Community For Better Health Care

Vol IX, No 8, July 27, 2010


In This Issue:

1.                  Featured Article: Why was the morning paper suddenly in a foreign tongue?

2.                  In the News: Politicians should stop masquerading as doctors

3.                  International Medicine: Cost Controls Have Failed

4.                  Medicare: Doctors vs. Obamacare - and Vice Versa

5.                  Medical Gluttony: Legal Excesses: Criminalize America's Productive Citizens

6.                  Medical Myths: Rationing will be Rational? Isn't that Un-American?

7.                  Overheard in the Medical Staff Lounge: Are supplements really dangerous?

8.                  Voices of Medicine: Who Speaks for Medicine?

9.                  The Bookshelf: The Anti-Smoking Crusade

10.              Hippocrates & His Kin: "There is no right way to do a wrong thing" 

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

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

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Remember that Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or Obama Care, was born for the benefit of the state and of a contemptuous disregard for people's welfare.

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1.      Featured Article: Why was the morning paper suddenly in a foreign tongue?                          

Oliver Sacks, A Neurologist's Notebook, "A Man of Letters," The New Yorker, June 28, 2010, p. 22

An abstrct about a man suffering from alexia, an inability to recognize written language.

In January of 2002, Canadian novelist Howard Engel sent the writer a letter about his experience with alexia sine agraphia, a form of visual agnosia which results in an inability to recognize written language. On the morning of July 31, 2001, Engel awoke and discovered that he could not read the newspaper. His room looked normal, and he could still read his clock, but his books were all unintelligible, all full of the same "Oriental"-looking script. At the hospital, it was determined that he had had a stroke which had affected a limited area of the visual parts of the brain, on the left side. He spent the next week in the neurology ward at Toronto's Mount Sina Hospital. He also had difficulties recognizing colors, faces, and everyday objects, yet he was surprised to find that he could still write. 

Yet he was surprised to find, as a nurse reminded him, that he could still write, even though he could not read; the medical term, she said, was "alexia sine agraphia." Howard was incredulous: how could he lose one but not tbe other? 

The nurse suggested that he sign his name. He hesitated, but, once he started, the writing seemed to flow all by itself, and  he followed his signature with two or three sentences. The act of writing seemed quite normal to him, effortless and automatic, like walking or talking. The nurse had no difficulty reading what he had written, but he himself could not read a single word. To his eyes, it was the same indecipherable "Serbo-Croatian" he had seen in the newspaper.

Two months after his stroke, Engel had moved to a milder form of alexia. He would slowly and laboriously puzzle out words, letter by letter. Whatever language a person is reading, the same area of inferotemporal cortex, the visual word form area, is activated. Why should all human beings have this built-in facility for reading when writing is a relatively recent cultural invention? We might call this the Wallace problem, for Alfred Russel Wallace, who discovered natural selection independent of Charles Darwin. Mark Changizi and his colleagues at Caltech examined more than a hundred ancient and modern writing systems. They have shown that all of them, while geometrically very different, share certain basic topological similarities. Writing, a cultural tool, has evolved to make use of the inferotemporal neurons' preference for certain shapes. The origin of writing and reading cannot be understood as a direct evolutionary adaptation. It is dependent on the plasticity of the brain, and on the fact that experience is as powerful an agent of change as natural selection. We are literate not by virtue of a divine intervention but through a cultural invention and a cultural selection that make a creative new use of a preëxisting neural proclivity. While Howard was still in the rehab hospital, he began keeping a "memory book," to record his thoughts. More than three months after his stroke, he returned home and decided to write a new novel, "Memory Book," which was published in 2005. It was followed by a memoir, "The Man Who Forgot How to Read," which came out in 2007.

Read more: - ixzz0u5nhoEa1
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2.      In the News: Politicians should stop masquerading as doctors

Politicians should not prescribe pills by John Gapper,
The Business World: Observations on business, finance, media and technology

What if there were a popular drug that had moderate benefits but was known to cause acute liver failure and death in some patients? Or another drug that had dangerous side effects including intestinal bleeding and ulcers?

Would it be right to let big pharmaceutical companies carry on marketing and selling them or ought they to be banned?

These drugs have existed for more than a century: they are paracetamol and aspirin. Perhaps they would not even be approved now for fear of toxicity but it is too late to withdraw them; instead, regulators periodically try to limit their use and to stop them being taken in combination with other medicines.

