Community For Better Health Care

Vol VII, No 16, Nov 25, 2008


In This Issue:

1.                  Featured Article: New Light on Creativity

2.                  In the News: Cancer Drugs Don't Help 75% Of The People Who Take Them

3.                  International Medicine: Socialized Medicine will Collapse with Information Technology

4.                  Medicare: The Stepchild of Social Security

5.                  Medical Gluttony: Changing Doctors May Decrease Quality and Increase Costs

6.                  Medical Myths: Ten Myths of the American Health Care System

7.                  Overheard in the Medical Staff Lounge: The Election is Over, Now What's Next?

8.                  Voices of Medicine: The Future Practice of Anesthesiology

9.                  From the Physician Patient Bookshelf: The Story of Our Constitution

10.              Hippocrates & His Kin: Don't Just Stand There, Do Something!

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

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Logan Clements, a pro-liberty filmmaker in Los Angeles, seeks funding for a movie exposing the truth about socialized medicine. Clements is the former publisher of "American Venture" magazine who made news in 2005 for a property rights project against eminent domain called the "Lost Liberty Hotel."
For more information visit or email

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1.      Featured Article:  New Light on Creativity

Neuroscience Sheds New Light on Creativity Wired Magazine, Oct 08, By Gregory Berns

Close your eyes and visualize the sun setting over a beach.

How detailed was your image? Did you envision a bland orb sinking below calm waters, or did you call up an image filled with activity -- palm trees swaying gently, waves lapping at your feet, perhaps a loved one holding your hand?

Now imagine you're standing on the surface of Pluto. What would a sunset look like from there? Notice how hard you had to work to imagine this scene. Did you picture a featureless ball of ice with the sun a speck of light barely brighter than a star along the horizon? Did you envision frozen lakes of exotic chemicals or icy fjords glimmering in the starlight?

What you conjured illuminates how our brains work, why it can be so hard to come up with new ideas -- and how you can rewire your mind to open up the holy grail of creativity. Recent advances in neuroscience, driven by functional magnetic resonance imaging (fMRI) that lets scientists watch brain activity as never before, have changed what we know about key attributes of creativity. These advances, for example, have swept away the idea that there is a pleasure center in the brain that somehow acts as an accelerator to the engine of human behavior. Rather, chemicals such as dopamine shuttle between neurons in ways that look remarkably like the calculations modern robots perform.

Creativity and imagination begin with perception. Neuroscientists have come to realize that how you perceive something isn't simply a product of what your eyes and ears transmit to your brain. It's a product of your brain itself. And iconoclasts, a class of people I define as those who do something that others say can't be done -- think Walt Disney, Steve Jobs, or Florence Nightingale -- see things differently. Literally. Some iconoclasts are born that way, but we all can learn how to see things not for what they are, but for what they might be.

Perception and imagination are linked because the brain uses the same neural circuits for both functions. Imagination is like running perception in reverse. The reason it's so difficult to imagine truly novel ideas has to do with how the brain interprets signals from your eyes. The images that strike your retina do not, by themselves, tell you with certainty what you are seeing. Visual perception is largely a result of statistical expectations, the brain's way of explaining ambiguous visual signals in the most likely way. And the likelihood of these explanations is a direct result of past experience.

Entire books have been written about learning, but the important elements for creative thinkers can be boiled down to this: Experience modifies the connections between neurons so that they become more efficient at processing information. Neuroscientists have observed that while an entire network of neurons might process a stimulus initially, by about the sixth presentation, the heavy lifting is performed by only a subset of neurons. Because fewer neurons are being used, the network becomes more efficient in carrying out its function.

The brain is fundamentally a lazy piece of meat. It doesn't want to waste energy. That's why there is a striking lack of imagination in most people's visualization of a beach sunset. It's an iconic image, so your brain simply takes the path of least resistance and reactivates neurons that have been optimized to process this sort of scene. If you imagine something that you have never actually seen, like a Pluto sunset, the possibilities for creative thinking become much greater because the brain can no longer rely on connections shaped by past experience.

In order to think creatively, you must develop new neural pathways and break out of the cycle of experience-dependent categorization. As Mark Twain said, "Education consists mainly in what we have unlearned." For most people, this does not come naturally. Often, the harder you try to think differently, the more rigid the categories become.

Most corporate off-sites, for example, are ineffective idea generators, because they're scheduled rather than organic; the brain has time to predict the future, which means the potential novelty will be diminished. . . Transplanting the same mix of people to a different location, even an exotic one, then dropping them into a conference room much like the one back home doesn't create an environment that leads to new insights. No, new insights come from new people and new environments -- any circumstance in which the brain has a hard time predicting what will happen next.

Fortunately, the networks that govern both perception and imagination can be reprogrammed. By deploying your attention differently, the frontal cortex, which contains rules for decision making, can reconfigure neural networks so that you can see things that you didn't see before. You need a novel stimulus -- either a new piece of information or an unfamiliar environment -- to jolt attentional systems awake. The more radical the change, the greater the likelihood of fresh insights.

Some of the most startling breakthroughs have had their origins in exactly these types of novel circumstances. . .   Walt Disney was a decent illustrator, but he didn't imagine the possibilities of animation until he saw his advertising illustrations projected onto the screen in a movie theater. In an extreme example, the preeminent glass artist Dale Chihuly didn't discover his sculptural genius until a car accident led to the loss of an eye and literally forced him to see the world differently. Only when the brain is confronted with stimuli that it has not encountered before does it start to reorganize perception. The surest way to provoke the imagination, then, is to seek out environments you have no experience with. They may have nothing to do with your area of expertise. It doesn't matter. Because the same systems in the brain carry out both perception and imagination, there will be cross talk. . .  To read the entire article, go to

Adapted from the book Iconoclast, by Gregory Berns, by permission of Harvard Business Press. Copyright 2008 Harvard Business School Publishing Corp. All Rights Reserved.

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2.      In the News: Revolutionaries: Merck's Free Radical, Forbes, by Matthew Herper

Cancer drugs don't help 75% of the people who take them. Stephen Friend says he can use science to end the crapshoot

In the downtrodden drug industry, Merck cancer guru Stephen Friend may be one of the last great dreamers. His latest idea is one that would completely change the secretive and siloed way the pharmaceutical business fights cancer: create a giant, open-to-the-public database that will include every cancer drug and every patient and how that patient is doing. Track everything and over time we might be able to raise the abysmal success rate of treatment.

