The Police State of Medicine
Dear Dr. Faria,
While sitting in a doctor's office in Phoenix, Arizona, I began to read a copy of your journal. I couldn't help notice the major theme of
this particular issue (July/August 1998) encompassed the outrageous behavior of various government groups, particularly the DEA.
An article written by Dr. Tad Lonergan was extremely interesting, especially since I knew Dr. Lonergan personally.
I met Dr. Lonergan approximately 20 years ago in Anaheim, California when I was injured. Dr. Lonergan healed me and became my personal physician while I resided in the area.
Over the course of several years I witnessed the expertise and kindness of Dr. Lonergan. The list of his unselfish deeds could fill several pages, but the bottom line is this physician takes the Hippocratic Oath seriously, and believes in pain management. He is a doctor who dedicates himself to his patients in practice, not in verse or reason of greed.
I contacted Dr. Lonergan to give him my condolences on his unfortunate debacle and ultimate fate at the hands of the DEA. I was even more surprised when he told me the only support he has received so far is from the AAPS! Apparently, there was not one peep, telephone call or letter of support from his colleagues prior to his trial.
This is a significant problem and makes one inquire where the AMA, the vaunted state and county medical societies are during such ambiguous prosecution of their members.
As an outsider (writer and author) who has watched this change in medicine, might I congratulate you on your brave and hard hitting publication. It should be in the hands of every state and federal legislator. The Medical Sentinel is professionally "put together."
Final Say --- IMEs or Juries
While medical necessity standards should be based on generally accepted standards of medical practice, the AMA is incorrect to assign such responsibility only to "properly qualified independent" physicians, who should have the final say when differences arise between treating physicians and health plans (AMNews editorial, April 5, 1999). The AMA is incorrect because such independent medical examiners (IME) are no more than servants of the powerful, well-financed, insurance companies. Unfortunately, many of our peers want to supplement their income with this kind of work. Therefore, I strongly believe that the final say should be in a jury...
IMEs cause benefits to be denied to many of my patients...In general, these IMEs have compromised opinions which must be in line with the health insurance strategy of providing none or only conservative (non-expensive) treatment. They represent a risk to honest physicians attempting to serve their patients, the same patients who can sue their physicians for medical malpractice but not the IME.
...If the final say in medical malpractice is on the jury, the jury, and not these hired guns, shall have the final say on medical necessity, too.
Wanda Velez-Ruiz, MD
Judicial Interference --- Justified
Many thanks to Mr. Andrew L. Schlafly, Esq. for the lucid discussion on the "Judicial Interference With the Right to Contract," (Medical Sentinel, March/April 1999). He (and rightly so) denounces the Judiciary's support for the government's interference in private contracting as "judiciary activism." That "interference" is just one of the many paternalistic actions of government which have been growing in the last few decades. We in the medical profession have been up in arms about this outrageous interference by third parties such as Medicare in the contractual relationship between patients and physicians.
My question to Mr. Schlafly, the Medical Sentinel and the medical profession is: Whose fault is it? Who justified paternalism? The answer is: not the government nor the politicians. Surely the politicians welcomed it wholeheartedly and applied with gusto, but it was the medical profession which justified and cultivated the paternalistic ideology. The "Mental Illness" ideology is the cornerstone of such justification. The basic tenet of the "mental illness" ideology is that a person, due to some kind of neuropathology, may loose her/his moral sense. For example: Senator Goldwater's political position was due to his "mental illness"; John Hinckley Jr., due to his "mental illness," did not know that shooting the president was wrong. Compulsory compassion and help for the "mentally ill" and the "mentally ill --- to be," became the natural consequence of such ideology. The medical profession has gone along with the "mental illness" fiction in spite of the mountains of ridiculous cases reported daily and in spite of the abundance of critical literature; the best example of which is the voluminous published work of Thomas S. Szasz, M.D. The "mental illness" ideology is not circumscribed to the so-called mentally ill persons, but it is a virulent, totalitarian concept that applies to all citizens. Let's look at our own house before we try to re-invent the wheel.
Nelson Borelli, MD
Mr. Schlafly Responds
Dr. Borelli is correct in describing judicial activism as "just one of the many paternalistic actions of government." It is humorous to note, however, that liberals now consider the word "paternalistic" to be derogatory. This term is being replaced by "compassionate."
Liberal nomenclature aside, judicial activism predates modern medicine. The Bill of Rights was partly an effort to curtail the arbitrary power of judges in Colonial America. See U.S. Constitution, Amendments IV-VIII.
Andrew L. Schlafly, Esq.
Dr. Orient Responds
I agree with Dr. Borelli. But I think the complicity of the medical profession extends far beyond the mental illness concept. Organized medicine is heavily promoting very intrusive legislation called a "Patients' Bill of Rights" that purports to "guarantee" the "quality of care" and the competence of physicians. This all assumes a disinterested omniscient elite that can pass enlightened judgment on everything. So both physicians and patients come under the umbrella of paternalism. There is no freedom without responsibility.
Jane M. Orient, MD
Many thanks for your message. I am delighted with Dr. Borelli's thoughtful gift and look forward to receiving your publications. I am well aware of and greatly value, your activities.
With Best Wishes,
Thomas Szasz, MD
How Perverted Can HMO Medicine Get?
Dear Dr. Orient,
HMOs have destroyed many long-term patient-physician relationships, they have created an ethical conflict of interest for physicians who must agree to withhold care to their patients for profit, and they have perpetrated the biggest scam of all time on patients whom they have promised "something for nothing." Managed care has unquestionably lowered the overall quality of medical care available today. But is this as bad as it gets?
Recently, one of my patients required an EEG, which I arranged to be done at our local hospital. Imagine my surprise when the hospital technicians informed me that I, as the treating neurologist, would not be allowed to read her EEG. Because the patient was forced into managed care by her husband's employer, and I don't participate in any form of managed care, another neurologist who has never seen the patient and who knows nothing about her clinical situation will be reading her EEG and sending the result to me. That's a little like holding the diaphragm of the stethoscope to your patient's chest while the earpieces are in another physician's ears. Oh say can you hear...it's getting worse every year.
Lawrence R. Huntoon, MD, PhD
Correspondence originally published in the Medical Sentinel 1999;4(4);117-118. Copyright©1999 Association of American Physicians and Surgeons (AAPS).