Community For Better Health Care

Vol V, No 8, July 25, 2006


In This Issue:


1.      Featured Article: Of Pills and Profits: In Defense of Big Pharma by Peter W. Huber, Commentary Magazine, July 2006.    

The more our health depends on their little pills, the more we seem to hate big drug companies. In The Constant Gardener (2000), John le Carré assigns to the pharmaceutical industry the role played by the KGB in his earlier novels. A villainous pharmaceutical company is using Kenya as a testing ground for a lethally defective drug, and people who find out about it die, too. Four recent, non-fiction indictments of the industry tell a similar story. Conflating the four into one, one might title them collectively How Big Pharma Deceives, Endangers, and Rips Us Off, with the Complicity of Doctors.

Two of these books are by former editors of the prestigious New England Journal of Medicine. Slamming the drug companies, Marcia Angell argues that Big Pharma, as it has come to be called, "uses its wealth and power to co-opt every institution that might stand in its way, including the U.S. Congress, the Food and Drug Administration, academic medical centers, and the medical profession itself." Slamming the medical profession, academics, and professional organizations, Jerome P. Kassirer, Angell's former boss, labels them Big Pharma's "whores." . . .

The bill of particulars, drawn from the books cited above, goes something like this. Most of what people believe about Big Pharma is just "mythology spun by the industry's immense public-relations apparatus." Forget miracle drugs - Big Pharma is not a "research-based industry," it is "an idea-licensing, pharmaceutical-formulating-and-manufacturing, clinical-testing, patenting, and marketing industry." As for "the few innovative drugs that do come to market," these "nearly always stem from publicly supported research" or are developed by small biotech firms. Big Pharma simply goes "trolling small companies all over the world for drugs to license." At most tweaking the chemistry of drugs developed by others, it advances medicine by "waiting for Godot." 

Moreover, these me-too drugs "usually target very common lifelong conditions - like arthritis or depression or high blood pressure or elevated cholesterol." Many just aren't needed, because older drugs already work as well or better, or because the new drugs are peddled to people who aren't sick. Big Pharma is thus "primarily a marketing machine to sell drugs of dubious benefit." . . .

So runs the indictment. Now for a story. In an April 2005 obituary, the New York Times described Maurice Hilleman as the man who "probably saved more lives than any other scientist in the 20th century." What kind of genius does it take to get that on your tombstone? Hilleman himself, it seems, "credited much of his success to his boyhood work with chickens." He went on to use fertilized chicken eggs to grow large quantities of bacteria and viruses that were then weakened or killed to produce vaccines. The technique was known before Hilleman arrived, but isolating and then safely breeding a pathogen requires the touch of a very delicate artist. "Maurice was that artist," another scientist later recalled; "no one had the green thumb of mass production that he had." 

By farming eggs, Maurice Hilleman saved tens of millions of lives, and prevented deafness, blindness, and other permanent disabilities among many millions more. No Albert Schweitzer or Florence Nightingale could ever post numbers like his. Doctors and nurses save lives one on one, and are paid by the hour. Hilleman saved lives by the carton, at grocery-store prices - acres of cartons, hundreds of millions of warm eggs replicating his genius around the clock. . . .

Manufacturing adds another tier of expense and risk. Development of the vaccines that eradicated polio from most of the Western world was funded mainly by the March of Dimes. That charitable foundation also oversaw the first field trials establishing the safety and efficacy of Jonas Salk's vaccine. It then handed the project to the government, which licensed five private companies to produce the vaccine. Although the government prescribed exactly how it was to be manufactured, the instructions were not quite the same as those the foundation had promulgated prior to the first trial. The Cutter Company, the smallest of the five licensees, followed the government's instructions to the letter, but failed to kill all the virus in the vaccine. Seventy thousand people suffered mild forms of polio. Two hundred were paralyzed. Ten died.

The Cutter tragedy helped spark changes in liability law that made it much easier to sue drug companies for their failures, even in the absence of negligence. Today, some liability claims are all but certain to be forthcoming when millions of users pop the same pill, and every drug carries with it an inescapable risk of bet-the-company litigation. Estimates of Merck's Vioxx exposure currently range from $5 to $50 billion. Along with other vaccine manufacturers, Merck is also defending claims that thimerosal, a mercury-based vaccine additive, causes autism. It almost certainly does not, but juries cannot always be trusted to get things right.

One influential writer has explained the process well. Tort lawyers, who know how to "prey on people's fears," "postulate increasingly obscure syndromes" that "can't be studied systematically." Juries "usually have no competence in the area," often "misinterpret science," and base their judgments on "emotional appeals." Moreover, "losing just one lawsuit can stimulate an avalanche of others, and each loss usually means the stakes grow higher in the next case." For a company that "loses just one of every ten or twenty cases, the costs can be enormous." Litigation can thus "destroy thriving companies," shut down "an important area of medical research," and even "threaten an entire industry."

It is a pity that Marcia Angell never mentions any of these consideration in her book touting "the truth about drug companies." The omission is all the more regrettable since she wrote the above words herself in Science on Trial, her 1996 book about breast-implant litigation, and they are as relevant today as they were ten years ago. . . .

