Community For Better Health Care

Vol IX, No 18, Dec 28, 2010


In This Issue:

1.                  Featured Article: A Hundred Billion Neurons – a Cosmic Headache

2.                  In the News: Placebos really work

3.                  International Medicine: It's time government called "time out" on the Canada Health Act

4.                  Medicare: When the Doctor Has a Boss

5.                  Medical Gluttony: Best Practices or Pay for Performance is really Gluttony in Disguise

6.                  Medical Myths: Slow Metabolism makes me gain weight

7.                  Overheard in the Medical Staff Lounge: When the Doctor Has a Boss

8.                  Voices of Medicine: A Homeless Man's Funeral . . .  

9.                  The Bookshelf: The Power To Control, A Review By JEREMY PHILIPS

10.              Hippocrates & His Kin: The Highest Pay Increases in Sacramento went to Hospital CEOs.

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

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

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                  Merry Christmas 2010                  

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 in 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, we will continue the battle for the Freedom we won in 1776, began losing in 1933, nearly completed in 2010, to eliminate the intrusion of government into our personal and private lives.  

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1.      Featured Article: A Hundred Billion Neurons – 100 Trillion Connections - a Cosmic Headache

The noise of billions of brain cells trying to communicate with one another may hold a crucial clue to understanding consciousness

100 Trillion Connections; January 2011; Scientific American Magazine; by Carl Zimmer; 6 Pages

In Brief

A single neuron cannot do much, but string a few hundred together and a primitive nervous system emerges, one sophisticated enough to keep a worm going.

More neurons equate to a more com­plex organism. A central preoccupa­tion of neuroscience is deducing the way billions of neurons produce the human mind.

Neuroscientists have begun to un­ravel the brain's complexity by adopt­ing research on other elaborate sys­tems, ranging from computer chips to the stock market.

Understanding the workings of the brain's intricate networks may provide clues to the underlying origins of dev­astating disorders, including schizo­phrenia and dementia.

A single neuron sits in a petri dish, crackling in lonely contentment. From time to time, it spontaneously unleashes a wave of electric current that travels down its length. If you deliver pulses of electricity to one end of the cell, the neuron may respond with extra spikes of voltage. Bathe the neuron in various neurotransmitters, and you can alter the strength and timing of its electrical waves. On its own, in its dish, the neuron can't do much. But join together 302 neurons, and they become a nervous system that can keep the worm Caenorhabditis elegans alive—sensing the animal's surroundings, making decisions and issuing commands to the worm's body. Join together 100 billion neurons—with 100 trillion connections—and you have yourself a human brain, capable of much, much more.

How our minds emerge from our flock of neurons remains deeply mysterious. It's the kind of question that neuroscience, for all its triumphs, has been ill equipped to answer. Some neuroscientists dedicate their careers to the workings of individual neurons. Others choose a higher scale: they might, for example, look at how the hippocampus, a cluster of millions of neurons, encodes memories. Others might look at the brain at an even higher scale, observing all the regions that become active when we perform a particular task, such as reading or feeling fear. But few have tried to contemplate the brain on its many scales at once. Their reticence stems, in part, from the sheer scope of the challenge. The interactions between just a few neurons can be a confusing thicket of feedbacks. Add 100 billion more neurons to the problem, and the endeavor turns into a cosmic headache.

Yet some neuroscientists think it is time to tackle the chal­lenge. They argue that we will never truly understand how the mind emerges from our nervous system if we break the brain down into disconnected pieces. Looking only at the parts would be like trying to figure out how water freezes by studying a sin­gle water molecule. "Ice" is a meaningless term on the scale of individual molecules. It emerges only from the interaction of a vast number of molecules, as they collectively lock into crystals.

Fortunately, neuroscientists can draw inspiration from other researchers who have been studying complexity in its many forms for decades—from stock markets to computer circuits to interacting genes and proteins in a single cell. A cell and a stock market may not seem to have much in common, but research­ers have found some underly­ing similarities in every com­plex system they have studied. They have also developed math­ematical tools that can be used to analyze those systems. Neuroscientists are picking up those tools and starting to use them to make sense of the brain's complexity. It's still early days, but their results so far are prom­ising. Scientists are discovering the rules by which billions of neurons are organized into networks, which, in turn, function together as a single, coherent network we call the brain. The organization of this network, sci­entists are finding, is crucial to our ability to make sense of an ever changing world. And some of the most devastating mental disorders, such as schizophrenia and dementia, may be partly the result of the collapse of the brain's networks. . .

