Correspondence (September/October 1999)

Correspondence (September/October 1999)

Regarding "Misinformation"

Dear Editor,
When I read the editorial "Misinformation" by Arthur B. Robinson, Ph.D. (Medical Sentinel, May/June 1999), I couldn't help but wish it were true that with the availability of unfiltered information "...truth will be the winner and misinformation the loser." The problem with this optimism is it's based on the false premise the reason misinformation and propaganda works is because the truth is unavailable. In a dictatorship, the reason for accepting propaganda may well be the failure to be exposed to the truth, but the problem in a democracy is the failure to accept the truth when exposed to it. The success of propaganda in a democracy is based upon the desire of the listener to believe it. He wants to believe it, not only because the notion proposed by the propagandist is more pleasant to the listener, but even more importantly, because in a democracy, he is himself invested in the propaganda. Since he believes that his government serves at his pleasure, based upon a vote in which he participated (even if his candidate did not win in this particular election), it is a repudiation of himself to oppose his government's propaganda.

The current situation in Kosovo is instructive. The majority of Americans want to believe that they are morally upright in the wake of the recent moral debacle of the Clinton administration and other current events such as recent school shootings. Going back even further, the majority would like moral absolution for its failure to act during the Nazi Holocaust. Thus, there's a great desire on the part of the majority to accept the propaganda offered by the Clinton administration regarding the invasion of Kosovo. This is compounded by the majority's need for validation of its recent decision, expressed through its elected officials, to support as its leader Clinton. Having just made the decision that Clinton was a good leader regardless of his character flaws, repudiating his decisions regarding Kosovo would constitute a repudiation of the majority's decision which it anguished over for more than a year. Thus we have a perfect example of the reason why propaganda such as we now hear relating to the Kosovo invasion, which is clearly in violation of international law and all previous U.S. positions, is successful despite the availability of the truth both on the airwaves and the Internet.

Edward R. Teitel, MD, MBA
Houston, TX

[That is why our Founding Fathers intended for us to have a Republic, not a Democracy, if we can keep it! See "America --- A Republic or a Democracy?" Medical Sentinel, News Capsules, January/February 1999. --- Ed.]

Smaller Government

Dear Editor,
Harry Browne's point about the difficulty of incremental change in the welfare state is very well taken. But I believe he underestimates the difficulty in achieving dramatic change.

Recently I attended a seminar in which the facilitator spoke about how we should all pay our taxes joyfully, as he does.

I'd be willing to bet that he, like so many other Americans, does not really pay income taxes. His pay is totally derived from tax revenues, without which his paycheck would be $0. He only pretends to pay taxes by receiving less money than the nominal amount of his salary.

The payroll tax burden is far higher than the income tax burden for millions of Americans, and Mr. Browne does not comment on that. And what about those who benefit from a negative income tax, or earned income tax credit?

We're heading down a vortex at an ever-accelerating pace.

Jane M. Orient, MD
Tucson, AZ

Medical Sentinel --- A Breath of Fresh Air

Dear Editor,
With very few exceptions, doctors in general, had been my impression, are a self-absorbed and intellectually weak group. After all, they have caved in to the pressure of malpractice litigation onslaught and the takeover of the practice of medicine by government kleptocrats and an assorted variety of leeches masquerading as reformers and do-gooders. I know now this is not true as I have just read your magazine which a physician friend handed me a few hours ago.

Even as I am not a member of the medical profession, I salute your pursuit, your intellectual anchors in liberty and limited government, and your taking a stand for what is right and just. In the war of ideas, I urge you not to settle for the middle ground. For this war is about freedom to exercise one's self interest and freedom from tyranny.

Those of us who love liberty, free markets, limited government and sound money, have a moral obligation to stand up, speak up and not give up. I will urge every physician I know to become a member of AAPS.

Anthony Deden
Sage Capitol Management, Inc.
Houston, TX

Dear Editor,
I read with great interest your article in the May/June 1999 issue of the Medical Sentinel. I cannot applaud you enough for exposing the Journal of the American Medical Association and the AMA for the socialistic biases they have obviously supported.

When I began my private practice in 1990, I automatically joined the AMA because I erroneously thought they would protect my interest as a voice for physicians across our profession. However, as the years went by and I paid close attention as to what actually was occurring through their overtly bureaucratic Chicago office, it became very clear to me that, as physicians, our interests were not a priority or even secondary.

This culminated approximately two years ago when I read an article published by the AMA president in their weekly newspaper update expounding the great gains the AMA had accomplished during the previous year. As I read through the list of a dozen "accomplishments" I realized that not one of these affected me as a practicing physician. In an era where our profession is being threatened by decreased reimbursements, managed care interference, and general low morale, there is not one accomplishment that was even remotely related to what I could see as the major issues in our medical profession. As a result, I did not renew my AMA membership. A few weeks later I received a form letter from the AMA president requesting that I inform them as to why I didn't renew my membership. I dictated a very gentle and kind letter, however very straightforward, leaving no doubt that the above reasons were the reasons that I decided not to renew my membership.

