Community For Better Health Care

Vol IV, No 16, Nov 22, 2005

In This Issue:

1.      Featured Article:  The Winning Edge: Passion and Perseverance Are More Important Than Talent

2.      In the News: For Americans, Getting Sick Has Its Price

3.      International Medicine: Teeth Tourism

4.      Medicare: VA Medicine Is Not a Good Model for Medicare

5.      Medical Gluttony: You Should Have Come to My Office Instead of Going to the Emergency Room. No Doctor! The Emergency Room Evaluation Was Free!

6.      Medical Myths: Let’s Solve the Uninsured Problem by Forcing Everyone to Purchase Health Insurance and Those That Can’t Afford to Will Be Subsidized

7.      Overheard in the Medical Staff Lounge: My Insurance Cost My Laboratory 80% Of Their Charges!

8.      Voices of Medicine: Physician Opinions in Various Local and Regional Medical Journals and in the Press: North Country; Constant Gardener: Sonoma Doctors Top 10 Brain Movies

9.      From the Physician Patient Bookshelf: The Tipping Point - How Little Things Can Make a Big Difference - by Malcolm Gladwell

10.  Hippocrates & His Kin: That’s His Real Name. He’s Not an Anal Cipher

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

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1.      Featured Article: The Winning Edge: Passion and Perseverance Are More Important Than Talent by Peter Doskoch writing in Psychology Today

Summary: We're primed to think that talent is the key to success. But what counts even more is a fusion of passion and perseverance. In a world of instant gratification, grit may yield the biggest payoff of all.

In the summer of 1994, in the tallest of Princeton University's ivory towers, Andrew Wiles was completing one of the most extraordinary odysseys in the history of math. For more than three decades, Wiles had been obsessed with Fermat's Last Theorem, a seemingly simple problem that had stumped mathematicians for 350 years. French mathematician Pierre de Fermat had noted that although there are plenty of solutions to the equation X2 + Y2 = Z2 (for example, 32 + 42 = 52), there is no corresponding solution if the numbers are cubed instead of squared. In fact, Fermat scribbled in the margin of a book that he had "truly marvelous" proof that the equation Xn + Yn = Zn has no solution if n is any number greater than 2. Unfortunately, he never put his proof on paper.

Wiles was 10 years old when he encountered the theorem. "It looked so simple, and yet all the great mathematicians in history couldn't solve it. I knew from that moment that I had to." When classmates were flocking to rock concerts, he was studying how geniuses of prior eras approached the problem. He abandoned the quest after college in order to focus on his budding academic career, but his obsession was rekindled in 1986, when a fellow mathematician showed that proving a certain mathematical hypothesis -- this one unsolved for a mere 30 years -- would also prove Fermat's theorem. He set aside all but the few classes he was teaching - and revealed his quest to no one but his wife. To disguise his single-mindedness, he rationed the publication of previously completed work.

Despite long hours of focus -- his only source of relaxation was playing with his two young children - the next few years produced little concrete progress. "I wasn't going to give up. It was just a question of which method would work," says Wiles. In 1993, after seven straight years of intense work - more than 15,000 hours - Wiles stepped up to the podium at a conference in England and, over the course of three lectures, presented his completed proof of Fermat's Last Theorem.

A media frenzy followed. The shy mathematician found himself named one of People magazine's 25 Most Intriguing People of the Year, alongside Oprah and Princess Diana. But a handful of peer reviewers poring over the 200-page proof found several small errors. Wiles set to work addressing them. After a full year of frustrating struggle, Wiles had the insight that allowed him to fix them.

Wiles' intellect is inarguably impressive; one of his colleagues told The New York Times that only 1 in 1,000 professional mathematicians were capable of understanding Wiles' work. However, the Princeton professor himself attributes his accomplishment not to his brains but to his persistence. "For me, it was the main thing," he says.

It is likely that somewhere, at this very moment, a parent or coach is declaring to a discouraged child that "quitters never win." But perseverance has come to seem like quaint lip service against the tide of interest in talent and aptitude, flashier gifts that nature, or genes, seem to inarguably confer.

And yet grit may turn out to be at least as good a gauge of future success as talent itself. In a series of provocative new studies at the University of Pennsylvania, researchers find that the gritty are more likely to achieve success in school, work and other pursuits -- perhaps because their passion and commitment help them endure the inevitable setbacks that occur in any long-term undertaking. In other words, it's not just talent that matters but also character. "Unless you're a genius, I don't think that you can ever do better than your competitors without a quality like grit," says Martin E. P. Seligman, director of the university's Positive Psychology Center.

Indeed, experts often speak of the "10-year rule" -- that it takes at least a decade of hard work or practice to become highly successful in most endeavors, from managing a hardware store to writing sitcoms -- and the ability to persist in the face of obstacles is almost always an essential ingredient in major achievements. The good news: Perhaps even more than talent, grit can be cultivated and strengthened.

How Much Does Talent Count?

Many of life's failures are people who did not realize how close they were to success when they gave up," opined Thomas Edison, a man almost as famous for lauding perspiration as he is for inventing the light bulb. If effort is the bedrock of success, what role do intelligence and other abilities play? "IQ counts for different amounts depending on the task and situation," emphasizes intelligence expert Robert Sternberg, dean of arts and sciences at Tufts University.

Manly large-scale analyses, however, suggest that a mere 25 percent of the differences between individuals in job performance -- and a third of the difference in grade point average -- can be attributed to IQ (personality factors, creativity and luck are said to contribute to the other 75 percent). Angela Duckworth, a graduate student at Penn who, together with Seligman, has conducted several key studies on grit, argues that the precise number isn't as important as knowing that intelligence accounts for only a fraction of success….

