Community For Better Health Care

Vol XI, No 11, Feb 2013

In This Issue:

  1. Featured Article: P r a c t i c e F u s i o n , # 1 Wi t h 25 M E l e c t r o n i c M e d i c a l R e c o r d s , D e b u t s I Pad App

  2. In the News: The Real Star War

  3. International Medicine: Single-Pay-er National Health Insurance around the World

  4. Medicare: In Healthcare reform, there is a perverse incentive to be uninsured

  5. Medical Gluttony: Frequently not recognized by patient, family, hospital, or physician

  6. Fiscal Myths: The Tax, Spend, and Regulate (TSR) Party can’t manage city finances either.

  7. Overheard in the Medical Staff Lounge: Has Obamacare Arrived early?

  8. Voices of Medicine: An Israelis Psychiatrist says Obama has a Mental Disorder

  9. The Bookshelf: The American Conservatory Theatre: Dead Metaphor

  10. Hippocrates & His Kin: Now we know why the Editor of Medical Tuesday was targeted.

  11. Restoring Accountability in Medicine, Government and Society

  12. Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

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The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 10th Annual World Health Care Congress will be held April 8-10, 2013 at the Gaylord Convention Center, Washington DC. For more information, visit The future is occurring NOW.

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  1. Featured Article: P r a c t i c e F u s i o n , # 1 in E M R Wi t h 25 M E l e c t r o n i c M e d i c a l R e c o r d s , D e b u t s I Pad App

With great power comes great responsibility, and in few places is that more true than the healthtech industry. Practice Fusion is the leading provider of electronic medical records, now helping 130,000 doctors to track records for 25 million patients, CEO Ryan Howard told me today. That’s over 3x the EMRs hosted by Kaiser Permanente or the VA. Practice Fusion is free for doctors and patients. It monetizes through a marketplace for labs, pharmacies, and drug companies who pay for preferred placement in front of doctors who direct a staggering $40 billion in spend a year through the platform. Its new iPad app, debuted today at Practice Fusion’s annual conference, will let these doctors access records while out of the office. Read more . . .

In addition to saving lives, the average doctor in California directs about $2.3 million a year in spend. Just imagine how much decision and recommendation power doctors have: “take this pill not that one”, “pick it up from this pharmacy”, “your test is being analyzed by this lab”. By next year, Howard tells me that figure will have grown well past the $60 billion a year spent through eBay. These medical service providers buy expensive banner ads in the Practice Fusion platform to ensure doctors choose them, and it’s making the company a lot of money.

Practice Fusion’s doctor and record uptake rate is growing exponentially. It counted 70,000 clients in April when it raised a $23 million series B, and by September when it took $6 million more in funding it had 100,000 health care providers on board. Now Practice Fusion is at 130,000, and with each new doctor comes roughly 2,000 new patients who can access their own medical records from anywhere. Doctors can begin using the product in minutes, and can pay to have all their existing paper records scanned in over a few days. Practice Fusion’s competitors can take 6 months or longer to get doctors set up.

Howard tells me “We’re effectively the Salesforce for doctors, and the Facebook for health.” He explains that through its APIs, Practice Fusion will become the hub for personal medical data from consumer devices and services such as FitBit and wireless weight scales. This includes 100Plus, the personalized health prediction platform Howard co-founded with funding from Peter Thiel and Founders Fund to let people see how healthy decisions can expand their lifespan. That hub could become another lucrative medical advertising magnet. More altruistically, Practice Fusion is working with Palantir and the CDC to power disease outbreak detection with its data.

At its core, though, Practice Fusion’s goal is to make medical record access instant and efficient. That’s why it debuted an iPad app for doctors on the go, designed by Cooper, the firm headed by Alan Cooper, the father of Visual Basic. It securely provides access to records so if a doctor gets an after-hours call about a patient, they have all their necessary medical data at hand so they can make informed decisions.

Prioritizing usability, doctors can see their day’s appointments and instantly dive into each patient’s chief complaint, allergies, problems, medications, family history, hospitalizations, and more. Doctors can record patient dictations of their symptoms, and combine their own assessment and treatment plan with pre-defined treatment plans for common ailments to minimize typing. They can also view lists of tasks, and receive push notifications of updates from their office . . . Read more . . .

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  1. In the News: The Real Star War

Asteroid defence

Something useful for America’s underemployed space agency to do

The Economist | From the print edition | Feb 23rd 2013

GEOGRAPHY matters. In 1908 a rock the size of a city block hit the Earth’s atmosphere at 15km (9 miles) a second. The explosion flattened an area the size of London. But the land in question was in Siberia, so few people noticed and those who did had little influence. Suppose, though, it had devastated a city in Europe or North America. The history of the 20th century would have been different, as the best scientific and engineering brains were brought to bear on the question of how to stop it happening again. Read more . . .