Friend, 54, has been a doctor who treated kids with cancer, an academic, an entrepreneur and a biotech chief executive. He helped develop a diagnostic test that predicts whether breast cancer will return after surgery. For five years he has been in charge of getting cancer drugs invented at Merck. Now 8 are in clinical trials, up from one, with 15 more preparing to enter trials. Friend is still unsatisfied. Why is it that, on average, three out of every four people who take a cancer medicine get lots of side effects but no benefit?

Researchers have been too willing to bet on hunches, he says, yet the technology to understand the complex biology of cancer is at hand. Spurred by Friend, Merck has spent billions on an arsenal of technologies for understanding how genes work. The resulting data stream is sent through the fastest supercomputer in the drug industry, a beast that consumes 64 kilowatts of power and is capable of 16 trillion calculations a second. Friend thinks he can accurately predict how groups of proteins in tumors work together and use that information to kill the cancer. He's trying to drag the secretive world of drug-discovery chemistry into the computer age.

The Friend way would take all the data collected each year from the thousands of cancer patients entered in trials, make it anonymous and put it into one database, preferably held by the government but definitely accessible to any physician or scientist. Right now those data are lost to the wind once the trial is over. But by keeping track of patients' genes, the genes in their tumors and what drugs they take, scientists will be able to discern patterns. Instead of trying drugs in order, from the ones that work most often to those that work least often, doctors will be able to pick the medicine that is most likely to help a particular patient. New medicines will get to market faster, along with diagnostic tests that will predict what will work. Friend predicts, somewhat optimistically, that prescribing decisions won't be based on "a promotional campaign." The database will decide.

"That future world is coming," says Friend. "And pharmaceutical companies can live in that world. If you develop the best drug and develop it for the right patient, all this does is get it to that right patient."

Merck has not done much so far to open its trial data to the world, nor have its rivals, but Merck has less to lose here and more to gain. It has fewer cancer drugs in human tests than Pfizer or AstraZeneca, and its shares have dropped by half this year. Friend is powering ahead, building a first stab at the big database with the H. Lee Moffitt Cancer Center in Tampa, Fla. Over the next five years every patient who walks through Moffitt's door will be asked to put genes and tumor samples in a database that will number 100,000 patients; 5,000 are already in. The database will provide information to the doctors doing research there and, eventually, to patients. If it turns out you have a gene that tells researchers what drug will work for you, Merck and Moffitt plan to let you know. Experiments that would have required weeks of thawing tumor samples now take a matter of hours.

"Right now most of medicine is based on a bunch of gray-haired guys who say, 'This is the way I do it and it seems to work,'" says Moffitt Director Bill S. Dalton. "We need to determine over time what is useful and what isn't. The only way to do that is to study 100,000 patients." . . .

A megadatabase "could save me months or years of trying to collect patient information," says Oregon Health & Science University oncologist Brian Druker, who helped get Novartis' potent tumor-fighter Gleevec to the market. But he questions whether researchers understand cancer biology well enough for Friend's highly computational approach to pay off in the short term. "Over the long term the Merck strategy will be the winning strategy," says Druker. "But right now I don't think we're quite there."

Merck has spent the past few years trying to dig out of one of the toughest periods of its 120-year history. In 2003 several experimental drugs for various diseases failed, all at once. In 2004 the blockbuster painkiller Vioxx was yanked because it caused heart problems. Merck settled its Vioxx liability claims last year for $5 billion. . .

Merck hopes fighting cancer is one way out of this funk. Friend was put in charge of Merck's cancer research efforts in 2003, two years after Merck bought the company he was running, Rosetta Inpharmatics. Friend had cofounded Rosetta in 1996 with Leland Hartwell, now director of the Fred Hutchinson Cancer Research Center in Seattle, and Leroy Hood, now president of the nearby Institute for Systems Biology. Like rival Affymetrix, Rosetta began selling tiny DNA chips that could be used to figure out how often cells were accessing their genes. . .

The first fruits of Rosetta's technology began to emerge with a 2002 article in the New England Journal of Medicine. Dutch researchers using Rosetta's software found a particular pattern of genetic signals within breast cancer tumors that could predict whether or not the cancer would return after surgery. The test is not a significant product for Merck but was approved by the FDA in 2007. It and a similar test made by a rival, Genomic Health of Redwood City, Calif., are widely used to guide post-op treatment strategy. . .

All of these bets are based on what Friend's giant computer tells him. "This is going to have to be the path taken by pharma in the future," says Hood of Friend's current work. "It's a gamble, but I think it's one that if Merck sticks with it, they'll win big."

Recently Friend took a detour on his way to a research conference in Chicago. He flew to Florida, rented a 1972 Chevy Chevelle and drove to Cape Canaveral to watch the space shuttle launch. He says it wasn't just that he wanted to recapture the feeling of the space race, when scientists were treated like heroes, but that he wanted to get a sense of a project that massive and complex. Creating a cancer drug is not that different.

"The puzzle's gotten big," he says of the cancer drug hunt. "But I think there is only one way to solve it."

To read the entire article, go to

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3.      International Medicine: Socialized Medicine will Collapse like Communism Because of Information Technology


          In The Constitution of Liberty, Friedrich Hayek gave a dire prognosis for the future of technology: "[W]e are probably only at the threshold of an age in which the technological possibilities of mind control are likely to grow rapidly and what may appear at first as innocuous or beneficial powers over the personality of the individual will be at the disposal of government. The greatest threats to human freedom probably still lie in the future."

          Hayek, like most of the leading intellectuals of his time, did not foresee the emergence of the Internet - the quintessential Hayekian spontaneous order. As a decentralized communication system facilitating the sending and receiving of messages by billions of people, the Internet has greatly shifted the balance of power away from governments and toward sovereign individuals. Even in its early days, the Internet played a vital role in bringing about the downfall of the Soviet Union's government. Since then, it has catalyzed tremendous economic, social, and political liberation in countries ranging from Cuba to the United States.

          While governments have tried to use modern communication technologies to monitor and regulate private individuals, their efforts are doomed to failure stemming from a much more powerful and competent market response.

