Community For Better Health Care

Vol VI, No 13, Oct 99, 2007


In This Issue:

1.                  Featured Article: Making Crime Legal

2.                  In the News: The Inconvenient Science of Racial DNA Profiling

3.                  International Medicine: Death, Canadian Style, By Bill Steigerwald

4.                  Medicare: Why Did We Ever Llet Health Care Get out of the Competitive MarketPlace

5.                  Medical Gluttony: Technology Leads to Gluttony Unless Controlled by Physicians

6.                  Medical Myths: America Has an Underclass of 47 Million Citizens with No Health Care

7.                  Overheard in the Medical Staff Lounge: Why Does Medicare Hate Doctors?

8.                  Voices of Medicine: The Evolution of HMOs and Disappearance of Medical Societies

9.                  From the Physician Patient Bookshelf: How Doctors Think, by Jerome Groopman, MD

10.              Hippocrates & His Kin: Saving Money by Reusing Needles?

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

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The Annual World Health Care Congress, co-sponsored by The Wall Street Journal, is the most prestigious meeting of chief and senior executives from all sectors of health care. Renowned authorities and practitioners assemble to present recent results and to develop innovative strategies that foster the creation of a cost-effective and accountable U.S. health-care system. The extraordinary conference agenda includes compelling keynote panel discussions, authoritative industry speakers, international best practices, and recently released case-study data. The 3rd annual conference was held April 17-19, 2006, in Washington, D.C. One of the regular attendees told me that the first Congress was approximately 90 percent pro-government medicine. This year it was 50 percent, indicating open forums such as these are critically important. The 5th Annual World Health Congress has been scheduled for April 21-23, 2008, also in Washington, D.C. The World Health Care Congress - Asia will be held in Singapore on May 21-23, 2008.  The 4th Annual World Health Congress – Europe will meet in Berlin on March 10-12, 2008. For more information, visit 

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Just as there is world conspiring to break laws, the political process works to remake laws to suit itself

We're supposed to smirk automatically at the phrase "conspiracy theory," as if the very idea of a conspiracy were somehow outlandish and, well, paranoid. But federal prosecutors seem to have made a pretty convincing case that Terry Nichols and Timothy McVeigh conspired to blow up the Alfred P. Murrah Federal Building in Oklahoma City in 1995. At least nobody is suggesting that all the jurors in the two trials were loco. 

The idea of conspiracy is essential to criminal law. It means nothing more than secret cooperation to commit criminal acts. It's implicit in such common expressions as "accomplice," "organized crime," and "getaway car." The alternative is to believe that criminals always act alone. Yes, and musicians always play solo. . . .

But the most damaging corruption may not consist in illegal acts. Just as there is a criminal "underworld" that continuously conspires to break the law, you can think of the political process as the working of an "overworld" in a sort of continuous conspiracy to remake the laws to suit itself.  To read more, please go to

If the widget industry can get tax subsidies by persuading legislators to make laws in its favor, no crime has been committed. And this can be accomplished without gross bribery. Key senators and congressmen may be receptive to the argument that new, high-tech widgets are vital to national defense (and might be manufactured in those honorable gentlemen's states). This patriotic proposal may be transacted over an informal lunch, immensely boosting the profits of the widget industry, and the taxpayer never the wiser. 

When there are no limits on what the taxing power may be used for, you are bound to get a whole class of people seeking to have it used in their behalf. What would otherwise be illegal - taking people's earnings by force - becomes legal when a government does it (just as inflating the currency, otherwise known as counterfeiting, becomes "increasing the money supply" when a government does or authorizes it). 

The class of people who live and prosper by discreetly arranging to have their larceny legalized is what I mean by the "overworld." Their ranks include politicians, businessmen, educators and many others. Because they control the legislative process, they not only don't have to commit crimes, they don't even think of themselves as shady operators. 

These folks do share certain characteristic attitudes. They dislike "extremism," by which they mean any political principle that would keep government power and activity to a minimum. They are equally opposed to communism and "cutthroat capitalism"" (whose evils they impartially equate with those of communism). They believe in an "affirmative role" for government, "flexible," "compassionate" and "adapted to today's needs." They tout the virtues of "compromise." They favor "partnership" between government and "the private sector," because the modern world is so "complex" and "interdependent." And of course they are scornful of "conspiracy theories." 

Such people always sound reasonable, and they are the type who control the government. If their sense of honor isn't very strong, it would also be hard to catch them doing anything flatly illegal. 

They aren't a secret cabal or a closed society. Anyone can join their ranks — anyone who wants to play the angles, to use the government for his own special benefit at the expense of the unsuspecting taxpayer. 

An overworld exists in every society, a parasite class that figures out how to get others to work for them while keeping the law on their side. In many societies there are outright lords and slave owners who may directly command their serfs and bondsmen; in a nominally egalitarian society, a more devious approach is necessary. 

You may be working much of the day to support your neighbor without knowing it. You know that a lot of your income goes to the government, but you don't exactly know where it goes from there. That's how the system is designed to work.

To read the entire article, go to

This is why we need a tax limitation amendment. When a lion devours its prey, it is satisfied and ends his hunt. There is no such relaxation in Congress or Legislatures in taxation -— it's a sweet tooth and each new tax just increases its appetite to devour. All public polls on taxation, including the Readers' Digest poll, always indicate that both rich and poor people think no one should have to work more than 25 percent of the time for the government. Our current marginal tax rate is approaching 50 percent. Should the government take over health care; the marginal rate will approach 75 percent. We would be working 75 percent of our time to feed this Congressional and Legislative Lion that is never satisfied. We need a constitution tax limiting amendment.

We propose that each level of government be limited to two taxes. Congress and Legislatures would not be able to dream up new taxes on unique activities or endeavors. To come close to the public-accepted limit of no more than 25 percent of our earnings to feed this avaricious lion, can we be as bold as to propose the following:

The federal government is limited to a 15 percent income tax and a 10 percent excise tax on interstate commerce, imports and international trade?

The state governments are limited to a 5 percent income tax and a 5 percent sales tax on products purchased or sold within the state?

The city/county councils would be limited to a one percent sales tax and a one percent property tax?

I know this doesn't quite meet the 25 percent limit that most Americans feel is just, but doesn't it come close? At least it would curb the appetite.

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2.      In the News: The Inconvenient Science of Racial DNA Profiling By Melba Newsome 10.05.07

On July 16, 2002, a survey crew from the Department of Transportation found Pam Kinamore's nude, decomposing body in the area along the banks of the Mississippi known as Whiskey Bay, just west of Baton Rouge. The police tested the DNA and quickly realized that they were dealing with a serial killer: the same man who had killed two other white, middle-class women in the area.

