Community For Better Health Care

Vol IX, No, 12, Sept 28, 2010


In This Issue:

1.                  Featured Article: The Military's Fight Against Soldier Suicides

2.                  In the News: No one even knew, or knows today, what an Accountable Care Organization is

3.                  International Medicine: Just Don't Try to Go the European Way

4.                  Medicare: Medicare Chief Actuary Disavows Trustees' Report  

5.                  Medical Gluttony: How to control disability gluttony

6.                  Medical Myths: EMR will improve health care

7.                  Overheard in the Medical Staff Lounge: Government is to protect us, not to take care of us

8.                  Voices of Medicine: Why Poetry?

9.                  The Bookshelf: Medical Humor

10.              Hippocrates & His Kin: Doctors look in the mirror - we allowed this to happened

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

Words of Wisdom, Recent Postings, In Memoriam . . .

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Always remember that Chancellor Otto von Bismarck, the father of socialized medicine in Germany, recognized in 1861 that a government gained loyalty by making its citizens dependent on the state by social insurance. Thus socialized medicine, or any single payer initiative, was born for the benefit of the state and of a contemptuous disregard for people's welfare.

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1.      Featured Article: The Military's Fight Against Soldier Suicides

by Robert Langreth, FORBES, Sept 7, 2010

Hit by rising suicide rates in the wake of two long wars, the Pentagon has suddenly become a prime mover in researching treatments for the suicidal. "They are leading the charge. There is nobody doing more for suicide prevention than the VA and the DOD," says Catholic University psychologist David Jobes.

The suicide problem first emerged in 2004 among soldiers in Iraq, says Colonel Carl Castro, a psychologist at the Army's Medical Research & Materiel Command. Now the suicide rate for the whole Army, which historically has been low, exceeds the rate for civilians. In 2009 a record 244 soldiers (active and reserves) killed themselves. This year there have been 156 so far.

The centerpiece of the Army's efforts is its $50 million, five-year study with the NIH that will follow more than 90,000 soldiers to identify risk factors for suicide. It is modeled on the famous Framingham Heart Study, which helped spot cholesterol and other risk factors for heart disease. A second $30 million project just getting going will create a suicide research consortium of top researchers to conduct a dozen rigorous trials of various therapies and drugs in suicidal soldiers and vets.

Cognitive behavioral therapy that focuses on teaching practical skills that help people get through crisis moments was shown to reduce suicide attempts by half in big 2005 trial on civilians. The military has started to test similar approaches.  One talk therapy trial is ongoing at Fort Carson, where infantry soldiers have had multiple combat deployments. Another trial is using skills training on suicidal inpatients at the Walter Reed Army Medical Center.

The VA, meanwhile, has put suicide prevention coordinators at all its hospitals and set up a 24-hour national crisis hotline. Unlike other hotlines, phone counselors can link directly to the VA's computerized medical records to ensure that patients get prompt follow-up care at their local center, says Janet Kemp, who directs the VA effort. . .

The VA's effort stems in part from Joshua Omvig, a soldier who shot himself in 2005 after returning from combat in Iraq. His death inspired Congress to pass a law mandating better services for suicidal veterans.

Meanwhile, the Air Force also has a well-known suicide prevention program it has been running for years to spot at-risk airmen.  It trains all its officers about the warning signs related to mental health issues and, in particular, suicide. Spotting trouble early is the key to successful treatment, says Lt. Col Michael Kindt, who directs the Air Force's program. . .  "We're creating a net that will have smaller and smaller holes so there's less likelihood of [people] falling through," says Kindt.

Former Forbes staff writer Rebecca Ruiz was my coauthor on this story.  Part VI in the series will be an interview with suicide treatment pioneer Marsha Linehan. For the full magazine story, see the Sept. 13 issue of Forbes

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2.      In the News: No one even knew, or knows today, what an Accountable Care Organization is

Consumer Power Report #231 Written By: Greg Scandlen Publication date: 07/21/2010
Publisher: Consumers for Health Care Choices at The Heartland Institute

I really hate it that I have to write about Obamacare every week. Unfortunately, the law is so sweeping and so onerous that it has taken all of the air out of the room and left little time to discuss anything else. We don't get to look at any other developments around the world or domestically in medicine or health care financing. We aren't even able to deal with the stalking horses of health information technology or comparative effectiveness research, which slightly preceded Obamacare by being inserted into the "stimulus package."

