Community For Better Health Care

Vol X, No 4, May 24, 2011


In This Issue:

1.                  Featured Article: The History of Memorial Day

2.                  In the News: How Brains Bounce Back from Physical Damage

3.                  International Medicine: Cancer survival rates in Europe and the United States

4.                  Medicare: Robbing Peter to pay Paul doesn’t help Peter or Medicare!

5.                  Medical Gluttony: “It Didn’t Cost Me Anything. I’m on MediCal!”

6.                  Medical Myths: It Didn’t Cost Anything!”

7.                  Overheard in the Medical Staff Lounge: Is Texas Governor Perry Presidential?

8.                  Voices of Medicine: Concierge Medicine Practice

9.                  The Bookshelf: The Rising Tide: The danger in failing to recognize the storms

10.              Hippocrates & His Kin: A Short History of Political Suicide

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

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

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Next week is Memorial Day

America, the Beautiful

O beautiful for pilgrim feet, whose stern impassioned stress
A thoroughfare for freedom beat across the wilderness!
America! America! God mend thine ev’ry flaw,
Confirm thy soul in self-control, thy liberty in law!

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1.      Featured Article: The History of Memorial Day


The first known observance of a Memorial Day-type observance was in Charleston, South Carolina in 1865; freedmen (freed enslaved Africans) commemorated and celebrated at the Washington Race Course, today the location of Hampton Park, and each year thereafter. African Americans founded what was then called "Decoration Day," now referred to as Memorial Day, at the graveyard of 257 Union soldiers and labeled the gravesite "Martyrs of the Race Course", on May 1, 1865.  

In a recent lecture, David Blight, Class of 1954 Professor of American History at Yale University, told the story of the first Memorial Day:

"During the last months of the [American Civil] war the Confederate Army turned the Washington race course [in Charleston, South Carolina] into an open air prison. And in that open air prison in the in-field of the horse track about 260 odd Union soldiers had died of disease and exposure. And they were buried in un-marked graves behind the grandstand of the race track. And by the way, there was no more important and symbolic site in low country planter slave holding life than their race track. The black folks of Charleston got organized. They knew about all this. They went to the site. They reinterred the buried men. They couldn’t mark them with names. They didn’t have any names. Then they made them proper graves. They built a fence around the cemetery. And over an archway they painted the inscription: “Martyrs of the Race Course.” And then on May 1, 1865 they held a parade of 10,000 people on the race track led by 3,000 black children carrying arms full of roses singing John Brown’s Body. As many as could fit got into the gravesite: Five black preachers read from scripture; A children’s choir sang the national anthem; America the Beautiful, and several spirituals. And then they broke from that and did what essentially you or I do on Memorial Day: They ran races, listened to speeches, the troops marched back and forth, and they held picnics. This was the first Memorial Day. African-Americans invented Memorial Day in Charleston, South Carolina. What you have there is black Americans recently freed from slavery announcing to the world with their flowers, their feet, and their songs what the War had been about. What they basically were creating was the Independence Day of a Second American Revolution.”

In the North

The friendship between General John Murray, a distinguished citizen of Waterloo, New York, and General John A. Logan, who helped bring attention to the event nationwide, was likely a factor in the holiday's growth. On May 5, 1868, in his capacity as commander-in-chief of the Grand Army of the Republic – the organization for Northern Civil War veterans – Logan issued a proclamation that "Decoration Day" should be observed nationwide. It was observed for the first time on May 30 of the same year; the date was chosen because it was not the anniversary of a battle.

There were events in 183 cemeteries in 27 states in 1868, and 336 in 1869. The northern states quickly adopted the holiday; Michigan made "Decoration Day" an official state holiday in 1871 and by 1890 every northern state followed suit. The ceremonies were sponsored by the Women's Relief Corps, which had 100,000 members. By 1870, the remains of nearly 300,000 Union dead had been buried in 73 national cemeteries, located mostly in the South, near the battlefields. The most famous are Gettysburg National Cemetery in Pennsylvania and Arlington National Cemetery, near Washington.

The Memorial Day speech became an occasion for Veterans, Politicians and Ministers to commemorate the War – and at first to rehash the atrocities of the enemy. They mixed religion and celebratory nationalism and provided a means for the people to make sense of their history in terms of sacrifice for a better nation, one closer to God. People of all religious beliefs joined together, and the point was often made that the German and Irish soldiers had become true Americans in the "baptism of blood" on the battlefield. By the end of the 1870s the rancor was gone and the speeches praised the brave soldiers both Blue and Gray. By the 1950s, the theme was American exceptionalism and duty to uphold freedom in the world.

Ironton, Ohio, lays claim to the nation's oldest continuously running Memorial Day parade. Its first parade was held May 5, 1868, and the town has held it every year since.

