News News News
WARRIORS IN SHORT SUPPLY
A lot of people are fantasizing about being soldiers these days.
The video game Modern Warfare 2: Call of Duty sold almost 5 million copies in its first 24 hours—the biggest debut in entertainment history. In related news, the U.S. military has a problem: a soft recruiting pool. Three out of four target-age Americans (ages 17 to 24) fail to meet the baseline requirements in education and physical fitness to even go to boot camp, let alone reach a battlefield.
These findings by a group of 100 active and retired military commanders, in a report called “Ready, Willing and Unable to Serve,” exposes a shameful weakness and loss of manliness in America and the West. In a dangerous world, this trend will end in ruin. The armed forces need troops. They are offering higher pay, more comfortable accommodations, increased privacy, bonuses, easier entrance requirements.
Meanwhile, standards for recruits are dropping. Drill sergeants have been told to yell less and mentor more. Privates are given more sleep, personal time, food and dessert— and less stress. The Army is trying to avoid injuries by replacing some of the running with stretching. Many soldiers have become overweight.
In one training exercise, trainees were “ambushed” aboard a truck, and rather than jumping down five feet to the ground to engage the enemy, they waited 10 seconds until a step stool was brought around back for them. The strong, robust warrior is disappearing. Not even America’s unmatched military spending can compensate for a society—and a soldiery—being swallowed up in soft selfishness, immorality and weakness. (The Trumpet Weekly Nov 21, 2009 p 8)
DEMAND FOR ARTIFICIAL JOINTS DRIVEN BY OBESITY
Researchers at the 2009 annual meeting of the American Academy of Orthopedic Surgeons presented two different studies showing that the need for hip and knee joint replacement surgery will double within the next ten years.
The surgeons point to increasing obesity as a factor causing joint failures in younger patients: by 2011 more than half of the patients requiring hip replacements will be under 65, and this will also be true for knee replacements by 2016. Currently, over 700,000 total hip and knee surgeries are performed in the U.S. every year.
The number of surgeons will be insufficient to meet future demand, creating long waits and rationing. The researchers estimated that in 2016, this shortage will prevent 46 percent of needed hip replacements and 72 percent of necessary knee replacements. (Alternatives, Nov 2009, p 38)
TELMISARTAN LOWERS BLOOD PRESSURE BUT NO OUTCOME BENEFIT
A randomized study of 20,332 patients indicated that treatment with the beta blocker telmisartan (Micartis) documents a variety of adverse effects, but the drug did nothing to prevent stroke, heart attack, congestive heart failure, cardiovascular deaths, or new onset diabetes.
The patients were 55 or older, and had already had an ischemic stroke in the previous 90 days. After the first 6,000 patients, the protocol was changed to allow those 50 to 54 to participate if they had a stroke within 120 days and if they also had two additional risk factors. (PRoFESS study: N. Engl. J. Med. 2008:359(12):1225-1237)
One of the reviewers of the study, Andrea Darby-Stewart, M.D., of Scottsdale, while reviewing this 2008 study, wonders “When a statin shows a minimal benefit in a flawed study, with a [number needed to treat to obtain benefit in one person] of 250 in patients with an elevated C-reactive protein level (the JUPITER study), it is given advance publication in the New England Journal of Medicine, the American Heart Association calls a press conference, and everyone in the media reports the new miracle breakthrough. When a standard therapy that everyone has bought into fails to provide any benefit, it is hurriedly buried in the graveyard of obscure news stories.” (American Family Physician Nov 15, 2009 p 1045)
Very well put, Dr. Darby-Stewart! Few physicians, and even fewer patients, want to find out that drugs they have been taking for years, at great expense and some risk, are not effective.
Publication bias occurs at many levels, with industry funded medical journals and medical schools that fall all over each other to embellish their benefactors and present themselves in the most heroic light, and researchers whose income and status solely depend on obtaining funds (often through medical schools or “non-profit” foundations) for these astoundingly expensive studies.
The mass media (also making big bucks from those “direct to consumer” ads) has little interest in featuring findings that cannot be characterized as “spectacular” or “another weapon in the war against….” whatever, so you will rarely hear about studies that undermine blind faith in medical technology. [Ed.]