Prescription drugs currently account for well under 20 percent of the health-care budget. Within a generation or two, they will undoubtedly account for most of it - which will be another good thing. Pharma's biochemical cures always end up far cheaper than the people-centered services they ultimately displace. Moreover, while much hands-on care only drags things out or soothes, the best medicines really cure. It is true that, early on in the pharmacological assault on a grave disease, drugs also stretch things out and can fail to beat the disease, so we often end up buying more drug and more doctor, too. But eventually drugs improve to the point where they beat the disease and thus lay off both doctor and hospital.

None of this can be very welcome to people who believe that the most important thing about health care is that it be uniform and universal. If you like the way Canada operates its health-care system, you will never like the way Big Pharma does drugs. And yet, step by inexorable step, advocates of Canadian health care are losing everywhere, and Big Pharma is taking over the business. . . .

Over the last decade, extraordinary advances in bioengineering have transformed pharmacology. Sooner or later, the industry and its pilot fish will surely find drugs that can halt colon, breast, and lung cancers, that can curb obesity and thus heart disease, and that will not merely suppress the HIV virus but purge it from the body completely.  A new pharmacology of the brain may cure depression and stop the onset of Alzheimer's. These and other once inscrutable scourges are now - essentially - becoming problems in diligent engineering.

They are very difficult and expensive problems, as engineering problems go. And government funding did indeed pay for much of the underlying science, and continues to pay for it, just as the industry's critics charge. Some 600 publicly traded pharmaceutical and biotechnology companies worldwide, however, are now capitalized at over $1.5 trillion. The industry's critics would subordinate current management to public-utility regulation. We will fare better, much better, if we streamline regulation, curb litigation, and unleash prices to make vaccines as alluring to Big Pharma as Viagra and Vaniqa.

To read the entire article, including the four book references, (subscription may be required) go to

 PETER W. HUBER is a senior fellow of the Manhattan Institute. His contributions to Commentary include "Telecom Undone - A Cautionary Tale" (January 2003), "Guns, Tobacco, Big Macs - and the Courts" (June 1999), and, with Mark P. Mills, "Getting Over Oil" (September 2005).

* * * * *

2.      In the News: The Climate Debate Continues

There Is No 'Consensus' On Global Warming By RICHARD S. LINDZEN, WSJ, June 26, 2006

According to Al Gore's new film "An Inconvenient Truth," we're in for "a planetary emergency": melting ice sheets, huge increases in sea levels, more and stronger hurricanes and invasions of tropical disease, among other cataclysms -- unless we change the way we live now.

Bill Clinton has become the latest evangelist for Mr. Gore's gospel, proclaiming that current weather events show that he and Mr. Gore were right about global warming, and we are all suffering the consequences of President Bush's obtuseness on the matter. And why not? Mr. Gore assures us that "the debate in the scientific community is over."

That statement, which Mr. Gore made in an interview with George Stephanopoulos on ABC, ought to have been followed by an asterisk. What exactly is this debate that Mr. Gore is referring to? Is there really a scientific community that is debating all these issues and then somehow agreeing in unison? Far from such a thing being over, it has never been clear to me what this "debate" actually is in the first place.

The media rarely help, of course. When Newsweek featured global warming in a 1988 issue, it was claimed that all scientists agreed. Periodically thereafter it was revealed that although there had been lingering doubts beforehand, now all scientists did indeed agree. Even Mr. Gore qualified his statement on ABC only a few minutes after he made it, clarifying things in an important way. When Mr. Stephanopoulos confronted Mr. Gore with the fact that the best estimates of rising sea levels are far less dire than he suggests in his movie, Mr. Gore defended his claims by noting that scientists "don't have any models that give them a high level of confidence" one way or the other and went on to claim -- in his defense -- that scientists "don't know… They just don't know."

So, presumably, those scientists do not belong to the "consensus." Yet their research is forced, whether the evidence supports it or not, into Mr. Gore's preferred global-warming template -- namely, shrill alarmism. To believe it requires that one ignore the truly inconvenient facts. To take the issue of rising sea levels, these include: that the Arctic was as warm or warmer in 1940; that icebergs have been known since time immemorial; that the evidence so far suggests that the Greenland ice sheet is actually growing on average. A likely result of all this is increased pressure pushing ice off the coastal perimeter of that country, which is depicted so ominously in Mr. Gore's movie. In the absence of factual context, these images are perhaps dire or alarming.

They are less so otherwise. Alpine glaciers have been retreating since the early 19th century, and were advancing for several centuries before that. Since about 1970, many of the glaciers have stopped retreating and some are now advancing again. And, frankly, we don't know why. . . .

* * *

More recently, a study in the journal Science by the social scientist Nancy Oreskes claimed that a search of the ISI Web of Knowledge Database for the years 1993 to 2003 under the key words "global climate change" produced 928 articles, all of whose abstracts supported what she referred to as the consensus view. A British social scientist, Benny Peiser, checked her procedure and found that only 913 of the 928 articles had abstracts at all, and that only 13 of the remaining 913 explicitly endorsed the so-called consensus view. Several actually opposed it. . . .