In the South

In Charleston, South Carolina, in 1865, freedmen (freed -enslaved Africans) celebrated at the Washington Race Course, today the location of Hampton Park. The site had been used as a temporary Confederate prison camp for captured Union soldiers in 1865, as well as a mass grave for Union soldiers who died there. Immediately after the cessation of hostilities, freedmen exhumed the bodies from the mass grave and reinterred them in individual graves. They built a fence around the graveyard with an entry arch and declared it a Union graveyard. On May 1, 1865, a crowd of up to 10,000, mainly black residents, including 2800 children, proceeded to the location for events that included sermons, singing, and a picnic on the grounds, thereby creating the first Decoration Day-type celebration.

Beginning in 1866, the Southern states had their own Memorial Days, ranging from April 26 to mid-June. The birthday of Confederate President Jefferson Davis, June 3, became a state holiday in 10 states by 1916. Across the South, associations were founded after the War to establish and care for permanent cemeteries for Confederate soldiers, organize commemorative ceremonies and sponsor impressive monuments as a permanent way of remembering the Confederate cause and tradition. Women provided the leadership in these associations, paving the way to establish themselves as capable of public leadership.

The earliest Confederate Memorial Day celebrations were simple, somber occasions for veterans and their families to honor the day and attend to local cemeteries. Around 1890, there was a shift from this consolatory emphasis on honoring specific soldiers to public commemoration of the Confederate cause. Changes in the ceremony's hymns and speeches reflect an evolution of the ritual into a symbol of cultural renewal and conservatism in the South. By 1913, however, the theme of American nationalism shared equal time with the Lost Cause.

Columbus, Mississippi, at its Decoration Day on April 25, 1866, commemorated both the Union and Confederate casualties buried in its cemetery.

At Gettysburg

The ceremonies and Memorial Day address at Gettysburg National Park were nationally famous, starting in 1868. In July 1913, veterans of the United States and Confederate armies gathered in Gettysburg to commemorate the fifty-year anniversary of one of the Civil War's bloodiest and most famous battle. The four-day "Blue-Gray Reunion" featured parades, reenactments, and speeches from a host of dignitaries, including President Woodrow Wilson, the first Southerner in the White House since the War. Congressman James Heflin of Alabama was given the honor of the main address. Heflin was a noted orator; two of his best-known speeches were an endorsement of the Lincoln Memorial and his call to make Mother's Day a holiday, but his choice as Memorial Day speaker was met with criticism. He was opposed for his racism, but his speech was moderate, stressing national unity and goodwill, and the newspapers, including those who opposed his invitation to speak, praised him. . .

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2.      In the News: How Brains Bounce Back from Physical Damage

After a traumatic injury, neurons that govern memory can regenerate.

 | Scientific American | May 20, 2011 |

For most of the past century the scientific consensus held that the adult human brain did not produce any new neurons. Researchers overturned that theory in the 1990s, but what role new neurons played in the adult human brain remained a mystery. Recent work now sug­gests that one role may be to help the brain recover from traumatic brain injury.  

Cory Blaiss, then at the University of Texas Southwestern Medical Center, and her colleagues genetically engineered mice such that the researchers could selectively turn neurogenesis on or off in a brain region called the hippocampus, a ribbon of tissue located under the neocortex that is important for learning and memory. They then administered blunt-force trauma to the brain and compared the performance of brain-injured mice that could produce new neurons to brain-­injured mice that could not. They sent each mouse through a water maze that required it to find a platform obscured beneath the surface of murky water. The researchers found that after injury only mice with intact neurogenesis could develop an efficient strategy to find the hid­den platform, a skill that is known to rely on spatial learning and memory. They concluded that without neurogenesis in the hippocampus, the recovery of cogni­tive functions after brain injury was signifi­cant­ly impaired.

The finding may lead to much needed therapeutic techniques. Deficits in learning and memory are nearly universal after a traumatic brain injury. The ability to stimulate more robust neurogenesis could lead to faster healing times or perhaps even more complete recovery of cognitive functions, a potentially life-changing prospect for the millions of people who suffer from traumatic brain injury every year. . .

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3.      International Medicine: Cancer survival rates in Europe and the United States

U.S. Cancer Care Is Number One by Betsy McCaughey, NCPA

During this presidential election season, candidates are urging Americans to radically overhaul our “broken” health care system. Before accepting the premise that the system is broken, consider the impressive evidence from the largest ever international study of cancer survival rates.  The data show that cancer patients live longer in the United States than anywhere else on the globe.  

Overall Cancer Survival Rates.   According to the survey of cancer survival rates in Europe and the United States, published recently in Lancet Oncology :

·                     American women have a 63 percent chance of living at least five years after a cancer diagnosis, compared to 56 percent for European women. 

·                     American men have a five-year survival rate of 66 percent — compared to only 47 percent for European men.

·                     Among European countries, only Sweden has an overall survival rate for men of more than 60 percent.

