News News News
MASSACHUSETTS PHYSICIAN SHORTAGE WORSENS
The only state that has mandated “universal” coverage for its citizens is discovering that there are not enough primary care doctors to provide these mandated services.
According to an annual workforce survey released in September by the Massachusetts Medical Society, less than 44 percent of internists are accepting new patients, down from 58 per cent in the previous year. 60 per cent of family practitioners are accepting new patients, down from 65 per cent last year and 70 per cent in 2007. (Medical Economics, Oct. 23, 2009 p 17).
YOGA FOR CHRONIC BACK PAIN
A 24 week course of yoga provides superior improvement than standard care in terms of reduced functional disability, pain, and depression. The study was performed at West Virginia University. (Spine 2009; 34:2066-2076. September 1, 2009).
ANOTHER VALIDATION FOR CHINESE INSIGHT
One of the more interesting secondary channels proposed by Chinese medical theory is chong mai, a system which connects the brain, the thyroid, the heart and the sexual organs. This is a system that has great practical utility, and one which I use therapeutically almost every day.
Far more sophisticated than the 19th century perspective that is presently the source of most medical thinking in the West, the Chinese system proposes interconnections that are extremely clinically relevant, though modern specialists are unable to take advantage of these by nature of their narrow training and viewpoint.
Physicians with broader training will be alert to the ever present possibility of treatment complications on organ systems related by the channel and network vessels.
A recent study in Sweden illustrates this interconnection: men treated with endocrine therapy for prostate cancer have an increased relative risk of 24% for nonfatal heart attack, 19% increased risk for arrhythmia, 31% for ischemic heart disease and 26% for heart failure. The risk of death from heart attack was increased by 28%, by arrhythmia by 5%, by ischemic heart disease 21% and death by heart failure, 26%. (Family Practice News, October 15, 2009 p 1)
ACUPUNCTURIST FACES CHARGES FOR QUACKERY
An acupuncturist reported to Sweden’s National Board of Health and Welfare under a law restricting medical quackery, faces charges after having treated a baby for colic. Under Swedish law, only authorized health and hospital staff are permitted to treat children under the age of eight with acupuncture. The baby received several acupuncture treatments for its colic, which helped the condition, according to its mother. (Sundsvalls Tidning and Dagbladet, 12 Apr, 2008).
BONE “EXPERTS” SUGGEST BIPHOSPHONATE “HOLIDAY”
At a conference on internal medicine at the University of Colorado, experts are suggesting that a solution to the increasing number of atypical fractures in patients taking biphosphonate drugs is to suspend the drugs for a period of 1-2 years if patients have been on them for 5 years and are considered “low risk”.
There are more than 70 reports of transverse fractures of the thigh bones in patients taking these drugs, two thirds of which are bilateral. There is no history of trauma in these patients, who are found to have fractures after developing intense, spontaneous thigh pain. (Family Practice News Sept 1, 2009 p 19).
MORE PUNISHMENT FOR DOCTORS WHO ACCEPT MEDICARE
Doctors who treat the nation’s elderly have been spared a greater than 20% cut in reimbursement this year, but plans to reduce Medicare payments by more than 21% are on track for 2010. The unpredictable and arbitrary manipulation of the Medicare system makes it difficult for physicians to maintain an expectation of stability in their cash flow, which, along with increased paperwork and regulatory burdens, is driving doctors to stop seeing Medicare beneficiaries.
Single payer plans such as Medicare are being promoted by politicians as a solution to our crumbling medical system, but doctors themselves do not want to be patients in this program. (CNN)
ENDOSCOPY-CAUSED INFECTION FOLLOW UP AT VETERAN’S ADMINISTRATION
In 2008, more than 10,000 veterans were exposed to blood borne infections at 3 VA medical centers when equipment was not sterilized properly. So far, nearly 50 have tested positive for hepatitis B or C, and 6 have tested positive for HIV.
Follow up testing in May at 42 VA medical centers indicated that only 43% were following appropriate cleaning protocols. Another set of tests in August were performed by the Office of the Inspector General, who reported that “nearly” all demonstrated proper cleaning techniques. (JAMA October 28, 2009 Vol 302 No. 16 p 1743).