The FBI, Louisiana State Police, Baton Rouge Police Department and sheriff's departments soon began a massive search. Based on an FBI profile and a confident eyewitness, the Multi-Agency Homicide Task Force futilely upended South Louisiana in search of a young white man who drove a white pick-up truck. They interrogated possible suspects, knocked on hundreds of doors, held frequent press conferences and sorted through thousands of tips.

In late December, after a fourth murder, police set up a dragnet to obtain DNA from some 1200 white men. Authorities spent months and more than a million dollars running those samples against the killer's. Still nothing.

In early March, 2003, investigators turned to Tony Frudakis, a molecular biologist who said he could determine the killer's race by analyzing his DNA. They were unsure about the science, so, before giving him the go-ahead, the task force sent Frudakis DNA swabs taken from 20 people whose race they knew and asked him to determine their races through blind testing. He nailed every single one. To read more, please go to

Still, when they gathered in the Baton Rouge police department for a conference call with Frudakis in mid-March, they were not prepared to hear or accept his conclusions about the killer.

"Your guy has substantial African ancestry," said Frudakis. "He could be Afro-Caribbean or African American but there is no chance that this is a Caucasian. No chance at all."

There was a prolonged, stunned silence, followed by a flurry of questions looking for doubt but Frudakis had none. Would he bet his life on this, they wanted to know? Absolutely. In fact, he was certain that the Baton Rouge serial killer was 85 percent Sub-Saharan African and 15 percent native American.

"This means we're going to turn our investigation in an entirely different direction," Frudakis recalls someone saying. "Are you comfortable with that?"

"Yes. I recommend you do that," he said. And now, rather than later since, in the time it took Frudakis to analyze the sample, the killer had claimed his fifth victim. The task force followed Frudakis' advice and, two months later, the killer was in custody.  . .

Colorblind CODIS, Genetic Drift

The DNA forensic products available at the time could only be used to match DNA specimens in the CODIS, or Combined DNA Index System, database which contains about 5 million DNA profiles. If investigators have a crime scene sample but no suspect, they run it against those in the database to see if it matches a sample already on file.

But while CODIS is good at linking the criminals who are already catalogued from other crimes, the system is useless in identifying physical characteristics. It says nothing about race. It has been specifically set up to reveal no racial information whatsoever, in part so that the test would be consistently accurate irrespective of race.

But non-scientific considerations also factored into how the system was established. When the national DNA Advisory Board selected the gene markers, or DNA sequences which have a known location on a chromosome, for CODIS, they deliberately chose not to include markers associated with ancestral geographic origins to avoid any political maelstrom.

DNAWitness, the test Frudakis applied in the Baton Rouge case, uses a set of 176 genetic markers selected precisely because they disclose the most information about physical characteristics. Some are found primarily in people of African heritage, while others are found mainly in people of Indo-European, Native American or South Asian heritage. . .

To read how the Racial DNA Profile Leads to Killer, go to

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3.      International Medicine: Death, Canadian Style, By Bill Steigerwald, 9/4/2007

If Canada's national health-care system is so dang wonderful, why are so many Canadians coming to America to pay for their own medical care?

Why is the hip replacement center of Canada in Ohio -- at the Cleveland Clinic, where 10 percent of its international patients are Canadians?

Why is the Brain and Spine Clinic in Buffalo serving about 10 border-crossing Canadians a week? Why did a Calgary woman recently have to drive several hundred miles to Great Falls, Mont., to give birth to her quadruplets?

It's simple. As the market-oriented Fraser Institute in Vancouver, B.C., can tell you, Canada's vaunted "free" government health-care system cannot or deliberately will not provide its 33 million citizens with the nonemergency health care they want and need when they need or want it.

Courtesy of the institute, here are some unflattering facts about Canada's sickly system: To read more, please go to

Number of Canadians on waiting lists for referrals to specialists or for medical services -- 875,000. 

Average wait from time of referral to treatment by a specialist -- 17.8 weeks.
Shortest waiting time -- oncology, 4.9 weeks.
Longest waiting times -- orthopedic surgery, 40.3 weeks.
Average wait to get an MRI -- 10.3 weeks nationally but 28 weeks in Newfoundland.
Average wait time for a surgery considered "elective," like a hip replacement -- four or more months.

Hello, Cleveland.
The Canadian system is horribly short on consumer choice and competition. But it isn't all bad -- if you don't mind waiting to access it. As health policy analyst Nadeem Esmail of the Fraser Institute said last week, it does "a decent job of saving your life but treats you terribly in the process."

Esmail says no one knows exactly how many Canadians go to the United States each year for medical care. His best estimate for 2006 -- a conservative one -- is 39,282. Whatever the actual number is, however, it is growing.

Clinics in Detroit and Buffalo market speedy MRIs, CTs or ultrasounds to Canadians which, by law, cannot be purchased privately in some provinces, including Ontario.

Ontario residents have three options: wait months for their free public MRI, travel to a province like Quebec where it is legal to buy one privately or travel to the U.S.

It's no wonder private medical and surgical brokers like Timely Medical Alternatives of Vancouver have sprung into existence. Rick Baker said his three-year-old company refers about 100 Canadians a month to U.S. clinics and hospitals for such things as MRIs and knee replacements.

Timely Medical's services came in handy for Lindsay McCreith, a retired auto body shop owner who was told in 2006 he probably had a brain tumor. He needed an MRI fast. But the wait time for a "free" public one was 4 1/2 months and it was illegal to purchase a private MRI in Ontario.

McCreith contacted Timely Medical, which got him an MRI the next day in Buffalo that showed he had a Titleist-sized tumor. Four and half weeks later, McCreith had received the brain surgery that could have taken eight months to happen in Canada -- if he had still been alive. It cost him $28,000 -- for which Canada's government won't reimburse him.

Stories like McCreith's -- and the downsides of Canadian and American health care – [was] exposed Sept. 14 by ABC's John Stossel in his "20/20" special, tentatively titled "Sick in America." Rick Baker hopes Hillary Clinton and her friends [were] watching.

Bill Steigerwald is the Pittsburgh Tribune-Review's associate editor. Call him at (412) 320-7983. E-mail him at:

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

--Canada's Supreme Court

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4.      Medicare: Why Did We Ever Let Health Care Get out of the Competitive MarketPlace?

