Community For Better Health Care

Vol V, No 12, Sept 26, 2006


In This Issue:


1.      Featured Article: Back from the Dead By Gary Greenberg, Wired Magazine, Sept 2006

A small but passionate group of doctors say that electricity applied deep in the brain can jolt patients out of irreversible comas. That's when the real problems begin.

For someone left for dead 12 years ago, Candice Ivey seems to be doing pretty well. She's still got her homecoming queen looks and A-student smarts. She has earned a college degree and holds a job as a recreational therapist in a retirement community. She has, however, lost her ballerina grace and now walks a bit like her feet are asleep. She slurs her words a little, too, which sometimes leads to trouble. "One time I got pulled over," she says in her North Carolina twang. "The cop looked at me and said, 'What have you been drinking?' I said, 'Nothing.' He said, 'Get out here and walk the line.' I was staggering all over the place. He said, 'All right, blow into this.' Of course I blew a zero, and he had to let me go."

In November 1994, when Ivey was 17, a log truck T-boned her Chevy Blazer. She remembers nothing of the next two months. But it's all seared into the memory of her mother, Elaine, especially the part where the doctors told her that Candice, who was in a coma and breathing by respirator, should be pronounced dead. Her brain, they said, was entirely and irreversibly destroyed by a week of swelling and bleeding and being pushed up against the inside of her skull like a ship scuttled on a reef.

A few days later, however, Candice proved the doctors wrong. Unhooked from the respirator, she continued to breathe on her own - something she couldn't have done if she were truly brain-dead. Now Elaine faced the horrible decision of whether or not to feed her child. The doctors warned her that Candice would probably never wake up, and if she did, she almost certainly would be unable to live independently. In the worst case, she would enter the permanent twilight known as a persistent vegetative state, in which she might sleep and wake and move her limbs, yawn and sneeze and utter sounds, but not in a way that was purposeful. Elaine decided to keep the feeding tube in place, which, she recalls, made the neurosurgeon furious. "He thought I was just prolonging her agony and that I would have a vegetable on my hands," she says. "But when it's your child lying there, you'll do anything."

In this case, anything included letting an orthopedic surgeon named Edwin Cooper try an experimental treatment. He approached Elaine out of the blue soon after the accident and urged her to let him put an electrified cuff on Candice's wrist. It sent a 20-milliampere charge - enough to make her hand clench and her arm tremble a little - into her median nerve, a major pathway to the brain. It might rouse her from her coma, he said.

"I thought it was hokey, if you want to know the truth," Elaine says. She agreed nonetheless - she was, she says, "drunk as a coot" from a combination of "nerve pills and a full glass of whisky" - and the cuff went on. Within a week, Elaine was sure that Candice was stirring. Her doctors doubted it. "They kept telling me it was just reflexes, but a momma knows." Then, just before New Year's Day, a month after the accident, Cooper asked Candice how many little pigs there were. She held up three fingers.

Now 29, Candice Ivey is thrilled to see the 64-year-old Cooper when he shows up at her door. She gives him a big, warm hug and sits close to him on the couch. They chat about the presentation on traumatic brain injury that she recently gave to nurses at Cooper's hospital, and how hearing the story of her ordeal again brought him to tears. As she tells me of her injury and its aftermath, she comes back time and again to her gratitude. "The wreck was my fault," she says. "But getting better, that was God's doing. He sent Dr. Cooper to my momma, didn't he?"

Edwin Cooper has been sent, or has sent himself, to about 60 severely brain-injured people since the mid-1980s, when he first made the accidental discovery that electrical stimulation had effects on arousal. He was using a neuro-stimulator to relieve spasticity in the limbs of microcephalics, people with abnormally small skulls who often have reduced mental capacity and poor muscle control. During the treatment, he recalls, one patient started looking around his room and smiling when people walked in, instead of staring blankly. Cooper had already observed that when he placed the stimulator on one arm of a quadriplegic patient to strengthen the muscles there, the opposite arm also got stronger. He concluded that the electricity was making its way to the brain, crossing to the opposite hemisphere, and stimulating arousal centers in the process. He began to wonder about the effect this might have on unconscious people. "I thought, if someone were normal and able-bodied but in a coma, maybe this would make a difference, maybe help wake them up," Cooper says. "It was like maybe we could reboot the brain."