WEST NILE VIRUS BECOMING A MAJOR CAUSE OF ENCEPHALITIS
First appearing in the U.S. in 1999, West Nile virus (WNV) is becoming almost as common as herpes simplex encephalitis, even though WNV is more common in the summer months and in certain areas, whereas herpes encephalitis is year round and not limited by the distribution of mosquitoes.
WNV causes three forms of neurologic disease; encephalitis in 55-60%, meningitis in 25-40%, and acute flaccid paralysis in 5-10%.
This latter manifestation resembles poliomyelitis, and can progress very quickly: “I’ve seen patients who were fine in the morning and quadriplegic in the evening”, states Dr. Kenneth Tyler, an infectious disease specialist, at a conference at Children’s Hospital in Denver. Patients with WNV also have cranial nerve symptoms 70 per cent of the time. Long term persistent neurologic symptoms are common. (Family Practice News Sept 1, 2009 p 24).
BREAST CANCER AFFECTING YOUNGER PATIENTS
As the levels of cancer rise in this country, younger patients are being affected: "You have breast tissue, so at any point, if you have that tissue in your body, it can become cancer," said Dr. Jennifer Litton, an assistant professor in the department of breast medical oncology at the University of Texas M.D. Anderson Cancer Center in Houston.
This helpful analysis reflects the present state of ignorance among the medical “experts” regarding the factors which are increasing the incidence of breast cancer. Increasing exposure to endocrine disrupting chemicals such as Bisphenol A in the food supply may be one reason that younger patients are now diagnosed.(CNN)
Despite the overwhelming hype and enormous cost of widespread mammography, there is very little evidence that lives are saved. For every 2000 patients aged 40-49 screened by mammography over 10 years, one life is saved. However, all 2000 are exposed to 10 yearly doses of X rays, 900 women with false positive mammograms undergo repeat mammograms and biopsies to show there is no evidence of cancer, 10 patients are treated for breast cancer they do not have, and roughly 640 to 1100 suffer painful complications of the mammography technique. (Journal of Family Practice Vol. 58 No. 7 July 2007 p 521).
Concerns that physical manipulation or radiation exposure is responsible for causing malignancies has not been addressed by the medical establishment, nor has the speculation that needle biopsy can contribute to the spread of cancer been refuted.
So much money is at stake with the screening and treatment industry that the controversy regarding the risks and benefits of this procedure is certain to continue.
ACUPUNCTURE & HOT FLASHES
In a study of 29 postmenopausal women who experienced at least seven moderate to severe hot flashes a day, active acupuncture was found to significantly decrease the severity of nocturnal flashes (by 28%) compared to 6% in women given sham acupuncture.
The frequency of flashes was reduced by more in the active treatment group compared to the sham but not significantly so. (A randomized controlled pilot study of acupuncture for postmenopausal hot flashes: effect on nocturnal hot flashes and sleep quality. Fertility and Sterility, September 2006; Vol. 86: pp. 700-710).
ACUPUNCTURE & BREECH PRESENTATION
A study of the effectiveness and cost of moxibustion for breech presentation compared to standard care found that the percentage of breech presentations after moxibustion was 24.5% compared to 42% for standard care, and that if only 10% of women opted for moxibustion it would overall be more effective and less costly than standard care. (The effectiveness and cost-effectiveness of Breech Version Acumoxa compared to standard care to correct breech presentation. Focus Altern Complement Ther 2006; 11: 05).
STEROIDS FAIL THE TENNIS ELBOW TEST
Corticosteroid injections for tennis elbow were found to be less effective at a one-year follow-up than either physiotherapy or no treatment (wait and see).
Three groups of patients with tennis elbow were assigned to receive either local steroid injections or eight physiotherapy sessions plus home exercises and self- manipulation. A third group (wait and see) were told that the condition would soon resolve and that they should modify their daily activities.
At six weeks the steroid group showed the most improvement (78%) compared to 65% in the physiotherapy group and 27% in the wait and see group. However at one year, the steroid group reported 72% reoccurrence, while participants in both other groups had either much improved or completely recovered. (Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ, Nov 2006; 333: 939).