When Medicare was implemented in 1966, my father's Blue Cross/Blue Shield premiums were about $300 a quarter. Without Medicare, they probably would have tripled to about $1000 a quarter. With Government taking over the senior's health care, the actual costs of Medicare exceeded projected costs about 400 percent. In addition, now non-Medicare people are paying Medicare taxes about equal to what an entire BC/BS policy would be if Medicare had never happened.  For instance, a worker at age 20 will be paying Medicare taxes equal to what a BC/BS premium would be for 45 years before he is ever insured by Medicare. Without Medicare, out health care costs would be manageable by the private citizen. Medicare is going broke despite 47 million uninsured Americans paying Medicare payroll taxes and remaining uninsured. To help understand this phenomenon, let us look at the premier Freedom Foundation expound on the problem.

The Goal Is Freedom (TGIF): Government Failure, by Sheldon Richman, October 5, 2007

Sheldon Richman is the editor of The Freeman and "In brief." TGIF appears Fridays. Comments welcome.

A popular academic rationalization for having government forcibly override people's economic decisions is the theory of market failure. Advocates of the free market have long emphasized that the countless self-regarding actions individuals perform daily in the marketplace generate a larger complex spontaneous, or undesigned, order -- that is, a high degree of interpersonal coordination that is remarkably pleasing to consumers. This is the social cooperation Ludwig von Mises placed at the center of his description of the market process.

Critics of the market realize this is a powerfully appealing feature of the economists' case for what these critics deride as the unfettered marketplace. (On the contrary, the free market, when permitted to work, is rather severely fettered by free consumer choice.) So this feature has been among the prime targets of those who would straitjacket or even abolish the market. Hence the attraction of market-failure theory.

The critics counter the coordination argument by claiming that market behavior can lead to less-than-favorable phenomena, such as free-riders (public goods) and prisoner's dilemmas. In theory these have the following characteristic: rational individual behavior brings about an overall result that the individuals themselves dislike. . . To read more, please go to

Market advocates have often pointed out that the market itself  -- if allowed to work -- contains fixes for these alleged failures, but an equally important point has gotten less attention. Accepting the critics' argument for the moment, it is fallacy to assert that any time the market is expected to generate suboptimal results, government should step in. Why is that a fallacy?

Because it assumes that the results of government preemption would be superior to whatever results the market would have produced. But that cannot be assumed. It has to be proved. And it has not been. Market critics have had enough time to bring forth the arguments. Where are they?

Mises and F. A. Hayek left behind a voluminous literature explaining that calculation and knowledge problems assure that government-generated outcomes will be inferior to market-generated outcomes. Israel Kirzner has specifically shown that these problems plague not only full-out central planning, but the regulatory state as well.

David Friedman has elaborated another argument against government inference. "Market failure," Friedman writes, applies to government itself in a more egregious form than it applies to the marketplace. And while the market has built-in corrective features, government does not.

In a December 2005 Liberty magazine article, "Do We Need Government?" Friedman wrote, "In order for government intervention to improve on the market outcome, it is not enough that there is something government could do that would give a better outcome. There must also be a reason to expect government to do it. ...[T]he incentives of the relevant political actors have to be such that it is in their best interest to act in way that result in the improved outcome."

Have we any grounds to assume that those incentives exist? Friedman thinks not. Representative democracy, he says, has a perverse incentive -- a free-rider problem -- right at its core: the voting system. "In order to figure out both what a politician is doing and whether he should be doing it, the voter must spend substantial amounts of time and effort studying the issues and the politician's voting behavior. In doing so, he is producing a public good -- better laws -- for a very large public. He himself collects only a tiny fraction of any benefit. Seen from the other side, he is bearing a large cost for a trivial gain -- an increase of perhaps one chance in a million in the probability that the right politician will get elected."

Thus even a voter who understands some economics and who would favor a reduction in government interference with the market has little incentive to exert much effort. (Bryan Caplan points out that most voters don't understand economics and are blinded by antimarket biases. The "public goods" problem Friedman describes gives them no incentive to examine and discard those biases.)

Friedman generalizes to this conclusion: "[T]here is no reason to expect individual rationality in that [political] market to lead to group rationality. In private markets, most of the time, an individual who makes a decision bears most, although not all, of the resulting costs, and receives most of the resulting benefits. In political markets that is rarely true. So we should expect that the market failure that results from A taking an action most whose costs or benefits are born by B, C, and D should be the exception in the private market, the rule in the political market. It follows that shifting control over human activities from the private market to the political market is likely to increase the problems associated with market failure, not decrease them" (emphasis added). . .

A final note: I'm uneasy with this problem being referred to as "market failure" even when it applies to politics. As Caplan says, we should "drop specious analogies between markets and politics, between shopping and voting."  Markets -- when they are allowed to work -- are based on consent. Politics is based on force. Using the same term -- market -- to describe both is confusing and unnecessary. The sort of failure Friedman discusses obviously is not exclusive to the economy, since it occurs in the political realm also. Thus it is imprecise to call it market failure. Maybe it's simply a social failure. Whatever we call it, let's avoid the qualifier market, for it only prejudices the case and lends an illusion of credibility to the statists' arguments.

To read the entire report, go to 

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

- Ronald Reagan

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5.      Medical Gluttony: Technology Leads to Gluttony Unless Controlled by Physicians

We have medical illiterates who are running for president spewing forth all kinds of illogical health schemes to force Americans into a restrictive, totalitarian, government-controlled health plan that comes with exorbitant costs, are poorly understood, and completely eliminates individual freedom. To turn the 47 million Americans who are frugal with their health care costs into mainstream medical gluttons will more than double the costs. To pay for preventive medicine, which is not cost effective when applied to the masses, will totally bankrupt needed health care. Today we join Professor Michael Wilkes exploring the issue of "If the technology is there, why can't I have it?"

Lung scans work, but treatment is tricky, by Dr. Michael Wilkes, Sac Bee, October 6, 2007

Two years ago, after 24 years of smoking, Mr. R quit his cigarette habit, in part because his kids pressured him and in part because smoking had become expensive and socially complicated.

He's been told that the smoke destroyed part of his lung, and he now has emphysema. Still, he feels pretty healthy, but he's worried about cancer. He tells his doctor that he's heard about a new scan that is good at detecting lung cancer early -- and he wants it.