Cooper started testing this hypothesis in 1993. Candice Ivey was one of his first research subjects, and her recovery remains the most spectacular. But Cooper has gathered data on 37 other patients in two studies (at the University of Virginia and East Carolina University). The results indicate that people given electrical stimulation emerge from comas sooner and then regain function more quickly than if they are given only traditional treatment. They're more likely to leave the hospital under their own steam, with less-severe disabilities than would be predicted by the nature and extent of their injuries. . .

To read the rest of the article, please go to

Gary Greenberg ( is a Connecticut-based writer and psychotherapist.         

* * * * *

2.      In the News: Welcome to Club Fed, WSJ, August 15, 2006

The closest thing to a lifetime sinecure in America is a federal government job, and now it turns out that it's also a very lucrative way to make a living.

New data from the U.S. Bureau of Economic Analysis confirm that the average federal civilian worker earns $106,579 a year in total compensation, or twice the $53,289 in wages and benefits for the typical private worker. This federal pay premium costs taxpayers big bucks because Uncle Sam's annual payroll is now $200 billion a year. No wonder that, with a per capita income of $46,782 a year, Washington, D.C. is the fourth richest among the nation's 360 metropolitan areas.

And this pay disparity keeps widening. The Cato Institute's Chris Edwards tracks government compensation, and he finds that in 1950 the average federal bureaucrat received $1.19 for every dollar that a private employee earned. By 1990 that ratio had risen to $1.51 and is now $2. In 2005 federal wages rose 5.8% compared to 3.3% in the private sector.

Since 2000 only one major industry, the booming oil and gas sector, has kept pace with the automatic pay increases for employees of "Club Fed." Federal pay has risen by 38%, double the 15% pay increase in private pay from 2000-2005. This is roughly double the rate for private workers in manufacturing, retail, finance, health care and construction.

 [Good Work If You Can Get It]It's true that many federal employees are in white collar occupations that often command high pay, but studies find that public sector workers enjoy a 20-30% pay bonus above comparably skilled private workers. And this differential does not account for one of the biggest benefits of a government job: civil service rules giving virtual lifetime job security. Airline mechanics, auto workers and software designers must all worry about business-cycle downturns or changes in technology or outsourcing, but Uncle Sam's 1.8 million civilian employees live in a recession-proof bubble.

As for performance, Mr. Edwards reports that only one in 5,000 federal non-defense employees is fired for cause each year. One federal manager recently told us of an administrative assistant who missed work "about half the time" thanks to an assortment of ailments, sick children and funerals for a mother who died on three separate occasions. When the agency heads finally fired her, they were slapped with an anti-discrimination lawsuit and the half-time worker pulling down a full-time salary was reinstated. . . To read the entire article, please go to

For an alternate point of view, go to

Club California: Bosses could get big raises. Governor says law's only beneficiary may be the prisons chief. Sacramento Bee, September 14, 2006.

Gov. Arnold Schwarzenegger signed a bill Wednesday that includes a provision added in the waning days of the legislative session allowing his administration to nearly double the pay of 50 top state bosses.

Under Assembly Bill 2936, the workers -- mostly heads of agencies and departments -- could get as much as 125 percent of the governor's salary, although the governor says he intends to extend the raise to only one or two officials.

Schwarzenegger doesn't take his pay. But in 2007, the salary assigned to his office is scheduled to increase to $206,500. That would mean the top administrators would qualify for as much as $258,125. Under current law, the salaries of the top supervisors are set in state law and top out at about 138,000. . .

To read more about purchasing votes and the rape of the public till, please go to"bosses%20could%20get%20big%20raises")&p_perpage=10&p_sort=YMD_date:D&xcal_useweights=no.

* * * * *

3.      International Medicine: Labour's Drive for Choice and Compensation in the NHS Is Opposed by BMA. What a Switch: Labor for Competition and Doctors for Socialized Medicine.

Privatisation by stealth is bad for your health, James Johnson, head of the BMA, says the reforms don't work.

I have been a doctor for over 36 years. As a vascular surgeon in Cheshire I see patients from a wide variety of backgrounds, and for me one of the finest aspects of our NHS is that patients are referred to me regardless of their financial status.

Of course the NHS has changed tremendously since I qualified and many of those changes are for the better. With the help of new medical technologies, powerful drugs and new surgical techniques, people are living longer and their expectations from doctors have never been higher.

I doubt that Aneurin Bevan would recognise today's health service: it is a huge, monolithic body that employs more than 1m people and on average about 48m patients have contact with the NHS every year. The government has invested unprecedented funds in the NHS and some parts of the service are getting better. Waiting lists are a good example and - it is important to say so - it is not all doom and gloom.

