Community For Better Health Care

Vol X, No 6, June 28, 2011


In This Issue:

1.                  Featured Article: It’s Worse Than You Think

2.                  In the News: What happened to Doctor—Patient Confidentiality?

3.                  International Medicine: Long Waits Cost Canadians Millions

4.                  Medicare: The Obama deficits portend a gloomy future.

5.                  Medical Gluttony: Non Emergency Care in Emergency Rooms

6.                  Medical Myths: Medicare Price Controls will save the government money

7.                  Overheard in the Medical Staff Lounge: Medical Practice is Changing

8.                  Voices of Medicine: Drug Expiration Date: Part II: A Costly Illusion

9.                  The Bookshelf: A Common Sense Platform for the 21st Century  

10.              Hippocrates & His Kin: A World Food Crisis?

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

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

* * * * *

Always 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 any single payer initiative, was born for the benefit of the state and of a contemptuous disregard for people’s welfare.

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

* * * * *

1.      Featured Article: It’s Worse Than You Think                                                                           

The Heartlander, Joseph L Bast, President
The bimonthly membership newsletter for The Heartland Institute.

Bast: Obamanomics - It’s Worse Than You Think

The official unemployment rate is back up to more than 9 percent, and the percent of workers who are unemployed or have given up trying to find jobs is higher than it was during the Great Depression.

George W. Bush may have owned the Great Recession of 2008–2009, but Barack Obama owns the Second Great Depression of 2011. His policies – call them Obamanomics – are to blame.

It Started with Higher Taxes

President Obama signed his first major tax increase into law just 16 days into his presidency, a 62-cents-per-pack tax increase on cigarettes. It broke his campaign promise not to increase taxes “a single cent” on households making less than $250,000 a year.

If it weren’t for furious public backlash during the 2010 elections, Obama would have reversed the 2001 and 2003 tax cuts, causing the top income tax rate to rise from 35 to 39.6 percent and the lowest rate to rise from 10 to 15 percent. The capital gains tax rate would have risen from 15 to 20 percent, and the dividends tax rate from 15 percent to 39.5 percent in 2011 and then another 3.8 points in 2013. The marriage penalty would have returned, and the child tax credit would have been cut in half. . .

Obama buried more than $500 billion in tax hikes over ten years in Obamacare, including a 10 percent tax on tanning salons, a $60 billion tax on insurance premiums, a $26.3 billion tax on medical device manufacturers, a $27 billion tax on prescription drugs. Starting in 2013, the 3.8 percent Medicare payroll tax will apply to investment income, a move that is expected to raise $123 billion over seven years.

Obamacare increases the Medicare hospital insurance payroll tax by 31 percent on income over $200,000 for singles and $250,000 for couples, expected to raise $86.8 billion over seven years. The itemized deduction from federal income taxes for medical expenses is reduced by raising the threshold from 7.5 percent of adjusted gross income to 10 percent, expected to raise $15.2 billion a year.

The tax deduction for employer-provided retirement prescription drug coverage is reduced, expected to raise $4.5 billion. And starting in 2018, a new special tax of 40 percent will apply to insurance policies costing more than $10,200 for individuals and $27,500 for families.

All this comes on top of a corporate income tax that is the highest of the 34 nations in the Organization for Economic Cooperation and Development. (Our combined state and federal rate is 39.2 percent, versus number two Japan at 35 percent.) Little wonder, then, that the recession was never as deep in other countries and their recovery has outpaced that of the U.S.

Then Came the Spending Increases

In his first year in office, Obama championed and signed into law a $787 billion “stimulus” act. Average spending for federal agencies rose by more than 50 percent between 2008 and 2010.

Federal government spending is now between 24 percent and 25 percent of GDP, up from 18 percent to 19 percent during the George W. Bush years.

The federal government now borrows 40 cents for every dollar it spends. In February, Obama unveiled a $3.73 trillion spending plan for 2012 with a projected deficit of $1.5 trillion. That comes on top of deficits of $1.3 trillion in 2010 and $1.4 trillion in 2009. The annual deficit, which was going down under Bush, jumped from 1.1 percent of GDP in 2007 to 11 percent this year.

Interest on the debt costs us $225 billion a year; the total debt stands at $14.2 trillion, 80 percent of GDP. That’s the highest since World War II.

Proposed cuts of $1 trillion or even $2 trillion over ten years sound enormous, but they shave barely ten percent off the proposed deficits, never mind actual spending. Just to get spending and deficits back to pre-Obama levels, spending has to be cut by $1 trillion a year, ten times what even most Republicans are talking about.

And Then Came Obamacare

Obama signed the Patient Protection and Affordable Care Act ... all 3,256 pages of it ... into law on March 23, 2010.

Most of the provisions don’t go into effect until 2014, but some of the taxes to fund it started immediately. By counting ten years of revenues and only six years of expenses, the administration was able to claim it will reduce the federal debt over the next ten years.

The Congressional Budget Office says the act will increase federal spending by $1 trillion over the first ten years ... but if you start the clock four years later, the cost rises to $2.4 trillion. This is the most expensive legislation ever approved by Congress and signed by a president. And these estimates almost certainly under-estimate real costs.

Obamacare creates more than 150 new bureaucracies, agencies, boards, commissions, and programs, including an Independent Payment Advisory Board with a mandate to cut Medicare spending by $3 trillion over the next 20 years.

Government officials are empowered to tell physicians what quality health care is and what it is not, and to tell insurers what health insurance they can sell, and to tell employers and individuals what insurance they must buy. It redistributes premium income among insurers under a new “risk adjustment” mechanism to ensure successful companies subsidize less successful companies.

This is all right out of “Atlas Shrugged.”

And no, you will not be able to keep your current doctor, or your current insurance company. Chances are, your current employer will dump you into the insurance exchange, where you may or may not get any subsidy toward your insurance premiums, depending on your income. If you make more than the poverty level and currently get insurance through your employer, chances are your insurance costs will go up.

What will happen to the quality of health care in America? We can look at Britain and Canada to see what happens when government discourages investment, fixes prices, and rations care. Long waiting lines for tests and surgery; millions of people suffering chronic pain unnecessarily; thousands of people dying every year while waiting.

Some consequences of Obamacare will be less visible but no less damaging: Less investment in care for the most vulnerable, such as premature babies and the elderly; no more progress in the war on cancer; no more investment in new drugs and therapies.

Where To From Here?

