Community For Better Health Care

Vol VI, No 19, Jan 15, 2008


In This Issue:

1.                  Featured Article: A Little "Braine Humour" to Start Your Tuesday

2.                  In the News: Progress Against the Common Cold?

3.                  International Medicine: Lancet's Editor Speaks Out on UK's National Health Service

4.                  Medicare: What's the Real Reason for Forcing Government Health Care on Every One?

5.                  Medical Gluttony: A Different Form of Mandate - A Fixed Time for Procedure Screening  

6.                  Medical Myths: More Government Spending Reduces Health Care Costs

7.                  Overheard in the Medical Staff Lounge: Hospital Price Transparency

8.                  Voices of Medicine: Perspectives from a Navy Anesthesiologist in Combat

9.                  Physician Patient Bookshelf: FORCED EXIT - The Slippery Slope From Assisted Suicide to Legalized Murder

10.              Hippocrates & His Kin: The Uninsured Reached Its Peak of 100 Percent in 1930

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

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The Annual World Health Care Congress, 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 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. This year it was 50 percent, indicating open forums such as these are critically important. The 5th Annual World Health Congress has been scheduled for April 21-23, 2008, also in Washington, D.C. The World Health Care Congress - Asia will be held in Singapore on May 21-23, 2008.  The 4th Annual World Health Congress – Europe will meet in Berlin on March 10-12, 2008. For more information, visit 

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1.      Featured Article: A Little "Braine Humour" to Start Your Tuesday

Looking at the Sun Can Trigger a Sneeze For some people, bright lights mean big sneezes By Karen Schrock, Scientific American, January 10, 2008

Have you ever emerged from a matinee movie, squinted into the sudden burst of sunlight and sneezed uncontrollably? Up to a third of the population will answer this question with an emphatic "Yes!" (whereas nearly everyone else scratches their head in confusion). Sneezing as the result of being exposed to a bright light - known as the photic sneeze reflex - is a genetic quirk that is still unexplained by science, even though it has intrigued some of history's greatest minds. To read more, please go to

Aristotle mused about why one sneezes more after looking at the sun in The Book of Problems: "Why does the heat of the sun provoke sneezing?" He surmised that the heat of the sun on the nose was probably responsible.

Some 2 ,000 years later, in the early 17th century, English philosopher Francis Bacon neatly refuted that idea by stepping into the sun with his eyes closed - the heat was still there, but the sneeze was not (a compact demonstration of the fledgling scientific method). Bacon's best guess was that the sun's light made the eyes water, and then that moisture ("braine humour," literally) seeped into and irritated the nose.

Humours aside, Bacon's moisture hypothesis seemed quite reasonable until our modern understanding of physiology made it clear that the sneeze happens too quickly after light exposure to be the result of the comparatively sluggish tear ducts. So neurology steps in: Most experts now agree that crossed wires in the brain are probably responsible for the photic sneeze reflex.

A sneeze is usually triggered by an irritation in the nose, which is sensed by the trigeminal nerve, a cranial nerve responsible for facial sensation and motor control. This nerve is in close proximity to the optic nerve, which senses, for example, a sudden flood of light entering the retina. As the optic nerve fires to signal the brain to constrict the pupils, the theory goes, some of the electrical signal is sensed by the trigeminal nerve and mistaken by the brain as an irritant in the nose. Hence, a sneeze. . .

The genetic culprit remains unidentified, but scientists are starting to take an interest in trying to find out. "I think it's worth doing," says Louis Ptαcek, a neurologist at the University of California, San Francisco, and an investigator at the Howard Hughes Medical Institute. Ptαcek studies episodic disorders such as epilepsy and migraine headaches, and he believes that investigating the photic sneeze reflex could shed light on their related neurology.

Epileptic seizures are sometimes triggered by flashing lights and migraine headaches are often accompanied by photophobia. "If we could find a gene that causes photic sneezing, we could study that gene and we might learn something about the visual pathway and some of these other reflex phenomena," Ptαcek says. . .

Beyond that blip of gravitas, papers published about photic sneezing have largely leaned toward the whimsical end of the spectrum. Consider one 1978 publication that took advantage of the then-raging acronym fad and suggested an alternate name for the photic sneeze reflex: Autosomal-dominant Compelling Helio-Ophthalmic Outburst syndrome, or, of course, ACHOO.

Read the entire article at

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2.      In the News: Progress Against the Common Cold?