Well, it has happened again, albeit less spectacularly. By chance, Siberia bore the brunt once more, when a meteor crashed in the Urals on February 15th, injuring more than 1,000 people. It could just as easily have hit Germany or Guangdong. Moreover, on the same day another, larger rock called 2012 DA14 passed within 27,000km of Earth. By astronomical standards, that is a hair’s breadth. It is time to think seriously about stopping such incidents by building a system that can detect space rocks with sufficient warning, and then either blast them or push them out of the way. It would be costly, of course, and would require the development of new technology. But, as luck would have it, there is a tool lying around that has both the money and the nous to do it, and which is currently underemployed and in need of a new mission.


NASA, America’s space agency, has become a curious hybrid. Part of it is one of the world’s leading scientific research organisations. This NASA sends robot probes to the planets, runs space telescopes and has already sponsored projects devoted to looking for large asteroids—the ones that would blow humanity to kingdom come if their orbits ever intersected that of the Earth. If such a large, “planet-killing” asteroid were discovered, though, the chances are that earthlings would have decades, or centuries, to act; a small nudge, judiciously applied by rocket motor or nuclear explosion (see article), would be enough to send it off course.

The real problem is “city-killers”—things too small for existing surveys to see, but large enough to do serious damage. And it is here that the other NASA might be brought into play. The non-scientific bit of the agency, the bit that brought you the Apollo project, has been looking for a proper job since 1972, when Apollo was cancelled. It thought it had found it in the Space Shuttle, but building a cheap, reliable orbital truck proved impossible. It thought it had found it in the International Space Station, but that has turned into a scientifically useless tin can in the sky. The latest wheeze is to build a rocket that might one day, many administrations hence, go to Mars.

In a well-ordered world, this bit of NASA would have been closed down years ago. That it has not been is due, in large measure, to the lobbying power of aerospace companies which see the agency as a way to divert money from taxpayers’ pockets into those of their shareholders. This pocket-picking would be less irksome if something useful came of it. Why not, therefore, change this part of NASA’s remit to protecting the planet from external attack, not by evil aliens but by an uncaring universe?

Two things would be needed. One is a bigger system of telescopes, either on the ground or in orbit, to give notice of a threat. The other is a way to counter the threat. That might be done with lasers, or with controlled explosions that would shift the incoming object’s orbit sufficiently to make it miss altogether, or (if that is not possible) hit an unpopulated area.

Developing all this would be a technological challenge worthy of NASA’s engineers. It would keep the agency’s bureaucrats in their jobs. It would keep the money flowing to the aerospace companies. It would probably cost no more than the space station (about $100 billion). And, if it worked, it would provide something that benefited not just America, but the world—precisely the sort of thing a rich country which often claims the moral high ground ought to be doing.

When Apollo 11 took off from the Moon on July 21st 1969, its crew left behind a plaque that read, “They came in peace, for all mankind”. What an opportunity both America and NASA now have to prove that they meant it.

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  1. International Medicine: Single-Payer National Health Insurance around the World

by John C. Goodman, Gerald L. Musgrave, and Devon M. Herrick

As we move further into the twenty-first century, it is clear that we are living with a number of institutions that were not designed for the Information Age. One of those institutions is health care.

Virtually everyone agrees that our health care system needs reform. But what kind of reform? Some on the right would like to see us return to the type of system that prevailed in the 1950s. Some on the left would like to see us copy one of the government-run systems established in the mid-twentieth century and variously called socialized medicine, national health insurance and, more recently, single-payer health insurance. For example, Physicians for a National Health Program, claiming membership of 8,000 physicians and medical students, contends that "single-payer national health insurance would resolve virtually all of the major problems facing America's health care system today."

We believe that neither of these two alternatives will work. But before we explain why, let us stop to consider some central problems that every reform faces. Read more . . .

The complete book: (PDF | 5MB)

Lives at Risk by John Goodman, was reviewed in the early days of MedicalTuesday. Review these 20 Myths of Single Payer Medicine starting in August 2002 for twenty issues at

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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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  1. Medicare: In Government medicine, there is a perverse incentive to be uninsured “free riders.”

As we move into the 21st century, it is clear that we are living with a number of institutions that were not designed for the Information Age. One of these institutions is our health care system.

Characteristics of an Ideal Health Care System

By John C. Goodman, President

National Center for Policy Analysis

NCPA Policy Report No. 242

Web site:

Why should government be involved at all in our health care system? Aside from providing care for low-income families, the most persuasive argument is that in the absence of coercion people will have an incentive to be uninsured “free riders.” In our society, people who choose not to pay for insurance know that they are likely to get health care anyway — even if they can’t pay for it. The reason is that there is a tacit, widely shared agreement that no one will be allowed to go without care. As a result, the willfully uninsured impose external costs on others — through the higher taxes or higher prices which subsidize the cost of their care. Read more . . .