FREQUENT DRINKING BETTER FOR MEN THAN WOMEN
It appears that daily drinking of alcohol benefits men but not women. A Danish study of over 50,000 middle-aged adults suggests that while drinking once a week lowers the risk of coronary heart disease in men by 7%, drinking daily reduces it by 41%.
In the case of women, there is no apparent significant difference between weekly drinking (36% reduction) and daily drinking (35% reduction). (BMJ, May 2006; 332: 1244-1248).
"Is Anyone Thinking?" Department
Reconstructing Health Care, Part III
Our plan will lower annual health care costs by $2500.00 for a typical family. For Americans satisfied with their current health insurance, nothing will change except their costs will go down.
Americans will also be able to choose from a range of private health insurance options though a new National Health Exchange, which will establish rules and standards for participating plans. The Exchange will also include a new public plan that will provide coverage similar to the kind members of Congress give themselves.
Senator Barack Obama, "Affordable Health Care for All Americans", Journal of the American Medical Association, October 22/29, 2008 p. 1927
Not a group to let the grass grow under their feet, Congress is galloping along with its plans for “reform”. We now have a 1980 page document from the House of Representatives that is equally as obscure as the monstrosity produced by the Senate.
Even the description of the bill is suspect; “To provide affordable, quality health care for all Americans and reduce the growth in health care spending, and for other purposes”
Nowhere in this bill is “quality health care” defined. Nowhere is “affordable” defined.
Lots of room for mischief here.
Keep an eye on the broad authorization for “other purposes”, also, as these will likely involve a variety of mandates that are too controversial, or confused, to be explicitly described. Many unforeseen consequences will flow from this “emergency” legislation, even when it can be easily predicted that one outcome will be that a large number of fat cats become fatter.
It is also evident that no elected official is reading, much less understanding the implications of, this legislation.
Since the Founding Fathers did not have the wisdom to establish a requirement for term limits for the legislative branch, many of these individuals have had the opportunity to work their mischief for decades.
“The more you observe politics, the more you've got to admit that each party is worse than the other” - Will Rogers
And, as Mr. Rogers observed, each has outdone the other in their attempts to destroy the beneficial traditions of medicine.
All parties in Washington, whether republican, democrat, or something else, stretching back to the Roosevelt administration, have favored establishing control of all health care cash flow.
This has been a sure path to power and riches, and is ideally suited to creating the grandiose and pompous illusion of helping us “little people”.
As can also be observed, all parties are completely committed to the third party payment system, inasmuch as dealing with a few favored intermediaries permits the most efficient diversion of cash into the control of government pooh-bahs.
It is also much easier to corrupt a large cash flow than a hundred thousand smaller ones, which is one reason that organized crime also favors a single payer system.
The inevitable result of government’s heavy hand of regulation will be a clone of the centralized, limited option, lowest common denominator style of medicine so well perfected by the Soviet Union.
Americans who had only a small, bitter taste of this style of medicine with health maintenance organizations will find the full course difficult to stomach.
ENDORSED BY THE OLIGARCHS
Another clear indication that the path to “reform” is has already taken a corrupt turn must certainly be the support of the upper echelons of both the AMA and the AARP, both of whom see benefits for their own entrenched interests. These organizations have demonstrated a truly majestic ability to betray the principles and interests of those they purport to represent, physicians and those over 55, respectively.
And, without doubt, endorsement was available from the echelons even without reading and understanding the legislation.
As pointed out elsewhere in these pages, the AMA’s makes more money as it creates complexity out of its coding monopoly. A third party system is the key to their power and wealth. Rank and file members of this organization who are still conscious became aware that the executives of the AMA never consulted them about this endorsement of a program but were told, essentially,"never mind, just get your noses back to the grindstones and leave us to manage your interests".
As long as government cuts out a large part of the health care pie and serves it to their fat cat beneficiaries, the more wealth will trickle back to the pockets of politicians or expended in support of their favored enterprises and projects and campaigns.
The only interests that remain unrepresented are those of the practicing physician and the patient.
