Physicians, Business, Professional and Information Technology Communities

 Networking to Restore Accountability in HealthCare & Medical Practice

 Tuesday, November 30, 2004

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MedicalTuesday refers to the meetings that were traditionally held on Tuesday evenings where physicians met with their colleagues and the interested business and professional communities to discuss the medical and health care issues of the day. As major changes occurred in health care delivery during the past several decades, the need for physicians to meet with the business and professional communities became even more important. However, proponents of third-party or single-payer health care felt these meetings were counter productive and they essentially disappeared. Rationing, a common component of government medicine throughout the world, was introduced into the United States with Health Maintenance Organizations (HMOs), under the illusion that this was free enterprise. Instead, the consumers (patients) lost all control of their personal and private health-care decision making, the reverse of what was needed to control health care costs and improve quality of care.

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In This Issue:
1. Change in Definition Results in an Increase to 37 Million Adults with Pre-Diabetes
2. Overcoming 100 Years of Market Distortions in the Health Care System
3. Health Savings Accounts: A Revolution in American Health Care
4. Beyond HSAs: The Next Steps in Building a Consumer-Directed Health Care System
5. Keynote Address: Can a "Consumer-Driven” Health Care System Succeed?
6. Myths of American Medicine: Criminalizing Physicians Protects Patients
7. Medical Gluttony: A New York Times Story from Patient Power
8. The MedicalTuesday Recommendations for Restoring Accountability in Medical Practice, HealthCare and Government

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1. Change in Definition Results in an Increase to 37 Million Adults with Pre-Diabetes
The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus recently reduced the lower cutoff point for impaired fasting glucose (IFG) level from 110 mg% to 100 mg%. (The new range for IFG is 100 mg% to 125 mg%.) The new American Diabetes Association criteria increased the number of Americans age 40 to 74 years with impaired fasting glucose from 8.5 million to 31 million and the number with pre-diabetes increased from 19.8 million to 37.3 million.

This new challenge to the profession and our patients is staggering. The warnings to patients about not stressing their pancreas with simple sugars and concentrated calories goes unheeded as can be seen by the over-consumption of Krispy Kreme donuts for breakfast, candy bars at break time,  and regular ice cream, pies, cakes and pastries for dessert, not to mention the concentrated calories sitting on most receptionists’ desks. This national epidemic will only be curbed as patients become consumer directed in their own health care. This will improve health habits through financial incentives of partial-premium payment, yearly deductible, and copayment at the time of each service without limit, thus never escaping the Medical MarketPlace controls, which are more effective than any HMO, insurance oversight or government program.

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California Health Care Leadership Academy, La Quinta, California, November 18-21, 2004.

I attended the first CMA Leadership Academy in 1997. It was primarily an HMO-single-payer-socialistic program with a token private practice speaker included so the participants could see what a dinosaur looked like. I vowed never to participate again. After eight years, the number of "dinosaurs" still comprise about half the physicians in practice in this state. So it was gratifying to see the 2004 speakers' list indicate a new direction for the Academy. The sessions were extremely valuable.

Since the majority of the members of MedicalTuesday is from outside of California, with an increasing international audience, we bring you this initial report. We feature the first three speakers and the Keynote speaker. Greg Scandlen, from the Consumer Health Center at Galen, discussed what caused our current market distortions; John Goodman, PhD, economist, President of the National Center for Policy Analysis, discussed the current revolution in American Health Care; Grace-Marie Turner, President of Galen, discussed where are we going; and Uwe E Reinhardt, PhD, economist from Princeton, discussed whether all this can really succeed.

MedicalTuesday reviews the newsletters and websites of the first three speakers in the first issue every month, normally arriving in your In Box on the second Tuesday. This second issue of the month, which normally arrives on the fourth Tuesday, was delayed because of the Leadership Conference.

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2. Overcoming 100 Years of Market Distortions in the Health Care System
Greg Scandlen, Director, Center for Consumer Driven Health Care at the Galen Institute, opened the Leadership Conference with a historical overview of how we got to the current state of health care.

The Formative Era, 1929 to 1949, was heralded with the formation of Blue Cross in 1929 after a prototype at Baylor University. Blue Cross, a nonprofit entity, provided up to 21 days of hospital care per year. The real distortion began with the federal wage and price freeze during the war when employers added health care to their tax free benefit programs.

The federal government began a massive hospital building program with the Hill-Burton act ushering in the Growth Era, 1949 to 1964. Blue Cross enrollment increased from three to 80 million subscribers, which subsequently increased hospital admissions and surgical procedures.

