Correspondence (May/June 1999)

Kudos to AAPS and the Medical Sentinel

Dear AAPS Doctors,
The purpose of this letter is to inform you of an action taken by the CMA's House of Delegates. By affirmative vote of the assembled Delegates and Alternates, CMA commends the Association of American Physicians and Surgeons for its successful efforts in making the documents of the secret Clinton Administration Health Care Task Force available to the public so that medical policy makers, historians and others may benefit.

John C. Lewin, MD
Executive Vice-President/CEO
California Medical Association
San Francisco, CA

 

Dear Editor,
Yes, I know all about your organization. You guys are some of the true heroes of today. You choose to do something rather than sit around on your butts and complain as so many of our colleagues seem to do. I applaud youThanks for your letter. I support your work and would be glad to entertain any way that we can work together...You also can check out my soon to be completely redone website at http://#www.offpedestal.org. It says it all. I think we are in sync.

Michael Greenberg, MD
AMNews Contributor
Grove Village, IL.

 

Dear Editor,
Thanks very much for the copy of the November 6, 1998 letter to AMNews...Once again and as always, the AMA is either actively or passively selling physicians out. Their political agenda is so translucent...Thanks also for all your hard work on the behalf of all physicians. Your tireless devotion is a tremendous benefit to us all!

John A. Kasch, MD
Past President, American Society of Dermatology (ASD)
Sacramento, CA

 

Dear Editor,
...You and the editorial board are to be commended for all your excellent work! When I get frustrated about the way the state and federal governments are eroding the medical system in the U.S., I can get a dose of enthusiasm to keep up the fight by reading the Medical Sentinel!

I should send you some information about the odious proposals that have surfaced in this formerly conservative state, thanks to Governor Jeanne Shaheen and the liberal Republicans...

P. Gardner Goldsmith
Amherst, New Hampshire

 

Dear Drs. Scherzer and Goltry,
Congratulations on the excellent articles you wrote in the November/December 1998 issue of the Medical Sentinel. You said exactly what needs to be said, if people would only pay attention.

Wallace Rubin, MD
Metairie, LA

 

Dear Dr. Meyer,
I am an avid reader of the Medical Sentinel, and want to compliment you on your recent contribution. Your book review of Sobel's Coolidge, as published in the January/February 1999 issue of the Medical Sentinel, is the best book review I have read in recent memory. In a concise manner, you conveyed a powerful message about the benefits of political inactivity. Your statistical references about Coolidge winning 17 out of 19 elections and using an average sentence length of nearly one-half that of Wilson were fascinating.

Interestingly, the English language lacks a proper word to describe the Coolidge approach to government. Walter Lippmann reluctantly used the term "political inactivity," while recognizing that Coolidge "worked hard at inactivity." Two other English words, forbearance and quiescence, more closely describe Coolidge's approach, but they also constitute imperfect descriptions.

The lack of an English word to describe Coolidge's political philosophy speaks volumes about the misguided historical attitudes towards government. While Sobel calls Coolidge an "enigma," the real enigma is mankind's irrational thinking about government.

Andrew L. Schlafly, Esq.
AAPS General Counsel
Wayne, NJ

 

Dr. Meyer Responds

 

Dear Mr. Schlafly,
Thanks for the kind note. I appreciate the opportunity that the Medical Sentinel has given me to write about things that are dear to me. I'm able to review books with a slightly different perspective than I can for Sacramento Medicine. You can read my Sacramento Medicine reviews on my web page: www.delmeyer.net or you can review my previous three years of editorials on my family web page: www.groupemeyer.com/del.

I enjoyed meeting you and finding out your relationship to a woman I admire and that she's doing well. Look forward to seeing you at the next meeting.

Delbert H. Meyer, MD
Carmichael, CA

We presume, of course, that Dr. Meyer is referring to Phyllis Schlafly, Director of Eagle Forum and the great vanquisher of the ERA.---Ed.


JAMA and Gun Control

In the December 23/30, 1998 issue of JAMA, Wintemute GJ, Drake CM, Beaumont JJ, Wright MA, and Parham CA, authored a pro-gun control article entitled, "Prior Misdemeanor Convictions as a Risk Factor for Later Violent and Firearm-Related Criminal Activity Among Authorized Purchasers of Handguns" (JAMA 1998;280(24):2083-2087). In the following letters, two physician respond to the editors of JAMA. We thought their response would be of interest to readers of the Medical Sentinel, particularly since physicians opposed to gun control as a public health issue are seldom given a chance to express their views in AMA publications.