However, all over the country, doctors are seriously worried about where the NHS is going. This was very clear last week at the British Medical Association's annual meeting in Belfast. Feelings ran very high and clinicians including GPs, junior doctors and consultants are demanding that healthcare should be delivered by providers that are accountable to patients, not shareholders.

News emerged on Friday that the government had been quietly encouraging tenders from the private sector for a wide range of roles in the management and support of primary care trusts: I am concerned that it only seems to be a short step to move from there to clinical services.

The NHS is struggling to manage deficits. Many healthcare professionals are losing their jobs and even some doctors face the risk of redundancy. Given that the UK is critically short of doctors, this does not make any sense.

Last week in Belfast many of my colleagues spoke of their worries regarding cancelled clinics, empty operating theatres and patient referrals diverted to referral management centres.

These centres really worry me. When a GP refers a patient to a certain consultant now, a bureaucrat at a management centre - often not even a trained doctor - reviews the case and has the power to redirect the patient to another consultant's list. This is ostensibly to make sure patients go to specialists with shorter waiting lists.

But the GP may have chosen a particular consultant for a good reason. Nobody should be able to second-guess the GP. . . .

No wonder the clinical workforce is up in arms. The BMA is a broad church with doctors from every part of the political spectrum and widely differing views on what to do to save the NHS. What unites us is the will and determination to keep the NHS comprehensive and free to patients, ethically rationed by clinical priority, equitably resourced and funded out of general taxation.

These fundamental values cannot be maintained if the NHS is broken up and tendered to private corporations. This is my vision for the NHS and I'm worried the government is taking us away from that.

The government's favoured method of raising quality and keeping prices down is to do what they do in supermarkets and offer choice and competition. There is no doubt it works in supermarkets - plenty of choice, good quality and low prices. But will it work in a health service where more "customers" - we doctors are old- fashioned enough to call them patients - do not mean more profit but more cost. . . .

The very last thing the UK should do is go for the American model of healthcare. . . .

My plea to government - one I shall make very clearly at the health summit - is to involve doctors in decisions at all levels. Many doctors are natural innovators but have become distanced from the running of the health service. I believe the only way to stop the rot is by clinicians becoming involved in every aspect of managing, running and shaping the NHS.

To read the entire article, please go to,,2092-2252273_1,00.html.

James Johnson is chairman of the British Medical Association

Since Kaiser Permanente already has clinicians involved in every aspect of managing, running, and shaping KP, they should have no problem in running the NHS.

* * * * *

4.      Medicare: Free Health Care Is A Fatal Notion, by Amy Ridenour, NCPA

Although national health care may be the Holy Grail of American liberalism, Amy Ridenour of the National Center for Public Policy Research sees this model more as a poisoned chalice.

It would be bad enough if national health care merely offered patients low-quality treatment. Even worse, Ridenour finds, it kills them:

  • Breast cancer is fatal to 25 percent of its American victims; in Great Britain and New Zealand, both socialized-medicine havens, breast cancer kills 46 percent of women it strikes.
  • Prostate cancer proves fatal to 19 percent of its American sufferers; in single-payer Canada, this ailment kills 25 percent of such men and eradicates 57 percent of their British counterparts.
  • After major surgery, a 2003 British study found, 2.5 percent of American patients died in the hospital versus nearly 10 percent of similar Britons; seriously ill U.S. hospital patients die at one-seventh the pace of those in the United Kingdom.

In addition, medicrats often distribute resources based on politics rather than science, leaving a disorganized and inefficient system for many patients, says Ridenour:

  • In usual circumstances, people over age 75 should not be accepted for treatment of end-state renal failure, according to New Zealand's official guidelines, unfortunately government controls kidney dialysis.
  • According to a Populus survey, 98 percent of Britons want to reduce the time between diagnosis and treatment.

For all its problems, says Ridenour, the United States' more market-friendly health system offers patients better care and would deliver greater advancements if government adopted liability reform, interstate medical insurance sales, unhindered health savings accounts and other pro-market improvements, says columnist Deroy Murdock.

Source: Deroy Murdock, "Free health care is a fatal notion,", August 28, 2006

For text:

For more on Health Issues:

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

- Ronald Reagan

 * * * * *

5.      Medical Gluttony: Maybe if We Just Repeated Everything, the Answers Would Appear.

This week, I saw a cardiac patient who had an emergency coronary artery bypass as he was returning from an overseas tour. When he got back, he developed a wound infection and they had to reopen his chest to debride the wound. He had lost 20 pounds in the process with his weight having gone from 185 to 165. He was trying to recover ten pounds by eating more, doing exercise, and playing golf. He was trying to find out what was keeping him so light.  He also had back pain and thought this might somehow be the result of some malignancy.

