Community For Better Health Care

Vol IV, No 14, Oct 25, 2005

In This Issue:


1.      Featured Article: Some Good News Behind Rising Health Care Costs by Daniel Weintraub, Bee Columnist, Tuesday, October 4, 2005

Americans have a love-hate relationship with health care spending. We love spending more on health care, as long as we feel as if someone else is paying the bill.

An excellent illustration of this comes in a flurry of recent news items about increased investment in health care around California. As hospitals and clinics commit billions of dollars to new projects to serve patients and higher salaries for their work forces, the announcements are treated as good news, which they are. But later, when these same costs generate statistics showing health care taking more from our pocketbooks, we'll focus only on what we consider the bad: the rising cost of health care.

I've never understood why health care came to be singled out as an industry that we do not want to see grow. The growth of the automobile industry or the computer industry is treated as a good thing, as high-paying jobs multiply and consumers are offered more choices. But when the same thing happens in the one industry we need to keep us alive and feeling good, it is more often than not seen as something bad.

I suppose one reason is that our health care purchases, unlike those for cars and computers, do not feel voluntary. If we have insurance, the premiums we pay are usually deducted from our paychecks, and it seems as if those payments are going for something we don't need or want - at the moment. The money we pay out of pocket when we are sick depresses us even more, because we feel coerced or backed into a corner. Few have the ability to step back at a time like that and compare what they spend on health care over time to what they spend on the other essentials of life - food, shelter, even clothing - and conclude that maybe their medical costs are a bargain.

Another reason that the expansion of the health care industry is considered a negative is that it is usually associated with the inability of some people to buy insurance. Although the number of people without health coverage in California has held steady over the past decade, even as our population has risen, the number without coverage has been rising lately, and many of us believe that even one person without insurance is one too many.

But this is really a separate issue from the total amount of money that we as a society spend on health care. And we need to separate the two as we define and evaluate the problem.

One big reason we are spending more on health care overall is that our population is aging. Older people tend to get sick more and need more health care. So it is only natural that health care would rise as a share of the economy. Denying care to old people would be one way to reduce what we spend on health care overall. But it would be inhumane and would do almost nothing to make care more accessible to the working poor.

Beyond our aging population, though, the cost of each medical procedure for all of us is also rising. It costs more to go to the doctor, more to be tested, more to be treated in a hospital. That's where the recent headlines help explain what is happening. . . .

To read the entire article, please go to

About the writer: The Bee's Daniel Weintraub can be reached at (916) 321-1914 or at Readers can see his daily Weblog at                                                                                  

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2.      In The News: Flu Drug Maker Roche Rejects Calls to Allow Production Of Generics Sabin Russell, Chronicle Medical Writer Thursday, October 13, 2005

Tamiflu, a pricey antiviral pill invented in a Bay Area lab and made in part from a spice used in Chinese cookery, has emerged as the world's first line of defense against bird flu should the deadly strain begin its feared spread among human beings.

As nations begin to stockpile the drug in anticipation of a flu pandemic, calls are mounting for countries to sidestep patents on the drug -- as Brazil first did for AIDS medications -- and make their own generic versions.

But Swiss pharmaceuticals giant Roche, which acquired rights to the drug from Gilead Sciences Inc. of Foster City in 1996, said Wednesday it had no intention of letting others make it.

"Roche ... fully intends to remain the sole manufacturer of Tamiflu,'' said company spokesman Terry Hurley.

The immediate problem is not the cost of Tamiflu, which runs about $60 for a 10-pill course of treatment, but a staggering gap between the sudden demand for it and the capacity of its sole manufacturer to produce it.

Although Roche has increased production of Tamiflu eightfold in the past two years, it will take $16 billion and 10 years to make enough of the drug for 20 percent of the world's population, said Klaus Stohr, director of the World Health Organization's Global Influenza Program, in comments to reporters in San Francisco last week.