Altogether Different

Not that researchers have ignored it altogether. Louis Terman, the legendary psychologist who followed a group of gifted boys from childhood to middle age, reported that "persistence in the accomplishment of ends" was one of the factors that distinguished the most successful men from the least successful. And in the most-cited paper in the giftedness literature, University of Connecticut psychologist Joseph Renzulli, director of the National Research Center on the Gifted and Talented, argued that "task commitment" -- perseverance, endurance and hard work -- is one of the three essential components of giftedness (along with ability and creativity). Indeed, Renzulli says, the evidence that these nonintellectual factors are critical to giftedness is "nothing short of overwhelming."

For the 95 percent of humanity that isn't recognized as gifted, Duckworth and Seligman have an egalitarian finding: Grit has value for people at all levels of ability.

In fact, their initial studies show that grit and intelligence are completely independent traits . . .

The Power of Passion

Certainly character was a tremendous asset to Andrew Wiles, who says he has a "single-mindedness that I don't see in most other people." But he also had "a special passion" for Fermat's Last Theorem. It is this sort of fervor and fascination that might just be the cornerstone of grit.

The idea that passion fuels perseverance has crucial implications: If grit -- and hence high achievement -- hinges on passion, then it's especially important for parents to expose their children to the broadest possible range of academic, artistic and athletic activities, to maximize the chances that something will capture the child's imagination. Helping children find their passion may turn out to be more important than addressing their academic weaknesses . . . 

Perseverance, he insists, "is purely a state of mind" that depends on one's happiness and level of discomfort. But because people are influenced by their environment, a person's grit may vary as circumstances change. Enduring the rigors of selling books door to door is a lot easier for someone hungry to prove themselves. "I don't think I'd make it if you sent me out today to sell books door to door," he offers. Diligence has not deserted him; it's just moved to a fancier address.

[Likewise, in health care we think that the talented administrators, economists and theoreticians have the key to success in our health-care challenges, and that we should have a single payer forcing health-care workers to follow the rules. But, as health care continues to deteriorate, primarily because of these restrictive rules, it will take the determination of someone in the community of doctors, nurses and patients to bring about the biggest payoff in personalized health care. Welcome to the forum.]

Peter Doskoch is a science writer based in New Jersey, and he is the former executive editor of Psychology Today.

To read the entire article, please go to

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2.      In the News: For Americans, Getting Sick Has Its Price by Rob Stein, Washington Post Staff Writer; Friday, November 4, 2005

[Comparisons across national boundaries with diverse health-care systems are usually fraught with great inaccuracies because of the definition of terms involved. Please see note at the end.]

Americans pay more when they get sick than people in other Western nations and get more confused, error-prone treatment, according to the largest survey to compare U.S. health care with other nations.

The survey of nearly 7,000 sick adults in the United States, Australia, Canada, New Zealand, Britain and Germany found Americans were the most likely to pay at least $1,000 in out-of-pocket expenses. More than half went without needed care because of cost and more than one-third endured mistakes and disorganized care when they did get treated. 

Although patients in every nation sometimes run into obstacles to getting care and deficiencies when they do get treated, the United States stood out for having the highest error rates, most disorganized care and highest costs, the survey found.

"What's striking is that we are clearly a world leader in how much we spend on health care," said Cathy Schoen, senior vice president for the Commonwealth Fund, a private, nonpartisan, nonprofit foundation that commissioned the survey. "We should be expecting to be the best. Clearly, we should be doing better."

Other experts agreed, saying the results offer the most recent evidence that the quality of care in the United States is seriously eroding even as health care costs skyrocket.

"This provides confirming evidence for what more and more health policy thinkers have been saying, which is, 'The American health care system is quietly imploding, and it's about time we did something about it,' " said Lucian L. Leape of the Harvard School of Public Health.

The new survey, the eighth in an annual series of cross-national surveys conducted by Harris Interactive for the fund, is the largest to examine health care quality across several nations during the same period. The survey was aimed at evaluating care across varying types of health care systems, including the market-driven U.S. system and those that have more government controls and subsidies.

[With due respect to the prestigious Commonwealth Fund, it should be noted that it is precisely the fact that patient responsibility is what reduces health care costs. We do not at this time have a market-driven health care system in the U.S. We have more controls than most socialized countries. If the $1000 of increased personal responsibility reduces health care by $2000, that is a savings of either $2000 of future insurance premiums or future taxes to pay for government health care, is it not? It is this return to the market-driven system that will save health care expenditures. What a bargain!]

[What constitutes medical error is widely variable across health-care systems and national boundaries. At a meeting in Florence, the topic of medical errors came up. At our table there were physicians from several European countries. They confided that if a nurse told them she made a medication error, and if it was not medically important, they would not report it. In the United States, a very litigious society, most hospitals require even the slightest error be reported to the legal staff. More than 90 percent of minor variations in care, which may not be exactly what the doctor orders, are inconsequential. I personally will tell the RN that there is no need to fill out an incident report. However, the vast majority of physicians that I know insist that these inconsequential errors be reported to the lawyers. Conversely, from anecdotal evidence at this conference, 90 percent of such inconsequential errors are never recorded in the countries with socialized health care. The reasons for this were even more interesting and tragic from a patient’s point of view. When asked if they would give a different answer to a government bureaucrat, they appeared startled and said that their comments to colleagues are confidential and they would deny the occurrence of any error. They would certainly not report it since all physicians and nurses make errors and it would only backfire. They couldn’t conceive of anyone being a whistleblower.]

