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The Uninsured:


Unlike Carlin's words, it is not that words about health care are profane or ... George Carlin. Program to Get Them to Wash Their Hands ... – PowerPoint PPT presentation

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Title: The Uninsured:

The Uninsured
  • Keep Them That Way Its Safer
  • National Congress on the Un and Underinsured
  • December 11, 2007
  • Edward T. Gluckmann, M.S.
  • President, Health Matters, Inc.
  • 20/200 Visionary
  • The opinions expressed are those of Mr. Gluckmann

The Uninsured Keep Them That Way Its Safer
National Congress On the Un and
UnderinsuredTable of Contents
  • Introduction-Solutions
  • Some Tables on Costs and Medical Care
  • MCR Impact
  • Infections Impact
  • Cancer Death Rates, Deaths and Survivals
  • Two Consumer Revolutions, One Women, One
  • Pillow Talk A Foot Note On Aging Impact
  • Alzheimers
  • Research On Research
  • How We Treat Those Who Treat Our Most Ill
  • Stents, Devises
  • Florida, Land Of Opportunity
  • Different Visions
  • Myths Deconstructed
  • Can You Play This Game?
  • Does He Or Does He Not?
  • Political Ploys
  • Cancer First and Last Word
  • Q A Anybody?

  • Solutions-change the thinking
  • Solutions-eliminate profit and advertising
  • Solutions-establish independent body-a public
    trust that approves only what can be platinum
    standard validated
  • Solutions-convert the word medical in any title,
    activity or name to wellness and then make its
    parts comport to that goal
  • Compensation is based on action to prevent first
    and treat later
  • Criminalize all activity that benefits an
    individual, institution or entity that is or
    appears as a conflict
  • Make them wash their hands
  • Create a National Wellness Service

  • Best Health Care System in the World
  • Today, the United States is undergoing a
    significant change in the language of medicine.
  • Words that once were said about the health care
    system reflexively, used to be assumed,
    increasingly cannot be said in public, or if
    uttered have to be seriously qualified.
  • Unlike Carlins words, it is not that words about
    health care are profane or offensive, it is that
    they are increasingly untenable and unbelievable.
  • Saying them suggests the speaker is out of touch
    with reality they are the equivalent of former
    President George H. W. Bushs shock at the
    supermarket checkout scanner.(5)
  • They are a sign that the speaker fails to
    appreciate the experiences of the average
    American who interacts with the health care
  • JAMA, V. 297, No. 19, 2131-33,May 16,
    2007Ezekiel J. Emanuel, MD, PhD, (Department of
    Clinical Bioethics, The Clinical Center, National
    Institutes of Health), Note Authors references
    numbers are in (..). Italic are mine for
    emphasis. Bold is quote from another source.

  • Best Health Care System in the
  • The statistics are
    damning The system a mess

  • Country Per Capita ()
    of GNP
  • USA
    6,000 16.0
  • Switzerland
    4,077 11.5
  • Norway
    3,966 9.7
  • Germany
    3,043 10.6
  • S. Korea
    1,149 8.2

  • USA Ranking
  • Life Expectancy
    45th (behind Bosnia)
  • Infant Mortality
  • (Per 1,000
    live births)
  • All
    6.37 (behind Cuba)
  • White
    5.7 (two times the rate of

  • Singapore/Sweden/Japan)

  • Number of Americans With Coverage By Type
  • Type Level of Insurance
  • Total Full Under
  • Med/Hosp/Drug 300 30 50
  • Dental 300 30
    140 130
  • Health/Wellness 300 30 10

  • Americans Rate Medical Care Received

  • California HMOs
  • Meets National Member
  • Care Standards Rating
  • 55 63
  • Based on reports for nine top HMOs that
  • cover 90 of HMO covered population in CA
  • State of California
    Website 10/2007