These market distortions ushered in the Regulatory Era, 1965 to 1980. Third-party health care divorced health care from its cost causing increased utilization as people are subsidized, rising costs as money pours into the system and increasingly high-tech and expensive supply. Medicare & Medicaid, aimed at the elderly and the poor, two populations not associated with employers, further separated health care from its cost. The federal government began pumping additional money into the system exceeding the state funding. Health spending increases, as a percent of GDP, caused near hysteria, bringing on regulations with a vengeance.

This ushered in the Competitive Era, 1981 - 1999, with the introduction of managed care. Managed care further increased the role of third-party payers and was based on a false premise - that fee-for-service is inflationary. Greg Scandlen disagrees: It is third-party payment that is inflationary. Managed Care increased the role of third-party payers and worked by external rationing, not by changing behaviors. Rationing, in turn, causes discontent and demands for further governmental interference.

Two thirds of Americans still feel that we are spending too LITTLE for health care and thus the Consumer Era, 2000 + became inevitable. Now we have a new paradigm: empower the patient; make it personal and portable; balance insurance and direct pay; restore patient/physician relationship; web-enable information; make agency accountable to consumer (Doctors make the best agent); and the ability to merge resources (currently if husband has 75% coverage and wife has 65% coverage, these benefits cannot be merged).

To review other presentations by Greg Scandlen on this topic, go to http://www.galen.org/.

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3. Health Savings Accounts: A Revolution in American Health Care - Health Savings Accounts
John C Goodman, PhD, President of the National Council for Policy Analysis, discussed the revolution in health care that is occurring. Current sources of health care spending are 15% from individuals and 85% from a third party. There are increasing opportunities to spend money on health care. Blood tests can cost thousands of dollars. Genetic tests currently available can total $1,000,000. If everyone got an expanded yearly physical - it would increase health care spending 40%.

Therefore, someone has to choose between health care and other uses of money. If national health insurance is chosen, there will be under providing to the sick, over providing to the healthy, more ancillary services such as non-emergency ambulance rides, fewer pap smears, fewer mammograms, fewer MRI scans, fewer PET scans. (If Barbara Streisand actually moved from LA to Canada, it would be illegal for her to buy an MRI or a Mammogram.)

With HSAs, the patients decide. Studies have shown that patients voluntarily increase their generic medications by almost 13% with a reduction in pharmacy costs by 11%. HSAs restore the doctor-patient relationship, provide the appropriate incentives for cost containment, are portable from job to job, and restore patient power. Be sure to read the whole story in their latest book:

The Definitive Work on Single-Payer National Health Insurance Around the World
by John C Goodman, Gerald R Musgrave, and Devon M Herrick.
To read a brief review, go to http://www.healthcarecom.net/JGLivesAtRisk.htm;
to order your copy, go to http://www.ncpa.org/pub/lives_risk.htm.

If you missed it, be sure to also order this one which is more relevant today than when written:

Shows how the health care system can be reformed by restoring power and responsibility
to individual consumers instead of a complex, faceless bureaucracy.
by John C. Goodman, President of the National Center for Policy Analysis,
and Gerald L. Musgrave, an NCPA Senior Fellow. http://www.ncpa.org/
The book is available in full-length hard cover and abridged paperback editions.
The abridged version of Patient Power has sold three hundred thousand copies.
It is published by the Cato Institute for $1.00.
Copies are available by calling the NCPA at (972) 386-6272.
To read a brief summary go to http://www.delmeyer.net/bkrev_PatientPower.htm

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4. Beyond HSAs: The Next Steps in Building a Consumer-Directed Health Care System
Grace-Marie Turner, President, The Galen Institute, poses the central policy question: Should decisions be controlled by government or by consumers in a freer and more competitive marketplace? The recent election results give consumer-directed care a boost. . . but not a guarantee of success. The REAL questions she poses: What is this new world about?

It's about Patient control: Consumers will have more choices in health insurance arrangements; Cost visibility: They will be more price conscious in shopping for insurance and medical services; Savings incentives: Consumers have more incentive to get the best product, service, and value for their money.

The Outlook? Short-term it will require a steep learning curve; Mid-term will see emerging opportunities; Longer-term will see innovative solutions that engage patients as partners in managing care and costs.

What are the Realities? The current top-down driven system is on a crash course with a fast-paced, information-driven economy. As Baby-boomers age, health care will become a higher priority and people will demand services they want and need. Individually-tailored medical care is  incompatible with central control. In short, political leaders won't be able to contain pressures with old methods.

