...The author of "Is there a Duty to Die" [philosophy professor John Hardwig, East Tennessee State University] utilized the same misguided arguments to "justify" death as those proposed centuries ago to defend the indefensible, namely, slavery.
Misguided philosophies redefine terms in order to justify the attainment of predetermined ends. That is to say, in order to justify the extermination of the sick human, the latter is conveniently redefined as a non-person. Likewise, in order to justify "people stealing" or slavery, misguided philosophies of yesteryear redefined black humans as less than persons or subhuman.
The redefinition of terms to suit the moment undergirds totalitarian or leftist ideology. For example, most laws passed by all current governments are arrogantly declared to be "just" not because they are per se just but because government says this or that law is just. It is a throw back to Louis XIV who pompously stated, L'Etat, C'est Moi ("The state, it is I").
Robert P. Gervais, MD
Dear Dr. Gervais,
The problem you noted in your January 3, 2002, letter is a manifestation of our subjective (utilitarian) philosophy with its politics of socialism and its population-based ethics relying on altruism (not benevolence).
All bioethicists reject the lessons of history and the teachings of Objectivist philosophy. So they must blur the distinction between animals and humans (never mind the faculties of reason), change the meaning of terms (language), use confusing and emotive ideas, and flawed reasoning --- gobbledegook, subterfuge and double-talk. Of course, they reject individual rights.
The Summer 2002 issue of the Medical Sentinel is on ethics.
Jerome C. Arnett, Jr., MD
Opting Out of Medicare --- Opposing Viewpoints
...In the early 1990s as mangled care and the government began in earnest to take over medicine, I decided I'd had enough.
I've always believed that ethical medical care cannot be delivered by a physician who has subordinated his judgment to that of an entity, such as the government or an insurance company, which has a vested interest in limiting or controlling health care. I felt, also, that it was the primary physicians who had the major part of the battle on their hands, as it was they and not the specialists, who were the entry points to the health care system.
Since I had thirty years of practice in a large southwestern city, a practice with no Medicaid and thirty percent Medicare, I decided if there was one primary physician in our area who could opt out of Medicare, it would be me. Thanks to the help of AAPS attorney Andrew Schlafly, I became the first and only physician in my area to opt out of the system on January 1, 1999 --- the beginning of an educational, humbling, and discouraging experience.
My wild-eyed guess was that I'd keep about 35 percent of the practice since the actual cost out of pocket for most patients would be peanuts compared to the total cost of each individual's health care; certainly, a few dollars per visit wouldn't stop patients from seeking the care of a doctor whom they had known for twenty years or more and whom "they would climb to the top of a mountain to see" --- should the doctor move his office there. Forget it; ninety-five percent of my patients departed, most saying, "you're a great doctor and have taken care of me and my family in a high quality, caring fashion for all these years; pay you? No way, José; Dr. X may not be the greatest, but he's on the list of providers my insurance company uses."
The emotional strain of seeing patients whom many times I had "gone the extra mile" for in their care leave my practice many times for nothing more than a perceived savings was very depressing. It did, however, drive home two basic principles: 1) I'm neither as important nor as essential to the community I'd spent years thinking I was --- and, attempting to practice in such a manner so as to deserve that status; and 2) The vast majority of Americans no longer value much of anything; loyalty and respect have been relegated to the "vague concept" status and really exist only in a minute percentage of our population. Physicians --- no, providers --- are public utilities to be regulated and treated with the same distrust and disdain as the water, electric, or gas companies.
So now, with my retirement fund having been totally depleted, my very nicely equipped office empty of patients, one lone secretary and my wife (nurse) sitting around reading catalogues while waiting for the occasional phone call, and the bills piling up for a fixed overhead that must be paid regardless of any patients, I've had to bow to the Hydra, acknowledge they're all-powerful, and ask permission to make a living.
The prospect of seeing my wife and myself living on $1263 per month Social Insecurity is grim, indeed, a situation I would have thought impossible ten years ago. Amerika --- the land of the free, a constitutional republic bought with the blood of patriots, a country that rightfully has been a beacon of hope in a world of dark despair --- has been dealt what is probably a fatal blow, not by some hostile foreign despot but from within, by our very own home-grown socialists. I've had to re-enter the system, take a job with a large group in the area, and close the practice.
It's very sad that Amerika's physicians have been sheep just like the rest of the population, following the voice of their shepherd --- the government/corporate managers --- as they're led right over the cliff of freedom into the abyss of servitude. Voices in the wilderness such as AAPS certainly have done as much as possible to warn the sheep of the slavery that would be the reward for those who refuse to heed the warning and continue to trade their heritage of freedom for short term, perceived gain. Unfortunately, few physicians understood, much less acted upon, the warning. Was it worth it? Probably not. Move over, Dolly - Baa, Baa, Baa!
