Community For Better Health Care

Vol IX, No 23, March 8, 2011


In This Issue:

1.                  Featured Article: Taming the Wild

2.                  In the News: Artificial intelligence is developing much more rapidly than most of us realize.

3.                  International Medicine: Here’s the ugly truth about government-controlled health care

4.                  Medicare: Medicare Newsletters may be more important to read than Medical Journals

5.                  Medical Gluttony: ER visits are becoming a separate circular practice which is gluttonous

6.                  Medical Myths: The Practice of Medicine is a Myth to most attorneys

7.                  Overheard in the Medical Staff Lounge: Professional Organizations

8.                  Voices of Medicine: ObamaCare Is Already Damaging Health Care

9.                  The Bookshelf: Stammering George the Sixth

10.              Hippocrates & His Kin: Troopers Hunt for Wisconsin Senators

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

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

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The Annual World Health Care Congress, a market of ideas, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 8th Annual World Health Care Congress will be held April 4-6, 2011 at the Gaylord Convention Center, Washington DC. For more information, visit The future is occurring NOW.

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1.      Featured Article: Animal Domestication

Taming the Wild

Only a handful of wild animal species have been successfully bred to get along with humans. The reason, scientists say, is found in their genes.

By Evan Ratliff, National Geographic

Photograph by Vincent J. Musi

"Hello! How are you doing?" Lyudmila Trut says, reaching down to unlatch the door of a wire cage labeled "Mavrik." We're standing between two long rows of similar crates on a farm just outside the city of Novosibirsk, in southern Siberia, and the 76-year-old biologist's greeting is addressed not to me but to the cage's furry occupant. Although I don't speak Russian, I recognize in her voice the tone of maternal adoration that dog owners adopt when addressing their pets.

Mavrik, the object of Trut's attention, is about the size of a Shetland sheepdog, with chestnut orange fur and a white bib down his front. He plays his designated role in turn: wagging his tail, rolling on his back, panting eagerly in anticipation of attention. In adjacent cages lining either side of the narrow, open-sided shed, dozens of canids do the same, yelping and clamoring in an explosion of fur and unbridled excitement. "As you can see," Trut says above the din, "all of them want human contact." Today, however, Mavrik is the lucky recipient. Trut reaches in and scoops him up, then hands him over to me. Cradled in my arms, gently jawing my hand in his mouth, he's as docile as any lapdog.

Except that Mavrik, as it happens, is not a dog at all. He's a fox. Hidden away on this overgrown property, flanked by birch forests and barred by a rusty metal gate, he and several hundred of his relatives are the only population of domesticated silver foxes in the world. (Most of them are, indeed, silver or dark gray; Mavrik is rare in his chestnut fur.) And by "domesticated" I don't mean captured and tamed, or raised by humans and conditioned by food to tolerate the occasional petting. I mean bred for domestication, as tame as your tabby cat or your Labrador. In fact, says Anna Kukekova, a Cornell researcher who studies the foxes, "they remind me a lot of golden retrievers, who are basically not aware that there are good people, bad people, people that they have met before, and those they haven't." These foxes treat any human as a potential companion, a behavior that is the product of arguably the most extraordinary breeding experiment ever conducted.

It started more than a half century ago, when Trut was still a graduate student. Led by a biologist named Dmitry Belyaev, researchers at the nearby Institute of Cytology and Genetics gathered up 130 foxes from fur farms. They then began breeding them with the goal of re-creating the evolution of wolves into dogs, a transformation that began more than 15,000 years ago.

With each generation of fox kits, Belyaev and his colleagues tested their reactions to human contact, selecting those most approachable to breed for the next generation. By the mid-1960s the experiment was working beyond what he could've imagined. They were producing foxes like Mavrik, not just unafraid of humans but actively seeking to bond with them. His team even repeated the experiment in two other species, mink and rats. "One huge thing that Belyaev showed was the timescale," says Gordon Lark, a University of Utah biologist who studies dog genetics. "If you told me the animal would now come sniff you at the front of the cage, I would say it's what I expect. But that they would become that friendly toward humans that quickly…wow."

Miraculously, Belyaev had compressed thousands of years of domestication into a few years. But he wasn't just looking to prove he could create friendly foxes. He had a hunch that he could use them to unlock domestication's molecular mysteries. Domesticated animals are known to share a common set of characteristics, a fact documented by Darwin in The Variation of Animals and Plants Under Domestication. They tend to be smaller, with floppier ears and curlier tails than their untamed progenitors. Such traits tend to make animals appear appealingly juvenile to humans. Their coats are sometimes spotted—piebald, in scientific terminology—while their wild ancestors' coats are solid. These and other traits, sometimes referred to as the domestication phenotype, exist in varying degrees across a remarkably wide range of species, from dogs, pigs, and cows to some nonmammalians like chickens, and even a few fish.