I pointed out that his current weight calculated to a body mass index (BMI) of 24, which is at the upper limits of normal. (Looking at the appropriate weight for each height produces a body mass index. A BMI of 19-24 is normal, 25-29 is overweight, 30-34 is obesity, 35-39 is marked obesity and over 40 is morbid obesity. To calculate your BMI, go to

Our examination included a careful check on possible lymph nodes, liver enlargement, abdominal masses, prostate nodules, stool check on the rectal glove which was negative. (President Reagan's colon cancer was found on his prostate examination when the stool on the doctor's exam glove was positive for blood. Hence, the double importance of men over 55 having prostate and stool hematest checks yearly.) All were negative.

We reviewed his medical record and found an unbelievable number of laboratory tests and x-rays. He wanted more MRIs and CT exams. He had a number of both, all of which were negative for any abnormal masses. He wanted them repeated. These were all current within the last three months. He wanted more blood panels. He had every conceivable panel and these were all recent. The liver tests were slightly abnormal but not in the hepatitis ranges. He was borderline anemic, but only 0.5 gm% down. His iron level was normal. I told him that his weight was really high normal, that these few abnormal tests could be repeated in another three months, or six months after the current sampling, and he should to try to adjust to his new ideal body weight.

When he left, I don't think he was a happy man. There was easily more than $10,000 worth of testing done in the past three months. His insurance took care of 100 percent. An extra $10,000 would have added nothing to his health or allayed his anxieties.

What are the answers? If this patient went to formal review, the administrative review may have felt sorry for him and allowed the expensive repeating of testing. However, there would have been no medical basis for his decision. The best control of medical costs is having the physician in charge. However, the patient must be at some financial risks to want to listen to the physician. This patient responsibility coupled with the physician's guidance reduces health care costs consistent with the highest level of medical care. It cannot be duplicated by any reviewing agency or administrative oversight. Eliminating the reviewing agencies and administrative oversight will save $ billions.

* * * * *

6.      Medical Myths: Government has real role in providing health care solutions for residents

Socialized bogeyman, Editorial, Sacramento Bee, September 10, 2006

Careful, Gov. Arnold Schwarzenegger. Your ghostwriter seems to have just made you an opponent of Medicare.

The opinion piece in question was designed to detail your reasons for vetoing Senate Bill 840 by Sheila Kuehl, D-Santa Monica. SB 840 would have revolutionized the state's health care system. Private insurers would have gone out of business. The state would have started paying directly for the health care of millions of Californians.

"I cannot support a government-run health care system," you wrote (or, more accurately, someone wrote for you).

Hmm. So what exactly is Medicare? Or, more important, what are Republicans and Democrats really fighting about when it comes to providing affordable health care to more Californians, and how can anyone find the elusive political compromise?

SB 840 sought to create one payer of health care -- the state -- for residents of California. That would be the so-called "single-payer" solution to our health care ills. The very term "single payer" tends to create political divides. And along those divides, the very real role of government in health care gets misunderstood.

"Socialized medicine is not the solution to our state's health care problems," wrote Schwarzenegger in vetoing SB 840. Actually, socialized medicine is as American as apple pie. No greater example is Medicare.

Medicare is essentially a single-payer form of health care. One payer -- the federal government -- provides the bulk of the funds to hospitals and doctors for the necessary care of millions of senior citizens. . .

Our problem with SB 840 was how the Democrats dangled it as veto bait from the get-go. No quest for common ground ever appeared evident, either by Democrats or Schwarzenegger. It was all about Democrats embracing government as the solution and Republicans denouncing it. In vetoing SB 840, Schwarzenegger followed the script.

Real progress in lowering health care costs and insuring more Californians will take a far more serious effort than the theater surrounding SB 840. It will start with the recognition that government is not the bad guy, and that government has an indispensable role in any solution.

[In an adjacent article, the author says it's time to choose between Medicare and Missiles. If we forgo missles to defend ourselves, when we are taken over, there won't be any Medicare. Yes, the choice between Medicare and Missles is really a no-brainer. We have to thank the editors at Sac Bee for putting government programs in such a focused perspective.]

Government has not provided any real health care solutions with either Medicare or Medicaid.

Disaster is looming in both programs. In fact, they are on life support.