What evidence is there that free riders are a problem? One piece of evidence is the number of uninsured:

Although it is common to think of the uninsured as having low incomes, many families who lack insurance are solidly middle class. And the largest increase in the number of uninsured in recent years has occurred among higher-income families:

In deciding to be uninsured by choice, many healthy individuals are undoubtedly responding to perverse incentives created by government policies.

Far from solving the free rider problem, most government interventions these days are making the problem worse. Indeed, we might be better off under a policy of laissez faire.

If we accept the free rider argument, however, what policy implications logically follow from it? One commonly proposed solution is to have government require people to purchase insurance. However, this is neither necessary nor sufficient. Instead, a complete solution would have 10 characteristics. Adhering to each of them would lead to a system that provides a reasonable form of universal coverage for everyone without adding to national health care spending and without intrusive and unenforceable government mandates. . .

To read Dr. Goodman’s Ten Recommendations, go to . . . .

People who fail to insure are likely to get health care anyway — even if they can’t pay for it.”

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

- Ronald Reagan

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  1. Medical Gluttony: Frequently not recognized by patient, family, hospital, or physician

The perspective of a pulmonary consultant occasional provides an overview of medicine. Recently a patient was referred for consultation of an emergency room evaluation. The family was very concerned over the report of a very abnormal chest x-ray. The report indicated right middle lobe collapse, interstitial infiltrates, calcified pleural plaques, and possible pneumonia. Read more . . .

I remembered him from previous consultations. He looked like a robust 70 year old Eastern European. He didn’t appear ill and looked about as I had remembered him. The son, who also served as the interpreter, re-expressed the concern of a serious and grave illness. Since his chart had been retired after five years of inactivity, a search of our computerized files found our previous consultations of 2001 and 2008.

As I perused my previous consultation, I read aloud my concern about his abnormal chest x-ray in 2001, how the patient had recalled that he had a similar abnormality of his middle lobe in Hungary in 1981, he had had a bronchoscopy which revealed a narrowed bronchus to the middle lobe, that biopsies were obtained and no cancer was found obstructing the middle lobe which is a common presentation of a middle lobe lung cancer. “But is the x-ray the same?” I stated that it is impossible to ascertain if they are identical without seeing the x-ray side-by-side on my viewing box, but that considering one radiologist reading the films in 2001 and a different radiologist reading the film in 2013, it would certain appear that they were describing essentially similar films.

But dad is so much more short of breath,” he said. “Well then, why don’t we measure his pulmonary function and determine why he’s so short of breath.” I found his old PFT on my laptop and printed it out showing a mid-expiratory flow rate of 14% of normal, and then did a current PFT which showed the same flow parameter at 12% of normal. The son immediately mentioned that his dad had obviously gotten 2% worse. I pointed out that this was probably within the standard deviation of testing and was really the same value. The son breathed a sigh of relief and the patient just smiled broadly as if he never had any concern.

Looking over the 41 pages of emergency room testing, it was apparent this was well beyond the usual average of $9,000 for an emergency room visit and was more like a $20,000 relatively “non-transparent” charge. How can these costs be controlled? This has occurred over a long period of government meddling into physician work hours, giving ER evaluations greater latitude in charging Medicare, and lack of patient copayments and deductibility, all previously discussed in this column.

Since the initial complaint was chest pain, and the initial electrocardiogram was normal, a 20% copayment on a $200 ECG may have satisfied the family that he wasn’t having a heart attack. If they had stopped the testing at this point when their 20% copayment was $40, it would have save Medicare more than $20,000 in costs. If the patient had gone to the same hospital emergency room where his first 2001 tests had occurred, the initial $250 chest x-ray could have been compared to the previous one and the 50 copayment may have satisfied the family and the $20,000 in hospital costs could have been contained. If the patient would have come to the same consultant in the office that saw him in 2001, a clinical diagnosis could have been made of no change. If the family anxieties could have been relieved at that point, then the whole $20,000 cost could have been contained. Continuity of care may be the biggest restrainer of health care costs increases.

But as long as the medical illiterate control the White House, the Congress, and the AMA, reason will never prevail.

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Medical Gluttony thrives in Government and Health Insurance Programs.

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

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  1. Fiscal Myths: The Tax, Spend, and Regulate (TSR) Party can’t manage city finances either.

Detroit faces a takeover by an emergency manager. The move by Michigan's governor would take control of the state's largest city out of the hands of elected leaders. Detroit, with an annual deficit of $327 million, the state of Michigan is taking on one of the most difficult turnaround projects ever attempted: a rescue of a sprawling city with $14 billion in debt, a depleted tax base, a legacy of government corruption—and very little time left to avert financial collapse. The city is on pace to run out of cash by June and, in the eyes of the state, unfit to govern itself. Gov. Rick Snyder said the financial manager would bring Detroit new promise. Read more . . .