So ... things are pretty bad! But as my old friend Bob Genetski used to tell me, “big problems mean big payoffs when they are solved.” Just simplifying the tax code, for example, could have a huge effect on economic efficiency.

The biggest battles right now ... the ones you need to get involved in, in order for us to win, are:

·                     Don’t raise the debt ceiling. Either freeze it, or make an increase contingent on major entitlement reform. This is being debated as this issue of The Heartlander goes to press, and it appears Republicans ... even Paul Ryan ... are prepared to compromise too soon and too easily with this president. . .

·                     The 2012 budget must reduce actual spending, not merely freeze discretionary spending at current levels as Obama proposed. Ryan’s plan is a good starting point, but it could be improved to achieve a balanced budget sooner.

·                     Block implementation of Obamacare. The House voted to defund it, but the Senate won’t follow suit. States can and should refuse to implement insurance exchanges.

·                     Take on the public-sector unions ... on collective bargaining rights, benefits, and pensions specifically. . .

·                     Vastly and rapidly expand school choice. High levels of spending on public K-12 schools is unsustainable, and school choice is a proven way to cut spending while improving quality. . .

·                     Vastly and rapidly expand development of the nation’s energy resources. We are the Saudi Arabia of coal and natural gas, and our oil reserves are growing fast, too. The only thing standing between us and energy independence is anti-energy policies. Remove them, and drill, baby, drill!

Obamanomics is very much worse than you thought ... but it can be stopped and undone. In the process, we can take back the country we love.
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

* * * * *

2.      In the News: What happened to Doctor—Patient Confidentiality?

Your Medical Secrets Are No Longer Safe

By Betsy McCaughey

Friday, 17 Jun 2011 11:57 AM

Congressman Anthony Weiner announced that he is seeking treatment for sexual “addiction.” A private person would want to keep that mortifying information to himself. But soon it may be difficult to keep any sensitive medical information strictly between you and the doctor you consult. The stimulus legislation of 2009 and the Obama health law enacted the following year established a national electronic health database that will hold and display your lifelong medical history.

Government will oversee the network linking doctors and hospitals. Doctors will have to enter your treatments in the database, and your doctors’ decisions will be monitored for compliance with guidelines imposed by the Secretary of Health and Human Services.

The stimulus legislation allocated billions for incentive payments to doctors and hospitals to become part of the network. In 2015, incentives get replaced with penalties on the doctors and hospitals that have not complied.

And Sec.1311 of the Obama health law says private health plans can pay only doctors who implement whatever the federal government dictates to improve “quality.” That could cover everything in medicine.

Before the Obama health law, patients who voluntarily bought insurance shared information with their insurer. Now government regulators will have access.

The advantage of an electronic medical record is obvious. When you need emergency care, a doctor can access your past illnesses, tests, and treatments with the click of a mouse. It will reduce testing, save money, and sometimes save a life. But there are dangers.

Mark Rothstein, a bioethicist at the University of Louisville School of Medicine, worries that the system discloses information that is no longer relevant but could be embarrassing. Your oral surgeon extracting a tooth doesn’t need to know about your erectile dysfunction or your bout with depression twenty years earlier. Nevertheless, it will be visible.

Federal proposals to protect privacy have been half-hearted. On May 31, the Department of Health and Human Services proposed allowing patients to request a report on who has electronically viewed their information. After the fact is too late. Patients should have to give consent before their doctor links their record to a nationwide database.

The National Committee on Vital and Health Statistics, a federal advisory committee, proposed permitting patients to keep categories of information, such as mental or reproductive health, out of the national data base.

The Goldwater Institute, a free market think tank suing to overturn the Obama health law, argues that the law violates privacy rights by compelling Americans to share “with millions of strangers who are not physicians, confidential private and personal medical history information they do not wish to share.”

The other issue is control of the patient’s care. In March, 2009 President Obama appointed David Blumenthal, a Harvard Medical School professor, to oversee the national electronic medical system. Blumenthal explained that his job was not about “just putting machinery into offices.” (New England Journal of Medicine, April 9. 2009) He said that if electronic technology is designed to save money, doctors will have to bow to a higher authority and use “clinical decision support,” medical lingo for computers telling doctors what to do.

Blumenthal, who has since resigned to return to academic medicine, predicted that many doctors would resist, resigning themselves to federal penalties or trying to get the law overturned.

Federal attempts to dictate how doctors treat patients will be challenged. In 2006, the United States Supreme Court struck down an attempt by the Bush administration to interfere in how doctors in Oregon treat terminally ill patients. The justices would not permit “a radical shift of authority from the States to the Federal Government to define general standards of medical practice in every locality.” That’s what the Obama health law does.

Meanwhile, the federal government is pushing ahead, and patients need to know that what occurs in their doctor’s office no longer stays there.

Read more on Your Medical Secrets Are No Longer Safe
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

* * * * *

3.      International Medicine: Long Waits Cost Canadians Millions

By Nadeem Esmail, The Frasier Institute

The national median waiting time in Canada from specialist appointment to treatment increased from 8 weeks in 2009 to 9.3 weeks in 2010.  But the measurement of waiting times, or the examination of the absolute delay Canadians must endure in order to receive medically necessary care, is only one way of looking at the burden of waiting for health care.  We can also calculate the privately borne cost of waiting: the value of the time that is lost while waiting for treatment, says Nadeem Esmail, the Fraser Institute's former Director of Health System Performance Studies and Manager of the Alberta Policy Research Center.

Esmail's estimation of the cost of waiting in 2010 uses a Statistics Canada finding that 11 percent of people were adversely affected by their wait for non-emergency surgery in 2005. 

This results in an estimate that nearly 1.13 million weeks were "lost" while patients waited for treatment.
However, because this estimate is based on the assumption that all individuals face the same wait time for treatment in each specialty/province combination, it is mathematically equivalent to assuming that 11 percent of the productivity of all Canadians waiting for care was lost to a combination of mental anguish and the pain and suffering that accompany any wait for treatment.

Multiplying this lost time by an estimate of the average weekly wage of Canadians in 2010 gives an estimate of the cost of the productive time that was lost while individuals waited for medically necessary treatment in 2010.

The estimated cost of waiting for care in Canada was roughly $10,043 for each individual among the 11 percent of patients in the queue. That works out to roughly $912 million in lost productivity and leisure time.

This estimate assumes that only those hours during the average work week should be counted as lost. Valuing all hours of the week, including evenings and weekends but excluding eight hours of sleep per night, at the average hourly wage would increase the estimated cost of waiting to more than $2.79 billion, or about $3,384 per person.