It isn't just us. There are a flood of conferences around the country aimed at employers and providers on topics such as "how to transform your business into an Accountable Care Organization." As if anyone wanted to be an Accountable Care Organization before this damned law was passed. No one even knew, or knows today, what an Accountable Care Organization is, but when the feds put up a hunk of moolah everyone jumps to get a piece of it.

And it isn't just today. This will be going on for the next 20 years. Already there are new proposals floating around in Congress to "improve and enhance" Obamacare. Every time a politician sneezes the entire health care system will reach for a hankie. And not one minute or one dollar of all of this has anything to do with actually caring for patients.

Health care is now about nothing except politics. -Greg Scandlen
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3.      International Medicine: International Health Systems

Just Don't Try to Go the European Way

By Grace-Marie Turner

Published in the Richmond Times-Dispatch, May 24, 2009

During his recent trip to Europe, President Obama told a French audience that America would never have European-style health care. "We are going to work hard to make sure that we have a health care system that won't be identical to what you have in Europe," he said.

This is encouraging news.

In France, for example, the government now dictates which doctors and specialists a patient can see. And strict reimbursement schedules can penalize doctors for performing costly procedures, even when those procedures are clinically determined to be best for the patient. Consequently, many doctors are refusing to treat patients with certain illnesses. . .

THINGS AREN'T much better in neighboring Switzerland.

In response to soaring medical costs, Swiss officials started forcing hospitals and specialty units to close. Between 1998 and 2000, the number of hospital beds dropped by six percent nationally. Not surprisingly, patients have experienced diminished access to care and are routinely shuffled from one facility to another.

Alphonse Crespo, a Swiss surgeon and think tank researcher, traces his nation's shift from a focus on choice and quality care to emphasizing cost reduction to 1994, when his country adopted a compulsory insurance system.

The Swiss have since put severe restrictions on private health options. In 2002, the Swiss government placed a limit on private medical offices. Doctors are now prohibited from setting up new practices unless another doctor's office in the area closes. Although unpopular, this rule may be extended through 2011.

The British health care system is quite open about its willingness to sacrifice quality of care for cost savings.

In 1999, British lawmakers created the National Institute for Health and Clinical Excellence to analyze whether various medical devices and pharmaceuticals are effective enough to justify their price. NICE issues regular "comparative-effectiveness" studies, and the National Health Service (NHS), Britain's public insurance system, uses them to decide which treatments are worth covering.

Because of these studies, the British health system routinely delays and denies access to new, life-saving medicines, forcing doctors to use older, less-effective treatments. Right now, British patients have access to only about 10 percent of the drugs that have been released in the U.S. market over the past two years.

Indeed, Britain recently made the headlines when NICE decided not to recommend payment by the NHS for several promising kidney cancer treatments. Agency officials determined they were too expensive, considering they extended patients' lives by "only" six months. Facing public pressure, British officials relented and approved one of the drugs. But three others still languish in approval purgatory.

NOT SURPRISINGLY, the quality of care in Britain has suffered severely. According to Lancet Oncology, the prestigious medical journal, less than 70 percent of British women diagnosed with breast cancer are alive at least five years after a cancer diagnosis, compared with nearly 84 percent for American women. For British men with prostate cancer, the five-year survival rate is just 51 percent. In America, the survival rate is 92 percent . . .

Obama's recent promise to create a uniquely American health reform solution was heartening. But if the president fails to deliver on his promise -- and he instead imports elements from these European health systems -- we could very well lose the opportunity to show the world that we can reform our health sector while protecting the quality of care and innovation Americans value so highly.

Grace-Marie Turner is president of the Galen Institute, a non-profit research organization focusing on patient-centered solutions to health reform.

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Nor does Canadian Medicare give timely access to healthcare, it only gives access to a waiting list.

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

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4.      Medicare: Medicare Chief Actuary Disavows Trustees' Report, Publishes Alternative Report

For the first time in Medicare history, the Medicare Chief Actuary has called the projections in a Medicare Trustees Report "unreasonable" and "implausible" and encouraged everyone to ignore them and view instead an "Illustrative Alternative" report, says John C. Goodman, President, CEO and the Kellye Wright Fellow with the National Center for Policy Analysis. 