"Something has to be done,'' said Ira Longini, an Emory University professor whose computer model of a potential avian flu pandemic shows that an outbreak could be snuffed out within a month by rushing antiviral drugs to the place where it started. "When you think of the potential damage a pandemic flu could do, and how little drug we have, the situation is quite absurd.

[The SF Chronicle web posting of this article stopped two paragraphs before the following which seems to be rather important in accessing the populist notion that someone could simply make a generic copy in a few months or a year or two. Even the World Health Organization admits that it would take at least two years to put a plant in action. It should be obvious that Roche, having years of research and know-how, having the plants, the technical methods of production already in progress, could expand their facilities and produce more Tamiflu far faster than any firm starting from scratch. Why was this important assessment omitted by the SF Chronicle from an otherwise excellent report from its web site posting, which normally gives a more enlarged account than the printed page. Here is the paragraph that was omitted:]

WHO flu chief [Klaus] Stohr is not optimistic that generic produces would be able to make Tamiflu. He told reporters in SF that the drug takes a full year to make and involves a potentially explosive process that would drive out all but the most sophisticate manufacturers. It would take a generic supplier at least “two years” to put a plant into action. 

James L Love, director of the Consumer Project on Technology in Washington, D.C., said that during the anthrax bioterrorism scare in 2001, both the United States and Canada had threatened to bypass the patent of Bayer Corp.'s antibiotic Cipro to assure a sufficient supply of the drug. The Tamiflu problem is similar.

"The WHO should buy stockpiles from generic suppliers,'' he said. "If patents are in the way, the WHO should ask the manufacturing country to issue the appropriate compulsory licenses. The patent owner will receive royalties, but we will have the stockpiles."

U.N. Secretary-General Kofi Annan has signaled a willingness to consider generic production of flu drugs and vaccines. During remarks at the World Health Organization headquarters in Geneva last week, he said drug companies should be "helpful" by not letting their patent claims interfere with access to medicines. "I wouldn't want to hear the kind of debate we got into when it came to the HIV anti-retrovirals,'' he said.

Roche will not release its Tamiflu production figures, deeming it "commercially sensitive" information, said Hurley, the company spokesman. However, he said the company produced "many hundreds of millions" of the pills annually. In response to WHO concerns about bird flu this summer, the company agreed to donate enough Tamiflu to treat 3 million people.

Although public awareness of the pandemic threat posed by the bird flu has blossomed in recent weeks, scientists have been warning since 1997 that the rogue influenza strain known as H5N1 could be the one that triggers a pandemic rivaling the devastating Spanish flu of 1918 -- which killed 50 million.

Tests on laboratory mice strongly suggest that Tamiflu -- and a lesser-known inhaled antiviral, Relenza -- are the only medications that can treat infection with the H5N1 strain.

Tamiflu has not been effective in the treatment of the small number of people who've contracted the H5N1 virus in Asia. Of 116 people infected since 2003, half have died. However, most of those patients were admitted to hospitals days or weeks after they became ill. Tamiflu is thought to work best within 36 hours of symptoms.

"Late treatment is clearly ineffective,'' said Dr. Frederick Hayden, a University of Virginia expert on flu drugs .  .  .  .

Secretary of Health and Human Services Michael Leavitt has said the U.S. government plans to buy 20 million courses of Tamiflu, although no timeframe for the purchase has been revealed. To accommodate U.S. demand for the drug, Roche is building Tamiflu production capacity in the United States, and spokesman Hurley said the plant -- actually a series of facilities owned by the company and subcontractors -- would be "up and running"

To read the entire report, please go to  

E-mail Sabin Russell at

Vaccination Is The Medical Sacrament Corresponding To Baptism

--Samuel Butler (1835-1902) English author, Samuel Butler’s Notebooks (1951)

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3.      International Medicine: What's so Bad about Assembly Line Healthcare? By Jon Miller

The October 8, 2005 news article from Singapore titled Thinking Out-of-the-Box Helps Alexandra Hospital Reduce Patient Waiting Time starts out "It worked for Toyota cars, so why not for patients at hospitals?" Why not indeed?