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3.      International Medicine: Teeth Tourism

NCPA – CEPA (Center for European Policy Analysis)

More Americans are joining Eastern Europeans on visits to the dentist. This fast growing phenomenon known as “teeth tourism” has increased in popularity over the last few years due to soaring medical costs and dwindling insurance benefits in the United States, as well as in other countries, says USA Today.

This relatively young trend finds that travelers, typically from wealthier countries, are visiting lesser-developed nations for medical care mixed with a vacation—all at cut-rate prices. The most popular destinations are situated in Eastern Europe, in particular, Hungary.

  • In Mosonmagyarovar, an estimated 150 dentists practice out of a population of 33,000.
  • In Sopron, the population is 58,000, with about the same number of dentists.

The reasons for their success: cheap manpower, cheap prices and inviting incentives. Moreover, businesses have supplied “dental week” packages that include airport transport and a free massage.

The difference in cost is outstanding:

  • For work on 26 teeth, including crowns, bridges and two extractions, the overall cost in the U.S. is estimated at $43,000.
  • In Hungary, the cost is $6,000.
  • Additionally, the country’s location allows patients to visit neighboring Austria, Slovakia and nearby Germany.

Of course, there are potential downsides. Locals may know some English, but German is the dominant second language. Dining can be difficult for sensitive teeth. Many businesses don’t accept credit cards. The term “buyer beware” is very much in play since there are fewer options after treatment, if the procedure has not gone well.

Those concerns aside, dentistry and tourism seem an ideal match, says USA Today.

Source: Mary Beth Marklein, “The Incidental tourist,” USA Today, July 29, 2005.

« Europe's Forgotton Youth | Europe's Population to Fall »


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4.      Medicare: VA Medicine Is Not A Good Model For Medicare

The Department of Veterans Affairs (VA) does good work, but it is not a viable model for Medicare, says Frank Lichtenberg, professor at the Columbia University Graduate School of Business.

In a recent report for the Manhattan Institute, he says veterans receive poor care because the VA discourages access to new drugs in an effort to control overall pharmaceutical costs. Consider:

  • Only 38 percent of the drugs approved in the 1990s, and 19 percent of the drugs approved by the Food and Drug Administration since 2000, are on the VA National Formulary.
  • The use of older drugs in the VA system reduced life expectancy by 2.04 months; the value of this reduction in longevity may be nearly $25,000 per person.
  • Veteran's life expectancy increased substantially before the National Formulary was introduced (between 1991 and 1997) but did not increase, and may have declined, after the Formulary was introduced (between 1997-2002); yet, the life expectancy of all U.S. males increased both before and after 1997.

In an interview with Investor's Business Daily, Lichtenberg explains why the VA's drug-price bargaining is wrong for Medicare. He believes it is a fallacy to say that just because you can give a low price to a relatively small segment of an entire market, that it should be the price everyone pays. If all Americans got the same price, he explains, total revenue of the pharmaceutical industry would be reduced and would undermine development of new drugs.

Pharmaceutical innovation plays an important role in reducing hospital and long-term-care use, and at $2,000 a day, even a small reduction in hospitalization means considerable savings. Lichtenberg does not think drug prices are high relative to value they deliver.

Source: Peter Benesh, "Want Cheap Drugs? Don't Scrimp on Quality, Says Prof," Investor's Business Daily, October 24, 2005; Press Release, "Cheaper but Less Effective Drugs: Should that be the Model?" Manhattan Institute, October 7, 2005; and Frank R. Lichtenberg, "Older Drugs, Shorter Lives? An Examination of the Health Effects of the Veterans Health Administration Formulary," Manhattan Institute, Medical Progress Report No. 2, October 2005.  

For Press Release:

For Lichtenberg Report:

For more on Health:

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

Ronald Reagan

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5.      Medical Gluttony: You Should Have Come to My Office and It Would Only Cost $100 Instead of $600 for the Average Emergency Room Charge. No Doctor! The Emergency Room Evaluation Was Free!

An asthmatic patient called me on Saturday because her asthma attack was into the third day. I reminded her that I didn’t see her in my office on Thursday or Friday to evaluate and treat. She said that she went to the emergency room instead and got a “shot.” But the asthma was getting worse.

I reminded her that the emergency room visit costs $600 on average; an office call to see me costs only $100. She said, “No doctor, I have a PPO insurance policy and the emergency room was free.” After making sure she had taken all her bronchodilators, started the antibiotic that all my asthma patients keep on reserve for when green phlegm occurs, and then added enough prednisone to break the asthma attack, I suggested she come in on Monday for an evaluation. I also reminded her that this phone call was free and the $600 ER charge was really not free - the insurance company would eventually get it back from her by increasing her premium. She agreed.

She did come in on Monday and was much improved as a result of the recommendations from the free telephone consultation. She was worse after the $600 emergency room consultation. In our working model of the ideal health plan for the U.S.A., these phone consultations will be reimbursable and thus save significant health-care costs.

This patient was one of three that utilized the Emergency Room needlessly this week. When patients think that a $600 medical evaluation is free, it should be painfully obvious that third-party health care is always gluttonous and unaffordable in the long term. Until we decide that there should never be any medical care that is totally free from a percentage co-payment, which gives the patient an index as to the total cost she incurred, health care will continue in its spiral increase without limit. The tragedy is the populist notion that a single payer will solve this problem, when in reality it will bring about medical rationing and denial of care. And some of that denial of necessary care will prove fatal.