His doctor is hesitant to order the test, which has left Mr. R feeling frustrated because he doesn't understand why, if a test is available, his doctor won't order it. To read more, please go to

Today in the United States, one-quarter of all cancer deaths are due to lung cancer -- more than the next four common cancers combined. For years, there has been a hope that medical technology (X-rays or saliva studies) might be able to detect lung cancer earlier, before it spreads and while it is still treatable.

Over the years, several excellent studies randomly assigned people to a group that received regular X-rays or to a control group that received only "usual care" based on their symptoms. In both groups, once a cancer was detected, people had surgery to remove it. This involves major chest surgery, where five out of every 100 people die as a result of the surgery and 20 out of every 100 have serious complications.

At the end of these studies, researchers found that X-rays did a very good job of picking up small cancers. These cancers were detected much earlier than if people had simply waited until they developed symptoms.

This might have been the end of the story if our goal was simply to find cancer early. But the ultimate goal of a screening test is not simply to find cancer but rather to prolong people's lives or improve the quality of their lives.

To everyone's surprise, the group with early detection of their lung cancer didn't live any longer than people who had cancer detected only after symptoms appeared. In fact, X-rays detected "lung cancers" in some people who ended up with major surgery, only to be told the "cancer" wasn't really cancer after all (false positive X-ray results). . .

So, along comes a relatively new type of scanner that is proven to detect even smaller lung cancers than traditional X-rays. While some doctors jumped on board and started to use the scan to screen for lung cancer in former smokers, others have appropriately asked: Does the scan really save lives -- particularly since the surgery for these early cancers is so dangerous?

A recent study suggests that these scans do not save lives. Again, it's not that the scan is flawed. A far more likely explanation is that our treatments are primitive and that at the time of detection, the cancer has already spread.

Unfortunately, we can't be certain that the scans are not helpful until larger, better-designed studies are completed -- and this won't happen for few more years.

Until then, it seems far better for Mr. R to wait and not be screened. It seems unnecessary to cause significant worry, perform risky surgery and expend large amounts of money before we know that what we're doing actually saves lives.

A more difficult task is to convince Mr. R that not ordering the test is really in his best interest and might save his life.

Now that medical information is so readily available, it is more important than ever to understand that not all technology is in your benefit. A careful discussion with your doctor is the best way forward.

Michael Wilkes, M.D., is a professor of medicine at the University of California, Davis. Identifying characteristics of patients mentioned in his column are changed to protect their confidentiality. Reach him at

[During my chest residency, we had a patient with a positive sputum cytology (pap smear). He had an abnormal left lung and a normal right lung on x-ray. However, the abnormal cytology was on, what appeared to be, his normal right lung. Since, there was no lesion on the right lung, the surgeons said the left lung contained the cancer, the bronchoscope had sampled the wrong lung, and they were chomping at the bit to take out the abnormal left lung. However, Dr. Robert Green, the Chief of Thoracic Medicine and Professor of Medicine at the University of Michigan School of Medicine, would not allow the surgeons to operate. He followed the patient with sputum pap smears every six months for two additional years, when lo and behold, there developed a lesion in the right lung. This was then removed and the patient cured with a moderate degree of shortness of breath for the rest of his life. Had my Chief acquiesced and allowed the surgeon to remove the abnormal left lung which was free of cancer, the patient would have been short of breath for these two years and when the real cancer appeared, he could not have been cured since he needed the cancerous right lung to live and would have died as it progressed. If this patient would have gotten the operation because it was available, it would have been a death knell two years later when he actually acquired the cancer.  As Dr. Wilkes notes above, it is important to follow the advice of your physician rather than demand a procedure just because it's available.

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6.      Medical Myths: America Has an Underclass of 47 Million Poor Citizens with No Health Care

Grace-Marie Turner of the Galen Institute gives us her experience in Europe and describes their perception of us as uncivilized and barbaric. The Europeans have no concept of our poor having a better health care system than their entire socialized state-run system. Very few of our Medicaid patients have any significant waiting compared to the European, UK and Canadian uncivilized and barbaric waiting periods. The alleged 47 million without health insurance are above the welfare level and most choose not to have insurance because with all the mandates our states impose, it is an increasingly poor use of money. Here is her recent newsletter. At the URL, you can read more about the great work that she does at the Galen.

In Rome last week, I debated Italian politicians on national radio, tried to explain our health system to government and industry leaders, and spoke at a conference at the Vatican about the fundamental values of health care and the common good.

Some take-aways: Europeans truly believe that we have a permanent underclass in the U.S. of 47 million poor citizens who have absolutely no access to health care. They are shocked at how barbaric we are and that any civilized country would tolerate such a thing.

When I tried to explain the facts -- through a translator -- to an Italian senator on RAI radio, he was incensed.

He didn't want to hear that we spend nearly as much as a percentage of our GDP on public programs -- to cover about one-third of our people -- as many European countries spend of their GDPs in total on health care. Or that almost half of our more than $2 trillion in health expenditures are primarily through these public programs that cover the poor, the aged, the disabled, veterans, and lower-income children. Or that many of the uninsured are temporarily without coverage in a system that ties health insurance to the workplace. Or that the uninsured do get care -- albeit in a far from ideal system -- through hospitals, private physicians, community health centers, charity clinics, and other means. Or that Americans value private coverage with its broader access to new technologies and medicines and faster access to surgeries and treatments.

It seemed almost as if he wanted people to believe that there is nothing at all to be learned from Americans so as not to crack the veneer of socialized systems. To read more, please go to

Our favorite free-market Italian think tank, the Istituto Bruno Leoni and its dynamic leaders, Alberto Mingardi and Carlo Stagnaro, arranged the radio interview and a luncheon with government and industry leaders to provide more detail on how the U.S. system works. Hearing the details of our complex network of private and public programs, and that the uninsured cannot be denied care at hospitals, was news to almost everyone there convinced that Michael Moore was right. Here is a copy of my remarks.

The main reason for my trip to Rome was to speak at a conference sponsored by the Acton Institute and the Pontifical Council for Pastoral Health Care at the Pontifical Gregorian University on Health, Technology, and the Common Good.

I said that the common good is achieved by a society in which individuals are responsible beings in a moral society that "embraces the truth about the transcendent origin and destiny of the human person," quoting the Action Institute's important mission statement. This responsibility extends to our families and communities.

The state purports to assume this role in providing for the common good, but interrupts the principle of subsidiarity, i.e., not to usurp the proper functions of the individual, the family, and the doctor-patient relationship.

Pope Benedict XVI wrote in his recent encyclical Deus Caritas Est, "We do not need a State which regulates and controls everything, but a State which, in accordance with the principles of subsidiarity, generously acknowledges and supports initiatives arising from the different social forces and combines spontaneity with closeness to those in need."