 

Dear JAMA Editors,
As a member of both the AMA and NRA, as well as a previous contributor of scientific articles for JAMA,(1) I wish to call to your readers' attention several complicating factors and observations that may have adversely affected the data and analysis of the retrospective cohort study of prior misdemeanor convictions as a risk factor for later violent and fire arm-related criminal activity among authorized purchasers of handguns reported by Wintemute et al,(2) and the subsequent call for legislative restriction against individuals with prior misdemeanor offenses by Brady, Brady and Cole,(3) and a call for violence related papers by the editorial staff of JAMA.(4)

First, this association of prior misdemeanor convictions with later more serious new crimes holds true even if the subject never owned a handgun. Since handgun ownership is an inclusion criteria in this study, it should not be surprising for future offenses committed by these subjects to involve a handgun. By restricting inclusion criteria to only hand gun owners, this study's results give the slanted conclusion that those with at least one prior misdemeanor conviction are much more likely than those with no prior criminal history to be charges with a new offense.

Secondly, there is no comparison in this study with the control group of law abiding citizens, and those with at least one prior misdemeanor conviction who are not handgun owners. By restricting the study to only handgun purchasers, and not including a control group of non-gun owners, the readers of JAMA are not able to assess from this paper the influence of the correlation of previous crimes or misdemeanors with later more violent crimes.

Third, this paper completely omits study of comparison of criminal records of those with one or more prior misdemeanor convictions and those with no convictions regarding offenses involving firearms or violence where the subject never legally purchased a handgun. This latter illegal group represent the most desperate criminals that would be least affected by handgun legislation.

Most of the reference used in this paper are "opinion publications" and are not scientific papers that have adequate control groups. Care must be taken in avoiding extrapolations or generalizations from such papers that do not include an adequate control group for comparison. Such uncontrolled studies help to propagate myths about guns that can threaten people's safety by frightening them and preventing them from using the most effective means to defend themselves.

The references in this article by Wintemute et al do not mention the definite monograph, More Guns, Less Crime: Understanding Crime and Gun Control Laws by John R. Lott, Jr. from the University of Chicago Law School.(5) The inclusion of such references that dispel the myths about guns and crime must be included in the public policy debate. Lott's monograph strongly indicates that allowing citizens to own guns saves lives. Recent reports of a several fold increase in violent crimes occurring after the outlawing of handgun purchases by law abiding citizens in Australia should prompt the editorial boards of peer reviewed journals such as JAMA to require inclusion of reports of contrary data or articles in the discussion of such papers, and should certainly, when requesting editorial comments such as the Brady article, also include editorial comments from other noted authorities with contrary views.

Finally, in addition to performing additional studies to include an appropriate control group of non-gun owners for comparison, Wintemute et al should consider similar studies involving subjects with illegally obtained handguns and subjects who own other lethal weapons such as knives. Would the editorial by Brady, Brady and Cole(3) still advocate the prohibition of knife purchases or possession of knives by individuals convicted of a prior misdemeanor? Would they advocate a "Brady Law" for knife purchasers too?

James H. Wood, MD
Chief, Section of Neurosurgery
West Paces Medical Center
Atlanta, GA

 

References

 

1. Wood JH, Fleischer AS. Observations during hypervolemic hemodilution of patients with acute focal cerebral ischemia. JAMA 1982;248:2999-3004.
2. Wintemute GJ, Drake CM, Beaumont JJ, Wright MA, Parham CA. Prior misdemeanor convictions as a risk factor for later violent and firearm-related criminal activity among authorized purchasers of handguns. JAMA 1998;280:2083-2087.
3. Brady S, Brady J, Cole TB. Handgun purchasers with misdemeanor convictions. JAMA 1998;280-2120-2121.
4. Flanagin A, Cole TB. Violence, a neglected epidemic; call for papers. JAMA 1998;280-2121.
5. Lott JR, Jr. More Guns, Less Crime: Understanding Crime and Gun Control Laws, Chicago, IL, University of Chicago Press, 1998.