* * *

So what, then, is one to make of this alleged debate? I would suggest at least three points.

First, nonscientists generally do not want to bother with understanding the science. Claims of consensus relieve policy types, environmental advocates and politicians of any need to do so. Such claims also serve to intimidate the public and even scientists -- especially those outside the area of climate dynamics. Secondly, given that the question of human attribution largely cannot be resolved, its use in promoting visions of disaster constitutes nothing so much as a bait-and-switch scam. That is an inauspicious beginning to what Mr. Gore claims is not a political issue but a "moral" crusade.

Lastly, there is a clear attempt to establish truth not by scientific methods but by perpetual repetition. An earlier attempt at this was accompanied by tragedy. Perhaps Marx was right. This time around we may have farce -- if we're lucky.

Mr. Lindzen is the Alfred P. Sloan Professor of Atmospheric Science at MIT.

To read the entire essay (subscription required) please go to To read responses, please continue below.

Earth's Climate Is Always Warming or Cooling, June 20, 2006

Roger C. Altman ("The Beltway's Energy1," editorial page, June 16), a Treasury official in the Clinton administration, says he is no climatologist, but then calls for energy policies that assume catastrophic global warming from carbon dioxide emitted in fossil-fuel burning. He doesn't reveal his sources of information - perhaps they are just various "experts" quoted in the press, or perhaps even Al Gore. But Mr. Gore, in his movie and elsewhere, never asks the key question: How much of current warming is due to natural causes? And how much is really human-caused? Anthropogenic warming is simply taken for granted as part of a claimed but nonexistent "complete" scientific consensus.

The current warming trend is not unusual: Climate is always either warming or cooling, and ice is either melting or accumulating. But thermometers can't talk and tell you the cause of climate change. This requires a comparison of the patterns of the observed warming with the best available models that incorporate both anthropogenic (greenhouse gases and aerosols) as well as natural climate forcings.

Fortunately, the U.S.-Climate Change Science Program, funded at $2 billion annually, has done just that in its first report:

Grease Guzzlers These Folks Fuel Their Diesel Cars With Cooking Oil. by Allan Lengel, Washington Post

In these days of eye-popping gas prices, Mike Leahy gets fuel for his Volkswagen Beetle at the Barking Dog, a popular Bethesda pub. Shane Sellers fuels up at a Chinese restaurant in Frederick. And Ben Tonken heads to a Tex-Mex eatery in the District.

"There's a bit of a smell when you get out," said Leahy, a D.C. lawyer. "A slight french fry smell. I kind of like it; it's kind of sweet. It smells better than diesel."

Welcome to the world of greasel -- the shorthand some use for grease and diesel. Leahy and the others are among a tiny but growing band of environmentalists and thrifty consumers who are turning to restaurants for free, used vegetable oil to fuel their diesel-engine cars. 

With a little filtration and a car conversion kit, oil that once fried potatoes, egg rolls or tortilla chips is ready for its second act: air pollution fighter. . . .

To read more about this unusual alternative with diesel drivers burning 30 gallons of canola oil a month, go to

* * * * *

3.      International Medicine: Is socialized medicine the prescription for better health?

Where Would You Rather Be Sick? By DAVID GRATZER, WSJ, June 15, 2006

Is socialized medicine the prescription for better health? A recent study comparing Americans and Canadians, widely reported in the press, seems to suggest just that. But there is much less here than meets the eye.

The study, based on a telephone survey of 3,500 Canadians and 5,200 Americans (conducted by Statistics Canada and the U.S. National Center for Health Statistics), was released by the American Journal of Public Health. According to it, Canadians are healthier and have better access to health care than Americans, and at lower overall cost. So is the Canadian system, where the government pays for and manages the health-care system, superior? "Our study," says co-author Dr. Steffie Woolhandler, "is a terrible indictment of the U.S. health-care system. Universal coverage under a national health insurance system is key to improving health."

It is not so clear that the survey data back up these claims. Consider access. According to the survey, Canadians are more likely to have a regular physician, to have seen a doctor in the past year, and to be able to afford medications. But the data are ambiguous; Americans are more likely to have received a pap test and mammogram, as well as treatment for high blood pressure. Moreover, Americans are generally more satisfied with their health care. (The survey did not ask about access to specialist care or diagnostic imaging.) 

So how does American health care actually measure up? If we look at how well it serves its sick citizens, American medicine excels. Prostate cancer is a case in point. The mortality rate from prostate cancer among American men is 19%. In contrast, mortality rates are somewhat higher in Canada (25%) and much higher in Europe (up to 57% in the U.K.). And comparisons in cardiac care - such as the recent Heart and Stroke Foundation of Canada study on post-heart-attack quality of life - find that American patients fare far better in morbidity. Say what you want about the problems of American health care: For those stricken with serious disease, there's no better place to be than in the U.S.