The costs of treating disease is a growing threat to the U.S. health care system. Public and private payers question how they can continue to pay the bills for an aging population. Hence, there is a new conversation. Coordinated care is a starting point for change. Engaging patients in their care management provides new support for physicians. This will improve prevention and disease management, increase value in medical care, provide greater access to information and thus more consumer input into care choices.

The next big thing? Consumer-driven care is inevitable in the information age.

The goal: Engaging consumers as partners rather than as adversaries in managing health costs and getting the best value for the health care dollars.

Physician opportunities: There will be more physicians with a cash-only practice; there will be  more long-term patient relationships; there will be greater opportunity to distinguish one's specialty skills; there will be incentives for continued advancements in technology.

Physician challenges: More competition from peers; more non-MDs offering lower-cost services, e.g. "Minute Clinics;" more price consciousness from patients; more informed and demanding patients armed with reams of studies from the internet.

Regina Herzlinger, PhD, Harvard Business School, predicts that the future will bring more alliances and partnerships; integrated information records for greater precision and efficiency in diagnosis and treatments; and personalize medical treatments.

Shoals ahead include centralized decisions over evidence-based medicine which can take away your control; some doctors are being forced to go without medical malpractice insurance; growing tension between hospitals and physicians; role of illegal immigration in forcing hospitals to shut down emergency rooms.

She challenges the CMA to be the leader in creating consumer-directed health plans; have doctors manage the quality rating system so you set your own standards for quality measurement; and CMA can offer a voluntary, peer-reviewed, network-driven outcomes measurements for physicians. She urges the CMA to act quickly or the market will organize around you!

To review some of her power point presentations, go to http://www.galen.org/fileuploads/MedImpact.ppt

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5. Keynote Address: Can a "Consumer-Driven" Health Care System Succeed?
Uwe E Reinhardt, PhD, Professor of Economics at Princeton, gave the keynote address. It was a tour de force, not only his prepared presentation, but his ability to incorporate freshly designed slides into his PDF lecture, taking issue with previous speakers.

Professor Reinhardt gave some very insightful comments on consumer-driven health care (CDHC). On the surface, he felt, the concept of high-deductible health insurance (HDHI) has great intuitive appeal. The underlying assumption is that the annual health spending of a normal family traces out something like a double-peaked curve. At its simplest, the idea is that the family can and should allocate an amount up to the annual deductible out of its own resources. Annual expenditures exceeding that deductible–so-called "catastrophically high" health expenditures–are to be paid by a health insurer under a "catastrophic health insurance" policy. For healthy families, the actual medical expenditures generally do not exceed the deductible.

For a family with chronically ill members, of course, the time profile of health spending would be considerably different. Such a family's annual out-of-pocket spending would likely be equal to the full annual deductible, year after year; plus whatever copayments they would have to bear for expenditures covered by insurance. To heighten the appeal of this idea to the insured, and to make if affordable, the proponents of the concept have three forms of tax-financed inducements:

1. making the premiums for the catastrophic health insurance tax-deductible;

2. allowing individuals or households to make annual, tax-deductible deposits up to a certain amount, into Health Savings Accounts (HSAs) - previously known as Medical Savings Accounts (MSAs) – to help defray outlays up to the annual deductible;

3. granting low-income individuals or households mean-tested, refundable tax credits up to certain amounts towards the purchase of their catastrophic policies and expenditures under the deductible.

Many of the most ardent proponents of the HDHI-HSA concept would prefer to graft it onto the individual insurance market, with the aim of driving employers out of the health-insurance business altogether. The objective is to decouple a family's health insurance from particular jobs in particular firms and to make that coverage perfectly portable among jobs and from employment to self-employment or to unemployment.

In principle, however, the HDHI-HSA construct can also be grafted onto the employment-based health insurance system. Here, a firm may procure catastrophic health insurance policies on a group-basis for entire risk pools of employees and, in addition, make non-taxable deposits into each employee's HSA.

Dr Reinhardt thinks that unless the catastrophic range of HDHI coverage was accompanied by a very high copayment, on top of the already high deductibles, the insured portion of HDHI spending would still have to be subject to some form of "managed care" by insurers, because it would then be like regular, traditional insurance subject to overutilization.

(The sine qua non of HealthPlanUSA is that in addition to an annual deductible equal to the average yearly routine maintenance health care costs for each decade of life, there is a percentage copayment without limit, so that the patient never escapes market forces, thus making the cost of managed care policing or government oversight unnecessary.)