Speedy New Medical Test can Identify Twelve Viruses at the Same Time, By Aaron Rowe  WIRD, January 07, 2008

On Thursday, the FDA approved a test that doctors can use to quickly diagnose twelve different types of viral infection -- including those which cause the common cold, pneumonia, and several varieties of flu.

With only a cotton swab from their patient's nose or mouth, the new diagnostic panel will allow physicians to make better decisions about which medications will be effective. Some drugs, such as Tamiflu (oseltamivir), only work on certain types of viruses. To read more, please go to

This speeds up the usual process of detecting and identifying respiratory viruses, which can take up to a week," Daniel G. Schultz, director of FDA Center for Devices and Radiological Health. "And, because this multiplex viral panel tests for 12 viruses at once, it uses less of a patient's test specimen."

Based in Texas, Luminex Corporation has a long history of building instruments that can check for almost anything -- bacteria, viruses, antibodies, disease genes. The key to their technology: tiny beads.

The biotech company produces color-coded spheres that latch onto telltale biological molecules. Each microscopic orb can only attach to molecules from one particular type of organism. In this case, Luminex scientists made beads that can grab onto amplified genetic material from viruses. A special scanner can read which beads have DNA stuck down to them -- and thus identify the virus.

You can see a step-by-step explanation of how the new test works here: Link

From the Luminex Website:  With a non-invasive, painless swab, xTAG RVP tests for:

Influenza A, influenza A-H1, influenza A-H3 and influenza B,which cause the majority of flu cases in the U.S.;

Adenovirus, which is responsible for approximately 10 percent of respiratory infections and a subtype of which the Centers for Disease Control (CDC) have recently identified as causing multiple deaths

Respiratory syncytial virus (RSV) A and B, the most common cause of bronchiolitis and pneumonia in infants and children

Metapneumovirus, a recently-discovered virus that causes flu-like symptoms and is thought to be the second leading cause of respiratory infection in children

Parainfluenza 1, 2, and 3, which can cause upper or lower respiratory infections in adults and children and, are thought to be responsible for about half of croup cases and 10-15 percent of bronchiolitis and bronchitis cases; and Rhinovirus, which causes the common cold.

It is the first multiplexed nucleic acid test for respiratory viruses cleared for in vitro diagnostic use by the FDA. It also is the first test of any kind cleared to detect human metapneumovirus, the first test cleared for influenza A subtyping, and the first molecular test cleared for adenovirus.  

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3.      International Medicine: Lancet's Editor Speaks Out on UK's National Health Service

Gordon Brown's Ideas Outdated:  Commentary By Richard Horton, 11/01/2008

As the NHS reaches its 60th anniversary, Gordon Brown has promised, like Tony Blair before him, to make Britain's health service a litmus test of his leadership. On Monday he set out his long-awaited and much-trailed vision. It was a dismal collection of patronising [sic] homilies, ill-thought out policies, and feeble rhetoric.

We have heard the words so many times before. Change, choice, and empowerment. What have these ideas achieved? The only significant transformation in the NHS that truly deserves applause is the steep reduction in waiting times for patients referred to specialist care. But after a decade in government, the public is entitled to ask: is that it?  To read more, please go to

This is what we know. A third of hospital trusts now fail to provide value for money. In last year's Audit Commission review, 27 trusts failed every single test of good management. Half of maternity units are operating out-of-date practices. The care of premature babies is inadequate and unsafe. Health inequalities are widening. Outbreaks of perfectly avoidable hospital infection are killing patients. According to Brown's own health guru, Derek Wanless, Labour's spectacular health investments have been largely wasted. Reforms have been rushed, productivity has not improved, and IT delays have blocked real progress.

Last week, the Royal Marsden Hospital burned. It was rightly said that the Marsden is an international centre of excellence in cancer treatment. But in the UK as a whole, survival for most cancers is worse than in Germany, France, Italy, and Spain. We have the distinction of delivering some of the worst cancer survival figures in Europe.

Prevention is Labour's big new idea. Except that Brown's concept of prevention is desperately outdated. It is a hopelessly false dichotomy to divide prevention from cure. The two are often one and the same. His headline screening programme for abdominal aortic aneurysms will require 60 specialist units in England alone, staffed by hundreds of surgeons, technicians, and administrators. It will take 10 years, screening 7000 men and performing many major operations annually, to make any dent in deaths from triple A. Brown's promise that his screening strategy will save 200,000 lives every year simply doesn't add up.