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2.      In the News: Placebos really work

Patients report improvement even when they know medicine is fake

AMINA KHAN, Los Angeles Times, Wednesday, Dec. 22,

A simple sugar pill may help treat a disease - even if patients know they're getting fake medicine. . .

"The conventional wisdom is you need to make a patient think they're taking a drug, you have to use deception and lies," said lead author Ted Kaptchuk, an associate professor of medicine at Harvard Medical School. And, Kaptchuk added, it seems many doctors do this: In one report, as many as half of rheumatologists and internists surveyed said they had intentionally given patients ineffective medication in the hopes it would have a positive result.

Kaptchuk, however, wondered whether the deception was needed. When he first tried to persuade fellow researchers to explore a sort of "honest" placebo, "they said it was nuts," he said. After all, didn't the whole effect hinge on people believing they were getting real treatment?

Patients were easier to enlist. "People said, 'Wow, that's weird' and we said, 'Yeah, we think it might work.' "

The researchers enrolled 80 people suffering from irritable bowel syndrome, explaining the experiment while framing it positively - they called it a novel "mind-body" therapy.

Half the patients were given a bottle with the word "placebo" printed on it. The pills it held, they were told, were like sugar pills. The patients were told they didn't even need to believe in the placebo effect, but had to take the pills twice daily.

The other half were given no treatment at all.

At the end of the three-week trial, 59 percent of the patients taking the placebo said their symptoms had been adequately relieved, far outstripping the 35 percent in the non-treatment group. . .

The results, which Kaptchuk said need to be replicated in a longer, larger study, show that placebo pills could be useful for chronic pain, depression and anxiety, among others, without the need for deception.

"My personal hypothesis is this would not happen without a positive doctor-patient relationship," Kaptchuk said.

Others agreed. "What seems to be the active ingredient is the warm, personal relationship," said Dr. Howard Brody of the University of Texas Medical Branch in Galveston, Texas.

Tor Wager, a cognitive neuroscientist at the University of Colorado at Boulder, said this and future research may help change the way doctors treat their patients.

"In terms of medical research, there's been a big gap between what people feel is true in the clinic and what is scientifically investigated," he said. "This study takes a step toward filling that gap. It shows the human context essentially does matter."

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3.      International Medicine: Why it's time government called "time out" on the Canada Health Act

Mark Rovere National Post, November 29, 2010

When it comes to Canadian health care, everyone seems to agree our system has problems and needs to be improved. But the discussion always seems to end there, with any new idea for reform immediately discarded by vote-sensitive politicians and vested special interest groups.

Witness the case of Maxime Bernier, who found himself under heavy criticism last month when he suggested the feds do away with the Canada Health Transfer and instead free up provincial tax room so that provinces could manage their own health care systems as they see fit. Bernier was accused of trying to dismantle the Canada Health Act and any further consideration of his proposal was effectively halted.

This week the Fraser Institute published a study with a policy recommendation that we felt federal and provincial governments should consider because it would be easier to introduce: a five-year population-wide moratorium of the Canada Health Act, essentially taking a "time out" from the Act. This would allow governments to try out any number of new policies that are currently limited or even prohibited in Canada, but which are in place in the majority of industrialized countries.

But as has become all too common in the health care debate, the National Post was soon reporting that federal Health Minister Leona Aglukkaq and Dr. Jeffrey Turnbull, president of the Canadian Medical Association, had rejected the idea out of hand . . .

According to 2007 data from the Oganization of Economic Cooperation and Development (OECD), Canada's health insurance system was the sixth most expensive among 28 OECD nations, but failed to match the majority of these nations in terms of providing medical resources and services to the country's citizens. Canada fell below the OECD average and ranked sub-par in 12 of 18 indicators used to compare the availability of medical services and resources. Importantly, on 16 of the 18 indicators of medical output, Canada finished below its own sixth place rank for health spending: meaning we tend to spend more and get less in return.