SENATE FAILS TO FIX MEDICARE
Physicians who see Medicare patients are paid by a system known as the “sustainable growth rate (SGR)” formula, created by those economic wonders in Washington. This equation has no relationship to reality, so it has needed a “fix” from Congress every year. Without this “fix”, physicians who see Medicare patients will face a 21 per cent pay cut in January 2010. The “Medicare Physician Fairness Act of 2009” would have reset the SGR to zero and eliminated the $245 billion in debt that has accumulated from Congressional “fixes” over the past six years. (Am Fam Phys Nov 15, 2009 p 1039)
The Alliance for Aging Research predicted in 2002 (Medical Never-Never Land: Ten Reasons Why America is Not Ready for the Coming Age Boom) that an additional 36,000 gerontologists will be needed by 2030 to treat the increased number of Americans who will be 65 and older.
The Alliance report states that “low numbers of geriatricians, current incentives for geriatric specialty practice, small numbers of fellowship spots, and the decline of student interest” means that “producing 30,000 new geriatricians by 2030 is improbable.” For the few primary care doctors who remain in practice, many inherent factors will make it harder to address the more complex and demanding disorders that present late in life, with the additional disincentive of Medicare’s arbitrary fee reductions (see above), incomprehensible regulations, and crippling legal sanctions and fines.
Congress has plenty of steam for “reform” but none for fixing the problems they have already created.
STRESS & FERTILITY
Women who had not ovulated for six months or longer (due to functional hypothalamic amenorrhea consequent to raised cortisol levels) were offered 20 weeks of cognitive behavior therapy to identify and resolve sources of stress in their lives.
Extraordinarily, 80% of the women started to ovulate again, compared to 25% of women randomized to a no-treatment group. The authors state that exercise, which is used by many women to counter stress, in fact can raise cortisol levels, whilst simply “lounging around” has little impact.
In a separate study reported to the conference, an Israeli team assessed the effects of laughter on IVF implantation success. Of 93 women who were entertained by a clown for 15 minutes after embryo transfer, 33 conceived, compared to 18 of 93 who did not receive the “clown treatment”. (22nd annual conference of the European Society of Human Reproduction and Embryology in Prague, Czech Republic, 20 June 2006).
CHINESE DOCTOR STIRS UP STORM
Professor Zhang Gongyao stirred up a hornets’ nest when he started a petition calling on the government to stop supporting Chinese medicine. He said that TCM had no rational foundation, was unscientific, used poisons and wastes in its treatments and posed a threat to biodiversity and conservation. Other scientists supported Zhang, calling TCM “backward” and “metaphysical”.
However a Health Ministry official responded, calling Zhang “ignorant” (of Chinese history) and stating that TCM was a “treasure of Chinese culture and indispensable”. The State Administration of Traditional Chinese Medicine called for an end to the “farce of repudiating TCM and going against our ancestors” and announced increased investment in TCM development and said that it wants to apply for World Intangible Heritage status for the system which accounts for nearly 300 million patient visits a year in China.
Now Chinese lawmakers have called for a law to enshrine the role of traditional Chinese medicine and improve the structure of the TCM healthcare system and promote education in, and the scientific study of, TCM. And the Chinese government has announced that more support will be given to bolster the development of TCM (the TCM industry has a total production value of around $10 billion U.S. dollars a year). China’s TCM governing body has said that it will set up a unified traditional Chinese medicine production and prescription standard system during the 2006-2010 period. China has over 3000 traditional medicine hospitals (310,000 beds).
VEGETARIANISM IS AN INTELLIGENT CHOICE
It is known that children who score higher in intelligence tests have a lower risk of coronary heart disease in later life.
It now appears that these children are also more likely to be vegetarian as adults, a dietary choice that is associated with lower cholesterol levels and a reduced risk of obesity and heart disease. Of 8179 adults aged 30 whose IQ was tested at age ten, 4.5% had become vegetarian.
The vegetarians were more likely to be female, to be of higher occupational social class and to have higher academic or vocational qualifications than non-vegetarians, although these differences were not reflected in their annual income, which was similar to that of non-vegetarians. (IQ in childhood and vegetarianism in adulthood: 1970 British cohort study. BMJ, doi:10.1136/bmj.39030.675069.55 (published 15 December 2006).
ACUPUNCTURE FACILITATES NATURAL BIRTH
Acupuncture significantly reduces duration of labor and reduces the need for augmentation of labor with contraction-stimulating drugs.