·                     For women, only three European countries (Sweden, Belgium and Switzerland) have an overall survival rate of more than 60 percent.

These figures reflect the care available to all Americans, not just those with private health coverage.  Great Britain, known for its 50-year-old government-run, universal health care system, fares worse than the European average:  British men have a five-year survival rate of only 45 percent; women, only 53 percent.

Survival Rates for Specific Cancers.   U.S. survival rates are higher than the average in Europe for 13 of 16 types of cancer reported in Lancet Oncology, confirming the results of previous studies.  As Figure II shows:

·                     Of cancers that affect primarily men, the survival rate among Americans for bladder cancer is 15 percentage points higher than the European average; for prostate cancer, it is 28 percentage points higher.

·                     Of cancers that affect women only, the survival rate among Americans for uterine cancer is about 5 percentage points higher than the European average; for breast cancer, it is 14 percentage points higher.

·                     The United States has survival rates of 90 percent or higher for five cancers (skin melanoma, breast, prostate, thyroid and testicular), but there is only one cancer for which the European survival rate reaches 90 percent (testicular). 

Furthermore, the Lancet Oncology study found that lung cancer patients in the United States have the best chance of surviving five years — about 16 percent — whereas patients in Great Britain have only an 8 percent chance, which is lower than the European average of 11 percent.

Results for Canada.  Canada's system of national health insurance is often cited as a model for the United States.  But an analysis of 2001 to 2003 data by June O'Neill, former director of the Congressional Budget Office, and economist David O'Neill, found that overall cancer survival rates are higher in the United States than in Canada: . . .

Early Diagnosis.   It is often claimed that people have better access to preventive screenings in universal health care systems.  But despite the large number of uninsured, cancer patients in the United States are most likely to be screened regularly, and once diagnosed, have the fastest access to treatment.  For example, a Commonwealth Fund report showed that women in the United States were more likely to get a PAP test for cervical cancer every two years than women in Australia, Canada, New Zealand and Great Britain, where health insurance is guaranteed by the government.

·                     In the United States, 85 percent of women aged 25 to 64 years have regular PAP smears, compared with 58 percent in Great Britain.

·                     The same is true for mammograms; in the United States, 84 percent of women aged 50 to 64 years get them regularly — a higher percentage than in Australia, Canada or New Zealand, and far higher than the 63 percent of British women.

Access to Treatments and Drugs.   Early diagnosis is important, but survival also depends on getting effective treatment quickly.  However, long waits for treatment are “common devices used to restrict access to care in countries with universal health insurance,” according to a report in Health Affairs.  The British National Health Service has set a target for reducing waits to no more than 18 weeks between the time their general practitioner refers them to a specialist and they actually begin treatment.  A study by the Royal College of Radiologists showed that such long waits are typical, and 13 percent of patients who need radiation never get it due to shortages of equipment and staff.

Another reason for the higher cancer survival rates in the United States is that Americans can get new, effective drugs long before they are available in most other countries.  A report in the Annals of Oncology by two Swedish scientists found:

·                     Cancer patients have the most access to 67 new drugs in France, the United States, Switzerland and Austria.

·                     Erlotinib, a new lung cancer therapy, was 10 times more likely to be prescribed for a patient in the United States than in Europe.

One of the report's authors, Nils Wilking, from the Karolinska Institute in Stockholm, explained that nearly half the improvement in survival rates in the United States in the 1990s was due to “the introduction of new oncology drugs,” and he urged other countries to make new drugs available faster.

Conclusion.   International comparisons establish that the most important factors in cancer survival are early diagnosis, time to treatment and access to the most effective drugs.  Some uninsured cancer patients in the United States encounter problems with timely treatment and access, but a far larger proportion of cancer patients in Europe face these troubles.  No country on the globe does as good a job overall as the United States.  Thus, the U.S. government should focus on ensuring that all cancer patients receive timely care, rather than radically overhauling the current system.

NCPA Brief Analyses | Health | No 596
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NHS & Canadian Medicare do not give timely access to healthcare, only access to a waiting list.

Waiting lists can be fatal in Cancer Care

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4.      Medicare: Robbing Peter to pay Paul doesn’t help Peter or Medicare!

Obama’s IPAB Board Will Control Medicare Decisions by Betsy McCaughey

A toxic political strategy is spreading across the land, one that involves Medicare. It threatens to bamboozle voters and allow the 2012 election to turn on a lie.

Democrats are making the obscenely false claim that they will "save Medicare as we've known it." On Wednesday, Democrats used this deceptive strategy to take the special election in the 26th congressional district in western New York. Sadly, this corrupt strategy is likely to be repeated. Voters need to know the facts.

The truth is, the Obama health law, passed by Democrats last year, already eviscerated Medicare — though seniors won't feel the effects for some time. And the reform plan Democrats are attacking — Rep. Paul Ryan's vision — would undo much of the damage to Medicare while charting a new course to ensure the program doesn't run out of money.

