Planning the Patient-Centered Health Plan for America


Current Issue:

6. Misdirection in Healthcare: Two Trillion Dollars per year wasted. Graphic Illustration by Paul Samuelson Showing How Limiting the Supply of Doctors Causes Higher Prices. (Source: Samuelson 1992

Market opponents have not only claimed there are too many doctors but also too many hospital beds. In 1972, the federal government started restricting the supply of hospitals with certificate-of-need (followed by repeal of the Hospital Survey and Construction Act in 1974). Alaska House of Representatives member Bob Lynn argued the true motivation was “large hospitals are … trying to make money by eliminating competition” under the pretext of using monopoly profits to provide better patient care. From 1965 to 1989, the number of hospital beds and occupied beds (per population) declined by 44 and 15 percent, respectively (Friedman 1992).

Today, the U.S. and Canada have less than 25 doctors and 30 hospital beds (per 10,000 population), compared to over 35 and 50, respectively, in most countries in continental Western Europe.

Mark Pearson, head of Division on Health Policy at The Organization for Economic Co-operation and Development (OECD), discussed possible reasons the U.S. spends more than two-and-a-half times per person more than most developed nations in the world, including relatively rich European countries: “The U.S. has fewer physicians and fewer physician consultations relative to its population. The U.S. also has fewer hospital beds for its population size and shorter average stays in hospital relative to other countries. Indeed, the lower numbers of physicians could help explain why they cost more; there is less competition for patients.” He adds that universities in other countries are still able to attract the best students to medicine (Kane 2012).

Solutions

The U.S. health-care market appears to behave according to laws of supply and demand (at least until the 1980s). Assuming government subsidy of the elderly and poor serves the public good, the cause of the “U.S. health care cost crisis” appears to be that government didn’t allow the supply of doctors and hospitals to respond to increased consumer demands. Politicians from both major political parties created a self-fulfilling prophesy by assuming markets couldn’t work in health care.

The obvious solution is to increase the supply of physicians and hospitals to meet demand. Unfortunately, if medical schools doubled their class sizes by next year, it could still take over 20 years to achieve the number of doctors relative to population found in continental Western Europe. Competition could be achieved quicker by relaxing the licensing requirements placed on para-medicals (e.g., nurses), and possibly also foreign educated doctors, to compete with U.S. physicians to the degree to which they are qualified.

If Obamacare is still necessary, the additional demands created by subsidizing even more consumers will require even more supply. Regardless, all major health care policies implemented by the U.S. government after 1965 will likely need to be repealed and the “playing field” leveled so new entrants can compete against previously subsidized and now entrenched providers.

Supply and demand graphs can illustrate the supply shift needed to balance the demand shift since 1965 (Figure 11). Once consumer demand for quality has been satisfied, the supply shift will result in more quantity of medical care supplied, greater access to medical care, lower prices, increased efficiency and real growth. By the definition of price-inelastic demand, total medical expenditures must decrease (e.g., from spending area I to II).

During the past 48 years, the U.S. has paid a heavy price for denying potential competitors entry into the health-care marketplace. The nation has likely wasted the equivalent of nearly two trillion dollars per year (in 2012 dollars). The costs are bankrupting the country as the leading contributor to the $16 trillion national debt (through spending on Medicare, Medicaid and Social Security). Health care is also the number one barrier to America’s global competitiveness (according to Edward Deming), and the largest contributor to financial stress and personal bankruptcies.

Read the entire article: https://mises.org/wire/how-government-regulations-made-healthcare-so-expensive

Also read the physician component: https://www.forbes.com/sites/realspin/2013/04/03/whos-to-blame-for-our-rising-healthcare-costs/#158fa120280c

Further Reading

AAMC (Association of American Medical Colleges). 2013. Medical School Admission Requirements Handbook.

Alford, Robert. 1975. “Health Care Politics: Ideological and Interest Group Barriers to Reform.” University of Chicago Press. xiv+294.

Baker, Lawrence. 1994. “Does Competition from HMOS Affect Fee-For-Service Physicians?” National Bureau of Economic Research working paper.

Editor. July 19, 1983. The Wall Street Journal. Editor. September 21, 1983. Wall Street Journal. 

Evans, Stanton. 1977. Human Events.

Friedman, Milton. 1962. Capitalism and Freedom. University of Chicago Press. 208 pages.

Friedman, Milton. 1992. Input and Output in Medical Care. Hoover Press. 16 pages.

Fodeman, Jason. April 7, 2011. “The New Health Law: Bad for Doctors, Awful for Patients.” Galen Institute. 

Gerber, Alex. 1971. The Gerber Report. David McKay. New York. 242 pages.

Goodman, Louis and Norbeck, Timothy. April 3, 2013. “Who’s To Blame For Our Rising Healthcare Costs?” Forbes.

Hazlitt, Henry. 2013.  Economics in One Lesson.

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Well-Meaning Regulations Often Worsen the Quality Of Care (QOC)

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Previous Issue:

When The Digital Revolution Took a Wrong Turn

The U.S. government claimed that turning medical charts into electronic records would make health care better, safer and cheaper. Ten years and $36 billion later, we became aware that the digital revolution had taken a very bad turn.

Death By 1,000 Clicks: Where Electronic Health Records Went Wrong By Fred Schulte and Erika Fry, Fortune March 18, 2019

Which brings us to the strange, sad, and aggravating story that unfolds below. It is not about one lawsuit or a piece of sloppy technology. Rather, it’s about a trouble-prone industry that intersects, in the most personal way, with every one of our lives. It’s about a $3.7 trillion health care system idling at the crossroads of progress. And it’s about a slew of unintended consequences — the surprising casualties of a big idea whose time had seemingly come.

The Virtual Magic Bullet

Electronic health records (EHR) were supposed to do a lot: make medicine safer, bring higher-quality care, empower patients, and yes, even save money. Boosters heralded an age when researchers could harness the big data within to reveal the most effective treatments for disease and sharply reduce medical errors. Patients, in turn, would have truly portable health records, being able to share their medical histories in a flash with doctors and hospitals anywhere in the country — essential when life-and-death decisions are being made in the ER.

But 10 years after President Barack Obama signed a law to accelerate the digitization of medical records — with the federal government, so far, sinking $36 billion into the effort — America has little to show for its investment. Kaiser Health News (KHN) and Fortune spoke with more than 100 physicians, patients, IT experts and administrators, health policy leaders, attorneys, top government officials and representatives at more than a half-dozen EHR vendors, including the CEOs of two of the companies. The interviews reveal a tragic missed opportunity: Rather than an electronic ecosystem of information, the nation’s thousands of EHRs largely remain a sprawling, disconnected patchwork. Moreover, the effort has handcuffed health providers to technology they mostly can’t stand and has enriched and empowered the $13-billion-a-year industry that sells it. . .