Belyaev suspected that as the foxes became domesticated, they too might begin to show aspects of a domestication phenotype. He was right again: Selecting which foxes to breed based solely on how well they got along with humans seemed to alter their physical appearance along with their dispositions. After only nine generations, the researchers recorded fox kits born with floppier ears. Piebald patterns appeared on their coats. By this time the foxes were already whining and wagging their tails in response to a human presence, behaviors never seen in wild foxes.

Driving those changes, Belyaev postulated, was a collection of genes that conferred a propensity to tameness—a genotype that the foxes perhaps shared with any species that could be domesticated. Here on the fox farm, Kukekova and Trut are searching for precisely those genes today. Elsewhere, researchers are delving into the DNA of pigs, chickens, horses, and other domesticated species, looking to pinpoint the genetic differences that came to distinguish them from their ancestors. The research, accelerated by the recent advances in rapid genome sequencing, aims to answer a fundamental biological question: "How is it possible to make this huge transformation from wild animals into domestic animals?" says Leif Andersson, a professor of genome biology at Uppsala University, in Sweden. The answer has implications for understanding not just how we domesticated animals, but how we tamed the wild in ourselves as well.

The exercise of dominion over plants and animals is arguably the most consequential event in human history. Along with cultivated agriculture, the ability to raise and manage domesticated fauna—of which wolves were likely the first, but chickens, cattle, and other food species the most important—altered the human diet, paving the way for settlements and eventually nation-states to flourish. By putting humans in close contact with animals, domestication also created vectors for the diseases that shaped society.

Yet the process by which it all happened has remained stubbornly impenetrable. Animal bones and stone carvings can sometimes shed light on the when and where each species came to live side by side with humans. More difficult to untangle is the how. Did a few curious boar creep closer to human populations, feeding off their garbage and with each successive generation becoming a little more a part of our diet? Did humans capture red jungle fowl, the ancestor of the modern chicken, straight from the wild—or did the fowl make the first approach? Out of 148 large mammal species on Earth, why have no more than 15 ever been domesticated? Why have we been able to tame and breed horses for thousands of years, but never their close relative the zebra, despite numerous attempts?

In fact, scientists have even struggled to define domestication precisely. We all know that individual animals can be trained to exist in close contact with humans. A tiger cub fed by hand, imprinting on its captors, may grow up to treat them like family. But that tiger's offspring, at birth, will be just as wild as its ancestors. Domestication, by contrast, is not a quality trained into an individual, but one bred into an entire population through generations of living in proximity to humans. Many if not most of the species' wild instincts have long since been lost. Domestication, in other words, is mostly in the genes.

Yet the borders between domesticated and wild are often fluid. A growing body of evidence shows that historically, domesticated animals likely played a large part in their own taming, habituating themselves to humans before we took an active role in the process. "My working hypothesis," says Greger Larson, an expert on genetics and domestication at Durham University in the United Kingdom, "is that with most of the early animals—dogs first, then pigs, sheep, and goats—there was probably a long period of time of unintentional management by humans." The word domestication "implies something top down, something that humans did intentionally," he says. "But the complex story is so much more interesting."

Continue » Read the entire article at National Geographic . . .  
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2.      In the News: Watson When Computers Beat Humans on Jeopardy

On Feb 16, the IBM computer Watson and former champions Ken Jennings and Brad Rutter concluded their series of challenges on the TV quiz show Jeopardy!      And the winner was—resoundingly—humankind.


“In healthcare, we talk about turning data into knowledge. That’s really what Watson does.”

Joe Jasinski, Program Director, IBM Healthcare and Life Sciences Research

Medical records, texts, journals and research documents are all written in natural language – a language that computers traditionally struggle to understand. A system that instantly delivers a single, precise answer from these documents could transform the healthcare industry.

Thought leaders including Dr. Herbert Chase, Professor of Clinical Medicine at Columbia University School of Physicians and Surgeons, share their thoughts on how the DeepQA technology that powers Watson could impact the way doctors diagnose and treat patients.

Smarter Answers for a Smarter Planet

Watson represents the latest in a long line of groundbreaking innovations from a company dedicated to building a Smarter Planet. Watson combines major advances in deep analytics and system design into a solution with the possibility to transform entire industries.

Watch as Sam Palmisano, Chairman and CEO of IBM, explains how this technology will impact the way humans communicate with computers and what this means for industries like healthcare, finance and customer service.

“Watson is the latest example of IBM's 100-year history of scientific discovery.”


Over the past three days,the TV show "Jeopardy!" featured a showdown between a clever IBM computer system called Watson and the two greatest "Jeopardy!" champions. Watson won handily. It won the preliminary practice round, tied Monday's opening round, and won by large margins on Tuesday and Wednesday. The point has been made: Watson can compete at the championship level—and is making it more difficult for anyone to argue that there are human tasks that computers will never achieve.