Socialized health-care systems fall short in these critical cases because governments strictly ration care in order to reduce the explosive growth of health spending. As a result, patients have less access to specialists, diagnostic equipment and pharmaceuticals. Economist David Henderson, who grew up in Canada, once remarked that it has the best health-care system in the world - if you have only a cold and you're willing to wait in your family doctor's office for three hours. But some patients have more than a simple cold - and the long waits they must endure before they get access to various diagnostic tests and medical procedures have been documented for years. Montreal businessman George Zeliotis, for example, faced a year-long wait for a hip replacement. He sued and, as the co-plaintiff in a recent, landmark case, got the Supreme Court of Canada to strike down two major Quebec laws that banned private health insurance.

Dr. Karen Lasser, the study's third author, says that "Based on our findings, if I had to choose between the two systems for my patients, I would choose the Canadian system hands down." Perhaps she would. But as a physician licensed in both countries, I'd disagree.

Dr. Gratzer is a senior fellow at the Manhattan Institute.

To read the entire article, please go to

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

--Canada's Supreme Court

* * * * *

4.      Medicare: The Fiasco of Castro's Socialist Medicine Over The Profit-Driven Capitalist Kind

Doctors Flee South America Sick Man Because It Was Political Rather Than Medical

Fidel Castro's vaunted overseas "free" medical program for the poor, which sent doctors to the slums of Caracas and elsewhere, is falling apart as doctors choose defection, says Investor's Business Daily (IBD). 

  • In Bolivia, at least 30 Cuban doctors out of 719 defected to freedom, according to Bolivian media.
  • In Venezuela, 4,000 Cuban doctors out of 15,000 also fled the country, Union Radio reported.

The result of the defections can be seen in the remnants of the program:

  • In western Caracas, a red-brick octagonal medical kiosk, the visible symbol of Castro's Cuban doctor operation, is boarded up; it was installed supposedly to provide 24-hour medical service to poor areas, but the doctors are gone.
  • Along the old Caracas/La Guaira highway, three more of the distinctive Cuban brick compounds, one after another, also were recently seen boarded up.
  • In the truly poor Caracas slums, known as ranchos, where cardboard boxes and corrugated steel serve as housing, no Cuban doctor kiosks are there at all.

It's no surprise why they did it, says IBD.  Defecting doctors say they are essentially there for a political purpose rather than to practice medicine.  Their "free" medical care amounts to industrial "dumping," putting real doctors out of business in places such as Venezuela, Bolivia and Central America.

Instead of showing the "humanity" of socialist medicine over the profit-driven capitalist kind as Castro intended, the current fiasco has shown that "free" medical care is as much in shortage in Caracas as it is in Havana, explains IBD.

Source: Editorial, "Doctors Flee South America Sick Man," Investor's Business Daily, July 15, 2006

For text (subscription required):

For more on Health:

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

- Ronald Reagan

 * * * * *

5.      Medical Gluttony : Patients reading their own report can cause excessive medical costs.

We recently saw a patient who brought in multiple lab tests, including a Dexa Scan. She was extremely anxious as to what it said. The top line under the doctor's justification for ordering the scan read:  Rule out osteoporosis.

The details of the report were totally normal and the impression read "Normal. No evidence of Osteoporosis."

The patient refused to be comforted. She kept pointing to the first line, which she felt was her life threatening diagnosis. After repeated explanations, she finally left the office saying to the receptionist, "I might have to find another doctor who will treat my osteoporosis."

* * * * *

6.      Medical Paradox: Solve the ER crunch by driving patients to the highest possible cost center.

Painful predicament: Crowded ERs are diverting more patients to nearby hospitals despite health risk, by Tomio Geron and Charlie Emrich, Sacramento Bee, July 2, 2006

Suffering sharp back pains, Kari Wolff had been waiting at UC Davis Medical Center's emergency room for two hours. Although the waiting room was not jammed, the pace at which patients were being seen was sluggish at best.

Long waits are common at hospital emergency rooms, but knowing that did not make Wolff feel any better. Her ailment did not seem life-threatening, but the pain was severe enough to prevent her from sleeping at night.

Wolff, a 41-year-old who lives in Natomas, was upset. "I'm really concerned about the fact that I hurt right now," she said.

According to a recent widely circulated report, patients nationwide are experiencing similar, if not worse, delays in obtaining emergency room care.

The study by the National Academy of Sciences' Institute of Medicine found that the challenges faced by local hospitals are part of a coast-to-coast crisis.

Emergency rooms throughout the United States are chronically overcrowded, underfunded and inefficiently managed -- even as demand grows for their services.

Although many emergency departments have closed nationwide, in the growing Sacramento region several hospitals plan expansions of their emergency rooms.

These include Kaiser Roseville, Kaiser South, Marshall in Placerville, Mercy Folsom, Methodist and Sutter, as well as UC Davis Medical Center. . .

Many of the reasons for emergency room crowding are out of hospitals' control, administrators and doctors say.

For example, some patients visit the emergency room not because they are seriously injured but because, lacking health insurance, they feel they have no other options. . .

Even people who are covered by insurance sometimes use the emergency room because their regular doctor is unavailable or lacks specialized equipment, according to Dr. Mark Smith, president of the California Health Care Foundation and a member of the committee that wrote the national report.

"If you have a doctor (and) next Tuesday is the earliest time he can see you, you're gonna go to the ER even if it's not an emergency -- if you're in pain," Smith said. "And I don't blame you."