But what's most troubling is the fact that almost every country in the industrialized world with a better performing health insurance system than Canada, also has public policies in place that are either prohibited or limited under the Canada Health Act. For instance, Canada is one of only four countries that ban patient cost sharing for the use of publicly funded hospital care, general practitioner care, and/or specialist care. Canada is also the only country that effectively prohibits private health insurance for hospital and physician services. Although private medical insurance is not banned specifically by the Canada Health Act, federal and provincial governments have historically interpreted the Act as intending to ban private insurance. While only six provinces legally prohibit private medical insurance for medically necessary services, all provinces have other policies in place that penalize providers who choose to bill privately for services. In practice, private insurance is generally only permitted to cover goods and services that are not covered by our universal government-run health insurance plan, mainly dental services and prescription drugs.  . . .

Therefore, in order to determine empirically whether Canada's health insurance system would improve if policies similar to those in the rest of the world were implemented, the federal government should temporarily suspend enforcement of the Canada Health Act.

A five-year moratorium would give provinces freedom and encourage experimentation with alternative financing schemes. It would encourage innovation and just as importantly, if some of the ideas did not lead to improved access to care, provinces could always revert to the current system.

It's obvious the status quo is not working, so why are governments afraid to try policies that have been shown to work elsewhere?

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

--Canadian Supreme Court Decision 2005 SCC 35, [2005] 1 S.C.R. 791

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4.      Medicare: When the Doctor Has a Boss

More Physicians Are Going to Work for Hospitals Rather Than Hanging a Shingle


The traditional model of doctors hanging up their own shingles is fading fast, as more go to work directly for hospitals that are building themselves into consolidated health-care providers.

The latest sign of the continued shift comes from a large Medical Group Management Association survey, which found that the share of responding practices that were hospital-owned last year hit 55%, up from 50% in 2008 and around 30% five years earlier.

The biggest U.S. physician-recruiting firm, Merritt Hawkins, a unit of AMN Healthcare Inc., said the share of its doctor searches that were for positions with hospitals hit 51% for the 12 months ended in March, up from 45% a year earlier and 19% five years ago. The number of searches for physician groups and partnerships has dropped.

The trend is tied to the needs of both doctors and hospitals, as well as to emerging changes in how insurers and government programs pay for care. Many doctors have become frustrated with the duties involved in practice ownership, including wrangling with insurers, dunning patients for their out-of-pocket fees and acquiring new technology. Some young physicians are choosing to avoid such issues altogether and seeking the sometimes more regular hours of salaried positions. . . .

Hospitals are also seeking to position themselves for new methods of payment, including an emerging model known as accountable-care organizations that is encouraged by the new federal health care law. These entities are supposed to save money and improve quality by better integrating patients'care, with the health-care provider sharing in the financial benefits of new efficiencies.

The consolidation wave is raising red flags among some regulators, researchers and health insurers, who warn that bigger health systems can use their leverage to push for higher rates. "We've always been concerned about combinations that are being done to increase prices," said Karen Ignagni, chief executive of America's Health Insurance Plans. . .

Read the entire article (subscription required) . . .
Also read Mathews' companion article on Who's to Blame . . .
Who's To Blame For High Health Costs? Study Suggests One Answer
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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: Best Practices or Pay for Performance is really Gluttony in Disguise

The best practices movement has gained a foothold with politicians who are desperately trying to control costs under the illusions that quality will reduce costs. However, they don't understand medical practice well enough to measure quality. In general, what is understood as quality is very expensive. Ordering tests under a protocol without medical judgment on each individual patient will always be more expensive.

Doctors are well aware that cancer of the colon has genetic factors, which cause it to have an increase in prevalence in some families. Thus, we check for colon cancer much earlier if there is a family history of colon cancer. We may check it 10 or even 15 years early if several members had cancer of the colon in their 40s or early 50s. Others with no family history of cancer of the colon, and a well-known understanding of their familial medical history, have a very low incidence of cancer of the colon.