In a state-controlled system, individual responsibility in using health care resources most efficiently is replaced by rationing by the state.

Every country's health care system is unique and each has its own challenges in moving to a system that respects and supports the sanctity of the individual. The U.S., while it has many problems that I described, I believe is further along this path in supporting individual freedom and rights over health care decisions and destiny. But all countries have an obligation to look for solutions that move us closer to the goal that advances the common good by respecting the dignity, the freedom, and the sanctity of human life.

I am preparing a written transcript of my remarks and will send you a link in next week's newsletter. Kudos to the Acton Institute, to its president Fr. Robert Sirico, and the Rome and U.S. Acton teams for producing this important conference.

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7.      Overheard in the Medical Staff Lounge: Why Does Medicare Hate Doctors?

Dr. Rosen: Well, what's the latest on all the physicians that moved out of St George Medical Center after the 80 percent rent increase starting in June? Anyone getting paid by Medicare or Medicaid yet?

Dr. Yancy: I moved out last week. It took me four months to decide where I wanted to go. So I've gotten paid until last month when I notified Medicare of a change in address. They want me to fill out a 20-page re-application form as if I was the new man on the block.

Dr. Patricia: I've been out three months and no Medicare payment. But I have largely an HMO and private practice. So I will only experience a 25 percent drop in income. I think I should be able to survive that.

Dr. Sam: I moved out within the first month, giving notice as soon as I made arrangements and gave my 30-day notice in May. So I've been without any Medicare or Medicaid or co-insurance going on five months. I'm seriously considering dropping out of Medicare and Medicaid as soon as this fiasco is over.

To read more, please go to

Dr. Michelle: Aren't you concerned about abandoning your Medicare patients?

Dr. Sam: Certainly. But patients have to wake up to the hostile environment the government creates in Health Care.

Dr. Milton: It should be obvious that if the government is getting this vicious with the physicians who provide the care, can the patients be far behind?

Dr. Rosen: After four months of non-payment, Medicare sent out a surveillance person to see if I really had an office and was practicing medicine.

Dr. Michelle: Now, that really is scary - Medicare cops in our own backyard?

Dr. Dave: I hope this gives more physicians the incentive to kiss off Medicare. Only if a critical mass of physicians leave government programs, will we get Medicare reform or eliminate Medicare and return to efficient low-cost private healthcare.

Dr. Rosen: But do we have effective leadership for Medicare reform? Every time the government does anything, the down side is always a worse program. Just look at Hilary's plan of 14 years ago. The Republicans put most of that fiasco into the HIPAA program. So we just traded one intrusion for another.

Dr. Edwards: You're right. We no longer have an effective counter party to the liberal Statist party. So both parties are enlarging government and destroying the practice of medicine.

Dr. Rosen: And destroying our freedom, the thing that makes our country unique and great.

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8.      Voices of Medicine: A Review of What Physicians Write in Regional Journals

VITAL SIGNS, Official Publication of the Fresno-Madeira Medical Society


Purposeful survival and progress of any medical society depends on the number of members and their involvement in day to day workings of the organization. 

There was time when being a member of a medical society directly benefited the membership. The discount in insurance rates, credentialing of its members and various contracts with insurance companies, all came with the membership. New members were anxious to join the society to reap the immediate rewards. With the evolution of HMOs and emergence of small IPAs, members started getting their own contracts, many times at much unfavorable terms. Physicians are inherently poor businessman since they are devoted to their profession and service to the sick and poor. To read more, please go to

I have spoken to many past members and discussed the benefits of joining our medical society which includes MICRA benefits and legislative support, personal and practice support, getting to know other colleagues and having a say in the ever changing practice of medicine.

These physicians either got upset at a trivial incidence or felt that as long as someone is doing all the work they don't have to spend their time or money. Nearly 100% of the attorneys belong to their associations, but less than 35% of the physicians feel the responsibility to be a member of an organization that relentlessly works to safeguard their interests. We as physicians have already lost a lot to different interest groups and are at the verge of losing more. The MICRA bill which saves us thousands of dollars every year is hanging by a thread (see page 12). Ordinary clerks and nurses dictate their terms when insurance companies are called for authorization of a procedure. I will give a small example of their ignorance. Once I asked for an authorization for repair of a large inguinal hernia. I was asked if I had exhausted all other medical treatment.

If we don't work together we may be facing the following situation:

When they came for the larger medical groups, I didn't care.

When they came for the specialists with high risk practices, I didn't care. 

When they came with the new laws which take away our freedom of practice and limit payments, I didn't care.

When they came for me, I turned around and around and there was nobody left to help me, and I started working for universal healthcare.

To read the entire president's message, go to

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9.      Book Review: Communication Gap By John Toton, MD, Sonoma Medicine, Fall 2007

How Doctors Think, by Jerome Groopman, MD, 320 pages, Houghton Mifflin, $26.

In How Doctors Think, the much-published Dr. Jerome Groopman uses multiple case histories (all of them initially misdiagnosed or mistreated) to highlight the perceived inability of doctors to think and communicate effectively with their patients - an issue of great importance in these times of medical stress and change. Groopman is a reluctant apologist for this issue, and he argues for corrections that he feels are needed. The case histories he presents are a sad journal, particularly since - from his perspective - all were preventable. Groopman also chronicles his own experiences with "aggressive back surgery" and a long effort to diagnose scaphoid-lunate ligament injury as the source of his own chronic wrist pain.

After much patient suffering or risky delays, the cases Groopman describes are almost always resolved by "open communication," including listening, open-ended questioning, systematic thinking, patient activation and engagement in the process, and exclusion of good patient-bad patient prejudices. Only through these methods can the arcane diagnoses of bulimia from celiac disease, dissecting aortic aneurysm, lymphoma, angina in a healthy athlete, immune deficiency in a child, and toxicity from an aspirin overdose in an illiterate patient be diagnosed and successfully treated.

Groopman accepts that we are in a time of rapid change in how we practice the art and science of medicine. The "older" generation, he explains, acquired their skills primarily by the Socratic method of sharing knowledge, questioning and responding, learning from our experience and that of our mentors, and on-the-job honing of these skills. We trust our experience; we learn from our errors. We search for the ONE diagnosis that seems to fit the data and explain the symptoms (Ockham's Razor). We always look for patterns and similarities so we can shortcut to the diagnosis. From there, it's just a short leap to developing "confirmation bias," often based on recent experiences, leading in turn to "diagnostic momentum." As a result, we sometimes give short shrift to atypical symptoms, especially with alcoholic, diabetic, or other stereotypical patients. To read more, please go to

The "younger" generation is in transition, but with much the same burden. They are taught to depend on algorithms, "diagnostic certainty," evidence-based diagnosis and treatment, computerized records and formulas, all available in one nice BOX (PalmPilot or Blackberry). They may be worshiping the science and ignoring the art of medicine.

