News News News
ANOTHER MEDICAL MYTH – THE “UNINSURED” ARE THE REASON FOR OVERCROWDED EMERGENCY ROOMS
In order to justify and promote further expansion of our corrupt third party payment system, academics, politicians, and their media footpads have created the myth that patients without insurance disproportionately utilize emergency services for non-emergency care. The false reason proposed is because the “uninsured” can’t afford and therefore don’t have primary care doctors: If only they had insurance, they would be going to their doctor’s offices for routine care.
An emergency physician from Michigan found that this often repeated assumption contrary to her own experience, and reviewed the data, finding no support for this widely held myth. In fact, most emergency room users are insured. Emergency departments are increasingly crowded because there are more aging patients with multiple illnesses and also an increasing incidence of urgent complications of chronic disease and treatments.
Medicaid enrollees are the most frequent users of emergency departments.
The other side of the issue is that fewer physicians are entering primary care because of ballooning overhead costs, third party and regulatory hassles, and increasing numbers of unfunded mandates from federal and local governments (see next item). The solution to crowded emergency rooms will not result from more mandated corruption, but from eliminating the factors that make it increasingly impossible for physicians to practice primary care medicine. (American Medical News, Nov 17, 2008, p. 5)
NEW FEDERAL TRADE COMMISSION MANDATE CREATES EXPENSE AND RISK FOR YOUR DOCTOR
Government bureaucracy has added another compulsory administrative task for physicians. Without pay, of course. As of November first, 2008, any doctor who does not have the patient pay their entire bill at the time of service is considered to be “extending credit” by the Federal Trade Commission. Physicians who defer payment by billing insurance are also covered by the new regulations.
Under these, physicians “must develop and implement written identity theft prevention programs”, in order to “prevent, detect, and respond” to identity theft. Those not in compliance are subject to fines of $2,500.00 per violation. As with most government rules, there is no evidence or rationale to prove that physicians and their practices are responsible for creating the problem of identity theft, or are capable of solving this law enforcement issue in any case.
Every new administrative and financial burden that doctors endure distracts from the focus and ability to provide medical care. In response to complaints by various medical associations, enforcement of the rules has been delayed until May of 2009. (American Medical News, November 17, 2008 p. 18)
“NONPROFIT” INSURANCE MONOPOLIES DEFEND THEIR TREASURE
Goldman Sachs health care industry analyst Matthew Borsch estimates the 30 largest nonprofit Blues have collective $37.5 billion in reserves in 2007, more than double the reserves they held in 2002. “Surplus builds up, in part, because reimbursement to physicians falls”, said William Cutler, PhD., Director of the center for Health Services Research at Georgia State University.
Most large nonprofits far exceed the reserves set by the BlueCross BlueShield Association and state regulations, so some in “organized” medicine are suggesting these funds be applied to benefit the public. “They’ve had certain non profit tax exemptions, they’ve been allowed to accumulate money, and we feel some of this money could be put to better use for the public.” says Michael Sandler, M.D., president of the Michigan State Medical Society.
Not surprisingly, fat cats in the BlueCross BlueShield system feel otherwise. (American Medical News October 27, 2008 p. 13)
NSAID RELATED LIVER DISEASE INCREASES 700% IN TEN YEARS
A study of 1.6 million MediCal participants who use non steroidal anti-inflammatories indicates that serious liver toxicity has increased by a factor of 7 between 1995 and 2005.
Dr. Gurkipal Singh presented these results at the annual European Congress of Rheumatology, and suggested that the increase in use of other potentially liver toxic drugs, such as statins, or the rise of nonalcoholic liver disease might be contributing to the increase. (Family Practice News, October 15, 2008 p. 24)
Trees release natural airborne antibodies known as phytoncides to protect their foliage. Japanese researchers speculate that these substances also benefit human forest visitors in a similar fashion.
Men who walked through a forest for a total of 6 hours over 2 days had an average 46% increase in “killer” white cells. Blood levels of anti cancer proteins also increased. The effect was not seen in men who walked in the city. The effect lasted up to 7 days in the study. (Int J Immunopathol Pharmacol. 2008 Jan-Mar;21(1):117-27)
Ed. note: One of the most excellent exercises for liver qi related imbalance is hiking in the woods.
COMPASSION IS GOOD FOR HEALTH
Previous studies have linked religious belief with better health outcomes. Now a study suggests that it is active compassion (which is valued in most religions) that is the active ingredient rather than simply religious belief or observance.
In the study of 441 adults, those with compassionate attitudes to others showed better markers of psychosocial health including less depression and stress, and greater social support. (Annals of Behavioral Medicine 2005; 30 (3): 217-224).