Instead of reducing costs, many say, EHRs, which were originally optimized for billing rather than for patient care, have instead made it easier to engage in “upcoding” or bill inflation (though some say the systems also make such fraud easier to catch).

More gravely still, a months-long joint investigation by KHN and Fortune has found that instead of streamlining medicine, the government’s EHR initiative has created a host of largely unacknowledged patient safety risks. Our investigation found that alarming reports of patient deaths, serious injuries and near misses — thousands of them — tied to software glitches, user errors or other flaws have piled up, largely unseen, in various government-funded and private repositories. . .

David Blumenthal, who, as Obama’s national coordinator for health information technology, was one of the architects of the EHR initiative, acknowledged to KHN and Fortune that electronic health records “have not fulfilled their potential. I think few would argue they have.”

The former president has likewise singled out the effort as one of his most disappointing, bemoaning in a January 2017 interview with Vox “the fact that there are still just mountains of paperwork … and the doctors still have to input stuff, and the nurses are spending all their time on all this administrative work. . .

Doctor burnout: Many doctors say they spend half their day or more clicking pulldown menus and typing rather than interacting with patients. . . Web of secrets: Entrenched policies continue to keep software failures out of public view. Vendors of electronic health records have imposed contractual “gag clauses” that discourage buyers from speaking out about safety issues and disastrous software installations — and some hospitals fight to withhold records from injured patients or their families. . .

Read more . . .

Kaiser Health News and Fortune Magazine collaborated on this joint investigation for three months. Fred Schulte is a senior correspondent for KHN. Erika Fry is an investigative reporter for Fortune.

Only certain images can be republished by partners. Email KHNweb@kff.org for more information.

This story can be republished for free (details).Editor’s Note: We can vouch that important records were readily available from doctor to doctors in most of our professional lifetimes. After the digital revolution along with the Health Insurance Portability and Accountability Act (HIPAA) this was impossible even in emergencies. Records were withheld while patients could be dying on the ER table until a signed release was delivered.

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Well-Meaning Regulations Often Worsen the
Quality Of Care (QOC)
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Past Issue:

The “New” Medical Morality: Hippocrates or Bioethics?

By Jeffrey Hall Dobken, M.D., M.P.H.

David Rothman, the author of “Strangers at the Bedside,”1writes that the most “distinguishing characteristic of medical ethics [is] the extent to which it was monopolized by practicing physicians, not by formal [trained] philosophers.…”

He asserted that serious social, behavioral, and cultural issues had to be confronted. These issues served as the basis for the development of bioethics and for attacking traditional Hippocratic medical ethics.

Medical ethics discussions of the 21st century have become partitioned as political, social, religious, cultural, academic, economic, governmental, and business issues, while attention to the actual medical ethical content of any given patient-specific circumstance may be proscribed or very narrowly defined.

The notion of American “healthcare reform” has empowered a community of non-medically as well as medically trained philosophical theorists, also called “bioethicists,” as the stewards of progressive medical ethics and thus the guardians of medical care. This is a complex, interwoven story and not simply, as an ethics argument might imply, a simple formulaic method establishing “right” from “wrong.”

The “Failure” of Traditional Medical Ethics

Jerome Kassirer, former editor of the New England Journal of Medicine, articulated in 1998 that the reorganization of healthcare (referring to managed-care organizations and the Clinton Administration’s proposed healthcare reform policies) had profoundly influenced physician roles, responsibilities and loyalties.2 Kassirer suggested then that American physicians were unable to balance the kind of care delivered against the cost of care, creating an inequity between fee-for-service patients, covered patients, and noncovered patients, and that only outside (central) authority could craft a solution. Kassirer concluded that “until we physicians demanded a national health system (single payer), there could be no equity” and that our medical delivery system was, in fact, unethical.3 This style of rhetoric attracted a following of academics and other supporters, some trained medical professionals and some not, to advance bioethics and its role in furthering “health care reform.”

Kassirer’s derogation of American medicine has been tested in the crucible created by the passage of centralized healthcare financing/insurance reimbursement reform, the Patient Protection and Affordable Care Act (PPACA or ACA). Along the way, bioethicists have volunteered their expertise and have, in large measure, enabled the transition from Hippocratic ethics to post-modern bioethics.

I now witness and experience the results as both a physician and a patient with a terminal disease. My case raises questions such as, “Is this really the best professionals can do?” and, by extension, “Has replacement of traditional Hippocratic ethics actually improved patient care?”

Since the enactment of PPACA and the subsequent remodeling, re-assigning, and displacement of the physician’s role, the probability that a stranger will be at the bedside during the moments of critical decision-making or terminal crisis predicts that classic Hippocratic values will likely not apply. Instead, the decision process will pass through current (sometimes mandated) bioethics guidelines.4 In this context, the neo-discipline of bioethics must be examined for moral effectiveness as well as clinical outcome. Perhaps the more acute question should be: Whose needs are being served, or whose interests being protected—those of the patient, the “system,” or the bioethics community? What is the actual moral, ethical goal?

Ethical Conflicts and Dilemmas

Framing ethical questions has passed from the physician to the bioethicist, medically trained or not, and falls into two broad categories: what decision is “needed,” and who should make the decision. Consider the hopelessly complicated and acrimonious debate surrounding the management and care of persons with life-limiting diagnoses and prognoses. The modification of language from “physician-assisted suicide” (PAS) to the “more acceptable” euphemism “physician assisted death” (PAD) characterizes how the bioethics community controls the lexicon and gains ownership of an issue,5 while marginalizing the physician.

In analyzing the results of their approach, bioethicists do not consider the outcome for the patient. Rather, they ask, “How effective is this bioethical approach?”  . . .

Issues such as theistic beliefs, sexual identity, marital definition and fidelity, debate about rights, social “injustices” (or, broadly, “justice”), racial harmony, definition of honor and truth-telling, and fidelity to a code, have all morphed into circumstantially defined concepts. Moreover, our dominant post-modern values definitions often seem to be conflicting or evolving (such as “gender identification,” sexual orientation, diversity issues, white privilege, black privilege, personal responsibility, illegitimacy, motherhood vs. womanhood, etc.). This moral quicksand predicts confusion in general conduct and fosters intergenerational sociocultural conflict,6 which then leads to the loss of a medical moral compass.