The point is that so-called "white pill" medicines, from painkillers to anti-cholesterol drugs, are chemicals that improve the health of some humans but can cause serious side-effects in others. Anyone who takes them needs to be informed about the benefits and risks.

But politicians are not good with balances of risk and reward, preferring black-and-white answers. This is why US politicians have been fiercely on the trail of Avandia, the anti-diabetes drug made by GlaxoSmithKline that has been linked with heart attacks. Like BP, another FTSE 100 company under attack, GSK is finding the political climate hard and capricious.

"Avandia is dangerous and should be pulled from the market," declared Rosa DeLauro, a Democratic member of the House of Representatives last month, citing two studies. Senators from both parties have been putting heavy pressure on regulators at the Food and Drug Administration.

Such interventions are unwise for two reasons. First, politicians lack the expertise to judge whether drugs should be withdrawn. Some studies suggest Avandia heightens the risk of heart attacks; others that it is no more dangerous than a comparable drug. Politicians are not trained in how to sift such evidence

Second, and more importantly, there are people nearby who are far better qualified to make a sound decision – the FDA's scientists. Congress has a pedigree watchdog to hand but has instead chosen to bark about particular drugs itself.

This is part of a pattern of political over-reach in business affairs, with Congressional committees cherry-picking thousands of documents they subpoena from companies to claim expertise on everything from oil-drilling techniques to derivatives. Presenting themselves as seekers after truth, they publish tiny extracts to embarrass executives.

Apart from the patent hypocrisy – they are really after scalps they can parade in front of voters – this is not their job. Their role is to make sure regulators are funded and correctly structured to let officials decide on complex matters such as prescription drug safety. . .

But regulators such as the FDA and the European Medicines Agency, which is now reviewing Avandia, are there because decisions over the risks and benefits of drugs – particularly as they are prescribed and taken in the real world – are difficult and finely balanced. A life-prolonging pill for one group of patients is poison for others.

Politicians have their own skills, but they should stop masquerading as doctors and scientists.

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3.      International Medicine: Cost Controls Have Failed

Under Budget Pressure, Canada Slowly Rethinks Health Care Model
By: Tabassum Rahmani
Publisher: The Heartland Institute 07/12/2010

In response to pressure from budget problems, Canada and its provinces are rethinking their national health care model as they seek to curb healthcare costs without demolishing the justifications for the state-funded system.

According to Devon Herrick, a senior fellow at the National Center for Policy Analysis in Dallas, Texas, the problems now facing Canada already affect other countries.

"Canada is facing the same problems as other developed countries with socialized health care systems," Herrick said. "There are never enough resources to provide care for all who demand it, and tax hikes are unpopular. Today, Canada is forced to increasingly rely on the private sector to boost access to care."

Cost Controls Have Failed

Health care in Canada is delivered through a publicly funded system, with a pricetag of roughly $183 billion in Canadian dollars ($174 billion U.S.) for FY 2009. A temporary spending fix to fill current funding gaps ends in 2013 and is unlikely to be extended.

Canada's system has not restrained the rising costs of health care, such as salaries for top hospital executives and doctors and spiraling costs for new medical technologies and drugs.

One province, Ontario, recently conducted an analysis which found health care costs could eat up 70 percent of its budget by 2022. Legislation has been introduced to tie hospital executive pay to the quality of patient care, and the province is considering saving money by putting more physicians on lower salaries. . .

‘Raise Taxes, Ration Access'

Brett Skinner, president of the Fraser Institute, a Canadian think tank, says Canada's national and provincial governments have been avoiding real reform.

"Canada is a federal state. The provincial governments have autonomous constitutional jurisdiction over health policy, and the national government intervenes extra-constitutionally by offering federal transfer payments to support health care systems in the Provinces, on the condition that they comply with the Canada Health Act," Skinner said.

Skinner says the provinces generally comply to avoid losing the government funding, but he maintains they have the constitutional jurisdiction to privatize health insurance if they choose.

"Canada has not announced any formal intentions to reassess the health model it imposes on the provinces, nor are the provinces formally reassessing their provincial health models," Skinner said. "Reform is incremental and reactionary, and continues to be characterized by a ‘pay more, get less' approach—which translates to ‘raise taxes, ration access.'"