According to the article the impact of Lean healthcare on patient flow included productivity improvement by 400% (from 22 to 70 patients seen per hour by a staff of 12) and wait times cut in half. This helped bring the cost of the health screening to $10 per patient (the article does not say what the original cost was). These are typical Lean implementation results.

The article mentions a million dollars of grant money in the Quality Improvement Fund through the Ministry of Health. It's on the table for any of you Lean healthcare consultants out there with time on your hands and an interest in helping out hospitals in Singapore.

What struck me about this article was the seeming ease with which this hospital adopted the "assembly line" concept. I have to confess having much less success at persuading hospitals in the U.S. to take a serious look at TPS (Toyota Production System). People with the letters M.D. after their name are particularly resistant to being placed, or having their patients placed on any kind of "production line" healthcare.

Let's be patient-centered for just a moment and imagine that healthcare doesn't revolve at all around MDs or their preconceptions of what a healthcare delivery process should be. A supreme example from India is Dr. Govindappa Venkataswamy of Sight Savers International. Dr. Govindappa helps people get their sight back for free. This is done through a "production line" process that performs 130,000 cataract operations per year.

In American English the colloquialism "production line" or "assembly line" is a negative term generally used by artists, craftsmen, designers or knowledge workers to mean work that is impersonal, mechanical or uncreative. To people who think what they do is different each time and impossible to standardize or streamline, or that they need a lot of "mental set up" or thinking time between transactions having their work measured and paced by a production line does not seem like a good idea. This is certainly one way of looking at the world.

When I hear the words "assembly line" I get a warm feeling. Really, I do. This, I am fairly certain, puts me in the minority. Of course I think of the Toyota assembly lines I have seen or production lines at other companies who have applied TPS principles. Seeing a well-designed and well-balanced production line run can be a beautiful thing. Personally, there are very few things I would not want delivered to me via Toyota-style assembly line, product or service.  .  .  .

To read the entire report, please to go

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4.      Medicare: Governor Vilsack Brings Lean Government to Iowa By Jon Miller, October 3, 2005 [In this section we frequently use government programs to help elucidate Medicare’s current and future fiscal challenges.]

In a TPM (Total Productive Maintenance) Cafe blog entry titled Making Government Work, Governor Tom Vilsack of Iowa talks about how he is bringing Lean government using kaizen ( and other tools.

Just a sample on this Lean government blog entry: "We combined four departments of government into one administrative agency, which improved service within state government and saved money at the same time."

There's more good information at the governor's Results Iowa website, including some good improvement metrics called the Operational Scan as well as their Enterprise Strategic Plan that is reminiscent of top level Hoshin Kanri ( objectives (which they appear to have cascaded down to at least the departmental level).

It's great to see a governor who is using Lean to cut costs when revenues fall so the state can maintain services for citizens. Write to your senator, governor or congressman and ask them to do kaizen at your local government! It's our duty as citizens (customers of the government) to ask, it's their duty as public servants to make wise use of our resources.

To read the entire report, please go to

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5.      Medical Gluttony: Does My Father Really Have Pneumonia Every Month Requiring Hospitalization?

Medical excesses do not always reside with the patient. Frequently they are system induced. When the system is run by a large variety of physicians and nurses, complicated by government mandates and intrusions, the health safety factor which was the reason for the initial mandate, has a life and excess of it’s own.

A Puerto Rican man, age 92, is brought in by his daughter after she insists on a pulmonary consultation because her father is transported to the hospital at least once a month. He stays several days, and is sent back to the facility on antibiotics. Each time, she is told he has pneumonia or congestive heart failure. She sees no change in his condition before he goes or after he comes back. She feels this is very disruptive to her father’s final years on earth. He was a truck driver for most of his life. The daughter does not know what exposures he may have had during the course of this employment. The patient is rather senile and doesn’t speak English.