The Premises of Bioethics

The four core principles of bioethics are patient autonomy, provider beneficence (doing “good”), provider non-maleficence (doing no harm), and justice (treating equal cases equally). Tom Beauchamp, Ph.D., and James Childress, Ph.D., developed these four principles as derivative replacement values in their critique of what they considered to be an outdated and outmoded Hippocratic Oath, which in their view had been lost or diluted over time.7

Bioethicists consider themselves politically diverse guardians of social justice, and ultimately stewards of correct thinking and ethical experience. As such selfless, incorruptible individuals, they consider themselves well positioned to lecture those of us less educated in moral matters.1

The Evolution of Bioethics

In the mid-1960s Beauchamp and Childress provided debate rules with their core principles that established a checklist to solve moral ethical dilemma, with a focus on social and cultural issues.8 These principles have evolved to control how bedside medical ethics are to be applied in the progressive, post-modern, post-Hippocratic era.

Bioethics defines itself as the field of study of the moral dimensions of the life sciences, derived from multiple ethical modalities in an interdisciplinary setting9 and carried out by scholars who migrated to the field from diverse academic disciplines. The majority of the original academic philosophical scholars were not medical professionals, but moral philosophers, theologians, clergy, attorneys, hospital administrators, nurses, therapists, and others. Their academic degrees were in law, business, economics, health policy and management, public health, social science, political science, or allied health sciences such as pharmacology or nursing.

A short list of the ancient and contemporary philosophical approaches used to fabricate the ethical foundations of bioethics was synopsized by Diego Gracia.10 The list demonstrates just how arcane and inaccessible the field is for those not intimately literate in pedantic philosophy: “phenomenology, hermeneutics, existentialism, care ethics, gender ethics, virtue ethics, communitarianism, discourse ethics and deliberate ethics have all been used to examine and explore medical ethics.”10 Expert bioethicists distinguish themselves from general members of society using language patterns or shibboleths.

An ex-president of the American Society of Bioethics and Humanities (ASBH), Mark Kuczewski, Ph.D., advanced that bioethicists serve as surrogates for the general public when issues of “ethical uncertainty” arise.8 From the website of the ASBH:

The Society is an educational organization whose purpose is to promote the exchange of ideas and foster multi-disciplinary, inter-disciplinary, and inter-professional scholarship, research, teaching, policy development, professional development, and collegiality among people engaged in all of the endeavors related to clinical and academic bioethics and the health-related humanities.11

The extension of this notion of an exchange of ideas, a “social ethical discussion,” has evolved to co-opt medical database facts. Use assessments in the bioethics paradigm balance “cost versus value”12 calculations by the Centers for Medicare and Medicaid Services (CMS) and the insurance payers. Acquisition of the medical database (lab tests, radiological assessment, biopsy, etc.) and treatment regimens (pharmacological to surgical to rehabilitation, etc.) have likewise been subject to bioethics scrutiny and judgment.13

The means to address ethical uncertainty, as defined by the bioethics community, is conceptualized as analytical thinking that is open to multiple interpretations and is based on a set of standards. These standards are set forth in the core competencies that ASBH members are expected to master and teach at the university or medical school level. There is also a specific code of conduct to which bioethicists are expected to adhere.14

The expectation of uniformity and conformity to this code contradicts any pretense of political diversity. There is demonstrable unanimity of techniques and purpose. In Kuczewski’s words, bioethicists have “become a professional and academic community that engages in practices that include shared narratives, values, and virtues”15 and thus will perform in a predictable and stereotypical manner. Establishing “bioethics considerations and guidelines” narrows the range of legitimate choices and limits physicians’ autonomous choices.8

The stated aim of preserving and protecting individual autonomy in medical decision-making for patients and their families has not only become limited in such a climate, but has been effectively negated, even though it is still presented as a core principle.7 Is this a subterfuge, or the inevitable unintended consequence of centrally planned and controlled health care decisions under the cloak of “moral authority and ethics”?

ASBH members are well-regarded, influential, and academically situated. They are employed by institutional review boards (IRBs), contribute to and edit medical and bioethical journals, testify in court, act as legislative consultants, and are often media and internet celebrities. They demonstrate that, as H.L. Mencken said, “What men value in the world is “not rights, but privileges.”16

The “demi-discipline” creation of Albert Jonsen, which is now independently powerful and politically progressive, has successfully displaced the traditional Hippocratic moral mile markers employed by the medical profession in virtually all the interactions that once defined the patient-physician relationship. This evolution was presumably needed to correct the traditional Hippocratic paternalism, portrayed as the adversary of autonomy. “Heroically,” in its own estimation, bioethics oversaw the reformation of antiquated, inadequate Hippocratic ethics in the evolving and messy technological environment of the late 20th century.

Turning these progressive moral philosophers into practical “professional” medical ethicists who adjudicate complex medical practice standards, has in large part advanced the machinery needed to promote the “reform of American healthcare.” . . .

According to the bioethicists’ view, the defects in AMERICAN Medicine and physicians flow from the Oath of Hippocrates: its antiquity, paternalism, ignorance of social justice, and its fostering of a greedy, self-interested and monopolistic medical profession.

What Is Hippocratic Medicine?

Hippocratic medicine is an historical construct achieved by picking out themes and theories in a framework that was unknown during its own time but synthesized in retrospect by historians. The so-called Hippocratic Corpus was not a sole authorship, but rather the product of many authors over more than two centuries.22 It is actually a library, or rather, the remains of a library . . .

Conclusion

Medicine and idealism have always been comfortable companions. There have always been and likely always will be practitioners whose medical practice was and is self-serving and exploitative. In the main, however, the Hippocratic ideal sets a moral standard that survived the centuries. It envisions the care of the sick as individual occurrences in the context of the needs of society. But collective society is not the patient. Bioethics represents a radical shift in focus away from the individual to the collective. The implications for patient care deserve sharp scrutiny, not blind acceptance of bioethical premises based on prestige and proclaimed lofty intentions.

Jeffrey Hall Dobken, M.D., M.P.H., holds a dual appointment as adjunct assistant professor, Departments of Epidemiology & Community Health and Environmental Sciences, School of Health Sciences and Practice, New York Medical College. He was a practicing allergist in N.J. and holds a certificate in bioethics from the Center for the Study of Society & Medicine, College of Physicians and Surgeons, Columbia University.

https://www.medpagetoday.com/columns/and-now-aword/22528.

Read the entire article at http://www.jpands.org/vol23no2/dobken.pdf to obtain the full perspective.