  • Comparison of Selected Benchmarks
  • Before/After Expanded Insurance

  • Before
    After .
  • Total Cost
    2,200,000,000,000 2,604,000,000,000
  • Cost Per Insured 7,333 -
    8,800 8,000 - 9,600
  • GDP 16
    -18 20 - 22
  • Quality Rating 37th -
    45th 37th - 45th
  • Waste 20 -
    70 35 - 75
  • Deaths Due to Care 449,000 -
    1,000,000 529,000 - 1,080,000
  • Add 50 billion to cover price
    increases and correction of estimated costs.
  • Depends on who is doing the count. But
    who is? Everyone!
  • USA compared to the world for selected
  • Estimated based on various indicators
    of waste.
  • Used conservative 80,000 additional
    deaths due to medical care received (MCR)

  • Standard Leading Cause of American Death
  • Rank/Cause
    Deaths () /Total Death Rate
  • All causes . . . . . . . .
    2,443,387 100.0 847.31
  • 1 Diseases of heart . .
    696,947 28.5 241.72
  • 2 Malignant neoplasms .
    557,271 22.8 193.23
  • 3 Cerebrovascular diseases . . . . . .
    162,672 6.7 56.44
  • 4 Chronic lower respiratory diseases. 124,816
    5.1 43.35
  • 5 Accidents (unintentional injuries) .
    106,742 4.4 37.06
  • 6 Diabetes mellitus . . . . . . . . . .
    73,249 3.0 25.47
  • 7 Influenza and pneumonia . . . . . .
    65,681 2.7 22.88
  • 8 Alzheimers disease. . . . . . . . . . .
    58,866 2.4 20.49
  • 9 Nephritis, nephrotic syndrome
  • and nephrosis
    . . . 40,974 1.7 14.21
  • 10 Septicemia . . . . . . . . . . . . . .
    33,865 1.4 11.70
  • 11 All other causes . . . (Residual)
    522,304 21.4 181.10

  • Leading Cause of American Death Rankings-Another
  • Rank/Cause
    Deaths () /Total Death Rate
  • All causes . . . . . . . .
    2,443,387 100.0 847.31
  • 1 MCR (Liberal)
    783,936 32.0
  • 2 Diseases of heart . .
    696,947 28.5 241.72
  • 3 Malignant neoplasms..
    557,271 22.8 193.20
  • 4 MCR (Conservative) 424,000
  • 5 Cerebrovascular diseases . . . . 162,672
    6.7 56.44
  • 6 Chronic lower respiratory dis. 124,816
    5.1 43.35
  • 7 Accidents (unintentional injuries).. 106,742
    4.4 37.06
  • 8 Diabetes mellitus . . . . . . . . . .
    73,249 3.0 25.47
  • 9 All other causes

  • A Leading Cause of Death Medical Care
    Received (MCR)
  • Condition Deaths
    Cost Author
  • Adverse Drug Reactions 106,000 12
    billion Lazarou(1), Suh(49)
  • Medical Error 98,000
    2 billion IOM(6)
  • Bedsore 115,000
    55 billion Xakellis(7), Barczak(8)
  • Infection
    88,000 5 billion Weinstein(9),
  • Malnutrition 108,800
    -------- Nurses Coalition(11)
  • Outpatients 199,000
    77 billion Starfield(12),
  • Unnecessary Procedures 37,136 122
    billion HCUP(3,13)
  • Surgery-Related 32,000
    9 billion AHRQ(85)
  • Totals 783,936
    282 billion or 12.8 of 2.2 trillion
  • The American Medical System Is The Leading Cause
    Of Death And Injury In The United States, Gary
    Null PhD,
  • Carolyn Dean MD ND, Martin Feldman MD, Debora
    Rasio MD, Dorothy Smith PhD. (..) indicates
    reference numbers
  • in original

  • Hospital MCR Deaths Per Year By Type
  • 12,000 - Unnecessary surgery
  • 7,000 - Medication errors
  • 20,000 - Other errors
  • 80,000 - Nosocomial infections
  • 106,000 - No error, adverse effects of
  • medications
  • Is US Health Really the Best in the World?,
    JAMA, July 26, 2000V. 284, No. 4 483-85

  • Hospital MCR Deaths Per Year
  • Medical Care Received (MCR)
  • Caused Deaths Per Year
  • 225,000
  • Is US Health Really the Best in
    the World?, JAMA, July 26, 2000, V. 284, No. 4

  • Medical Injury Is Significant Threat
  • In conclusion, our results clearly show
  • that medical injuries in hospitals
  • a significant threat to patients and
  • substantial costs to society.
  • Excess Length of Stay, Charges, and Mortality
    Attributable to Medical Injuries During
    Hospitalization, JAMA, 2003290 1868-1874

  • There is trouble at
  • the most unlikely of places
  • An ambulance just arrived at the famous
  • Pinata Hospital
  • The patient was heard screaming
  • to the ER Nurse!
  • Please hurry, Im losing my candy.