* * * * *

7.      Overheard in the Medical Staff Lounge: Reading the Comics-- my Immense Ego

Joe: I need a job where my immense Ego seems normal. I've decided to be a doctor. I will determine who lives and who dies.

How many terminal diseases do you think you'll treat in a medical career?

Joe: Who said anything about terminal? I will find a way to make any disease terminal. I'm going to write a book, "How to legally commit homicide and make it look like medically assisted suicide."

What if a guy comes in with just mild hypertension?

Joe: I will devise the lethal combination of antihypertensive drugs that the patient is already taking that will make him glide off into Somaliland and he won't even know what's going on. And his heirs will be very happy. (After Dilbert, Feb 4, 2006)


Dr Rosen: Have you heard that Newsweek Magazine states that preventative health care is expected to grow from $300 billion to $1 trillion in just a decade?

Dr Michelle: How will people be able to afford that? We'll have to make preventive medicine a covered health insurance benefit.

Dr Rosen: You've got to be kidding. That will double insurance costs and make preventive medicine unaffordable.

Dr Michelle: Only the government will be able to regulate and reduce the costs of preventive care.

Dr Rosen: Every regulation and control that government has implemented since the advent of Medicare in 1965, has just skyrocketed the cost unnecessarily. It has done more to put the cost of health care out of reach than physicians, hospitals, and high tech combined. It's time to get government out of health care.

Dr Michelle: I can't believe you Rosen. Are you saying that Medicare isn't the best thing that has ever happened for sick and old people?

Dr Rosen: Sick people are now paying more than half of their heath care costs, which is more than the 100 percent they were paying in 1965. So without Medicare, sick seniors wouldn't be paying any more and be in control of their health care including quality of care.

Dr Michelle: Rosen, you make me sick. I think I'll wander across the street to my office and see sick patients before I really get ill.

* * * * *

8.      Voices of Medicine: What Are Doctors Writing About?

Richard B Warner, MD, President of the Kansas Medical Society, Inaugural Address

. . .  Let me share with you another little piece of my education that has a bearing on all this planning. While I was a medical student, I took an unusual opportunity to see the world by participating in the KU – University of the Philippines exchange program. This program was originally negotiated by Dr. Wescoe, (a Physician, Pharmacologist, Dean of the KU School of Medicine, and then Chancellor of the University of Kansas) and for fifteen years it sent three students a year each way to study abroad. I did my second year of medical school at the University of the Philippines in Manila. IN the course of the year, I was able to trade my microscope for a camera and travel around the world.

One of the most intriguing places I visited that year was Hong Kong. It was the most vibrant place I have ever been. At the time I was not aware of the economic basis of what I was seeing, but it was obvious that huge numbers of refugees from Communist China were being absorbed into Hong Kong and people were prospering. The population of Hong Kong expanded from half a million people after World War II to ten times that number in the next half century. The fascinating thing is, in 1970 the standard of living in Hong Kong was about one fourth that of its colonial power, Great Britain. Thirty-six years later it surppassed Britain by a least a third. In 1969 I was unaware that the policies that allowed this tremendous growth were maintained by the Financial Secretary of Hong Kong, Sir John Cowperthwaite, who died just this past January.

While the rest of the British Commonwealth was pursuing socialism and welfare statism, Sir John Cowperthwaite was a steadfast practitioner of laissez faire capitalism.  He said that his job was getting the government to do the hardest thing - nothing. He maintained that "In the long run, the aggregate of decisions of individual business men, exercising individual judgment in a free economy, even if often mistaken is less likely to do harm that the centralized decisions of a government, and certainly the harm is likely to be counteracted faster." Cowperthwaite forbade the collection of more than the most rudimentary statistics, arguing that statistics only gave government planners more ammunition for their own plans. Once an interviewer asked him why he didn't allow the collection of statistics, and Sir John replied, "Just as sure as I do, some genius will think he knows what it all means."

(We will be discussing with Dr Warner options to obtain the rest of his speech, which has not been posted on the web site.)

* * * * *

9.      Book Review: Freakonomics, by Steven Levitt, Reviewed by Gerry Smedinghoff

In 1965, after several years of steadily increasing auto fatalities, Ralph Nader declared that the automobile was the scourge of the country and must be disciplined. Yet, in the two decades from 1925 to 1945, the auto fatality rate (measured in deaths per mile traveled) had dropped by 50 percent. And in the next 20 years from 1945 to 1965 - when his landmark book Unsafe at Any Speed was published - the auto fatality rate was reduced by another 50 percent. But instead of praising the auto industry for its unprecedented and phenomenal safety record, in the absence of government regulation, he chose to accuse it of criminal negligence.