 

The Police State of Medicine


Dear Governor Pataki,
At its 1998 annual meeting, the Illinois State Medical Society House of Delegates passed a resolution opposing the criminalization of medical mistakes and supporting the cause of Gerald Einaugler, M.D. of New York. While we are most thankful that you have commuted Dr. Einaugler's sentence, we are writing today to urgently request that you grant him a full and prompt pardon.

It is our understanding that Dr. Einaugler was convicted of a criminal offense while exercising good faith clinical judgment, and that the conviction was based on testimony which was later retracted. We also understand that Dr. Einaugler is barred from participating in Medicare and Medicaid as long as the conviction stands, and that this exclusion has resulted in his personal, professional, and economic ruin.

Delegates to the ISMS House take seriously our responsibility to represent the approximately 17,000 physician members from across Illinois. We speak with a unified voice when we vigorously affirm our intolerance toward the criminalization of malpractice. It is our belief that such action interferes with appropriate decision-making toward patients and ultimately threatens the quality of patient care.

For Dr. Einaugler's sake and the sake of all physicians who face the threat of criminal liability and jail when exercising good faith medical judgment, we ask that you act now to pardon Dr. Einaugler. Thank you for your consideration of this very serious matter.

Arthur R. Traugott, MD
Chairman, Board of Trustees
Illinois State Medical Society
Chicago, IL

Census


Dear Editor,
Reference is made to "Census" in Medical Sentinel, Vol. 4, No. 1, pp. 36-37 that debunks the current politically correct population explosion myth and mania used to promote Hillary Clinton's proposal to estimate the 2000 census.

Arthur B. Robinson, PhD in his Access to Energy for December 1998 (Volume 26, Number 4) supports with concrete data my contention.

"21st Century, Fall 1998, p. 8, reports that U.S. Census Bureau data shows that the 20-year decline in world population growth rate accelerated in 1997 and the first half of 1998. Of the 157 countries included, 17 had falling populations a year ago. Now 30 have falling populations and 16 more have zero population growth.

"World population stands at 5.9 billion. The world population growth rate in the 1980s was 2 percent. In 1992, it was 1.7 percent; in 1997, it was 1.4 percent; and now it is 1.3 percent per year."

Curtis W. Caine, MD
Brandon, MS

 

AMA and Peer Review


Dear Editor,
I hope you have accessed the AMA website for medical ethics because as an AMA member I am in a quandary as to what to do. In their documents you can find what I think are many seeds of our destruction. While the majority of the information sounds good, it essentially amounts to belated and reactive postures to the orderly transfer of our autonomy to resource managers who hide behind "public health" and "quality" as quasi-legal terms of art which they are not...

The issue of who practices is of course the same as who is credentialed. Credentialing based on scientific knowledge and ethics no longer occurs...

Peer review thus maintains its protected and revered status whether or not its fundamental purpose is thwarted by corporate bylaws which deprive physicians and by extension patients of basic civil liberties...Peer review is such a revered activity that the legislature has guaranteed that no lawsuit for wrongful discharge can ever be successfully litigated because there is absolutely no discovery and no recovery. This supposedly protects public health and assures quality. The managed care and private hospital attorneys argue that because one is not prohibited from initiating a lawsuit, albeit quixotic, he still maintains enough of his civil liberties to make it legal....

Please check out the web page at http://www.ama-assn.org/mem-data/special/omss/omssadv/98dec17a.html.

Robert Kimber, MD
Atlanta, GA

Thriving Outside Managed Care


Dear Editor,

A colleague psychiatrist shared with me the article "Thriving Outside Managed Care" by Dr. Robert Emmons (Medical Sentinel, Vol. 3, No. 6). This is an inspirational article. It contains what I believe psychiatry and medicine is all about. Dr. Emmons exemplifies what taking personal responsibility as a physician must be for every physician today.

I am tired of witnessing medical professional organizations trying to change legislation, trying to suit managed care organizations, and trying to manipulate the media in order to defend medicine. The effort must start at home, with the individual physician. Medical organizations need to encourage this type of practice.

Dr. Emmons has taken control of what he can control and that is what needs to be recognized as a remarkable courageous move on his part. Please, pass this on to Dr. Emmons from one of his supporters.