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Well-Meaning Regulations Often Worsen the Quality Of Care (QOC)

Past Issue:

Modernization can at times be very expensive

I served my internship at Wayne County General Hospital. We were the first class of 36 interns to work in the new 500 bed orange and silver aluminum hospital built in the form of a Grecian cross-a square center with four arms of equal length. The old hospital had the standard characteristic large 40 to 60 bed wards that most of the public hospitals had in the 1960s, whether county, city or state. Furthermore, Michigan was the first state that placed doctors under state wage laws which was $300 a month for full time work. The majority of the hospitals in the United States were paying interns $25 to $50 a month. Since at that time most house staff were unmarried and received free room and board at the hospital, it was a living wage. We felt privileged.  There were 500 beds on four floors above the street level with 125 patients on each floor, as I recall. There were 2 five bed rooms in the corner of each floor which was one wing of a red cross. The rest of the rooms had 4 beds, with a couple of two bed semi-private rooms for special medical needs such as isolation or an occasional high-level county official. (more…)

Past Issue:

Sham Peer Review

PSYCHIATRIC EVALUATIONS ARE HAZARDOUS TO THE DOCTOR’S CAREER.

By Richard B. Willner, Executive Director of The Center for Peer Review Justice

http://www.PeerReviewJustice.org

In this day of excessive regulation and hindsight aided evaluation a new danger is even more pressing.  Various administrative boards that are established by states, the federal government or associated agencies maybe have their origin from well-meaning agencies.   The history of unbridled power almost invariably asserts itself with some sort of self-appointed expertise.

This expertise becomes one of defining a problem, in this case some type of professional practitioner, and then looking, searching for the reasons to label the professional. The complainant and the reported complaint, assuming there is a complaint and is not made up by whole cloth by the agency, is always asserted as “secret” – “confidential” so the professional has no capacity to discover from where the allegation arose.  (more…)

Past Issue:

Sham Peer Review Shelters a Deadly and Malicious Virus

The Poliner Case: the Clinical Story

Disingenuous “concern for patients” is used to conceal malicious motives in a legalized charade

Lawrence R. Poliner, M.D.

Like a deadly virus sheltered within an immune cell, peer review has been infected. Ironically, some, who have sworn to “first do no harm,” now use peer review as a weapon of harm– “Doctors Who Hurt Doctors.” Disingenuous “concern for patients” is used to conceal malicious motives in a legalized charade where absolute immunity protects those who utter the words “peer review,” and where form trumps substance at every level.  (more…)

Past Issue:

Introduction of disruptive digital innovations

Is Digital Health The Future Of Healthcare?

–Originally appeared on Quora:
the place to gain and share knowledge,
empowering people to learn from others and better understand the world
.

    University of Texas School of Biomedical Informatics, Educating leaders in health informatics since 1997

Answered Mar 15, 2018 · Featured on Forbes and Apple News
Author has 161 answers and 96k answer views

Worldwide, healthcare is at the intersection of ever-rising costs and the introduction of disruptive digital innovations, digital health innovations will expectantly play a significant role in:

  • Curbing long-term healthcare costs
  • Enabling better healthcare outcomes
  • Empowering both the patient and the healthcare provider with real-time data and connections with each other
  • Enabling the introduction of new contributors to the healthcare ecosystem

(more…)

Past Issue:

Regulating the Doctor/Patient interface

Regulating the Doctor/Patient interface is a serious misdirection in American Health Care for which we are criticized with no convincing argument being raised by the medical profession because they have been hoodwinked by our organizations who emphasize improving quality when we already have the highest quality of medical care found anywhere in the world.

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Well-Meaning Regulations Worsen Quality of Care.

Past Issue:

Medicaid Expansion Increased Health Insurance Enrollment

October 23, 2015

Last year’s changes in health insurance enrollment are of particular interest, as 2014 was the year in which key provisions of the Affordable Care Act (ACA, or Obamacare) took effect — most notably, the offeringof subsidies for coverage purchased through the new government exchanges and the ACA’s Medicaid expansion.

The increased enrollment in individual-market plans in 2014 equates to 40.6 percent growth in a single year for that market segment. By comparison, during the previous three years, total enrollment in individual-market plans was nearly flat, fluctuating narrowly around 12 million individuals.

  • Enrollment in individual-market policies increased by almost 4.8 million individuals during 2014.
  • For the employer-group-coverage market, enrollment in fully insured plans dropped by 6.6 million individuals, while enrollment in self-insured plans increased by 2.1 million individuals.
  • The net increase in private health insurance in 2014 was just 260,000 people.

The nearly 9 million person increase during 2014 in enrollment in Medicaid and CHIP equated to single-year growth in those programs of 14.7 percent — compared to the preceding three years’ average annual growth rate of 2.3 percent. However, as noted, Medicaid enrollment growth during 2014 occurred disproportionately in states that adopted the ACA Medicaid expansion. In the states with the Medicaid expansion in effect, enrollment grew by 23.2 percent; while in the states without the expansion in effect, enrollment increased by 2.9 percent — or just above the pre-ACA trend.

The growth in Medicaid enrollment over the course of the year occurred disproportionately in states with the ACA Medicaid expansion in effect. Indeed, the expansion states accounted for 92 percent of total Medicaid enrollment growth in 2014. When it comes to increasing the number of individuals with health insurance coverage, the net effect of the ACA in 2014 was almost entirely a simple expansion of Medicaid.

Source: Edmund F. Haislmaier, “2014 Health Insurance Enrollment: Increase Due Almost Entirely to Medicaid Expansion,” Heritage Foundation, October 15, 2015.

See more at: http://www.ncpa.org/sub/dpd/index.php?Article_ID=26186#sthash.uL5cjXMy.dpuf

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Well-Meaning Programs Worsen Cost of Care.

Past Issue:

Medicare at Age 50: Unlikely to Make It to 100

Americans born in 1900 and earlier were eligible for Medicare at its inception in 1965, but the life expectancy for men and women born in 1900 was under 50 years of age. The few men who lived to see their 65th birthdays around the time Medicare began could only expect to live another dozen years or so — and women could only expect a few years more than men, says senior fellow Devon Herrick of the National Center for Policy Analysis.

Life expectancy has increased dramatically over the past half-century. As a result: About percent 70 of Americans born in 1950 are still alive and now reaching Medicare eligibility at age 65. One-in-five Americans born in 1950 will live to see their 85th birthday. Men born in 1950 and turning 65 today can expect to live another 17 years, while women can expect another 20 years of life.

It is not just the proportion of Americans reaching Medicare eligibility that is driving up the program’s cost, nor is it the number of years they remain on Medicare. Per capita spending on Medicare beneficiaries has also skyrocketed:

In 1970, annual per capita Medicare spending was only $385. Today it is $12,430, and it is projected to approach $19,000 a decade from now.

Of the $12,430 spent per beneficiary in 2014, $5,400 was spent on physician care while $4,900 was spent on hospital care.

About $2,100 was spent on drug therapy.

Spending on Medicare beneficiaries is on course to grow another 58 percent in the coming nine years. In 1970, payroll taxes and premiums paid for virtually all Medicare spending. Today, general revenues are needed to pay about 43 percent of Medicare costs — comprising about 1.5 percent of GDP. Only two decades from now, general revenues will be needed to cover more than half of the program’s costs.