"Jeopardy!" involves understanding complexities of humor, puns, metaphors, analogies, ironies and other subtleties. Elsewhere, computers are advancing on many other fronts, from ...

Read the entire article in the WSJ – Subscription required . . .
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3.      International Medicine: Here’s the ugly truth about government-controlled health care

Despite UK Government Pledge, Dying Cancer Patients Are Refused Life-Extending Drugs On Cost Grounds.

Here’s the ugly truth about government-controlled health care in the UK:  people die.   It happens because the government can’t afford to treat them all, so they ration who gets the meds. Too bad for you if you don’t fit their formula.

The UK's Telegraph (2/26, Donnelly) reported that an investigation by The Sunday Telegraph uncovered "more than 80 cases in which desperately sick NHS patients have been refused the cancer drugs their doctor sought, in the four months since a £200 million fund was introduced to stop health authorities rationing treatments." The fund was developed by the "Coalition so that those suffering from cancer would never again be refused drugs on grounds of cost." But in its first "four months, the fund has paid for approximately 1,300 patients' drugs -- even though research last March suggested up to 20,000 cancer patients' lives were being shortened each year by drugs rationing." 

“A few extra months towards the end of a patient’s life can mean the difference between seeing a child get married or graduate.”

Barbara Moss, 56, from Worcester, became one of the most high-profile cases to be refused drugs by the NHS after she was diagnosed with bowel cancer.

After doctors said that without Avastin she would only live for a matter of months, her 86-year-old mother gave her funds to pay for the drugs.

More than four years later, the former schoolteacher is “climbing mountains and enjoying every moment” of life.

Her case, featured in The Sunday Telegraph, was among several to trigger a public outcry about the way NHS rationing decisions are made, resulting in a Conservative party election manifesto pledge last year to set up the £200 million drugs fund. . .

Read the entire report in the Telegraph. . . .
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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

The UK National Health Service does not give timely access to cancer drugs—only to a death wait.

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4.      Medicare: Medicare Newsletters may be more important to read than Medical Journals

All Medicare providers are eligible to earn a 1 percent incentive on their total Medicare Part B allowed charges by electronically prescribing a total of 25 times from Jan. 1 to Dec. 31, 2011 and having at least 10 percent of their total Medicare Part B charges made up of denominator codes.  

Additionally, providers who want to avoid a 1 percent penalty in 2012 must report an e-prescribing measure through their claims at least 10 times between Jan. 1 and June 30, 2011. Furthermore, providers who successfully report the e-prescribing measure in 2011 will also be exempt from a 1.5 percent penalty in 2013. CMS requires that this submission be performed through claims; providers are not allowed to use a registry or electronic health record (EHR) to avoid the penalty in 2012.

If you plan to participate in the EHR incentive program in 2011, you will not be eligible to collect the 1 percent e-prescribing bonus. CMS does not allow physicians to collect both bonuses. However, since NPs and PAs are not eligible for the Medicare EHR incentive program, they can continue collecting the e-prescribing bonus.

Will these one percent bonuses pay for the extra time to read the rules to win and become indentured slaves to Medicare?

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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: ER visits are becoming a separate circular practice which is unaccountable.

Patients have become sophisticated in gaming the Medicaid and Medicare system. Since more and more tests and procedures involved a delay, pre-authorization, problems in obtaining a physician consult who accepts Medicare and Medicaid; patients are going more frequently to the emergency rooms since they can short circuit the entire controls to referrals with diagnostic testing order directly in the Emergency Departments without any insurance oversight or controls. While it might take a week or two to get authorization for an MRI in the outpatient setting, it is done within the hour from the emergency room. A specialist consult may take weeks for approval. However, if the emergency room physician feels that a neurology consult is required to move the patient to the next stage, it will be accomplished, frequently with in the hour rather than weeks.  

A patient recently went to the emergency room for what she considered sinus congestion with a stuffy nose. Rather than treat this symptomatically and empirically, a CT scan of the sinuses was obtained for possible sinusitis. Although this was read as negative, the ENT consultant thought he saw a deviated septum and told the patient to make an appointment with him so he could straighten it surgically. But before she comes to his office, he advised her to obtain an allergy consultation which he also arranged and which she did. A whole battery of allergy tests were done, which is not, an insignificant charge. All were negative. She made an appointment with the ENT surgeon to have her deviated septum surgically straightened. She was advised to stop by her personal physician to obtain an ECG prior to the surgery.

On reviewing her chart while the ECG was obtained, the above studies were discussed with the patient. On reviewing the CT of the sinuses, she was appalled that they were read as negative for a deviated septum or for any sinus infection which she was led to believe was present. She was given a copy of her ECG and one was sent to her ENT surgeon.

She inquired why she should take a copy to the ENT surgeon.

Rather than get involved in a political confrontation, she was advised to keep the appointment and take a copy of the CT report and discuss it frankly with the ENT surgeon. She left saying she would not sign any surgical permit.