The Obama health law cut future funding for Medicare by $575 billion over the next decade and used $410 billion of that money to expand eligibility for Medicaid. It’s like robbing Peter to pay Paul, only it’s robbing Grandma to benefit Medicaid recipients.  

The nation needs to spend less on government programs, and entitlement reform is key. The best way to reform entitlements is not to start new ones. Don't miss the point here. The Obama health law is redistributing the wealth — taking money out of Medicare to create new entitlements and millions more government dependents. Seniors are being forced to sacrifice to pay for this.

According to projections from the Obama administration’s actuaries, Medicare will spend $14,731 per senior in 2019, instead of $16,162 if the health law had not passed. That’s less care for seniors.

Such cuts might be justifiable if the “savings” extended the financial life of Medicare. Mr. Obama and Health and Human Services Secretary Kathleen Sebelius frequently make that false claim. But in truth, the Obama health law raids Medicare, leaving less money to take care of the next generation of retirees.

So what can that next generation, retiring a decade from now, count on? The Obama health law puts those decision in the hands of an unelected board called the Independent Payment Advisory Board, IPAB, a cost-cutting panel.

The board is a radical departure from Medicare as we’ve known it. Congress cedes nearly all control of Medicare spending on the rationale that budgeting decisions should be shielded from outraged seniors and political pressures.

On April 13, the president reiterated that the board would decide what care is “unnecessary” for seniors, and that he would like to see IPAB’s unprecedented powers increased.

Even the Congressional Budget Office cautioned that as the nation’s debt crisis worsens, benefits will be put on the board’s chopping block. IPAB is drawing fire from AARP and Democratic Rep. Pete Stark (California).

Last week, President Obama indicated that he would like to reduce the deficit by taking an additional $200 billion from Medicare over the next decade. That would be IPAB’s job too.

Ryan's plan, passed by the Republican majority in the House of Representatives, was distorted into a scare machine to intimidate voters in the western New York race. The truth is, seniors would be safer under the Ryan plan than under Medicare Obama style. . .

Let's hope voters examine the plain facts because one thing is clear — Obama and the Democratic Party are not saving Medicare “as we know it.”

Read more: Obama's IPAB Board Will Control Medicare Decisions
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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: “It Didn’t Cost Me Anything. I’m on MediCal!”

Mary, a 33-year-old lady, stated that she went to the Emergency Room twice last month. When asked, “Why?” she said, “Well I had two emergencies.” When asked what did they find wrong with her? She replied that she had pulled a muscle in her chest. But they did dozens of tests including CT scans and MRI and she was pleased to find out that everything else was just fine.

When asked whether she thought the rather large expenditure in tests was justified, she replied, “It didn’t cost me anything. I’m on MediCal.”

And so the Medical Gluttony continues. Someone else, the taxpayers in this case, picked up the tab. The patient felt no pain. The patient felt no responsibility. The patient was unable to understand the costs. She furthermore did not understand these costs as unnecessary for her health. Thus gluttonous behavior becomes the norm in the absence of any responsibility.

Patients will never understand the costs and thus be able to contain costs unless they have a percentage co-payment. This is the single most important item in health care reform—patient responsibility through a percentage share of cost. Even if only ten percent. Someone in that family will help her figure it out. And that someone who is paying her ten percent will make sure s/he never will have to pay another 10 percent. Even if its only 10 percent of the basic ER charge of $600 if no testing is done. In this case, more than $9,000 worth of testing was done. Since a pulled muscle will never show up on the $9,000 of sophisticated tests, it was a diagnosis that could have been rendered at the very beginning sans tests. The entire visit was pure medical gluttony.

This is always understood by responsible Americans. Even the socialist should understand it. However, the socialist has a predicament if the patient ever became responsible. How could he ever control the patient as a political pawn if the patient became responsible for his gluttonous behavior?

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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: “It Didn’t Cost Anything!”

Sarah, a 43-year-old lady, came in for her second visit and announced that she went to the Emergency Room since seen last month. When asked, “Why?” she glared “Well I had an emergency last week.”  When asked what did they find wrong with her? She replied that they had found a tender breastbone in her chest. But they did dozens of tests including CT scans and MRI and she was pleased to find out that everything else was just fine.

When asked whether she thought the rather large expenditure in tests was justified, she replied, “It didn’t cost me anything.  I’m on MediCal.”

And so the Medical Myth continues. Someone else, the taxpayers in this case, picked up the tab. The patient felt no pain. The patient felt no responsibility. The patient was unable to understand the costs.