Worse, his plan to give more power to GPs to control health budgets makes no sense. Modern health care is delivered by teams. The services available in any given region should be determined by public-health specialists, hospital consultants, nurses, and pharmacists, among others, as well as GPs. Brown's thinking about the organisation of health care is a generation out of date.

A large part of the problem is the Department of Health. In a little publicised report last year by the independent think tank, the Nuffield Trust, the department was diagnosed as ill-equipped to manage Britain's increasingly complex health needs. Its actions are confused, contradictory, and muddled. Most front-line NHS staff would agree with this view.

If Gordon Brown really wants a new vision for the NHS, he needs to dismantle a department that is, by common consent among experts, unfit for the purpose of protecting the health of our nation. But that is the one policy he will never announce.

• Dr Richard Horton is editor of The Lancet

The NHS does not give timely access to health care, it only gives access to a waiting list.

Eventually you will enjoy Europe's worst care.

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4.      Medicare: What's the Real Reason for Forcing Government Health Care on Every One?

The Truth about Mandatory Health Insurance, By BETSY MCCAUGHEY, WSJ, January 4, 2008

This week, Hillary Clinton's supporters attacked Barack Obama for not proposing a federal mandate that every American buy health insurance. Mr. Obama's health plan, they said, is a "Band-Aid" for the nation's gaping wound: 47 million people without health insurance. Mrs. Clinton would require all Americans to get coverage. Presidential candidates John Edwards and Christopher Dodd say they would, too. Not Mr. Obama.

Imposing a federal mandate is a hot issue on the campaign trail. It's also a burning issue in Congress, where Democratic Sen. Ron Wyden and Republican Sen. Bob Bennett are pushing the Healthy Americans Act, which would require everyone not in Medicaid or another government program to buy health insurance.

But is mandatory health insurance really a good idea? Requiring catastrophic coverage (our parents called it major medical) probably is smart. This would ensure that a person who is hurt in a car accident or diagnosed with a costly illness can pay his own medical bills, instead of being a burden on society.

But catastrophic coverage is not what the mandate advocates want. They would require that everyone have comprehensive health insurance, covering preventive and routine care. To read more, please go to

The rationale for this mandate is not personal responsibility but "shared responsibility," a polite way of saying shared costs. Requiring comprehensive coverage, the argument goes, will make it affordable for the sick, by pulling the young and the healthy -- neither of whom use these health services very much -- into the insurance pool. Advocates also argue that requiring this type of coverage will cure overcrowded emergency rooms and help tame skyrocketing health costs.

These arguments are based on myths, not facts.

The first myth is that it's fair to make everyone pay the same price for health insurance. It is not: For young people who rarely use health services, this is a rip-off. If people in their 20s paid attention to politics and voted, politicians wouldn't dare try this.

According to the latest Census data, 56% of the uninsured are adults aged 18-34. True enough, forcing them to be a part of a same-price-for-everyone insurance pool will likely bring down premiums. These young people generally need minimal health care ($1,500 a year, on average, according to a Commonwealth Fund study).

In most states, (but not New York and Vermont), young adults who buy health insurance are charged premiums that reflect their low medical needs. A 25-year-old man can buy a $1,000 deductible policy for a quarter to a third of what a 55-year-old man has to pay. (In Manchester, N.H., a 25-year-old man pays $156 per month, while a 55-year-old pays $542 for the same policy, according to

Both the Clinton proposal and the bipartisan congressional proposal prohibit insurers from giving such price breaks to the young. Their mandates would force the young to subsidize the health tab for the middle-aged generation. This subsidy would come on top of the payroll tax younger people already pay to support today's Medicare recipients. This is contrary to a fundamental American principle. This nation has always believed in making life better for its children, not exploiting them. . .

The second myth behind federal mandate proposals is this: Lack of insurance forces people into the emergency room for routine health care. "It's a hidden tax, the high cost of emergency room visits that could have been prevented by a much less expensive doctor's appointment," Mrs. Clinton said recently. The truth is that the uninsured do not use emergency rooms more than other people.

Federal data (the Medical Expenditure Panel Survey provided by the Agency for Healthcare Research and Quality) show that the elderly are most inclined to go to the emergency room, though they are universally covered by Medicare. . .

The third myth, in the words of Mr. Edwards, is that a "system that leaves 47 million Americans without health care is a moral disgrace." The remedy he has in mind is a mandate.

The rise in the number of uninsured people (up from 42 million in 2002) is not due to a sudden moral failure of the country or a broken health system. Instead, a major cause is immigration and cultural differences that make recent arrivals especially likely to be uninsured. . .