A study randomized 100 women with spontaneous rupture of membranes at term to either acupuncture or no acupuncture. Treatment was individualized on the basis of traditional Chinese medical diagnosis and used three points per patient from a pool of nine possible choices. Treatment principles applied were to increase energy, soften the cervix and open the Conception vessel.
Although time from membrane rupture to delivery did not differ significantly between the groups, length of active labor was significantly reduced in the acupuncture group by a mean difference of 1.7 hours. In addition, significantly fewer patients in the acupuncture group required oxytocin (used to stimulate contractions) for longer than two hours.
Medical induction of labor was eventually necessary in 15 acupuncture patients and 20 controls. When induction was carried out, women assigned to acupuncture completed the active phase of labor in half the time compared to controls, a statistically significant difference. (Acupuncture administered after spontaneous rupture of membranes at term significantly reduces the length of birth and use of oxytocin. A randomized controlled trial. Acta Obstet Gynecol Scand. 2006;85(11):1348-53).
YOUNGER SIBLINGS WITTIER
Younger siblings tend to be funnier, according to a study of 1000 children for Ocean Village Laughter Lines by Professor Richard Wiseman. He suggests that younger children in a family tend to have to compete for parental attention and being witty is one strategy. The study also found a gender difference with 70% of females finding it hard to remember a punch line compared to 50% of males. Previous research has found that younger siblings are more adventurous and more rebellious.
"Is Anyone Thinking?" Department
Reconstructing Health Care, Part IV
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
A RETURN TO THE ROOTS OF MEDICINE
The United States is being treated to an expensive spectacle that purports to be about medicine, but is really about the control of two resources: money and power. As these are the two most powerful drugs known to our elected “representatives”, as long as they can “pay” for it with other people’s money, there will always be an ever-increasing demand.
Acquiring more of these two inebriants is the sole reason for their efforts. Any resemblance to actual concern for patient welfare or the future of medicine is purely theatrical effect.
How do we know this? Merely by looking at the end results of all their efforts over the past 70 years.
In every case, both here and abroad, and all throughout history, State interference with patient physician relationships has resulted in degradation and out of control expense. Some State systems are worse than others, at least providing a template to indicate directions that have not worked.
Presently, our government is preparing to complete its seizure over a vast number of resources that make up the “health care sector’. Even if the results of this first attempt are incremental and provide only a morsel of sustenance to stimulate the appetite of our elitist plutocrats, there will soon be a second helping, and then a third.
Like hungry dogs, the elitists are always starving for more power and wealth, and this luscious pear is just coming into reach. There will also be an added benefit: the opportunity to cut deals that will benefit their political and industry cronies.
Their mouths water with the thought of possessing this prize: They hope for it: They plot for it: They talk about it in vast and grandiose speeches for C-span and the Congressional Record, and in whispered conspiracies behind closed doors:
They set their factotums to write paragraphs of statutes that will snare this juicy reward, with only a moderate effort to hide their deed within the obscuration of legislation and legal doubletalk.
Their thoughts and actions are so obsessed with this Project, and the rewards potentially so great, they are even staying late in their lairs to plot strategies to seize this suddenly low hanging fruit.
Quickly, quickly, they must scramble to enact these changes and procedures in the dark of night and the blackness of hidden motives so as to have them all wrapped up as a surprise for Christmas.
And, when the “gift” is unwrapped and finally revealed, the excited children will discover that they did not receive a toy after all, but rather the promise of a toy maybe sometime in the future. After all the pretty wrappings are removed, the toy will be seen to be damaged and not a shiny and pretty as promised.
Realization will dawn that the price for the toy is far greater than expected, and will have to be paid for right now, whereas the promises will be kept sometime in the future.
And subject to change.
THE PRESENT COURSE
As it stands, the present trajectory leads to an industrialized system of medicine where all treatments will be limited by bureaucrats who will decide which treatments and disorders will be paid for, i.e.; “covered”; much as it is today, but to a far greater degree. There may be some people with what passes for medical education on these government-established panels of experts, but none will be the sort of clinicians that have actual practice experience. And none will have any experience in actually running a practice.