This was the case for Glenda Lowe of Vacaville, who waited 2 ½ hours at the UC Davis Medical Center emergency room to be treated for staph infection in her sinuses.

"I'm about ready to leave and drive home," Lowe said, exasperated.

Her condition was not life-threatening, but she could not get through to her doctor. . . .

Of course, those visiting the emergency room with real medical crises will get seen promptly. "If you're critically injured, you will get attended to immediately," said Dr. Nathan Kuppermann, chair of emergency medicine at UC Davis Medical Center.

But those who are not seriously injured will find themselves increasingly steered toward appropriate care.

For instance, Kaiser screens patients while they wait and sends non-critical cases to an onsite medical treatment unit, equipped to handle 30 percent to 40 percent of the people streaming into the emergency room, officials said. . . .

About the writer: The Bee's Tomio Geron can be reached at (916) 321-1041 or

[This article does not make any attempt to evaluate whether the patient took the first step in alleviating the pain. Did any of them take a pain pill before going to the ER? We see patients on emergency almost daily with severe pain stating that their pain is far too severe to consider such mundane treatment as Tylenol or Motrin. However, when we give them two extra strength Tylenol tables at the beginning of the evaluation, in many instances the pain is relieved before the conclusion of our evaluation. Many emergency evaluations are performed with the patient's expectation that their pain warrants thousands of dollars worth of testing and MRIs. In most instances, conventional pain therapy will give the patient and the clinician the best clue as to the severity of the pain. This attitude will not change as long as health insurance covers the first dollar cost of medical evaluation. If the patient had to pay the first 20 percent or 30 percent (several hundred dollars of the expected several thousand dollar evaluation), health care costs in this country would drop precipitously over night. It would then become affordable.]

[The answer to the painful predicament: Start taking pain pills. If two ES Tylenol don't relieve the pain, take two more after two hours and then call the doctor. Don't go to the emergency room for non-emergency conditions. Don't force hospitals to add millions of dollars of construction and expand unnecessary services.]

Why is it so difficult to instill reason into health care? Because expensive unnecessary evaluations are nearly free and, therefore, used irresponsibly.

* * * * *

7.      Overheard in the Medical Staff Lounge: Huge Pay Hikes for Government Workers

Dr. Sam was livid after reading about the 18% pay raises for California's state top elected state officials. Elected officials received salary boosts of $23,625 to $31,500 per year. The governor does not accept state pay - but if he ever changes his mind, the hike would boost his salary to $206,500 instead of $175,000 if he were to take his salary. He donates his time and energies to the People of California as a public servant and in the public service. Legislative salaries received an additional two percent, on top of the 12 percent they recently received, making them tops in the nation by more than $30,000 per year.

Dr. Sam notes that his pay has been level for about the same period of time and now Medicare is trying to reduce his fees by 14 percent.

Jim Sanders, BEE Capital Bureau, Sacramento BEE, Saturday, June 24, 2006, FP.

* * * * *

8.      Voices of Medicine: Abusive Peer Review

[Abusive Peer Review is a serious problem for physicians. We regularly feature two organizations that are involved in correcting this abuse. To review the issues and to read some horror stories against physicians, please go to, or or, or, or Here's another heart felt "Voice of Medicine" from a hurting physician suffering from professional homicide.]


On September 1, 1995, Presbyterian hospital called me to their imposing corporate Board Room in Charlotte, NC and dropped a bomb on me.  They said they were summarily suspending my hospital privileges at 4 pm that day!

Suspension from a hospital is a kiss of death for any physician!  I knew that I would never be able to deliver any more babies nor take care of women who needed gynecologic surgery.  The future of my family went bleak in front of my eyes. 

I knew that they had been reviewing my charts for several months now.  But I had no idea that they would not even give me a chance to present my side of the story with regard to any of those charts before taking such Draconian action.  This was truly a stab in the back.

"We do not have to tell you what the charts are."  Said then CEO of Presbyterian hospital and chief of ob-gyn.  They simply stated that I had 24 "problematic" charts, as determined by the peer review committee. 

I had received my M.D. from New Jersey Medical School in 1985 and finished my ob-gyn residency from Temple University hospital in 1989.  I had come to Charlotte in 1990 and become a member of Presbyterian hospital medical staff as an ob-gyn physician.

On December 1994, I had a surgical mishap.  Inadvertently, I punctured the external iliac artery in a patient during laparoscopy.  This was unfortunate but a known complication of such a procedure.  I immediately proceeded to laparotomy.  I summoned a general surgeon and a cardiovascular surgeon to assist me with the repair.  The patient went home after a few days stay in the hospital.  My malpractice insurance company as well as several independent reviewers determined that I met the standard of care in this case.  However, citing business reasons, the insurance company later decided to settle the lawsuit for 300K.

Following the incident, Presbyterian hospital went on a fishing expedition of my charts from over a two year period.  Most of these charts had been filed in the hospital archives as having had no problems with them.  Anyway, a departmental "peer review" committee headed by Dr. X somehow managed to label 24 of them "problematic" out of my 102 charts reviewed.