Source: Devon Herrick, “Medicare at Age 50: Unlikely to Make It to 100,” National Center for Policy Analysis, October 21, 2015. –

See more at: http://www.ncpa.org/sub/dpd/index.php?Article_ID=26184#sthash.qD4gSaC3.dpuf

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Well-Meaning Regulations Worsen Quality of Care.

Past Issue:

Do Mammograms Save Lives?

In the 1980s, Dr. Eugene Robin, a Research Pulmonologist at Stanford, had a weekly column in the San Francisco Examiner. Having had a very distinguished career writing research papers, books, editing journals, chairing international symposia, he thought he’d try his hand in the popular press. In this column, he explored numerous areas of medicine for the lay public. He eventually had a column on the Risks of Mammography. He cited that doing regular mammograms in young women could actually increase the risks of breast cancer. He never had another column. We all just assumed that it was not politically advantageous for the Examiner to continue in an arena in which they couldn’t control such content. The uninformed public would not be able to accept such content “which every American ‘knew’ could not be true.” Everyone knew that a screening test for a disease just could not cause the disease they were screening for. The News media knew that public opinion was more valid than the professor’s opinion—even if based on scientific evidence.

Now after 30 years, this discussion is once again open to debate. Freedom of speech can only be suppressed for so long. We return to –The Mammography Debate Read more . . .

Mammography for breast cancer screening

Most major health organizations have concluded that mammography saves lives. However, there is ongoing debate over:

  • How much benefit there is from mammography (especially in younger women)
  • The over-diagnosis and over-treatment of breast cancer

The benefit of mammography for women ages 40 to 49

Mammography in women 40 to 49 saves lives, but the benefit is less than for older women.

Some health organizations have concluded that the modest survival benefits of mammography in women in their 40s outweigh the risks of false positive results. The National Comprehensive Cancer Network recommends routine mammography for women starting at age 40 and the American Cancer Society recommends starting at age 45 [15,105].

The U.S. Preventive Services Task Force meta-analysis of eight randomized controlled trials found that mammography modestly reduced the risk of breast cancer mortality (death) in women 40 to 49 [13]. This study found that to prevent one breast cancer death, 1,904 women 40 to 49 would need to be screened with mammography [13].

Weighing the benefits and risks, the Task Force does not recommend routine mammography for all women in their 40s [13].

Instead, the Task Force, as well as the American College of Physicians, recommends that women 40 to 49 discuss the benefits and risks of mammography screening with their health care providers. Then together, they should make informed decisions about when to start mammography screening [13,18,105]. The American Cancer Society recommends informed decision-making for women ages 40 to 44 [105].

Informed decisions are guided by a woman’s breast cancer risk profile. Women at higher risk of breast cancer are more likely to benefit from mammography [18,105]. Decisions should also be guided by a woman’s preferences based on the potential pros and cons of mammography [18].

The U.S. Preventive Services Task Force recommends that routine mammography screening begin at age 50 [13].

To be continued in July 2014 HPUSA . . .

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Well-Meaning Guidelines May Worsen Quality of Care.

Past Issue:

Hospitals taking over private practices

by Manoj Jain, MD, MPH

A decade and a half ago, when I moved to Memphis, I proudly hung a sign outside an office I shared with another doctor. It had my name followed by an MD. I had started my own small business as a solo practitioner in medicine.

Over the years, the practice has grown. I now have several employees and my own office, with the names of several other doctors alongside mine on the sign.

But across Memphis and the nation, health care delivery systems are shifting, and doctors are radically changing how they practice medicine. In a matter of a few years, small and large medical practices are crumbling, lumping, merging, or rebuilding — depending on one’s perspective.

According to the Medical Group Management Association, in 2005 more than 65 percent of medical practices were physician-owned. Within three years that figure had dropped to 50 percent, and by now I suspect it is much lower.

So why all these changes, and ultimately what will it mean for patients?

For one, providing health care is becoming increasingly complex. Keeping up with innumerable regulations from private insurers and the government, transitioning to electronic medical records (EMR) and caring for a growing population of chronically ill patients make it nearly impossible for a full-time practicing doctor to manage patients and a practice. For example, last year, I invested $15,000 in an EMR only to scrap it because it did not connect efficiently with hospital computer records.

There is another more significant reason for the demise of physician-owned practices. Two years ago, a cardiologist educated me over a coffee at Starbucks about the way Medicare was changing its payments. For the technical component of an echocardiogram, a hospital-outpatient department receives $450, while a physician-owned cardiology office gets $180. “It doesn’t make sense. We are going to go out of business.” According to rumors, that’s what was happening with many large private practices that had invested heavily in technology and diagnostic equipment. With the cuts, the practices were not sustainable.

So why did Medicare cut payment to doctors for office procedures? Many studies have found that if doctors have medical equipment in their offices, they tend to overuse it. One study showed that doctors who have an MRI machine in their office tend to order three times more MRI scans per 1,000 office visits compared to other physicians. For a cardiologist it was 2.6 times more cardiac echoes, according to a 2009 Medicare Payment Advisory Commission’s report. Overuse of imaging studies is a major factor contributing to skyrocketing health care costs.

So I asked a few doctors why did Medicare not cut payments to the hospitals. Some say, “That is coming soon,” while others say, “The hospital lobby was stronger than the doctor lobby.”
Whatever the case, the new health care landscape gives hospitals greater control over local health care resources. But as one hospital CEO told me, “I really don’t want to take over doctor practices. Managing doctors is like herding cats. But there is no choice.” . . .

Manoj Jain is an infectious disease physician and contributor to the Washington Post. He can be reached at his self-titled site, Dr. Manoj Jain.

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Well-Meaning Regulations Worsen Quality of Care.

Past Issue:

Misdirection in our Country at Large

Occupy Wall Street

By Dr. Thomas Sowell

The current Occupy Wall Street movement is the best illustration to date of what President Barack Obama’s America looks like. It is an America where the lawless, unaccomplished, ignorant and incompetent rule. It is an America where those who have sacrificed nothing pillage and destroy the lives of those who have sacrificed greatly.

It is an America where history is rewritten to honor dictators, murderers and thieves. It is an America where violence, racism, hatred, class warfare and murder are all promoted as acceptable means of overturning the American civil society.

It is an America where humans have been degraded to the level of animals: defecating in public, having sex in public, devoid of basic hygiene.

It is an America where the basic tenets of a civil society, including faith, family, a free press and individual rights, have been rejected.

It is an America where our founding documents have been shredded and, with them, every person’s guaranteed liberties.