[It should also be noted that on our recent trip to Washington, DC, when visiting the “staffers” of members of Congress, not one of the health-care experts that will be writing the health-care laws for the Congress of the United States knew what third-party payments meant. Heaven help us.]

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6.      Medical Myths: Let’s Solve the Uninsured Problem by Forcing Everyone to Purchase Health Insurance and Those That Can’t Afford to Will Be Subsidized.

An executive in organized medicine recently wrote an OpEd article stating: We need a new approach to financing universal access that is more practical and affordable, while still socially responsible and ethical. Though many details remain to be worked out, the goal of instituting an individual health-insurance requirement to cover all Americans is admirable. Nothing could be more critically important for business and medical professionals in every state to consider.

The Supreme Court of Canada ruled that being on the waiting list of a country with universal health care was not the same as having access to health care. People in any country with socialized medicine have universal coverage and access to a waiting list but may never have access to health care. California has a universal car insurance requirement. Having been struck three times by an uninsured motorist, most of us can vouch that such laws by fairy godmother legislatures, applied to the health care field, are not practical, affordable, socially responsible or ethical. It is important that physician organizations purge from their leadership positions those that continue to popularize such untruths. They are not doing our profession, our patients or the business community a service by promoting such Medical Myths.

[Charles] Munger, as usual, was more succinct [than Warren Buffett]: "The cause of reform is hurt, not helped, when an activist makes an idiotic suggestion." At the Berkshire Hathaway annual meeting which attracted nearly 20,000 attendees.

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7.      Overheard in the Medical Staff Lounge: My Insurance Cost My Laboratory 80% Of Their Charges!

Dr Rosen: I just received the printout of my Blue Cross payment for my laboratory work. The bill was $404.25 and Blue Cross disallowed $332.40 and paid $64.68 and my co-payment was $7.17. I’m so embarrassed to face my friends in the laboratory that I will have to have my laboratory work done at a different laboratory in the future where I’m unknown.

Dr Ruth: I’ve had a similar experience. But you know my patients think it’s great. They feel that those laboratories must really be gauging sick patients with exorbitant charges. They think the government and Blue Cross is protecting them from excessive charges since they are able to reduce the charges to about 20 percent of the fee. They have no concept that laboratories must quietly eliminate some expensive tests so they won’t be forced to do them at a major loss, eliminating an important item from some patients' diagnosis or treatment.

Dr Rosen: They have no concept of the free market and how much more ruthless it is to reduce charges. The important difference is that in the free market, the final charge will always be enough to sustain the laboratory and the health care system. But it isn’t only our patients that suffer this misconception. A large percentage of the general population also believes this. Basic economic principles no longer seem to be taught in our schools.

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8.            Voices of Medicine: Physician Opinions in the Various Local and Regional Medical Journals and the Press: North Country; Constant Gardener: Sonoma Doctors Top 10 Brain Movies.

"North Country" Alerts Public - Legal Mind-Rape!  by James J Murtagh, M.D.

Warning: movie spoiler alert. If you have not seen North Country, consider seeing the film before reading further.

[Note:  James Murtagh has spent 20 years as an Intensive Care Unit physician at a major Southeast hospital. Murtagh is also a founder of the medial ethics consulting group "Team Integrity." Murtagh recently chaired a congressional forum, "The Health Integrity Project," as reported in Time Magazine, in collaboration with Tom Devine at the Washington "Government Accountability Project."]  

I just got back from the magnificent film North Country, about a woman who wanted equality in a northern Minnesota mine, and as a man, I am shocked. How can equal pay for equal work even be an issue in 1990s America? Worse, why does America allow the "Nuts and Sluts" hardball legal tactic used against witnesses that is so common in our society, and so vividly depicted in this film? Have we come a long way, baby, when lawyers use "nuts and sluts," mind-rape, and hardball threats to witnesses? America needs to be shocked that the women of North Country had to put their lives and their families on the line to speak the truth. Sadly, we're not.

 North Country, like The Insider, All the President's Men, Serpico, Silkwood, get pegged as films with a message, but they are more.  These films are just darn good stories, a lone person up against a gargantuan system, the High Noons of our time. The story of human freedom retold from David and Goliath, Rocky, Spartacus, and Sophocles. This woman put everything, her job, her friends, and even her life on the line. Yes, she was speaking out equality for women, but more broadly, she was speaking out for the right to speak. Like Terry Malloy from the classic On the Waterfront, she wanted conscience and freedom in a place where very little existed.

I don't agree with either the extreme right or left, but I will defend to the death any Speaker, and I will protect the speaker's family as if it were my own.

Do not be fooled. This film is not just Northern Minnesota mines in the 1990s.  Enron-type lawyers use hardball legal tactics everyday to invade honest people's lives. To distort the vital issues of war and peace. To put unsafe medicines in our cabinets. Americans urgently need real information on health and safety, national preparedness.

Our society has to address the horrors brought on by hardball legal mind-rape.

Nuts and sluts. Attacks on the family lives of witnesses. Big tobacco did exactly this to Jeffrey Wigand, Big Nuclear to Silkwood, and Nixon to reporters. In fact, Nixon commissioned the Malek Manuel, the still-classic "nuts and sluts" textbook used by Enron-type corporations to "screw their enemies." First, paint your adversary as a nut. Every single person alive has a skeleton that can be rattled, magnified, and distorted until the person looks nutty. Second, every human being, even Gandhi, is vulnerable to sexual innuendo, real or fabricated. Even a saint can be put into a "he-said, she-said" situation.