Tabassum Rahmani ( writes from Dublin, California.

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

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

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4.      Medicare: Doctors vs. Obamacare - and Vice Versa By: Robert E. Moffitt

Publisher: The Heartland Institute,  07/14/2010

Don't expect doctors to give the Patient Protection and Affordable Care Act a clean bill of health. The act will reinforce the worst features of existing third-party payment arrangements in both the private and public sectors, arrangements that already compromise the professional independence and integrity of the medical profession.

Doctors will find themselves subject to more, not less, government regulation and oversight. Moreover, they will become increasingly dependent on unreliable government reimbursement via Medicare and Medicaid payment, as irrational government payment approaches are expanded to larger portions of the population.

Under the new law an estimated 18 million of the 34 million who would gain coverage over the next 10 years would be enrolled in Medicaid. Such a massive Medicaid expansion will displace private health coverage and expand government control over health care financing and delivery.

Physician payments in the major entitlement programs are well below the prevailing rates in the private sector. On average, doctors in Medicare are paid 81 percent of private payment; physicians in Medicaid are paid 56 percent of private payment.

No Payment Fixes

The new law does not substantially change the general pattern of the government's systems of physician payment. Indeed, it only expands their reach and adds new regulatory restrictions.

For example, beginning this year the new law will prohibit physicians from referring patients to hospitals in which they have ownership, with the exception of those that treat a large number of patients enrolled in Medicaid. . .

Draconian Payment Formulas

Medicare authorizes a set of administrative payment systems for doctors and hospitals. For physicians, the basic Medicare fee schedule is based on a formula called the Resource Based Relative Value Scale (RBRVS), which pays physicians based on the estimated "inputs" required to provide a medical service, such as the time, energy, and effort.

Medicare physician payment is annually updated on the basis of the Sustainable Growth Rate (SGR) formula, which ties annual physician payment increases to the performance of the general economy. Under the SGR, without congressional intervention the initial Medicare pay cut would amount to 21.3 percent.

The impact is not hard to fathom. The Fairfield County Medical Association in Connecticut reported that if such cuts were to take effect, 41 percent of county doctors would stop taking new Medicare patients, and nearly one out of four doctors would drop Medicare altogether. . .

Government in the Operating Room

On top of existing payment rules, regulations, and guidelines, the new law creates numerous new federal agencies, boards, and commissions. Three have direct relevance to physicians and the practice of medicine. . .

Much of the outcome of this legislation will depend on how the findings and recommendations of these regulatory entities are implemented and whether the recommendations are accompanied by financial incentives, penalties, or regulatory requirements. In any case, this is not a prescription for medical innovation.

Surprise: Doctors Unhappy

Polling results identify deep discontent among doctors. A recent U.S. survey of physicians conducted by Athena Health and the online physician community Sermo found 79 percent of U.S. physicians are less optimistic about the future of medicine, 66 percent indicated they would consider dropping out of government health programs, and 53 percent would consider opting out of insurance altogether.

More ominously, with the nation already facing a shortage of physicians, particularly in geriatrics and primary care, many doctors also say they would leave the profession altogether.

None of this should be surprising. The new law doesn't address doctors' most pressing concerns, such as tort reform. And it worsens the already painful problems caused by third-party payment and government red tape.

Patient Control of Spending

A key goal of health care reform should be to restore the traditional doctor-patient relationship. In such a relationship, doctors are the key decision-makers in the delivery of care, and patients are the key decision-makers in the financing of care. This cannot be achieved unless and until patients control health care dollars and decisions and third party insurance executives are directly accountable to those who pay the health care bills.

Obviously, Congress needs to start over and get it right.

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

- Ronald Reagan

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5.      Medical Gluttony: Legal Excesses: Criminalize America's Productive Citizens

Crime and punishment in America - Rough justice
America locks up too many people, some for acts that should not even be criminal.
The Economist
Jul 22nd 2010

In 2000 four Americans were charged with importing lobster tails in plastic bags rather than cardboard boxes, in violation of a Honduran regulation that Honduras no longer enforces. They had fallen foul of the Lacey Act, which bars Americans from breaking foreign rules when hunting or fishing. The original intent was to prevent Americans from, say, poaching elephants in Kenya. But it has been interpreted to mean that they must abide by every footling wildlife regulation on Earth. The lobstermen had no idea they were breaking the law. Yet three of them got eight years apiece. Two are still in jail.