Source: Nadeem Esmail, "The Private Cost of Public Queues," Fraser Institute, March/April 2011.

For text:

For more on Health Issues:

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

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

In case you missed it above: The average cost of being on the waiting list is $3,384 per person.

* * * * *

4.      Medicare: The Obama deficits portend a gloomy future.

Commentary by Pete du Pont, The Wall Street Journal, February 16, 2010

Is it, as President Reagan's re-election commercial said, "morning in America"? Back then it was, but not anymore; it is economic evening in America as our nation's spending, government programs and deficits balloon. The federal deficit this fiscal year will be $1.6 trillion, or about 10.6% of gross domestic product. That is the largest deficit since World War II, and even President Obama's optimistic estimates show our deficits will not return to sustainable levels for at least the next decade.

The administration's projection of total federal spending over those 10 years (2011-20) is $45.8 trillion, while expected taxes and other receipts will be $37.3 trillion. The $8.5 trillion deficit is about 20% of spending. And all of these numbers are based on a full and lasting economic recovery, which, based on current experience, is a pretty optimistic projection.

Earlier this month, The Wall Street Journal's editorial page did an analysis of the federal government's debt that will be held by the public over the coming decade. When the Democrats took control of Congress in 2007, the debt held by the public was 36.2% of GDP. It rose to 40.2% the next year. This year it will be about 63.6%, next year 68.6%, then 77% of GDP in 2020. And the Obama administration's budget estimates 218% in 2050.

The reason for these rising deficits is the huge increases in federal spending--the intended growth of the federal government--that Congress and the president are pushing. The deficit in 2007 was $160 billion. In the next year the Pelosi-Reid Congress took it up to $458 billion, and when President Obama came into office in 2009 it hit $1.4 trillion. The current 2010 projected deficit is $1.6 trillion, which will lead to a tripling of our national debt from 2008 to 2020.

To the White House and congressional Democrats, these large figures are not a surprise, a mistake or a worry. They part of a strategy to Europeanize America, to make the government larger, broader and in charge of almost everything. And that would of course require broad and massive tax increases. The Washington Post's Robert Samuelson calculated that to fund all the future deficit expenditures would require taxes to increase "by roughly 50 percent from the average 1970-2009 tax burden." A 50% tax increase would become a permanent part of a declining America, just as such tax increases have become a permanent part of declining European countries.

Or as Sen. Judd Gregg, top Republican on the Budget Committee, put it the other day, this huge deficit spending "is a death certificate to the American dream for our children. Their lives will be mortgaged by the debt we put on their backs." Michael Boskin, chairman of the Council of Economic Advisers under the first President Bush, noted in The Wall Street Journal last week that President Obama will have added more debt in his first two years in office than George W. Bush did in eight years. In his first 15 months, Mr. Obama will have raised the debt burden as a percentage of GDP by more than President Reagan did in all of his eight years.

This administration wants larger, not smaller government; broader, not lesser regulation; and greater government, not greater individual liberties. That would make our country weaker on the international stage, make it much more difficult for us to handle future recessions, and even more difficult to implement new programs or strategies that may be needed to improve our economy. Lawrence Summers, now director of the president's National Economic Council, once asked, "How long can the world's biggest borrower remain the world's biggest power?" Obviously not very long, and we are rapidly moving in the wrong economic direction.

Mr. Boskin also pointed out that all this "is by a large margin the most risky fiscal strategy in American history." As noted above, the national debt will rise to more than double GDP, and once it gets close to 100%, Mr. Boskin adds, there will be "a dramatic slowing of economic growth by at least one percentage point a year," since people will expect higher taxes, higher interest rates and no visible resolution of the enormous and unsustainable deficits that have come to pass.

All of this means we are indeed beginning to see a new America, dusk rather than dawn, Europeanization rather than the life, liberty and the pursuit of happiness that has brought us the world's best economy and a standard of living for which the rest of the world strives. Unfortunately, that economy was yesterday's, but will not be tomorrow's.

View in PDF
Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

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

- Ronald Reagan

It is evening in America

 * * * * *

5.      Medical Gluttony: Non Emergency Care in Emergency Rooms

A patient was referred to me for a chronic cough of several months duration. His physician thought this might be allergic and prescribed an albuterol inhaler. The patient didn’t think he had asthma so saw no reason to use it.

His family persuaded him to go to the emergency room the day before his appointment with me. He was not worse that day. His family was just getting tired of hearing him cough. He was given a cough syrup and told to be sure he kept his appointment with me since cough is one of the most frequent symptoms of lung disease.

When seen, the Emergency Room treatment did not help. However, he had a chest x-ray, electrocardiogram, lab work, scans, and CT of the chest, which he stated were all normal.

He didn’t have his albuterol inhaler with him, so we elected to measure his Pulmonary Function first and confirmed that it was an allergic cough with his PFT showing rather significant asthma. We then proceeded to administer the Albuterol inhaler for the post bronchodilator study. His coughing stopped immediately. If we had given him the bronchodilator initially, then the PFT may have returned to normal and the diagnosis not have been convincing. Doing the PFT out of sequence (before the usual medical history followed by physical examination followed by the PFT) allowed a diagnostic pulmonary testing that confirmed the diagnosis.

We then proceeded into completing the medical history, the remainder of the physical examination, and then it was time for the post bronchodilator PFT, which is usually done 20 minutes after the albuterol. The second PFT was nearly normal. Thus we were able to confirm a diagnostic asthma study.

Our entire consultation, physical examination and PFT were about $400. The ER charge at our hospital is $600 for the room before any testing is done. The average charge of the ER visit is usually ten times that.

He had experienced the cough for several months. If he had fended off his family and avoided a useless ER visit since he had a pulmonary consult scheduled the following day, he would have saved the considerable hospital ER charge. Hospital charges are not transparent, but let’s assume the ER visit was $4,000 (most would be more like $6,000 to $9,000), he obtained definitive care in my office for 10% of his ER visit.

When this was brought to the family’s attention, they replied they couldn’t wait another day. After three months of coughing, “Can’t wait one more day?” They would rather have a non-Pulmonologist evaluate a pulmonary complaint and spend thousands of dollars of premium money (theirs and others with the same company), which is entirely Medical Gluttony.