In North Country, the big law thugs discover the heroine was raped as a child. With glee, the law thugs distorts horribly, calling the woman a slut, even turning her family and her child against her. This tactic is as old as Salem witch trials. The year1984 passed, but Big Brother is not dead.

When there is smoke, it is not true there is always fire. Big legal thugs burn money and blow the fabricated some anywhere they please. McCarthy knew this. Frankly, I cringe when Rush Limbaugh derides our mothers and sisters asking for equal rights as "femin-nazis." America sends Martha Stewart to jail but Kenny Lay to the golf course.

Look at the Karl Rove- Plame affair. Wilson's wife CIA clearances blown in a pressure tactic to discredit reports on yellow cake.  As in North Country, Rove decided the issue (yellow cake, sexual equality, the constitution, etc.) was no longer the issue; the issue was Wilson's wife. Have you no decency sirs? Ironically, Karl Rove broke the same law that sent Martha Stewart to jail: lying to the FBI.

Look at health care and drug companies and Vioxx. This spring, I had the privilege of hosting a Congressional forum on health integrity. The country's bravest health care workers testified to shocking hardball corruption in HMOs. HCA, an HMO operated by the family of Senator William Frist, actually admitted shaking down the American public for two billion dollars.  First-hand testimony from thirty doctors showing that HMO hardball causes thousands deaths and costs billions of dollars is posted at

Americans need to see North Country, and resolve that Enron hardball legal thugs cannot stand, not in energy, not in defense, not in mining, not in Washington D.C., and not in HMOs. This is not just a terrific film; it is an opportunity to explore the deep and searching questions as a society losing important freedoms.

Time to round up the usual suspects, America. We must no longer allow hardball lawyers to trample the rights of women, or men, or children.

To read the entire review, please go to


"Constant Gardener" - Time for Medical Whistleblowers to come in from the cold! by James J Murtagh, M.D


Warning: movie spoiler alert. If you have not seen Constant Gardener, consider seeing the film before reading further.


The Constant Gardener proves once again John le Carré is the master not just of spy novels, but also of the most basic human drives. And the central moral problems of our times. Some fans despaired that the fall of the Berlin wall would mean the end of the cold war spy novel. Now its clear the clash of warring new world order camps just intensifies the need for human intelligence, and for master spy craft.


Le Carré once wrote on fighting communism. Now, he writes on the evils of unbridled capitalism, and on bad faith in medicine.


The Constant Gardener begins with murder of the wife of a British diplomat in Nairobi, who blew the whistle on a pharmaceutical giant. The drug company was cynically using of Africans as guinea pigs, developing an incredibly lucrative antibiotic against drug-resistant TB. The stakes are high, and British intelligence has been called in to protect the drug company.


James Bond, no longer needed to fight S.P.E.C.T.E.R., becomes a mercenary in the fight against medical whistleblowers. In an earlier book, a secret agent with a conscience, such as George Smiley, might have restored balance. But no more. 


But does le Carre write fiction? Constant Gardener is tame compared to non-fiction headlines. Real life doctors daily battle bad faith that harms real patients. Actual whistleblowers, including James Alderson, exposed the mammoth Health Corporation of America (HCA, formerly known as Columbia HCA) for ripping off two billion dollars from the US public, and suffer the same "spy versus spy" legal hardball depicted in the film. Nor is the use of human guinea pigs by pharmaceutical giants limited to Africa. Dr. Linda Peeno testified to Congress that Humana knowingly withdrew standard care from U.S. patients, killing thousands, to increase the bottom line. NIH whistleblower Dr. Jonathan Fishbein reported that bad faith in research resulted in deaths. Suppressed research could have stopped the Vioxx debacle. One Dallas jury was so enraged by bad faith in medicine at a Texas HMO that it awarded $366 million dollars to Dr. Larry Poliner. Much of this information is posted at


A congressional forum I moderated this spring concluded the nation can't afford poor quality, unsafe medicine with jacked up prices. Bad faith in for-profit HMOs and drug companies leads to billions being diverted in high-profile political scams. Good faith in medicine is now an important matter of national security.


Reality is more sobering than a le Carre novel. HCA, controlled by the family of Senator William Frist, played a key role in the Texas Ranger purchase that put George W. Bush on the map. Karl Rove, in turn, helped Senator Frist to become the majority leader. Could even le Carre have plotted the scion of the world's largest HMO leading the US Senate, and then becoming a front-runner for president in 2008? Remember Godfather's Vito Corleone dying wish that Michael could have become Senator Corleone, or Judge Corleone? The real interdependence between HMOs, drug companies and U.S. politics is beyond anything contemplated in fiction.


Could even George Smiley thwart such a plan? 


The Constant Gardener is a magnificent film about real humans standing up to the terror of drug cartel thugs. It could just as well be about the real life terror inflicted by government agencies against whistleblowers standing up for the public good, and for human decency. In an age when we have given unprecedented power to Big Brother, and to agents of the patriot act, we must insist those who wield this power aid the weak and the innocent. In the fight to preserve human freedom, it is good to have John le Carré as the master of all spymasters chart the dangers of bad faith in medicine, research, and politics.


From Sonoma Medicine, The Magazine of the Sonoma County Medical Association Medical Arts: Top 10 Movies About the Brain by Colleen Foy-Sterling, MD

Because this issue of Sonoma Medicine focuses on memory and the brain, I asked some of my favorite “brains” to briefly expound on their favorite movies about the brain and its functions. I invite you to rent or buy these movies and send yourself on a gleeful mind-trip. They are listed in no particular order.