By exclusive focus on expanding an elaborate payment mechanism, our elitists are hiding a few inconvenient truths:
YOU WON’T HAVE A DOCTOR
Regardless of what fantasies are spun in the Nation’s capitol, there are too few capable primary care physicians to meet existing needs. Those that are, are retiring early, and fewer students are entering the field. You may have “insurance” mandated by the pooh-bahs, but there will be no one to accept it.
According to an article in the December 2009 Journal of Family Practice (p 633), the number of medical school graduates who choose family medicine decreased 52 percent from 1997 to 2006, and the percentage of internal medicine residents entering primary care dropped 63 percent in the same period.
In 2005, the average full time primary care practitioner had a “panel” of 2300 patients, which is too many for a single physician to provide adequate care; see Am J Public Health 2003; 93:635-641, and Ann Fam Med 2005; 3:209-214.
In areas of “shortage” where primary care physicians are fewer, even larger numbers of patients are expected to find a “medical home”. In a 2006 national survey, little more than 1 in 4 adults age 18-64 said they could easily reach their doctors by phone, get after hours care, or schedule timely office visits.
Solutions offered by the medical establishment include “virtual visits” via telephone or email and training more non-physician “providers”, but nothing that will alter the increasing needs of an aging population with more chronic disorders and many complex drug regimens. Certainly the prospect of being treated by a decreasing number of dumbed-down “providers” bodes ill.
ANOTHER REASON PHYSICIANS WILL GIVE UP TREATING THE ELDERLY, AND THEN EVERYONE ELSE
In the name of “eliminating waste”, physicians who treat Medicare patients face yet another level of harassment; a new system of “recovery audit contractors” dissuades participation by creating a league of inspectors who will inspect charts, invade privacy, and recover “overpayments”.
Doctors in 2010 will face Recovery Audit Contractors, Medicare Administrative Contractors, Comprehensive Error Rate Testing Contractors, Office of Inspector General Contractors, and Program Safeguard Contractors.
“Surprise” as well as scheduled inspections by the contractors will certainly disrupt practices, divert needed personnel, and waste time. Errors will need to be “appealed”.
The costs for this will be borne by physicians, and, of course, the taxpayer. Whether 10 billion dollars is “recovered” over 5 years, as promised, is doubtful, though there will always be a way to massage the numbers to make this program look good.
Of course, five sets of inspectors will hardly be sufficient after "reform" is established.
THE REALITY WILL SET IN SOON
As visualized by the elitists, your care will be provided by technicians, reading computer screens and determining how to allot you the treatments that have been “approved” by the quasi-governmental rules now being so obscurely created. This may have very little to do with what you need, but unless you are a fat cat, you will not be permitted options, nor will you be permitted to “opt out” of the system.
Remember; for citizens over 65, the choice is any system they want, as long as it’s Medicare. This is also the model for "reform".
THE ROAD TO NOWHERE
No matter what payment system is in place, the present concepts of disease as a mechanical breakdown that can be “fixed” with drugs or surgery are delusions. An obvious example is the “obesity epidemic”. Behaviors that are far removed from the influence of physicians are responsible for large segments of pathology and their associated costs in money and suffering.
Progress with diabetes, heart disease, infectious disease, and accidental and criminal induced trauma will not be affected at all by “medical homes”, “evidence based medicine”, eliminating “waste”, “pay for performance” or any of the popular mantras promoted by the political and medical establishments because their origins are rooted in choices that patients make.
Significant changes in peoples’ behavior, character, and level of personal responsibility would be required for real progress in addressing illness and death.
Medicalizing diseases such as overeating and alcoholism is not only wrongheaded, but ineffective. Expecting physicians to address domestic violence, social injustice, poor parenting, and childish behavior in adults is as absurd as expecting us to control the weather.
Nonetheless, delusional agendas like these are constantly generated by congressional aides, think tanks, medical “experts”, and social engineering organizations.
IT COULD BE DIFFERENT
Eliminating third party interference and returning to the traditional roots of medicine would allow a reversal of some of these pernicious trends, but medical education would have to revert to its roots also.
The backwards looking curriculums of the 19th century, still taught at every U.S. medical school, would have to be updated to a truly evidence based system. Fossilized thinking and brain dead faculty of medical schools would have to be purged, an extremely unlikely proposition.
But what would it be like if medical school faculty as well as medical students were chosen at least partly on the basis of their character, and this quality encouraged and reinforced during training?