Nader may have known numbers, but he was completely ignorant of statistics. What he didn't know was that while auto fatalities were increasing at an alarming rate, Americans were buying cars and driving at an even more alarming rate. In other words, he never adjusted the fatality data for exposures. But while actuaries and statisticians may have ignored or even mocked his buffoonery, Nader became famous and built a legacy, laughing all the way to the bank.

The mass media may now be in the process of anointing a new Ralph Nader, a University of Chicago

economics professor named Steven Levitt, co-author of the new book Freakonomics: A Rogue Economist Explores the Hidden Side of Everything. A more accurate subtitle would be, "A Rogue Economist Asks the Right Questions but Gets the Wrong Answers."


In spite of the book's problems, Levitt's work and methodology are a huge improvement on Nader's hatchet job of the auto industry.  This is why Milton Friedman cites John Maynard Keynes as one of the most important economists of the 20th century:

Because brave pioneers must be allowed to get everything wrong, before more knowledgeable successors can get things right. Thus the benefit of this book is not what Levitt says but how he teaches his readers to think.

Levitt's primary fault is that he appears to pose his questions only to himself, where a little peer review and insider expertise would have saved him the trouble of writing much of the book and saved readers from being misled by it. Levitt just can't help but believe that the first possible explanation that comes to his mind to explain two correlating variables must be correct.  His secondary fault is that he fearlessly dives into the most treacherous of academic exercises, employing the discipline of economics to explain everyday phenomena that don't appear to make sense, without realizing just how difficult and frustrating this task can be. Which is another way of saying that most economists find it difficult to do much better.  But to Levitt's credit, he does expose several popular media myths with robust statistical data. . .

To read the entire review, go to

Gerry Smedinghoff is the director of actuarial services for TriWest Healthcare Alliance in Phoenix. He is a frequent speaker on actuarial and economic issues, and his writings have appeared in the Washington Post, Las Vegas Review-Journal, Skydiving, Vital Speeches of the Day, Contingencies, and Society of Actuaries publications.

* * * * *

10.  Hippocrates & His Kin: Bureaucratic Doctors are Interested in Power, not Patients

Dr James Johnson, President of BMA: The very last thing the UK should do is go for the American model of healthcare.

Bureaucratic doctors would lose all their power if they didn't have a 12-month waiting list to manipulate.

Today's health service: it is a huge, monolithic body that employs more than 1m people and on average about 48m patients have contact with the NHS every year.

Are these 48m physician visits or 48m patients in contact to get on a waiting list requiring follow-up contacts to see how they're progressing along that list?

Dr James Johnson: In my vision for the NHS, there needs to be more focus on emergency care and the improvement of long-term conditions.

With one million employees of the NHS, I'm sure there must be at least one million visions as to what's wrong - just like any other government program.

Old doctors never die, they just lose their patience. Sometimes they also lose their patients.

* * * * *

11.  Physicians Restoring Accountability in Medical Practice, Government and Society:


•                      John and Alieta Eck, MDs, for their first-century solution to twenty-first century needs. With 46 million people in this country uninsured, we need an innovative solution apart from the place of employment and apart from the government. To read the rest of the story, go to and check out their history, mission statement, newsletter, and a host of other information. For their article, "Are you really insured?," go to For the latest on their Antigua Project, please go to . You may be interested in a Medical Timeshare in a resort.


•                      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.  If I can do it, caring for the uninsured in a small rural town, any doctor can.

•                      PRIVATE NEUROLOGY is a Third-Party-Free Practice in Derby, NY with Larry Huntoon, MD, PhD, FANN. Dr Huntoon does not allow any HMO or government interference in your medical care. "Since I am not forced to use CPT codes and ICD-9 codes (coding numbers required on claim forms) in our practice, I have been able to keep our fee structure very simple." I have no interest in "playing games" so as to "run up the bill." My goal is to provide competent, compassionate, ethical care at a price that patients can afford. I also believe in an honest day's pay for an honest day's work.  Please Note that PAYMENT IS EXPECTED AT THE TIME OF SERVICE.   Private Neurology also guarantees that medical records in our office are kept totally private and confidential - in accordance with the Oath of Hippocrates. Since I am a non-covered entity under HIPAA, your medical records are safe from the increased risk of disclosure under HIPAA law.

•                      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.