America is different from the rest of the world in lots of ways, many of them good. One of the bad ones is its willingness to lock up its citizens (see our briefing). One American adult in 100 festers behind bars (with the rate rising to one in nine for young black men). Its imprisoned population, at 2.3m, exceeds that of 15 of its states. No other rich country is nearly as punitive as the Land of the Free. The rate of incarceration is a fifth of America's level in Britain, a ninth in Germany and a twelfth in Japan.

Tougher than thou

Some parts of America have long taken a tough, frontier attitude to justice. That tendency sharpened around four decades ago as rising crime became an emotive political issue and voters took to backing politicians who promised to stamp on it. This created a ratchet effect: lawmakers who wish to sound tough must propose laws tougher than the ones that the last chap who wanted to sound tough proposed. When the crime rate falls, tough sentences are hailed as the cause, even when demography or other factors may matter more; when the rate rises tough sentences are demanded to solve the problem. As a result, America's incarceration rate has quadrupled since 1970. . .

Many states have mandatory minimum sentences, which remove judges' discretion to show mercy, even when the circumstances of a case cry out for it. "Three strikes" laws, which were at first used to put away persistently violent criminals for life, have in several states been applied to lesser offenders. The war on drugs has led to harsh sentences not just for dealing illegal drugs, but also for selling prescription drugs illegally. Peddling a handful can lead to a 15-year sentence.

Muddle plays a large role. America imprisons people for technical violations of immigration laws, environmental standards and arcane business rules. So many federal rules carry criminal penalties that experts struggle to count them. Many are incomprehensible. Few are ever repealed, though the Supreme Court recently pared back a law against depriving the public of "the intangible right of honest services", which prosecutors loved because they could use it against almost anyone. Still, they have plenty of other weapons. By counting each e-mail sent by a white-collar wrongdoer as a separate case of wire fraud, prosecutors can threaten him with a gargantuan sentence unless he confesses, or informs on his boss. The potential for injustice is obvious. *

As a result American prisons are now packed not only with thugs and rapists but also with petty thieves, small-time drug dealers and criminals who, though scary when they were young and strong, are now too grey and arthritic to pose a threat. Some 200,000 inmates are over 50—roughly as many as there were prisoners of all ages in 1970. Prison is an excellent way to keep dangerous criminals off the streets, but the more people you lock up, the less dangerous each extra prisoner is likely to be. And since prison is expensive—$50,000 per inmate per year in California—the cost of imprisoning criminals often far exceeds the benefits, in terms of crimes averted.

Less punishment, less crime

. . . Some parts of America are bucking the national trend. New York cut its incarceration rate by 15% between 1997 and 2007, while reducing violent crime by 40%. This is welcome, but deeper reforms are required.

America needs fewer and clearer laws, so that citizens do not need a law degree to stay out of jail. Acts that can be regulated should not be criminalised. Prosecutors' powers should be clipped: most white-collar suspects are not Al Capone, and should not be treated as if they were. Mandatory minimum sentencing laws should be repealed, or replaced with guidelines. The most dangerous criminals must be locked up, but states could try harder to reintegrate the softer cases into society, by encouraging them to study or work and by ending the pointlessly vindictive gesture of not letting them vote.

It seems odd that a country that rejoices in limiting the power of the state should give so many draconian powers to its government, yet for the past 40 years American lawmakers have generally regarded selling to voters the idea of locking up fewer people as political suicide. An era of budgetary constraint, however, is as good a time as any to try. Sooner or later American voters will realise that their incarceration policies are unjust and inefficient; politicians who point that out to them now may, in the end, get some credit.

* For the members of the AAPS who see their colleagues receive gargantuan fines and prison terms for every line of billing for what prosecutors feel are inappropriate ICD9 codes, this is very important to understand others that are being criminalize.

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Legal Gluttony thrives in Government Excess.

Legal Gluttony Disappears with Part-time Legislatures and Congress

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6.      Medical Myths: Rationing will be Rational? Isn't that Un-American?

Myth 26. Government-directed rationing will be rational. AAPS, November 28th, 2009

It all sounds very reasonable: to set priorities, to use the most effective therapies, to serve the neediest first. Rationing is a given, say reform advocates. Insurance companies already do it. Let's just make it rational and fair.