The patient is seen with his chest x-ray, which is very abnormal with plaques, fibrosis, and consolidations. There were also several hospital notes from two hospitals where he was hospitalized. These list pneumonia and heart failure along with hypertension and hypercholesterolemia as his diagnosis. The University note also lists the previous chest x-rays, which have shown plaques, fibrosis, and consolidations consistent with asbestosis.

This information should have stopped the notion that the patient was having something new and acute such as heart failure or pneumonia. However, with the fragmentation of medical care brought on by mandates and the hassles of being a personal physician in this age of government micromanaging every aspect of health care, the physician that covers the facility receives the x-ray report, probably on a phone call from a nursing attendant, and becomes frightened with all the bureaucratic intrusions and possible malpractice suit for not saving a patient’s life, (most likely doesn’t even know the patient or his age) or worse yet, a Medicare Audit for inappropriate care, and just tells the facility attendant “Send him to the hospital emergency room for an evaluation.” The physicians in the hospital emergency room, who may not have previously seen this patient, have no prior records, will practice defensive medicine, admit him and probably repeat the studies done elsewhere to which they do not have access. After a few days, the hospitalist, rather than the personal physician, feels comfortable that the x-ray represents chronic changes from a lifetime of exposures, and is irrelevant to his current condition. The patient then is discharged back to the facility.

But no one evaluates the cost in the overview of health care. There is no hospitalization, no matter how brief, that will cost less than several thousand dollars. If the personal physician, who had seen the patient previous to his move to a facility, had been allowed to continue to cover his patient, he would have prevented the massive health care costs over a number of months. But with all the Medicare and bureaucratic intrusions, very few physicians will take it upon themselves to follow even their long time patients in multiple facilities that they choose. And the facilities prefer to have their own doctor manage hundreds of patients even though the doctor may not know any of them. The available information is gleaned by an attendant, who may not have had any major medical assistant training, and the level of care plummets and the cost of care rises astronomically.

The approach by medical bureaucrats would be to increase the extent and complicity of the algorithms of all possible human responses in a highly variable, unpredictable medical situation which would only further complicate health care delivery, further lower the level of care and continue the upwards spiral in health care costs.

The only answer is to free the personal physician from all bureaucratic, government, insurance carrier and HMO intrusions and allow him to use his superior judgment in health care. Many specialists feel the personal physician does not order enough tests. But isn’t excessive unnecessary testing a major problem in runaway health care costs? Isn’t it better to have a personal family doctor or internist or pediatrician who knows the patient well in charge of keeping costs in line without hurting the patient, rather than Medicare, HMO or insurance administrators policing the system from afar, not knowing the unique needs of the patient and having no idea of what damage they are doing to this patient by withholding treatment? Having the personal physician in charge will normally improve the quality of care and reduce health care costs to the lowest possible level. And that’s not counting the elimination of the probable hundred billion dollar bureaucracy micromanaging health care.

We have to ask ourselves whether medicine is to remain a humanitarian and respected profession or a new but depersonalized science in the service of prolonging life rather than diminishing human suffering.

Elizabeth Kübler-Ross (Swiss-born US Psychiatrist, on Death and Dying Ch 2, 1969)


The Complicated Medicare Rules & Regulations

Will Soon Prevent More Americans From Receiving Health Care

Than Poverty or Lack of Health Insurance

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6.      Medical Myths: Universal Coverage Means Access to Health Care

Many Americans, patients, politicians and even Medical Societies argue that Americans should be covered with a universal health plan, such as Canada has, so that every American has access to health care.