Reinhardt makes a number of other very important economic assertions and problems with lack of actuarial data for CDHC.

For Dr Reinhardt's latest article on The Swiss Health System: Regulated Competition Without Managed Care, see JAMA, Sept 8, 2004 - Vol 292, No 10, pp 1227 - 1231 in response to an article by Regina Herzlinger, PhD, on page 1213 in the same issue.

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6. Myths of American Medicine: Criminalizing Physicians Protects Patients
Madeleine Pelner Cosman, PhD, JD, Esq, in her upcoming book Who Owns Your Body, gives Nine Myths of American Medicine. See October 26, 2004, for Myth One and November 9, 2004, for Myth Two. (www.MedicalTuesday.net).

Myth 3: Legislation Criminalizing Physicians Protects Patients from Injury and Injustice

In 1965 the law creating Medicare was gentle civil law established to provide excellent medical care to America’s vulnerable elderly and disabled. Medicaid was established to extend medical welfare benefits to the very poor. The medical law was not coercive and did not meddle in physicians’ decisions or office practices. This chapter examines seven laws governing modern American medicine, starting with changes in the Social Security Act in 1965 that created Medicare and Medicaid to the stunningly restrictive Health Insurance Portability and Accountability Act (HIPAA) of 1996, the most brutal law of them all. Each law increasingly restricts physicians’ rights to practice ethical, independent medicine. Each law holds the physician to a more unreasonable legal requirement to know and understand the laws. In 1965 no doctor could be prosecuted unless he knew a particular act was wrong and he did it willingly and intentionally. Now doctors are prosecuted because they should have known and they are convicted and jailed even when not intending to do wrong. The physician treating by best ethical judgment for the patient’s best interests who knows specific treatment is medically necessary nevertheless is indicted by the government for providing "medically unnecessary" care, which, in translation, means whatever Medicare refuses to pay for.

From the civil lariat of the first Medicare law in 1965 through the criminal noose of current HIPAA, each of seven major laws becomes more restrictive, oppressive, and punitive:

• The Stark Law or The Ethics in Patient Referrals Act (Stark), and so called Stark II
• The Medicare and Medicaid Patient and Program Protection Act (MMPPPA)
Health Care Quality Improvement Act
Medicare Fraud and Abuse Safe Harbor Regulations (Safe Harbors) of MMPPPA
Health Insurance Portability and Accountability Act (HIPAA)
Emergency Medical Treatment and Active Labor Act (EMTALA)
Balanced Budget Act’s Section 4507

Nine cases demonstrate armored links in a litigation chain that has become a weapon in zealous prosecutors’ arsenals. The infamous Greber One Purpose rule viciously extends the long arm of the law to hook many types of otherwise reasonable and legitimate referrals to hospitals and referrals to diagnostic and treatment centers. Medical law as written and as interpreted in the courts includes patients in the criminality of their prosecuted and convicted doctors. These cases, like those the cases discussed in the previous chapter, implicate patients in:

• the crime of referrals
• the crime of medically unnecessary surgery
• the crime of billing for treatments requested by patients and which helped, not hurt them

 TRUTH 3: Legislation Criminalizing Physicians Protects the Programs and Their Budgets

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7. Medical Gluttony: A New York Times Medicare Story from Patient Power
Consider the case of an 80-year-old man who suffered from the condition of "slowing down." Despite the physician's counsel that the condition was perfectly normal at age 80, the patient and his wife went on a literal shopping spree in the medical marketplace. As the physician explained to the New York Times:

A few days ago the couple came in for a follow-up visit. They were upset. At their daughter's insistence they had gone to an out-of-town neurologist. She had wanted the "best" for her father and would spare no (Medicare) expense to get it. The patient had undergone a CAT scan, a magnetic resonance imaging, a spinal tap, a brain-stem evoke potential and a carotid duplex ultrasound.

No remediable problems were discovered. The Medicare billing was more than $4,000 (1994 dollars) so far. . . but they were emotionally exhausted by the experience and anxious over what portion of the expenses might not be covered by insurance.