The governor's decision represents a turning point for a city that was once the industrial capital of America and an engine of its growth. Six decades ago, Detroit was a city of nearly two million people brimming with factory jobs that offered immigrants from the South and abroad a pathway into the American middle class. Today, it is a city of just over 700,000 residents, confronting widespread poverty, blight and diminished municipal services.

The manager will have sweeping power to set the financial direction of the city. The appointee will also have the ability to break municipal labor contracts starting later this month when a new state law takes effect. Elected leaders in Detroit could lose their jobs, but the emergency manager could also retain some of them by setting new salaries and modifying duties.

When President John F Kennedy lower tax rates in the 1960s and improved tax revenue in the process, we thought this would educated the TSR party that raising tax rates would be counterproductive. But it only lasted one term.

Some of us forgot that JFK also allowed government workers to unionize. This eliminated all thoughts of fair taxations and allows government unions to destroy our heritage with incessant irresponsible taxation and spending increases. This has now lasted for 50 years.

When Washington is shown to be unfit to govern, who would be able to be the manager of the United States of America and re-introduce fiscal responsibility?

To read more, see MATTHEW DOLAN, WSJ,

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Fiscal Myths originate when TSRs take over the government and not worry over finances.
Myths disappear when the Constitutional party is in charge of fiscal responsibility.

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  1. Overheard in the Medical Staff Lounge: Has Obamacare Arrived early?

Dr. Rosen: Last week everyone seemed depressed over the happenings in medicine.

Dr. Milton: We have had an influx of new welfare patients into our HMO. We’re adjusting.

Dr. Ruth: We have not participated in accepting the MediCal patients who have been newly added to our HMO.

Dr. Edwards: I’ve always had a base of 10-20% of my practice being welfare. We have accepted these with careful scrutiny.

Dr. Michelle: How do you scrutinize MediCal or Welfare patients? Read more . . .

Dr. Edwards: It isn’t easy. But we feel an obligation to the poorer members of our society. We can usually determine after the second visit whether they are the Dregs of Society and are “takers” and happy being “takers” or are they temporarily down and out and appreciate the American Freedom of opportunity and looking for a brighter day tomorrow. Look at the billionaires in our culture who came to America with very little cash in their pockets.

Dr. Yancy: I have a MediCal free practice and I intend to keep it that way. If I see a MediCal patient who really needs my surgical care, I may see one on an individual basis. But I don’t charge for my services. It’s charitable and free. I’m not going to deal with the state bureaucracy, hassles, condescending attitudes, such as let’s see a copy of your medical records or surgery reports within one week for one-third of my standard fee. My estimate is that the hassles and their costs frequently exceed the one-third fee they pay me. This means that I’m doing charity but not recognized as such. I’ll just do real charity in these cases.

Dr. Rosen. Yancy brings up an excellent point. When we do MediCal which just barely covers our office cost but none of the doctors net fee, we get criticized for doing what amounts to charity. Why not do real charity and not charge anything for those in the MediCal ranks we see. Then control those ranks to say ten percent of our practice. Physicians would then be praised instead of constantly criticized.

Dr. Michelle: Milton, how are you adjusting to your influx of MediCal patients into your HMO?

Dr. Milton: It was a bigger eye opener than I would have ever thought. The very first day that those 500 welfare MediCal patients were place into our panel, we were deluged with unbelievable demands on our office.

Dr. Michelle: What do you mean? Didn’t you just have a different type of office patient?

Dr. Milton: If that were all there was to it, we would have been happy to service this population. But my wife, who runs my single employee office, normally came to work and had two or three phone messages and then she proceeded to the day’s work. The very first day, this increased to 60 messages. We hadn’t fully realized that these 500 patients don’t work, they all have cell phones, they called the office at all hours of day or night, and some even showed up expecting to be seen immediately. One even threatened to sue if we didn’t see him immediately. It took my wife three hour to get through all these phone messages and then another two hours to process these requests. And mind you, these patients had not yet been seen or evaluated but that didn’t stop them from requesting prescriptions, lab work, x-rays, referrals before their first appointment.

Dr. Rosen: And if you tried to explain to these folks that it would be a violation of the Medical Practice Act to do any one of those things without an exam, they would probably not understand this jeopardy of your license to practice Medicine or Surgery. And then add that would also eliminate your sole source of income would fall on deaf ears. They know that all doctors are rich and don’t need an income.

Dr. Edwards: This reminds me of one patient that complained a lot about doctors making too much money. The rich just don’t want to pay taxes to help the poor folks. I asked him that perhaps the rich should pay 100%? He replied, “Certainly, they can well afford it.” I then suggested that perhaps the rich should pay 200% in taxes. He again replied, “Certainly, they can well afford it.”