And patients will never understand the costs and thus be able to contain costs unless they have a percentage co-payment. This is the single most important item in health care reform—patient responsibility through a percentage share of cost. Even if only ten percent. Someone in that family will help her figure it out. And that someone who is paying her ten percent will make sure s/he never will have to pay another 10 percent. Even if its only 10 percent of the basic ER charge of $600 if no testing is done. Since costochondritis will never show up on the $9,000 of sophisticated tests, it was a diagnosis that could have been rendered at the very beginning sans tests.

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Medical Myths Originate When Someone Else Pays The Medical Bills.

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

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7.      Overheard in the Medical Staff Lounge: Is Texas Governor Perry Presidential?

Dr. Rosen: During the past month, we have pilloried Gingrich and Romney. Meanwhile the Governor of Texas may have joined the race after the most powerful person on the candidate’s team, his wife, told him the next election was so crucial, that he has to run.

Dr. Edwards: That would be a breath of fresh air.

Dr. Milton: I would have to agree with that. He looks so presidential.  

Dr.  Dave: I think he also looks very Reaganesque.

Dr. Dave: He looks like someone who will make all the Generals of the World take notice if he became the Commander-in-Chief of the USA.

Dr. Sam: I think he looks like the first Constitutionalist that could win and also save our country from going backwards 200+ years in one administration.

Dr. Kaleb: I think he would also gain the respect of the Mid-East.

Dr. Rosen: Do you think he could straighten out the 20 Arab States?

Dr. Dave: Yes, I think he would make them tremble.

Dr. Ruth: What about the downtrodden women in the Middle East?

Dr. Dave: He could be a great boon to women’s rights. Can you imagine a Texan’s reaction if his wife couldn’t drive his car in Saudi?

Dr. Rosen: Such things will come about gradually; but it will take a sledgehammer to drive the initial point home, such as a woman heading a motorcade.

Dr. Kaleb: I think the women would come out of their huts and out from behind their burqas.

Dr. Rosen: There’s a ground swell of women in France, New South Wales and other Muslim enclaves in states the world over where if they refuse to remove their veils for police, they will face jail.

Dr. Kaleb: That will really add momentum to the movement.

Dr. Rosen: I think we’d begin to see a lot of good things happening if we had a strong leader restoring freedom in the world’s greatest democracy.

Dr. Milton: Let’s just hope that Governor Perry will run. Anybody have a lead into his wife’s circle who could provide more influence?

Dr. Edwards: I think Governor Perry could be the third greatest president right along with George Washington and Abraham Lincoln.

Dr. Michelle: I’m already feeling more optimistic about our future.

Dr. Milton: Paul Johnson, the British Columnist in Forbes, stated recently in his monthly column that America is crying for strong leadership.

Dr. Edwards: I think Governor Perry could answer that cry.

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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

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8.      Voices of Medicine: A Review of Local and Regional Practice Experiences 

Concierge Medicine Practice

Thomas W. LaGrelius MD, FAAFP
As a concierge doctor in Torrance, CA and past president of AAPP, as well as a good friend of Dr. Martin Schulman, I certainly enjoyed reading your May 11 San Diego Union Tribune article on concierge medicine.  One of my patients brought it in for me today.  It was excellent.  Thank you.  We are seeing almost daily examples of such positive reporting on our mode of practice.   See link:
A couple things you should know that were not touched on in the article.  As well as saving lives and improving care, concierge medicine is saving money and increasing the access to primary care doctors, not the other way around as some of its critics claim.  Here's how.  
Our patients have been shown in studies done for example by Qliance in Seattle and MDVIP in Florida to consume 4-8 times as much primary care doctor time, but to visit the ERs 65% less, see consultant physicians 50% less, be hospitalized 25% less, have 35% fewer hospital days and consume 50-95% less prescription drugs.  These latter are very costly medical services compared to concierge primary care.  The minor cost of having a concierge doctor is therefore proven to be many times offset by the savings at the secondary care level.  Many former critics of concierge medicine, who are often as concerned about cost savings as they are about quality of care, are therefore now starting to ask how we can do this for everyone!
As to increased access, I for example am 68 years old, but I come from a long line of Swedes who stay well and can work till they are 90.  I plan to practice till I am at least 80.  I could easily afford to retire and would have done so already had I not converted my practice to concierge in 2005-6.  I care for about 600 patients in a very detailed manner.  Most are geriatric, since I am a geriatrician, and they have more complex, difficult problems than average as do the patients of most concierge doctors.  Concierge medicine is thus preserving senior doctors like me in practice for decades longer, caring for the sickest members of our society.  This would be impossible in the insurance based "hamster wheel" style we used to practice.  
If you come to an AAPP meeting (the next one is in New York in October) you will find happy doctors, a rarity in the rest of the profession where doctors are leaving practice in their 50s and doing anything they can to get out of clinical medicine.  Thus concierge medicine is INCREASING access to primary care while the insurance system we are escaping from is drastically cutting that access.  It is the insurance based system of primary care the critics should be attacking since primary care is not an insurable event, but a low cost relationship easily destroyed by third party interference and price fixing.
Furthermore, until a few years ago 50% of medical students entered a primary care pathway after medical school.  In recent years that percentage has fallen to 8%.  I give talks occasionally (I'd love to give more) at medical schools to students who want to do primary care but believe it is impossible to do so in the current insurance based system that forces them to see too many patients and never do hospital care, degrading them to little more than triage nurses.  Seeing what concierge doctors do inspires them and for the first time in years they have hope.  This year there has been a slight up-tic in students entering primary care pathways.  This also is INCREASING access to primary care.  We hope as the model advances that this small up-tic becomes a flood. . . 
Thomas W. LaGrelius MD, FAAFP
Diplomate of the American Board of Family Practice and Geriatric Medicine
Skypark Preferred Family Care, a Concierge primary care medical practice
Torrance, CA 90505
President, Los Angeles County Medical Association Southwest District
Chair Emeritus, Founder and VP, INDOC  310-214-9921
Director, Past Board Chair and Past President, AAPP the national concierge doctors professional society 877-746-7301
Director, Secretary and Past President, SBIP  310-534-8805