It is an America where, ultimately, great suffering will come to the American people, but the rulers like Obama, Michelle Obama, Harry Reid, Nancy Pelosi, Barney Frank, Chris Dodd, Joe Biden, Jesse Jackson, Louis Farrakhan, liberal college professors, union bosses and other loyal liberal/Communist Party members will live in opulent splendor.

It is the America that Obama and the Democratic Party have created with the willing assistance of the American media, Hollywood, unions, universities, the Communist Party of America, the Black Panthers and numerous anti-American foreign entities.

Barack Obama has brought more destruction upon this country in four years than any other event in the history of our nation, but it is just the beginning of what he and his comrades are capable of.

The Occupy Wall Street movement is just another step in their plan for the annihilation of America.

“Socialism, in general, has a record of failure so blatant that only an intellectual could ignore or evade it.”

—Thomas Sowell

Thanks to Dr. Loofbourow for bringing this to our attention. 11-13-11

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Regulations under Obama will worsen not only Freedom, but Quality of HealthCare.

Past Issue:

Atlas Shrugged Part II

Atlas Shrugged’ Film Banks on Election Fever
By DON STEINBERG, WSJ

To a strict bottom-line capitalist, the new movie “Atlas Shrugged Part II” might not look like a model enterprise. “Atlas Shrugged Part I,” released last year, cost businessman John Aglialoro about $25 million (and 19 years) to bring to the screen. Its domestic box-office take was a tepid $4.6 million. Critics’ reviews, arguably, were worse.

Few flops earn sequels. But Mr. Aglialoro, chief executive of exercise-equipment maker Cybex International CYBI 0.00% and a longtime disciple of “Atlas Shrugged” author Ayn Rand, thinks the timing is right. Rebuffed by Hollywood, he and fellow producer Harmon Kaslow, whose horror credits include “Cemetery Gates” and “Boo,” have built their own studio, hopeful that a nation embroiled in debate over the distribution of wealth will put “Part II” in the black. The urgency quickened when Mitt Romney named as his running mate another Rand acolyte, Rep. Paul Ryan (though he has soft-pedaled his enthusiasm for her in the campaign). The movie hits theaters Oct. 12.

“Atlas Shrugged,” published in 1957, was the last novel by the Russian-born Ms. Rand, who at age 12 saw her father’s business confiscated in the Bolshevik Revolution. The 1,100-page book, written in three parts, is a futuristic fable about the dangers of collectivist government. Call it poli-sci-fi. It’s set in an America with a faltering economy, misled by bureaucrats who keep devising ways to take money from successful innovators in the name of public good.

Business leaders, meanwhile, are mysteriously vanishing. It turns out they’re going on strike, fed up with supporting the world—hence the title. They decamp to a hidden gulch and pledge to “never live for the sake of another man.” The heroine, Dagny Taggart, is desperately trying to save her family’s railroad company and discovers possible salvation in a motor that could generate limitless energy by capturing static electricity from the air. But its inventor, John Galt, already has taken his leave.

The polarizing book has been labeled the Bible of Selfishness. It also has inspired millions. Mr. Aglialoro says he was “zapped” when he read “Atlas” in his 20s.

“I thought, ‘Wow, gee, you’re entitled without guilt to your own life,’ ” he says. “Benevolence and charity are wonderful things, when they’re voluntary and on your terms. But what arrogance to have an entitlement society that expects it. Or to feel that you’ve got to ‘give back.’ I don’t know what the hell you took in the first place that you feel you have to give back.”

The film adaptation became its own saga. The mercurial Ms. Rand adapted her novel “The Fountainhead” for a King Vidor film starring Gary Cooper in 1949 and hated much of the movie, according to a 2004 biography by Jeffrey Britting. After her death in 1982, repeated efforts to turn her “Atlas” into cinema fizzled. Angelina Jolie was attached; Philadelphia Flyers owner Ed Snider optioned the rights; Randall Wallace (“Braveheart,” “Pearl Harbor”) wrote a script that covered the opus in a single film. In 1992, Mr. Aglialoro paid $1 million for a 15-year lease on the film rights, a duration he had to extend.

“I thought it would be a short period of time for investors to come in,” he says. “But all these entities couldn’t get it done. Ultimately, it’s not a movie Hollywood wants to embrace.”

Finally made on a modest budget (after huge start-up expenses, production was around $5.5 million), “Part I” was pounded by critics, who rated it at 11% “fresh,” lower than “Showgirls” and “Ishtar,” according to RottenTomatoes.com. Viewers, however, scored it at 74%.

“Part II” faced a new setback when Cybex lost a liability lawsuit in 2010 alleging that one of its weight machines had tipped over on a woman, leaving her paralyzed.

“I feel so sorry for her,” Mr. Aglialoro says. “She jumped up on there and pulled the machine back on herself while she was stretching.” The parties settled for $19.5 million in February. Cybex stock dropped so low the company faced delisting.

“The lawsuit was crippling,” Mr. Aglialoro says. He put just $5 million into “Part II” but recruited additional investors, allowing Atlas Productions to spend $10 million on production and $10 million more on marketing. The new film will open on three times as many screens as the first installment. It’s slicker and faster-paced, with a train crash and a jet-plane chase. The lead roles have all been filled by different actors, with Samantha Mathis replacing Taylor Schilling as Taggart. Cameos include Sean Hannity, Grover Norquist and Teller of Penn & Teller (Teller speaks). And in inspired casting, the two top government officials are played by Ray Wise and Paul McCrane, who were murderous hoods together in “RoboCop” and have spent careers portraying creepy villains with oversize foreheads.

The producers showed snippets to supporters of presidential candidate and fervent libertarian Ron Paul at the Republican convention and held screenings at the Heritage Foundation and Cato Institute in Washington.

“I’m making this as a warning,” says Mr. Aglialoro. “It’s about what happens when heroic producers disappear, and they leave the job of creating prosperity to the moochers and, God forbid, the politicians.”

Mr. Kaslow admits that after all their effort, one hurdle remains: “The challenge is that our audience doesn’t go to the movies that often.”

WSJ:  http://online.wsj.com/article/SB10000872396390444592404578032291709944404.html

Past Issue:

Modernization can at times be very expensive and misdirected

I served my internship at Wayne County General Hospital. We were the first class of 36 interns to work in the new 500 bed orange and silver aluminum hospital in the form of a Grecian cross-a square center with four arms of equal length. The old hospital had the standard characteristic large 40 to 60 bed wards that most of the public hospitals had in the 1960s, whether county, city or state. Furthermore, Michigan was the first state that place doctors under that state wage laws which was $300 a month for full time work. The majority of the hospitals in the United States were paying $25 to $50 a month. Since at that time most house staff were unmarried and received free room and board at the hospital, it was a living wage. We felt privileged. There were 500 beds on four floors above the street level with 125 patients on each floor, as I recall. There were 2 five bed rooms in the corner of each floor which was one wing of a red cross, the rest of the rooms had 4 beds, with a couple of two bed semi-private rooms for special medical needs such as isolation or an occasional high level county official.