These facts should point the presidential candidates and Congress toward a sounder policy on health insurance.

According to the Census Bureau, of the 47 million uninsured, nearly 10 million have household incomes of at least $75,000. They probably can afford coverage but have chosen not to buy it. Another 14 million of the uninsured are already eligible for government programs such as Medicaid (for low income adults) and the State Children's Health Insurance Program (for children) and simply need to sign up.

That leaves about 23.7 million people -- some citizens, others newcomers -- who cannot afford coverage. It's up to the nation to decide what to do about that. One thing is clear: Mandating that everyone, including young adults, buy insurance, and then hiding a hefty, cost sharing tax inside their premium, is an unfair solution.

Ms. McCaughey, a former lieutenant governor of New York, is an adjunct senior fellow at the Hudson Institute.

To read the entire article, go to

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

- Ronald Reagan

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5.      Medical Gluttony: A Different Form of Mandate - A Fixed Time for Procedure Screening

Recently I ordered a CT imaging study on a patient. The front office of the Radiological Service said there needed to be a creatinine and a BUN performed. My office manager checked the chart and there was a creatinine of 0.9 done 60 days ago. The x-ray facility said it needed to be less than 30 days.

A patient who had his annual exam with a full evaluation including major organ screening would not need to have a repeat test in two months. What was the dilemma?

I could have easily ordered the duplicate test to please the radiological mandate and probably added close to a hundred dollars of unnecessary health care costs. That would be simple but highly unethical. So, since my office manager could not persuade the radiological service front office to accept the 60 day test, I decided in the national interest of conserving health care costs and improving patient care and not unnecessarily inconveniencing my patient, I would call the radiological facility. It took about three minutes to wade through the front desk, the second in command, the facility supervisor, and then the radiologist's personal assistant. When the assistant returned to the phone, he said the radiologist was in the midst of a procedure and would call me back. About five minutes later, he returned the call and I interrupted an evaluation of the patient I was seeing to answer the call. We were disconnected. What is the dilemma now? Should I go through the above routine again or should I let him call me back and re-interrupt my care of the patient I was seeing. To read more, please go to

I decided to call back, and keep my patient waiting longer now rather than another re-interruption and another wait. The Chief radiologist came on the line and was very pleasant. I explained the situation and asked him if he felt it was a necessary health care expenditure to repeat the kidney tests in a stable patient when the function was so good? When he heard the patient was stable, he agreed with me, took the patient's name and said he would have them proceed with the radiological CT with contrast.

He was kind enough to briefly discuss that this was a "best practice mandate" that was handed down from their national organization. The local group had simply rubber stamped the recommendation. He agreed that it was an excessive health care cost, that not repeating the test would not jeopardize the patient during the procedure, and that repeating it would not produce any improvement in health outcomes.

The office cost for this entire episode was probably equal to the $100 that the test would have cost. However, such mandates are very common. It is not only the hundreds of million folks getting x-ray procedures but also any type of procedure.

This reminded me of a patient who had a complete annual evaluation and had an electrocardiogram in anticipation of cataract surgery. The operation had been delayed and it was now seven months after her ECG. The surgical center required an ECG not over six months old. So an unnecessary ECG had to be redone. Cataract surgery is one of the lowest risks for cardiac complications. The cost? Medicare pays physicians about $20 for an ECG. For the past 20 years, the usual charge is about $80. It never changed because the reimbursement kept going down. The hospitals charge $180 for it. No one seems to have any idea of what hospitals actually receive since most hospital charges and receipts remain secretive. But cataract surgery is a very common procedure and tens of millions of seniors require one. The list goes on and on and on. By the time you add up the hundreds of millions of mandated procedures done yearly, it adds up to tens of billions. Before long, you're talking of real health care costs.

There are two significant lessons. As the best practices mandates are implemented, there will be a huge increase in health care costs under the illusion that this improves health care. Generally it doesn't.

Patients have gotten so used to these inconveniences and personal costs, that they perceive them as necessary for their protection as if someone out there is watching over them. Maybe the oppressive government is keeping them from harm. But they don't.