My own experience with establishing a minimum level of good character in medical students for my electives met with both hostility and failure, largely as a reflection of the absence of good character among the faculty in the school where I was teaching.
But this doesn’t have to be the case. Degradation of character did not seem to be so prevalent when I started offering electives, but only after about 16 years. The quality of students may have even improved in the years since I discontinued offering electives in Oriental medicine.
Nonetheless, a new method of choosing and evaluating medical students would be necessary to reverse the present trends.
An unexamined fundamental issue, much more important than deciding how much we will pay them is determining what qualities and skills we require of physicians. Do we want them to be scolds, wellness coaches, team players, problem solvers, cash generators, data generating robots, pharmaceutical salesmen, marriage counselors, cheerleaders, technicians, providers, gatekeepers, security consultants, or trustworthy advocates?
Each of these roles and many more have been proposed and/or mandated by various third parties who control the patient physician relationship. In contrast, traditional cultures have clear guidelines for both selecting and educating their embedded healers, as well as the skills expected of them.
In the modern world, the only two parties who have legitimate and valid moral and economic claim to decide these matters have been disenfranchised; physicians and patients.
There isn’t a single medical school in the United States that provides would-be physicians with an education in the classic foundations of medicine outside of the obsolete 19th century model. It is indicative that not one student in 18 years could provide me with a correct definition of “medicine” as simple and clear as that which any apprentice to a Tibetan doctor could provide in the 8th century.
Not a single medical school teaches proven skills to help students develop compassion and wisdom. None provides training in skills that physicians need to establish and maintain mental clarity and equanimity. Classical Oriental medical training includes all of these.
In contrast, every medical school in the United States requires all prospective students to spend years in the study of pointless and irrelevant "prerequisites".
Modern training for doctors is almost entirely focused on the transitory skill set needed to prescribe drugs and surgery, much of which becomes obsolete, or is found to be incorrect within years of their acceptance as dogma. Wisdom practices that have remained unchanged since before the time of the Greeks are entirely excluded from modern medical education.
Elimination of useless and obsolete subjects from the curriculum would provide time to teach physicians to be problem solvers and to focus on the patient for their information, rather than an error prone technology. In a world where the priority is to build a long term relationship rather than a short term billing opportunity, there will also be time to teach patients how to have a productive relationship with their doctor.
Established long term relationships in medicine have become so rare that the average patient doesn’t even know what is expected of them. They have been brainwashed into accepting the commercial model of a doctor “provider” and so are incapable of imagining anything beyond a profit and loss model, much as they might with a salesman or a banker. Trust, so essential to both parties in a therapeutic relationship, was an early casualty to the “business model” of medicine.
Both physicians and patients have the power to restore the path of medicine to one of integrity, trust, and effectiveness, but it will require a change in all of our attitudes and expectations. Indeed, we are the only parties who can change the present destructive trajectory. As miniscule as the chances are, the only path to a medical system worthy of the effort will come from rejecting the exploitative model imposed by corrupting outside interests.
Calling Dr. Kafka
The average physician has to spend $68,000.00 a year and uncountable hours puzzling out and trying to comply with regulations, rules, and deadlines developed by insurance companies to deter, delay and deny payment for medical care.
One of the best methods available is to confound the doctor with silly and illogical reasons for denial. The more absurd, the better, as it makes it impossible to argue from any position of common sense.
One which I have been receiving recently characterizes me as a "provider not found". The fact that these denial letters clearly list my name and address as the "provider" that is "not found", and that these are delivered easily and openly by the United States Postal Service to my address of record proves that there are some bureaucrats who have a wonderful sense of playfulness when it comes to justification for stealing other people's money.
Another example of this type of good natured tomfoolery is the denial letter shown above.
Here, the claim cannot be processed because the name of the patient is "illegible". The fact that the "illegible" name of the patient (which I have blacked out for privacy reasons) is printed and spelled correctly in 15 point bold at the top of the letter does not trouble the insurance reviewers. Rigorous training has allowed them to offer up such hogwash without even the trace of embarrassment that would trouble anyone who has even a smidgen of good character or integrity. People with the latter attributes are not welcome in the insurance industry.
How reassuring it is that so many decisions regarding your well being and perhaps even your life are, by law, entrusted to organizations such as these.