I have seen this Medicare madness happen too often. It is caused by many factors, but contrary to public opinion, physician greed is not high on the list. I tried to stop the crime, but found I was just a pawn in a ruthless game, whose rules are excess and waste. Who will stop the madness? Posted at http://www.delmeyer.net/bkrev_PatientPower.htm

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

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8. MedicalTuesday Supports These Efforts of the Medical and Professional Community in Restoring Accountability in Medical Practice, HeathCare and Government

PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, provides prompt care for many of the injuries and illnesses treated in Emergency Rooms at a fraction of the usual emergency room fees. Be sure to read his article on how the Robert Wood Johnson Foundation is using "Cover the Uninsured" as a ruse to promote single-payer HeathCare by government mandate. Read the whole article "Health Coverage Does Not Equal Health Care" at  http://www.emergiclinic.com.  Read Dr Berry’s response to Physician’s Support of Single-Payer Health Care or Socialism at http://www.delmeyer.net/hmc2004.htm#by%20Robert%20Berry.

Dr Vern Cherewatenko concerning success in restoring private-based medical practice which has grown internationally through the SimpleCare model network, http://www.simplecare.com.  Any patient or provider may become a member of SimpleCare. A number of brochures are available on line about a practice that is becoming increasingly popular. There have been a number of news network and press reports. For the AP article: on April 27, 2004, go to  http://apnews.myway.com/article/20040404/D81O7R7O0.html.

Dr David MacDonald started Liberty Health Group, http://www.LibertyHealthGroup.com, to assist physicians in controlling their own medical benefit costs for their staff and patients. There is extensive data available for your study. Dr Dave is available to speak to your group on a consultative basis.

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. Please visit them at http://www.zhcenter.org and check out their history, mission statement, newsletter, and a host of other information. For their article “Are you really insured?” go to http://www.healthplanusa.net/AE-AreYouReallyInsured.htm.

Madeleine Pelner Cosman, JD, PhD, Esq, has made important efforts in restoring accountability in health care. Please visit http://www.healthplanusa.net/MPCosman.htm to view some of her articles that highlight the government’s efforts in criminalizing medicine, and the introduction to her new book, Who Owns Your Body. For other OpEd articles that are important to the practice of medicine and health care in general, click on her name at http://www.healthcarecom.net/OpEd.htm.

David J Gibson, MD, Consulting Partner of Illumination Medical, Inc. http://www.illuminationmedical.com/, has made important contributions to the free Medical MarketPlace in speeches and writings. His series of articles in Sacramento Medicine can be found at http://www.ssvms.org. Dr Gibson edited the March/April historical issue. To read his current article, Health Plans and the Role of Physicians, Pharmacists go to http://www.ssvms.org/articles/0411gibson.asp. For additional articles such as Health Care Inflation see http://www.healthplanusa.net/DGHealthCareInflation.htm.

Dr Richard B Willner, President, Center Peer Review Justice Inc, reports his latest success story and the secret of helping doctors keep their medical license. On a daily basis, doctors are reviewed, are suspended, lose their medical licenses and go to jail on trumped-up charges. These "extra"-legal services are necessary services that your lawyer does not offer. Stay posted with a wealth of information at http://www.peerreview.org. The Center for Peer Review Justice now has a Joint Venture Partner so they can offer Headhunting for those MDs who have been DataBanked and cannot find a new job.

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. He then went to St Rochus Hospital in the city of Pest and reduced the epidemic of puerperal fever to 0.85 percent. The rate in Vienna was still 10-15 percent. 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: All we ask is that peer review be done with “clean hands.” To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, Medicine is a Rough Playing Field, see http://www.delmeyer.net/HMCPeer.htm#by%20Verner%20Waite%20and%20Robert%20Walker. To see Attorney Sharon Kime’s response, as well as the California Medical Board response, see http://www.delmeyer.net/HMCPeerRev.htm. 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. For the current website and to read some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to http://www.semmelweissociety.net.

Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), http://www.sepp.net, for making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals, with a special page for our colleagues in nursing. Several free newsletters are available.

Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column that is at NewsMax. Please log on to review the last five weeks topics or click on archives to see the last two years topics at http://www.newsmax.com/pundits/Medicine_Men.shtml. With the cost of weddings increasing 15 fold in one generation, approaching $20,000, read this week’s column: Wedding Psychosis - A New Diagnosis is Born at http://www.newsmax.com/archives/articles/2004/11/16/150541.shtml.

The Association of American Physicians & Surgeons (http://www.AAPSonline.org), 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 scroll down on the left to departments and click on News of the Day. The “AAPS News,” written by Jane Orient, MD, and archived on this site, provides valuable information on a monthly basis. This month, review Electronic Medical Records. 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. 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
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If you would like to participate in this informational campaign on behalf of your patients or the HeathCare community, please send your resume to Personnel@MedicalTuesday.net.