Today, Groopman comments, all physicians are challenged to see more patients faster, like "checking the passengers in the windows of a train, as you stand watching it speed by, for a one-in-a-thousand diagnosis." Cost controls, managed care, medical economics, and those insurance company algorithms that are used to apply a "standard" to your exceptional case place an even greater responsibility on doctors and patients to think on the same wavelength.

Pharmaceutical and surgical companies, with perks and advertising, attempt to influence doctors' and patients' thinking about the care they need or want. These attempts cause unreasonable demands or expectations that cannot be met but must be responded to. There is no free lunch, and higher premiums and drug prices are the predictable result.

Malpractice risk is always in the background of every doctor-patient interaction, prescription, or treatment. That risk is compounded if there is no mutual understanding of each others thinking, needs, and issues.

Though Groopman seems to have written How Doctors Think for a general audience, it may be more appropriately used as a primer for physicians to focus awareness about problems we have interacting and communicating with our patients. The case histories Groopman presents emphasize this issue. However, since his stories emphasize the emotional side more than the complexities of the diagnostic challenges, I wonder if much of the importance of his discussion is lost in the tragedy of the patient experiences he chronicles. . .

To read the entire review, go to

Dr. Toton is an orthopaedic surgeon in private practice in Healdsburg.

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10.  Hippocrates & His Kin: A Diabetic saved 95% by re-using his lancet-needle against advice.

A patient who paid for his diabetic paraphernalia, glucometer lancets, and testing strips noted that the fancy lancet-needles cost about one dollar each or three dollars a day if he checked his finger stick three times a day as was recommended. That calculates out to more than a thousand dollars a year. He decided to use the alcohol wipes provided to wipe his fingertip to also wipe the needle on his lancet for re-use. He said he changed the needle once a month, just like he did his Gillette Mach Three razor. Thus, he saved more than a thousand dollars a year (365 days x $3 = $1095; 12 months x $1 = $36 per year; $1095 - $36 = $1059 saved). To read more, please go to

Physicians and nurses universally criticized this and stated this was terrible medical practice or the result of lack of government medicine where all the items are free. However, this one item is an extra thousand dollars that premiums have to cover if you expect private health insurance policies to cover, or $1000 in taxes if you want the government to cover it.

Also, this patient did this on his own. He had health insurance, but stated this was his effort to keep health costs under control. Also, he's been doing this for over a year and has not had a single hint of infection in his fingers as a result of reusing single-user needles. Such savings maneuvers will never be found in any treatment or best practice protocol or any algorithm designed by physicians or bureaucrats.

People left to their own ingenuity will save money in mysterious and unconventional ways. Government regulation will eliminate such savings and will always cost more. When we have a national health plan, costs will easily double which means taxes will double and waiting lists will prevent access to care as experienced in Canada, UK, Europe and all socialized countries.

No One Can Pay Late Except The Government.

Wal-Mart is being sued $millions because it did not pay for lunch breaks or a few minutes of extra work here and there. One suit was settled for $500 in damages for each instance of not getting paid within one month.

In Sacramento, many of the doctors moved out of an office building when the rent was increased by 80 percent. Since these doctors haven't been paid by Medicare going on 200 days, why can't they get the same $500 damages for each instance of nonpayment? At 10 Medicare patients a day for 200 days, or 2,000 instances of nonpayment at $500 per instance, wouldn't that fine equal about $1 million in damages if the government treated doctors the same as Wal-Mart employees?

When will doctors understand that the government bureaucrats simply hate us? When will we begin reality thinking and eliminate government healthcare?

Picture Headlines:  A US Airways Boarding Area: Arrivals Bad to Worse

With one in four flights arriving late this year, the government is talking tough. Officials are considering forcing carriers to shrink their flight schedules or pay more to fly during peak travel periods, though the traveling public could end up with higher fares as a result. Why not a non-government mandated solution?

After I experienced four missed flights on America West and then US Airways because of delays with two unscheduled overnight delays, I simply quit flying the airline. If everyone that was inconvenienced did the same, the problem would be resolved in an amicable rather than a hostile and costly manner. Either the airline would get its act together, or it would go out of business. The problem would then be solved. It would not require expensive government interference, lawsuits or higher fares. It would save us all money. 

You have to remember: If you send an attorney, brotherly love goes out of the window, human kindness takes a powder, things get expensive at $300 per hour on each side of the Judge's bench, and the end result is never pleasant and usually worse. It's like sending in a Doberman or a Rottweiler - those guys get vicious.

The freedom to choose allows almost all disagreements to be resolved amicably. Government disagreements and actions always end in hostilities and eliminate brotherly love.

How Can a Community Become a City Without Any Industry or Revenue?

There's been a spate of local communities around Sacramento trying to become cities. Citrus Heights is one of the more recent. Without any industries, a major source of revenue becomes the speed traps allowing citations and multiple arrests. When this wasn't enough, they adjusted their speed limit lower than the cities on either side and they began citing dozens, as documented on a local news program.

To speed up the city-hood incorporation process of other small bedroom communities between Sacramento and Carmichael, cities are making contributions of their taxpayer funds. The Sac BEE reported that Citrus Heights gave $15,000. Using a law based on the prohibition of governmental bodies from making gifts of public funds, action is being brought against this free-for-all of taxpayer dollars being used as bureaucratic gifts.

Taxes Are the Free Spending Bank Accounts for Bureaucrats.

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


•                      The National Center for Policy Analysis, John C Goodman, PhD, President, who along with Gerald L. Musgrave, and Devon M. Herrick wrote Lives at Risk issues a weekly Health Policy Digest, a health summary of the full NCPA daily report. You may log on at and register to receive one or more of these reports. This month, consider reading U.S. CANCER CARE IS NUMBERONE. There is impressive evidence from the largest ever international study of cancer survival rates that shows cancer patients live longer in the United States than anywhere else on the globe, says Betsy McCaughey, a former lieutenant governor of New York and chairman of the Committee to Reduce Infection Deaths (

•                      Pacific Research Institute, ( Sally C Pipes, President and CEO, John R Graham, Director of Health Care Studies, publish a monthly Health Policy Prescription newsletter, which is very timely to our current health care situation. You may subscribe at or access their health page at This month, be sure to read what's new in Texas: Texas Hold 'Em: Doctors Flood Into Lone Star State.