The patient being involved in the decision matter, not only prevented unnecessary surgery, but stopped the exorbitant costs in the tracts, although she already had more than $10,000 worth of unnecessary tests and consults from the Emergency Department. These tests and consults were more than 100 times as expensive as one office visit to obtain the necessary medications for treatment.

Before we cast blame on the Emergency Department, we must understand that they have a different mission which must allow for moving seriously ill and critical patient with all dispatch. Hence, when a patient comes in with an ordinary outpatient medical problem, an element of patient responsibility is necessary. This only comes with a significant co-payment which in our research analysis comes to 20 percent for emergency room visits. That would have stop this exorbitant cost when the MRI was ordered and the patient refused to sign the permit since it would itemize her 20 percent co-payment and she would immediately see that her medical problem did not warrant her paying perhaps $200 of a $1000 list price.

There is no quicker way to fiscal responsibility and restraint in health care than a healthy patient co-payment.

The government regulations are imposed under the rational of controlling costs or practice patterns. However, there are always patients who will be smarter than the government bureaucrats and will be able to work around the regulations and mandates. A hospital administrator once told me, when a new Medicare directive was received, that they frequently hire another administrative specialist to work around the government regulation. The cost of another salary was cheaper than the cost of more government regulations.

There is no other way to reduce health care costs than to remove the government regs and mandates.

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Medical Gluttony thrives in Government and Health Insurance Programs.

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

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6.      Medical Myths: The practice of medicine is a myth to most attorneys.

Medical practice starts with a physician doing a medical history and physical examination. This makes the clinical diagnosis in two-thirds of patient encounters. A few laboratory tests, ECGs, x-rays, PFTs generally confirm the clinical diagnosis in most of the others. Only in very few cases is the diagnosis absolutely certain or sometimes still totally in doubt. Generally we deal in clinical terms treating the best diagnostic impressions.

Lawyers, on the other hand, work in a laws, rules and regulation environment and expect physicians to do the same. You either follow the law, rule or regulation or you’re guilty even if you’ve provided better care than the law, rules or regulations would have allowed.  

The thousands of pages of Obama Laws, Rules, and Regulations in the Health Care Reform Act were primarily written by attorneys. What’s best for patients was not the primary drive. It was usually economics, practice guidelines (usually rules or mandates) that non-medical people can measure and control. This then leads to fines or in the case of physicians, also possible incarceration.   

Patient benefit is never the primary drive in any lawsuit. It’s always whether the hospital or physician is guilty or not guilty.

When I was in medical school in the 1960s, professors of medicine would readily admit their fallibility by wondering out loud how many of their patients were in the grave because of their medical misjudgments. They would then point out new information and research that made diagnosis and treatment more accurate thereby decreasing fatalities. Attorneys look at this as medical error for which someone should be held accountable, judged guilty, fined or other retribution, e.g. loss of property (medical licensure, the basis of our ability to make an income). The point of the professors was to instill in the budding physician of tomorrow a humanity and humility in which we always strive to do our best. Our best is not always good enough in a lawyer’s or judge’s view. When that is not enough, what more is there to give?

As we comply with the Obama laws, rules, regulations and other mandates that circumnavigate the legislative laws, we no longer are able to think of the patient first. Primum non nocere – first do no harm has been the principal precept of medical ethics that all medical students are taught in medical school and is a fundamental principle for emergency medical services around the world. Since at least 1860, the phrase has been for physicians a hallowed expression of hope, intention, humility and recognition that human acts with good intentions may have unwanted consequences.

These concepts are not understood by the legal profession as they outline laws, rules, regulations and mandates. Physicians must now first make sure that they don’t violate the new health care laws, rules, regulations and mandates. The patient’s welfare must now become secondary.

This was exemplified by a senior physician who advised me not to fully evaluate patients admitted to the hospital. He suggested I pick out a primary complaint, evaluate it, treat it and dscharge the patient as soon as possible. Total care was no longer affordable in the current health care environment.

The corollary is seen in Medicare micromanaged healthcare. Physicians and hospitals are pushed to discharge as rapidly as possible. However, if the patient is readmitted, Medicare holds the physician and hospital responsible and may not pay for the readmission since it implies inferior care, which is the likely result of Medicare’s micromanagement.

Thus economics and inferior care, rather than the patient, is the primary concern of medical practice today.

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Medical Myths originate when lawyers or others make medical decisions.

Medical Myths will disappear when Physicians regain charge of their medical practice.

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7.      Overheard in the Medical Staff Lounge: Professional organizations

Dr. Rosen: Do most of us have membership in the local medical society?

Dr. Dave:  I dropped my membership several years ago. I couldn’t see where it helped in any fashion.

Dr. Yancy: I put in an application when I arrived in Sacramento. They found a gap of three months in my curriculum vitae and asked me to explain. Read more

Dr. Rosen: That should not have been hard to do. Wouldn’t they accept that you took three months off? People in training do that, you know.