  • Is There An Extra Doctor In the House?
  • One analysis overcomes some of these
    limitations by estimating adverse effects in
    outpatient care and including adverse effects
    other than death.11.
  • Adverse effects 4-18
  • Extra doc visits
  • Extra prescriptions
  • Extra ER Visits
  • Extra Hospital
    Admissions 8,000,000
  • Extra Long Term
    Admissions 3,000,000
  • Extra Deaths 199,000
  • Extra Cost
  • Is US Health Really the Best in the
    World?, JAMA.2000 284 483-485 Barbara
    Starfield, MD, MPH, Department of Health Policy
    and Management, Johns Hopkins School of Hygiene
    and Public Health. Her reference in article 11
    Epidemiology and medical error, Weingart SN,
    Wilson RM, Gibberd RW, Harrison B.. BMJ.

  • Just Keep Me From The ER This Time
  • 50 million unnecessary annual visits to the ER
  • 95 per minute
  • by the time I finish?
  • What is the cost?
  • What is the benefit?
  • National Center for Health Statistics

  • Medical Care Received (MCR)
  • Caused Deaths Per Year
  • Hospital Based Deaths
  • Non-Hospital Based Deaths
  • Total Deaths 424,000
  • Is US Health Really the Best in the World?, JAMA,
    July 26, 2000, V. 284, No. 4 483-85

  • A Hospital Is No Place To Be Sick
  • Infections Acquired During Hospital Stays
    Kill More People Than Breast Cancer, Auto
    Accidents and AIDS Combined Reports on the
    impact of 19,154 reported hospital acquired
    infections (HAI) in 2005 at 168 hospitals in
  • Average Length of Stay 20.6
    (days) 4.5 (days)
  • Extra Days
    396,129 - 0 -
  • Extra Hospital Charges 3.5
    billion - 0 -
  • Average Hospital Charges 185,260
  • Hospital Patients Who Died 12.9
  • This report recommends that everyone wash
    their hands!
  • Other reports suggest that patients have
    friends stay with them in the hospital to
    protect them from human errors and complacency!
  • Hospital-acquired Infections in
    Pennsylvania, Pennsylvania Health Care Cost
    Containment Council, November 2006, Data
    Reporting Period January 1, 2005 - December 31,
    2005, Pennsylvania Health Care Cost Containment
    Council, November 2006

  • A Hospital Is Just A Taxi With The Meter Running
  • The .
    Excess .
  • Event LOS Charges
  • Surgical Care
  • Post-op
  • Sepsis 10.89 57,727
  • Dehiscence 9.42 40,323
  • Medical Care
  • Infection 9.58 38,656
  • Attributable
  • Excess Length of Stay, Charges, and Mortality
    Attributable to Medical Injuries During
  • JAMA, 2003 290 1868-1874

  • Rising Resistance Rising
  • S. aureus (staph) 32 vs. methicillin
  • S. aureus (staph) 98 vs. penicillin
  • E. faecium 70 vs. cirpofloxian/ampicillin
  • S. pneumoniae (strep) 37 vs. penicillin
  • Everyday exposure to toxic pollutants,
    Scientific American, Feb/March 1998 86-91

  • Staph Infections Life Threatening
  • CC/Symptoms
  • 94,000 MRSA Infections
  • 19,000 MRSA Deaths
  • Risk Factors Most MRSA associated with health
  • Unnecessary, recent or long-term
    prescribing of antibiotics
  • Antibiotics in food and water
  • Current or recent hospitalization
    or residing in a long-term care facility
  • Invasive procedures/Bacterial
  • History They do not wash their hands
  • Takes time to wash
  • Time is money
  • No incentive to wash
  • More illness, more income
  • Diagnosis Dirty Hands
  • Treatment Wash Hands
  • Prognosis Uncertain
  • Medical Drugs Pollute Water Supply,
    Maria P. Elliott and Edward T. Gluckmann, Green
    Times, V.27, No. 3, 2007 Pages 11-12