These mandates also further distort the smooth operation of medical care. Medicare and Medicaid will respond by reducing the pay for physicians to $15 for an ECG and then further reducing it to $10 and finally declaring that it is part of an office visit and no re-imbursement is required. Rectal exam with a stool occult blood test requires some costs of the reagent and slides but is no longer reimbursed. Urologists respond by no longer doing a stool occult blood test on prostate exams. Internists generally absorb the cost, which reduces their incomes. But it causes doctors to lose sight of quality health care by following what Medicare and Medicaid pay, not what is best practice. Remember, President Reagan found his cancer of the colon when his personal physician found a positive stool guaiac blood test on his prostate exam. He then had a colonoscopy to find where the blood was coming from which diagnosed his colon cancer. It was then resected and he was cured. Without the stool occult blood test the cancer could have metastasized before symptoms occurred.

Every mandate, rule, best practice guidelines, although well intentioned, whether they come from government, insurance carriers, or our own professional organizations, have their down side. These then have various poorly understood mostly undesirable consequences. They all distort the free exchange of medical information and patient-centered appropriate practice. It will continue to get worse until we get government and insurance carriers out of the practice of medicine. Does this country have the will and ability to do this? Do our own professional organizations have this desire or will? There are no more new worlds, such as ours or Australia, to flee to for opportunity. If we can't do it, no one can. Is it really that hopeless?

Remember, it only takes one person with determination to change the world. Will it be You or me?

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6.      Medical Myths: More Government Spending Reduces Health Care Costs

Health Alert: Advice to Candidates (From the Expert Who Explodes Medical Myths)
It's a law of human nature.  Whenever people start discussing health policy, their IQs fall by 15 points.
Exhibit A:  Critics who complain that the US health care system outspends every other country and gets nothing in return and then advocate. . . (can it be?). . . more spending!  
For Senator Obama, it's $60 billion more every year.  
For Senators Clinton and Edwards, it's $120 billion - more than $1,000 per year for every household in   
Exhibit B:  Critics who complain that the error rate in US hospitals is way above anything that is tolerable in any other industry and then advocate more rules and regulations that would . . . (surprise!) . . . make it more difficult for hospitals to operate like other businesses.
Exhibit C:  Critics who complain that poor people have inadequate access to health care and then advocate enrolling them in health plans where . . . (you guessed it) . . . they will have even less access than they have today. 
Under ordinary circumstances this would all be laughable, but in health care - hey, they might get away with it. To read more about a health plan to help solve the problem, please go to
Now imagine a health plan that goes a long way toward solving the problems of cost, quality and access by (a) not spending any more money, (b) repealing laws and regulations instead of enacting new ones and (c) dismantling bureaucracies rather than creating and expanding them.
Now compare your vision to mine by clicking
The basis for the NCPA vision, by the way, is the realization that the key to reform lies not in changing patients, doctors and hospitals, but in changing government - systematically removing all of the ways in which bad government policies distort incentives and make our problems worse.  See  " Applying the Do No Harm Principle to Health Policy Reform" in the Journal of Legal Medicine.    
John Goodman, PhD, President, National Center for Policy Analysis
12770 Coit Rd., Suite 800, Dallas, Texas 75251,
Subscribe to this digest:  

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7.      Overheard in the Medical Staff Lounge: Hospital Price Transparency

Dr. Rosen: I'm getting more complaints about hospital charges.

Dr. Ruth: I've always gotten them. I just brush them off and tell my patients that doctors have no control over hospital charges.

Dr. Edwards: When I say something like that, my patients just smile. They say that we're just being modest. Everyone knows that doctors control the hospitals. To read more, please go to

Dr. Dave: You know, I've experienced the same. Patients really blame us for all the health care costs.

Dr. Sam: I just tell them my vote to reduce them didn't count. They just outnumbered us.

Dr. Rosen: I've had a few that brought in their hospital statements. They are very illuminating. One had a two day stay for a pacemaker implant and a statement for $78,000 or $39,000 a day. One had a five day ICU bill for $43,000 or about $8500 a day.

Dr. Milton: The hospitals all seem to be expanding despite the fact that more and more is done as outpatient.

Dr. Rosen: Hospitals are trying to capture more and more of the out patient business. When their lobbyist get a law passed to allow them to practice medicine, they will begin to put the doctors on salary.

Dr. Yancy: Once doctors are on a hospital payroll, the doctors will become total slaves. Who's going to go against the administrator that signs his pay check?

Dr. Michelle: Do you really think it will be that bad?

Dr. Ruth: They may be subtle about it but eventually they will become our enemies.

Dr. Rosen: Not only will they control us. There will be no break in their spending habits. Hospital costs will go even higher.

Dr. Yancy: The patients will be the ultimate losers.

Dr. Rosen: But how can we convince them before it's too late?