Going from 40 and 60 bed open wards to the large number of semi-private rooms required a large increase in nursing staff. Whereas two RN’s could oversee 40 or 60 patients in the old facility, it would take two RNs to oversee every three or four rooms of four patients each. The county balked at the expense of tripling the number of RNs for the same number of patients.  The county hired efficiency experts to evaluate the RNs and to reduce their number. They recommended exactly what they were hired to do.

The doctors observed the nurses working feverishly at the desk taking down the orders we had written and proceeding to implement them. The efficiency experts making their rounds would count out loud the number of nurses at the desk: one, two, three, four nurses at the desk not seeing patients. We asked them what they thought the numbers meant. One said, obviously you’re over staffed when more than one nurse is sitting at the desk. Shouldn’t they be out on the floor doing some nursing?

The experts obviously had no understanding of nursing. When their report was submitted, and administration tried to reduce the number of nurses, a firestorm erupted. For a while it looked like we might not have RNs at all. I don’t think the doctors were very thrilled with the prospect that they might end up bathing their patients and emptying their bedpans.

Eventually the administration tossed out the expensive study and we all went back to practicing medicine and the nurses resumed the care of our patients.


Are we having the same problems today, except on a more massive scale? Don’t we have medical efficiency experts, the insurance carriers, HMOs, Medicare, Medicaid telling us how to practice medicine? Telling us what tests we are allowed to order, what drugs we are able to use, which hospital we are allowed to admit our patients, which consultants are approved, which x-ray facility is in our patient’s insurance plan, which laboratory will they reimburse, which respiratory company are we allowed to order oxygen for our patients in lung failure.  And since each insurance carrier and HMO has their own preferred drug formulary and consultants, it sometimes is not easy to steer a patient in the correct direction. This top-down management ultimately comes from the White House, the Senate, the House, and the Supreme Court who don’t seem to have a clue as to what the practice of medicine entails.

Instead of being lean and efficient, it is turning out to be costly and inefficient. Many of our patients are relating horror stories as to having been on medications for decades which were working beautifully and now, because of new regulations or an insurance change, being placed on substitutes and their blood pressures are out of control; they are wheezing more than ever because their bronchodilators  have been changed by a new insurance company; their new oxygen company took two months to get oxygen to them while they are gasping for breath not being able to walk to the next room; how much their health insurance premiums have increased; how much their medications cost and health care costs have spun out of control.
The patients have now partially accommodated to these huge changes over the past two years. It would create havoc to toss out these changes that Obamacare made, without a smooth transition to a market base plan.

The most dangerous campaign statement is to “REPEAL” and “REVISE” when no one has submitted a revised plan that the public will accept. This could destroy the Conservative Political Party from making constructive changes and the “Tax /Spend/ and Regulate” party would proceed to destroy American Medical and Health Freedom. Their success is really guaranteed with the ease in which the “Tax /Spend/ and Regulate” party operates.  Since the regulation of human beings is essentially impossible, as the Fascists, Communist, and the Socialists have well demonstrated but still don’t believe, they can continue to SPEND, then with the progressive income TAX, it is easy to increase taxes on the masses which may not fully understand what they are approving, and when this doesn’t go as planned, they have to REGULATE our freedom as we drift backwards into a Statist Civilization. We will then have to try to advance to a free society again repeating what our forefathers accomplished by establishing American Freedom. How many hundreds of years will it take to reach 1776 again?

Follow this HealthPlanUSA column for some answers to our health care conundrum.
America, it is critical to wake up before it’s too late.

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Well-Meaning Regulations Worsen Quality of Care.

Past Issue:

Modernization can at times be very expensive and misdirected

In the 1980s, Dr. Eugene Robin, a Research Pulmonologist at Stanford, had a weekly column in the San Francisco Examiner. Having had a very distinguished career writing research papers, books, editing journals, chairing international symposia, he thought he’d try his hand in the popular press. In this column, he explored numerous areas of medicine for the lay public. He eventually had a column on the Risks of Mammography. He cited that doing regular mammograms in young women could actually increase the risks of breast cancer. He never had another column. We all just assumed that it was not politically advantageous for the Examiner to continue in an arena in which they couldn’t control such content. The uninformed public would not be able to accept such content “which every American ‘knew’ could not be true.” Everyone knew that a screening test for a disease just could not cause the disease they were screening for. The News media knew that public opinion was more valid than the professor’s opinion – even if based on scientific evidence.

Now after 30 years, this discussion is once again open to debate. Freedom of speech can only be suppressed for so long. We return to –The Mammography Debate

Mammography for breast cancer screening

Most major health organizations have concluded that mammography saves lives. However, there is ongoing debate over:

  • How much benefit there is from mammography (especially in younger women)
  • The over-diagnosis and over-treatment of breast cancer

The benefit of mammography for women ages 40 to 49

Mammography in women 40 to 49 saves lives, but the benefit is less than for older women.

Some health organizations have concluded that the modest survival benefits of mammography in women in their 40s outweigh the risks of false positive results. The National Comprehensive Cancer Network recommends routine mammography for women starting at age 40 and the American Cancer Society recommends starting at age 45 [15,105].

The U.S. Preventive Services Task Force meta-analysis of eight randomized controlled trials found that mammography modestly reduced the risk of breast cancer mortality (death) in women 40 to 49 [13]. This study found that to prevent one breast cancer death, 1,904 women 40 to 49 would need to be screened with mammography [13].

Weighing the benefits and risks, the Task Force does not recommend routine mammography for all women in their 40s [13].

Instead, the Task Force, as well as the American College of Physicians, recommends that women 40 to 49 discuss the benefits and risks of mammography screening with their health care providers. Then together, they should make informed decisions about when to start mammography screening [13,18,105]. The American Cancer Society recommends informed decision-making for women ages 40 to 44 [105].

Informed decisions are guided by a woman’s breast cancer risk profile. Women at higher risk of breast cancer are more likely to benefit from mammography [18,105]. Decisions should also be guided by a woman’s preferences based on the potential pros and cons of mammography [18].

The U.S. Preventive Services Task Force recommends that routine mammography screening begin at age 50 [13].

To be continued in July 2014 HPUSA . . .

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Well-Meaning Regulations Worsen Quality of Care.