What’s the answer? In our experience and research, this type of Medical Gluttony will not be affected by any government mandate until the co-payment changes from the usual $25 or $50 to a percentage co-payment. To prevent abuse and not interfere with necessary health care, the ER co-pay should be 20%. On a $600 basic charge, that would be $120 cash or credit card at the registration desk. Our research suggests that about 90% of non-emergency care would turn away from the registration desk and keep the next day appointment, previously made in this case. The few that feel they have an emergency may change their mind during the course of the next six hours of waiting in the ER after realizing that wait was half way towards tomorrow’s appointment with a specialist.

Thus Medical Gluttony stops immediately on the same day, the same visit, and is prevented in the future.
What an easy and quick way to control health care costs.

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Medical Gluttony thrives in Government and Health Insurance Programs with Full Coverage.

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

* * * * *

6.      Medical Myths: Medicare Price Controls will save the government money

Sally Pipes: PIPING UP: Senior Citizens Will Pay Dearly For Health Care Price ControlsSenior Citizens Will Pay Dearly For Health Care Price Controls

Squabbles over spending cuts have ruled the negotiations over increasing the debt ceiling. But even after the ink is dry on the budget deal just passed, lawmakers will still be charged with reducing federal spending further.

One proposal that refuses to die would impose price controls on prescription drugs in the Medicare Part D program. Sen. Jay Rockefeller (D-W.Va.) and Rep. Henry Waxman (D-Calif.) are the latest lawmakers to advocate such an approach.

Price controls may seem like a tempting way to save the government money on prescription drugs, but in reality, they’ll force seniors to pay more for the drugs they need — or worse, deprive them of access to critical medicines. . .

Nevermind that Part D’s costs have been about 40 percent lower than the Congressional Budget Office’s (CBO) initial estimates. Or that Part D plans have negotiated rebates on brand-name prescription drugs of between 20 and 30 percent — which they’ve passed onto beneficiaries in the form of lower premiums.

Critics of the program believe that prices could still be lower.

They draw their inspiration from Medicaid. The federal government legally requires drugmakers to pay several rebates for drugs consumed by Medicaid patients. Experts estimate that the average rebate for a brand-name drug in 2011 reaches 40%.

Of course, a mandated 40-percent discount is larger than the 20% to 30% rebates that are the norm currently in Part D. CBO therefore projects that instituting Medicaid-style price controls in Part D for the low-income Americans eligible for both Medicare and Medicaid could save up to $112 billion over 10 years.

That begs an important question. If Medicaid is able to secure bigger rebates than Part D, wouldn’t both patients and the government benefit from extending Medicaid’s price controls to Medicare’s low-income beneficiaries, at the very least?

In a word, no. According to a new analysis from former CBO Director Douglas Holtz-Eakin and economist Michael Ramlet, instituting Medicaid-style rebates in Part D would drive beneficiaries’ monthly premiums up between 19.6% and 39.4%.

All told, Holtz-Eakin and Ramlet project that new rebates in Part D would increase seniors’ annual out-of-pocket drug costs by $1.5 to $3.7 billion. That translates to as much as $208.80 in additional costs for every senior — every year.

Why the huge increases? A phenomenon known as “cost-shifting.”

Drug manufacturers won’t just absorb the financial hit associated with paying higher rebates to the government. They’ll pass those costs along. So insurance plans participating in Part D will not be able to secure the rebates of 20-30 percent they’d received pre-price controls, as drug companies will have less room to negotiate.

Consequently, seniors will pay more for coverage.

Privately insured folks will similarly face higher prescription-drug prices, as manufacturers try to shore up their balance sheets.

Indeed, as Dr. Scott Gottlieb, an economist and practicing physician, stated in testimony before the Senate’s Special Committee on Aging, “Mandatory rebates create a strong incentive for companies to launch drugs at higher prices in anticipation of the payments that they will have to provide to the states and the federal government.”

In other words, the cost-savings associated with extending Medicaid-style price controls are entirely illusory — particularly if drug makers just raise prices before the new rebates go into effect.

Meanwhile, the evidence suggests the Part D as currently structured is actually lowering drug costs across the market. According to one recent study, average retail prices for non-Medicare patients are down 5.4% — yielding savings of about $2.6 billion per year.

As Gottlieb put it in his testimony, the “economic benefits of Part D’s competitive structure . . . spill over into the rest of the commercial market.”

Make no mistake — lawmakers must find ways to trim federal spending. But expanding Medicaid-style price controls into Part D will not deliver the savings promised. Instead, premiums will rise, benefits will fall, and seniors will bear costs far greater than any of Uncle Sam’s potential savings.

Sally C. Pipes is President, CEO, and Taube Fellow in Health Care Studies at the Pacific Research Institute. Her latest book is The Truth About Obamacare (Regnery 2010).

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Medical Myths Originate When Someone Else Pays The Medical Bills.

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

* * * * *

7.      Overheard in the Medical Staff Lounge: Medical Practice is Changing

Dr. Edwards: Is anyone noting a change in their practice composition? I have a private and managed care combination. I take my share of Medicaid patients. But now I’m feeling like I’m getting the Medicaid through the HMO door surreptitiously.

Dr. Dave: I have gotten my fill of Medicaid patients. They miss too many appointments. They don’t follow through on recommendations and are generally noncompliant. They call the office for minutiae with no appreciating for tying up a receptionist for 10 or 15 minutes at $20 to $25 an hour. Costs go up and income goes down.

Dr. Ruth: I have my share of Medicaid or Welfare patients. But I never joined an HMO and thus my practice is not a’ changing. I just never wanted anyone to take advantage of me. I regulate my time to the nearest 10 minutes since I'm jockeying patient and family time.

Dr. Kaleb: I’ve been able to take any patient that calls for an appointment. Over the two years I’ve been in practice, my schedule is essentially full. So I can be more selective. At the present time I would estimate that I have 50 percent Medicaid, 40 percent Medicare and the rest a variety of patients. But my accountant says I will have to start being more selective. The 50 percent Medicaid patients bring in less than 10 percent of my income. But they occupy close to two-thirds of my time. We have a new baby at home and I scarcely see him. I really think that I could increase my practice to 75 percent Medicaid and increase my hours to 70 per week instead of 60 and have less income for more work and less time with my wife and baby.

Dr. Milton: I have tried to balance my practice as much as I can. I see about 20 percent Medicaid, 40 percent managed care and 40 percent Medicare and private patients. I’m beginning to see the same thing that Edwards is seeing, more Medicaid are slipping into my practice through the HMO door. And I don’t appreciate that.