 The alternative opens this way: 

"The Trustees Report is necessarily based on current law; as a result of questions regarding the operations of certain Medicare provisions, however, the projections shown in the report do not represent the 'best estimate' of actual future Medicare expenditures." 

·                     Noting that the formal Trustees report assumes Medicare physician fees will be reduced by 30 percent over the next three years, Chief Actuary Richard Foster says that's "implausible."

·                     In addition, the Trustees report assumes Medicare fees will fall below Medicaid rates by 2019 and fall further and further behind private payment rates in future years. 

As explained in an April 22 report by Foster, the health reform law will cause: 

·                     Cuts in Medicare spending of $575 billion over the next decade.

·                     7½ million members of Medicare Advantage plans to lose their coverage and cause another 7½ million to face higher premiums and benefit cuts.

·                     About one in seven facilities -- hospitals, skilled nursing facilities, home health agencies and hospices -- to become unprofitable and possibly drop out of Medicare altogether.

·                     Many doctors to quit seeing Medicare patients entirely. 

The alternative report says that the number of facilities that would become unprofitable will grow to 25 percent by 2030 and 40 percent by 2050 if the health reform law is implemented as written. 

Source: John C. Goodman, "UNPRECEDENTED: Medicare Chief Actuary Disavows Trustees' Report, Publishes an Alternative Report ," Right Side News, August 9, 2010. 

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

- Ronald Reagan

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5.      Medical Gluttony: How to control disability gluttony

How To Reduce Disability: Lessons From Chile NCPA

Disability costs are rising in many countries, including the United States. Disability is the fastest-rising component of U.S. Social Security, growing at nearly twice the rate of retirement benefit spending. Chile, however, reversed this trend when it implemented a new retirement and disability benefits system in 1981, says Estelle James, a senior fellow with the National Center for Policy Analysis. 

In the United States, current workers pay taxes to fund the benefits of today's retired and disabled workers, however, under the Chilean system adopted in 1981: 

·                     Workers prefund their retirement with individual accounts that are invested by private pension companies and earn market rates of return.

·                     The accounts are also used to partially fund disability and survivors' benefits for workers who have not reached retirement.

·                     Additionally, each pension company is required to provide group disability and survivors' insurance for its affiliated workers. . .

Disabled workers were guaranteed a defined benefit for the remainder of their lives: 70 percent of their average wage if totally disabled or 50 percent if partially disabled.  In the long run, workers' savings were projected to cover about 50 percent of their disability benefits. . .

As a result of this process and other factors, the disability rate among Chilean workers fell significantly after 1981 and is now less than half that in the United States, after controlling for age, says James: 

·                     Workers in the new Chilean system are only 21 percent to 35 percent as likely to start a disability pension as they were in the old system, after controlling for age and gender.

·                     In 1999, among 45- to 54-year-olds, 2.9 per thousand covered members of the new system in Chile were accepted to newly disabled status, compared to 7.8 per thousand in the United States.

·                     For 55- to 59-year olds, these numbers were 7.2 per thousand in Chile, compared to 13.9 per thousand in the United States.  

Source: Estelle James, "How To Reduce Disability: Lessons From Chile," National Center for Policy Analysis, August 24, 2010. 

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Medical Gluttony thrives in Government and Health Insurance Programs.

Gluttony Disappears with Appropriate Deductibles and Co-payments on Every Service.

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6.      Medical Myths: EMR will improved health care

AAPS Myth 32. Information technology will improve efficiency and safety.

A large part of the savings projected from "healthcare reform" is supposed to come from wider use of information technology. The federal government is expected to "invest" some $45 billion in encouraging (or compelling) doctors and hospitals to use electronic records systems.

"Information is the lifeblood of modern medicine. Health information technology (HIT) is destined to be its circulatory system," writes David Blumenthal, M.D., M.P.P., of the Office of that National Coordinator for Health Information Technology (New England Journal of Medicine 12/30/09). "Physicians and institutions trying to practice highest-quality medicine without HIT are like Olympians trying to perform with a failing heart," he states. . .

In the real world, there are many problems in implementation. The University of California San Francisco Medical Center is one institution that is quietly writing off about a third of the $50 million it has poured into electronic medical records over the past 5 years. The system is still not fully up and running. UCSF terminated its contractor and is prepared to start part of the project from scratch (Huffington Post 11/23/09).

According to one study, between 50% and 80% of electronic health records systems fail. The larger the EHR project, the higher the risk of failure (IEEE Spectrum 1/1/10).

