get to the office and send the patient the first statement with a warning that if their insurance company doesn't respond within 30 days, I expect payment.
Dr. Dave: You surgeons can get their attention with a $1,500 bill. If I did that with every $150 office call, my CPA says I would lose 10 percent of the fee with each statement.
Dr. Rosen: The insurance company can play games with the $150 charges. They know you can't take any significant legal action, paying an attorney $300 an hour to collect a few $150 bills.
Dr. Patricia: I see you guys are getting close to agreeing with me. Let the government take over and get rid of the insurance companies. Then we'll get a check every two weeks.
Dr. Sam: Or every month or three? Have you forgotten the September "No Check-Write for two weeks" already? And no make-up checks that I could determine with a slight blip in income. I'm beginning to understand that wasn't really a loan from doctors for fiscal reasons. It was pure harassment, causing confusion in doctors' billing offices, and elimination of income.
Dr. Patricia: But if we were dependent on the government for our entire income, they would be our friends and would treat us better. We would all get government salaries. Like the VA or the Military doctors. They get paid on time, every two weeks or every month.
Dr. Rosen: But if there were no private practice competition, the government doctors' salaries would slowly edge downward to make room for the administrators' salaries to migrate upwards. The government will never be the doctor's friend. And we must make sure that we are never the government's patsies. We should sever our Medicare and Medicaid ties and sink or swim. I know we will swim quite well after the third time we come up for air.
To read more staff room talk, go to www.medicaltuesday.net/archives/july1106.htm#OVERHEARD.
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Hippocrates Upended: A Cause for Revaluation of the American Physician By Donald J. Prolo, M.D.
What the earthquake of 1906 did to the Bay Area, World War II in 1941 and the advent of Medicare in 1965 did to the American physician. Let us look at the parallels. Before Hippocrates, physicians could be hired as assassins to do in an enemy or facilitate the premature demise of a parent for early inheritance. Now physicians are paid to perform according to the bureaucratic formulas and edicts of the federal government, business groups, insurance companies, HMOs and IPAs. Lost in this third-party deluge of financial forces is the primacy, prestige and freedom of a properly educated and licensed physician to act and advocate entirely for the patient, as well as the patient's freedom to choose a physician and to expect that physician to honor a sacred bond of trust. American medicine has been reduced to considerations of what percent of gross domestic product can be spent on healthcare, how many forms can reasonably be completed before a third party will pay, whether an insurer will allow an assistant at surgery, and how fast a patient can be rushed through an examination or discharged from the hospital.
The impact of these exactions on the value of both the patient and the physician is enormous. Our contemporary ethos is to devalue patients, their physicians, and their bond of trust in order to legitimize payer coercion. The patient becomes a pawn, the doctor becomes a wage slave, and both lose their freedom to aspire to and achieve their highest hopes and calling.
If the dignity and stature of physicians are not universally idealized societal values, then patients cannot be healed. A sick, fragile human, ravaged by physical and/or emotional illness, surrenders himself or herself to the mercy and unmitigated loyalty of a physician. This experience is not analogous to standing in line awaiting service from a bank teller or a grocery clerk. This profound act of self-exposure and trust by a patient to the skills and mercy of a physician is a difference in kind from all other human interactions, not a difference in degree.
Societies do not grant this privilege casually: Consider the rigorous and prolonged educational process, national board examinations, licensure, specialty training, specialty board certification, and maintenance of certification and recertification. Paradoxically, the federal government and its echoing chorus of commercial business and payers now expect the physicians to behave as drones, groveling annually to the Congress for their share of a diminishing handout. The fact is that it is only collectively through our professional associations that we can respond in an effective manner. It has been stated, "Medicine is, at its center, a moral enterprise grounded in a covenant of trust. This covenant obliges physicians to be competent and to use their competence in the patient's interests. Today, this covenant of trust is significantly threatened. By its traditions and very nature, medicine is a special kind of human activity - one that cannot be pursued effectively without the virtues of humility, honesty, intellectual integrity, compassion and effacement of excessive self-interest. Our first obligation must be to serve the good of those persons who seek our help and trust us to provide it." "Ask not what organized medicine can do for you; ask what we can do for our patients." The strangulating grip of third-party influence destroying health care over financing issues must be broken.
Let us insist on revaluation of the American physician as the cornerstone critical to the healing power of physicians.
Let us pledge eternal warfare against influences and health systems that violate our calling.
Let us renew our commitment to the 2,400-year-old Oath of Hippocrates, immortalizing the patient-physician covenant.