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

Bulletin of the California Society of Anesthesiologists, Summer, 2007

Tales from the Battlefield: Perspectives from a Navy Anesthesiologist in Combat
By Patrick K. Boyle, M.D.


In March 2004, Naval medical personnel responded to the anticipated needs of the First Marine Division during Operation Iraqi Freedom and formed a small 26-person unit using personnel and supplies from two preexisting surgical companies. The Surgical Shock Trauma Platoon (SSTP) was based at Camp Taqaddum, Iraq, a former Army Command that offered a troop medical clinic with minimal trauma surgical support. Staffing initially included an anesthesiologist, a general surgeon, an orthopedic surgeon, and an emergency room physician to provide rapid resuscitative surgical care near the point of injury. The physical layout of the unit included a single tent stabilization area, a single tent operating room, and a rudimentary ward for postoperative care and minimal holding. This article details the experiences and challenges of a Navy anesthesiologist staffing this surgical unit during its first month of deployment concurrent with military operations in Fallujah in April 2004. To read more, please go to


While working at Naval Medical Center, San Diego in February 2004, I received two weeks notice that I was being deployed to Iraq with a surgical unit. During my mission in Iraq, I drew on previous Naval experiences with aviation and Marines to provide the best medical care possible to service members and civilians under my care. After arriving in Kuwait, our group flew to Al Taqaddum, a former Iraqi Air Force base. While waiting for supplies, we planned the physical layout of the unit and conducted trauma training lectures for nurses and hospital corpsmen. Along with the surgeons, I assisted the Army troop medical clinic with immediate surgical-related problems and reacquainted myself with peripheral nerve block techniques. I remembered Vietnam reports wherein regional anesthesia was used during peak patient-receiving periods.

As a result, I quickly found the utility of doing a wrist block when I assisted our surgeon with a hand debridement after a Marine inadvertently cut himself with a knife. After this experience, I started preparing for the possibility of using regional anesthesia on or near the battlefield and found this technique to be useful later in the deployment.

Blast and Combat Injuries

After treating the Marine with the hand injury, the surgical team had its first introduction to what would become a familiar scenario: blast injuries among troops. Fortunately, the body armor that coalition troops wore reduced significantly the numbers of abdominal and chest injuries. In stark contrast, many suspected insurgent cases involved the chest and abdomen, owing to the lack of body armor. In one instance, a young Army officer was brought to the clinic with severe damage to one foot and both legs after stepping on an improvised explosive device. The surgeon and I assisted the Army team in stabilizing and debriding the patient's wound prior to evacuation to the Army's Combat Support Hospital in Baghdad. Luckily, this patient survived his blast injury and this incident heightened my awareness of the effects of blast injuries on the population of patients in this setting, something unfamiliar to most anesthesiologists who don't practice in a trauma environment.

The unit consisted of tents placed on plywood platforms. We trained each day by working through a mock trauma case, concluding with a lecture if we were not engaged in clinical activities. On the first day our unit became operational, our training was out the window when a Humvee ambulance arrived unannounced and presented our first patient, a coalition Iraqi truck driver who sustained AK-47 wounds to his abdomen and hand. This first surgical case became a five-hour abdominal exploration and bowel repair performed in an operating room tent without air conditioning where temperatures exceeded 100 degrees. Shortly thereafter, we received a Marine who sustained a massive head wound from a bomb and arrived dead, followed by another young soldier with a penetrating neck wound requiring immediate exploration.  Afterwards, I thought it would be a long deployment if it stayed this busy every day. . .

To read the sections on Combat injuries, Challenges, treating Iraqi people and a summary of Dr. Boyle's experiences, go to  (670 words)

Patrick K. Boyle, M.D., is an active-duty Navy anesthesiologist practicing in San Diego, California. He is currently the Vice Chairman and Chief Medical Officer of the Department of Anesthesiology at Naval Medical Center, San Diego.

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9.      Book Review: From our archives: PhysicianPatientBookshelf.htm

FORCED EXIT - The Slippery Slope From Assisted Suicide to Legalized Murder, by Wesley J Smith

Wesley J Smith, author of No Contest: Corporate Lawyers and the Perversion of Justice in America, opens his prologue of Forced Exit with the story of a dear friend who spent years planning her suicide and after inviting friends to the event, none of whom came, exited this life quietly. Smith, an Oakland attorney, contacted the executrix and obtained her suicide file wherein he found newsletters and other scurrilous documents from the Hemlock Society that thoroughly sickened him.