•                      Dr. Nimish Gosrani has set up a blend between concierge medicine and a cash-only practice. "Patients can pay $600 a year, plus $10 per visit, to see him as many times in a year as they want. He offers a financing plan through a financing company for those unable to plop down $600 all at once." Patients may also see him on a simple fee-for-service basis, with fees ranging from $70 for a simple office visit to $300 for a comprehensive physical. Dr. Gosrani reports that he saves two hours per day that he used to spend dealing with insurance company paperwork. To read more, go to

·                     Dr. Elizabeth Vaughan is another Greensboro physician who has developed some fame for not accepting any insurance payments, including Medicare and Medicaid. She simply charges by the hour like other professionals do. Dr. Vaughan's web site is at, where you can see her march in a miniskirt for Breast Health without a Bra.

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

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

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

•                      Semmelweis Society International, Verner S. Waite MD, FACS, Founder; Henry Butler MD, FACS, President; Ralph Bard MD, JD, Vice President; W. Hinnant MD, JD, Secretary-Treasurer; is named after Ignaz Philipp Semmelweis, MD (1818-1865), an obstetrician who has been hailed as the savior of mothers. He noted maternal mortality of 25-30 percent in the obstetrical clinic in Vienna. He also noted that the first division of the clinic run by medical students had a death rate 2-3 times as high as the second division run by midwives. He also noticed that medical students came from the dissecting room to the maternity ward. He ordered the students to wash their hands in a solution of chlorinated lime before each examination. The maternal mortality dropped, and by 1848 no women died in childbirth in his division. He lost his appointment the following year and was unable to obtain a teaching appointment Although ahead of his peers, he was not accepted by them. When Dr Verner Waite received similar treatment from a hospital, he organized the Semmelweis Society with his own funds using Dr Semmelweis as a model: To read the article he wrote at my request for Sacramento Medicine when I was editor in 1994, see To see Attorney Sharon Kime's response, as well as the California Medical Board response, see Scroll down to read some very interesting letters to the editor from the Medical Board of California, from a member of the MBC, and from Deane Hillsman, MD.

To view some horror stories of atrocities against physicians and how organized medicine still treats this problem, please go to

•                      Dennis Gabos, MD, President of the Society for the Education of Physicians and Patients (SEPP), is making efforts in Protecting, Preserving, and Promoting the Rights, Freedoms and Responsibilities of Patients and Health Care Professionals. For more information, go to

•                     Robert J Cihak, MD, former president of the AAPS, and Michael Arnold Glueck, M.D, write an informative Medicine Men column at NewsMax. Please log on to review the last five weeks' topics or click on archives to see the last two years' topics at This week's column is A Lawyer by Any Other Name . . . 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 or go directly to it at and read about Privacy breaches reported by nearly half of federal contractors. The "AAPS News," written by Jane Orient, MD, and archived on this site, provides valuable information on a monthly basis. Read the latest newsletters at Scroll further to the official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. Or go directly to the journal at There are a number of important articles that can be accessed from the Table of Contents page of the current issue. Don't miss the excellent article on Sham Peer Review or the extensive book review section including Malignant Medical Myths at

•                      The 63rd Annual Meeting of the AAPS, in Phoenix, AZ, September 13-16, was a huge success. To read this press release, go to 


"It's NOT about the money."

            Bookmark, as your gateway to a vast amount of important information. 


* * * * *

Thank you for joining the MedicalTuesday.Network and Have Your Friends Do the Same. If you receive this as an invitation, please go to and enter you email address and join the 20,000 members who receive this newsletter. If you are one of the 50,000 guests that surf our web sites, we thank you and invite you to join the email network on a regular basis by subscribing at the website above. 

Please note that sections 1-4, 8-9 are entirely attributable quotes and editorial comments are in brackets. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.

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

Spammator Note: MedicalTuesday uses many standard medical terms considered forbidden by many spammators. We are not always able to avoid appropriate medical terminology in the abbreviated edition sent by e-newsletter. (The Web Edition is always complete.) As readers use new spammators with an increasing rejection rate, we are not always able to navigate around these palace guards. If you miss some editions of MedicalTuesday, you may want to check your spammator settings and make appropriate adjustments. To assure uninterrupted delivery, subscribe directly from the website rather than personal communication:

Del Meyer  

Del Meyer, MD, Editor & Founder

6620 Coyle Avenue, Ste 122, Carmichael, CA 95608

Words of Wisdom

Thomas Sowell:  If you had asked me whether singing "Sweet Georgia Brown" in Polish would be funny, I would have said "NO." But, when Mel Brooks and Anne Bancroft sang it as a duet in Polish, I laughed so hard that my sides literally hurt.  Most of us - if not all of us - are grossly incompetent at other people's jobs. That is why it is so dangerous to have politicians telling doctors, farmers, bankers, entrepreneurs and others what to do.