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Del Meyer

Del Meyer, MD, CEO & Founder
6620 Coyle Avenue, Ste 122, Carmichael, CA 95608

 Words of Wisdom

Mark Twain: Suppose you were an idiot. And suppose you were a member of congress. But, I repeat myself.

Ayn Rand:  When so many laws (mandates) are passed that no one can observe all of them, then you have a nation of lawbreakers. You can then get conviction after conviction for total servitude.

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

 Review some recent postings below.

Voices of Medicine: To read a review of the first issue of Sacramento Medicine in 1950, go to http://www.ssvms.org/articles/0403vom.asp remembering that the first 132 years are no longer available. To read this year's series of my column, the "Voices of Medicine," go to http://healthcarecom.net/vom2004.htm.

Patient Power: Solving America's Health Care Crises by John C Goodman, PhD and Gerald L Musgrave, PhD. Cato Institute. http://www.delmeyer.net/bkrev_PatientPower.htm.

Bio-Medical Ethics with a recent update on Genetics, Cloning and Stem Cell Research can be found at http://www.delmeyer.net/GeneticsCloningStemCellResearch.htm.

Charles B Clark, MD: A Piece of the Pie: What are we going to tell those bright-eyed little boys and girls who are going to be the doctors of tomorrow? When there isn’t anything left for them, are we going to tell them we didn’t fight because the changes were inevitable anyway? What are we going to say when they ask us why we laid down and died when things got a little tough? Are we going to feel good about ourselves when we tell them it’s all right because we got a piece of the pie? Read Dr Clark at http://www.healthcarecom.net/CBCPieceofPie.htm. Also be sure to read his most recent posting at http://www.healthcarecom.net/CBCFeedingMonster.htm.

Ada P Kahn, PhD: Foreword to "Encyclopedia of Work-Related Injuries, Illnesses and Health Issues. Dr Kahn came to Sacramento in February and I joined her on a Channel 31 interview about her book. I was privileged to write the foreword which we’ve posted at http://www.delmeyer.net/MedInfo2004.htm.To purchase the book, go to http://www.factsonfile.com/ and type in KAHN under search.

Henry Chang, MD: WEIGHT LOST FOREVER - The Five Second Guide to Permanent Weight Loss suggest daily weights to stem the weight loss before it becomes a problem and, if it does,  how to take it off and keep it off. Congratulations to Dr Chang for winning the Sacramento Publishers and Authors 2004 award for “Best Health Book of the Year.” Read our review at http://www.healthcarecom.net/bkrev_WeightLostForever.htm.

Tammy Bruce: The Death of Right and Wrong (Understanding the difference between the right and the left on our culture and values.) http://www.townhall.com/bookclub/bruce.html. Reviewed by Courtney Rosenbladt

An Alzheimer's Story: To read a touching story by a nurse about her Alzheimer's patient, go to http://www.delmeyer.net/MedInfo2003.htm.

An Entrepreneur's Story: AriadneCapital (http://www.AriadneCapital.com) provided the initial funding for MedicalTuesday and the Global Trademarking. Julie Meyer, the CEO, has a clear vision in her mind of the world that she wants to live in, and it's considerably different from how it looks now. If you're an entrepreneurial woman, or if you lost hope or are having difficulty envisioning success, (if you'll forgive a little nepotism), the following article may be of interest to you: http://observer.guardian.co.uk/business/story/0,6903,1237363,00.html.

 On This Date in History - November 23

On this date in 1744, Abigail Smith Adams was born in Weymouth, Massachusetts. In 1800, she became the First Lady of a new nation in a brand new Executive Mansion, being the wife of one president and the mother of another. She became one of the first major spokeswomen for the cause of women's rights in the infant nation.

On this date in 1848, the first women's medical society in America was founded. It was called the Female Medical Educational Society and all of the officers were men!

On This Date in History - November 30

On this date in 1874, Winston Leonard Spencer Churchill was born in Oxfordshire, England. After a distinguished career as a writer and politician, he reach the retirement age of 65 by embarking on a new job, as Prime Minister of the United Kingdom, when the Kingdom was fighting for its life in World War II.

On this date in 1835, Samuel L Clemens, better known as Mark Twain, was born in Florida, Missouri. Among his many words of wit and wisdom, one sentence struck a chord: "Thunder is good, thunder is impressive; but it is lightning that does the work."

On this date in 1939, after signing a treaty with Nazi Germany, the Soviet Union invaded little Finland, and cast itself as an imperialistic nation.

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