Did Dr. X have more experience than I as an ob-gyn?  No, we both finished medical school and residency in same years.  The difference is that he is a good old Southern boy trained at Chapel Hill while I am India born, with my residency from Philadelphia.  He was later promoted to the position of the chief of the ob-gyn department. 

Although I repeatedly asked the hospital for an independent external review of my charts, the hospital did not grant that simple request.  The Medical Board of North Carolina asked an experienced ob-gyn physician from Charlotte, Dr. Y to review my cases.  He as well as several other reviewers found my charts to be within the standard of care. 

According to a letter circulated by Dr. Z in October 1998 among the hospital's medical staff, I was the first physician to be suspended in 20 years at Presbyterian hospital!  Was it just a coincidence that I was the first ob-gyn physician of Indian origin at Presbyterian hospital?  I decided to do a little research starting with the local courts.  I found out the following facts, which are true to the best of my knowledge. To read more about the lethal actions of a hospital that generally is protected from civil court review, please go to

* * * * *

9.      Cinema Review: "Guantánamo": Torture, Blowback, and Innocence by James J Murtagh, M.D.

Warning: movie spoiler alert. If you have not seen Guantánamo, consider seeing the film before reading further. However, most people know this is a docu-drama about mistreatment of prisoners, this spoiler alert may not be necessary.

"They said we will make you wish to die and it will not happen"

- Ameen Saeed Al-Sheik, detainee No. 151362,

Does Innocence Matter? Does truth matter? Can American democracy spread through torture camps?

The searing documentary "Road to Guantánamo" shows Americans the vivid depictions of beatings, torture, interrogation and death in the American gulag just 90 miles from our shore. This is the story of the "Tipton Three," British citizens in the wrong place at the wrong time, captured and sent to American camps "X-ray" and "Delta" with absolutely no due process, and absolutely no evidence of any wrongdoing.

Worse, the film reveals none of the roughly 600 detainees in Cuba have been found guilty of crime, and not one piece of usable intelligence was obtained. This reflects what courageous European journalists like David Rose have written in acclaimed books. Unfortunately, despite the books in evidence, the US press has been slow to alert the public to the true problem.

Ameen Saeed Al-Sheik said the prisoners at Abu Ghraib and at Guantánamo were told they would wish for death, but not be allowed to die. Can there be a better description of true torture? More than sixty Guantánamo prisoners at least attempted suicide testifies to the Ameen's accuracy.

Identical torture methods have been exposed at Guantánamo and Abu Ghraib. It is clear  torture was systematic, planned, and sanctioned by the highest Dept. of Defense officials. Torture was not from a few "bad apple" low ranking solders. As David Rose exposed, Guantánamo was actually the prototype for American torture camps elsewhere, including Abu Ghraib.

High-ranking U.S. officials decided in 2001 that torture would be used as an instrument of American policy.

Administration apologists try to redefine the meaning of torture, or to redefine the Geneva convention. But these same apologist officials lost all credibility with their claims of "Weapons of mass destruction." Fool me once, shame on you. A series of supposed "slam-dunk" evidence proved absolutely false.

Americans can now see what happens at Guantanamo, and hear the words of the Tipton trio. Americans know torture when they see it, and no amount of artful dodging from Rumsfeld can change the stark, brutal fact of unjustified American gulags.

The victims of torture at Guantanamo and Abu Ghraib suffer, but so do our own soldiers who are forced to inflict the torment.

"Blowback," the unintended consequences of secret military operations on US society at home, was examined in the recent film, "Why we fight." Torture incites the worst of all possible blowback, and we will all suffer the consequences. Torture not only inflames our enemies, it inflames our friends, and it inflames our own citizens to despair on our own pledge to support "justice for all." To read the entire review, or to read other Op-Ed reviews by Dr Murtagh, please go to

* * * * *

10.  Hippocrates & His Kin: Burglars Have the Right to Be Protected from Householders

Burglars Need Protection From Violent Citizens? JOYCE LEE MALCOLM , WSJ, July 8, 2006;

In response to the July 1 Letter to the Editor disputing my June 17 editorial-page commentary "Mad Dogs and Englishmen": Clearly, Barry Watts is not a regular newspaper reader. He prefers to dismiss as "total nonsense" my reference to the British Home Office policy of letting offenders of 60 different crimes off with cautions; nevertheless, the policy was confirmed by an official report in March. Cautions have been used, if more selectively, for some time. In 2004, 40 rapists were let off with cautions. As for Tony Martin, the farmer jailed for shooting two career burglars who broke into his home in the dead of night, government lawyers advised ministers that "as members of the public, burglars have the right to be protected from violent householders." Not surprisingly, a study reported by BBC News found 67% of house burglars agreed that once inside a property, burglary was "virtually risk free."

Any Doctors Interested in Cross Training into  Virtually Risk Free Profession?

Did You Know That 37 Percent Of Malpractice Claims Did Not Involve Medical Errors?

The New England Journal of Medicine reports in its May 11, 2006 issue that 37 percent of malpractice claims did not involve a medical mistake? Even more surprising is that 3 percent of malpractice cases had no medical injuries? For every dollar spent on compensation, 54 cents went to administrative expenses (including those involving lawyers, experts, and courts).