A recent Medical Grand Rounds at the University of California, Davis Medical Center had a world authority presentation of colon cancer. One of the take-home messages is that there are far too many colonoscopies done than can be justified medically. The professor even stated that if your patient was not disposed for colon screening, try to get a screening colon check by the late 50s and then a second one by the late 60s when the incidence of cancer of the colon is the highest. He felt very little cancer would be missed in these patients, which many consider non-compliant with the current HMO recommendations of annual stool checks or every two year colon checks starting at age 50.

HMO doctors who don't comply will have a reduction in their reimbursements. At the last HMO meeting, the CFO stated that if all doctors would comply with best practices and P4P protocols, they could make an extra $10,000 per quarter in bonuses.

Comparing costs of the doctors that order everything the bureaucrats desire for quality in P4P is rather striking. In just this one disease screening, the difference between two colonoscopies in the average patient not at risk, at say $2500 each, is a lifetime cost of $5,000. For someone having a colonoscopy at age 50, 55, 60, 65, 70, 75, 80 and 85, the lifetime cost would be $20,000 for no yield in quality. But the doctor that does a gluttonous P4P will not only increase the health care cost of this procedure by $15,000 per patient, he will also collect his additional $10,000 per quarter or $40,000 per year or $320,000 in P4P bonuses. Assume just 100 patients per year, that is an extra $1.5 million in health care costs per year over his practice, plus his additional $320,000 bonus or $1.8 million in health care costs. Compare this with the physician that practices high quality patient centered care at $5,000 per patient. For the same 100 patients, the cost would be $500,000 or one-half million sans bonuses.

How many physicians do you think will prostitute themselves and their practices to get paid the P4P reimbursements?

How many ethical physicians will we have left after 10 years of government interference and practice manipulations?

When Hitler paid physicians their P4P (pay for performance) bonus to determine which Jews had lives not worth living, very few ethical physicians refused to participate. When will we reach the point of no return?

Who among us will remain ethical with our heads raised to the heavens?

Heaven help us!?

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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: Slow Metabolism makes me gain weight.

Boosting Metabolism to Lose Weight: What Works, What Doesn't
By Adrienne Forman, M.S., R.D. Environmental Nutrition, January 2006

Dieters often lament that a slow metabolism keeps them from losing weight. Marketers of weight-loss products capitalize on this belief by offering ways to boost metabolism and "melt away" unwanted pounds. Is a faster metabolism really the key to weight loss? And can you really speed up your metabolism?

Metabolism refers to the way the body uses energy (measured in calories). The body uses calories in three ways: 1) To sustain vital body functions like breathing, heart rate, waste removal, cells growth and repair. Even at rest all this accounts for up to 75% of the calories you burn daily. 2) For physical activity, and 3) for digestion and absorption of food which uses about 10% of a day's calories.

The speed at which the body burns calories when at rest is called your resting metabolic rate (RMR). . .

The only way to know your RMR is to have a health and fitness professional measure it. . .  It measures oxygen consumption, which reflects the rate at which you body burns calories. Cutting calories below your RMR is not smart, because your body then shifts into starvation mode, lowering your metabolic rate even more. So even if you are eating less, it can actually be harder to lose weight, because your body is fighting to conserve the energy it has stored in body fat. . .

"The vast majority of weight loss is explained by how much people cut calories and how much they exercise."

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Medical Myths originate when patients listen to rumors.

Myths disappear when patients do their research of scientific facts.

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7.      Overheard in the Medical Staff Lounge: When the Doctor Has a Boss

More Physicians Are Going to Work for Hospitals Rather Than Hanging a Shingle
By Anna Wilde Mathews, WSJ
The traditional model of doctors hanging up their own shingles is fading fast, as more go to work directly for hospitals that are building themselves into consolidated health-care providers. . . .
Adding to the incentive, some procedures are paid more richly if done in a hospital than in a doctor-owned clinic. If doctors are employed by hospitals, this extra money can be figured indirectly into their compensation. Under anti-kickback laws, they still can't be rewarded directly for ordering services such as imaging tests that are lucrative for the hospital but may not be needed.

Dr. Rosen: What do you think of the Anna Mathews' article about doctors going to work for the hospitals?