To read the original along with the references, please click on Hippocrates at
Donald Prolo, M.D., is a neurosurgeon practicing in San Jose, California. He is the past president of the California Association of Neurologic Surgeons and the president of the Santa Clara County Medical Association. He also serves on the Executive Committee of the Specialty Delegation to the California Medical Association.
To read the Voices of Medicine Archives, please go to www.healthcarecom.net/voicemed.htm.
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THE BEST OF MEDICAL HUMOR - A Collection of Articles, Essays, Poetry, and Letters Published in the Medical Literature, 2nd Edition, By Howard J Bennett, MD
Just as medical texts required second and further revisions on a regular basis, Dr Howard Bennett revised his book on Medical Humor because humor changes. Over 50% of this edition is new. On the faculty of George Washington University School of Medicine in Washington, DC, Bennett did extensive library research to collect witty, humorous aphorisms and items as the subtitle states. This is not a joke book. It won't make an audience belly laugh or fall out of their seats. But it will make you smile and feel good.
Just seeing the informed consent for a hernia with signature lines of the patient, his lawyer, the doctor's lawyer, the hospital's lawyer, the anesthesiologist's lawyer, the mother-in-law, and the notary public will allow you to see today's realities, reflect on them, and decide that we've gone too far and pull back to the real realities.
He found a pulmonary fellow who sent his wife a valentine when he thought that the cardiac system was receiving far too much attention: Roses are red, Violets are blue, Without your lungs, Your blood would be too.
There are short witty essays "On the Professional Patient," "Dial a Lawyer," "PostMortem Medicine--A New Specialty," "Managed Care: The Fast-Food-for-Thought Therapy Approach," all with references for further reading! His Medical Horoscopes is rather ingenious. This is just a wonderful volume to have within reach when inspiration fails or the mood simply needs elevating.
To read more reviews, please go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
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government ran out of funds and Newt Gingrich was in charge. He did what
any respectful business does. Cut spending and layoff excessive staff. Actually
the government ran out of funds decades ago but there is a renegade crowd in
D.C. that is calling a spade a shovel, or rather a spoon. When the government
shut down by calling off 800,000 nonessential workers, David Lettermen
commented that maybe we have found the cause of our national problem . . .
Jackie Mason, on CNN, stated that it was obvious that the 40% put on furlough
should not be rehired. Since the other 60% didn't seem to be exerting
themselves to get additional work done, he suggested that another 10% or half
of the 2 million federal workers should be furloughed . . . Debra Saunders in
the SFChronicle, commenting on this showdown, stated that the $66 per year
Medicare premium increase is reasonable since retirees are getting $126,700
more in lifetime benefits than they paid into the system. . . The national debt
Newt, where are you now when we need you?
Doctors' incomes continue to fall. The current estimate is that after paying over $180,000 in expenses, we make about $150,000 for our 3000-hour year which is about $50 an hour. About the same as the "handy man" that fixed the skylight and ceiling in my office. Except we had to have an extra 12 years of higher, professional and post doctoral education to allow us to make this humongous hourly wage.
Another prediction missed the mark: The SF-based Pew Health Professions Commission, a private foundation of 21 experts from universities, the health care and health insurance industries, and other private and public organizations, predicts that in 2007 there will be a surplus of at least 100,000 doctors, 200,000 nurses and 40,000 pharmacists. They recommend closing one-fifth of the medical schools and dramatically reducing the FMG's in US residencies. They attribute the surplus in medical professionals to the government subsidies in the 1960s and 1970s, which encouraged the excessive construction of medical schools, and to managed care... But without the government push to increase medical school enrollment and residency programs, neither the mass importing of FMGs or managed care would have occurred. Nearly all our current ills are caused by government planning. Unfortunately, much of government planning is done by physicians in the bureaucracy. The challenge is how can we keep from hurting ourselves.
Von Gordon Sauter, Former CEO of KVIE Channel 6 (Public/Government TV) spoke at a meeting of the Comstock Club. As you know, some people inside of public radio and TV are bemoaning shrinking government money. Sauter replied, "Once the government gives you money, you accept the government concept on how you will proceed. Government money does not help . . ."
And with that, we wish everyone a Merry Christmas and a professionally satisfying Happy New Year.
And may you have less trouble than Santa, courtesy of Dr Ron Virmani.
"Twas the night before Christmas and Santa's a wreck!
How to live in a world that is politically correct?
Four reindeers just vanished without much propriety,
Released to the wild by the Humane society.
His workers would no longer answer to "elves"
"Vertically challenged" they were now calling themselves.
Both the hours and conditions at the North Pole
Were alleged by their union to stifle the soul.
Equal employment had made it quite clear
He had better not employ only reindeer.