Frankenstein (1931). According to Dr. Allan Fishbein, radiologist at Petaluma Valley Hospital, there is no finer movie about the human mind. He especially enjoys the scene when the transplanted brain is “fired up.” He says, “It’s the closest Hollywood has ever gotten to true neurology!”

Awakenings (1990). Dr. Richard Mendius, neurologist, recommends this classic and comments: “How can you go wrong with a movie based on a book by a neurologist (Dr. Oliver Sacks), starring Robin Williams and Robert De Niro?” He has a point. De Niro is brilliant as a man who has been in a coma since he was a teenager. The good doctor secures permission to try out a new drug that revives such patients. Apparently, both De Niro and Williams spent time with Dr. Sacks, observing patients on his ward.

Confessions of a Dangerous Mind (2002). A guilty pleasure, I must admit this is one of my favorites. Was this millionaire game-show creator also a double-agent? Or are we let in on some of his fantastic imaginings? Or was he simply mentally ill and delusional? We will never know. The tag line: “Some things are better left top secret.” 

Memento (2000). Guy Pierce stars as a man who loses his short-term memory while looking for his wife’s murderer. The tale is told in reverse order, in a film-noir style. The film is complex, suspenseful, and creative. Just keeping it all together is a workout for the mind.

Being John Malkovich (1999). John Cusack is a puppeteer who discovers a secret door in his office that dumps out into John Malkovich’s brain, allowing visitors 15 minutes of experience in the movie star’s life.

Charly (1968). Cliff Robertson won an Oscar for Best Actor as Charly, a mentally retarded man who is brought to a near-genius but emotionally immature state by an experimental drug. Bring tissues.

A Beautiful Mind (2001). Everyone mentioned this one, so I included it! The true story of Nobel Prize-winning mathematician John Ash, who starts out working in game theory and descends into schizophrenia. Many film-goers thought he really was a government spy, believing his delusions to be real.

Mindwalk (1990). Book-lover and world-traveler Betsy Lanning, who works with me, spent much of her adult life in France and immediately came up with this one. A politician and a poet walk among the beautiful and haunting scenery of the medieval island of Mont St. Michel, eventually meeting up with a scientist. The entire movie is a conversation of thoughts and a meeting of minds.

Koyaanisqatsi (1982). A barrage of time-lapse cinematography hits your mind and puts you in a trance. See how many commercials and music videos used this as their original template. Mind-blowing for its time.

What the Bleep Do We Know? (2005). Family physician and homeopathist Dr. April Hurley says this movie changes the way we think about how our minds work and shows how little we really know.

You may want to peruse the original at

To read a symposium on The Brain, go to

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9.      Book Review: The Tipping Point - How Little Things Can Make a Big Difference - by Malcolm Gladwell

The Tipping Point is a book about change and presents a new way of understanding why change so often happens quickly and unexpectedly. Gladwell says the best way to understand the emergence of fashion trends, the ebb and flow of crime waves, the transformation of unknown books into bestsellers, or the rise of teenage smoking or any number of other mysterious changes that mark everyday life is to think of them as epidemics. Ideas and products and messages and behaviors spread just like viruses do. The three rules of the Tipping Point - the Law of the Few, the Stickiness Factor, the Power of Context - offer a way of making sense of epidemics. They provide us with direction for how to go about reaching a Tipping Point.

The Law of the Few: On the afternoon of April 18, 1775, a young boy who worked at a livery stable in Boston overheard one British army officer say to another something about “hell to pay tomorrow.” The stable boy ran with the news to Boston’s North End, to the home of a silversmith named Paul Revere. Revere listened gravely; this was not the first rumor to come his way that day. As the afternoon wore on, Revere and his close friend Joseph Warren became more and more convinced that the British were about to make a major move that had long been rumored - to march to the town of Lexington, to arrest the colonial leaders John Hancock and Samuel Adams and then on to the town of Concord to seize the stores of guns and ammunition that some of the local colonial militia had stored there. At 10 o’clock that night, Warren and Revere met and decided they had to warn the communities surrounding Boston Harbor. At midnight Revere jumped on a horse at the ferry landing at Charlestown and began his “midnight ride” to Lexington passing through Charlestown, Medford, North Cambridge, Menotomy - knocking on doors and telling them to spread the word “The British are Coming.” Each in turn spreads the word to others like a virus until alarms were going off through the entire region.

When the British finally began their march toward Lexington on the morning of the nineteenth, their foray into the countryside was met - to their utter astonishment - with organized and fierce resistance and they were soundly beaten. From that exchange came the war known as the American Revolution. Gladwell feels the Paul Revere’s ride is perhaps the most famous historical example of a word-of-mouth epidemic – The British are Coming.

The Tipping Point For Hush Puppies - the classic American brushed-suede shoes with the lightweight crepe sole - came somewhere between late 1994 and early 1995. The brand had been all but dead until that point. Sales were down to 30,000 pairs a year, mostly to backwoods outlets and mall-town family stores. Wolverine, the company that makes Hush Puppies, was thinking of phasing out the shoes that made them famous.