Dr. Milton: I think it's abhorent. Every unbiased decision you make regarding a patient will be reviewed from a financial aspect.

Dr.  Edwards: Despite some successful alliances, such as the Kaiser Permanente, I agree with Milton they are all suspect and dangerous. Not only for physician and patients but for insurance companies and healthcare costs.

Dr. Paul: How do you figure?

Dr. Edwards: The physician will never again be totally free or objective in caring for patients. He will be practicing in a glass cage and every action, prescription, or test will be reviewed. It is to the hospital's benefit in regard to utilization and reimbursement and the hammer and ax will be couched in terms of quality of care.

Dr. Paul: As long as QOC is the primary end point, isn't that what we should all be working towards?

Dr. Edwards: But quality of care is different at different times.

Dr. Rosen: It is also different at the same time by different organizations.

Dr. Paul: You lost me Rosen.

Dr. Rosen: In the 1970s, the hospital's favorite doctors were those that ordered numerous tests. The most favorite were the ones who ordered daily electrolytes, daily chest x-rays, daily ECGs, daily blood counts, etc., et. al., ad infinitum.

Dr. Paul: Maybe that's what the patient needed.

Dr. Rosen: But we all see our patients every day or even oftener and if we need another set of laboratory tests, we can order them daily. Otherwise there will be excessive costs. That's what the hospital desires, insurance companies are neutral and patients at any financial risk never know if the excessive costs are important.

Dr. Paul: But patient's really don't care since they are not concerned about costs.

Dr. Rosen: That's precisely the point. Patients with no significant copay except a fixed $25, $50 or $100 have no financial concern after the first five minutes when that is used up. This opens Pandora's Box where whatever the doctor orders, the patient shall have.

Dr. Paul: That's why patients obtain insurance with little or no co-payment or deductibles. It saves them money.

Dr. Milton: Nobody seems to think of the longterm costs as insurance companies have to increase their premium by double digits because physicians and patients do excessive utilizations of unnecessary tests and unnecessary treatments, all of which is seen as life saving by the patient's family.

Dr. Rosen: I had a nine-year-old patient some years ago who fractured his cervical spine and was on a ventilator. There were a number of consultants on the case and money was no object. Until one day, I was approached by the father for advice. He told me that he had a million dollar cap on his health insurance and after three weeks his hospital bill was approaching $600,000. At the present rate, he would no longer have insurance on his boy in two more weeks if the $200,000-per-week continued. I took it upon myself to go through the charge and change every six-hour order to an every 24-hour order. I changed every daily order to an every-other-day order. Several days later he thanked me for cutting the hospital bill in half.

Dr. Milton: So even a million dollar maximum can save money in such cases.

Dr. Rosen: When Managed Care came into vogue in the 1980's, they placed reviewers, primarily RNs, on every hospital ward to police the actions of doctors in order to eliminate unnecessary hospital stays and implement transfers. So doctors began ordering less tests and less treatment.

Dr. Paul: You really believe that?

Dr. Rosen: I was personally approached informally by another physician in my specialty saying, "Rosen, let me give you some advice. We can no longer evaluate all of the patient's complaints when they come into the hospitals. Just pick out the most important one, evaluate and treat it, and get the patient out of the hospital as fast as you can."

Dr. Paul: You're putting me on.

Dr. Rosen: The soft passive aggressive tone of that doctor really scared me to death. My wife even noticed when I got home.

Dr. Edwards: Hospital practice is couched in the format of foundations. But make no mistake. That is just a legal arrangment. The oversight  is really the same as if those in charge were the same directors.

Dr. Milton: I think Kaiser Permanente has probably done the best job of keeping the physican practice totally separate with the Non-Profit Kaiser Foundation and Kaiser Health Plan contracting with the private Permanente Medical Group. It appears to be a rather solid marriage, at least at this time.