So Dancer & Donner, Commet & Cupid
Were replaced with four pigs, which really looked stupid.
All the runners were removed from Santa's sleigh;
The ruts were deemed dangerous by the E.P.A.!
Besides, people had started to call the cops,
When they heard noises on their rooftops.
To demonstrate the strangeness of life's ebbs & flows,
Rudolph was suing for unauthorized use of his nose.
He went on Geraldo, & in front of the nation,
He demanded several million in compensation.
Half the reindeers were gone, along with his wife,
Who suddenly decided she'd had enough of this life.
She joined a self-help group, & left in a whiz,
Demanding forevermore he addressed her as Ms.
As for the gifts, why he had ne'er a notion
That making choice would cause such commotion.
Nothing of leather, nothing of fur,
This meant nothing for him, & nothing for her.
Nothing that might be construed to pollute,
Nothing to aim and nothing to shoot.
Nothing that clamored or made lots of noise;
Nothing for just girls, or just for the boys.
Nothing that hinted of being gender specific,
And nothing that's warlike or non-pacifistic.
No candy or sweets they're bad for the tooth,
And nothing that seems to embellish the truth.
So Santa just stood there, disheveled, perplexed,
He simply couldn't figure out what to do next.
He tried to be merry, he tried to be gay,
But one has to be careful with that word today
His sack was quite empty, flung to the ground.
Could anything acceptable ever be found?
Something special was needed, a gift that he might
Give to all without angering the left or the right.
An offering that would satisfy, with no indecision,
Each group of people, every religion.
So here is his gift, its price beyond worth ---
"May you & your loved ones enjoy Peace on Earth!"
* * * * *
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 www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to www.healthplanusa.net/AE-AreYouReallyInsured.htm.
PATMOS EmergiClinic - www.emergiclinic.com - 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 www.emergiclinic.com. To read more on Dr Berry, please click on his the various topics at his website above.
PRIVATE NEUROLOGY is a Third-Party-Free Practice in
Michael J. Harris, MD - www.northernurology.com - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis" at www.northernurology.com/articles/healthcarereform/administrativectomy.html.
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 2550 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 www.simplecare.com.
Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to www.libertyhealthgroup.com/Liberty_Solutions.htm. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.
Dr. Nimish Gosrani has set up a blend between concierge medicine and a cash-only practice. "Patients can pay $600 a year, plus $10 per visit, to see him as many times in a year as they want. He offers a financing plan through a financing company for those unable to plop down $600 all at once." Patients may also see him on a simple fee-for-service basis, with fees ranging from $70 for a simple office visit to $300 for a comprehensive physical. Dr. Gosrani reports that he saves two hours per day that he used to spend dealing with insurance company paperwork. To read more, go to http://cgi.photobooks.com/scripts/troll.cgi?dbase=moses&page=2&setsize=10&practice=Nimish+C.+Gosrani%2C+MD&pict_id=2001670.
· Dr. Elizabeth Vaughan is another Greensboro physician who has developed some fame for not accepting any insurance payments, including Medicare and Medicaid. She simply charges by the hour like other professionals do. Dr. Vaughan's web site is at www.VaughanMedical.com, where you can see her march in a miniskirt for Breast Health without a Bra.
· 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 www.signonsandiego.com/news/obituaries/20060311-9999-1m11cosman.html. She will be remembered for her important work, Who Owns Your Body, which is reviewed at www.delmeyer.net/bkrev_WhoOwnsYourBody.htm. Please go to www.healthplanusa.net/MPCosman.htm 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 www.healthcarecom.net/OpEd.htm.
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 www.ssvms.org. To read his "Lessons from the Past," go to www.ssvms.org/articles/0403gibson.asp. For additional articles, such as the cost of Single Payer, go to www.healthplanusa.net/DGSinglePayer.htm; for Health Care Inflation, go to www.healthplanusa.net/DGHealthCareInflation.htm. To read his latest column, Politicians Cannot Manage a Health Care System, go to www.ssvms.org/articles/0609gibson.asp.
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 www.peerreview.org.
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 www.delmeyer.net/HMCPeerRev.htm. To see Attorney Sharon Kime's response, as well as the California Medical Board response, see www.delmeyer.net/HMCPeerRev.htm. 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 www.semmelweissociety.net.
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 www.sepp.net.
Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at www.newsmax.com/pundits/Medicine_Men.shtml. This week's column is on Hysteria Prompted DDT Banning and can be read at www.newsmax.com/archives/articles/2006/12/7/144107.shtml.