Dr. Jacques Chaoulli challenged restrictions in Canada's government‑run health care system, a Quebec law that had banned private health insurance and private payment for services covered under Medicare, Canada's socialized health care program. The Supreme Court of Canada struck down this law on June 9, 2005, ruling that the Canadian Single-Payer Health Care System Caused Situations in Which Patients Suffered and Died on Waiting Lists, in Violation of the Rights to Life, Liberty, and Security. "Access to a waiting list is not access to health care," the Canadian Supreme Court said in its ruling.

Medical Fact: Universal coverage only means that you have access to a waiting list. You may never get Health Care. You may also die waiting.

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7.      Overheard In The Medical Staff Lounge: How Do You Deal with a Patient Who Doesn’t Know How to Say Thank You?

Dr Edwards:  Mrs Ruth, an 85-year-old lady with severe heart disease, managed to survive an episode of congestive heart failure. During a follow up evaluation she told me, “I think I’m falling in love with you.” How, she could be my grandmother. I’ve been trying to redirect her emotions for months, but it doesn’t seem to work. I’ve alerted my staff that the exam door must always remain open when she’s here and I want them inside the examining room if the door is closed.

Dr Rosen:  Yes, I remember during psychiatry in medical school, the professor said many patients would fall in love with you. It was important to recognize this as a clumsy way for a patient to express appreciation or say thank you. But it does seem difficult to inform the patient that they are trying to say thank you for what they feel were services of tremendous help to them. After all, almost all of what we do in life is of a very personal nature – something that someone outside of medicine has difficulty in comprehending.

Dr Edwards: This 85-year-old patient came in today with a new gray and blue plastic splint on her fractured right ankle. But the unusual part was that for age 85, she was well made up, had on a new complementary (to the color of her boot) suit and blouse, heels and hose on her left foot, and tried to give me a squeeze. I had trouble disengaging as I helped her up on the exam table.

Dr Rosen: I remember the previous State Medical Board had cops who would investigate such occurrences when someone who didn’t understand patient care, or may have even been a member of the physician’s staff, observed such advances, and would report it anonymously to the State Medical Board. The Board would just assume this was non-professional conduct or sexual indiscretion with a patient that must have been instigated by the physician and would arrest them. This intrusion into medical practice will eventually drive physicians out of medicine and patients will be totally at the mercy of, and subjected to, non-medically trained medical bureaucrats.

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8.      Voices of Medicine: From the Various Local and Regional Medical Journals and the Press.

Doctor Interview: Patients Also Need to Communicate by Vicki Rackner, M.D., President, Medical Bridges, Seattle,WSJ, October 7, 2005; Page A17

I appreciate Laura Landro's excellent "Informed Patient" column "Teaching Doctors How to Interview1" (Personal Journal, Sept. 21). Let's be honest. When it comes to communication, doctors fall into one of two categories: those who get it and those who don't. Those who get it are more likely to take advantage of a program that enhances their patient interview skills.

As both a doctor and a patient, I think of the medical interview as a dialogue. While I applaud those physicians who invest in communicating more effectively, patients can make a similar commitment. Patients can be coached to prepare for their doctor appointments. They can be clear about their observations, fears, concerns and expectations. They can be encouraged to ask for an understandable statement of the medical problem and treatment options.

The reality is that patients have more skin in this game than doctors; patients have a strong incentive to communicate clearly. In fact, the patient is the great untapped resource that offers solutions to our current health-care conundrum.


URL for this article (subscription required):




Medical Records: How Long to Keep Them by Sondra K Jacoby, Executive Director of the Santa Barbara County Medical Society, as excerpted from CMA On-Call.

Sondra Jacoby discusses some of the factors to consider before you pitch the old patient records. California statutory authorities which specifically regulate a physician's retention of medical records are found, among other places, in the Medi-Cal Act, the law governing the Emergency Medical Services Fund, the California Uniform Controlled Substances Act, the Knox-Keene Act, OSHA rules, and the Workers' Compensation laws.