Instructional materials from real institutions include such eye-openers as a complicated 90-page guide for simply entering orders and a 30-page House-Wide Discharge (Depart Process) Training Manual. It is no longer possible to discharge a patient by writing prescriptions and a "discharge today" order in the record. "It's a wonder clinicians can get any clinical work done at all any more," writes Scot Silverstein, M.D. (Health Care Renewal 1/3/10).

For more than a decade, Silverstein has been making the case that "health IT is very, very much harder than it looks, especially to those in IT lacking healthcare expertise." Health IT is still largely a social experiment, and hospitals are a highly risky environment for implementing it. . . .

"Paper records, being flexible, portable and tolerant of ambiguity, support the complex work of clinical practice remarkably well…. [H]igh-tech healthcare environments such as intensive care units often make extensive use of paper charts, white boards, sticky notes, and oral communication" (Health Care Renewal 12/15/09).

HIT has become intensely political, note Greenbaugh et al. Publishers need to "invite studies that ‘tell it like it is,' perhaps using the critical fiction technique to ensure anonymity."

Silverstein calls the idea that "investment of tens of billions of dollars on a frenetic timeframe" will create massive quality improvements and cost savings "the height of magical thinking and political hubris."

Specializing in medical informatics, Silverstein is not opposed to HIT, he in fact supports it and dedicated his career to informatics. He is only opposed to HIT that is badly done. He observes that local projects built by experts are far more likely to provide major benefits than extant "shrink-wrapped" and massively expensive HIT.

Numerous serious problems have been reported with HIT in operation. Some prompted an Oct 16, 2009, letter from Senator Charles Grassley (R-IA) to Cerner Chief Executive Officer Neal Patterson.

Sen Grassley wrote: "Over the past year, I have received numerous complaints from patients, medical practitioners and technologies engineers regarding difficulties…with HIT and CPOE devices…. These complaints include faulty software that miscalculated intracranial pressures and interchanged kilograms and pounds, resulting in incorrect medication dosages."

Sen Grassley also referred to "gag orders" that prohibit disclosure of defects, and lack of a system to monitor performance of these devices.

Experienced systems professionals are increasingly raising concerns about the poor design of electronic medical records (EMRs), which frequently require workarounds and patches. The process is "unsustainable" and could lead to "data breakdowns" (Design Dialogues 11/12/09).

Some physicians like their EMR system, but one senior internist at a major hospital, who feared losing his job if he spoke on the record, reported on one 2006 system that crashed soon after it went online. He struggled to keep patients alive while vendor employees "ran around with no idea how to work their own equipment" (Washington Post 10/25/09).

One study showed that more than one in five hospital medication errors were caused at least in part by computers (ibid.) . . .

HIT raises serious liability concerns, note Sharona Hoffman and Andy Podgurski of Case Western Reserve University. "EHR [electronic health records] systems cannot remain unregulated and largely unscrutinized. It is only with appropriate interventions that they will become a much-hoped for blessing rather than a curse for health care professionals and patients."

In an earlier report, these authors concluded that "the advantages of EHR systems will outweigh their risks only if these systems are developed and maintained with rigorous adherence to best software engineering." Unlike other life-critical medical devices subjected to FDA oversight, EHR systems have not been comprehensively assessed.

The Veterans Administration system of EHRs has been in use since the mid-1990s. While reportedly very successful, a software problem that led to major treatment errors in 2008 is still under review. Though no evidence of harm to any patient was found, "the potential for serious injury was staggering" (Ann Intern Med 2009;151:293-296).

After a harrowing hospital experience featuring many staff members pushing around "laptops on wheeled sticks," his life having been saved by a heroic ICU nurse who worked around the system, and his wife who sneaked his inhaler into his room, a very intelligent patient concluded that "electronic health information systems are mostly broken."

"The national health information network envisioned by President Barack Obama is a pipedream," he writes (Joe Bugajski, "The Data Model That Nearly Killed Me," 3/17/09).

So why did Congress authorize $20 billion for HIT in the stimulus package? Proponents relied on a 2005 RAND estimate of $77 billion in savings—based on the assumption of an error-free system that would be rapidly implemented by 90% of all facilities. Even if achieved, $77 billion would be only 4.5% of total costs, placed at $1.7 trillion by RAND, writes Greg Scandlen (Heartland Institute 2/20/09).