Thinking that the matter was closed, it was to my surprise that, about a month later, I received a letter from the president stating, although the points I had made may be legitimate, he was quite proud of the accomplishments of the AMA. Dr. Faria, it was at this point that I knew that the AMA leadership not only didn't care about the medical profession, but clearly had a social agenda that not only was quite liberal in nature and quite socialistic in flavor, but also the organization itself would do nothing to help solve the real problems of our medical profession.

I have tried to pass this message on to as many physicians as I can speak to about it; however, I'm still surprised to find that some physicians will mechanically resubscribe as an AMA member. It is through the Association of American Physicians and Surgeons (AAPS), and similar organizations (for instance, the American Society of General Physicians), that I can have any hope of moving our profession to a more noble status, as it once enjoyed.

In summary, Dr. Faria, I think your experience and mine, as I hope many, has led us to believe that the only way to make the changes we seek in our profession will be to do it ourselves. I would hope, as time goes on, we will see the development of grassroot organizations that will affect real change in our medical profession which would include no government interference and back to a relationship that we once enjoyed with our patients. In addition, I am not embarrassed to say that I would also hope that would include some type of fair reimbursement to physicians.

Once again, I want to thank you for the article. It was a pleasure to read it, and I wish you well in the future.

Donald E. Hura, MD
Columbus, OH

Dear Editor,
Your recent editorial (May/June 1999 Medical Sentinel) is an aggregate of facts and truths that sets the record straight as to how American medicine is becoming socialized.

Tragically, since the late 1930s, too often the AMA leadership has not only yielded to liberal political leaders, ploys, and socialistic programs --- but the AMA leadership itself has acted and proposed plans not in harmony with the highest standards of Hippocratic ethics. Indeed, many times they have acted even contrary to same.

For example, in 1977 and for several years preceding, the AMA was working to advance National Health Insurance. In 1977, the AMA's bill in Congress, H.R. 1818, sponsored National Health Insurance. It was through the yeoman efforts of yours truly, through calling the first Special Session ever of the House of Delegates of the Ohio State Medical Association (OSMA) in its 131 year history, called by Delegates, that OSMA action of the preceding regular session, May 1977, was reversed by 97.6 percent (not to go along with AMA). This subsequently led to the AMA's House of Delegates calling for the abandonment of H.R. 1818.

Just a brief respite. But has the AMA leadership stood firm on principle, on safeguarding the Declaration of Independence, the U.S. Constitution, or the ethics of Hippocrates? Has the leadership progressively engaged in political compromises to facilitate its position of power "[with a seat] at the table" where, in fact, American medicine is being "served" to be consumed?

Our medical leaders are appointed to be stewards of the blessings of liberty and our ethics of Hippocrates. They ought not to cooperate in any way when government is effecting their demise. 'Tis long past time to redeclare independence from oppressive bureaucracy at home and in no way to abet its growth and power as too often the leadership of the AMA has been doing.

In the mid- to late 1840s, the famous French statesman, economist, philosopher Frederic Bastiat wrote a unique primer titled The Law. It is only 80 pages long. Every physician --- indeed, every American citizen --- should read it.* Since our government has become so irresponsible and is out of bounds of the constraints of the Declaration of Independence and the U.S. Constitution, and is too often perverting the Law, then it is the duty of the leaders of the AMA to do all possible, including the education of the membership, to adhere and act on the mandates of the Declaration of Independence stating --- "Whenever any Form of Government becomes destructive of these ends, it is the right (duty and obligation) of the People to alter or abolish it and institute new Government --- based on principles."

Right on Dr. Faria. You are a lighthouse radiating beams of truth, integrity, responsibility, dedication to transcendent principles, and all that would secure the blessings of life, liberty, and the pursuit of happiness as we proceed in our necessary task of preserving, protecting, and passing on our great American heritage and legacy of freedom.

God bless you and Godspeed.
Nino M. Camardese, MD
Norwalk, OH

"Snake Oil" Cures in Health Care Policy Blunderland

Dear Editor,
Conrad Meier's article on snake oil in health care policy (Medical Sentinel, May/June 1999) deftly calls attention to the adverse effects of state-mandated coverages in health insurance policies. Required inclusion of many paramedical services, routine checkups, and other ancillary items progressively boost premiums beyond an affordable range, with the predictable result that there are fewer people who take out insurance or continue existing policies.

He then cites last year's study by the Galen Institute in partners with the Heritage Foundation, in which 16 states with the most sweeping burdens had been foisted on insurance policies, had increases of uninsured in the population eight times that of the remaining, less regulated states. Table 2, showing the increases of uninsured in each of the 16 states since 1990, inexplicably and seriously understates the problem, I think. With the disclaimer that I am not a statistician, I see in the last column in the table piddling percentage figures of a few points. Wouldn't a more valid comparison be to post the percentage increase of the post-regulatory group over the pre-regulatory group? Then we have Ohio 24%, Vermont 33%, New York 34%, Iowa 46%, and New Jersey 53%. (New Hampshire notably showed a slight improvement over the study period; something in the data is missing.)