•                      The Mercatus Center at George Mason University ( is a strong advocate for accountability in government. Maurice McTigue, QSO, a Distinguished Visiting Scholar, a former member of Parliament and cabinet minister in New Zealand, is now director of the Mercatus Center's Government Accountability Project. Join the Mercatus Center for Excellence in Government. This month, see another example of government regulation harming our society: Innovation and Corporate Governance: The Impact of Sarbanes-Oxley.

•                      The National Association of Health Underwriters, The NAHU's Vision Statement: Every American will have access to private sector solutions for health, financial and retirement security and the services of insurance professionals. There are numerous important issues listed on the opening page.  Be sure to scan their professional journal, Health Insurance Underwriters (HIU), for articles of importance in the Health Insurance MarketPlace. The HIU magazine, with Jim Hostetler as the executive editor, covers technology, legislation and product news - everything that affects how health insurance professionals do business. Be sure to review the current articles listed on their table of contents at To read my latest column, Can the Health Insurance Industry Survive?, you may go directly to

•                      To read the rest of this column, please go to

•                      The Galen Institute, Grace-Marie Turner President and Founder, has a weekly Health Policy Newsletter sent every Friday to which you may subscribe by logging on at A new study of purchasers of Health Savings Accounts shows that the new health care financing arrangements are appealing to those who previously were shut out of the insurance market, to families, to older Americans, and to workers of all income levels. This month be sure to read, Government micromanagement won't reform health industry at

•                      Greg Scandlen, an expert in Health Savings Accounts (HSAs) has embarked on a new mission: Consumers for Health Care Choices (CHCC). To read the initial series of his newsletter, Consumers Power Reports, go to To join, go to  Be sure to read Prescription for change:  Employers, insurers, providers, and the government have all taken their turn at trying to fix American Health Care. Now it's the Consumers turn at Be sure to read the current newsletter, There are two great movements going on in health care today.

•                      The Heartland Institute,, publishes the Health Care News. Read the late Conrad F Meier on What is Free-Market Health Care? at   You may sign up for their health care email newsletter at

•                      The Foundation for Economic Education,, has been publishing The Freeman - Ideas On Liberty, Freedom's Magazine, for over 50 years, with Richard M Ebeling, PhD, President, and Sheldon Richman as editor. Having bound copies of this running treatise on free-market economics for over 40 years, I still take pleasure in the relevant articles by Leonard Read and others who have devoted their lives to the cause of liberty. I have a patient who has read this journal since it was a mimeographed newsletter fifty years ago. This month, you might savor the article Water Supplies Affected by Ethanol Production [For Fuel] and the accompanying article, Ethanol versus the Poor.

•                      The Council for Affordable Health Insurance,, founded by Greg Scandlen in 1991, where he served as CEO for five years, is an association of insurance companies, actuarial firms, legislative consultants, physicians and insurance agents. Their mission is to develop and promote free-market solutions to America's health-care challenges by enabling a robust and competitive health insurance market that will achieve and maintain access to affordable, high-quality health care for all Americans. "The belief that more medical care means better medical care is deeply entrenched . . . Our study suggests that perhaps a third of medical spending is now devoted to services that don't appear to improve health or the quality of care–and may even make things worse." If you want to ruin your day, you might look at the current upgrade of the 2008 Presidential Candidates on Health Care Reform, which also gives their websites.

•                      The Independence Institute,, is a free-market think-tank in Golden, Colorado, that has a Health Care Policy Center, with Linda Gorman as Director. Be sure to sign up for the monthly Health Care Policy Center Newsletter at Read her latest newsletter, Preventive care gone wild.

•                      Martin Masse, Director of Publications at the Montreal Economic Institute, is the publisher of the webzine: Le Quebecois Libre. Please log on at to review his free-market based articles, some of which will allow you to brush up on your French. You may also register to receive copies of their webzine on a regular basis. This month, read ATLAS & ECONOMICS: CELEBRATING ATLAS SHRUGGED'S 50TH ANNIVERSARY.

•                      The Fraser Institute, an independent public policy organization, focuses on the role competitive markets play in providing for the economic and social well being of all Canadians. Canadians celebrated Tax Freedom Day on June 21 and Quebec on July 11, the date they stopped paying taxes and started working for themselves. Log on at for an overview of the extensive research articles that are available. You may want to go directly to their health research section at Read their philosophy, A free and prosperous world through choice, markets and responsibility.

•                      The Heritage Foundation,, founded in 1973, is a research and educational institute whose mission is to formulate and promote public policies based on the principles of free enterprise, limited government, individual freedom, traditional American values and a strong national defense. The Center for Health Policy Studies supports and does extensive research on health care policy that is readily available at their site. This month, peruse Congress Loads Spending Bills with Pork and Earmarks. To stress your coronaries and carotids, review six pages of pork projects at

•                      The Ludwig von Mises Institute, Lew Rockwell, President, is a rich source of free-market materials, probably the best daily course in economics we've seen. If you read these essays on a daily basis, it would probably be equivalent to taking Economics 11 and 51 in college. Please log on at to obtain the foundation's daily reports. This month, try to understand The Language of Government Decisions. "In the eyes of governments, the private sector is a big buffet table. The enticing cuisine is just sitting there, waiting to be dished out to satisfy the appetites of the rent seekers who reinforce government power." You may also log on to Lew's premier free-market site at to read some of his lectures to medical groups. To learn how state medicine subsidizes illness, see; or to find out why anyone would want to be an MD today, see

•                      CATO. The Cato Institute ( was founded in 1977 by Edward H. Crane, with Charles Koch of Koch Industries. It is a nonprofit public policy research foundation headquartered in Washington, D.C. The Institute is named for Cato's Letters, a series of pamphlets that helped lay the philosophical foundation for the American Revolution. The Mission: The Cato Institute seeks to broaden the parameters of public policy debate to allow consideration of the traditional American principles of limited government, individual liberty, free markets and peace. Ed Crane reminds us that the framers of the Constitution designed to protect our liberty through a system of federalism and divided powers so that most of the governance would be at the state level where abuse of power would be limited by the citizens' ability to choose among 13 (and now 50) different systems of state government. Thus, we could all seek our favorite moral turpitude and live in our comfort zone recognizing our differences and still be proud of our unity as Americans. Michael F. Cannon is the Cato Institute's Director of Health Policy Studies. Read his bio at This month, consider reading Legal Trends in Bioethics.