Dr. Yancy: Hey you guys better get use to that. That’s the name of the Obama game. Better get that desk out of your office, replace it with a fold down writing area and add a second door to your office or you’ll never make it through the day.

Dr. Rosen: That’s also my understanding of what’s happening. With 35 million folks in Medicaid, and with Obama planning to place another 35 million, it will totally overwhelm the system and us. But we can’t be sure as to how much duplication there is. When Pew did his statistics that came up with 35 million uninsured, many of the Medicaid patients checked off “Uninsured.” They felt that since they couldn’t find a doctor, they basically didn’t have any significant insurance coverage. So we may find that a lot of the uninsured already have Medicaid. So the Obama plan won’t help them.

Dr. Sam: There is only one solution to all these problems. That is to get the government out of health care.

Dr. Dave: That’s easier said than done.

Dr. Sam: If all doctors quit accepting insurance, the problem would be over.

Dr. Dave: If you quit accepting insurance and go on a cash basis, you won’t have any patients.

Dr.  Sam: You miss understood me. If ALL DOCTORS quit accepting insurance, there would only be a week or two of no patients. They then start drifting in and before long you would have a huge snow bank full of patients.

Dr. Rosen: What most doctors don’t realize is that without insurance, even if you dropped your fees 50 percent, that would still top what you get from Medicaid. Then competition would keep the price low and the volume up. That would essentially solve the health care crisis. No government interference. No health insurance to police what we do. No copying of our patient charts for outside review of our quality, which already is the best in the world. We would have just a confidential Doctor-Patient interface. Everyone would be happy. Everyone would be happy except the health insurance companies and the government. But we’re not in the business of making the government and health insurance companies happy. We’re in the business of providing excellent care to our patients and making them well and happy. That will never happen in government control or mandated medicine.

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

* * * * *

8.      Voices of Medicine: A Review of Regional Medical Journals: Drug Expiration Dates: Part II

Bulletin of the Humboldt-Del Norte County Medical Society,March 2011


The Drug Expiration Date: Part II: A Costly Illusion

Last month’s Bulletin editorial began a discussion of pharmaceutical expiration dates. This is the second in the series . . .

The FDA Regulations

Since 1979 the FDA has required that drug products bear an expiration date determined by appropriate stability testing (21 CFR 211.137 and 211.166). The FDA defines the expiration date as “the date placed on the container/labels of a drug product designating the time during which a batch of the product is expected to remain within the approved shelf life specifications if stored under defined conditions, and after which it may not be used.” Federally mandated shelf life specifications require drugs to safely maintain 90% of their originally labeled content.  There are exceptions for those drugs with a narrow therapeutic index.

The Morphing of the Expiration Date

There is a substantial body of evidence that pharmaceutical manufacturers are not determining the length of time that their drugs remain safe and effective1,3,4,5. Current FDA enforcement policy allows them instead to choose an arbitrary date and to perform tests demonstrating safety and potency as of that selected date only, and label that arbitrary date as the drug’s expiration date. According to the Pharmaceutical Research and Manufacturers of America (PhRMA), marketed prescription drug products in the U.S.  have expiration dates ranging from 12 to 60 months from the time of manufacture. In practice the industry has chosen to set the maximum arbitrary date on the more conservative side. “Two to three years is a very comfortable point of commercial convenience,” said Mark van Arandonk, senior director for pharmaceutical development at Pharmacia & Upjohn Inc, when quoted in a Wall Street Journal article on this subject4.  In short, the much touted and legally enforced ‘expiration date’ is more accurately described as an ‘arbitrary quality assurance date’. The continued use of the term ‘expiration date’ (to expire means to come to an end, to die) is a falsehood that perpetuates a costly illusion.

Enter the USP’s ‘Beyond Use’ Date

The United States Pharmacopeia (USP) is a non-governmental, official public standards-setting authority for prescription and OTC medicines and other healthcare products manufactured or sold in the United States. In 1985 the USP declared that once the manufacturer’s original shipping container is opened and the drug product is transferred to another container for dispensing or repackaging, the expiration date no longer applies. They urged that all medications dispensed in this fashion be relabeled with a one-year maximum “Beyond Use” date stating, “Do not use after ___.” In 1997 the USP made this a requirement for participating pharmacists and by 2000, 17 states had passed laws mandating that their pharmacists comply. According to the AMA, there is little scientific basis for this action, yet for some reason current AMA policy (Policy H-115.983) supports it6. Thus the misleading ‘expiration date’ has been upgraded into an even more illusory ‘beyond use’ date requiring pharmacists to order patients to discard potentially safe and effective medications (see SLEP study below) yearly. Do patients really do this? A Wall Street Journal survey of 1000 patients found that 70% said they would not take outdated prescription medicines and 72% said they would not take expired OTC meds.

The DoD/FDA Shelf Life Extension Program (SLEP) 1,2

As I mentioned in last month’s article, in 1985 the military questioned the validity of expiration dating and asked the FDA to see if these dates had a basis in fact. They didn’t. They were not even close. In 88% of 3005 lots of 122 drug products eventually tested, they found that the drugs remained stable for an average of 66 months longer than their labeled expiration date.3 In SLEP’s first year, these significant shelf life extensions saved the Department of Defense (DoD) 59 times the cost of testing by obviating the need for discarding perfectly good medications. Between the years of 1993 and 1998, for $3.9M in testing, SLEP saved over $263M in drug wastage. The pharmaceutical companies have never found fault with SLEP’s procedures or scientific determinations.  The following are some specific SLEP findings that might be of interest. As you read them, understand that according to the 1992 FDA SLEP director Francis Flaherty, the outdate extensions SLEP authorizes are “intentionally conservative,” in that if SLEP extended an outdate by 36 months it had concluded that the drug would be safe and effective (maintaining at least 90% of its labeled active ingredient without degrading into toxic substances) for at least 72 months.4


In 1963 G.W. Frimpter et al reported in JAMA, (184:111) that outdated tetracycline degraded into a toxic substance, causing kidney damage and reversible Fanconi’s syndrome. This has been the only known study to purport that a prescription medication became toxic with age. Despite the fact that other studies failed to confirm this report, the spread of this misperception continues to ensnare physicians and pharmacists.

In fact the current (2010) Merck Manual listing for tetracycline still proclaims this illusion of toxicity. The SLEP study determined that this perception is not supported by fact. To the contrary, SLEP found tetracycline to be quite stable. If stored correctly it can be used safely for years beyond its stated expiration date.