Dr. Rosen: That’s an excellent illustration of entitlements vs charity. Many of my TSR friends think that welfare is charity. But force charity or entitlement is not charity at all. With entitlement, people always want more. There never is enough. It brings out the worst in human beings. With charity from the heart, there is always thankfulness; it brings out the best in us.

Dr. Milton: That probably characterizes the difference in these patients very well. The paying patient is always appreciative. All at once we have a whole slew of patients who are not only extremely demanding, but also very litigious. They report every little variance they are not use to, to their HMO and this brings a large amount of paper work to clear our name. Last week a patient asked me for some suggestions on reducing her weight. I pointed out to her that to maintain her weight, pointing with my hand, she had to be eating 2,000 calories per day. By reducing that by one-fourth or 500 calories would equal 3500 calories or one pound per week. She reported me to her HMO as saying that I insulted her by saying she was fat. I not only got letters from the HMO, but also the state agency overseeing HMO to explain my non-professional behavior and a copy of the medical chart. The HIPAA regulations essentially allow all government and insurance agencies access to a patient’s chart without the patient’s knowledge.

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The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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  1. Voices of Medicine: Dr. Sam Vaknin, Israelis Psychiatrist, says Obama has a Mental Disorder

By Michael A. Haberman, MD, An Israeli M.D.

The Voice of a physician in another part of the world

A Reflection Of What Is Happening To The USA—In The Eyes Of Others!

Israeli doctor says Obama has a mental disorder—
Labels him a pathological narcissist.
No greater insanity than electing one says Dr. Sam Vaknin an Israeli psychologist.
Another view on our president.

Dr. Vaknin states "I must confess I was impressed by Obama from the first time I saw him. At first I was excited to see a black candidate. He looked youthful, spoke well, appeared to be confident, a wholesome presidential package. I was put off soon, not just because of his shallowness but also because there was an air of haughtiness in his demeanor that was unsettling. His posture and his body language were louder than his empty words. Obama's speeches are unlike any political speech we have heard in American history. Never a politician in this land had such quasi "religious" impact on so many people.

The fact that Obama is a total incognito with Zero accomplishment, makes this inexplicable infatuation alarming.  Obama is not an ordinary man. He is not a genius. In fact he is quite ignorant on most important subjects." Read more . . .

Dr. Sam Vaknin, the author of the Malignant Self Love believes "Barack Obama appears to be a narcissist." Vaknin is a world authority on narcissism. He understands narcissism and describes the inner mind of a narcissist like no other person. When he talks about narcissism everyone listens. Vaknin says that Obama's language, posture and demeanor, and the testimonies of his closest, dearest friends suggest that the man is either a narcissist or he may have narcissistic personality disorder (NPD).

Narcissists project a grandiose but false image of themselves. Jim Jones, the charismatic leader of People's  Temple, the man who led over 900 of his followers to cheerfully commit mass suicide and even murder their own children was also a narcissist. David Koresh, Charles Manson, Joseph Koni, Shoko Asahara, Stalin, Saddam, Mao, Kim Jong Ill and Adolph Hitler are a few examples of narcissists of our time. All these men had a tremendous influence over their fanciers. They created a personality cult around themselves and with their blazing speeches elevated their admirers, filled their hearts with enthusiasm and instilled in their minds a new zest for life.  They gave them hope! They promised them the moon, but alas, invariably they brought them to their doom.

When you are a victim of a cult of personality, you don't know it until it is too late. One determining factor in the development of NPD is childhood abuse "Obama's early life was decidedly chaotic and replete with traumatic and mentally bruising dislocations, "says Vaknin. "Mixed-race marriages were even less common then. His parents went through a divorce when he was an infant two years old. Obama saw his father only once again, before he died in a car accident. Then his mother re-married and Obama had to relocate to Indonesia , a foreign land with a radically foreign culture, to be raised by a step-father. At the age of ten, he was whisked off to live with his maternal (white) grandparents.  He saw his mother only intermittently in the following few years and then she vanished from his life in 1979. "She died of cancer in 1995."

One must never underestimate the manipulative genius of pathological narcissists. They project such an imposing personality that it overwhelms those around them.   Charmed by the charisma of the narcissist, people become like clay in his hands. They cheerfully do his bidding and delight to be at his service. 

The narcissist shapes the world around himself and reduces others in his own inverted image. He creates a cult of personality. His admirers become his co-dependents. Narcissists have no interest in things that do not help them to reach their personal objective. They are  focused on one thing alone and that is power. All other issues are meaningless to them and they do not want to waste their precious time on trivialities. Anything that does not help them is beneath them and does not deserve their attention.

If an issue raised in the Senate does not help Obama in one way or another, he has no interest in it. The "present" vote is a safe vote. No one can criticize him if things go wrong. Those issues are unworthy by their very nature because they are not about him.