Dr. Yancy: But I wasn’t in training.

Dr. Rosen: Well, if you were in practice, you certainly could take three months off.

Dr. Yancy: I’m no longer sure just what all the fuss was about. But I just got fed up with the process. They wanted me to withdraw my application.

Dr. Patricia: Well, did you?

Dr. Yancy: I just left it in Limbo and never pursued it further. I felt the society was probably inconsequential to my career and practice.

Dr. Joseph: I was a member for 40 years of practice and when I retired, I was a non-paying senior and kept getting the society magazine and kept up with all the news.

Dr. Sam: Did you think it was worth it?

Dr. Joseph: In those days it was just assumed that you would join the club. The society and the medical board were working fairly closely together.

Dr. Sam: I joined when I started practice, but dropped out of the AMA a short time later. When I no longer felt the CMA was in my interest, I dropped out of everything since the local society requires CMA membership.

Dr. Paul: I never joined. The pediatricians I knew and shared call with said I shouldn’t waste my money.

Dr. Patricia: Were you ever sorry?

Dr. Paul: In pediatrics, we’re basically on the front line and referrals are from other patients and mothers. So we really don’t need to interface with society members. I did join the Pediatric Group on the second Tuesday of the month. That was always a welcome respite with colleagues at our Aldo’s Restaurant.

Dr. Edwards: That reminds me that I belonged to the Internal Medicine Society and we met on the fourth Tuesday of the month also at Aldo’s. But I also enjoyed the Medical Society on the third Tuesday of every month.

Dr. Milton: I, too, enjoyed both of those meetings. There were collegial and educational. I remember the medical society filled the largest ballroom in town at the Sacramento Inn. I believe we had more than 20 tables filled. Now we can scarcely fill three or four tables.

Dr. Edwards: And it’s no longer monthly. It’s three or four times a year. How sad.

Dr. Rosen: As the societies have become irrelevant, what has taken its place?

Dr. Ruth: We formerly had hospital staff meetings every month. These have now also essentially been reduced to once or twice a year.

Dr. Rosen: Since we no longer have the society, specialty and staff meetings, it looks like managed care meetings have replaced these where we are more-or-less told how to perform. We have lost our independence.

Dr. Milton: Any thoughts on how to regain our position in the health care establishment?

Dr. Paul: I just plan to keep on practicing pediatrics and let all the busy bodies try to ruin our practice.

Dr. Milton: All these outsiders and do gooders certainly will not improve our practice.

Dr. Rosen: Maybe that’s why the government, Medicare and lawyers have taken over. There’s no resistance when you’re filling a void.

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The Staff Lounge Is Where Unfiltered Opinions Are Heard.

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

ObamaCare Is Already Damaging Health Care

Many of its changes don't kick in until 2014. But the law is forcing dramatic consolidation and reducing choice in the industry.


The Republicans who now control the House of Representatives hope to repeal or defund ObamaCare, but the law has already yielded profound, destructive changes that will not be undone by repeal or defunding alone. Active steps and new laws will be needed to repair the damage.   

The most significant change is a wave of frantic consolidation in the health industry. Because the law mandates that insurers accept all patients regardless of pre-existing conditions, insurers will not make money with their current premium and provider-payment structures. As a result, they have already started to raise premiums and cut payments to doctors and hospitals. Smaller and weaker insurers are being forced to sell themselves to larger entities.

Doctors and hospitals, meanwhile, have decided that they cannot survive unless they achieve massive size—and fast. Six years ago, doctors owned more than two-thirds of U.S. medical practices, according to the Medical Group Management Association. By next year, nearly two-thirds will be salaried employees of larger institutions.

Consolidation is not necessarily bad, as larger medical practices and hospital systems can create some efficiencies. But in the context of ObamaCare's spiderweb of rules and regulations, consolidation is more akin to collectivization. It means that government bureaucrats will be able to impose controls with much greater ease.

With far fewer and much larger entities to browbeat, all changes in Medicare and Medicaid policies will go through the entire system like a shock wave. There will be far fewer individual insurers, doctors, hospitals, device makers, drug manufacturers, nursing homes and other health-care players to resist.

There is little mystery how the government will exercise its power. Choices will be limited. Pathways to expensive specialist care such as advanced radiology and surgery will decline. Cutting-edge devices and medicines will come into the system much more slowly and be used much less frequently.

This is why simply defunding enforcement of the individual mandate and other upcoming directives will not be enough: Given all this consolidation, limits on treatment choices are already becoming hardwired into the system. Lawmakers must take concrete steps to stop and reverse this.

On the provider end, this means enacting tax and other economic shields for insurers and providers that choose not to succumb to the financial pressure encouraging consolidation. It means unwinding all of the rules—about data compilation, reporting and compliance requirements, and information technology—designed to increase overhead to the point that only massive and easily regulated provider organizations can survive.