But then something strange happened. At a fashion shoot, two Hush Puppies executives - Owen Baxter and Geoffrey Lewis - ran into a stylist from New York who told them that the classic Hush Puppies had suddenly become hip in the clubs and bars of downtown Manhattan. "We were being told," Baxter recalls, "that there were resale shops in the Village, in Soho, where the shoes were being sold. People were going to the Ma and Pa stores, the little stores that still carried them, and buying them up." Baxter and Lewis were baffled at first. It made no sense to them that shoes that were so obviously out of fashion could make a comeback. "We were told that Isaac Mizrahi was wearing the shoes himself," Lewis says. "I think it’s fair to say that at the time we had no idea who Isaac Mizrahi was."

By the fall of 1995, things began to happen in a rush. Designers called wanting to use Hush Puppies in their spring collections. In Los Angeles, the designer Joel Fitzgerald put a twenty-five foot inflatable basset hound - the symbol of Hush Puppies brand - on the roof of his Hollywood store and gutted an adjoining art gallery to turn it into a Hush Puppies boutique. While he was still painting and putting up shelves, the actor Pee-wee Herman walked in and asked for a couple of pairs. "It was total word of mouth," Fitzgerald remembers. In 1995, the company sold 430,000 pairs of the classic Hush Puppies, and the next year it sold four times that, and the year after that still more, until Hush Puppies were one again a staple of the wardrobe of the young "American male."

In 1996 Hush Puppies won the prize for best accessory at the Council of Fashion Designers awards dinner at Lincoln Center, and the president of the firm stood up on the state with Calvin Klein and Donna Karan and accepted an award for an achievement that - as he would be the first to admit - his company had almost nothing to do with. Hush Puppies had suddenly exploded, and it all started with a handful of kids in the East Village and Soho, who were wearing them precisely because no one else would wear them. And then the fad spread. No one was trying to make Hush Puppies a trend, but that’s exactly what happened. The shoes passed a certain point in popularity and they tipped.

To read the entire review, including the story of Bernie Goetz and the rise and fall of New York City Crime, please go to

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10.  Hippocrates & His Kin: That’s His Real Name. He’s Not An Anal Cipher.

At last week’s Medical Grand Rounds at the University of California at Davis, the Professor of Infectious Disease was discussing Clostridium difficile diarrhea. This is frequently a complication of multiple or prolonged antimicrobial usage. He referred to a paper by Dr Aas. The standing room audience of doctors let out a chuckle. The professor immediately responded, “No that is his real name. Not his stage name.”

Do you suppose his research interest may have been determined by his real name? Instant graphic medical notoriety?

Nobel Laureate Richard Smalley sat in front of Congress with no hair, as a result of his chemotherapy, and talked about the promise of nanotechnology for cancer and other diseases and how it would pay off for his children. Some thought it was absolutely riveting. Congress authorized the National Nanotechnology Initiative. Federal spending for the initiative amounted to more than $1 billion this fiscal year.

Now we know how to conquer all diseases: Have someone with the disease sit in front of our impressionable Congress and bewitchingly tell them of the horror and hope of their disease. Can you imagine someone with Huntington’s Chorea with uncontrollable hemiballistic movements of all extremities attempting to sit on a chair in front of a committee trying to explain the horror of what he’s going through to these lay people? They would immediately start a National Huntington’s Chorea Initiative and fund it with the lowest amount that Congress can recognize--One Billion Dollars--to conquer the syndrome. This should give impetus to about a thousand other disease sufferers to do the same. With a paltry One Billion Dollars to a thousand diseases, Congress could spend an extra One Trillion Dollars per year. That kind of spending would indeed be an orgiastic experience for Congress. To paraphrase George Carlin, “I might never leave DC—even if I’m not reelected.”

The kindly looking pharmacist tells his patient: "You can save hundreds of dollars a year by signing up for the new Medicare prescription-drug benefit.”  Such commercial are part of the publicity barrage that is occurring to market drug coverage to older Americans. The campaign being aided by extensive research on what appeals to older people -- they tend to trust pharmacists, for example -- and by government recommendations on the best language to use.  The drug benefit is the biggest expansion in the history of Medicare, the federal health program for the elderly and disabled. Most of the cost will be picked up by the government. (See Sarah Lueck in WSJ

Wouldn’t it be more accurate to say the costs will be picked up by present, future, and even unborn generations of working Americans?

At a recent managed care meeting, the pharmacist was expounding on the pharmacy benefit program expansion of Medicare, now known as Medicare Part D. She pointed out that this program carries a price tag of $720 billion over 10 years, or about $72 billion per year. She also mentioned that the marketing budget for Medicare Part D, to convince seniors to participate, is $300 billion over the next three years, or about $100 billion per year.

It is only in government that a product promotion can exceed the product cost.

To read more Hippocrates columns, please go to


The US Treasury must be some bank account with unlimited overdraft capabilities.

Of course. It reaches into every citizen’s personal bank account.

Do you suppose we could serve Congress vinegar in champagne glasses to restore reality?

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11.  Restoring Accountability in Medical Practice 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, which has caused New Jersey to have the highest health insurance and malpractice premiums in the world. To read the rest of the story, go to and check out their history, mission statement, newsletter, and a host of other information. Be sure to go to and read the remarks of Drs. John and Alieta Eck their amazing story by clicking on From Zarephath to Antigua announcing their plans to convert a new facility in Antigua into a first class tertiary care hospital for medical tourism. Begin to make plans to bring your family and spend a few months providing care in a resort area. What a wonderful change of pace for a physician including his or her family.