Some say that Comparative Effectiveness Research (CER) isn't really about rationing. "Nothing in the legislation…provided for payment restriction based on CER findings," writes Jerry Avorn (N Engl J Med 2009;360:1927-1929). It's "Orwellian" to suggest such a thing. Anyway, "unaffordability rations care far more than comparative studies ever could."

The end-stage of rationing actually has little to do with comparative effectiveness. There are more basic questions: "Have you suffered enough yet?" And "Can you get through the clinic door?"

One young Canadian mother suffered from pain and incontinence and required a walker, because of spondylolisthesis. She aggressively presented herself at four surgeons' offices before or after hours or at lunch, pleading her case. Four surgeons saw her. Three said she'd just have to wait, as others were either older than she was and/or had already suffered longer. Finally a surgeon took pity on her and worked her in—only 6 months later—because she was "too young to have to live like that." Never mind the need for emergent surgery in the event of neurologic compromise, or more than 2 years of total disability.

CER results can't be applied until a patient can get a diagnosis. A video team documented efforts to get help from Canadian clinics, and then interviewed a number of Canadians.

CER is not needed to determine that it is traumatic and less safe to give birth in corridors or reception areas because labor beds are full—as 4,000 mothers did in the UK in 2008. The government cut maternity beds by 22%, although birth rates were up 20% in some areas, and spending on the National Health Service was tripled (Daily Mail 8/26/09).

A pediatric ophthalmologist, in the only such practice in Georgia still accepting Medicaid, writes that Medicaid will not pay for the antibiotic needed for an infected corneal ulcer. It takes a year to approve a contact lens after surgery for neonatal cataract. Private funding fills the gap. No research is needed to tell the difference between successful treatment and likely blindness (Zane F. Pollard, M.D., American Thinker. August 2008). But how many such treatments would be denied while approval wended its way through a system with 111 bureaucracies?

With or without CER, government plans always ration care. "The idea of an omnipotent board that makes unpopular decisions on access and price isn't a new construct. It's a European import. In countries such as France and Germany, layers of bureaucracy like health boards have been specifically engineered to delay the adoption of new medical products and services, thus lowering spending" (Scott Gottlieb, Wall St J 6/25/09).

We have our own examples in the U.S., as in Oregon.

Throwing $1.1 billion into CER is guaranteed to produce no new knowledge—only poorly controlled data about the implementation in different practice settings of methods already tested for safety and efficacy in well-controlled studies (Naik AD, Petersen LA. The neglected purpose of comparative-effectiveness research. N Engl J Med 2009;360:1229-1231). It will provide the rationale for rationing.

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Medical Myths Originate When Someone Else Pays The Medical Bills.

Myths Disappear When Patients Pay Appropriate Deductibles and Co-Payments on Every Service.

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7.      Overheard in the Medical Staff Lounge: Are supplements really dangerous?

Dr. Milton: Did you see the article in Consumer's Report about some supplements being dangerous?

Dr. Edwards: Yes, I did. But I don't know of any patients that use the ones they listed, except maybe Yohimbe.

Dr. Milton: I have some patients that take that and say it's effective in helping them rejuvenate their desire.

Dr. Edwards: That's probably the placebo effect.

Dr. Ruth: I have a lot of patients that seem to take the various herbal supplements and I basically don't get involved.

Dr. Michelle: I don't either because I know very little about them and I don't want to appear uninformed in front of my patients.

Dr. Paul: My pediatric patients, or rather their mothers, don't seem to use much in the way of herbs.

Dr. Rosen: So where do we stand on food supplements?

Dr. Edwards: It seems to be a moving target with changing goals that seem to confuse patients and their doctors.

Dr. Milton: I'm sure we all read the stories in the various newspapers and journals. Sometimes the anecdotal stories found in the general press keep us conversant with the times we live in.

Dr. Edwards: We could possibly keep a Health Letter around to educate our patients with some solid reading material.

Dr. Rosen: And educate ourselves also.

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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

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8.      Voices of Medicine: A Review of What Doctors Write About

Who Speaks for Medicine?


At a moment when everyone's joining the debate over health-care reform, who speaks for medicine?

By 'medicine' I mean that ancient art and science with origins before Hippocrates, that discipline that has the patient at its center; I'm talking about the 'medicine' that deans across the country will invoke in a few weeks as they exhort first-year medical students to embrace the ideals and values of the noble profession.