Dr. Rosen: True. However, I've seen some young physicians,who I thought were good, efficient and cost conscious, who did not make it to partnership in two or three years. As near as the doctor could tell, he didn't differentiate well enough between the average generic price and the extremely low-cost generic price. When there are millions of prescriptions for 25 five-cent antihistamines vs millions for five-cent antihistamines, before long you are talking millions of dollars just between different generics. They both look very cheap, but a million 100-tablet prescriptons of one verses a million 100-tablet prescriptions of the other could mean the difference between $25 M and $5 M, or $20 million cost savings. That makes a doctor expendable and unacceptable for partnership.

Dr. Milton: As I said in the beginning of our discussion, hospital practice, even when it's disguised as foundation practice, is dangerous for our profession, for our patients, for the welfare of our country and healthcare costs in general. Hospitals will do well because of their clout. But eventually free enterprise will eliminate the high-cost centers. As physicians, we best be ready for this.

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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 Articles from Doctors

A Homeless Man's Funeral . . . submitted by Dr. George Karr
As a bagpiper, I play many gigs. Recently I was asked by a funeral director to play at a graveside service for a homeless man. He had no family or friends, so the service was to be at a pauper's cemetery in the Missouri back country. As I was not familiar with the backwoods, I got lost and, being a typical man, I didn't stop for directions. I finally arrived an hour late and saw the funeral guy had evidently gone and the hearse was nowhere in sight. There were only the diggers and crew left and they were eating lunch. I felt badly and apologized to the men for being late. I went to the side of the grave and looked down and the vault lid was already in place. I didn't know what else to do, so I started to play. 
The workers put down their lunches and began to gather around. I played out my heart and soul for this man with no family and friends. I played like I've never played before for this homeless man. And as I played ‘Amazing Grace' the workers began to weep. They wept. I wept, we all wept together. When I finished I packed up my bagpipes and started for my car. Though my head hung low, my heart was full.
As I opened the door to my car, I heard one of the workers say, "I never seen nothin' like that before and I've been putting in septic tanks for twenty years." 
Apparently I'm still lost . . .     –The Bagpiper
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VOM Is an Insider's View of What Doctors are Thinking, Joking and Writing about.

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9.      Book Review: The Master Switch by Tim Wu, Knopf, 366 pages, $27.95

The Power To Control,  A Review By JEREMY PHILIPS, WSJ
Is Internet freedom threatened more by dominant companies or by the government's efforts to hem them in?

In the early days of the radio industry, in the 1920s, almost anyone could become a broadcaster. There were few barriers to entry, basically just some cheap equipment to acquire. The bigger broadcasters soon realized that wealth creation depended on restricting market entry and limiting competition. Before long, regulation—especially the licensing of radio frequencies—transformed the open radio landscape into a "closed" oligopoly, with few players instead of many.

In "The Master Switch," Tim Wu, a professor at Columbia University, argues that the Internet also risks becoming a closed system unless certain steps are taken. In his telling, information industries—including radio, television and telecommunications—begin as relatively open sectors of the economy but get co-opted by private interests, often abetted by the state. What starts as a hobby or a cottage industry ends up as a monopoly or cartel.

In such an environment, success often depends on snuffing out competitors before they become formidable. In Greek mythology, Kronos—ruler of the universe—was warned by an oracle that one of his children would dethrone him. Logically, he took pre-emptive action: Each time his wife gave birth, he seized the new child and ate it. Applied to corporate strategy, the "Kronos Effect" is the attempt by a dominant company to devour its challengers in their infancy. . . .

In such an environment, success often depends on snuffing out competitors before they become formidable. In Greek mythology, Kronos—ruler of the universe—was warned by an oracle that one of his children would dethrone him. Logically, he took pre-emptive action: Each time his wife gave birth, he seized the new child and ate it. Applied to corporate strategy, the "Kronos Effect" is the attempt by a dominant company to devour its challengers in their infancy. . .

Mr. Wu notes that, for most of the 20th century, AT&T operated the "most lucrative monopoly in history." In the early 1980s, the U.S. government broke the monopoly up, but its longevity was the result of government regulation. . .

In the past, then, even arrangements aimed at maximizing competition have ended up entrenching the dominant player. Some argue that the Internet will avoid this fate because it is "inherently open." Mr. Wu isn't so sure. In fact, he says, "with everything on one network, the potential power to control is so much greater." He worries about major players dominating the Internet, stifling innovation and free speech. . . .