ACUPUNCTURE IN SCHOOL
An English school in Somerset is offering acupuncture to those pupils identified as suffering from anxiety and stress, ADHD and problems controlling anger. The project, at the 900-pupil Stanchester Community Comprehensive School, is entirely voluntary.
The pupils who are offered treatment almost invariably opt for the needle option (as opposed to a milder electro-magnetic pen treatment), love to learn the Chinese names of the points and report positive changes to general wellbeing and ability to control stress and anger.
DECLINE OF ACUPUNCTURE IN CHINA
China Daily reports a worrying decline in acupuncture practice. At the same time as more and more foreign students are studying acupuncture in China and the practice is flourishing world-wide, on its home territory it is in trouble. As hospitals earn much more from profitable drugs (both Chinese traditional and Western), acupuncture is often neglected both in hospital clinics and in research departments.
Acupuncturists are poorly paid, and many are travelling abroad to seek better earnings. At the same time, in order to obtain international recognition, much effort has gone into theoretical research into acupuncture which has become increasingly divorced from clinical practice. (Xinhua News).
ACUPUNCTURE/ACUPRESSURE FOR CHEMOTHERAPY VOMITING
A systematic review published by the Cochrane Collaboration, an international organization that evaluates medical research, pooled results from nine studies into the use of acupuncture for post-chemotherapy vomiting.
Overall, 22% of patients who received acupuncture suffered vomiting the first day after chemotherapy, compared to 33% of those who did not receive acupuncture. When acupressure studies were evaluated, it was found that it was able to relieve nausea the day after chemotherapy (which acupuncture did not do) although it had no effect on vomiting. (Ezzo JM et al. Acupuncture-point stimulation for chemotherapy-induced nausea or vomiting. The Cochrane Database of Systematic Reviews 2006, Issue 2).
MEDICINAL PLANTS FACE EXTINCTION
A team representing botanic gardens across 120 countries identified 400 plants used for medicinal purposes that are at risk of extinction. Those most at risk include the yew tree (the bark of which forms the basis for one of the world's most widely used cancer drugs, paclitaxel), hoodia gordonii (the subject of intense pharmaceutical company interest as an appetite suppressant), magnolia (used in TCM for thousands of years and under threat from deforestation) and autumn crocus (a treatment for gout and leukemia).
The authors express strong concern about the implications for the future of healthcare, warning that that cures for diseases such as cancer and HIV may become "extinct before they are ever found". (Botanic Gardens Conservation International)
VITAMIN D PROTECTS AGAINST HEART DISEASE AND CANCER
Vitamin D deficiency is already known to be associated with osteoporosis, now two new studies suggest that it may also be associated with heart disease and poorer prognosis for some cancers. A US cohort study of 1739 people with no cardiovascular disease at baseline showed that those with low blood concentrations of vitamin D had twice the risk of a first cardiovascular event, such as a heart attack or stroke, over the five year follow up. Vitamin D deficiency was common among study participants. (Vitamin D deficiency and risk of cardiovascular disease. Circulation. 2008 Jan 29;117(4):503-11).
A second Norwegian study calculated the average yield of vitamin D from sunlight in people in different latitudes and compared this with the incidence of, and mortality from, the major internal cancers. Solar radiation is the main cause of skin cancers, but it is also the main source of human vitamin D, which has been shown to improve outcomes in patients with major internal cancers (including prostate, breast and colon).
The study showed that although the incidences of major internal cancers were higher in countries at lower latitudes, the survival prognosis improved significantly. The authors concluded that increased sun exposure may lead to improved cancer prognosis and that warnings to avoid sunlight because of the risk of skin cancer should be balanced against the health benefits of exposure to sunlight. (Addressing the health benefits and risks, involving vitamin D or skin cancer, of increased sun exposure. Proc Natl Acad Sci USA. 2008 Jan 15;105(2):668-73).
PREGNANT WOMEN DEFICIENT IN IODINE
A Canadian study suggests that more than 70% of pregnant women have iodine levels below the range recommended by the World Health Organization. Recommended intake is 200-300 micrograms a day. Maternal iodine deficiency has been associated with an increased risk of complications including stillbirth and spontaneous abortion, as well as developmental problems in children, including developmental delay and mental retardation. (Family Practice News, October 15, 2008 p. 20)
FEWER EPIDURALS WITH ACUPUNCTURE
A Norwegian study has shown that women who receive acupuncture during labor have a significantly reduced rate of epidural anesthesia. (Nesheim BI, Kinge R. Performance of acupuncture as labor analgesia in the clinical setting. Acta Obstet Gynecol Scand. 2006;85(4):441-3).