Legislators will have to scrub the 2,700-page ObamaCare law line by line to remove all of the disincentives for medical practices, hospitals and others to remain smaller and independent.. /. . .

ObamaCare is already doing great damage, even years before its individual mandate and other controls kick in. Its systematic undoing is an urgent necessity.

Dr. Krieger, is a plastic surgeon

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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 & Cinematic Review: The King’s Speech

Stammering George the Sixth

By Prof Charles Andrews

“Three kings in one year” is the chapter heading for 1936 in The Long Week-End, Robert Graves and Alan Hodge’s social history of Great Britain for the years between the wars. Still one of the most insightful and readable accounts of those years, Graves and Hodge’s 1941 study mentions only in passing the central conceit of Tom Hooper’s new film: “...the King made a broadcast speech, in which he dedicated himself to National Service. It was noted with relief that his voice, though hesitant, carried well and that he only showed one slight trace of a stammer” (357). The King’s Speech is a backstage view of royal life and particularly of the Duke of York’s (Colin Firth) arduous preparations for his reign. King George V (Michael Gambon) died in January 1936, leaving the throne to the charismatic but feckless Edward VIII (Guy Pearce) who abdicated eleven months later. Against his own wishes, the younger brother became King George VI on the eve of World War Two and, more importantly for the film, in an era of mass communication when royalty were no longer distant figures but voices broadcast into their subjects’ living rooms.  

Speaking of a “behind the scenes” look at this historical moment seems particularly apt given that the film functions at one level as a film about theater—political theater staged with the highest stakes as the world collapses into global warfare. Like Mike Leigh’s Topsy-Turvy (1999) which used the stormy partnership of Gilbert and Sullivan as an entry point into social dynamics of the nineteenth century British stage, Hooper’s film focuses on the personal triumph of King George’s speech therapy and the rich-yet-trying friendship with his therapist Lionel Logue (Geoffrey Rush). Around the edges of this central relationship is the rise of Hitler, the maneuvering of Churchill, and the transition from Stanley Baldwin to Neville Chamberlain as Prime Minister. The tension in the film is largely produced by the King’s rehearsals for major public performances—his coronation and his first radio broadcast about the war. Colin Firth fills these rehearsals with self-hating grimaces and delivers each line as though ripping through taciturnity. His portrayal of the King is modeled on the restraint of his breakout role as Mr. Darcy in the BBC’s Pride and Prejudice, though without the damp-shirted virility that propelled him to stardom. Instead, we have a fine actor playing a bad one.

Playing his role as the King, the second son of George V, Firth’s character fears his subjects’ scorn while accepting his fate as their figurehead and national emblem. Looking and sounding the part of monarch is essential to reassuring the public and to retaining the dwindling power of the monarchy. Pretending to have power is the fate of modern British royalty, and in the modern technological era the voice is paramount in this pretense.

Today, new communication technologies such as television and the Internet allow unprecedented access to the up-to-the-second thoughts of public (and private) figures, but The King’s Speech looks back with a kind of wistfulness to the age of the wireless and the newsreel camera as an analogue to our contemporary scene. The Archbishop (Derek Jacobi) notes that mass media is a Pandora’s box that cannot be closed, and we, along with George VI, must agree. Twitter feeds, Facebook walls, and YouTube’s viral videos all seem an extension of Pandora’s furies, and thus we sympathize with the new King who is asked to do what his grandfather never would have. But we also see an era when the politician has much more control over his self-presentation. In a few public appearances, he must act braver than and more eloquent than he really is, but those times are limited and brief. . .

But the film’s emotional core and its most engaging political content is the friendship between Lionel Logue and the King (called, after a tussle with nicknames, “Bertie”). So few films manage to depict friendships among adult men. Rio Bravo (1959) is in a class by itself in many ways, but the most impressive aspect of that film is the warmth and complexity seen in the several generations of men whose friendships deepen throughout their ordeal. Today’s go-to genre for male bonding is the “bromance” popularized by Judd Apatow (Superbad, Funny People, etc.) as an extension of the overgrown man-child comedies of Adam Sandler. This genre, whose charms depend on how hilarious you find unemployed men in their thirties sucking bongs and drifting through gay panic, seems to be the best that current Hollywood can do to represent homo-sociality. In this shadow, The King’s Speech casts a refreshing light by showing two happily married, middle-aged men with children growing emotionally close through a shared project despite their radical differences in class, status, and even nationality. A recurring theme in the film is that Logue’s Australian heritage makes him unfit for British society. At an audition for Richard III, a casting director tells Logue that he doesn’t think their play needs a king “from the colonies.” And there is concern that elocution lessons from an Australian will lead to a rustic accent. Lionel and Bertie’s hard-earned intimacy gives the film its dramatic force, its emotional sensibility, and its political nuance—a remarkable feat in the absence of other models. . .