Two Views Professional Practice Of Medicine I
recently went to a new doctor and noticed he was
located in something called the Professional
Building. I felt better right away.  Isnt it a
bit unnerving that doctors call what they do

George Carlin
  • Program to Get Them to Wash Their Hands
  • Teach hand washing (Medical School and Residency)
  • Put hand washing questions on all board exams
  • Add to credentialing process (Washes hands
    Often? Vigorously?)
  • Have soap companies fund research and CME (Reduce
  • Develop a new CPT code (P4P, Positive Incentive)
  • Report failure to wash to Homeland Security (Be
    Alert and Report!)
  • Rate all providers who fail to wash hands.
  • Fine providers for failure to wash hands
    (Negative Incentive)
  • Provide universal insurance for 50,000,000
    uninsured Americans?
  • Fail! Hear my mothers, Edward, wash your
    hands. over intercom.
  • (Equivalent of
    legal water-boarding.)
  • System Failure versus Personal
    Accountability The Case for Clean Hands, NEJM,
    V. 355, No. 2, 121-123, 7/13/2006

Change in the US Death Rates by Cause, 1950
Rate Per 100,000
1950 2003
Age-adjusted to 2000 US standard
population. Sources 1950 Mortality Data -
CDC/NCHS, NVSS, Mortality Revised. 2003 Mortality
Data US Mortality Public Use Data Tape, 2003,
NCHS, Centers for Disease Control and Prevention,
Trends in the Number of Cancer Deaths Among Men
and Women, US, 1930-2003
Number of Cancer Deaths
Source US Mortality Public Use Data Tape, 2003,
National Center for Health Statistics, Centers
for Disease Control and Prevention, 2006.
Five-year Relative Survival () During Three
Time Periods By Cancer Site
  • All sites 50 53 65
  • Breast (female) 75 78 88
  • Colon 50 58 64
  • Leukemia 34 41 48
  • Lung and bronchus 12 14 15
  • Melanoma 80 85 92
  • Non-Hodgkin lymphoma 47 54 60
  • Ovary 37 41 45
  • Pancreas 3 3 5
  • Prostate 67 75 100
  • Rectum 49 55 65
  • Urinary bladder 73 78 82

5-year relative survival rates based on follow
up of patients through 2002. Recent changes in
classification of ovarian cancer have affected
1995-2001 survival rates. Source Surveillance,
Epidemiology, and End Results Program, 1975-2002,
Division of Cancer Control and Population
Sciences, National Cancer Institute, 2005.
  • Another Warrior Fights Cancer
  • 'Her determination to fight the disease is an
    inspiration to all of us. President Bush
  • 'I always admired Congresswoman strong
    convictions and the tenacity.. John W. Warner
  • She underwent chemotherapy treatments and a
    mastectomyin 2005. When the cancer returned, she
    underwent chemotherapy again...
  • ..she died...after a 2-year battle with the
  • Congresswoman Dies After Cancer Fight, New
    York Times, October 10, 2007

  • Womens Revolution
  • HRT associated with cancer, heart disease and
    stroke in media
  • Millions of women stopped following physician
  • Millions stopped hormone replacement therapy
  • 14,000 fewer new cases in 2003
  • 7 decline in breast cancer between 2002 and 2003
  • It takes breast cancer a long time to develop
  • ..but here we are primarily talking about
    existing cancers that are fueled by hormones and
    that slow or stop their growing when a source of
    fuel is cut.
  • "It is the largest single drop in breast cancer
    incidence within a single year..
  • Fewer breast cancers linked to less hormone
    therapy, Reuters, December 14, 2006
  • Findings reported by MD Anderson based
    researchers at the 29th Annual San Antonio Breast
    Cancer Symposium

  • Lung Cancer - Black Revolution
  • Lower rate of lung cancer surgery among black
    patients due partly to communication problems,
    study finds
  • Even with equal access, blacks are about half as
    likely as whites to undergo surgery that could
    save their lives
  • Black men have higher death rates than white men
    for lung cancer
  • Smoking explains virtually all the disparity
    between black men and white men in cancer
    mortality rates Dana-Farber Cancer Institute,
    Website, Christopher Lathan, MD, Spring/Summer