BOTOX® MIGRATES ALONG NERVES
Many physicians and patients believe injections of Botox® toxin remain where they are put, but Matteo Caleo of the Institute of Neuroscience in Pisa has found that botulinum toxin can travel down nerve fibers and into the brain within days. Though the study was on rats, Calleo states that “We suspect that this spread is a common occurrence after toxin delivery”. The effect of botulinum toxin when it spreads into the central nervous system has not been studied. (The Journal of Neuroscience, doi:10.1523/JNEUROSCI.0375-08.2008)
"What Were They Thinking?" Department
A HOUSE IS NOT A HOME
The dilapidated house of “organized” medicine is desperately trying to create a folklore that will hold our crumbling and ineffectual medical system together. The American Medical Association, the American Academy of Pediatrics, the American Academy of Family Physicians, the American College of Physicians, and the American Osteopathic Association have jointly issued “principles” underlying their solution: The “medical home”.
More fakelore than folklore, this latest offering of medical mythology offers politicians and the public a fantasy vision that magically centralizes all capability and responsibility for medical care within a warm and fuzzy nest of healing. Patients will be able to relax in the assurance that all their medical treatment will be overseen by the wise and wonderful wizards of medical treatment that will inhabit this halcyon future.
Don’t look behind that curtain, folks, because this vision is unattainable with the present generation of primary care doctors. An entirely new paradigm of training and practice would have to collectively and simultaneously appear in medical schools, hospital systems and every practitioner in the United States for this idyll to come about.
Primary care practitioners simply don’t have the training or the influence to unify the divided house of medical specialties into the grand coordinated vision of these five bureaucracies, whose very existence as separate entities reveals some of the irrationality underlying this proposal.
Furthermore, the numbers of primary care doctors are insufficient to meet present demands, and there is almost a 100 percent certainty that this population will diminish in the future.
More than 50% of practicing primary care doctors have already indicated their desire to leave medicine , in part because of increasing workloads, financial pressure, and various regulatory hassles. Dissatisfaction with working conditions and loss of autonomy and authority are other factors reducing the availability of the leagues of “personal” physicians who would be needed to operate the “medical home” model.
Few medical students see the value of training for 8 years to become a factotum in a government-run clinic, so it is not surprising that only two percent of current medical students plan to take up primary care. By the time they finish training, the numbers will have shrunk even further.
Creating unfunded mandates for increased workloads with open ended responsibility and liability, as in this proposal, can only decrease the attractiveness of a career in primary care medicine. Wishing that primary care doctors can somehow acquire the power and wisdom to manage every “element of the complex health care system” (Principle number four) will not make it so.
We will be hearing much more about the “medical home” model from academics and politicians as these fables serve as justification for their ambitions to control medicine and its cashflow. However, the Joint Principles of the Patient-Centered Medical Home is paradoxically a distraction to the need for real reform of our medical system. As propaganda and fakelore, the specifics themselves are instructive:
1. Personal physician - each patient has an ongoing relationship with a personal physician trained to provide first contact, continuous and comprehensive care.
Your options for a “personal” physician are largely determined by your employer and your “health” plan, and patients are presently forced to change physicians every few years for a variety of reasons, so “continuous” care is largely impossible in the present system. The “medical home” proposal offers no solution for this reality.
As in all relationships, maintaining a therapeutic relationship takes work above and beyond just showing up for an appointment and checking a few boxes on a form. Is there any evidence that physicians and patients are competent and interested in making this effort?
Physicians in our specialty driven system are not trained to provide “comprehensive” care, and their range of procedures and practices are restricted by specialty boards and hospital accreditation committees. The psychology and culture of specialists affirm that they can do some things better than generalists, and they have defended their territory with verve and determination. Specialists make more money for the health care fat cats, providing them with the political and economic influence to dominate health care.
Insurance coverage also determines who will be paid, and how much, for similar work product. In the present system, a plastic surgeon will always be paid more to stitch up a laceration than a family practitioner. Other aspects of “comprehensive care” are may also be unavailable for “personal physicians”; specialist pressure and liability concerns have prevented many doctors from providing obstetrics; the day of the “general” surgeon and the G.P. who performed basic surgery and office based primary care is long past.
Patients have shown that they are not willing to accept “gatekeeper” or other limits on their ability to consult a specialist, further eroding the scope of any physician who tries to provide “comprehensive” care. Only coercive mandates that limit a patient’s ability to “choose their doctor” will change this reality.