Obama's election as the first black president of the Harvard Law Review led to a contract and advance to write a book about race relations. The University of Chicago Law School provided him a lot longer than expected and at the end it evolved into, guess what? His own autobiography! Instead of writing a scholarly paper focusing on race relations, for which he had been paid, Obama could not resist writing about his most sublime self. He entitled the book Dreams from My Father.

Not surprisingly, Adolph Hitler also wrote his own autobiography when he was still a nobody. So did Stalin. For a narcissist no subject is as important as his own self. Why would he waste his precious time and genius writing about insignificant things when he can write about such an august being as himself?

Narcissists are often callous and even ruthless. As the norm, they lack conscience. This is evident from Obama's lack of interest in his own brother who lives on only one dollar per month. A man who lives in luxury, who takes a private jet to vacation in Hawaii, and who raised nearly half a billion dollars for his campaign (something unprecedented in history) has no interest in the plight of his own brother. Why?  Because, his brother cannot be used for his ascent to power. A narcissist cares for no one but himself.

This election was like no other in the history of America. The issues were insignificant compared to what is at stake. What can be more dangerous than having a man bereft of conscience, a serial liar, and one who cannot distinguish his fantasies from reality as the leader of the free world?

I hate to sound alarmist, but one is a fool if one is not alarmed. Many politicians are narcissists. They pose no threat to others. They are simply self-serving and selfish. Obama evidences symptoms of pathological narcissism, which is different from the run-of-the-mill narcissism of a Richard Nixon or a Bill Clinton for example. To him reality and fantasy are intertwined.

This is a mental health issue, not just a character flaw.  Pathological narcissists are dangerous because they look normal and even intelligent. It is this disguise that makes them treacherous. Today the Democrats have placed all their hopes in Obama. But this man could put an end to their party. The great majority of blacks voted for Obama. Only a fool does not know that their support for him is racially driven. This is racism, pure and simple.

The downside of this is that if Obama turns out to be the disaster I predict, he will cause widespread resentment among the whites. The blacks are unlikely to give up their support of their man. Cultic mentality is pernicious and unrelenting. They will dig their heads deeper in the sand and blame Obama's detractors of racism. This will cause a backlash among the whites. The white supremacists will take advantage of the discontent and they will receive widespread support. I predict that in less than four years, racial tensions will increase to levels never seen since the turbulent 1960's.

Obama will set the clock back decades.  America is the bastion of freedom. The peace of the world depends on the strength of America, and its weakness translates into the triumph of terrorism and victory of rogue nations. It is no wonder that Ahmadinejad, Hugo Chavez, the Castroists, the Hezbollah, the Hamas, the lawyers of the Guantanamo terrorists, and virtually all sworn enemies of America are so thrilled by the prospect of their man in the White House.

America is on the verge of destruction. There is no insanity greater than electing a pathological narcissist as president.

Michael A. Haberman, MD, An Israeli M.D.

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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about

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  1. Book and Theater Review: The American Conservatory Theatre: Dead Metaphor

A.C.T. Presents the World Premiere of George F. Walker's Hilarious Political Comedy
Dead Metaphor

February 28 to March 24, 2013

Directed by Irene Lewis, this dark comedy--from one of Canada's most acclaimed playwrights--satirizes the hypocrisies and politics of postwar living

A soldier returns from the Middle East to find work in this audacious and hilarious dark comedy

SAN FRANCISCO (January 15, 2013)—American Conservatory Theater (A.C.T.) welcomes the . . . world premiere of Dead Metaphor —George F. Walker’s dark comedy that satirizes the hypocrisies and politics of postwar living. When Dean returns home from the war in the Middle East and hits the job market, he discovers that his superior military skills don’t get him very far in the business world. His readjustment to non-bunker life begins by moving in with his aging parents and pregnant ex-(and soon-to-be current) wife. When he is offered a job as poster boy for a crusading politician on her own mission for “truth and justice,” his military ethics collide with the unscrupulous world of national political campaigns—and he discovers that his unique skill set may be his best asset after all. Read more . . .

Says A.C.T. Artistic Director Carey Perloff: “I read Dead Metaphor all in one sitting—the first scene made me laugh out loud, the second scene was a shocker, and by the third scene I was totally hooked. In the spirit of Bruce Norris’s Clybourne Park, George Walker has an incredible knack for mining dark humor out of impossible circumstances, deploying a kind of vivid satire to make us listen to our own clichés and become aware of our own hypocrisy. And I can think of no one better than Irene Lewis, who staged a brilliant production of David Mamet’s Race for us last season, to bring to life this world premiere by a major Canadian writer. A.C.T. audiences are in for an outrageous ride and a vivid glimpse at the underbelly of modern life and contemporary politics.”