  • Lung Cancer - Black Revolution
  • Death rates for black men went up as smoking
  • Smoking among black men peaked in 1990
  • CDC has registered sharp declines in black men
    smoking since 2001
  • When smoking declined cancer rates dropped
  • 1990 - 2000, the mortality rate dropped 11
  • If black men stopped smoking, their cancer rates
    would drop 66
  • Lung cancer rates as an index of tobacco
    smoke exposures validation against black male
    non- lung cancer death rates, 1969-2000, Prev
    Med. 38(5)511-15

  • Cancer Care More Aggressive
  • Near Death Study
  • Doctors efforts are costly, futile attempt to
    extend lives
  • Chemo up 6
  • Chemo up 34 in patients who died within two
  • Doctors should review their treatment regimens
  • Doctors should in some cases focus on palliative
  • Hospice care reduces aggressive treatment
    improves quality of life for terminally ill
  • Study suggests more cancer patients
    receiving aggressive care at end-of-life,
    Dan-Farber Cancer Institute,
  • June 4, 2003

  • Annualized Cost To Buy 20 Days
  • 143,612 - Localized Cancer
  • 145,861 - Regional Cancer
  • 1,190,322 - Metastatic Cancer
  • 70-90 of lung cancer smoking related
  • Smoking prevention and cessation programs are
    more promising
  • Survival Benefit Minimal Despite Rising Cost
    of Lung Cancer Treatment in Elderly, Cancer, 2007
    (reported in) MedScape Medical News, October 25,

  • Sleep On This For A While
  • Poor sleep among the elderly, it turns out,
  • is not because of aging itself, but mostly
  • because of illnesses or the medications
  • used to treat them.
  • The Elderly Always Sleep Worse, and Other
    Myths of Aging, NY Times, October 23, 2007

Dark Blue Is Medical Cost Increases Due To Aging!
  • Early Detection, Survival and Marketing
  • Claims made
  • -Cancer survival rates increased
  • -2.3 million breast cancer survivors
  • SCR Best Cancer Treatment (Surgery,
  • Chemo, Radiation)
  • New Ventures Help Fight the Frustrations of
    Fighting Breast Cancer, New York Times, October
    25, 2007

  • Early Detection, Survival and Advertising
  • Disfigurement/Pain/Realism/Death
  • Cancer as bad as it is, emotionally had an end
  • Lymphedema complication, forever affects quality
    of life
  • Optimistic survivors also realists
  • Since their book was published, 2 of 3 co-authors
  • New Ventures Help Fight the Frustrations
    of Fighting Breast Cancer, New York
  • Times, October 25, 2007

  • Early Detection, Survival and Sales
  • Drive to find disease early that leads to..
  • Diagnostic epidemic that leads to..
  • Medicalization of everyday life that leads to..
  • 50 of Americans diagnosed as diseased that leads
  • More disease caused by tests, treatment and drugs
    that leads to..
  • Threat to Americans health that leads to..
  • America spends more than any other country that
    leads to..
  • America having (Please check all that apply)
  • ___ The best care in the world
  • ___ A need to stop the hemorrhaging first
  • ___ Some of the lowest world wide
  • ___ A need to spend an additional
  • Whats Making Us Sick Is an Epidemic of
    Diagnoses, New York Times, January 2, 2007

  • Early Detection, Survival and
  • 40 of summer camp kids on chronic prescription
  • Arthritis without joint pain
  • Stomach damage without heartburn
  • Million prostate cancers patients who have lived
    as long without being diagnosed as a cancer
  • Biggest health threat is our health-care system
  • Pre-diseased population gt those who get the
  • Labeling causes anxiety, sense of vulnerability
  • a
    particular concern in children
  • Whats Making Us Sick Is an Epidemic of
    Diagnoses, New York Times, January 2, 2007