Since most of the money from malpractice cases never reaches the patient, the best malpractice reform would be to place every trial attorney on a salary, say the average doctor's salary of $150,000, reduced yearly by the same rate that the Feds reduce Medicare reimbursement each  year and then give all patients that feels they have been injured, a life time health insurance plan, Medicaid, our welfare card, which gives our poorest 20 percent (6 million of our 30 million Californians, for instance) access to more extensive care than the UK's National Health Service.

Anyone Want To Figure Out The HealthCare Cost Savings From This Approach?

To read more Hippocrates in the archives, please go to

* * * * *

11.  Organizations Restoring Accountability in Medical Practice, Government and Society:


                      John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to The Zarephath Health Center submitted its formal proposal to the government of Antigua & Barbuda on June 26th.  The decision will be made in the next week or so.  Former Mayor of Jersey City and NJ Republican Gubernatorial Candidate Bret Schundler wrote most of the proposal and is ready to dive into this project should we get the nod.  His was the first governmental entity to offer medical savings accounts to its employees back in 1994, so his interest in health care reform goes way back.  Bret has traveled with us to Antigua and has caught the vision for what medical tourism could mean to US patients, hopefully providing the competition and stimulus to provoke reform in our US community hospitals.  We look forward to the big announcement of the Government of Antigua & Barbuda-- hopefully that the Zarephath Health Center and those who believe in true free markets will have the chance to operate their beautiful facility, the Mount Saint Johns Medical Centre, for medical tourism.  We'll keep you posted.    Alieta Eck


                      PATMOS EmergiClinic - - where Robert Berry, MD, an emergency physician and internist practices. Here is his story: Three years ago, I left ER medicine to establish a primary care clinic in a town of about 15,000 in northeast Tennessee - primarily for the uninsured, but also for anyone willing to pay me for my care at the time of service.  I named the clinic PATMOS EmergiClinic - for the island where John was exiled and an acronym for "payment at time of service."  I have no third party contracts...not commercial, not Medicare, TennCare or worker's compensation. My practice today has over 4,000 patient charts.  My patients are typically between 5-50 years old, but I do have a significant number of Medicare patients.  A year ago, over 95 percent of the patients I saw had no insurance.  Today, that figure may be 75 percent.  But even those with insurance learn a simple lesson when they come to me: health insurance does not equal healthcare, at least not at my clinic. I clearly tell my patients how much a visit will cost.  Everything is up front and honest.  I will prepare a billing claim for my patients with insurance, for a small fee, but I expect them to pay me when I see them.  Because I need only one employee in my office, my costs are low.  For the same services, I charge about 60 percent of charges made by other local clinics, 40 percent of what the local urgent care clinic charges and less than 20 percent of what the local ER charges.  I am the best bargain in town.  If I can do it, caring for the uninsured in a small rural town, any doctor can. To read more on Dr Berry, please to go

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

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

                      Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network. Dr Vern calls his practice PIFATOS – Pay In Full At Time Of Service, the "Cash-Based Revolution." The patient pays in full before leaving. Because doctor charges are anywhere from 25–50 percent inflated due to administrative costs caused by the health insurance industry, you'll be paying drastically reduced rates for your medical expenses. In conjunction with a regular catastrophic health insurance policy to cover extremely costly procedures, PIFATOS can save the average healthy adult and/or family up to $5000/year! To read the rest of the story, go to 

                      Dr David MacDonald started Liberty Health Group. To compare the traditional health insurance model with the Liberty high-deductible model, go to There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.

                      Dr. Nimish Gosrani has set up a blend between concierge medicine and a cash-only practice. "Patients can pay $600 a year, plus $10 per visit, to see him as many times in a year as they want. He offers a financing plan through a financing company for those unable to plop down $600 all at once." Patients may also see him on a simple fee-for-service basis, with fees ranging from $70 for a simple office visit to $300 for a comprehensive physical. Dr. Gosrani reports that he saves two hours per day that he used to spend dealing with insurance company paperwork. To read more, go to

·                     Dr. Elizabeth Vaughan is another Greensboro physician who has developed some fame for not accepting any insurance payments, including Medicare and Medicaid. She simply charges by the hour like other professionals do. Dr. Vaughan's web site is at, where you can see her march in a miniskirt (Should she look more professional?) for Breast Health without a Bra. Careful or you may change your habits if you read her entire page.

                      Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at She will be remembered for her important work, Who Owns Your Body, which is reviewed at Please go to to view some of her articles that highlight the government's efforts in criminalizing medicine. For other Op-Ed articles that are important to the practice of medicine and health care in general, click on her name at

                      David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at To read his "Lessons from the Past," go to For additional articles, such as the cost of Single Payer, go to; for Health Care Inflation, go to

                      Dr Richard B Willner, President, Center Peer Review Justice Inc, states: We are a group of healthcare doctors -- physicians, podiatrists, dentists, osteopaths -- who have experienced and/or witnessed the tragedy of the perversion of medical peer review by malice and bad faith. We have seen the statutory immunity, which is provided to our "peers" for the purposes of quality assurance and credentialing, used as cover to allow those "peers" to ruin careers and reputations to further their own, usually monetary agenda of destroying the competition. We are dedicated to the exposure, conviction, and sanction of any and all doctors, and affiliated hospitals, HMOs, medical boards, and other such institutions, which would use peer review as a weapon to unfairly destroy other professionals. Read the rest of the story, as well as a wealth of information, at

                      Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848 no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see To see Attorney Sharon Kime's response, as well as the California Medical Board response, see Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.