John M. Sherman, MD
El Paso, TX
It has been three and one-half years since I opted out of Medicare and I couldn't be more satisfied. Before I took the step, I was always resentful my fees were fixed by the government and were so low that I could not cover my overhead. Then I had to constantly contemplate the disturbing thought that if I made an inadvertent coding error, I could be fined and prosecuted. Philosophically, I also considered the Medicare program to be anti-American and anti-freedom. I resent the unjust manner in which Medicare is administered by the bureaucrats and the so-called fraud and abuse witch hunts that threaten the livelihood of every physician. Medicare is the antithesis of the values that were the foundation of this country and a constant peril to our constitutional liberties. Any MBA will tell you that the business of the Medicare reimbursement is unsound.
When I opted out of Medicare, I knew I would lose some referrals --- either because of professional jealousy or because of Medicare administrative problems. I also had a problem with the socialistic attitude engendered by government in many Medicare recipients --- namely, that they were "entitled" to my services every hour of the day including weekends for non-emergent care. For this, I received very little reimbursement and even less gratitude. This is the type of mentality engendered by government socialistic programs.
There is no looking back, and I would have opted out of Medicare sooner except the hospital where I had the contract for anesthesia services required that I accept Medicare as part of the contract. This was before I was enlightened. No more! But that is another issue --- hospital exclusive contracts. These contracts are always written for the benefit of the hospital and violate many of our beliefs about free enterprise.
I am now very happy that I had the courage to take that final step to opt out of Medicare --- and break the oppressive shackles of government medicine.
Mary Jo Curran, MD
I opted out of Medicare three years ago because I could not participate in that pathological system and still practice good psychiatry.
I learned in residency that paying for treatment motivates people to improve. They are more inclined to communicate, cooperate and comply. They make the most of their visits and need fewer of them. They are empowered to make conscious choices about how to allocate their resources.
Unfortunately, the Medicare, third-party payer and socialized medicine factions work in opposition to this fundamental principle. They reward infirmity and feed dependency. They are creating a whiny and debilitated populace that has forgotten basic self-respect and common sense.
Our current system disconnects the patient from the cost, creating the illusion that others are more responsible for his health than he is. Meanwhile, we have brainwashed ourselves into believing insurance is more valuable than health care itself, but we all know insurance doesn't guarantee --- and often obstructs --- good health care.
Not only have I opted out of Medicare, but I have resigned from all managed care contracts. My patients understand up front that they are expected to pay me at the time of service. Thus, money issues are properly addressed in the therapy room, and patients' experiences with their insurance companies become teaching tools.
I will not get rich doing business this way, but I am doing the job I was trained to do. Also, I have very low overhead, very little stress, and I don't have to worry about the Medicare police barging with guns into my office and traumatizing my patients.
At this point I have diverged so far from the mainstream there is little hope of return. People like me, who choose to be healers rather than "providers" (read "enablers") are a dying breed. There are more of them than there are of us, and they have louder voices, more money and more political clout.
But that doesn't make them right.
Katharine C. Otto, MD
Regarding "Neuropharmacology as
a Long-Range Strategic War Policy"
Dr. Russell Blaylock's article, "Neuropharmacology as a Long-Range Strategic War Policy" (Spring 2002) proposes a bizarre reason for continuing the war on drugs. The major threats to the U.S. come from within, not without. As long as we remain free, the U.S. will never see a Russian or any other occupational force within our borders. Perhaps in the past the USSR wished "to destroy the moral foundation of Western society and weaken our ability to resist future military invasion." This was a futile wish. Freedom won and their evil empire is gone. If the "Russian mafia" is currently a major player in the U.S. drug trade, it is because black markets are lucrative.
Blaylock blames the drug trade for the "growing loss of respect for law and order." This disrespect occurs not because of the drug trade but because of the laws against the "production, money laundering, drug smuggling and distribution" of drugs. These laws criminalize the drug trade. Furthermore, these laws do not work. There are as many drug users as ever. Not only that, enforcement requires national police forces as the DEA, BATF, FBI, CIA, etc. These agencies have mission creep that is leading to a police state. We will always have social problems. It is much better to trust freedom and civil society, not government, to contain them.
He speculates, "excitotoxic reactions in the brain, will lead to a society filled with young people crippled by neurodegenerative diseases." An even bigger threat to our youth is our government's persecuting and jailing drug users. Most agree that our current and immediate past U.S. presidents have both used drugs. Would our country be stronger if we had jailed them for youthful dalliances? Does it make our country stronger to prosecute over a million drug users a year? By so doing, we turn them into criminals. This is what weakens our country.
The drug war has significant collateral damage. Police invade our privacy looking for drugs. They confiscate cash on not the proof but the assumption that it came from the drug trade. Prohibition did not stop alcohol use. Instead it led to the lawlessness and violence of the Mafia. The drug war does the same and also leads to and corruption of the police. This corruption creates holes in our national borders and as terrorism waxes, this is dangerous. We futilely try to stop other countries from producing lucrative drugs. In the past, the U.S. supported the Taliban in Afghanistan. The Taliban kept their side of the bargain by destroying the poppy fields. However, this also triggered the law of unintended consequences as we witness the twisted acts of our former allies. In Columbia, our drug containment policies are leading toward disaster.