Most likely, "every penny of the $20 billion will be wasted on systems that don't work and can never be implemented. That was the outcome of federal attempts to upgrade technology at the IRS, the FBI, and the air traffic control system."

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Medical Myths Originate When Someone Else Mandates The Medical System.

Myths Disappear When Patients and their Doctors Manage Every Service.

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7.      Overheard in the Medical Staff Lounge: Government is to protect us, not to take care of us

Dr. Edwards: Last week we were discussing whether the prime purpose of government is to protect us or to take care of us.

Dr. Milton: Some of us felt that the government can't do both and has to choose. When the government tries to take care of us, there will never be enough to what the public feels they are entitled to.

Dr. Edwards: Have you ever heard of anyone on the public dole think that he had enough dough?

Dr. Paul: Of course not. No one ever thinks he has enough. But we have to live within limits. Rather than have the rich get more of everything, it's time the poor had an equal share.

Dr. Edwards: Do you really think like Obama's father that income taxes should be 100% and the government parcels out to everyone what the government thinks he or she needs rather than the individual decide what he needs?

Dr. Paul: If the government were totally in charge, then everyone would be satisfied that he or she got their fair share.

Dr. Milton: But the incentive to work would be lost and gradually the total share becomes less and less. As the total gets less and less, our individual share gets less and less.

Dr. Paul: But it wouldn't have to be so and it shouldn't be so. It's time to get our priorities in order. It would have been easy without all the money Bush spent on the Middle East wars.

Dr. Edwards: There you go again. Everything in the world is Bush's fault.

Dr. Rosen: Actually there is another aspect to the Iraq war that's never mentioned. Because of the war, we've found out how uncivilized much of the Middle East is. I still can't believe the News Clip of five Iraqis holding an American face down while the sixth one was sawing his neck in two. I can still vividly see the guy struggle and it took the entire effort of the five men each holding an arm or a leg or the head while his neck was being sawed into. And then as they cut through the spine the entire body got limp. Then when they had the head off, one of the men held it up, climbed on top of his car and held it out for the world to see what they would like to do to all of our countrymen.

Dr. Milton: That was truly not only uncivilized, but totally non-human.

Dr. Rosen: I think President Bush got cold feet because of all the political pressure. If he had just gone in and won the war, doing everything necessary to subdue the savages, and then occupied the country for as long as it took to civilize them, he should have been awarded the Nobel Peace Prize.

Dr. Edwards: Did MacArthur occupy Japan for nearly a dozen years after WWII?

Dr. Milton: We also still have 60,000 troops in South Korea to keep peace in that peninsula.

Dr. Rosen: If President Truman had not fired General MacArthur just before he took on the Chinese Hordes across the Yalu River, we would not have a North Korean problem today.

Dr. Milton: Hitting the Chinese Hordes just before they invade Korea would be considered normal war strategy and there would never have been a North Korea, a world problem today.

Dr. Edwards: Vietnam would then probably also have been free.

Dr. Rosen: With nearly every Arab child growing up from kindergarten to high school to hate the Jews, it would take at least 12 years of Iraqi occupation to allow a full generation to become educated and understand freedom. On my last trip to Israel, I actually observed a teacher ask a child; "Who are the Jews?" "They are our enemy." "What do we do with our enemies?" "We kill them."

Dr. Milton: That type of indoctrination cannot be reversed in just a few years like the socialist think, and we should get out of Iraq.

Dr. Rosen: Our job there has just begun. Too bad Bush didn't stand up to the Socialists and just tell them like it is. We should have Air Force bases there in perpetuity just like in Japan and Korea.

Dr. Milton: That would have assured a stable Democratic Republic in Iraq which would have a beneficial effect on the other Arab countries to give freedom to their people, educate girls as well as boys and remove the second-class status of their women.

Dr. Rosen: What a great cause it would have been for freedom in the world that would have assured continued freedom in America as well as Europe, which according to Mark Steyn will soon be Eurabia.

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The Staff Lounge Is Where Unfiltered Medical Opinions Are Heard.

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

Why Poetry? By Matt Joseph, MD

That's more or less the question I was asked to answer by the editor of Sonoma Medicine.

The simplest answer—and only half-joking—is that poetry takes less time than prose. And poetry helps in the wooing of women, more specifically my wife, to whom I proposed with a poem, and with whom I kept a long-distance relationship alive with the judicious use of poems.