Our esteemed medical societies and academies aren't speaking for medicine; they are lobbyists, defending their financial self-interests, lining up for or against the latest bill being proposed. Our great academic institutions and our esteemed medical schools have historically spoken for the cause of medicine, but these days many medical schools are more like big companies with complex financial interests in large hospitals and clinical practices.  What about the large foundations dedicated to health care, such as the Robert Wood Johnson Foundation or the Kaiser Family Foundation? I think their voices have become more potent as they seem largely free of the kinds of conflicts of interest that bind many of us, but they are not quite the voice of medicine.

Before we are irretrievably sucked into Washington's political maneuvering, we desperately need doctors and nurses to speak for the art of medicine. As William Osler, the father and spokesperson of modern medicine said a century ago:

You are in this profession as a calling, not as a business; as a calling which exacts from you at every turn self-sacrifice, devotion, love and tenderness to your fellow-men. Once you get down to a purely business level, your influence is gone and the true light of your life is dimmed. You must work in the missionary spirit with a breadth of charity that raises you far above the petty jealousies of life. . .

I know of primary-care doctors who give their weekends to clinics for the homeless; I know of specialists who volunteer their services to community nonprofits. At a time when many practitioners turn down Medicare and Medicaid patients because government reimbursements don't even pay for overhead costs, others continue to treat them. Long before concierge medicine made house calls fashionable and lucrative, practitioners I know in Laredo and El Paso made home visits to the housebound, poor and elderly. And then of course there is our new Surgeon General - a dedicated primary care physician, a strong signal from the President about the kind of doctors the nation needs.

Physicians like those should speak up for medicine, and argue in favor of paying doctors to spend time with their patients. They should fight against a payment system that has created perverse incentives that encourage unnecessary treatments. Let's make it as lucrative to talk to the patient as it is to do to the patient.

A physician who gets to know the patient can discuss difficult subjects such as end-of-life care while the patient is still relatively healthy -- often sparing them the pain and huge expense of spending their last days of life in an intensive care unit. Physicians with good relationships with their patients can guide them away from futile therapies whose only proven efficacy is making money for drug companies, hospitals and doctors. How wonderful if all our lobbying societies would agree that our goal should be to fulfill Dr. Peabody's old maxim, and not to simply restate it generation after generation: "The secret of the care of the patient is in caring for the patient."

Abraham Verghese is a practicing internist and a professor of medicine at Stanford. His most recent book is Cutting for Stone.

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

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9.      Book Review: The Anti-Smoking Crusade

FOR YOUR OWN GOOD - The Anti-Smoking Crusade and the Tyranny of Public Health,
by Jacob Sullum

Jacob Sullum, Reason Magazine, editor and featured speaker at the Banquet of the 55th Annual Meeting of the Association of American Physicians and Surgeons in Raleigh, North Carolina on October 10, 1998, spoke on "Doctor's Orders: How Public Health Lobbyists Prescribe Morality." With many Tobacco suits having been settled since Sullum's address, a look at his book is enlightening. On the frontispiece, the author quotes former Surgeon General C. Everett Koop: "1984: I believe the ultimate goal should be a smoke-free society by the year 2000; 1996: From my point of view, anything that stops smoking is good." The second quotation, though disturbing, lends perspective to the issues Sullum discusses.

As conference participants noted, most physicians are to the right of center, while many of our leaders and administrators are to the left of center. Unfortunately, because those left of center often prejudge the motives of those right of center, a reason-based discussion becomes difficult. Sullum's book deals with principles and he asserts that even when the goals of both sides are identical, those on the left see the issues not as a matter of principle, but of expediency. Those on the right perceive the efforts of those on the left to try to rescue tens of millions of smokers as an exercise in tyranny that resorts to censorship, punitive taxes, and violations of property rights.

Sullum begins by pointing out the prejudices inherent in the voice of reason. He works for Reason magazine, published by Reason Foundation, a think tank to which Philip Morris Companies contribute. Although the Reason Foundation does not support tobacco research, and tobacco contributions are less than 1% of the revenues, Sullum has been accused of being in an industry-financed conspiracy to undermine the anti-smoking movement. Some refer to "Mr. Sullum and his tobacco patrons." How can one prevent all contributions from organizations of questionable merit?