Bayer gives a 2-3 year outdate label on their aspirin and states that it should be destroyed after that date. SLEP found that this product was good for at least 4 years from manufacture, and Dr. Jens Carstensen, professor emeritus of pharmacy at the University of Wisconsin found that it was still stable after 5 years. Interestingly, the 2010 Merck Manual states that aspirin, too, becomes toxic beyond its stated expiration date. Like tetracycline, this toxicity is not supported by fact. Acetylsalicylic acid (ASA) may break down into salicylic acid and acetic acid (the active ingredient in vinegar) after prolonged exposure to heat and humidity, but neither substance is toxic at these levels. Salicylic acid was actually a precursor of aspirin (ASA) and is still being used as an anti-inflammatory.


The DoD maintains a large stockpile of Cipro (Bayer) to deal with the threat of disseminated anthrax. It carries a 3 year outdate. SLEP was asked to evaluate Cipro stability and found the tablets to safely maintain potency for at least 13 years after manufacture.

Atropine injectable:

Not a common household medication, “Costly, Continued From Page 3 this drug is used in hospitals and clinics world wide to control secretions and cardiac arrhythmias. It’s also important in the treatment of nerve gas poisoning. The standard military outdate was for 2 years after manufacture. SLEP found it to be stable for 15 years after manufacture.

Pralidoxime HCL autoinjector:

This nerve gas antidote carried an initial shelf life of 5 years. SLEP found it to be safe and effective for 18 years.

Diazepam autoinjector:

This anti-seizure medication (Valium) carried an initial shelf life of 4 years. SLEP extended it to 9 years.

Doxycycline tablets:

Its initial shelf life was 2 years. SLEP found it still safe and effective at 7 years.

The list goes on and on:

Penicillin, Thorazine, Tagamet, Lasix, Dilantin, potassium iodide, captopril, cefoxitin, each had their outdates extended by SLEP investigators.

Summary to Date:

It is clear from the above data that, as the FDA’s SLEP director stated years ago4, expiration dates (and by extension, ‘beyond use dates’) have essentially no bearing on whether or not a drug is usable for a longer period. The stated expiration date does not mean or even imply that a given drug will stop being effective or become harmful after that date. That is the simple truth. It appears that the FDA has abdicated its responsibility to enforce compliance with the expiration date regulations, for instead of requiring drug makers to determine a drug’s actual expiration date, — that is, when it can be reasonably expected to become unsafe and/or lose more than 10% of its declared potency—the FDA has allowed the industry to create “arbitrary quality assurance dates” and falsely label them “expiration dates” or, even worse, as “beyond use” dates. But then, as a former FDA expiration date compliance chief, Joel Davis, once said: “It’s not the job of the FDA to be concerned about a consumer’s economic would be up to Congress to impose changes.”4

1 Extending the Shelf Life of Critical Chemical, Biological, Nuclear and Radiological (CRBN) Medical Materiel Using the FDA/DoD Shelf Life Extension Program Oct 1, 2009

2 SLEP Website homepage:

3 Lyon RC, Taylor JS, Porter DA, et al. Stability profiles of drug products extended beyond labeled expiration dates. J Pharm Sci 2006;95(7):1549-1560.

4 Cohen LP. Many medicines prove potent for years past their expiration dates. Wall Street Journal. March 28, 2000.            

5 Maximizing State and Local Medical Countermeasure Stockpile Investments Through the Shelf-Life Extension Program. Brooke Courtney, Joshua Easton, Thomas V. Inglesby, and Christine SooHoo Biosecurity and Bioterrorism: Volume 7, Number 1, 2009 © Mary Ann Liebert, Inc. DOI: 10.1089/bsp.2009.0011 URL: website/resources/publications/2009/2009-03-27-max_st_local_med_cntr.html 

6 American Medical Association. (2008, February). Report 1 of the Council on Scientific Affairs (A001): Pharmaceutical expiration dates. §

This editorial will be continued next month as we look a bit more at SLEP and also at some of the costs – social, environmental and political – of the drug expiration date illusion.

Read the entire OpEd . . .

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

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

* * * * *

9.      Book Review: A Common Sense Platform for the 21st Century  

A Common Sense Platform for the 21st Century by Beverly Eakman, Midnight Whistler Publisher,  © 2010, ISBN 1452887721 (soft cover); ISBN-13: 978-1452887722, (soft cover)

Book Review: A Common Sense Platform for the 21st Century, Posted on by carlstrauss.

A Common Sense Platform for the 21st Century (Platform) has been formulated by award winning author and columnist Beverly K. Eakman. Among a long list of credentials and works, Ms. Eakman has most recently contributed feature length articles to The Washington Times, National Review, and The Washington Post. She was also Editor in Chief of NASA’s official newspaper, and chief speechwriter for Chief Justice Warren E. Burger. Ms. Eakman’s award winning books include Educating for the New World Order, and Cloning of the American Mind: Eradicating Morality through Education. A more comprehensive list of Ms. Ekman’s background and works can be found herePlatform (Midnight Whistler Publishers) is available in paperback and in Kindle format. Among other locations, it can be found at Amazon (ISBN: 1452887721).

Ms. Eakman’s new book contains a platform for candidates and political groups who might be best described as Constitutionalists, or more casually referred to as freedom loving Americans. Aside from the platform itself, the author guides us through the reasons for the need of a new platform. This is done through a review of both positive and negative events in American history, as well as the mind-set that has led to the events that have put us in our current, unenviable position. Tea Party people are definitely the prime audience for this book, but the real world problems, and common sense solutions provided, would likely spark active thought in anyone willing to give the book a chance. This is critical if the new American Revival is to reach past the choir and out to those who are not yet paying full attention. The movement to reinstate Constitutional principles must reach past the Tea Party if it is to succeed. Platform takes a long stride in this direction.

Within Platform’s 120 pages, Ms. Eakman does a nice job of condensing the common sense notions that drift through so many minds, but given busy lifestyles, don’t often thicken into complete and organized thoughts. For example, she points to the obsession that the Boomer generation seems to have with rules and limitations. It is both gratifying and eye-opening when she leads us to consider both the irony and the danger of this fixation. One way she does this is by highlighting the gap between modern American attitudes and the more traditional mode of American thinking.