The Association of American Physicians & Surgeons (www.AAPSonline.org), 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 scroll down on the left to departments and click on News of the Day in Perspective: National health insurance in trouble in Europe; doctors fleeing Germany or go directly to it at www.aapsonline.org/nod/newsofday372.php. 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 PERILS OF "HEALTH CARE" at http://www.aapsonline.org/newsletters/dec06.php. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. www.jpands.org/. There are a number of important articles that can be accessed from the Table of Contents page of the current issue. www.jpands.org/jpands1104.htm. Don't miss the excellent articles on Restoring True Insurance or the extensive book review section which coverssix great books this month.
* * * * *
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Del Meyer, MD, Editor & Founder
6620 Coyle Avenue, Ste 122, Carmichael, CA 95608
Words of Wisdom & Question Why
Peter Drucker's Insight for December 26: The Masses have become prepared to abandon freedom if freedom is incompatible with equality; If freedom is incompatible with security, they will decide for security. To be free or not has become a secondary question. Why will society be more likely to embrace complete regimentation and totalitarianism in the absence of strong institutions?
--From "The End of Economic Man" in reference to the embrace by Europe of Nazism to escape the demons of war and depression.
Some Recent Postings
HOW TO LOWER YOUR CHOLESTEROL Without Drugs: www.delmeyer.net/MedInfo2006.htm
HOW TO LOSE WEIGHT WITHOUT DIETING or How I lost My 30 Pounds: www.delmeyer.net/MedInfo2006.htm#How to Lose Weight Without Dieting
The legacy of Milton
Friedman, a giant among economists
, To read more, please go to www.medicaltuesday.net/org.asp . I N 1946 two American economists published a pamphlet attacking
rent controls. "It was", recalled one of them many years later,
"my first taste of public controversy." In the American Economic
Review, no less, a critic dismissed "Roofs or Ceilings" as
"a political tract". The same reviewer gave the pair a proper
savaging in a newspaper: "Economists who sign their names to drivel of
this sort do no service to the profession they represent."
The reminiscing author was Milton Friedman, who died on November 16th, aged 94. In the wake of the Great Depression and the second world war, with the Keynesian revolution still young, championing the free market was deeply unfashionable, even (or especially) among economists. Mr Friedman and kindred spirits - such as Friedrich von Hayek, author of "The Road to Serfdom" - were seen as cranks. Surely the horrors of the Depression had shown that markets were not to be trusted? The state, it was plain, should be master of the market; and, equipped with John Maynard Keynes's "General Theory", governments should spend and borrow to keep the economy topped up and unemployment at bay.
That economists and policymakers think differently now is to a great degree Mr Friedman's achievement. He was the most influential economist of the second half of the 20th century (Keynes died in 1946), possibly of all of it. In 1998, in "Two Lucky People", the memoir he wrote with his wife, Rose, he could claim to be "in the mainstream of thought, not, as we were 50 years ago, a derided minority", and no one could dispute it.
Perhaps Mr Friedman became not only a great economist but also an influential one because he had a love of argument. As a boy he liked to make himself heard. He claimed to have had few memories of a school which he attended in Rahway, the New Jersey town his family had moved to when Brooklyn-born Milton was 13 months old, but he remembered getting a nickname. "I tended to talk very loud, indeed shout"; so when someone mentioned the proverb "Still water runs deep", he was dubbed "Shallow".
His classmates could scarcely have chosen a less apt moniker. Directly or indirectly, Mr Friedman brought about profound changes in the way his profession, politicians and the public thought of economic questions, in at least three enormously important and connected areas. In all of them his thinking was widely regarded at the outset as eccentric or worse.
The first of those areas is summed up by "Capitalism and Freedom", the title of a book published in 1962 (see our review). To Mr Friedman, the two were inextricably intertwined: without economic freedom - capitalism - there could be no political freedom. Governments, he argued, should do little more than enforce contracts, promote competition, "provide a monetary framework" (of which more below) and protect the "irresponsible, whether madman or child".
To read the entire article, please go to www.economist.com/business/displaystory.cfm?story_id=E1_RPTPJNV.
On This Date in History December 26
On this date in 1893, Mao Tse-tung, the godfather of Chinese Communism, was born. Even more than Lenin, Mao Tse-tung became a sort of Biblical prophet to his people. The sayings of Chairman Mao became gospel. Our founding fathers are venerated for their views and deeds, but no one man has been enshrined - thank goodness.
On this date, the day after Christmas, is a holiday in Britain known as Boxing Day. The story is that it became known as Boxing Day because it was the day when presents were given in boxes to the postmen, retainers and so forth.
Speaker's Lifetime Library, © 1979, Leonard and Thelma Spinrad