Sullum has learned about his own motives. When only 10 years old, he put up "Thank You For Not Smoking" signs around the family home and hid the ashtrays his parents had for their guests. Years later he realized that he had not been concerned about the guests' health-- he was on a power kick based on moral superiority.

Sullum's next self-realization came after giving up his crusade for a smoke-free society. He began to understand that freedom to make choices comes from accepting responsibility for the consequences of one's actions, agreeing with John Stuart Mill that the only time a person should be made to do something against their will, is when their action harm others--"his own good, either physical or moral, is not a sufficient warrant." . . .

Sullum valiantly strikes for a return to reason. The lack of reason among the numerous members of the anti-smoking forces prevents them from understanding freedom to choose, personal liberty and responsibility, and rational behavior. However, our efforts must continue or we will lose life, liberty, and the pursuit of happiness.

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The Book Review Section Is an Insider's View of What Doctors Are Reading and Writing.

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10.  Hippocrates & His Kin: Short Story

Crap "was a dumb thing to say"

In the mid-1980s, Gerald Ratner took over as chief executive of the family jewellery chain. He transformed it from 130 stores with sales of £13m into a public company with 2,500 stores and sales of more than £1.2bn. Then in 1991 he made a speech at the Institute of Directors referring to his products as "total crap" and boasting that some of his earrings were "cheaper than a prawn sandwich". The speech, instantly seized on by the media, wiped an estimated £500m from the value of the company. He left the business the following year. By Emma Jacobs, FT, 7-16-10

What a way to lose a half billion.

Are we getting more like Europe?

The only similarity between the US and Europe is that we have the Grande Canyon and they've got a bottomless pit. -Pauline Skypala, FT July 12, 2010.

Don't Worry, Pauline. We will also have a bottomless pit shortly.

Side Effects

I'm not sure what is worse: not knowing the side effects of certain medications or knowing the side effects of certain medications.  -by Charles Memminger

The side effects of some sleeping pills can scare you sleepless.

"There is no right way to do a wrong thing" 

The owner of the Phoenix Suns basketball team, Robert Sarver, opposes AZ's new immigration laws.

Arizona 's Governor, Jan Brewer, released the following statement in response to Sarver's criticism of the new law:
"What if the owners of the Suns discovered that hordes of people were sneaking into games without paying?
What if they had a good idea who the gate-crashers are, but the ushers and security personnel were not allowed to ask these folks to produce their ticket stubs, thus non-paying attendees couldn't be ejected.
What if Suns' ownership was expected to provide those who sneaked in with complimentary eats and drink?
And what if, on those days when a gate-crasher became ill or injured, the Suns had to provide free medical care and shelter?" -Arizona Gov. Jan Brewer

"What If" analogies put issues into perspective.

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

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

                      John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to

                      Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .

                      PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .

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

                      FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder,, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser's view on today's health care problem: In today's proposals for sweeping changes in the field of medicine, the term "socialized medicine" is never used. Instead we hear demands for "universal," "mandatory," "singlepayer," and/or "comprehensive" systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this "nationalized financing" or "nationalized health insurance." In a more honest day, it was called socialized medicine.

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

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

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

                      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 OpEd 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

                      ReflectiveMedical Information Systems (RMIS), delivering information that empowers patients, is a new venture by Dr. Gibson, one of our regular contributors, and his research group which will go far in making health care costs transparent. This site provides access to information related to medical costs as an informational and educational service to users of the website. This site contains general information regarding the historical, estimates, actual and Medicare range of amounts paid to providers and billed by providers to treat the procedures listed. These amounts were calculated based on actual claims paid. These amounts are not estimates of costs that may be incurred in the future. Although national or regional representations and estimates may be displayed, data from certain areas may not be included. You may want to follow this development at During your visit you may wish to enroll your own data to attract patients to your practice. This is truly innovative and has been needed for a long time. Congratulations to Dr. Gibson and staff for being at the cutting edge of healthcare reform with transparency. 

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

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

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

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

                      The Association of American Physicians & Surgeons (, The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: How Dr. Berwick Will Control Your Doctor & You. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read: New Rules: The pace of the transformation change promised by candidate Obama is breathtaking. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.