•                      The Ethan Allen Institute,, is one of some 41 similar but independent state organizations associated with the State Policy Network (SPN). The mission is to put into practice the fundamentals of a free society: individual liberty, private property, competitive free enterprise, limited and frugal government, strong local communities, personal responsibility, and expanded opportunity for human endeavor.

•                      The Free State Project, with a goal of Liberty in Our Lifetime,, is an agreement among 20,000 pro-liberty activists to move to New Hampshire, where they will exert the fullest practical effort toward the creation of a society in which the maximum role of government is the protection of life, liberty, and property. The success of the Project would likely entail reductions in taxation and regulation, reforms at all levels of government to expand individual rights and free markets, and a restoration of constitutional federalism, demonstrating the benefits of liberty to the rest of the nation and the world. [It is indeed a tragedy that the burden of government in the U.S., a freedom society for its first 150 years, is so great that people want to escape to a state solely for the purpose of reducing that oppression. We hope this gives each of us an impetus to restore freedom from government intrusion in our own state.]

•                      The St. Croix Review, a bimonthly journal of ideas, reason and good sense. Discover the most incisive, honest, and informative little journal west of the Hudson at St. Croix recognizes that the world is very dangerous. Conservatives are staunch defenders of the homeland. But as Russell Kirk believed, war time allows the federal government grow at a frightful pace. We expect government to win the wars we engage, and we expect that our borders be guarded. But St Croix feels the impulses of the Administration and Congress are often misguided. The politicians of both parties in Washington overreach so that we see with disgust the explosion of earmarks and perpetually increasing spending on programs that have nothing to do with winning the war. There is too much power given to Washington. Even in war time we have to push for limited government - while giving the government the necessary tools to win the war. This month, be sure to read Angus MacDonald's editorial giving perspective on Global Warming. Also, read Thomas Martin's perspective on Universal Health Care System. ". . . why should any government offer free health care to people who do not care for their own health. . . It makes as much sense to offer a universal dental care system to people who refuse to brush their teeth, or a universal auto insurance system to demolition derby drivers." Subscription may be required.

•                      Hillsdale College, the premier small liberal arts college in southern Michigan with about 1,200 students, was founded in 1844 with the mission of "educating for liberty." It is proud of its principled refusal to accept any federal funds, even in the form of student grants and loans, and of its historic policy of non-discrimination and equal opportunity. The price of freedom is never cheap. While schools throughout the nation are bowing to an unconstitutional federal mandate that schools must adopt a Constitution Day curriculum each September 17th or lose federal funds, Hillsdale students take a semester-long course on the Constitution restoring civics education and developing a civics textbook, a Constitution Reader. You may log on at to register for the annual weeklong von Mises Seminars, held every February, or their famous Shavano Institute. Congratulations to Hillsdale for its national rankings in the USNews College rankings. Changes in the Carnegie classifications, along with Hillsdale's continuing rise to national prominence, prompted the Foundation to move the College from the regional to the national liberal arts college classification. Please log on and register to receive Imprimis, their national speech digest that reaches more than one million readers each month. This month, read The Legacy of the 1936 Election by Amity Shlaes. The last ten years of Imprimis are archived

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Del Meyer

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

 Words of Wisdom

Giving money and power to government is like giving whiskey and car keys to teenage boys. -P.J. O'Rourke.

No man's life, liberty, or property are safe while the legislature is in session. -Mark Twain (1866)

One does not make unnecessary decisions any more than a good surgeon does unnecessary surgery. -Peter Drucker

Some Recent Postings

Can the Health Insurance Industry Survive? By Del Meyer, MD

Consumer-Driven Health Care: An Overview, by Michael S. Fidlow,

In Memoriam

Alex the African Grey, Science's best known parrot died on September 6th, aged 31, Economist, Sep 20th 2007

THE last time Irene Pepperberg saw Alex she said goodnight as usual. "You be good," said Alex. "I love you." "I love you, too." "You'll be in tomorrow?" "Yes, I'll be in tomorrow." But Alex (his name supposedly an acronym of Avian Learning Experiment) died in his cage that night, bringing to an end a life spent learning complex tasks that, it had been originally thought, only primates could master.

In science as in most fields of endeavour, it is important to have the right tool for the job. Early studies of linguistic ability in apes concluded it was virtually non-existent. But researchers had made the elementary error of trying to teach their anthropoid subjects to speak. Chimpanzee vocal cords are simply not up to this - and it was not until someone had the idea of teaching chimps sign language that any progress was made. To read more, please go to

Even then, the researchers remained human-centric. Their assumption was that chimps might be able to understand and use human sign language because they are humanity's nearest living relatives. It took a brilliant insight to turn this human-centricity on its head and look at the capabilities of a species only distantly related to humanity, but which can, nevertheless, speak the words people speak: a parrot.

The insight in question came to Dr Pepperberg, then a 28-year-old theoretical chemist, in 1977. To follow it up, she bought a one-year-old African Grey parrot at random from a pet shop. Thus began one of the best-known double acts in the field of animal-behaviour science.

. . . The question was, was Alex merely parroting Dr Pepperberg? Or would that pejorative term have to be redefined? Do parrots actually understand what they are saying?

 Bird brained

. . . A British researcher called Nicholas Humphrey had proposed that intelligence evolves in response to the social environment rather than the natural one. The more complex the society an animal lives in, the more wits it needs to prosper.

The reason why primates are intelligent, according to Dr Humphrey, is that they generally live in groups. And, just as group living promotes intelligence, so intelligence allows larger groups to function, providing a spur for the evolution of yet more intelligence. If Dr Humphrey is right, only social animals can be intelligent - and so far he has been borne out.

Flocks of, say, starlings or herds of wildebeest do not count as real societies. They are just protective agglomerations in which individuals do not have complex social relations with each other. But parrots such as Alex live in societies in the wild, in the way that monkeys and apes do, and thus Dr Pepperberg reasoned, Alex might have evolved advanced cognitive abilities. Also like primates, parrots live long enough to make the time-consuming process of learning worthwhile. Combined with his ability to speak (or at least "vocalise") words, Alex looked a promising experimental subject. . . To read the entire obituary, please go to


On This Date in History - October 9

On this date in 1701, the Collegiate School of Connecticut was chartered. The name was later changed to Yale University.

After Leonard and Thelma Spinrad