. . . the way it conveys stage fright, the sweep of history, and the compassion of two men elevates it above any small film morass. The strident eloquence of Hitler, which acts as a counterpoint to King George’s petrified stammer, provides a sinister undercurrent. In the end, stern British stick-to-itiveness prevails, and viewers may leave a bit more concerned for their leaders despite their privilege. In our modern technocracy, it is refreshing to be reminded that two people sharing faith and fate might transcend the anomie of their day.  

Charles Andrews is Assistant Professor of English at Whitworth University.

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The Review Section Is an Insider’s View of What Films and Books Doctors are Seeing & Reading.

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10.  Hippocrates & His Kin: Troopers Hunt for Wisconsin Senators

Playing Cops and Robbers

Wisconsin Republican lawmakers dispatched state troopers to the homes of absent Democratic senators in search of a quorum Thursday but came up empty as the state's legislative standoff continued.

Isn’t it amazing that State Senators are now the fugitives?


Lawyers break through the steel roof.

Big Law’s $1250 an hour club for high stakes law that only high profile cases such as “bankruptcy” and “M & A” (Mergers & Acquisitions) can afford.

I’d rather be a physician making $125 an hour treating the poor and needy.

Billing system errors

Thirty percent of medical bills contain errors. –Stephen Parente, Professor of Health Finance at the University of Minnesota.

How many are caused by confusions from what’s covered and what’s denied by insurance carriers.

We’ve seen hospital bills in which 80 percent of charges were denied by Medicare or Insurance carriers.

I wonder if that is considered an error or business as usual.

The Fugitives from Wisconsin are found

Reporters found the Wisconsin lawmakers in the State of Illinois. Alas, the Wisconsin State Police could not go into Illinois to capture and bring them back to justice.

What fugitives except lawmakers could have a more secure safe house?

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

* * * * *

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

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

                      Pacific Research Institute, ( Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may signup to receive their newsletters via email by clicking on the email tab or directly access their health care blog. This month read about the California Sick Tax . . .

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

                      To read the rest of this column, please go to

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

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

                      Greg Scandlen, an expert in Health Savings Accounts (HSAs), has embarked on a new mission: Consumers for Health Care Choices (CHCC). Read the initial series of his newsletter, Consumers Power Reports. Become a member of CHCC, The voice of the health care consumer. Be sure to read Prescription for change: Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn. Greg has joined the Heartland Institute, where current newsletters can be found.

                      The Heartland Institute,, Joseph Bast, President, publishes the Health Care News and the Heartlander. You may sign up for their health care email newsletter. Read the late Conrad F Meier on What is Free-Market Health Care?. This month, be sure to read what 33 governors wrote to President Obama.

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

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

                      The Independence Institute,, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter. Read the latest OpEd on Protecting HealthCare Freedom.

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

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

                      The Heritage Foundation,, founded in 1973, is a research and educational institute whose mission was to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. -- However, since they supported the socialistic health plan instituted by Mitt Romney in Massachusetts, which is replaying the Medicare excessive increases in its first two years, and was used by some as a justification for the Obama plan, they have lost sight of their mission and we will no longer feature them as a freedom loving institution and have canceled our contributions. We would also caution that should Mitt Romney ever run for National office again, he would be dangerous in the cause of freedom in health care. The WSJ paints him as being to the left of Barrack Hussein Obama. We would also advise Steve Forbes to disassociate himself from this institution.

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

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

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

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

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

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

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Words of Wisdom

In the present state of medical knowledge, a pronouncement of the sentence of “incurable” on a patient places a serious responsibility on the physician and implies a greater knowledge than he possesses.Ernst P. Boas

If a little knowledge is dangerous, where is the man who has so much as to be out of danger? –Thomas H. Huxley.

Many of the supposed increasers of knowledge have only given a new name, and often a worse, to what was well known before. –August W. Hare 

Our present knowledge of the universe is such as to leave us with a very inadequate conception of the majesty of existence. –Sir Oliver J. Lodge

Some Recent Postings


MEDICAL TUESDAY - NEWSLETTER - Vol IX, No 22, Feb 22, 2011

1.                  Featured Article: The Neuroscience of True Grit

2.                  In the News: Personalized Medicine adding an extra nine years of life

3.                  International Medicine: In case of overdose, consult a lifeguard

4.                  Medicare: An Account of Political Self-Destruction by Tevi Troy

5.                  Medical Gluttony: I want my Gastric Bypass

6.                  Medical Myths: Peer review improves health care.

7.                  Overheard in the Medical Staff Lounge: What is changing in health care

8.                  Voices of Medicine: Informed Spousal Consent: A Great Idea Worth Spreading 

9.                  The Bookshelf: Death Orders by Anna Geifman

10.              Hippocrates & His Kin: Hospital Directives

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

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

Utilizing the $2 Trillion Information Technology Industry

To Transform the $3 Trillion HealthCare Industry into Affordable HealthCare

Through Innovation by moving from a Vertical to a Horizontal Industry

Thus eliminating $1 Trillion wasted

Insuring every American without spending the Extra $1Trillion Projected

To purchase a copy of the business plan, go to the bookstore at

In This Issue:

1.         Featured Article: Bad Medicine

2.         In the News: :  Federal Largess allows Crime to Flourish

3.         International Healthcare: Greece Told to Privatize HealthCare before Bailouts

4.         Government Healthcare: Around the World

5.         Lean HealthCare: Going Horizontal

6.         Misdirection in Healthcare: Why Doctors Don’t Want Free-Market Medicine

7.         Overheard on Capital Hill: Jefferson's tender lament didn't make it into the Declaration

8.         Innovations in Healthcare: Health Care's 'Radical Improver'

9.         The Health Plan for the USA: An Increasing Challenge: A Stranger in our Midst

10.        Restoring Accountability in Medical Practice by Moving from a Vertical to a Horizontal Industry:

In Memoriam

Thomas DeBaggio, herb-grower and Alzheimer’s patient, died on February 21st, aged 69

AS THE smiling customer brought the potted plant to the cash register at DeBaggio Herbs in Chantilly, Virginia, Tom DeBaggio began to panic. The plant was small, with spiny, silvery leaves, woody stems and blue flowers. When rubbed between the fingers it gave off a warm, strong, piney smell, a bit like floor polish. But he did not know what it was. He fumbled for the tag, and when he couldn’t find that, asked his wife Joyce what it could be. She told him, rosemary.

Yet he knew rosemary. He probably loved it more than any other plant in his nursery—though the basils and lavenders were right up there, too. He had once been called the best rosemaryologist in America for the work he had done, combing the world for new varieties or cultivating his own. “Gorizia”, found in Italy, with lobelia-blue flowers; “Madalene Hill”, which could take the worst soil and the coldest weather; “Lottie DeBaggio”, straight and pale-flowered, named after his grandmother; “Joyce DeBaggio”, with gold-edged leaves, named after his wife. The last was possibly his favourite, grown from one small, unusual, yellow branch. But now, in 1999, after 25 years in the nursery, he barely knew any of those familiar friends. Come to that, he was having trouble with the cash register, too.

On a beautiful spring day—weather that urged him into the garden, as if he wasn’t there already potting and watering, planting and selling, for 16 hours a day—the doctor told him he had early-onset Alzheimer’s Disease. He was 57. His first reaction was to rage and cry. His second was to go into his greenhouse, where the rosemary plants were in misty, lovely flower, and pull from somewhere the cruel adage that rosemary meant remembrance. But his third reaction was more positive, or desperate. He would try to chronicle for people what having Alzheimer’s was like.

Before he had turned, in 1974, to herb-growing, he had been a journalist on the Wilmington Independent and the Northern Virginia Sun. He hadn’t lasted long at either; his ideas were too left-wing. But there was still a novel in him, somewhere. He knew how to use words, and he realised that as long as he could articulate them, write them, recognise them and arrange them—all tasks that became increasingly difficult—he could give doctors an insight into a world few rationally entered, and almost no one spoke of. At the same time, he could try to pin down the thin, fast-fading shadow that was himself and his past. Otherwise, there would be nothing left.

In the four years after his diagnosis he gave four interviews to National Public Radio; appeared on Oprah Winfrey’s TV talk show; was filmed for an HBO documentary; and produced two books, “Losing My Mind” and “When It Gets Dark”. His interview answers often started confidently, with a rush of distant memories—his report on the first integrated high-school dinner in Virginia, the name of his editor, the exact time he handed in his copy—but foundered in tears when the words failed. He would cry, but then go on. The words were there somewhere, behind blurred window glass, in dark corners, as long as he could remember what he was searching for. That was the trouble: he would suddenly find himself driving his car on Route 50, or in the garden with watering can in hand, and have no idea why he was there. . .

Read the entire obituary plus six soul touching responses in The Economist (Subscription required) . . .

On This Date in History – March 8

On this date in 1841, Oliver Wendell Holmes, Jr., who served 30 years on the United States Supreme Court, was born. He was famous already because he was Oliver Wendell Holmes, Jr., son of the doctor and author who was one of the great literary figures of New England’s golden age. He chose what many sons of famous fathers would, to walk a different path. His world was the law. He became as famous for the brilliance of his dissents as for the power of his judgments. Like his father, he was noted for being a brilliant writer.

On this date in 1952, Arnold Schuster was shot and killed in Brooklyn, after he recognized a legendary bank robber named Willie Sutton and told the police. The murder was never solved and discouraged many other law-abiding citizens from turning criminals in to the police.

After Leonard and Thelma Spinrad

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We must 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.

We must also remember that ObamaCare has nothing to do with appropriate healthcare; it was projected to gain loyalty by making citizens depended on the government and eliminating their choice and chance in improving their welfare or healthcare.