“[M]odern Americans, on the whole, do not equate accelerating incursions into their daily lives or the overabundance of rules, regulations and handouts with control, dependency and collectivism. Indeed, talk of self-sufficiency today is akin to being called a “loner,” and we are reminded daily that loners are dangerous, on a level with sociopaths.”

This statement and others like it trumpet how the American spirit has been altered, and ultimately, the book offers ideas on how to correct for this sway.

It’s funny to have to mention, but many of the thoughts expressed in Platform are so commonly sensible that they may actually seem drastic to some modern political observers. In “Section 6—The Platform,” the following concept is presented.

“No single agency of government can hold power greater than the people’s elected representatives, and no elected representative can attest to powers greater than the legal citizenry that keeps him or her in office.”

This is simple enough, but a timely example of the need for the restoration of this concept can be found in the recent FCC “Net Neutrality” decree. Factually, creating federal regulations is specifically restricted to Congress (see the U.S. Constitution: Article I, Section 1, sentence 1). However, three of five unelected and unaccountable administrators at the FCC voted, and simply granted themselves the power to regulate aspects of the Internet for 300 million people. This is power that our representatives in Congress (the people) have refused to award to them, and that the courts (the guardians of justice) have actually ruled illegal. This is regulation without representation, and is just the sort of thing Ms. Eakman is referring to in the above quote.

The reader will find that most of the concepts presented in Platform have been presented before—one way or the other. However, the importance of this book lies in its success in pulling these common sense ideas together into a one-stop political guidebook. The platform itself is well organized, the problems and solutions presented are timely and understandable, and there are a couple of sections that are openly reminiscent of this country’s founding era. These elements are well mixed to make Platform educational, motivational, and even exciting.

There is just one aspect of Platform that falls into the “disappointment” category. It’s painful to disclose, but there are several noticeable typing errors (Paperback, First Edition, October 2010). Platform as a whole is great, and is full of little gems (get your highlighter out). However, the scattered editing mistakes may obscure the book’s greater points when perused by a reluctant or skeptical reader. Certainly, the book should have been more thoroughly proofread.

The Constitution is the rule book for Washington, but the players have ignored the rules for decades. This is because the people have not been paying attention. The luxury that results from a society founded in liberty has distracted us, and now we are faced with the loss of our liberty, as well as the subsequent loss of the abundance that goes with it. We must begin to pay attention and be involved, and then remain vigilant thereafter. Platform is an excellent guidebook for this pursuit, a guidebook that can lead us back to Constitutional principles. In this respect, rather than calling it a guidebook, Platform might be better described as a treasure map.

This entry was posted in Limited Government, The Cause, Uncategorized. Bookmark the permalink.


This book review is found at 

To read more book reviews . . .

To read book reviews topically . . .

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

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

* * * * *

10.  Hippocrates & His Kin: A World Food Crisis?

The NASA space shuttle program goes into cyberspace or limbo?

The John F Kennedy race to the moon is finished after 40 years with the 135th departure in the 30-year-old shuttle program with Atlantis’ last flight. The herds of satellites occupying orbital space have made modern communications possible. They are integral not only to communications but also social media, business transactions, military operations and surveillance, surveys for charting world resources and climate, and the GPS devices that help us keep tract of ourselves and others. The Challenger and Columbia disasters set back the program, which never approached an early objective to fly every few weeks at a cost of $7 million a flight mushrooming to $1.5 billion a mission.

That’s a 200-fold increase in cost over projections.
About like other government programs such as Social Security and Medicare.

With 14 trillion in debt and each family owing $125,000 is America now the poorest country in the world?

A World Food Crisis?

Countless experiments have established that increased carbon dioxide levels not only speed up plant growth, but enable plants to do better under stressed conditions of drought, pollution and attacks by insects and fungi. –Independent Institute

The Beneficial Side of Global Warming?

Read More . . .

Please complete these forms so we can deliver oxygen to your patient.

A request from Medicaid asks “Does your patient still need oxygen?”

No. The patient died on March 23, 2011. There is no further need for oxygen.

Could you give us the last oxygen saturation level to verify that he no longer needs oxygen?

Assuming the casket is permeable to oxygen, his Saturation of Oxygen is 20%.

We then got a 12-month authorization that our patient still needs oxygen.

I wish it were this easy to get oxygen for living hypoxic patients.

To read more HHK . . .
To read more HMC . . .

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

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

* * * * *

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.

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.

To read the rest of this section, please go to

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

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

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

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

ReflectiveMedical Information Systems (RMIS), delivering information that empowers patients, is a new venture by Dr. Gibson 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

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

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

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

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

Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives. He now has a new column with Richard Dolinar, MD, worth reading at

The Association of American Physicians & Surgeons (, The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians. Be sure to read News of the Day in Perspective: HuffPo & Public Radio praise free market health care solutions. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.

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

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

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

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

Words of Wisdom

“Only government can take perfectly good paper, cover it with perfectly good ink, and make the combination worthless.” –Reagan on Paper Money

The Constitution is not an instrument for the government to restrain the people; it is an instrument for the people to restrain the government - lest it come to dominate our lives and interests.” - Patrick Henry

Some Recent Postings

In The June 14 Issue:

1.      Featured Article: How Social Media Shapes Medical Practice

2.      In the News: The Costly Bureaucracy of Medical Board Certification

3.      International Medicine: Americans are assuming reform that Russia has abandoned.

4.      Medicare: America has changed its course, perhaps forever.

5.      Medical Gluttony: The Private vs Public Welfare System

6.      Medical Myths: Missed Appointments Save Money

7.      Overheard in the Medical Staff Lounge: The High Cost of Health Care

8.      Voices of Medicine: Drug Expiration Date: A Costly Illusion

9.      The Bookshelf: The Story of Dr. Sidney R. Garfield

10.  Hippocrates & His Kin: Public Pensions are a Black Hole for taxpayers

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

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

In Memoriam

Sir Patrick Leigh Fermor, traveller, writer and war hero, died on June 10th, aged 96

The Economist | Jun 16th 2011 | from the print edition

ONE evening in the spring of 1934, 19-year-old Patrick Leigh Fermor, making his way on foot from the Hook of Holland to Constantinople, found himself taking tea under flowering horse-chestnut trees at the kastely of Korosladany, in Hungary.