Thayer Smith, MD
Downey, CA

Mr. Meier Responds

Thank you for taking the time to comment. The percent of increase cited by the Galen Institute is hardly "piddling" when you consider each states' population. While I agree it is proper to interpret the uninsured rate in the manner you describe, it was my intent to draw attention to the Galen study, not to re-interpret their statistics. To understand the New Hampshire anomaly, you need to review the entire Galen report. Please contact me by e-mail and I will send it. [email protected].

Conrad F. Meier
Health Policy Advisor
The Heartland Institute
19 South LaSalle, Suite 903
Chicago, IL 60603

Flexner's Legacy (In Proper Perspective)

Dear Dr. Harris,
The article, "Around the Continent in 180 Days: The Controversial Journey of Abraham Flexner," by Mark D. Hiatt (Pharos, Winter 1999) is the most factual and best researched piece written about Abraham Flexner and his legacy in recent memory. I suspect that many readers of The Pharos have only read platitudes and accolades about Flexner and his great legacy over the years...

We learn from this article (and from Flexner's 1960 autobiography) that he more than failed his grandmother's admonition of "not leaping to hasty conclusions."(1) In fact, the evidence points toward the inescapable conclusion that Flexner had and worked with preconceived notions, with premeditated ideas of what he wanted to find in the unscientific survey of medical schools he conducted, and the conclusions he wanted to draw about American medical education.

The 1910 Flexner Report was a concoction of the Carnegie Foundation, the Rockefeller General Education Board, and the American Medical Association (AMA). This is, of course, reminiscent of the AMA's 1983 secret pact with the Health Care Financing Administration (HCFA) that grants the AMA a monopoly over the publication of CPT codes that brings that organization a large portion of its $130 million non-dues operating budget.(2) These are the expensive books physicians must buy from the AMA yearly in order to bill for services rendered. It's also reminiscent of the closed-door meetings of the 1993 Clinton Health Care Task Force in which, again, entities were working behind closed doors in violation of the open door requirements of the Federal Advisory Committee Act (FACA). The Association of American Physicians and Surgeons (AAPS) brought and won a lawsuit against the government that forced the state to bring sunshine to these activities and thereby AAPS became a major force in derailing the Health Security Act of 1993.

In the case of the Flexner Report, the AMA benefited because it strove to eliminate competing sects such as homeopaths and osteopaths, as well as to reduce "the flood of graduates" from medical schools as to decrease competition and thereby raise physicians' income. In the case of the Carnegie Foundation and the Rockefeller Trust, these entities sought to promote the Fabian socialist ideas of education of pragmatist philosopher and educator John Dewey. They sought to implement his socialistic, progressive education methods into American medical school curricula and training, and eventually change the medical profession from within along collectivist, authoritarian lines.(3) In fact, Flexner himself cited Dewey as his "ultimate authority."4 And as Hiatt points out, Flexner asserted that "the community through such regulation undertakes to abridge the freedom of particular individuals[and] individualism," purportedly, for the common good, and as to accomplish greater societal ends.(1)

Indeed, in the wake of the Flexner report, the medical profession became smaller in numbers, but richer in income; medical education became dependent on foundation and government grants (rather than the free market "commercialism" that Dewey and Flexner abhored). The downside, of course, is that in time the profession became more and more regulated by the state, physicians began losing their independence, and the profession began to have its time-honored, individual-based ethics (according to the Oath and tradition of Hippocrates), subverted into a collectivist, corporate ethic, an authoritarian ethic --- i.e., where individual autonomy is subordinated to the collective in the name of the purported common good.(5,6)

Miguel A. Faria, Jr., M.D.
Editor-in-Chief, Medical Sentinel of the Association of American Physicians and Surgeons (AAPS)

References

1. Hiatt MD. Around the continent in 180 days: The controversial journey of Abraham Flexner. Pharos 1999;62(1):18-24.
2. Schlafly AS. AMA's secret pact with HCFA. Medical Sentinel 1999;3(4):149-150.
3. Faria MA Jr. Why the decline in American education and morals. Medical Sentinel 1997;2(1):14.
4. Gamble JG. The relevance of John Dewey's philosophy to graduate medical education. Pharos 1994;57(2):17.
5. Faria MA Jr. The transformation of medical ethics through time (part I): Medical oaths and statist controls. Medical Sentinel 1998;3(1):19-24. (www.haciendapub.com)
6. Faria MA Jr. The transformation of medical ethics through time (part II): Medical ethics and organized medicine. Medical Sentinel 1998;3(2):53-56. (www.haciendapub.com)

This letter was sent but not published in The Pharos. I thought it would be of interest to the readers of the Medical Sentinel.

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