  • Early Detection, Survival and Impact on Children
  • Psychiatrists in several states get most drug
  • Psychiatrists who do take the money, tend to
    prescribe the most antipsychotic drugs to
  • These drugs are risky and not FDA approved for
  • Psychiatrists know the dangers
  • Antipsychotic drugs are a large expense for
  • Psychiatrists Top List in Drug Maker Gifts,
    New York Times, June 27, 2007

  • Early Detection, Survival and Causes of Disease
  • Assumption is all diagnosis are beneficial.
  • Early Detection Prevention Threat
  • But at the extreme, the logic of early detection
    is absurd
  • Biggest health threat is our health-care system
  • Pre-diseased population gt those who get the
  • Labeling causes anxiety, sense of vulnerability
  • a particular
    concern in children
  • Whats Making Us Sick Is an Epidemic of
    Diagnoses, New York Times, January 2, 2007

  • Early Detection, Survival,
  • Disease epidemic Treatment epidemic
  • Not all treatments have important benefits
  • Some involve potential harm
  • Some harm is not immediately known
  • Being labeled pre-diseased or at risk but
    destined to remain healthy, treatment can only
    cause harm.
  • Whats Making Us Sick Is an Epidemic of
    Diagnoses, New York Times, January 2, 2007

  • Early Detection, Survival
  • Good 4 Business! Bad 4 Business?
  • The epidemic of diagnoses has many causes.
  • More diagnoses mean more money, stature
  • - Drug and device manufacturers
  • - Hospitals and physicians,
  • - Disease-based advocacy organizations
  • - Researchers
  • - National Institutes of Health
  • - Anyone promoting a disease
  • Whats Making Us Sick Is an Epidemic of
    Diagnoses, New York Times, January 2, 2007

  • Wheres Proof Treatment Works, Works Safely
  • Gold Standard-randomized double blind,
    placebo-controlled trials.
  • Platinum Standard-monitor actual outcomes for all
    patients for 1,3,5,7,10 years.
  • How many physicians, surgeons or hospitals can
    produce cost/benefit data (i.e. positive and
    negative outcomes vs. charges/fees)?
  • Without the proof there is information, value or
  • meaningful use by consumers!

  • Off-Label Prescribing Thars AU,
  • But No Standard, In Them Thar Hills
  • Summary of Number of Drug Uses, By Off-label
    Status and Level of Supporting Evidence, United
    States, July 2005 through December 2006, IMS
    Health National Therapeutic and Disease Index,
    Estimated DRUG USES IN THOUSANDS, United States
  • Generic Total Uncertain/ Evidence
  • On-Label Off-Label Inadequate Inadequate
  • 112,033 42,692 37,387 7,380
  • 72 28 87
    17 70
  • of total prescriptions generic
    on-label total off-label of total that
    are off-label 5,305,000 or 12 off-label
    prescriptions were deemed OK. Off-Label Drug Use,
    Stanford School of Medicine, Stanford Prevention
    Research Center, Randall Stafford, MD, PhD., Week
    of 06/04/2007

  • 3,430 Billion Reasons Explain Rising Costs
  • Mo./Year Company/Drug/Disease Allegations
  • 9/2007 Sanofi-Aventis
    Violated False 190
  • /Anzemet/Cancer Claims

  • Inflated Prices/Physicians

  • Profits, Medicare/Medicaid
  • 9/2007 Bristol Meyers Squibb/ Illegally
    Promoted 515
  • Abilify/Anti-psychotic use
    for Off-label
  • Drug
    Use-Pediatric/ Dementia

  • By Consulting Fees/Luxury Trips
  • 9/2007 Zommer, Biomet
    Kickbacks/Surgeons 311
  • DePuy Orthopaedics (JJ)
  • Smith Nephew/
  • Replacement Hips Knees
  • 2006 Medtronics
    Consulting Fees/Free 40
  • Spinal Implants
    Travel/Other Perks
  • 2007
    Again Accused of

  • Similar Charges-not Settled (yet)
  • 2007 Purdue Frederick/
    Misbranding/Misleading 634
  • When asked why he robbed banks, Willy Sutton said
    Thats Where the Money Is
  • Willie was wrong!
  • Willie would not find 3,430,000,000 in most
  • This is the tip of the iceberg.
  • Nothing went to any victim.
  • No part of these settlements went to improve
    patient safety.
  • No physician was
  • reported,
  • disciplined
  • charged with accepting bribes,
  • compromising patient care or
  • censured for reflecting poorly on the profession.