Medi-Cal records must be retained for three years after the date of last service. Every physician who prescribes, dispenses or administers a controlled substance classified as Schedule II or III must make and keep a record of that transaction for at least three years. Workers' Compensation examiners must retain all medical-legal reports for five years from the date of the employee's evaluation.

HIPAA does not create new rules for retention of medical records, but does create rules for physicians to maintain all of the following in written or electronic form for at least six years from the date of creation: a) HIPAA Privacy Rule required policies & Procedures, b) all HIPAA Privacy Rule related communications required to be in writing, and c) all HIPAA Privacy Rule related actions or designations required to be documented.


The statute of limitations in California generally requires that an adult's action for medical malpractice be brought within three years after the date of injury or one year after the plaintiff discovers. For patients under 18, a malpractice action must be brought within three years of the date of the alleged wrongful act, except that patients under six have at least until their eighth birthday.


Jacoby suggests that despite statutory requirements, all Medical records be retained indefinitely, or 25 years since the date last seen or 10 years after a minor reaches age 18. Since 99 percent of claims against hospitals are filed within 20 yeas of the incident, she suggests a minimum of ten years as a reasonable alternative.

URL: - mmn


Author D Silk, MD, the editor of the Bulletin of the Orange County Medical Society, suggests that we should stop crowing about the evolution of medicine from a cottage industry to big business as if that transition means progress. He says it doesn't. "Like your grandmother's pies and hand-tailored suits, some services are better done by individuals working in their own microenvironments than in corporate beehives. Turning out sick patients on a production line . . . is a sociologic experiment that [is] unfortunate for our patients and ourselves . . . despite widespread dissatisfaction . . . Even a flawed system may last for two or three decades before its weaknesses become so prominent that it disintegrates. It took Russian Communism 70 years to fall of its own weight. . . Doctors were not perfect before corporate medicine besmirched the horizon. But when medicine was a cottage industry, a single error in technique or judgment resulting in a malpractice suit . . . became a local headline. Now billion dollar frauds by corporate medicine are almost daily headlines. When the service must be personal and individual, private schools, portrait painting, playwriting, tailor-made suits, home cooking, dressmakers, nurses, and doctors are all examples of the superiority of what some may derisively call a cottage industry."

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9.      Book Review: HEALTHY COMPETITION - What’s Holding Back Health Care and How to Free it by Michael F Cannon & Michael D Tanner, Cato Institute Washington, DC © 2005, ISBN 1-930865-81-3, 173 pp, $10.  Introduction: What Can Competition Do for Patients?

America's healthcare system is at a crossroads, faced with rising costs, quality concerns, and a lack of patient control. Some blame market forces. Yet many troubles can be traced directly to pervasive government influence: entitlements, tax laws, and costly regulations. Consumer choice and competition deliver higher quality and lower prices in other areas of the economy. In this new book, Cannon and Tanner argue that removing restrictions can do the same for health care.

In the introduction, the authors give us their views on the current health care situation in the United States. They observe that it seems to grow less affordable each year; that prices for medical care consistently rise faster than prices for non-medical items; that health insurance premiums are rising faster than both inflation and earnings; and are taking up an increasing share of family budgets. Without health insurance, families risk enormous medical bills in the event of serious illness or injury. Yet tens of millions of Americans have no health insurance, either because it has become too expensive or isn’t worth the price. Government spending adds a number of very large (if somewhat hidden) items to the nation’s health care bill.

The burden of paying for health care is only part of the problem. America is a leader in medical innovation. Many Americans receive the best care available anywhere in the world, and many foreigners visit America to take advantage of cutting-edge medicine. . . .

Furthermore, patients seem to be losing control over their health care decisions. Many patients would value being able to make their own health care decisions, with the advice of their doctors, more than they value being able to choose their own cars, car insurance, or computers. Yet Americans have fewer choices when it comes to health insurance than they do with car insurance. 