Hayek Did Not Know the Internet

          When Friedrich Hayek's The Constitution of Liberty was first published in 1960, the Internet did not exist; nor did its military predecessor, ARPANET, which was initiated in 1969. Fifteen years after the horrors of World War II, the means by which the totalitarian regimes of Nazi Germany and the Soviet Union used mass broadcasting technology to indoctrinate their people were still recent memories. During the Nuremberg Trials, Albert Speer himself expressed the Nazi regime's effectiveness at using technology to spread propaganda: "Through technical devices like the radio and the loudspeaker, eighty million people were deprived of independent thought. It was thereby possible to subject them to the will of one man." Faced with such facts, Hayek understandably feared future uses of mass broadcasting technology.

          Indeed, in a world where the only mass communication technologies were radio and films, the scales of power were shifted toward totalitarian governments and away from sovereign individuals. According to Christopher Kedzie, "Since traditional broadcast media are located closest to the dictator's optimum they are almost certain to be employed as a powerful political weapon."  . . .

          Totalitarian states with the resources to control the small number of radio broadcasts and films in existence during the 1930s and 1940s could influence their subjects without major competition from their nonstate opponents.

          Hayek was not alone in fearing the combination of technology and government. In 1984, published in 1949, George Orwell portrayed an all-encompassing surveillance state that completely controlled not only the present flow of information but also the historical record. But Orwell also lacked the benefit of seeing subsequent technological developments and the cost reductions they entailed for ordinary private individuals. In the words of Richard Muller, "Orwell's error was remarkably simple: he assumed that only the state would be able to afford high-tech - an assumption shared by virtually every prophet, science-fiction writer, and futurist. But it has proven to be wrong."

          We do not live in an Orwellian world today, in large part because of Moore's Law: "In 1965, Gordon Moore, the co-founder of Intel Corp., predicted that, every 18 months, the processing power of a silicon chip would double as transistor density increased, a forecast that has proven uncannily accurate." This exponential growth in processing power has enabled cutting-edge technology to spread beyond the purview of governments and into the hands of over a billion individuals around the world.

. . . The story of the Internet is one of piecewise relinquishment of government control and empowerment of private individuals and organizations.

          Unlike early radio and television, technologies with many possible message originators - such as the telephone and especially the Internet - are highly damaging to powerful governments, because they introduce competition into the market of ideas.

          The telephone has its weaknesses; the recipients of any given message are few, and it is possible to wiretap telephone lines and restrict their number - as the Soviet government tried to do prior to Mikhail Gorbachev's policy of Glasnost (openness).

          The Internet, however, is far more resilient. Unlike earlier broadcasting technologies, the Internet has no central nexus from which it can be effectively controlled and restricted. Tim Swanson notes that the Internet "is an amalgamation, an assortment of heterogeneous computer systems with varying capabilities linked together by various protocols." It is impossible to silence the Internet by seizing pieces of Internet hardware - even in a concerted effort to do so within any given country. In Kedzie's words, "Neither the autonomy nor the influence of electronic networks is constrained by national boundaries." It is entirely possible for a political dissident in one country to have his website hosted in a different part of the world - far from the reach of the authorities against whom he writes and speaks . . .

Some governments seeking to restrict the free flow of ideas have attempted to extensively limit their subjects' access to the Internet. But blocking online content is like using a sieve to stop the flow of water. China's government requires search engines such as Google to block content critical of the Communist Party. However, such censorship is ineffectual and fails to substantively restrict access to even the most "threatening" ideas. James Glassman notes with amusement that the Chinese government "blocks access to certain websites, including that of the Washington Post but not of my own far more subversive free-market technology site,"

          Even restricting access to virtually every major Western media source would not address the millions of online articles, political blogs, small magazines, videos, and audio recordings that Chinese and other government officials do not know and cannot know about.

          Search engines that filter out combinations of provocative keywords still cannot detect metaphors, allegories, subtle allusions, satires, and even unusual turns of phrase. Moreover, they cannot stop individuals from using the local knowledge of their friends and associates in order to find websites without the aid of major search engines.

          Throughout his work, Hayek emphasizes the importance of particular knowledge of time and place in shaping individual decisions - as well as a centralized bureaucracy's inability to access such knowledge. Much of individuals' awareness of content on the Internet arises from their possession of such local knowledge. A Hayekian analysis would suggest that governments are powerless to even know the nature of this knowledge, much less to interfere with its transmission.

The Early Internet and the Downfall of the Soviet Union

          To merely say that the Internet has made the effective large-scale censorship of ideas impossible would understate the case for the Internet as a tool of unprecedented individual liberation. The Internet has the power to bring down oppressive governments - a power that was manifested even in its early days. For instance, the Internet played an indispensable role in destroying the Union of Soviet Socialist Republics.

          The USSR was destroyed not by the conventional means of invasion or violent revolution, but by the flow of information. In the words of Shimon Peres, Communism fell without the participation of the Russian army, for or against; it fell without having a new political party against the Communists - if at all, it was done by the Communists; it fell without the intervention of the United States, Europe, China or anybody else …. . . Authoritarian governments became weak the minute they could no longer blind their people or control information. . .

Government Threats and Market Solutions

          Of course, governments can and do attempt to use even contemporary decentralized technologies in order to increase their ability to monitor, regulate, and restrict individuals. But they cannot succeed in the long run. After all, the most advanced technologies accessible to governments today are fundamentally market driven, meaning that they are driven by the choices of individual consumers, who do not wish to be monitored, regulated, and restricted.

          Whether a particular technology is adopted or rejected is no longer subject to the decisions of government officials or even firms in partnership with governments. Rather, according to Glassman, "technology emerges from a process, undirected by the state or any other central authority, that encourages variety, spontaneity and discovery through trial and error. The incentives that motivate this process depend on free minds operating within free markets."

          Businesses cannot force technologies that consumers do not want onto those consumers; if they tried, they would quickly lose market share. Timothy Terrell notes a trend common throughout history: "Technologies that do not present the consumer with any significant cost or quality advantage will quickly disappear."

          The only way a government can impose controls on consumers through technology is by sneaking around the market and establishing covert surveillance and regulation. But if such a threat exists, the market will respond to it - and will do so more competently than the government. Glassman observes that technology also provides countervailing power. While government may now have the power to eavesdrop on conversations a mile away, the speakers themselves now have the power to block the reception. Government can intercept Internet messages, but the senders of those messages can encrypt them in a way they could never encrypt written messages.

Read the entire article at

[Socialized control of medicine is similar to a dictator's control of political freedom. As people in other countries see the advances in Medicine we enjoy in America, they will eventually break down the walls that restrict their access to care. We must always be on guard so that we don't succumb to government control of our medical freedom under the euphemistic term of single payer medicine - the socialized system from which the rest of world is trying to extract itself.]