Joel Kahan, MD
Palm Beach Gardens, FL

 

The Health Care System as a Dysfunctional Family


Dr. John Sonne's article, "The Health Care System as a Dysfunctional Family" (Medical Sentinel, Vol. 4, No. 1), was right on target. Among the many cogent ideas he expressed was the importance of recognizing the misuse of words, and the subtle alteration in thinking which results therefrom. I would like to bring attention to additional examples of the misuse of words serving to alter people's perceptions of themselves and their relationships with others.

First is "the nation's children." The nation has no children. Only parents have children. While children live in a nation, they are not possessions of the nation. This term should be challenged wherever it appears.

Another is "national health." There is no such thing as national health. Only individuals enjoy health, or suffer from lack of it.

Most offensive is "human resources." This term has replaced "employee" and "personnel." Employee conveys the idea of a human relationship between an employee and an employer. Personnel implies recognition that the people concern are persons. Human resources reduces people to a status of expendability. After all, resources are developed for the purpose of being expended. The U.S. Senate even has a Committee of Labor and Human Resources.

"Workforce," a term now being used in connection with schooling (not to be mistaken for educational), implies organization under central planning and control, replacing individual self-determination.

The more we get used to hearing and accepting the use of given terminology, the more our thoughts and attitudes succumb to the subtle implications of those terms, without our recognizing that change has been brought about in us. Do not use, do not accept destructive terminology.

Lawrence A. Dunegan, MD
Pittsburgh, PA

 

An excellent description and explanation of changes in the language for political purposes is, of course, found in George Orwell's prophetic classic 1984. I'd like to suggest that interested readers re-read this classic as I've done, paying careful attention to Orwell's explanation for alterations in language and the quest for the "final" and 11th edition of Oceania's Newspeak Dictionary. ---Ed.

 

Gift Subscriptions to the Medical Sentinel


Dear Miguel,
Your recent article in the Medical Sentinel about the decline of England and gun control was absolutely terrific. This is the best article I have read on any topic in many months...Finally, is it possible to give gifts of the Medical Sentinel to libraries, and hope that they renew? We need to understand the library purchasing system better, and get into that market for the Medical Sentinel. Keep up the great work.

Andrew L. Schlafly, Esq.
Wayne, NJ

 

Dear Andy,
Thank you for your kind words. We are very fortunate, if it is not providential, to have you as our General Counsel...Andy, there are 15,300 public libraries and their branches in the U.S. Of this number, via courtesy of the AAPS Board of Directors or direct subscriptions, 2600 medical libraries are already getting the Medical Sentinel. The National Library of Medicine, Mayo Clinic, Robert Wood Johnson Foundation, Columbia University, Central Research Library Pfizer, Inc., Creighton Univ. Health Sciences Library, etc. have us in their catalogues.

There are also over 7,000 hospital libraries. Here, individual AAPS members can also help us tremendously by extending library subscriptions to their individual hospital libraries and, in some cases, urging hospital administrators in those hospitals in which they practice and have influence to subscribe to the Medical Sentinel. This is what Dr. Lawrence Huntoon of Jamestown, New York, Dr. David Pasek of Charlotte, North Carolina, and Dr. Edwin A. Meeks of Jonesboro, Tennessee, and others have done. [Thank you!] ---MAF

 

Dear Miguel,
Those are good numbers, 15,300 public libraries and 7,000 hospital libraries. What I recommend is a campaign to inform and encourage AAPS members to make a gift of the Medical Sentinel to their local public library or hospital library, with a letter to the administrator describing the gift and with the hope that the administrator will include it on their buying list next year.

How about this as a possible draft letter for AAPS members:

Head Librarian,
C/O __ Library
<address>

I am hereby donating one-year's subscription of the Medical Sentinel to your periodicals. I trust that you will agree that this journal is a welcome addition to your fine collection.

Sincerely,
_____, M.D.

cc: Medical Sentinel (with check enclosure)

 

Fellow AAPS members: Does your medical library subscribe? Does your hospital library get the Medical Sentinel? Make sure they do by urging the head librarian to subscribe or by donating a gift subscription! ---Ed.


Correspondence originally published in the Medical Sentinel 1999;4(3);77-81. Copyright©1999 Association of American Physicians and Surgeons (AAPS).