SMALL IS BEAUTIFUL
The only true reform that would benefit medical care would be to return all responsibility to individuals. Fat cats would argue that health care is too complex and expensive; but it has become so only because of the ponderous burden of profit driven regulation and corruption of patient and physician loyalty and good character.
If the unequal tax treatment of medical costs were eliminated along with the distorted effect of involving employers in the third party payment system, many of the problems we now have would disappear.
FIRE YOUR BOSS
Employers have never had legitimacy to determine medical options for their employees, as they have neither the expertise nor the correct incentive. Their involvement reflects a distortion created by the tax code 60 years ago, and this fundamental error has contributed much to our present dilemma. The goals of business are not consistent with the goals of medicine, as has been amply demonstrated.
If employers were an efficient and effective force for improving health, it would be more logical to give them control of patient’s food choices. Diet is at least as important to overall health as medications and surgery, yet few would demand the benefit of creating employer sponsored control of grocery shopping.
Let’s get your boss out of the business of making life and death decisions for you, as well as those that might lead to financial ruin. Deconstructing the employer based system will result in benefits for both business and the workers.
Eliminate the burdensome regulations and tax complications of these programs, and a major drain on business cash flow is eliminated.
Employees will benefit by more than $12,000.00 a year in direct costs, and thousands more in indirect relief from taxes, fees, copayments, and deductibles. They will not have to change doctors every few years after some human resource lackey finds a slightly cheaper program to force their employees into.
A REAL ALTERNATIVE TO FAKE REFORM
All payments to medical providers could be tax deductible for patients, as they are for businesses presently. Elimination of third party control of health care will eliminate the entire constellation of denials, copayments, deductibles, and preexisting condition scams.
Establishment of tax favored savings accounts will allow patients to pay directly for medical services and prescribed drugs and supplements. Deconstruction of the present Patients can establish tax favored savings accounts.
Doctors will save roughly $68,000.00 a year in staff and expense required to wheedle and cajole their rightful reimbursement from those who have no interest in either the patient’s benefit or the doctor’s skill.
All of the vast and wasteful expenditures of time and money to adhere to constantly changing third party requirements will disappear. This time and resources effort can then be directed to actual medical care and attention to patient needs, instead of mastering arcane codes and appeasing the arbitrary whims of insurance bureaucrats and their political footpads.
Returning economic clout to patients will quickly improve the present non responsiveness of practitioners whose poor performance derives from a focus on procedures rather than results. The true costs of treatment will be revealed as the layers of “value-subtracted” tax are purged from our system.
The 3 dollar urinalysis will again cost 3 dollars, not the 350 dollar “list” price charged that is eventually reduced to 12 dollars when it is eventually paid by the third party system six months later. Every cost will be subject to true transparency, not the present inflated and fictional "billing charge", obscured by layers of insider deals.
TAX CREDITS FOR PRACTITIONERS
Why should the giant medical industries and hospitals receive subsidies and exemptions from property taxes when small practices and individual practitioners receive none?
Equal treatment would go a long way to keeping doctors and other professionals in practice and supporting an alternative to industrial-style medicine. No reconstruction of the health care system will succeed without increasing the numbers of physicians, nurses, and others who actually have to provide the treatment and make the diagnoses. The ranks of these highly trained and irreplaceable workers are shrinking and not being replenished.
BIG EXPENSES CAN BE SUBSIDIZED MUCH CHEAPER THAN THE PRESENT PATH OF “REFORM”
Even when inflated costs return to Earth, there will still be some very expensive procedures and drugs. Long hospitalizations and rehabilitations will require substantial cash flow.
Nonetheless, in a country where low interest loans and subsidies exist for people who want to buy a $35,000.00 car, or a $250,000.00 house, it is possible to create a system of low interest or no interest financing so that people can be responsible for their choices, and still pay for medical procedures that exceed their cash flow for one reason or another. Those who qualify will still have Medicaid.
Seizure of all the monies and property of the robber baron medical "insurance" industry and their fat cat executives will also establish sufficient funding for the aforementioned loans, as well as a chance for every citizen to enjoy at least a partial cash return of the wealth that has been stolen from them for so many decades.
Next: Re-educating Physicians and Patients