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

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

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4.      Medicare: The Stepchild of Social Security

Making Social Security More Harmful By J. R. Clark and Dwight R. Lee

J. R. Clark holds the Probasco Chair of Free Enterprise at the University of Tennessee at Chattanooga. Dwight Lee holds the William J. O'Neil Chair of Global Markets and Freedom in the Cox School of Business at Southern Methodist University.

Social Security is a fundamentally flawed system. If a private firm offered such a retirement system and made the same claims for it that the federal government makes for Social Security, that firm would quickly become a poster child for corporate fraud, and its managers would soon be convicted of criminal charges.

There are two fraudulent claims the federal government makes about Social Security that deserve special attention. By considering how these two claims interact with each other, it becomes clear that the politicians and pundits who defend Social Security are increasing the harm it is imposing on American workers.

Two Fraudulent Claims

Consider first that ever since Social Security was enacted in 1935 Americans have been told that their "contributions" are being deposited into their own account to pay for their retirement benefits. This claim has become more implicitly suggested than explicitly stated in recent Social Security brochures, but not in the statements of politicians when opposing any attempt to partially privatize the program. Al Gore, in his 2000 presidential campaign, assured the public that if he were elected our Social Security "contributions" would remain secure in a "lockbox" until our retirements. It was never made entirely clear whether we each had our very own lockbox or all the money was in one big lockbox.

We cannot find any serious study that estimates how many people really believe that the taxes they pay to Social Security are being saved and invested to finance their retirement, instead of being spent immediately by politicians, as is actually the case. But it is clear that many do believe that they have a personal Social Security account containing the money to fund their retirement benefits. Alan Greenspan recounts in his recent book, The Age of Turbulence, a story told by former House leader Tom Foley. When Foley tried to inform his mother that there were no lockboxes containing the money to pay for Social Security, she told him, "I hope you will not be offended at how surprised and shocked I am to find that the majority leader of the House of Representatives knows nothing about Social Security."

The other fraudulent claim made about Social Security (again, from the very beginning of the program) is that employees pay only half the cost, with employers paying the other half. This claim is widely seen as plausible because the legislation authorizing Social Security clearly stipulates that the required payments are to be split evenly between employees and employers. If this were true, then employees would now be paying 6.2 percent of their before-tax income up to $102,000 a year; employers would match that amount.

As any good student in an economic-principles course should learn, however, the amount of a payroll tax actually paid by employees and employers has absolutely nothing to do with what politicians mandate in legislation. It is true that each worker has 6.2 percent of his after-tax income deducted from his paycheck and sent to the Social Security Administration (SSA) and his employer sends in the same amount. But by altering the wages employers pay and workers receive, these payments change the supply and demand schedules for labor - at a given nominal wage, different amounts of labor will be supplied and demanded than before. (In the lingo of economics, the supply and demand curves shift.) Until we know how wages and salaries change in response to these shifts, we cannot tell how much of the Social Security cost is paid by the employees and how much is paid by employers. For example, if a worker's salary is reduced by exactly the same amount that the employer sends to the SSA for her, then the cost to the employer is nothing (what he pays for the worker's Social Security is offset by the lower salary) and the worker ends up paying the entire cost. . .

The employer requirement to send a check to the SSA for each worker equal to 6.2 percent of salary revises downward the firm's demand schedule for labor according to the amount of this check. This reduction in demand, considered by itself, obviously reduces the salary the firm is willing to pay each worker. Similarly, the Social Security deduction from each worker's paycheck reduces the labor supply by revising upward the supply schedule by the amount of this deduction, assuming that there is no expected benefit from Social Security. . .

. . .  In fact, as we show in our Economic Inquiry article, workers are made worse off by Social Security unless the benefits they expect and actually receive are at least equal to the total amount paid for Social Security by both the workers and their employers.

Defrauding Workers

We are now able to nail down our main point - that advocates of Social Security are defrauding American workers in two ways. First, claims which leave the impression that money paid into Social Security is being saved for our retirements lead workers to believe their benefits are more secure than they are.

Second, persistent claims that workers pay only half the Social Security tax lead them to believe their benefits cost them less than they really do.

These fraudulent claims clearly increase the political viability of Social Security by misleading workers into expecting larger benefits than they will receive. But it is worse than this. By generating exaggerated expectations of Social Security benefits, the two claims are actually reducing the net benefits workers receive by increasing the amount they are paying for them with lower wages.

It is ironic that those pundits and politicians who oppose even the most timid moves to privatize Social Security by downplaying, or denying outright, its Ponzi-scheme nature are widely seen as protectors of American workers.

To read the entire article, go to

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

- Ronald Reagan

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5.      Medical Gluttony: Changing Doctors May Increase Cost and Decrease Quality

Marjorie had pleural and parenchymal tuberculosis as an adolescent. Hence she had parenchymal (Lung) nodules in the apex of her lung and thickened pleura in the lung base on one side. She had been appropriately treated with antituberculous drugs. She then followed the prescribed regimen of follow up x-rays every three months for two years, every six months for three years and then yearly.  If the new x-ray, when compared to the old x-ray, was essentially identical, one could safely say there was no recurrent activity.

She went to the emergency room for a minor trauma and cut to her hand on Friday evening. This was treated and a chest x-ray was obtained for reasons unclear. No medical indication was recorded on the requisition. The x-ray was very abnormal. Since her previous x-rays were done elsewhere, there were none to compare. Hence, the radiologist appropriately listed all the findings, suggesting multiple etiologies, and suggested studies to rule out tuberculosis, cancer, or multinodular disease. The hospitalist on duty in the evening admitted the patient and ordered a sputum culture for TB, isolated the patient against her wishes and demands, and ordered a CT of her chest. The hospitalist on duty the next day, proceeded with the same direction of testing, and started antituberculous treatment. The family became very anxious when their wife and mother was thought to have reactivated her tuberculosis. The patient subsequently stated that neither hospitalist doctor that admitted her or the one that saw her the next two days on the weekend asked her about her known tuberculosis, the treatment in a sanatorium, drugs for two years and numerous follow up x-rays.