Past Issue:

Physician Assisted Killing

A patient with obstructive sleep apnea came in for his annual evaluation. He had been snoring for decades, but about six years ago, his wife noted that his snoring stopped abruptly in the middle of the night. She observed her husband and noted that his chest was still moving, as if he was breathing, but there was no snoring. She then put her hand over his mouth and nose and did not find any air movement. She woke her husband immediately and after a loud strider, he began breathing. She insisted he see his pulmonologist as soon as he could obtain an appointment. He was immediately scheduled for a Polysomnogram (sleep study). This confirmed the diagnosis of sleep apnea (no breath) and determined the optimal pressure to set the Continuous Positive Airway Pressure (C-PAP) device on to wear at night to assure continuous breathing while asleep. This was working fine.

As I was finishing my exam and writing his prescriptions, he casually mentioned that a friend of the family, who had sleep apnea, had respiratory failure requiring oxygen. His C-PAP was powered by oxygen pressure rather than compressed air. The friend was getting increasingly depressed over his disability and told my patient that sometimes he thought that he would just turn the machine off and end it all. Although my patient tried to joke him out of this approach, he apparently decided one night that he’d had enough. He turned off the machine and the oxygen and quietly died during the night. This is a peaceful way ending one’s life without any pain. It also is a quiet way to commit suicide with any physician accomplist.

With all the emphasis on physician-assisted suicide, it is indeed unfortunate, if not absolutely heinous, that physicians should play the role of executioner. That such a proposition can be passed by public vote underscores the lack of basic medical knowledge we have been unable to provide to the public. They don’t need an executioner to write a lethal dose of barbiturates. The patients have numerous lethal doses of medications already in their possession. Most patients now get a 90-day supply of medications. If there are any cardiac, blood pressure, narcotic, hypnotic or psychiatric medications among them, it would not even take a full bottle to do the fateful tragic deed. Whether in The Netherlands, Oregon or Europe, we should never have to worry about whether our doctor is wearing the white coat of healing or the black cloak of an executioner.

A doctor in The Netherlands confided in me during a break in a medical meeting in Amsterdam that he once admitted an elderly lady to the hospital. She said she worried about being put to death while in the hospital. The doctor I was speaking with assured her that he would watch over her to make sure that didn’t happen. The next weekend, he signed her out to a colleague. When he came back on Monday, he looked for her and couldn’t find her. The nurse said she had “died.” He quickly summoned his colleague as to what happened. He was told, “We needed the bed.” He said he now felt it was a horrible tragedy for physicians to be involved in assisted suicide. It is more often an execution and not for a medical or “relief-of-pain” reason that is commonly given. It may be just an administrative decision on allocation of beds.

Statistics in Oregon, the first state in which physicians are allowed to kill patients who request it, indicate that perhaps as many as half of these patients have not signed a valid request that they wanted to be executed. These hospital mistakes are permanent. They are not simple medication errors that the Institute of Medicine feels are so tragic. Many of them are inconsequential and can be easily reversed. Physician execution of patients can never be reversed.

Healthcare is such a private matter we may never know how many were put to death for nefarious reasons. I’ve had a number of patients complained that they were convince that a family member was killed during their last hospital stay.  A colleague confided in me that a patient he was seeing in consultation, who was in respiratory failure, was given a large dose of morphine and died during the night. The dose given would be appropriate for an otherwise healthy patient, e.g. one with herniated disc pain or a bone fracture.  Patients in lung failure need all their energy to breath and stay alive. A dose of most narcotics or sedatives will place such a patient into permanent rest. And it was not picked up in medical death chart review. Physicians are required by California law to relieve pain. Hence, it’s an easy way to quietly extinguish a life without raising any eyebrows. It also avoids prosecution.

Updated from MedInfoLine2005

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Well-Meaning Regulations Worsen Quality of Care or can even make it Lethal.

Past Issue:

The Mammography Debate Continues

Over-diagnosis and over-treatment
WE RECENTLY NOTED THE U.S. PREVENTIVE SERVICES TASK FORCE ON MAMMOGRAPHY SCREENING ALONG WITH
DR. ROBBINS CAUTIONS IN THE 1980’S – WE RETURN TO THE DEBATE: SEE THE HPUSA MARCH ISSUE.
THERE ARE VALID CONCERNS ABOUT THE OVER-DIAGNOSIS AND OVER-TREATMENT OF “DUCTAL CARCINOMA IN SITU” (DCIS) AND SMALL, SLOW-GROWING INVASIVE BREAST CANCERS WITH MAMMOGRAPHY SCREENING.

Over-diagnosis

Since the introduction of mammography in the 1980s, the number of women diagnosed with DCIS has increased a lot. In 2015, it is estimated that there will be about 50,000 new cases of DCIS [38].

Over-diagnosis occurs when a mammogram finds DCIS or small, invasive breast cancers that would have never caused symptoms or problems if left untreated. These breast cancers may never grow and some may even shrink on their own. Or, a person may die from another cause before the breast cancer became a problem.

Some researchers estimate that about 20 to 30 percent of DCIS and invasive breast cancers found with mammography may be over-diagnosed [23].

Over-treatment

Although DCIS is non-invasive, without treatment, the abnormal cells can sometimes become invasive over time. Left untreated, about 40 to 50 percent of DCIS cases may progress to invasive breast cancer [39]. (These numbers are estimates.) Higher grade DCIS may be more likely than lower grade DCIS to turn into invasive cancer if left untreated.

At this time, there is no way to tell which cases of DCIS will become invasive breast cancer and which will not. So, women with DCIS are treated with lumpectomy (also called breast conserving surgery) plus radiation therapy or mastectomy. Some women are also treated with hormone therapy.

Since not all cases of DCIS will become invasive breast cancer, some women with DCIS may be over-treated. These women never would have developed invasive breast cancer, with or without treatment.

Researchers are studying ways to identify the cases of DCIS most likely to turn into invasive breast cancer. This would allow treatment to be targeted to those who are at higher risk and might allow some people to avoid treatment.

At this time, however, the standard of care is to treat every case of DCIS as if it might turn into invasive breast cancer.

Learn more about DCIS.

Read more from our Chief Scientific Advisor, Dr. Eric Winer, as he comments on the issue of mammography leading to over-diagnosis and over-treatment.
What does this mean for you?

Despite some ongoing debate, mammography is still the most effective screening tool used today for the early detection of breast cancer.

While any health decision is a personal one that involves weighing benefits and risks, most health organizations recommend women get mammograms on a regular basis. . .  Read more . . .

Learn more about breast cancer screening recommendations for women at average risk.
Learn more about breast cancer screening recommendations for women at higher risk.
See more at: http://ww5.komen.org/BreastCancer/TheMammographyDebate.html#sthash.V7WfdMIz.dpuf

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Well-Meaning Regulations May Worsen Quality of Care

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