Doctors Sue to Overturn the Health Care Bill  Monday, March 29th, 2010
The Association of American Physicians and Surgeons (AAPS) became the first medical society to sue to overturn the newly enacted health care bill, the Patient Protection and Affordable Care Act (PPACA). AAPS sued Friday in the U.S. District Court for the District of Columbia.

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Words of Wisdom

"Nothing can stop the man with the right mental attitude from achieving his goal; nothing on earth can help the man with the wrong mental attitude." - Thomas Jefferson: Third U.S. President

"High expectations are the key to everything." - Sam Walton: the founder of Wal-Mart Corporation

"You can have it all. Just not all at once." - Oprah Winfrey: Television host, publisher, and book critic

Some Recent Postings

THE INNOVATOR'S DILEMMA by Clayton M. Christensen . . .

CLONING OF THE AMERICAN MIND - Eradicating Morality Through Education, by B. K. Eakman . . .

FALSE HOPES - Why America's Quest for Perfect Health Is a Recipe for Failure by Daniel Callahan . . .

In Memoriam

Pius Mau Piailug, master navigator, died on July 12th, aged 78,
Economist, Jul 22nd 2010

IN THE spring of 1976 Mau Piailug offered to sail a boat from Hawaii to Tahiti. The expedition, covering 2,500 miles, was organised by the Polynesian Voyaging Society to see if ancient seafarers could have gone that way, through open ocean. The boat was beautiful, a double-hulled canoe named Hokule'a, or "Star of Gladness" (Arcturus to Western science). But there was no one to captain her. At that time, Mau was the only man who knew the ancient Polynesian art of sailing by the stars, the feel of the wind and the look of the sea. So he stepped forward.

As a Micronesian he did not know the waters or the winds round Tahiti, far south-east. But he had an image of Tahiti in his head. He knew that if he aimed for that image, he would not get lost. And he never did. More than 2,000 miles out, a flock of small white terns skimmed past the Hokule'a heading for the still invisible Mataiva Atoll, next to Tahiti. Mau knew then that the voyage was almost over.

On that month-long trip he carried no compass, sextant or charts. He was not against modern instruments on principle. A compass could occasionally be useful in daylight; and, at least in old age, he wore a chunky watch. But Mau did not operate on latitude, longitude, angles, or mathematical calculations of any kind. He walked, and sailed, under an arching web of stars moving slowly east to west from their rising to their setting points, and knew them so well—more than 100 of them by name, and their associated stars by colour, light and habit—that he seemed to hold a whole cosmos in his head, with himself, determined, stocky and unassuming, at the nub of the celestial action.

Sharing breadfruit

Setting out on an ocean voyage, with water in gourds and pounded tubers tied up in leaves, he would point his canoe into the right slant of wind, and then along a path between a rising star and an opposite, setting one. With his departure star astern and his destination star ahead, he could keep to his course. By day he was guided by the rising and setting sun but also by the ocean herself, the mother of life. He could read how far he was from shore, and its direction, by the feel of the swell against the hull. He could detect shallower water by colour, and see the light of invisible lagoons reflected in the undersides of clouds. Sweeter-tasting fish meant rivers in the offing; groups of birds, homing in the evening, showed him where land lay. . . .

Read the entire obituary . . .

On This Date in History - July 27

On this date in 1866, the Atlantic cable between England and the U.S. was completed. Our age of communications that began in the middle of the nineteenth century has been growing ever since. The Atlantic cable made it possible for news to cross the ocean immediately, and that, in turn, speeded up the tempo of events to a pace never before known. What we say or do here will - if it makes news - be out in no time.

On this date in 1953, the Korean armistice was signed in Panmunjom after two years of seemingly endless negotiations. It was an uneasy truce for decades thereafter, and its anniversary reminds us that a tense peace has only one thing to recommend it, namely that it is better than a hot war. The hardest part often is trying to decide whether the settlement is really a step forward at all.

After Leonard and Thelma Spinrad


The 7th Annual World Health Care Congress

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

The 7th Annual World Health Care Congress was held April 12-14, 2010
Washington, DC
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In partnership with, the Annual World Health Care Congress is the most prestigious meeting of chief and senior executives from all sectors of health care. The 2010 conference convened 2,000 CEOs, senior executives and government officials from the nation's largest employers, hospitals, health systems, health plans, pharmaceutical and biotech companies, and leading government agencies. Please watch this section for further reports in the future as well as