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

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9.      Book Review: The Rising Tide: The danger in failing to recognize the storms

Turning the Tide By Charles F. Stanley

In His Own Words

Over the years, I have been privileged to see and walk along some of the most magnificent beaches in the world. Not long ago, I was at a Hawaiian seashore known for its tremendous waves—ones worthy of surfing excursions—and I was acutely aware of the rise and fall of the tides.

On several occasions in the past, this particular coastline has had waves that rose more than twenty feet high. A man at the hotel called those times “an extreme surfer’s paradise.”

While the unfurling and crashing of breakers of that magnitude may excite avid surfers, the rest of us may be frightened by such an overpowering crush of water—fantastic to look at, perhaps, but only from a distance.  

As I gazed out at the ocean, knowing the potential danger for great waves, my thoughts turned to the painful reality of the tsunami that crashed into Southeast Asia in 2004. The devastation in terms of lives and property loss was enormous.

I then began to think about the riptides that can periodically make a beach too dangerous for swimming. Although these tides can be identified by lifeguards and experts as they watch from elevated perches, they are not as easily recognized by beachgoers on the shore or those already in the water. Once an innocent swimmer has been caught in the clutches of such a powerful current, escape is extremely difficult. Rescue is often perilous for those who seek to help. Death is frequently the result.

I considered the rising floodwaters that have devastated many areas in our nation. We live in an age where it is not at all unusual to hear a newscaster report, “Nothing of this magnitude has ever been experienced here before.”

I asked myself, What makes tides go from beautiful to dangerous? What causes the sea to swell and produce a wave that washes away beaches and cities? What creates those waves?

The answer in many cases is storms.

Some of the squalls pound on the surface of the waters, while others occur far away, causing a ripple effect throughout the ocean. 

Some tempests involve fierce winds, and others, a seemingly endless amount of heavy rain.

Regardless of how these whirlwinds and downpours occur or where they originate, they cause seismic shifts in the waters—and the tides rise with immensely destructive power.

These observations of nature started me thinking about the issues that I will discuss in this book—tempests which occur in our nation and also in our personal lives. These storms don’t necessarily have anything to do with the weather. They are situations in our lives that devastate us just like a category five hurricane that ravages a coastal village. They may arise due to our finances, a broken relationship, a lost job, a crippling illness, or any number of distressing circumstances. The dark, threatening clouds roll in—large, turbulent, and overwhelming. They destroy our peace and security, and we cannot escape their fury. We don’t know what to do or where to go,

I am convinced that our country is facing just such a storm. We are experiencing a destructive, man-made tide, that is deteriorating our country at a frightening pace. And as an American citizen, father, grandfather, and preacher of the Word, I feel the responsibility to speak up about the issues in our country and in our personal lives that require our attention and intercession as believers.

The storms of life cause tides to mount up—even to the point of overwhelming us with tragedy, turmoil, and deeply-rooted fears.

We experience catastrophic times not just natural, everyday problems, but also man-made disasters. Sadly, if we don’t come to grip with our crises and learn how to manage effectively through them, we will continue to find ourselves in increasingly desperate times.

Just as our personal tempests can devastate our lives if we do not respond to them correctly, cataclysmic storms can drastically affect our nation as well. So after my experience on that Hawaiian beach, I sat down to make a list of the storms our country is currently undergoing. I came up with twenty concerns that I truly believe warrant prayer and godly action….

This book introduction in the author’s own words is found at . . .

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

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10.  Hippocrates & His Kin: A Short History of Political Suicide

SNAP hasn’t put a dent in poverty or hunger

Nearly 21 million households are now reliant on the Department of Agriculture’s Supplemental Nutrition Assistance Program (SNAP).