On Monday, she saw a third hospitalist who sat down and spoke with her and obtained the first real medical history. He made a phone call to the pulmonologist who faxed him Marjorie's medical history and x-ray reports. The decision was made in a matter of minutes that the only problem was a minor laceration that was sutured in the Emergency Room and was clean and healing well. There had been no medical reason for the hospitalization and no reason to suspect tuberculosis reactivation. He promptly discharged her with directions to have her sutures removed in one week.

This is not an isolated case. It is a frequent occurrence in practice because the patient's personal physician is excluded from taking care of her in the hospital, thus interrupting the efficient continuity of care. Although many studies and reports continue to show the efficiency of having a fulltime hospital physician who is in the hospital continuously, this is frequently not the case. It may be the case in an acute care situation where the treatment changes from hour to hour, but in a large percentage of cases, the patient only needs physician supervision once or possibly twice daily. This has been the usual standard of care for many decades and still is.

There needs to be further study on the new so-called specialty of "hospitalist" - not primarily directed to hospital efficiency, but to cost effective efficiency. This is a very difficult study to do since many of the hospital charts no longer reference the prehospital care. Hence, the study would show cost-effective care when looking at the entire spectrum of care; it may not be cost effective to the patient or improve the quality of care.

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6.      Medical Myths: Sally Pipes of the Pacific Research Institute has just published Ten Myths of the American Health Care System

SAN FRANCISCO – The Pacific Research Institute has just released The Top Ten Myths of American Health Care: A Citizen's Guide. This is the latest book from health care scholar, and PRI President and CEO Sally C. Pipes.

The book's foreword is by Steve Forbes: "For anyone interested in getting to the core of America's health care troubles, this is the perfect book," he writes. "And for health care policy makers, it should be required reading."

In her 182-page book, Ms. Pipes takes on ten popular myths about the state of health care in America. The final chapter lays out several patient-centered prescriptions for reform. 

"I wrote this short book as a citizen's guide. Each chapter tackles a complex issue in straight-forward, easy-to-understand language," said Ms. Pipes.

The book challenges the conventional belief that only government can fix our health care system. In fact, says Ms. Pipes, "government overreach has put the system in a state of crisis."

A complete list of chapters can be found below.

In her conclusion, Ms. Pipes offers some ways to fix the country's biggest health care problems. "If we want to bring costs down and extend coverage to more Americans, we have to open the health care marketplace to competition -- by abolishing costly government regulations and reforming the tax code to make insurance more affordable."

"We can solve the health care problems that plague the United States," concluded Ms. Pipes. "But we won't solve them if we continue to believe the many myths that plague the health care debate."

Myth One: Government Health Care Is More Efficient
Myth Two: We're Spending Too Much on Health Care
Myth Three: Forty-Six Million Americans Can't Get Health Care
Myth Four: High Drug Prices Drive Up Health Care Costs
Myth Five: Importing Drugs Would Reduce Health Care Costs
Myth Six: Universal Coverage Can Be Achieved by Forcing Everyone to Buy Insurance
Myth Seven: Government Prevention Programs Reduce Health Care Costs
Myth Eight: We Need More Government to Insure Poor Americans
Myth Nine: Health Information Technology Is a Silver Bullet for Reducing Costs
Myth Ten: Government-Run Health Care Systems in Other Countries are Better and Cheaper than America's
Solutions: Markets, Consumer Choice, and Innovation

Read PDF Study | Purchase Book

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7.      Overheard in the Medical Staff Lounge: The Election is Over, Now What?

Dr. Rosen: Well, the elections are over. What happened? What's next?

Dr. Dave: Well, I'm bracing myself for the tax and spend programs coming down the pike.

Dr. Edwards: If Obama really spends an extra $Trillion as promised, he has to get it from the citizens and that will precipitate a depression just like when Hoover increased taxes to pay for his bailout.

Dr. Dave: And then FDR came to the White House and encouraged farmers to destroy crops and livestock in order to raise prices.

Dr. Michelle: I'd forgotten that. How gruesome. I'm sure Barrack Obama won't do anything that foolish.

Dr. Yancy: Or more foolish like raising taxes on struggling people.

Dr. Michelle: But Mr Obama says he'll lower taxes for 95% of us. That's got to include me.

Dr. Dave: Don't count on it. He's changing his tune dramatically. He's asking us not to expect all his promises during his first term.

Dr. Rosen: He won't be able to deliver all his promises during his second term either.

Dr. Ruth: How do you figure?

Dr. Rosen: The 1929 crash and the depression of 1933 was just a warmup for the one coming in 2009.

Dr. Paul: I'm a new pediatrician on the staff. Like the American Academy of Pediatrics, we're all for single-payer medicine which will solve all our problems.

Dr. Edwards: There won't be any money to come close to that fiasco.

Dr. Paul: People just can't afford health care. I see babies going without shots because their parents can't afford it.

Dr. Edwards: Don't your patients have insurance?

Dr. Paul: Most of them have Medicaid.

Dr. Edwards: Medicaid pays for immunizations.

Dr. Paul: But Medicaid is really squeezing my income.

Dr. Edwards: What makes you think when the government covers us all with Medicaid, you'll have more money?

Dr. Paul: It can't get worse. It's only going to get better.

Dr. Yancy: That's totally irrational. Have you had your serology checked lately?

Dr. Paul: I see this is a hotbed of Republicans here.

Dr. Edwards: Not necessarily. Physicians have traditionally been conservative and I did vote for the veteran. But I'm glad that he lost.

Dr. Paul: Well, I voted for Obama and I'm glad he won.

Dr. Edwards: If the war hero had won, with the looming depression, he would have had a declining approval rate starting in February. It wouldn't have gotten as low as Congress' ratings, which I understand has now sunk to less than 10 percent, but a negative rating would have a terrible effect on getting on with the program. 

Dr. Paul: Obama will get us through this ordeal just fine.

Dr. Rosen: I just read last week's article in the New Yorker on Obama. He's a very shrewd man. Most people interpreted his "Change" slogan in regards to the economy. He even broadsided Jesse Jackson and others that have been down in the mouth about the future of race. Obama didn't make it an issue and his "Change" brought about a change to a new race in the White House. We should be thankful for that great accomplishment which probably no other black man, except perhaps Colin Powell, could have brought about. He's a smooth operator and we'll see very shortly what he can do. Nobody has any idea what that really is.

To read the NewYorker on The Joshua Generation by David Remnick, go to

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

CSA Bulletins: Summer 2008 - Volume 57, Number 3

The Future Practice of Anesthesiology By Patricia A. Kapur, M.D.