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The Book Review Section Is an Insider's View of What Doctors are Reading about.

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10.  Hippocrates & His Kin: The Highest Pay Increases in Sacramento went to Hospital CEOs.

The Cost of Compliance

A survey by Ernst & Young in August and September of 380 executives found that 31% are most concerned about the cost of compliance with the [healthcare] law, while 16% were most concerned about their overall readiness to comply.

If these costs could be converted into health insurance, maybe we could get everyone covered and not comply?

The Burden of Compliance

"There's an administrative burden just to try and understand the 2400 pages of the document" says Jenn Mann, Vice President of human resources at software maker SAS Institute, Inc. As a result of the reform, SAS is doubling its legal and consultant expenses for 2011, says Ms. Mann.

If these costs could be converted into health insurance, maybe we could get everyone covered and not comply?

Understanding Compliance

Borders Groups Inc. has increased health-care-related consulting by around 20% to help it understand the law says Rosalind Thompson, senior vice president of human resources.

If these costs could be converted into health insurance, maybe we could get everyone covered and not comply?

Many Capital CEOs got 2009 Pay Hikes, Sac Bee, by Rick Daysog

The average compensation for the region's top bosses – excluding those from privately held companies – was $542,144, according to filings with the Securities and Exchange Commission, Internal Revenue Service and the U.S. Labor Department.

During the same year, the median income for households in the four-county Sacramento area fell 5.6 percent to $57,361, the lowest level in at least a decade. . .

Some of the highest-paid people here include the heads of health care companies and statewide industry trade groups, which operate as nonprofits.

Sutter Health, one of the nation's largest health care systems, paid 14 of its executives $1 million or more in total compensation in 2009, according to Sutter's tax filings with the IRS.

[Sutter] CEO Patrick Fry was the region's highest-paid CEO with a compensation package valued at $3.99 million, a 41.3 percent increase from the year-earlier period. . .

If these costs could be converted into health insurance, maybe we could get everyone covered and not comply?

Read more: - ixzz1AZpIeIp3

It looks like In Health Care, is where the Money is.

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Today & Tomorrow

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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.

                      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. 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:  In Commonwealth of Virginia v. Kathleen Sebelius, Judge Henry E Hudson found that Congress cannot expand the Commerce Clause of the U.S. Constitution to force people to buy a product. 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: If there is a bomb under the foundations of your house, you do not propose "tweaking" it. You want it disarmed, removed, and dismantled. 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.

The AAPS California Chapter is an unincorporated association made up of members. The Goal of the AAPS California Chapter is to carry on the activities of the Association of American Physicians and Surgeons (AAPS) on a statewide basis. This is accomplished by having meetings and providing communications that support the medical professional needs and interests of independent physicians in private practice. To join the AAPS California Chapter, all you need to do is join national AAPS and be a physician licensed to practice in the State of California. There is no additional cost or fee to be a member of the AAPS California State Chapter.
Go to California Chapter Web Page . . .

Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"

 PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.

Our motto, "omnia pro aegroto" means "all for the patient."

* * * * *

Words of Wisdom

"Confidence is going after Moby Dick in a rowboat and taking the tartar sauce with you." - Zig Ziglar: Motivational author and speaker.

"Much of the stress that people feel doesn't come from having too much to do. It comes from not finishing what they've started." - David Allen: Management consultant, trainer, and author.

"The majority of individuals view their surroundings with a minimal amount of observational effort. They are unaware of the rich tapestry of details that surrounds them, such as the subtle movement of a person's hand or foot that might betray his thoughts or intentions." - Joe Navarro: Former FBI agent and expert on nonverbal language.

"It doesn't matter where you are coming from. All that matters is where you are going."
- Brian Tracy: Self-help author, speaker, and lecturer.