The "less time" part sounds glib, but it's true. Physicians may not have the market cornered on busy jobs, but we are pretty flat-out as a group, and my need for a creative outlet requires something that can be done in small parcels of time. Now that I have two young children, those small parcels feel more like very tiny match boxes. Poetry, when the muse hits, can be a near-spontaneous act. Revising takes a little longer, but the overall process is definitely shorter than writing War and Peace.

This all sort of nibbles at the edges of the question, "Why?" E.B. White said that talking about comedy is like dissecting a frog: you may understand the frog more, but it tends to die in the process. Same goes for most creative endeavors, including poetry. BUT … since I was asked: poetry is an emotional snap shot. It allows me to preserve a moment in time, to contain all the twisting, sometimes contradictory emotions and realities that can exist in a single instant. Sometimes poetry allows me to find the real meaning of a moment, and at its best, it can even help shape the way an event has affected me. In the end, when I have the time and energy, I write poetry about the things I don't want to forget.

That's why.

Read the entire review and some of Dr. Joseph's own verse . . .
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VOM Is an Insider's View of What Doctors are Thinking, Saying and Writing about.

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9.      Book Review:  MEDICAL HUMOR

THE BEST OF MEDICAL HUMOR - A Collection of Articles, Essays, Poetry, and Letters Published in the Medical Literature, 2nd Edition, By Howard J Bennett, MD,

Just as medical texts required second and further revisions on a regular basis, Dr Howard Bennett revised his book on Medical Humor because humor changes. Over 50% of this edition is new. On the faculty of George Washington University School of Medicine in Washington, DC, Bennett did extensive library research to collect witty, humorous aphorisms and items as the subtitle states. This is not a joke book. It won't make an audience belly laugh or fall out of their seats. But it will make you smile and feel good.

Just seeing the informed consent for a hernia with signature lines of the patient, his lawyer, the doctor's lawyer, the hospital's lawyer, the anesthesiologist's lawyer, the mother-in-law, and the notary public will allow you to see today's realities, reflect on them, and decide that we've gone too far and pull back to the real realities.

He found a pulmonary fellow who sent his wife a valentine when he thought that the cardiac system was receiving far too much attention: Roses are red, Violets are blue, Without your lungs, Your blood would be too.

There are short witty essays "On the Professional Patient," "Dial a Lawyer," "PostMortem Medicine--A New Specialty," "Managed Care: The Fast-Food-for-Thought Therapy Approach," all with references for further reading! His Medical Horoscopes is rather ingenious. This is just a wonderful volume to have within reach when inspiration fails or the mood simply needs elevating.          –Del Meyer, MD

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The Book Review Section Is an Insider's View of What Doctors are Reading about.

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10.  Hippocrates & His Kin: Doctors look in the mirror - we allowed this to happened

Don't blame Obama, doctors - look in the mirror. We (using the medical "we") allowed this to happen. However, we can take the power of medical decision-making away from the government and give it back to our patients at any time whenever we choose to stop accepting Medicare and Medicaid and all other forms of insurance. Why don't we get back to cash on the barrel, charity care for those truly in need, spending our time actually healing patients rather than coding and billing, and the practice of medicine the way we envisioned it when we applied for medical school? All it takes is a little fortitude.

With Medical Illiterates in Washington, D.C., pushing the move to EMR before the Medical Industry is ready to absorb this technology safely, more than one in five hospital medication errors were caused at least in part by computers. (Electronic medical errors.)

After the eighty-three year old lady finished her annual physical examination, the doctor said, "You are in fine shape for your age, Mrs. Mallory, but tell me, do you still have intercourse?"

"Just a minute, I'll have to ask my husband," she said.

She stepped out into the crowded reception room and yelled out loud: "Henry, do we still have intercourse?"

And there was a hush. You could have heard a pin drop.

Henry answered impatiently, "If I told you once, Irma, I told you a hundred times. What we have is Blue Cross!

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Hippocrates and His Kin / Hippocrates Modern Colleagues
The Challenges of Yesteryear, Today & Tomorrow

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

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

                      Medi-Share Medi-Share is based on the biblical principles of caring for and sharing in one another's burdens (as outlined in Galatians 6:2). And as such, adhering to biblical principles of health and lifestyle are important requirements for membership in Medi-Share. This is not insurance. Read more . . .