This motivated Smith to research into death, the inventing of the right to die that is driving people to embrace the death culture, and euthanasia's betrayal of medicine. He finds that a society that believes in nothing can offer no argument even against death. Seen in this light, support for euthanasia is not a cause but rather a symptom of the broad breakdown of "community" and the ongoing unraveling of our mutual interconnectedness. The consequences of this moral Balkanization can be seen in the disintegration of family cohesiveness; in the growing nihilism among young people that has led to a rise in suicides, drug use, and other destructive behaviors; in the growing belief that the lives of sick, disabled, and dying people are so meaningless that helping them kill themselves can be countenanced and even encouraged. To read more, please go to

Smith calls acceptance of euthanasia "terminal nonjudgmentalism." He finds a good example in A Chosen Death by Lonny Shavelson, an emergency physician, who describes "Gene" who has had strokes and depression but is not terminal. Sarah, from the Hemlock Society, is given the task of assisting in his death. Sarah found her first killing experience tremendously satisfying and powerful, "the most intimate experience you can share with a person... More than sex. More than birth." Sarah gives Gene the poisonous brew as if she were handing him a beer. Gene drinks the liquid, falls asleep on Sarah's lap who then places a plastic bag over his head and croons, "See the light. Go to the light." But Gene, suddenly faced with the prospect of immediate death, changes his mind and screams out . . . and tries to rip the bag off his face. Sarah won't allow it, catches Gene's wrist and holds it. Gene's body thrust upwards and Sarah lays across Gene's shoulders. . . pinning him down, twisting the bag to seal it tight. Gene's body stops moving.

Smith says what happened to Gene is murder. He further feels that the ethical thing for Dr Shavelson to have done was to knock Sarah off the helpless man and then dial 911 for an ambulance and the police. Shavelson describes his thoughts on whether to act or observe the death, and Smith calls this non-decision "terminal nonjudgmentalism," or TNJ. He feels that what Shavelson and other death fundamentalists miss is that so-called protective guidelines for the "hopelessly ill" are meaningless; they provide only a veneer of respectability. Once killing is deemed an appropriate response to suffering, the threshold dividing "acceptable" from "unacceptable" killing will be continually under siege. But the fiction of control, essential to the public's acceptance of euthanasia, will have to be maintained, so the definition of what will be seen as "legitimate" killing will be expanded continually. . . .

To read the entire review, go to

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10.  Hippocrates & His Kin: The Uninsured Reached Its Peak of 100 Percent in 1930

One hundred million Americans lack disability coverage. Sixty-eight million lack life insurance. Only 45 million lack health insurance for a short while. Only about 10-15 million have no health insurance for a full year. That's only 5 percent of the population compared to 100 percent 80 years ago. Hasn't free enterprise nearly solved the problem?

Why don't we pass a simple law feeding all insurance companies more premiums?
Can the tallest building in most cities get any taller?

Can't we just pass a law forcing everyone to buy health insurance?

The three of the four democratic candidates want to force people to purchase health insurance. California has a similar law that is suppose to force every driver to purchase car insurance. Has it worked?

Why is it that almost everyone I know has been hit by a California driver without car insurance?

To read more, please go to

Where did the SCHIP Money go?

In Ohio enough went to CareSource, a highly profitable Medicaid HMO that is erecting a $55 million building in Dayton.

Now if we could get more people to buy insurance, we could build even larger palaces for the CEOs.

P4P May be illegal in 37 states.

Paying physicians to meet performance measures might be construed as kickbacks according to the AMA.

What has ever kept the government from doing something illegal?

Texas has decreed that 18 percent of physicians are incompetent.

The Texas legislature has expressed in a bill that 18 percent of physicians should be disciplined rather than the 10 percent currently disciplined. Texas physicians are worried that the Texas Medical Board will need to turn trivial and irrelevant complaints into "results" to comply.

Looks like we'll have even more doctor's offices being invaded by officers with guns.
Whatever happened to gun control?

To read more vignettes, please go to

To read Hippocrates Modern Colleagues, go to

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


•                      The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at and register to receive one or more of these reports.

•                      Pacific Research Institute, ( Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may subscribe at or access their health page at

•                      The Mercatus Center at George Mason University ( is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government.

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

•                      To read the rest of this column, please go to

•                      The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at A new study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels.

•                      Greg Scandlen, an expert in Health Savings Accounts (HSAs) has embarked on a new mission: Consumers for Health Care Choices (CHCC). To read the initial series of his newsletter, Consumers Power Reports, go to To join, go to  Be sure to read Prescription for change:  Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn at

•                      The Heartland Institute,, publishes the Health Care News. Read the late Conrad F Meier on What is Free-Market Health Care?. You may sign up for their health care email newsletter at

•                      The Foundation for Economic Education,, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling, PhD, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago.