Leo Tolstoy: From the day when the first members of council placed exterior authority higher than interior, that is to say, recognized the decisions of men united in councils as more important and more sacred than reason and conscience; on that day began lies that caused the loss of millions of human beings and which continue their unhappy work to the present day.

Stand Up for what is Right, Even if you're Standing Alone.

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

Some Recent Postings

July HPUSA Issue:

April HPUSA Issue:

January HPUSA Issue:

In Memoriam

One of our loyal subscribers, a decagenarian, who had problems with email, would frequently write saying, "I'm an old man and I missed the current issue of MedicalTuesday. Please send it."  We always did and helped him get his email address corrected with the dots in the right place. He died last week at age 98.

Doctor doubled as care pioneer. By Robert D. Dαvila - Bee Staff Writer, Saturday, September 16, 2006

Dr. Ralph C. Teall, a longtime Sacramento physician who struggled to start a practice during the Great Depression and became an influential leader in state and national medical organizations, died Thursday. He was 98. . .

Dr. Teall was active in professional issues while practicing family medicine for almost four decades. He opened his first office in a small space near Sutter's Fort in 1935 with money he scraped together by working as a doctor in a Grass Valley conservation camp and at an emergency hospital next to the Sacramento police station.

He served as president of the Sacramento Medical Society in 1949 and was elected president of the California Medical Association in 1965 after working on the first schedule of "usual, customary or reasonable" fees. His efforts helped established uniformity among doctors for costs of medical services. . .

Dr. Teall also was a compelling public speaker with a booming voice, keen grasp of policy issues and persuasive arguments, colleagues said. He became vice president of the American Medical Association in 1971 and remained active in professional activities long after retiring from his medical practice in 1973.

A caring doctor and jovial colleague, he was widely respected for his dedication to professional issues and his willingness to mentor new doctors.

Dr. Teall was born in 1907 in the Los Angeles suburb of Gardena. He had a paper route, worked in a grocery store and did other jobs while growing up in a religious family that valued helping others, his daughter said.

He continued working to put himself through medical school at the University of California, San Francisco, where he graduated in 1932. He interned in Oakland and worked as a resident at Sutter Hospital in Sacramento before starting a surgical fellowship at the Mayo Clinic in Minnesota . . .

He returned to Sacramento to practice family medicine, often taking his children on house calls. He also worked as a medical adviser for insurance companies and medical director of the Easter Seal Society. He left during World War II to be a flight surgeon in the Army Air Force, serving in the Pacific and flying on two bombing raids over Tokyo.

In a 1993 interview with Sacramento Medicine, Dr. Teall reminisced about changes in Sacramento and the medical profession during his career, including the start of Medi-Cal and fee schedules. For many years, he said, most doctors worked in a medical arts building on L Street across from Capitol Park. Meanwhile, the hospital next to the police station drew swarms of reporters looking for a good story, including a young Herb Caen.

"You hear a lot of complaining these days, and there are those (doctors) who are in it for the money, but most are still motivated by the desire to do something for people," he said. "And that's never going to change."

To read the entire obit, please go do

On This Date in History

On this date in 1960, the first presidential debate occurred. Candidates John F Kennedy and Richard M Nixon started a trend in national election campaigns with their televised, face-to-face confrontation. The power of words and their delivery - not to mention a close shave - were never more dramatically illustrated.  It became a common forum for presidential campaigns in the future, offering voters both a chance to contrast and compare the opinions of the candidates without media bias.

On this date in 1919, President Woodrow Wilson collapsed.  He had been on the road conducting a forty-date speaking tour. His mission was to garner the nation's support for the Treaty of Versailles. Unfortunately, he did not rally the people to accept the far-reaching, global nature of the treaty, which would have involved the United States in the international political arena for the first time. It would take another world war and three more decades before Americans were convinced that they were not an isolated entity, but rather one of the world's major hubs.

On this date in 1815, the Act of the Holy Alliance was signed by the Czar of Russia, the Emperor of Austro-Hungary, and the King of Prussia.  The agreement stated that: "they will consider themselves as members of one and the same Christian nation." Gradually other Christian monarchs throughout Europe signed the act with the exception of two key figures: Great Britain's king and the pope himself.

Speaker's Lifetime Library, © 1979, Leonard and Thelma Spinrad