In conclusion, Dr. Blaylock says that, "If we are to survive as a nation, we must face the truth. The old Soviet intelligence services have joined forces with the Russian mafia in a quest to dominate the world." Perhaps so but it is folly to combat this by escalating the war on drugs. The best way to neuter the Russian mafia is to eliminate their profits by abandoning the failed war on drugs.
Bert Loftman, MD
Dr. Blaylock Replies
Dr. Loftman's response rehashes the same old tired refrain still echoing from the libertarians and leftist-extremists. You don't solve the problem of robbery by legalizing theft, even though this was advocated by Bakunin. ("Robbery is one of the most honorable forms of Russian national life.")
The major error in Loftman's letter assumes Soviet communism is dead and is no longer a threat. Nothing could be further from the truth. Most of those within the U.S. who are working to destroy our freedoms are also communists, communist sympathizers, socialists and collectivists of various stripes. They have been working for over a century to create just the society he fears. (See "Managed Truth: A Great Danger to our Republic," Medical Sentinel, November/December 1998.)
While I disagree with criminalizing the user, we should the seller. Our number one target should be states behind the drug program --- Cuba, Russia, China, North Korea and the FARC. And, as I pointed out, we have failed to inform the public that this is a war, not just a sign of the times.
There is an intimate connection between terrorism and the drug trade --- they cannot be separated. Are we also to ignore terrorism? Sure we must be careful not to respond by forming a totalitarian system, but we do have to protect our citizens. If we follow Loftman's ideas we will bring about the very destruction of our free society that he wishes to avoid. I suggest he carefully re-read my article, peruse Dr. Joseph Douglass' article "Influencing Behavior and Mental Processes in Covert Operations" (Medical Sentinel, Winter 2001) and his book, Red Cocaine --- The Drugging of America and the West (2nd edition, Edward Harle Limited, London and New York, 1999, phone: 212-447-5111), before setting on such suicidal ideas.
Russell L. Blaylock, MD
"Irradiating the Mail and Food"
I was shocked and sorry that you published a biased article on how we need to irradiate food. This is another failing industry that has lived on government subsidies since its inception, looking for an outlet for their business. Common sense defies the use of radiation in our food supply. We have enough contamination in our food supply as it is. The author states that the AMA and World Health Organization supports irradiation. This in itself should be enough evidence to keep us from irradiating our foods.
William J. Rea, MD
Biased article? It was a short News Capsule quoted item, "Irradiating the Mail and Food," Medical Sentinel 2002;7(1):5. We did publish a comprehensive scholarly article on a related subject that may be of interest. See Cohen, BL. "The cancer risk from low level radiation: a review of recent evidence." Medical Sentinel 2000;5(4):128-131.-Ed.
Dr. Orient Replies
I find it very interesting that the very physicians who want minimal government interference in their own unusual practices still wish to deny Americans the freedom to choose irradiated food. I would like such food to be prominently labeled so that I can find it more easily. One could make the case, however, that it is nonirradiated food that should be prominently labeled --- just as raw milk was back in the days when one could still find it in the supermarket.
It is hard to see that the radiated food industry has profited much from government subsidies, when essentially it does not exist in this country to any significant extent. Whatever subsidies it has received have been more than outweighed by the crushing load of oppressive and unnecessarily restrictive regulations.
These regulations are based on the Linear No-Threshold Hypothesis, extrapolating the danger of radiation exposure at high doses down to the zero-zero origin. (Of course, irradiated food does not expose the consumer to radiation in any case.) The actual evidence that we have for exposure to low doses of radiation shows it to be beneficial. The best and most massive data sets are totally inconsistent with the LNT Hypothesis. However, the health physics industry simply stonewalls on this issue because the LNT is a full-employment program for them. Or so they think --- there might be greatly expanded employment opportunities if people were allowed to benefit from the science and industry that could flourish in the absence of absurd regulations and media-promoted hysteria over the radiation demon.
The AMA and the WHO also support aseptic surgery, good sanitary engineering, and accurate labeling of products. I expect that Dr. Rea does also. We should evaluate technology based on sound science, not guilt by association.
Jane M. Orient, MD
Canadian Provinces Move Toward Privatization of Medical Care
"The premiers of Alberta, Ontario, and British Columbia say ballooning costs and long delays for some procedures can be solved only by private initiatives. 'Our healthcare system is on life support, and it is fading fast,' said British Columbia Premier Gordon Campbell.
"Canada's universal health care system now eats up as much as 40 percent of provincial budgets. Originally a 50/50 split in financial responsibility between the national and provincial government, the national share has been declining for years, currently around 15 percent.
"Provincial premiers, such as Ralph Klein of Alberta, have begun discussing for-profit health care and privatized contracting as alternatives. Klein is exploring the possibility of allowing more private hospitals, eliminating unionized employees, and offering profit-based incentives as a way to improve health care."
(Http://www.csmonitor.com/2002/0228/p07s02-woam.htm. From Health Care News, April 2002, p.17.)
Correspondence originally published in the Medical Sentinel 2002;7(2);33-36. Copyright©2002 Association of American Physicians and Surgeons (AAPS).