Predicting the future is risky at best; however, some general trends can be anticipated, even if not known specifically when they will become manifest. An example would be the evolution from desktop to laptop to handheld computer devices. A tipping point is reached when the next device becomes dominant, although all three technologies coexist for some time.  Models of medical care delivery that have technological and human components, such as anesthesiology, are similarly on an evolutionary continuum and are propelled forward with each new technological advance. 

Examples of some of the technological advances which are propelling changes in anesthesiology care delivery include such items as better methods for determining the state of patients' comorbidities, for example, advanced noninvasive cardiovascular testing which allows for better anesthesia risk assessments; genetic profiling of patients for drug tailoring; computer-controlled infusion pumps for physiologic feedback-controlled drug administration; rapid advances in noninvasive intraoperative monitoring devices; technology for remote viewing of intraoperative monitor screens, lab results; real-time remote camera and voice contact with ORs; and so on. The question that anesthesiology decision makers need to face in preparing physicians in practice and physicians in training for such a future is not "How long can we make the current situation last?" but, rather, "How can we prepare anesthesiologists appropriately for the career opportunities that anesthesiologists of 2015 or 2025 will face in their professional practice?"

Although classic literature tells us that we see the future "… through a glass darkly …," it is not all murky, and we can make some extrapolations. We do know that advances in home health infrastructure and home care technology means that hospitals will focus on the acutely and severely ill with increased numbers of critical care units compared to ward-level care. There will be safer drugs with minimal side effects, while pharmacogenetics will allow drug and dose tailoring to improve safety and reduce therapeutic misadventures. Noninvasive monitoring and transdermal- or transmucosal-based "lab" tests may obviate the need for extensive experience with invasive monitor placement and interpretation, and/or for skills for arterial/venous blood or other body fluid sampling. Remote robotics will replace a certain number of in-OR surgeons.

Remote physicians with telemedicine-inspired, two-way video techniques already have replaced on-site physicians in ICUs for hard-to-serve hospitals and on ICU night-shifts in the United States. Already in the U.S., remote reading of specialty monitors in the ORs, such as EEGs, SSEPs, and TEEs, commonly is done by neurologists or cardiologists, similar to online radiology image interpretation from continents away. Why not have an anesthesiologist remotely overseeing numerous ORs, by way of electronic access to automated anesthesia records, an intranet connection to intraoperative physiologic monitor screens, two-way video/voice communication to each OR, access to instantaneous output from intra-op lab tests machines, among other things. . .

Opportunities in the broader areas encompassed by the anesthesiology knowledge and skill set remain tremendous. The opportunities may continue to evolve even further in the coming years, but they will still include the need for talented providers in all areas of acute, sophisticated, and critical care of patients presenting for interventional care, if that is interpreted in the broadest sense with a focus on the most severely ill patients. All anesthesiologists need to remain broadly capable, willing to transform to incorporate new technology and supervisory/management skills, and ready to move aggressively into the new opportunities to contribute their unique knowledge and skills for the optimization of care of the acute patients presenting across the illness continuum.

To read the rest of a detailed specialty projection, go to

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9.      Book Review: The Story of Our Constitution

We The People – The Story of Our Constitution, by Lynne Cheney, Simon & Schuster Books for Young Readers, New York, © 2008, ISBN: 13-978-1-4169-5418-7, 30 pp, $17.99, $21 Can.

"The happy union of these states is a wonder; their Constitution a miracle; their example the hope of liberty throughout the world." -James Madison

Cheney observes that in 1787, our young country was in turmoil. The central government was unable to pay off debts, there was armed insurrection in Massachusetts, and foreign governments were taking advantage of our weakness. The question of the hour, James Madison wrote, was "whether the American experiment was to be a blessing to the world or to blast forever the hopes which the republican cause had inspired."

The story of our founding document is a tale of persistence, as delegates kept on despite obstacles that at times made their task seem impossible. It is a tale of creativity, with the delegates providing a framework for a government entirely new. History might have gone otherwise but for the framers' genius, and we should be grateful for James Madison, George Washington, Benjamin Franklin, and the others gathered in Philadelphia.

"The citizens of America . . . are from this period to be considered as the actors on a most conspicuous theater, which seems to be peculiarly designated by Providence for the display of human greatness and felicity." -George Washington

Astride his favorite horse, Nelson, on October 19, 1781, General George Washington looked on as thousands of British soldiers marched out of Yorktown, Virginia, to lay down their arms. Americans, with help from France, had just won the battle that would end the Revolutionary War.  For the British, this loss was a shock. Theirs was the mightiest army in the world, and they had thought it impossible that the Americans would defeat them.

For the citizens of our country, living on a vast and bountiful continent, it seemed like a new age was dawning. A free and independent America would surely prosper and become a great and mighty nation.

"I am mortified beyond expression when I view the clouds which have spread over the brightest morn that ever dawned upon any country." -George Washington

America had adopted rules for governing called the Articles of Confederation. They didn't work very well and trouble became apparent over the next several years. The states printed their own money. They refused to pay off the debts from the Revolutionary War. Other countries were taking advantage of the weakness of the United States. The British refused to move out of military posts they were supposed to give up after the Revolutionary War. Massachusetts' farmers couldn't pay their debts, rose up against the government and tried to seize a building in Springfield where guns and ammunition were kept. The militia fired upon them. Americans were killing Americans.

"The great fabric to be raised would be more stable and durable if it should rest on the solid foundation of the people themselves." -James Madison

In 1787, delegates from twelve states traveled to a convention in Philadelphia to figure out a better plan for governing the country. Madison, the first to arrive, believed the current government was near collapse. In his room at a Philadelphia boardinghouse, Madison, a small man of great learning, labored over a plan to present to the convention. His boldest idea was that the nation's government start with the people. Rather than have the state legislatures choose the members of Congress, Madison proposed that the people have a direct say in who represented them.

George Washington hated to leave his beloved home at Mount Vernon, but was worried with thirteen states all pulling in different directions, which he felt could bring ruin upon America. The people of Philadelphia remembered how this tall, dignified man had persisted in the darkest hours of the Revolution, when it had seemed impossible that America would win her war for independence. They remembered how he had given up power after the war when some had wanted to make him a king. All across America he was loved and respected. When he arrived in Philadelphia on May 13, the bells rang out to celebrate his arrival and joyful crowds gathered to greet him. With him at the convention, Americans were more likely to look favorably upon what the delegates decided.