Dan Rubin writes in the program about his conversation with the Playwright, George F. Walker:

In 1971, George F. Walker was a 23-year-old taxi driver from Toronto’s working-class East End. While carting fares around the city, he saw a Factory Theatre Lab poster calling for play submissions by Canadian Playwrights—part of founding artistic director Ken Gass’s visionary “Canadian Only” policy, one of the sparks of Toronto’s theater movement in the 1970s

Walker had been scribbling poems and short stories since high school. Friends from the neighborhood had always said he would become a writer Local writing groups were closed to a working-class kid, however. They were reserved for University of Toronto graduates. And Walker had no idea how approach publishers. Theater in Toronto, on the other hand, “was just getting started,” he remembers, “and they’d take anyone.”

So Walker wrote his first play, The Prince of Naples, and submitted it. A week later, he learned that it would receive a production. On the first day of rehearsal, Walker saw director Paul Bettis’ copy of the script. On it, dramaturg John Palme had written a note: “This guy is a genuine subversive. We’ve got to produce him.”

Where the title of Dead Metaphor came from, Walker explains. There used to be a time when we didn’t send soldiers off to fight wars and then forget entirely about them, like they weren’t even part of our society. Less than one percent of both our populations has anything to do with them. So something that used to mean something—soldiers fighting for their country—is now irrelevant. It is a dead thing. We don’t even know where they are. Off they go and then they come back into our world, many of them in trouble, messed up and with nowhere to go. They come back and they only get noticed when they’re in trouble. And we’re in trouble too.

A.C.T.’s 2012–13 season also features the world premiere music theater event Stuck Elevator (April 4–28), the Bay Area premiere of The National Theatre of Scotland’s internationally acclaimed production of Black Watch (May 9–June 9), and a new production of Tom Stoppard’s ravishing masterwork Arcadia (May 16–June 9).

This play review is found at

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  1. Hippocrates & His Kin: Now we know why the Editor of Medical Tuesday was targeted.

Several years ago the editor of MedicalTuesday received a notice of a tax audit alleging an under payment of an amount that equaled 90% of his income that year. After six months of researching files with my CPA, essentially all of the charges were reversed. How could the IRS come up with any reasonable idea that 90% of my deductions, which were essentially the same over many years, should be disallowed?

This was obviously a targeted audit.

CEO of Starbucks, tells Christians, to sell their Starbucks stock.

Steven Schultz, CEO of Starbucks, told Christians, if they don’t like his stance on Gay marriage, to Sell their Starbuck Stock and take their business elsewhere. He said the current 10% drop in his stock price was just a normal variant. Many of us that normally visited Starbuck have followed his advice and have switched to Peet’s Coffey.

A recent walk by the normally very busy Starbucks across from my office found three workers not working. No one was in line for coffee either. You suppose the coffee crowd is taking his advice?

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

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  1. Restoring Accountability in Medical Practice, HealthCare, Government and Society:

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

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

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  1. Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

Words of Wisdom


Definitions: adult female humans; the distaff side; formerly the weaker sex; the ladies; the first improvement on man; the female of the species; “the last thing civilized by man” (George Meredith); the eternal feminine.

. . . can’t live with them, or without them. Aristophanes, Lysistrata, 411 B. C.

A sufficient measure of civilization is the influence of good women. Ralph Wald Emerson, Society and Solitude: Civilization, 1870.

Man has his will—but woman has her way. Oliver Wendell Holmes, The Autocrat at the Breakfast-Table, 1958.

Women’s work is never done—by a man. (Anonymous aphorisms)

A man just works from sun to sun, but women’s work is never done. (Anonymous aphorisms)

Some Recent Postings

In The January Issue:

  1. Featured Article: Women in foxholes

  2. In the News: How can a wife be either a man or a woman in a civil society?

  3. International Medicine: The Metrics of Health System Performance

  4. Medicare: A Digital Shift on Health Data Swells Profits in an Industry

  5. Medical Gluttony: Electronic Prescribing, Automated Refills, and Obamacare.

  6. Medical Myths: Gastric Bypass Obesity Surgery is Cost-Effective Weight Loss

  7. Overheard in the Medical Staff Lounge: Same Song, Same Verse

  8. Voices of Medicine: Medical Weight Loss by Jennifer Hubert,DO

  9. The Bookshelf: The Children Of Men: What to Expect When No One's Expecting

  10. Hippocrates & His Kin: “The new "29ers."

  11. Restoring Accountability in Medicine, Government and Society

  12. Words of Wisdom, Recent Postings, In Memoriam, Today in History . . .

In Memoriam

Rita Levi-Montalcini, biologist, died on December 30th, aged 103

The ECONOMIST | Jan 5th 2013 | From the print edition

THE advantage of living to a very great age is that you tend to have the last word. Rita Levi-Montalcini saw her scientific discoveries sniffed at throughout the 1950s and 1960s, only to win the Nobel prize for physiology in 1986. She conducted her early experiments in hiding, but rose to the pinnacle of Italian public life. Along the way, she proved that you can exude bella figura from every pore and still win the world’s highest intellectual honour. Both were a matter of precision, of flair, and of insisting—sometimes loudly, sometimes in silence—on what she wanted.