In Memoriam

Adolf Busch The Man Who Said No to Hitler

His life was not in danger under the Nazis, but his soul was. He chose exile over a devil's bargain


Adolf Busch, the greatest German violinist of the 20th century, is now known only to classical-record collectors who treasure the searchingly eloquent 78s that he cut with Rudolf Serkin, his son-in-law and recital partner, and the Busch Quartet, the ensemble that he led for three decades. But there is another reason to remember him, one that in the long run may well count for as much as the music that he made: Mr. Busch's name is at the very top of the short list of German musicians who refused to kowtow to Adolf Hitler. This latter aspect of his life is described in detail in Tully Potter's "Adolf Busch: The Life of a Honest Musician" (Toccata Press), the first full-length biography of the violinist ever to be published. It is at once a stirring tale and a disturbing one.

Most of us, I suspect, like to think of artists as a breed apart, a cadre of idealists whose souls have been ennobled by long exposure to beauty. The truth, however, is that they are every bit as human as the rest of us, and that a certain number of them are self-centered opportunists who are perfectly willing to ignore evil so long as the evildoers leave them in peace to do their work. That was pretty much what many German musicians did when the Nazis came to power in 1933. Within a matter of days, Hitler and his henchmen started putting into place a policy of systematic persecution of German Jews. Numerous well-known Jewish musicians, including Bruno Walter, Otto Klemperer and Emanuel Feuermann, either were forced out of their posts or quit in protest.

In April, mere weeks after Hitler seized the levers of power, the Busch Quartet decided to stop playing in Germany. Mr. Busch also canceled his remaining recitals with Mr. Serkin, issuing this statement: "Because of the impression made on me by the actions of my Christian compatriots against German Jews…I find it necessary to break off my concert tour in Germany." What makes this act so significant is that Mr. Busch was the only well-known non-Jewish German classical musician to emigrate from Germany solely as a matter of principle—and one of a bare handful of non-Jewish European musicians, including Arturo Toscanini and Pablo Casals, who resolved to stop performing there for the same reason.

Virtually all of the other big names in Austro-German music, including Wilhelm Furtwängler, Walter Gieseking, Herbert von Karajan, Carl Orff and Richard Strauss, stayed behind, some because they were active supporters of Hitler and others because they thought that the Nazis would dry up and blow away. Mr. Busch knew better. In a prophetic letter, he wrote, "Some of them believe that if they only 'play along,' the atrocities and injustice that are part and parcel of the movement will be tempered, can be turned around…they do not notice that they can only have a retarding effect, that the atrocities will still take place, only perhaps a bit later."

Mr. Busch's principled stand was motivated in part by the fact that many of his closest friends and colleagues were Jewish, including Mr. Serkin and Karl Doktor, the violist of the Busch Quartet. But the Nazis, who were keenly aware of the force of public opinion, were prepared to look the other way at such things in order to prevent prominent non-Jewish Germans from leaving the country in protest. As late as 1937, it was discreetly made known to Mr. Busch that if he returned, the Nazi government would let Mr. Serkin come back as well. "If you hang Hitler in the middle, with Goering on the left and Goebbels on the right, I'll return to Germany," he replied. . . .

—Mr. Teachout, the Journal's drama critic, writes "Sightings" every other Friday. He is the author of "Pops: A Life of Louis Armstrong." Write to him at

Columnist's name 


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On This Date in History - December 28

On this date in 1869, William F. Semple of Mount Vernon, Ohio, received a patent for chewing gum. We had gums of various kinds before then, but Mr Semple's patent covered "The combination of rubber with other articles" for "an acceptable chewing gum."  The virtue of chewing gum is that it is still there when you finish - which is what suggests a rubber additive.

On this date in 1917, H. L. Mencken published an article in The New York Evening Mail describing the origin of the Great American bathtub, how it was first installed in a mansion in Cincinnati by one Adam Thompson in 1842, and how various states passed laws to regulate or tax it. The article was a pure hoax; Mencken never intended it to be taken seriously, but it was. To this day, you can probably find articles relaying as fact the items of Mencken's imagination.

After Leonard and Thelma Spinrad

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The Annual World Health Care Congress

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

In partnership with, the 7th Annual World Health Care Congress was the most prestigious meeting of chief and senior executives from all sectors of health care. The 2010 conference convened 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. Please watch this section for further reports in the future as well as


The 8th Annual World Health Care Congress will be held April 4-6, 2011
Washington, DC
Toll Free: 800-767-9499