Employers have been making decisions about Americans’ health insurance for as long as anyone can remember. Government also makes many health insurance decisions for consumers, particularly senior citizens. In recent years, employers and insurance companies have begun making what amounts to treatment decisions as well. Although managed care probably does eliminate some unnecessary costs, patients resent the lack of choice this entails, and doctors resent the intrusion on their professional judgment.

Quality, affordability, and choice seem to present tradeoffs: getting more of one seems to involve getting less of the others. On the one hand, employers, insurance companies, and government can set limits on what treatments they will cover. This may eliminate low-quality care. But it also reduces patient choice and would sometimes block access to necessary care. On the other hand, if patients are given free rein, what’s to prevent them from overutilizing the health care system or choosing low-quality care and imposing costs on everyone else?

How can high-quality health care be made affordable, without sacrificing patient choice? That is a question asked over and over again in health policy circles. It underlies debates over health insurance, prescription drugs, primary and preventive care, hospital care, and aid to the poor. And it has stumped policymakers in Washington and the state capitols for generations. The thesis of this book is that the way to find solutions to the vexing problems of America’s health care system is through a competitive market process. We do not claim to know any particular solution to these problems. We do, however, propose a method of discovering them.

Why Competition? Competition is a tool for finding answers we don’t have.

To read the rest of the introduction and why competition gives us the health care answers, please go to the Cato Bookstore:

To read some of the other book reviews that are available, please go to

This will never be a civilized country until we expend more money for books than for chewing gum.        –Elbert Hubbard

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10.  Hippocrates & His Kin: Impotence Pills May Cause You To See In Blue

Federal health officials are examining rare reports of eye damage among some men using impotence drugs. The drugs also may have other rare side effects on vision. Warning labels for Viagra, Cialis and Levitra list such potential side effects, according to the drugs’ Web sites. Example:

Viagra “Less common side effects that may occur are temporary changes in color vision (such as trouble telling the difference between blue and green objects or having a blue color tinge to them), eyes being more sensitive to light or blurred vision.”

I explained the side effects of the pill to a patient, including headache, indigestion and a temporary blue tinge in one's vision, to which he replied, "Well, I'd rather have a red velvet tinge to my vision during these times, but blue will do."



An attorney at a medical conference was describing a pain doctor with the expert medical witness lying under oath. The judge refused to rule against the perjury testimony. The attorney told the doctors that if this case would be mentioned to entering law students, he estimated that 90 percent of the class would immediately leave and find another career or profession.

Can’t we enroll a “stoolie” in each Law School for at least the opening day? Wouldn’t that be the quickest way to clean up our Congress, our legislatures, as well as our country?



Russia, for example, has reported that it now gets more tax revenues from the rich from its 13% flat tax than from its pre-existing Swiss cheese tax code with massive evasion and 50%-plus tax rates. Russia's revenues with the flat tax grew in real terms by 28% in 2001, 21% in 2002, and 31% in 2003, according to a recent analysis by the Hoover Institution. If the U.S. had that kind of revenue growth, our politicians would be wringing their hands over what to do with budget surpluses.

Last year the Internal Revenue code achieved a new Olympic record for complexity, with nine million words -- 12 times the length of the King James Bible. High tax rates and mindless tax complexity are an economic ball and chain. We hope President Bush's tax reform commission will cut through the class-warfare blather later this month and endorse a simple, broad-based, single-rate tax system.



John Grisham, a lawyer turned novelist with a genre of legal thrillers, mentioned that a half-billionaire attorney was complaining that he could be a billionaire by now if he didn’t have to share half of his winnings with patients. Well, it looks like the Visa class action suit has become nirvana. I received an extensive packet of documents to complete and forward to the claims administrator in New York. On the front, was a note that I’ve been identified as a member of the Class.  As a Class Member you are entitled to receive a Cash payment, which is estimated to be $0. Looks like taking all the defendant’s money wasn’t enough for these attorneys, so that they had to also take all of the plaintiff’s moneys.

