AAPS "Freedom Fighters"
Dear Dr. Faria,
It was a pleasure to meet you at the AAPS meeting. I am telling all my physician friends to join AAPS. So often, doctors in private practice feel as if there is "no hope." A weekend spent with physicians who value freedom, and are willing to fight for it, was a big boost.
In my mail on my return was a copy of Dermatology World. I thought you would be interested in page 5.*
Leah S. McCormack, MD
Forest Hills, NY
* Resolution 198.4 --- Capitation's Impact on Medical Ethics:
The American Academy of Dermatology (AAD) Ethics Committee or another appropriate committee or task force draft a position statement on capitation which would assess the impact of capitation on the individual patient, as well as the effects on the physicians....
The deliberations that the Ethics Committee take into account the
ideas expressed in Miguel A. Faria, Jr., M.D., articles, The Transformation
of Medical Ethics Through Time (Part I): Medical Oaths and Statist Controls,
Medical Sentinel, Vol. 3, No. 1, January-February 1998, pp. 19-24; and (Part
II): Medical Ethics and Organized Medicine, Medical Sentinel, Vol. 3, No.
2, March/April 1998, pp. 53-56; Editor's Corner, Managed Care-Corporate
Socialized Medicine, Medical Sentinel, Vol. 3, No. 2, March/April 1998,
Dr. Faria has been invited to deliver the Schneidermann Lecture at
the next annual meeting of the American Academy of Dermatology, March 20,
1999, New Orleans, Louisiana.
Dear Dr. Faria,
Thanks for sending me copies of your articles from the Medical Sentinel; I enjoyed them very much. Speaking to you and the other AAPS members at the convention in Raleigh was most encouraging. I am glad to see a bunch of savvy freedom fighters with the courage to stand up to Big Government...
All the best,
Democrats and Republicans are engaged in a political test of wills to find the "right" answer to the multitude of ills created by HMO medicine. While Democrats are trying to say their Patient Bill of Rights is bigger and better than the Republican plan, the Clinton administration is asking an appeals court to overturn a tremendous victory won by Medicare HMO patients which gave them significant consumer protections and new rights. But, we must remember this is the same administration that told people over 65 they had no right to escape the functional and intentional rationing of their Medicare entitlement by choosing private medical care on a case by case basis.
The best prescription for recreating the health care free market which existed before World War II would be to return tax equity to working Americans, as economist Milton Friedman has suggested many times in the past. This would permit us to "own" our own health insurance once again. (Would anyone think it wise to change auto or homeowner's insurance every time we change jobs?) Such common sense reformation of the tax code, offering us privately owned insurance with high deductibles, would also create the same incentives and checks and balances inherent in the MSA concept. Tax equity would foster real competition by again melding the recipient of health care into the purchaser. Why would anyone oppose this sensible reform?
For years, the Association of American Physicians and Surgeons has been quite vocal about the problems created by HMOs. A few years ago, the Arizona Chapter of the AAPS led the way nationally when it played a key role in a state law which required HMOs to disclose financial incentives for their physicians (bonuses for "cost-effectiveness"), gag rules, etc. As strongly as we feel about holding accountable any physician or organization which endangers patient care, we urge caution in seeking a solution to HMO rationing through expanded government control of the HMO industry. It was government, after all, that gave us HMOs, and government which sought (and still seeks) to provide universal (rationed) health care through managed care "alliances" of HMOs under the Clinton Plan - 60 percent of which has actually been enacted by various laws since 1993! As government establishes law after law to "fix" the problem it created, it will only make medical care more costly and unwieldy. The way out of this mess is by demanding tax equity as a first --- and very necessary --- step.
Joseph M. Scherzer, MD
Assessing Risks in the Home
I take exception to the list of hazards in the home as presented by John Graham of the Harvard Center for Risk Analysis. Only some of the risks are based on actual statistics (numbers 2-6). Numbers 1 (indoor radon), 7 (environmental tobacco smoke), 8 and 9 (formaldehyde gas and insulation fibers), and 10 (electro-magnetic fields) are based on extrapolation, poor statistics that probably do not account for confounding variables, and pure speculation. Most of them help to support more intrusive regulation by the Environmental Protection Agency. Note that real deaths from accidental electrocution are not on the list, whereas hypothetical deaths from EMF are.
Instead of causing deaths, "risk" number 1 probably prevents them. Undoubtedly, high-dose radon is carcinogenic. From the excess lung cancers occurring in uranium miners, the risk from radon in homes is calculated by extrapolating to the (0,0) origin on the basis of the No-Threshold Linear Hypothesis (namely that risk is a linear function of dose at all levels). This hypothesis was tested in a study of lung cancer incidence versus average home radon levels in counties containing 90 percent of the U.S. population. If lung cancer rate corrected for smoking is plotted against radon exposure, the Non-Threshold Linear Hypothesis predicts a positive slope (+7%/pCiL-1). The data give a negative slope (-8%/pCiL-1). The probability of such a deviation resulting from chance alone (the "P value") is not only less than 0.01; it is <10-80. Stratifying data by each of 54 potentially confounding variables decreases the "discrepancy" only slightly.
Bernard Cohen concludes only that the No-Threshold Linear Hypothesis must be rejected, at least for radon. Others would call this evidence for radiation hormesis, the concept that low-dose exposure decreases risk, possibly by stimulating natural defense mechanisms.
Two lectures by Dr. Cohen, plus scientific references, are available on a CD-ROM (along with more than 70 other lectures on risks and purported risks). For information, call Doctors for Disaster Preparedness, (520) 325-2680.
Jane M. Orient, MD
In the case of radon, I for one think we are indeed dealing with the phenomenon of hormesis, accounting for the extreme effects of protection at low levels and a real risk at very high levels. I agree that risks #7-10 are speculative and unsupported by the scientific evidence. As for the benefits of firearm possession in the hands of law-abiding citizens, it far outweighs the risks of accidental firearm discharge (risk #6), as has been made abundantly clear in the pages of the Medical Sentinel. ---Ed.
Triage of the Elderly
Canada's Medicare for everyone has devalued doctors, patients, and the Canadian dollar. But in the U.S.A., socialist propaganda continues, like the BORG of Star Trek, "You will be assimilated!"
Patient protection from HMOs by government is fraud. The U.S. Ninth Circuit Court of Appeals affirmed, "Government cannot avoid the due process requirements of the Constitution merely by delegating its duty to determine Medicare coverage to private entities" (Grijalva v. Shalala # 97-15877).
So HMOs are part of government, and government does not protect you from government...
Economist Milton Friedman advises, "Follow the money..." [Only] medical savings accounts (MSAs) provide escape from health [care] tyranny...managers fear the competition...The president vetoed the entire federal budget until Congress suffocated MSA choice with regulations.
Howard Long, MD
Correspondence originally published in the Medical Sentinel 1999;4(1);1-2. Copyright©1999 Association of American Physicians and Surgeons (AAPS).