2. Physician directed medical practice – the personal physician leads a team of individuals at the practice level who collectively take responsibility for the ongoing care of patients.
In fantasyland, medicine is a “team” sport, with the physician as the “leader”. Despite the vintage of this oft repeated lie, there is no evidence that this is an appropriate representation of actual clinical practice. Which of the many physicians involved in a patient’s care will be awarded this “leader” role? How is it possible to have both a “leader”, and “collective responsibility”? Vague and self contradictory pronouncements are commonplace clues that major flaws and empty promises are inherent in this proposal.
Presently, primary doctors lose all control over treatment when a patient is admitted to the hospital, especially if their care is provided by “hospitalists”, who are full time hospital specialists. Currently, every participant in a patient’s care is trained to jealously guard their autonomy, reflecting the prevalent culture of medicine.
“Collective” responsibility is also another euphemism in bureaucracy-speak that really means no one is responsible. Reference our Legislative, Executive, and Judicial branches of government to understand how individuals can escape responsibility for collective "decisions".
3. Whole person orientation – the personal physician is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals. This includes care for all stages of life; acute care; chronic care; preventive services; and end of life care.
Find me a single doctor in the United States who can fulfill this mandate. There isn’t a medical school in America whose curriculum covers the range of subjects that would lead to this level of ability in their graduates. All post graduate training is presently heavily hospital and acute episode based. The shortcomings of chronic disease management in the United States have been well documented.
“Arranging care” is a euphemism for referring to a specialist. Frequently, the specialist “keeps” the patient and never refers them back to the primary care doctor, thus destroying the concept of the continuity of the “home”. Perhaps a “medical rooming house” might be a better metaphor.
Aside from vaccination, “preventive” care has very little place in modern medicine, unless aggressive treatment of already diagnosed risk factors with drugs and surgery is magically relabeled “prevention”.
4. Care is coordinated and/or integrated across all elements of the complex health care system (e.g., subspecialty care, hospitals, home health agencies, nursing homes) and the patient’s community (e.g., family, public and private community based services). Care is facilitated by registries, information technology, health information exchange and other means to assure that patients get the indicated care when and where they need and want it in a culturally and linguistically appropriate manner.
This statement represents another fantasy of omnipotence for the primary care doctor who can “assure” patients get indicated care, even in those rare instances when everyone agrees on what treatment is “indicated”. Enforcing unity among the staffs of different “elements of the … health care system” would require Czar-like powers and a private police force.
Information technology and registries “facilitates” nothing, “assures” nothing, and has nothing to do with creating insights into either cultural factors or capability to relieve suffering. Providing care when and where patients “want” it is a pretty tall order, if you think about it. Why not anytime, anywhere? At this point, the mandate for “linguistically appropriate” care is enigmatic.
With regard to the benefits of technology, just this month I referred a patient to two different neurologists to obtain an MRI of his head. The first instead wanted an esoteric test that had no clinical value, and the patient wasn’t happy with this doctor’s approach or communication skills.
The second ordered the indicated test, but neither specialist, both of whom use the most advanced electronic system available in Cleveland, documented the history of the patient’s symptoms correctly, the correct list of the medications he was taking or the treatment that he was receiving from me. It is commonplace to find major errors of this sort in electronic records.
Another recent patient had to be hospitalized with spinal cord damage. Despite her treatment on a ward in a new, 350 million dollar building, there weren’t enough nurses to provide her with a simple catheterization of the bladder at the interval ordered by the attending hospital-based doctor. She consequently developed an infection that I diagnosed and could have treated in a day, but it took 5 days for the “high technology” doctors to get around to providing antibiotics. Oh, and the heat was not working in her “patient-centered” suite, so a family member couldn’t stay there with her during her hospitalization.
The reality is that you can’t create a home without mature and supportive family relationships, and we can’t have “medical” homes without repairing the many rifts that exist between patients and physicians.
These rifts have, to a great degree, been created by organized medicine itself, though the philosophies it endorses and the outside interference that it has permitted and even invited.
Aiding in the destruction of their heritage, previous generations of physicians have shortsightedly sold their professionalism in exchange for a lifetime of subservience by subsequent generations of doctors. Together, government bureaucrats and their physician toadies have destroyed the sanctity of the physician patient relationship. Now that the result has been spectacular failure, the creation of this public relations fable seems to be the best that they can come up with.
But this fable has no message of truth to offer: Belief in this lie will eventually result in the foreclosure on organized medicine’s medical home model after a great deal of money disappears. Sound familiar?