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

•                      The Independence Institute,, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter at 

•                      Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis.

•                      The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 28, the date they stopped paying taxes and started working for themselves. Log on at for an overview of the extensive research articles that are available. You may want to go directly to their health research section at

•                      The Heritage Foundation,, founded in 1973, is a research and educational institute whose mission is to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site.

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

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

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

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

•                      The St. Croix Review, a bimonthly journal of ideas, recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, war time allows the federal government grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in war time we have to push for limited government - while giving the government the necessary tools to win the war. To read a variety of articles in this arena, please go to

•                      Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read Historian Paul Johnson on Heroes: What Great Statesmen Have to Teach Us. The last ten years of Imprimis are archived

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 Words of Wit & Wisdom

Government is an endless pursuit of new ways to tax.

They use to say that the only thing the government didn't tax was taxes. Then President Johnson invented the surtax.

Things are so bad now that the Internal Revenue Service even taxes your patience.

Some Recent or Relevant Postings

THE BEST OF MEDICAL HUMOR - A Collection of Articles, Essays, Poetry, and Letters Published in the Medical Literature

Universal Health Care: Can the Health Insurance Industry Survive?

In Memoriam

Benazir Bhutto, Pakistani politician, was killed on December 27th, aged 54

WHEN Zulfikar Ali Bhutto was deposed as Pakistan's prime minister in 1977, his 24-year-old daughter, Benazir, looked on the bright side. She expected General Zia ul-Haq, the coup leader, to hold elections in a few months. "Don't be an idiot, Pinkie," said her father, using the nickname inspired by her rosy complexion as an infant, "Armies do not take over power to relinquish it." To read more, please go to

Benazir idolised [sic] her father, who was executed by the military regime two years later. She inherited the leadership of his Pakistan People's Party - still the country's biggest - and some of his attributes: the curious, potent blend of idealism and cynicism, of willful blindness and breathtaking courage, of populist charisma and elitist arrogance. Yet she seems never fully to have absorbed that piece of paternal wisdom. She devoted the last years of her life to trying to topple - or share power with - another coup leader, Pervez Musharraf, Pakistan's president.

Benazir straddled three very different worlds. One was a feudal fief: her family's land in Sindh province. . .

Benazir also belonged to the world of the international elite. She was educated at a convent in Karachi, and then at Harvard and Oxford. . .

At Oxford, she impressed her father - also an alumnus - by becoming president of the Union, a debating society with a line in leaden sophomoric wit. In one debate, an opponent described her father as "a tradesman of some description. A butcher, I gather." Benazir looked as if she had been slapped in the face. Her father earned this sobriquet from the slaughter in East Pakistan as Bangladesh struggled to be born. She remembered watching television in disgust as a Pakistani general surrendered, with a hug, to an Indian. Benazir thought he should have shot himself instead.

That was her third world: Pakistani patriot, centre-left populist, democrat and ruthless politician. Like India's Indira Gandhi, Bangladesh's Sheikh Hasina Wajed, and Myanmar's Aung San Suu Kyi, she risked and suffered much to fulfill her father's legacy. She endured grim years in detention after her father's death. Both her brothers died unnaturally - the younger one in a mysterious poisoning in France, the elder in a murder in Pakistan for which her husband Asif was charged (and exonerated) but some family members still blame her. . .

After her assassination, a handwritten will was produced. Foreseeing her own untimely end, it bequeathed her party, like the dynastic heirloom it has become, to her husband, who said he would pass leadership to their 19-year-old son. For a woman who claimed to be driven by a burning desire to bring democracy to Pakistan, it was a curious legacy.

To read the entire obit, go to

On This Date in History - January 15

On this date in 1929, Martin Luther King, Jr., was born. His birthday is observed as Human Relations Day.

On this date in 1899, "The Man with the Hoe," whom poet Edwin Markham described in a great poem, was published.

"Bowed by the weight of centuries he leans
Upon his hoe and gazes on the ground,
The emptiness of ages in his face,
And on his back the burden of the world."

The burden is there. What are we doing about it?

After Leonard and Thelma Spinrad



Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the truth about socialized medicine. Clements is the former publisher of "American Venture" magazine who made news in 2005 for a property rights project against eminent domain called the "Lost Liberty Hotel."
For more information visit or email