                      PATMOS EmergiClinic - where Robert Berry, MD, an emergency physician and internist, practices. To read his story and the background for naming his clinic PATMOS EmergiClinic - the island where John was exiled and an acronym for "payment at time of service," go to To read more on Dr Berry, please click on the various topics at his website. To review How to Start a Third-Party Free Medical Practice . . .

                      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. 

                      FIRM: Freedom and Individual Rights in Medicine, Lin Zinser, JD, Founder,, researches and studies the work of scholars and policy experts in the areas of health care, law, philosophy, and economics to inform and to foster public debate on the causes and potential solutions of rising costs of health care and health insurance. Read Lin Zinser's view on today's health care problem:  In today's proposals for sweeping changes in the field of medicine, the term "socialized medicine" is never used. Instead we hear demands for "universal," "mandatory," "singlepayer," and/or "comprehensive" systems. These demands aim to force one healthcare plan (sometimes with options) onto all Americans; it is a plan under which all medical services are paid for, and thus controlled, by government agencies. Sometimes, proponents call this "nationalized financing" or "nationalized health insurance." In a more honest day, it was called socialized medicine.

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

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

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

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

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

                      ReflectiveMedical Information Systems (RMIS), delivering information that empowers patients, is a new venture by Dr. Gibson, one of our regular contributors, and his research group which will go far in making health care costs transparent. This site provides access to information related to medical costs as an informational and educational service to users of the website. This site contains general information regarding the historical, estimates, actual and Medicare range of amounts paid to providers and billed by providers to treat the procedures listed. These amounts were calculated based on actual claims paid. These amounts are not estimates of costs that may be incurred in the future. Although national or regional representations and estimates may be displayed, data from certain areas may not be included. You may want to follow this development at During your visit you may wish to enroll your own data to attract patients to your practice. This is truly innovative and has been needed for a long time. Congratulations to Dr. Gibson and staff for being at the cutting edge of healthcare reform with transparency. 

                      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, who wrote an informative Medicine Men column at NewsMax, have now retired. Please log on to review the archives. He now has a new column with Richard Dolinar, MD, worth reading 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 read News of the Day in Perspective. Don't miss the "AAPS News," written by Jane Orient, MD, and archived on this site which provides valuable information on a monthly basis. Browse the archives of their official organ, the Journal of American Physicians and Surgeons, with Larry Huntoon, MD, PhD, a neurologist in New York, as the Editor-in-Chief. There are a number of important articles that can be accessed from the Table of Contents.


The AAPS California Chapter is an unincorporated association made up of members. The Goal of the AAPS California Chapter is to carry on the activities of the Association of American Physicians and Surgeons (AAPS) on a statewide basis. This is accomplished by having meetings and providing communications that support the medical professional needs and interests of independent physicians in private practice. To join the AAPS California Chapter, all you need to do is join national AAPS and be a physician licensed to practice in the State of California. There is no additional cost or fee to be a member of the AAPS California State Chapter.
Go to California Chapter Web Page . . .

Bottom line: "We are the best deal Physicians can get from a statewide physician based organization!"

 PA-AAPS is the Pennsylvania Chapter of the Association of American Physicians and Surgeons (AAPS), a non-partisan professional association of physicians in all types of practices and specialties across the country. Since 1943, AAPS has been dedicated to the highest ethical standards of the Oath of Hippocrates and to preserving the sanctity of the patient-physician relationship and the practice of private medicine. We welcome all physicians (M.D. and D.O.) as members. Podiatrists, dentists, chiropractors and other medical professionals are welcome to join as professional associate members. Staff members and the public are welcome as associate members. Medical students are welcome to join free of charge.

Our motto, "omnia pro aegroto" means "all for the patient."

Words of Wisdom

Courage is like love; it must have hope for nourishment. -Napoleon Bonaparte 

Start every day off with a smile and get it over with. -W. C. Fields

"You can lead a man to Congress, but you can't make him think." -Milton Berle

I felt a tremendous sadness for men who can't deal with a woman of their own age. -Michael Caine

On This Date in History - September 28

On this date in 1820, Friedrich Engels, who coauthored the Communist Manifesto with Karl Marx, was born in Germany. Engels also edited a considerable portion of Marx's writings. Very few people work alone and most of life is a collaboration.