"To the man who unites all hearts." -A popular toast of the time, offered to honor George Washington.

James Madison was presenting his ideas to his fellow Virginians while waiting for a quorum of 29 men to arrive eleven days after the proposed starting date. On May 29, one of the Virginia representatives proposed Madison's plan to the assembled delegates. Governor Edmund Randolph described a government of three branches: Legislative or the Congress; Judicial or the courts; and a national executive. The legislative branch would have two parts or houses, with the people of each state electing the members of the first house. Although some delegates felt the people couldn't be trusted to choose their representatives, most disagreed. They thought that the place for government to begin was with the people.

"The national legislative powers ought to flow immediately from the people." -James Wilson, Delegate from Pennsylvania

The Articles of Confederation gave each state one vote. The Virginia Plan gave more representatives and more votes to states with more people. The small states believed that their interests would be trampled upon.

"We would soon submit to a foreign power than submit to be deprived of an equality of suffrage." -John Dickinson, Delegate from Delaware

The oldest delegate was inventor and statesman Benjamin Franklin. At 81, he was carried in a sedan chair from his home to the convention. Although he commanded great respect, he could not get the quarreling delegates to put their anger aside as they fought through the sweltering month of June. Roger Sherman of Connecticut proposed that in one house of the legislature, states be represented according to size and in the other, the Senate, each state have an equal number of votes.  But the idea went nowhere. Dr. Franklin suggested that the delegates send for a chaplain to lead them in prayer. The leaders of the Revolution had sought God's help, he said, and so should those who were trying to build a new nation.

"How has it happened . . . that we have not hitherto once thought of humbly applying to the Father of lights to illuminate our understandings?" -Benjamin Franklin, Delegate from Pennsylvania

The delegates did not call for a chaplain. But as the Fourth of July neared, they stopped arguing long enough to choose a committee that came up with a compromise similar to the one Sherman proposed. While the members of the committee were at work, other delegates took a break. George Washington went fishing.

 "…went up to one Jane Moore's in the vicinity of Valley Forge to get trout." –George Washington

On September 17, after the final draft of the Constitution was read aloud, Benjamin Franklin addressed the convention. He told the delegates that there were parts of the document with which he did not agree, but that over a long life he had learned he was not always right. On the whole, he said, the Constitution was astonishingly good, and he hoped that other delegates who had doubts would join him in signing it. Several refused. George Washington, as president of the convention, was the first to put his name to the Constitution, then thirty-seven others followed, state by state. As the last delegate signed the document, Dr. Franklin looked at the sun painted on the back of George Washington's chair and saw in it a sign of a new beginning for America.

"… at length I have the happiness to know that it is a rising and not a setting sun." –Benjamin Franklin

By July 4, 1788, the people of ten states, the required three-fourths majority, had, after sometimes fierce debate, ratified the Constitution which made it the supreme law of the country. It was time for celebration. In Philadelphia, after early morning bells and a cannon salute, crowds lined the streets to watch high-stepping horses lead a parade of flags, bands and floats. Citizens of every occupation marched, weavers followed by chair makers, bricklayers, and gilders; book binders by coppersmiths and clergymen. At the end of the parade came feasting and an oration. "Happy country!" proclaimed convention delegate James Wilson. "May thy happiness be perpetual!"

" ‘Tis done! We have become a nation." –Benjamin Rush, Citizen of Pennsylvania - and of the United States of America

The delegates recognized that no document is perfect and so they included ways of amending it. The first ten amendments, called the Bill of Rights, were passed by two thirds of the Congress in 1789, and ratified by three fourths of the states in 1791, which safeguarded the freedoms of speech, religion and the press. Amendments after the Civil War did away with slavery and provided that the right to vote will not be restricted on account of race. In 1920, the Constitution was amended to recognize the right of women to vote.

Lynne Cheney, an educator and senior fellow of the American Enterprise Institute, provides a history lesson for parents and their children. This book puts the struggles and the founding of our nation and constitution in perspective. She recognizes that there were Americans who looked at the Constitution and did not see themselves. Today, "We The People" includes all of us working together, to make our great country greater still.

To read the rest of the review, go to

To read more book reviews, go to

To read book reviews topically, go to

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10.  Hippocrates & His Kin: The "Don't just stand there" paradox.

Don't just stand there, Do Something!

At a postgraduate course on Pulmonary Physiology in Boston, a Harvard Professor was quizzing the class on a problem in the ER. The responses were a little too timid for him. The patient was in dire straights but the physiologic abnormalities were not apparent as the lab tests were being processed. Some of the class felt there should be watchful waiting. The professor stated that they graded interns on "Don't just stand there, Do Something." He further clarified this, "even if it is wrong." The residents and fellows in the class were very polite and didn't take up the issue of "Do no harm."

Sometimes the higher quality of care is standing there with watchful observation and waiting.

Don't do something, just stand there.

At the Medical Grand Rounds at the University of California at Davis on Thursday morning, Professor Margaret Beliveau, MD, from the Mayo Clinic College of Medicine, was the guest. The title of her presentation was "Perioperative Care of Elderly Patients." She did an excellent job of discussing the caution required in the care of the elderly fragile patients in getting them ready for required surgery. Sometimes correcting some physiologic abnormality too aggressively can be dangerous. The subtitle of her talk, "Don't do something, just stand there," was her catch phrase for caution.

Sometimes the higher quality of care is just standing there before you do something and then doing it cautiously.

Don't Just Do Something. Stand There.

So the above headline in the WSJ on October 31, 2008,  by Russell Roberts caught my eye. It was an important commentary on our times. What will Obama do?

People ask me if the current mess feels like 1929. But the right comparison is 1932, when Herbert Hoover was desperately trying anything, anything at all, to get the economy going. The stock market had crashed. The economy was starting to follow it down. So what did Hoover and his fellow policy makers do?

In 1930, Congress passed a massive tariff increase, in hopes of protecting American jobs. Hoover signed it. But it simply accelerated the economy's slide. The Federal Reserve contracted the money supply, taking a recession and making it into a depression. By 1932, real GDP was 25% lower than three years earlier.

Hoover increased federal spending steadily, including an increase in real terms of about 40% in 1932. At the same time, fearful that deficits were harmful, Hoover raised income taxes.