                      PATMOS EmergiClinic - - where Robert Berry, MD, an emergency physician and internist practices. “I named the clinic PATMOS EmergiClinic - for the island where John was exiled and an acronym for ‘payment at time of service.’ I have no third party contracts - not commercial, not Medicare, TennCare or worker's compensation. My practice today has over 4,000 patient charts.  My patients are typically between 5-50 years old, but I do have a significant number of Medicare patients. Because I need only one employee in my office, my costs are low.  For the same services, I charge about 60 percent of charges made by other local clinics, 40 percent of what the local urgent care clinic charges and less than 20 percent of what the local ER charges.  I am the best bargain in town.” To read more on Dr Berry, please to go

                      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 or Medicaid, no HIPAA, just patient care. Dr Harris is nationally recognized for his medical care system reform initiatives. He lists his CV and publications on the website. To understand that Medical Bureaucrats and Administrators are basically Medical Illiterates telling the experts how to practice medicine, be sure to savor his article on "Administrativectomy: The Cure For Toxic Bureaucratosis" at

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

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

                      Madeleine Pelner Cosman, JD, PhD, Esq, has made important efforts in restoring accountability in health care. She has now published her important work, Who Owns Your Body. To read a review, go to Please go to to view some of her articles that highlight the government’s efforts in criminalizing medicine, as well as her latest article on Bird Flu.

                      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 and for Health Care Inflation, go to

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

                      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.

                      Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks’ topics or click on archives to see the last two years’ topics at Be sure to read this week’s column on New Medicare Drug Plan Offers Few Meds and Little Care before you sign up for a disaster.

                      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 review News of the Day, paying special attention to the November issue on how the Medicare Drug Plan may leave patients without their medications, by logging on at The “AAPS News,” written by Jane Orient, MD, and archived on this site, provides valuable information on a monthly basis. Be sure to read the October issue on Paying for Medical Care at Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. Be sure to read Dr Jacques Chaoulli, M.D., on his nine-year fight on the Long Road to Freedom in Canadian Medicine at There are a number of important articles that can be accessed from the Table of Contents page of the current issue.


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Stay Tuned to the MedicalTuesday.Network and Have Your Friends Do the Same.

Please note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.

Del Meyer       

Del Meyer, MD, Editor & Founder

6620 Coyle Avenue, Ste 122, Carmichael, CA 95608

Words of Humor

Warren Buffet: "I didn't say it was your fault. I said I was going to blame it on you." Quote from the Boss... Corporate Humor

Warren Buffet: Quote from the Boss after overriding the decision of a task force he created to find a solution: "I'm sorry if I ever gave you the impression your input would have any effect on my decision for the outcome of this project!"


Words of Wisdom

Lee Iacocca, developer of the Ford Mustang before becoming Chairman of Chrysler Corporation of America, where he developed the K-Car and the Minivan, said it best about task forces. He had a task force to evaluate the purchase of General Motors. After reviewing the required sale of several GM subsidiaries to make the purchase possible, he told the task force it would be easier to purchase Greece. He had a task force to evaluate the purchase of American Motors Corporation that came back and told him it was not a good fit and recommended against the acquisition. Iacocca, a mnemonic for his title, (I Am Chairman Of Chrysler Corporation of America) then purchased AMC. Going against the recommendations of both task forces, as I recall he stated that the information each task force provided was critical in his decision-making process.

Earl Nightingale:  Every business must have a man on a white horse to be successful.

Edward Langley, Artist 1928-1995: What this country needs are more unemployed politicians.

P.J. O’Rourke, Civil Libertarian:  Giving money and power to government is like giving whiskey and car keys to teenage boys.

Voltaire: The art of government consists of taking as much money as possible from one party of citizens to give to the other.


In Remembrance

Nobel Laureate Richard Smalley, a Rice University professor who shared the 1996 Nobel Prize in chemistry with fellow Rice chemist Robert Curl and British chemist Sir Harold Kroto for the discovery of the new form of carbon, helped discover buckyballs, the soccer ball-shaped form of carbon, and championed the field of nanotechnology, has died at the age of 62 on Friday, October 28, 2005, at M.D. Anderson Cancer Center from his leukemia. Nanotechnology, for things measured in billionths of a meter, involves manipulating materials on an atomic or molecular scale to build microscopic devices.

"In my view, this was a singular event in the history of nanotechnology," said Neal Lane, a senior fellow at Rice University's Baker Institute for Public Policy. "It not only created a whole new field of 'fullerene chemistry,' it immediately made feasible the notion of making things from the bottom up, just as physicist Richard Feynman had predicted 50 years earlier." Smalley's research remained focused on the compounds until his death. His leadership helped lead the U.S. to launch the National Nanotechnology Initiative in 2000.

"These little nanothings, and the technology that assembles and manipulates them — nanotechnology — will revolutionize our industries and our lives," he told the U.S. House of Representatives in 1999 while arguing for the creation of the National Nanotechnology Initiative to support the research. "Rick overwhelmingly carried the day," said Caltech chemist James Heath, a former student of Smalley's. "He sat there in front of Congress with no hair, as a result of the chemotherapy, and talked about the promise of nanotechnology for cancer and other diseases and how it would pay off for his children. It was absolutely riveting." Federal spending for the initiative amounted to more than $1 billion this fiscal year.,1,2688226.story?ctrack=1&cset=true

[What seems to be overlooked, even in obituaries, is that technology will always be developed and promoted by the entrepreneurs making some industrious people very wealthy. We should not lead people to think that ‘riveting Congress” to extract money from the citizenry, is a “Nobel” thing]

On This Date in History – November 22

On this date in 1906, SOS was adopted as the international distress signal. We still haven’t come up with an international greeting signal!

On this date in 1963, President John F Kennedy was assassinated.