We sat talking until it was lighting-up time, and indoors pools of lamplight were being kindled with spills along the succession of lavender-smelling rooms. It lit the backs of bindings, pictures, furniture which had reached exactly the right pitch of faded country-house shabbiness, curtains laundered hundreds of times over and music open above the keys of a piano. What music? I can’t remember; but suddenly, sailing into my mind after all these years, there is a bowl on the piano of enormous white and red peonies and a few petals have dropped on the polished floor.

Wherever he went, the dusty young traveller stumbled on scenes like this. His hosts in the oddest corners of central Europe dressed in black tie for dinner, played ferocious bicycle polo in the courtyard, or catalogued their butterfly collections in cavernous libraries where he could lose himself deliriously among folios, almanacs and scrolls with dangling seals. They lent him pearl-handled pistols and a superb chestnut horse “with more than a touch of Arab to his brow” to take him across the plains. Long Turkish nargileh were indolently smoked, Tokay swigged from cut glass; while, upstairs, staff would be neatly laying out on his bed the rumpled canvas trousers and thin tweed jacket which were the smartest clothes he had, purchased for his odyssey from Millet’s army surplus in the Strand.

He had set out on his great walk for a jumble of reasons, but mostly to have fun. He felt “preternaturally light”, as he left London, “as though I were already away and floating like a djinn escaped from its flask.” Formal education didn’t suit him; the wild, noisy boy couldn’t bear to be hemmed in with rules or bounds, and had been expelled from King’s Canterbury for holding hands with a greengrocer’s daughter. Yet he loved books, especially the tales of Sir Walter Scott and Charles Kingsley’s “Heroes”, and could now see himself as a knight or a wandering scholar, going from castle to castle or, just as happily, sleeping in woods and barns or under the stars.

In his rucksack he carried, besides pencils and notebooks, poetry. As he went he recited Keats, Marlowe and Shakespeare, astonishing the rustics he met—just as he would later amaze his dinner guests, in Worcestershire or in his Elysian house by the sea in deepest Greece, with non-stop recitations, arcane facts, stories and songs, not infrequently ending with “It’s a Long Way to Tipperary” sung in Hindi.

He was a compulsive autodidact, wanting to know the names and nature of everything. Entering a strange region, he would grapple with its history, rifling through the Encyclopedia Britannica and Meyers Konversationslexicon to trace the movements of tribes and the collision of cultures, producing in his books whole page-lists of Klephts and Armatoles, Kroumides and Koniarides, Phanariots of the Sublime Porte and boyars of Moldowallachia, until his readers swooned. With the same high-spirited eagerness, and a flask full of local fire-water, he would run into taverns, caves, shepherd huts and gypsy camps, hungry to pick up the unknown language and join in. Dashing and courteous, splendidly handsome, he wished often for the strange hats he saw, bowler or thin-brimmed, foot-high or scarlet-plumed, in order to flourish them high to all the people who wished him well.

Critics of his two best-loved books, “A Time of Gifts” (1977) and “Between the Woods and the Water” (1986), complained that he swanned through 1930s Europe without noticing the clouds. . . Though both books were written decades after the event, he added no politics to them. Culture, beauty, romance and laughter were what he saw and cared for. . .

He refused a knighthood almost to the end, pointing out that he had written only a slow handful of books. This was true. He had become famous largely for chronicling a Europe that had been swept away, and had spent a charmed life without a regular job, fed—as he liked to put it—like Elijah, by the ravens. But he had done more. His wandering, writing life evoked the essential unity of Europe, the cultural and linguistic intertwinings and layer upon layer of shared history; and all with a lightness, and an infectious joy, that inspired many others to set out in the same way.

Read the entire obituary in The Economist – Subscription required . . .

On This Date in History – June 28

On this date in 1914, Gavrilo Princip, a Serbian revolutionary, who apparently with some knowledge on the part of the Serbian government, planned a blow against Austria-Hungary by assassinating Austria’s Archduke Francis Ferdinand in Sarajevo, Bosnia. The killing of the heir to the throne of the Austro-Hungarian Empire was the trigger for World War I.

On this date in 1919, the Treaty of Versailles was signed which ended World War I, on the same date on which War had been triggered in 1914, which some say was poetic justice. However, wrapping things up so neatly does not make the package palatable. The United States never ratified the Treaty of Versailles because it contained provisions for the League of Nations, which the United States did not join.

After Leonard and Thelma Spinrad

* * * * *

Thank you for joining the MedicalTuesday.Network and Have Your Friends Do the Same. If you receive this as an invitation, please go to, enter you email address and join the 10,000 members who receive this newsletter. If you are one of the 80,000 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. To subscribe to our companion publication concerning health plans and our pending national challenges, please go to and enter your email address. Then go to the archives to scan the last several important HPUSA newsletters and current issues in healthcare.

Please note that sections 1-4, 6, 8-9 are entirely attributable quotes and editorial comments are in brackets. Permission to reprint portions has been requested and may be pending with the understanding that the reader is referred back to the author's original site. We respect copyright as exemplified by George Helprin who is the author, most recently, of “Digital Barbarism,” just published by HarperCollins. We hope our highlighting articles leads to greater exposure of their work and brings more viewers to their page. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.

ALSO NOTE: 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, as a service to his patients, his profession, and in the public interest for his country.

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: Also subscribe to our companion newsletter concerning current and future health care plans:

Del Meyer      

Del Meyer, MD, Editor & Founder

6945 Fair Oaks Blvd, Ste A-2, Carmichael, CA 95608

Feedback . . .
Subscribe MedicalTuesday . . .
Subscribe HealthPlanUSA . . .

Announcing The 1st Annual World Health Care Congress Latin America, October, 2011 in
São Paulo, Brazil

The World Health Care Congress (WHCC) convenes the most prestigious forum of global health industry executives and public policy makers. Building on the 8th annual event in the United States, the 7th annual event in Europe and the inaugural Middle East event, we are pleased to announce the 1st Annual World Health Care Congress - Latin America to be held in October, 2011 in São Paulo, Brazil.

This prominent international forum is the only conference in which over 500 leaders from all regions of Latin America will convene to address access, quality and cost issues, including Latin American health ministers, government officials, hospital/health system executives, insurance executives, health technology innovators, pharmaceutical, medical device, and supplier executives.

World Health Care Congress Latin America will address escalating challenges such as improving access to quality care, financing and insurance models for health care, driving innovation in health IT, promoting evidence-based medicine and clinical best practices. World Health Care Congress Latin America will feature a series of plenary keynotes, invitational executive Summits, in-depth working group sessions on emerging issues, as well as substantial business development and networking opportunities.