The battles raged right from the beginning, at the heart of her wealthy Jewish family in Turin. Her father, a mathematician, electrical engineer and all-round “Victorian”, believed that women should not study. Quite against his wishes, she enrolled in medical school. On her graduation in 1936 she became an assistant to Giuseppe Levi, a histologist who taught her the technique of silver-staining nerve cells so that they could be seen more clearly under a microscope. The fascists, however, had other plans for her, and in 1938 barred her from academia. Undaunted—laughingly defiant, in fact, that il Duce should think her “inferior”—she set up a primitive lab in her bedroom to carry out work on chicken embryos. Levi, barred too, now came to work for her in secret, their roles reversed. . .

The dark side of the brain Read more . . .

With a mother and twin sister who were both painters, she, too, often thought like an artist. She made intuitive, imaginative leaps which she then tested by experiment, rather than edging towards the truth in pigeon steps. Many of her papers she illustrated herself (delighting to draw the haloes of nerve fibres growing out in orderly confidence from the ganglia of chicks); she made her own clothes and designed her own jewellery. Tiny and bird-like, with a beautiful coif of white or rinsed hair in old age, she wore high heels with her lab coat, and wielded her minute spatulas with exquisitely manicured hands.

An ardent champion of scientific training for women (she set up a foundation for it), she never married or had children. It was a girlhood decision she never regretted; she simply refused to play second fiddle, as her mother had. Nor did she care to stop. Long after her “retirement”, la professoressa continued to work tirelessly on science and, after becoming a senator for life in 2001, in politics. She actively supported the centre-left governments of Romano Prodi and enjoyed hobbling those of Silvio Berlusconi, especially when they proposed laws unhelpful to research. Despite her own artistic bent, she lamented that human beings in the modern age were too much led by the “archaic”, emotional right hemisphere of their brains.

One of her great wishes was to bequeath to Italy a world-class institute for scientific research. She did so in 2002, when the European Brain Research Institute (EBRI) was launched in Rome. EBRI later suffered from lack of money, and she was accused of acting like an autocrat over it; but she was swiftly forgiven, in Italy at least. Her 100th birthday party was held in 2009 in Rome’s city hall, where—elegant as ever in a dark blue suit—the “Lady of the Cells” toasted herself in sparkling wine, took a crumb of the hazelnut and chocolate cake, and, with an arch of a perfect eyebrow, declared her brain in better shape than it had been when she was 20.

Read the entire Obituary in The Economist . . .

On This Month in History - February

On February 1, 1790, the U. S. Supreme Court convened for the first time in New York.

February 2, Ground Hog Day. Legend says that if the groundhog comes out today and happens to see his shadow, he crawls back into his burrow for six more weeks of winter.

February 3, 1943, Four Chaplains Day. This marks the heroic death of four men of the cloth—a Catholic Priest, a Jewish rabbi and two Protestant ministers—who gave their life jackets to others and went down together in the sinking of the troop transport Dorchester in the North Atlantic during WW II. If we can die together, perhaps we can learn how to live together.

February 6, 1911, Ronald Reagan’s Birthday. Ronald Reagan, our fortieth president, viewed with satisfaction the achievements of his innovative program known as the Reagan Revolution, which aimed to reinvigorate the American people and reduce their reliance upon Government. He felt he had fulfilled his campaign pledge of 1980 to restore "the great, confident roar of American progress and growth and optimism."

February 12, 1809, Abraham Lincoln’s Birthday. Abraham Lincoln, our sixteenth president, warned the South in his Inaugural Address: "In your hands, my dissatisfied fellow countrymen, and not in mine, is the momentous issue of civil war. The government will not assail you ... You have no oath registered in Heaven to destroy the government, while I shall have the most solemn one to preserve, protect and defend it."

February 22, 1732, George Washington’s Birthday. On April 30, 1789, George Washington, standing on the balcony of Federal Hall on Wall Street in New York, took his oath of office as the first President of the United States. "As the first of everything, in our situation will serve to establish a Precedent," he wrote James Madison, "it is devoutly wished on my part, that these precedents may be fixed on true principles."

After Leonard and Thelma Spinrad

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Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, any single payer initiative, Social Security was born for the benefit of the state and of a contemptuous disregard for people’s welfare.

We must also remember that ObamaCare has nothing to do with appropriate healthcare; it was similarly projected to gain loyalty by making American citizens dependent on the government and eliminating their choice and chance in improving their welfare or quality of healthcare. Socialists know that once people are enslaved, freedom seems too risky to pursue.