To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to

                      Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to

                      Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at This week's column is on Customer Service Rage and Anxiety - A New Medical Entity and can be read at

                      The Association of American Physicians & Surgeons (, The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians.  Be sure to scroll down on the left to departments and click on News of the Day. The "AAPS News," written by Jane Orient, MD, and archived on this site, provides valuable information on a monthly basis. Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents page of the current issue at Don't miss the excellent article on Sham Peer Review or the extensive book review section.

Be sure to Attend the 63rd Annual Meeting of the AAPS, in Phoenix, AZ, September 13-16. For info, please go to, your gateway to a vast amount of important information.  


* * * * *

Thank you for joining the MedicalTuesday.Network and have your friends do the same. If you receive this as an invitation, please go to and enter you email address and join the 20,000 members who receive this newsletter. If you are one of the 50,000 guests that surf our web sites, we thank you and invite you to join the email network on a regular basis by subscribing at the website above. 

Please note that sections 1-4, 8-9 are entirely attributable quotes and editorial comments are in brackets. Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.

MedicalTuesday receives no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the research and writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, in the public interest for his country and as a service to his patients and his profession.

Spammator Note: MedicalTuesday uses many standard medical terms considered forbidden by many spammators. We are not always able to avoid appropriate medical terminology in the abbreviated edition sent by e-newsletter. (The Web Edition is always complete.) As readers use new spammators with an increasing rejection rate, we are not always able to navigate around these palace guards. If you miss some editions of MedicalTuesday, you may want to check your spammator settings and make appropriate adjustments. To assure uninterrupted delivery, subscribe directly from the website rather than personal communication:

Del Meyer       

Del Meyer, MD, Editor & Founder

6620 Coyle Avenue, Ste 122, Carmichael, CA 95608

Words of Wisdom

Dwight D Eisenhower: There are a number of things wrong with Washington. One of them is that everyone has been too long away from home. May 11, 1955

Ronal Reagan: The government is like a baby's alimentary canal - with a happy appetite at one end and no responsibility at the other.

Winston Churchill: We contend that for a nation to try to tax itself into prosperity is like a man standing in a bucket and trying to lift himself up by the handle.

Mark Twain:  The only difference between the tax man and a taxidermist is that the taxidermist leaves the skin.

Some Recent Postings

The Encyclopedia of Stress and Stress-Related Diseases by Ada P. Kahn, PhD, has now been published. To read the foreword we wrote, please go to Published by Facts On File: Enter Kahn in the search box.

OpEd/Cinematic Reviews:

Did Presbyterian Hospital Discriminate? You Decide


In Memoriam

Kenneth Lay, founder of Enron, died on July 5th, aged 64

SOON after the collapse of Enron, a giant American energy company, in 2001, the Rev Jesse Jackson likened its founder, Kenneth Lay, to Job. No boils disfigured Mr Lay's smooth, well-groomed head, and nothing had befallen his camels or his servants; but in his own mind, he was an innocent victim. Even after he was convicted, in May, of presiding over the most infamous of all corporate frauds, Mr Lay continued to protest that he had done nothing wrong. To most people, Enron's collapse stood for the worst sort of greed and excess. To him, his spectacular downfall seemed like an inexplicable punishment from the God he had followed so long and so devoutly.

Until Enron started to unravel, with the full extent of its creative accounting slowly becoming known, Mr Lay's life had been a model of the American dream of rising from rags to riches on the strength of merit and hard work. His beginnings were lowly . . .

Under Mr Lay, Enron was transformed from a dull gas business into a trading firm that was closer to a hedge fund than an energy producer. It also ventured abroad, although its enterprises in Brazil, India and Britain were to generate the first cracks in an image that in the late 1990s had made it one of Fortune's most-admired companies and a darling of the stockmarket.

As Enron went seemingly from strength to strength, Mr Lay turned increasingly to politics . . .

To understand why politics is a misstep in the business world, please go to

On This Date in History - July 25

On this date in 1952, the Commonwealth of Puerto Rico came into existence as that territory gained self-government (short of statehood status) in the United States. At the time, it was thought that this would solve the problem of the island's status, but we learned soon enough that the hope was premature. But Commonwealth Day certainly deserves to be considered a noble attempt and a good start.

This is the first day of the last week of July, which is the National Farm Safety Week. We sometimes think of the bucolic, rustic charms of the old country farm that we forget the risks. Farming is a risky business and it uses a lot of powerful machinery. There is always an idea among city folk that the city is where the risks are. This week is a time to remember the realities of farming.

Speaker's Lifetime Library, © 1979, Leonard and Thelma Spinard