The program cost taxpayers over $68 billion last year, twice as much as in 2007, and accounts for 67 percent of the USDA’s total budget, compared to 26 percent in 1980. . .

Critics complain that SNAP hasn’t put a dent in poverty or hunger while taking away funds from other efforts that should be the main focus of the USDA, specifically agricultural programs, according to ABC News.

Has anyone heard of a federal program outside of the Military and State Dept that works?

A Short History of Political Suicide – John Steele Gordon, WSJ, Thurs June 9, 2011

As the late historian Stephen Ambrose once explained on PBS’s “NewsHour” about the Clinton-Lewinsky scandal, “God created man with a penis and a brain and gave him only enough blood to run one at a time.”

With the Weiner’s Sex Pictures sent over the Internet, why haven’t we come across his Wiener yet?

Question: When will patients be concerned about spending $8K to $10K in the Emergency Room, finding nothing, and feeling good about it?

Answer: When they will have a 20% co-payment on ER costs and finally figure out the $1600 or $2000 co-pay out of their own pocket will make the expense of $8K to $10K of taxpayers money seem like real theft? Or Fraud? Or Embezzlement of taxpayers or premium payers’ money for personal benefit?

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

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

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

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

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, and his research group which will go far in making health care costs transparent. This site provides access to information related to medical costs as an informational and educational service to users of the website. This site contains general information regarding the historical, estimates, actual and Medicare range of amounts paid to providers and billed by providers to treat the procedures listed. These amounts were calculated based on actual claims paid. These amounts are not estimates of costs that may be incurred in the future. Although national or regional representations and estimates may be displayed, data from certain areas may not be included. You may want to follow this development at Congratulations to Dr. Gibson and staff for being at the cutting edge of healthcare reform with transparency. 

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

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

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

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

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:  ?. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. This month, be sure to read ? . 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 by Gertrude Himmelfarb (1922-

Professor emeritus of history at the Graduate School of the City University of New York, a fellow of the British Academy, the Royal Historical Society, the American Philosophical Society, and the American Academy of Arts and Science. A prolific author in the history of ideas.

With the rise of communism and Nazism, many liberals, normally inclined to a moderate, pluralistic, pragmatic view of liberty, were persuaded that the only security against an absolutistic regime was an absolute principle of liberty. . . Against absolute despotism the only adequate response seemed to be absolute liberty.

This was—and still is—the psychological basis of the “slippery slope” argument. . . This is the argument used by liberals in support of government subsidies for such “art” as the photograph of a crucifix submerged in urine. . .  Yet the same liberals who advocate the largest freedom for artists (including the freedom to be subsidized) also tend to support in the name of the same freedom, the strictest separation of church and state—with the curious result that the photograph of a crucifix immersed in urine can be exhibited in a public school, but a crucifix not immersed in urine cannot be exhibited. On Looking into the Abyss, 1994

Some Recent Postings

In The May 10 Issue:

1.          Featured Article: Why Are Asthma Rates Soaring?

2.                  In the News:  How Much Do Public Schools Spend on Teaching?

3.                  International Medicine: The international rankings of healthcare: The Worst Study Ever?

4.                  Medicare: RomneyCare could put the US on the Road to Single-Payer Socialized Medicine

5.                  Medical Gluttony: The Hospital Bill

6.                  Medical Myths: You should drink at least eight glasses of water a day

7.                  Overheard in the Medical Staff Lounge: Is Mitt Romney Presidential?

8.                  Voices of Medicine: COMMENTARY:  Saying Goodbye to Dr. Marcus Welby

9.                  The Bookshelf: CLONING OF THE AMERICAN MIND

10.              Hippocrates & His Kin: A modest proposal for a more honest politics

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

In Memoriam

Osama bin Laden, the world’s most wanted terrorist, died on May 2nd, aged 54

The Economist | May 5th 2011 | from the print edition

WHEN he gave interviews to foreign journalists, which he did rarely, Osama bin Laden had a way of looking down at his hands. This, and his soft, slightly raspy voice, and his gentle eyes—as well as the fact that he allowed no instantaneous translation—helped conceal what he was saying: that it was the duty of all Muslims to kill unbelievers, especially Americans, and that when he had seen the bodies of the infidels flying “like dust motes” on September 11th 2001, his heart had filled with joy.

His mien was that of the sage, not the killer. He seldom shed blood himself, though his treasured Kalashnikov, which he carried everywhere, was said to have been wrested in single combat from a Russian soldier in Afghanistan. As a rule he observed from afar as “his boys” blew up the American base at Khobar in Saudi Arabia, or the USS Cole in Yemen (he wrote a poem about that, the little dinghy bobbing on the waves) or the American embassies in Kenya and Tanzania, where in 1998 more than 200 died. Terrorism could be commendable or reprehensible, he smoothly agreed, but this was “blessed terror”, in defence of Islam. At first he denied any part in the 9/11 attacks, but at last pride got the better of him: yes, it was he who had guided his 19 brothers towards their “easy” targets.