To read more Hippocrates columns, please go to


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11.  Restoring Accountability in Medical Practice and Society

                      John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. 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 If you missed the Benefit Banquet September 16th, 2005 at the Doubletree Hotel in Somerset, NJ you can still read the remarks of Drs. John and Alieta Eck. Go to First read the amazing story told by Dr. Alieta Eck, MD at the ZHC Banquet on September 16th, 2005 “Who we are and what we do.” It’ll make you dig out your old Hippocratic Oath and read it again. It might even make you rearrange your practice priorities.


                      PATMOS EmergiClinic - - where Robert Berry, MD, an emergency physician and internist practices. Here is his story: Three years ago, I left ER medicine to establish a primary care clinic in a town of about 15,000 in northeast Tennessee - primarily for the uninsured, but also for anyone willing to pay me for my care at the time of service.  I named the clinic PATMOS EmergiClinic - for the island where John was exiled and an acronym for "payment at time of service."  I have no third party contracts ...not commercial, not Medicare, TennCare or worker's compensation. My practice today has over 4,000 patient charts.  My patients are typically between 5-50 years old, but I do have a significant number of Medicare patients.  A year ago, over 95 percent of the patients I saw had no insurance.  Today, that figure may be 75 percent.  But even those with insurance learn a simple lesson when they come to me: health insurance does not equal healthcare, at least not at my clinic. I clearly tell my patients how much a visit will cost.  Everything is up front and honest.  I will prepare a billing claim for my patients with insurance, for a small fee, but I expect them to pay me when I see them.  Because I need only one employee in my office, my costs are low.  For the same services, I charge about 60 percent of charges made by other local clinics, 40 percent of what the local urgent care clinic charges and less than 20 percent of what the local ER charges.  I am the best bargain in town.  My income last year was about average of an ER doc - not great - but I'm free and having fun. If I can do it, caring for the uninsured in a small rural town, any doctor can. As I see it, the real question is: Are we going to be Hippocratic doctors?  To read more on Dr Berry, please to go

                      Michael J. Harris, MD - - an active member in the American Urological Association, Association of American Physicians and Surgeons, Societe' Internationale D'Urologie, has an active cash'n carry practice in urology in Traverse City, Michigan. He has no contracts, no Medicare, 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" at

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

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

                      Madeleine Pelner Cosman, JD, PhD, Esq, has made important efforts in restoring accountability in health care. She has now published her important work, Who Owns Your Body. To read a review, go to Please go to to view some of her articles that highlight the government’s efforts in criminalizing medicine. 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 click on archives to see the last two years’ topics at This week’s column is on Temporary Brittle Bone Disease and Infant Fractures and can be found at  

                      The Association of American Physicians & Surgeons (, The Voice for Private Physicians Since 1943, representing physicians in their struggles against bureaucratic medicine, loss of medical privacy, and intrusion by the government into the personal and confidential relationship between patients and their physicians.  Be sure to scroll down on the left to departments and click on News of the Day. Be sure to read Could the Medicare drug benefit shorten lives at The “AAPS News,” written by Jane Orient, MD, and archived on this site, provides valuable information on a monthly basis. 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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Del Meyer       

Del Meyer, MD, Editor & Founder

6620 Coyle Avenue, Ste 122, Carmichael, CA 95608

Words of Wisdom

John Stuart Mill (1806-73) English philosopher, economist, On Liberty, Ch 3, 1859: The general tendency of things throughout the world is to render mediocrity the ascendant power among mankind.

On This Date in History – October 25

This was the day in 1854 of the fateful Charge of the Light Brigade, when they rode into the valley of death. It is a lot easier to quote Tennyson’s poem than to remember the circumstances of the event, which took place at the Battle of Balaclava during the Crimean War. Particularly, we remember lines like “Their's not to make reply, Their's not to reason why, Their's but to do and die.” Are we being told to do things as medical professionals against our clinical judgment and not be able to ask or reason why, but just to do it or die?