On this date in 1974, when President Ford was barely in office a little more than a month and a half, Betty Ford made news in a surprising way. She had a mastectomy. Even though such news seldom made the press, her encouragement to go public also encouraged other women who badly needed mastectomies to feel the operation worthwhile.

After Leonard and Thelma Spinrad

In Memoriam

Graham "Mont" Liggins, investigator of the mysteries of birth and breath, died on August 24, aged 84

The Economist, Sep 2nd 2010

HE FORGOT about the sheep. He had meant to dump it in the incinerator on the way home from work. It was still in the car boot, and starting to smell. When he remembered, and forced it down the incinerator chute, it was already bloating, and the gassy innards instantly caught fire. The force of the explosion sent ash 200 feet into the air over Auckland.

Graham Liggins (grinning, above) was trying to find out what triggered labour. As a New Zealander, he had naturally turned to sheep. But his pursuit led to some of the most important discoveries in obstetrics, and the saving of hundreds of thousands of tiny, struggling lives.

He had first got hooked on the subject in the late 1940s, at the end of his clinical training at Auckland hospital. He was not, in his own mind, a natural doctor, being far keener on skiing, golf, girls, and having fun; his party trick was blowing fire. But family pressure had induced him to follow his father into medicine, and he began to be fascinated by the difficulties of birth.

In those years, premature birth was often a death sentence. The baby's lungs would be like small blobs of liver, unable or scarcely able to inflate. America's best doctors could not save Patrick Kennedy, born five weeks early in 1963 to John F. Kennedy and his wife Jackie. Dr Liggins (known as "Mont" after his childhood craze for Monty the Mouse) was determined to understand why such births occurred, and to prevent them.

Squeezing his research into evenings after long days delivering babies, he began by questioning the theory, held since Aristotle, that the mother's body instigated labour. He read of animals with prolonged pregnancies whose fetuses lacked a pituitary gland. This sent him to the animal research station at Ruakura among the sheep, and there, in an unsterile theatre, he began with much trial and error to remove the pituitary glands of unborn lambs. That surgery, as he discovered later with huge excitement, delayed the onset of labour. It was the fetus therefore, not the mother, that determined when labour started.

A stint at the University of California had consolidated those findings. Back in Auckland, though, money was tight. Dr Liggins patched together a laboratory for himself in a condemned shed, no thing of beauty, but quite adequate: the sort of place he had haunted as a boy in the small gold-rush town of Thames in North Island, where he had squeezed down abandoned mine shafts and made his gang headquarters in derelict wooden huts, staying overnight in the creepy kauri forest to feast on sausages and chocolate.

In his shed, treading with care to avoid the rotting floorboards, he continued his research into fetal lambs. Having removed their pituitaries, he then infused the lambs with cortisol, a hormone indirectly produced by that gland. Each time, the ewe gave birth two days later. The signal for labour, at least in sheep, had been revealed.

Then serendipity stepped in. One morning Dr Liggins discovered that a lamb he had infused with cortisol had been born overnight. It was so premature that its lungs should have been uninflatable, yet it was breathing. He realised that the cortisol had caused its lungs to mature early. In 1972, with his colleague Ross Howie (left above), he carried out a trial in which synthetic cortisol was given to women in premature labour. Amazingly, it reduced by half the number of babies dying.

Read the entire obituary in the Economist . . .

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Please note that sections 1-4, 6, 8-9 are entirely attributable quotes and editorial comments are in brackets. Permission to reprint portions has been requested and may be pending with the understanding that the reader is referred back to the author's original site. We respect copyright as exemplified by George Helprin who is the author, most recently, of "Digital Barbarism," just published by HarperCollins. We hope our highlighting articles leads to greater exposure of their work and brings more viewers to their page. Please also note: Articles that appear in MedicalTuesday may not reflect the opinion of the editorial staff.

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The Annual World Health Care Congress

Advancing solutions for business and health care CEOs to implement new models for health care affordability, coverage and quality.

In partnership with, the 7th Annual World Health Care Congress was the most prestigious meeting of chief and senior executives from all sectors of health care. The 2010 conference convened 2,000 CEOs, senior executives and government officials from the nation's largest employers, hospitals, health systems, health plans, pharmaceutical and biotech companies, and leading government agencies. Please watch this section for further reports in the future as well as








The 8th Annual World Health Care Congress will be held April 4-6, 2011
Washington, DC
Toll Free: 800-767-9499