How he really saw himself was as a construction engineer. Construction had made the bin Laden family fortune, $5 billion at least, from which he had inherited $25m-30m. (There had been much more, perhaps $250m, and a yearly stipend of $7m, until his native Saudi Arabia expelled him in 1991 and froze his assets; but Allah provided for his servant, and some of his several dozen half-brothers and sisters slipped him money.) In the 1980s he bought excavators, dump trucks and bulldozers, sometimes driving them himself, digging trenches for the mujahideen to fight along in Afghanistan against the Soviet invaders, blasting tunnels in the mountains for their arms dumps and field hospitals, until in 1989 the unbeliever-enemy withdrew in shame and disgrace.

He made roads in Sudan, too, when he was exiled there in the 1990s, including a new highway from Khartoum to Port Sudan. But he was mostly building his terror network, starting with the guesthouses and weapons he provided in Afghanistan through his maktab al-khidamat (“services office”), then creating al-Qaeda, “the base”. Much of this was done with Abdullah Azzam, his religious mentor; later, the terror-work was directed by Ayman al-Zawahiri and others; but it was he who first recorded, in hundreds of individual files, the details of each eager recruit, the date of arrival, what he had done for the cause. Keenly, he followed the media coverage of the atrocities he inspired, playing the world’s press like a violin when he chose. He built the brand and turned it into a global franchise; his face advertised it, even as he disappeared. If just two fighters held up a piece of cloth with “al-Qaeda” on it, he said proudly, American generals would run to the place in swarms.

His mind and approach were those of a businessman. The same caution that characterised his fugitive existence in Afghanistan and Pakistan—avoiding phones, the internet, even watches, anything that might be used to track him, slipping from cave to safe house to compound—featured in his investments, which were profitable and practical. No political ideology guided him, though he might lie for hours at night thinking, or read for most of the day. The polite, pious rich boy, who had left university without a degree, became neither an intellectual nor a visionary.

Pure rage was all he needed, roused especially by the Israeli invasion of Lebanon in 1982 and the arrival of American troops in Saudi Arabia, on the holy ground of the two mosques in Mecca and Medina, in 1990. Hatred of America had tormented him for as long as he could remember. To drive out the infidels, to establish Palestine and destroy Israel, to eject the “heretics” who ruled in Saudi Arabia, to purify Islam itself with Wahhabist fundamentalism, were his ambitions. If they boiled down to a doctrine, it was a violent form of jihad, the holy duty of all Muslims, to make God’s word victorious; or just what he called “reciprocity”, an eye for an eye.

Facing the assassins

. . . the best thing in his life, he said, was that his jihads had destroyed the myth of all-conquering superpowers.

The price set on his head for more than a decade never bothered him, for Allah determined every breath in his body, and could ensure that the bombs dropped on his hideout at Tora Bora, or on his convoy through the mountains, never touched him. His martyr’s time would come when it came. The difference between pure Muslims and Americans, he said, was that Americans loved life, whereas Muslims loved death. Whether or not he resisted when the Crusaders’ special forces arrived, their bullets could only exalt him.

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

On This Date in History - May 24

On this date in 1844, Samuel F. B. Morse sent the first telegraph message: “What hath God wrought!” between Washington and Baltimore. The telegraph helped knit the nation together as much as the railroad had, and it furnished the basis for one of the first international languages, the language of dot and dash. It also introduced the practice of virtue first taught to Americans by the fact that telegrams were priced by the word.

On this date in 1883, the Brooklyn Bridge opened linking Brooklyn and Manhattan Island. America has crossed a lot of other bridges since then, but for some reason no other has had quite the cachet of the still impressive span down at the lower end of Manhattan Island. Nobody who ever jumped off a bridge ever won the fame that came to Steve Brodie for supposedly having survived a leap from the Brooklyn Bridge.

After Leonard and Thelma Spinrad

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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.

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Our National Hymn

God of our fathers, whose almighty hand
Leads forth in beauty all the starry band
Of shining worlds in splendor through the skies
Our grateful songs before your throne arise.

Your love divine has led us in the past,
In this free land by you our lot is cast,
Oh, be our Ruler, Guardian, Guide and Stay,
Your Word our law, your paths our chosen way.

From war’s alarms, from deadly pestilence,
Make your strong arm our ever sure defense;
Your true religion in our hearts increase,
Your boundless goodness nourish us in peace.

In Memory of our Veterans who wrote us a blank check for “whatever it takes” for our freedom.

Del Meyer      

Del Meyer, MD, Editor & Founder

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

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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.

For more information on the World Health Care Congress Latin America . . .

For information on the 9th Annual World Health Care Congress on April 16-18, 2012 . . .