Nothing worked. So Franklin Roosevelt came into office pledging stronger medicine. Enter even bigger increases in government spending. Government nationalization. Bigger deficits. Destruction of crops and livestock in the name of raising prices. Government-organized cartels. A greater empowerment of unions. It was a whirlwind of activity without any real plan.

It worked for a while, but then, in 1938, the economy turned sour again. Unemployment, which had been falling, spiked again, reaching 19%. Consumption didn't recover to its prewar levels until 1945.

To read the rest of this article and what happened then and what is happening now, go to

Mr. Roberts is a professor of economics at George Mason University and a research fellow at Stanford University's Hoover Institution. His latest book is "The Price of Everything: A Parable of Possibility and Prosperity" (Princeton University Press, 2008).

Fallout from Proposition 8

The artistic director for the California Musical Theatre resigned because a growing number of artists threatened to boycott the organization because of his donation to Proposition 8, the initiative to preserve marriage. After his campaign contribution popped up on the entertainment websites, other blogs showed up from artists and writers withdrawing their permission for the California Musical Theatre to produce any of their works.

Well, so much for free speech and tolerance in the entertainment industry.

To read more HHK, go to 

To read more HMC, go to

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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

•                      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.

•                      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. Dr. Huntoon practices Neurology at Derby, New York.

•                      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.

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

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

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

•                      Madeleine Pelner Cosman, JD, PhD, Esq, who has made important efforts in restoring accountability in health care, has died (1937-2006). Her obituary is at She will be remembered for her important work, Who Owns Your Body, which is reviewed at Please go to to view some of her articles that highlight the government's efforts in criminalizing medicine. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at

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

•                      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, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or you may prefer to peruse the archives.

•                      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: Obama promises to follow Europe's lead on treating carbon dioxide as a pollutant; Europe may head the opposite direction.  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 how "Money and power are of inextricably intertwined. With money, one can buy power, and with power, one can appropriate money." 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. Have some fun this month and read Another Modest Proposal: Universal Legal Care. Don't miss the excellent book review section which covers four great books this month.

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ALSO NOTE: MedicalTuesday receives no government, foundation, or private funds. The entire cost of the website URLs, website posting, distribution, managing editor, email editor, and the research and writing is solely paid for and donated by the Founding Editor, while continuing his Pulmonary Practice, as a service to his patients, his profession, and in the public interest for his country.

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Del Meyer       

Del Meyer, MD, Editor & Founder

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

Words of Wisdom

The best argument against a bad argument is not censorship, but a better argument. -Clifford Durr, Civil Rights Pioneer. (Quoted by Allen E. Hess, PhD, Prof, Auburn University at Montgomery in "Here is What Academic Freedom Really Means.")

"Political Genius consists of hearing the distant hoofbeat of the horse of history and then leaping to catch the passing horseman by the coattails." -Otto von Bismarck

Politics is the art by which politicians obtain campaign contributions from the rich and votes from the poor on the pretext of protecting each from the other. -Thomas Jefferson

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

Some Recent Postings

HEROES by Paul Johnson

A TIME FOR FREEDOM by Lynne Cheney,

HOW DOCTORS THINK by Jerome Groopman, MD

DISCLOSURE by Michael Crichton

STATE OF FEAR by Michael Crichton

In Memoriam

Best-Selling Author Michael Crichton Dies, LOS ANGELES, Nov. 5, 2008, (CBS) 

Best-selling author and filmmaker Michael Crichton died unexpectedly in Los Angeles Tuesday, after a courageous and private battle against cancer, his family said in a statement. He was 66.

Crichton was a brand-name author, known for his stories of disaster and systematic breakdown, such as the rampant microbe of "The Andromeda Strain" or dinosaurs running amok in "Jurassic Park," one of his many million-selling books that became major Hollywood movies.

Crichton also created the hospital drama "ER" for television. His most recent novel, "Next," about genetics and law, was published in December 2006.

"While the world knew him as a great story teller that challenged our preconceived notions about the world around us -- and entertained us all while doing so -- his wife Sherri, daughter Taylor, family and friends knew Michael Crichton as a devoted husband, loving father and generous friend who inspired each of us to strive to see the wonders of our world through new eyes," the statement said. "He did this with a wry sense of humor that those who were privileged to know him personally will never forget."

Through his books, Crichton served as an inspiration to students of all ages, challenged scientists in many fields, and illuminated the mysteries of the world in a way all could understand.

"He will be profoundly missed by those whose lives he touched, but he leaves behind the greatest gifts of a thirst for knowledge, the desire to understand, and the wisdom to use our minds to better our world," the statement added.

Born in Chicago Oct. 23, 1942, Crichton graduated summa cum laude from Harvard College, received his MD from Harvard Medical School, and was a postdoctoral fellow at the Salk Institute for Biological Studies, researching public policy with Jacob Bronowski. He taught courses in anthropology at Cambridge University and writing at MIT.

Crichton's 2004 bestseller, "State of Fear," acknowledged the world was growing warmer, but challenged extreme anthropogenic warming scenarios. His views were strongly condemned by environmentalists, who alleged that the author was hurting efforts to pass legislation to reduce emissions of carbon dioxide.

Crichton's first bestseller, "The Andromeda Strain," was published while he was still a medical student. He later worked full time on film and writing. One of the most popular writers in the world, his books have been translated into thirty-six languages, and thirteen have been made into films.

Crichton won an Emmy, a Peabody, and a Writer's Guild of America Award for "ER." In 2002, a newly discovered ankylosaur was named for him: Crichtonsaurus bohlini.

A private funeral service is expected, but no further details will be released to the public.


On This Date in History - November 25

On this date in 1917, Russian held its last free election until 70 years later. It was for the purpose of electing a constituent assembly; and the Russian voters chose an assembly in which less than a third of the deputies were Communists. So naturally, the Bolsheviks suppressed the assembly when it convened the following January.

On this date in 1864, Benjamin Disraeli, one of the most sophisticated men of his time, noted that "The characteristic of the present age is craving credulity." That was over a hundred years ago, and in another country, Great Britain. If he were alive today, I suspect he would say the same thing. "Craving credulity," the ardent eagerness to find things to believe in, is one of the problems of our time. Young people - and older ones - follow false prophets and waste their substance on false illusions. Will this change? Is it a phenomenon of our times or of all times?

Today is St Catherine's Day in Paris where, according to tradition, the young seamstresses are supposed to go out on a carnival manhunt.

After Leonard and Thelma Spinrad