  • 4.85 Billion Settlement Is Victory
  • For Drug Company
  • 2001 JAMA article warns of Vioxx risks
  • 9/2002 Vioxx increased risk of heart
  • Merck spends more than 1.2 billion on
    Vioxx-related legal fees
  • 9/2004 Vioxx withdrawn by Merck
  • 8/2005 First verdict 253,500,000 (Reduced to
    less than 25,000,000)
  • 2006/2007, Merck defeats 8 of 10 plaintiffs in
    CA, FL, NJ, IL, LA
  • 11/2007 Merck settles 27,000 Vioxx suits for
    4.85 billion
  • Settlement 9 months profits
  • Wall Street reacted favorably
  • Merck still facing civil and criminal action by
    several states and feds
  • Merck Agrees to Settle Vioxx Suits for
    4.85 Billion, New York Times, November 9, 2007
  • Analysts See Merck Victory in Vioxx
    Settlement, New York Times, November 10, 2007

  • Regrettable Human Error
  • September 2006
  • F.D.A. reconvenes safety panel and OKs continued
    use of drug
  • Company study showing adverse impact of drug not
    revealed to F.D.A.
  • Company says failure to report findings was due
    to Click here to return to Regrets
  • October 2007
  • Researchers stopped a study of drug because 50
    more likely to die vs. alternatives
  • Drug increased the risks of kidney
    failure, heart attack and stroke
  • Causes 10,000 to 11,000 kidney
    failures a year (Click here to return to Regrets)
  • Stop and save more than 1 billion a
    year in dialysis costs
  • November 2007
  • Bayer AG announced agreed to withdraw its
    controversial heart surgery drug
  • F.D.A. could not identify any population where
    the benefits outweigh the risks
  • Bayer says drug is beneficial when used as
    directed (Click here to return to Regrets)
  • Heart Surgery Drug Pulled From Market,
    New York Times, November 6,2007

How Many Errors Were Not Detected?
  • Non-Hospital Drug Adverse
    Effects Reported
  • To the FDA in 1998 and
  • Event 1998
    2005 Increase
  • All Drugs
  • Serious, adverse 34,966
    89,842 260
  • Serious, fatal 5,519
    15,107 270
  • 13 new biotech products 580
    9,181 1,580
  • These data show a marked increase in
    reported deaths and serious injuries associated
    with drug therapy over the study period. The
    results highlight the importance of this public
    health problem and illustrate the need for
    improved systems to manage the risks of
    prescription drugs.
  • Serious Adverse Drug Events Reported to
    the Food and Drug Administration, 1998-2005, Arch
    Intern Med,  20071671752-1759

  • A Drug Sharks Tale
  • Lipitor patent runs till 2010
  • Generic for Zocor, a Lipitor competitor, is now
  • Pfizers response
  • Tell Wall Street Will spend two times
    more for ads
  • Argue that a non-gold standard study
    shows value
  • Attack insurers
  • Hire a BIG name, hit man for ads
  • Maker of Lipitor Digs In to Fight Generic Rival,
    New York Times, November 3, 2007

  • Some More Tales
  • FDA cannot guarantee the safety of the nation's
    drug supply
  • Foreign companies manufacture 80 of all
    ingredients used by American drug makers
  • FDAs records are poor
  • FDA cannot even say what it inspected
  • F.D.A. Is Unable to Ensure Drugs Are
    Safe, Panel Is Told, NYT, November 2, 2007
  • 20,157 buys a patient less than one month of
    increased survival
  • Results are not surprising
  • There is no early detection screen of
    proven worth as yet,.."
  • There are no good predictors to
    identify lung cancer at an early stage,.
  • you would not expect an increase
    in early diagnosis to affect improvement in
    survival. (Stephen Spiro, MD, head, department
    of thoracic medicine, University College London
    Hospitals National Health Service Trust, UK)
  • Survival Benefit Minimal Despite
    Rising Cost of Lung Cancer Treatment in Elderly,
    Medscape Medical News, October 25, 2007

  • AlzheimersDiseaseResearchDrugs
  • Scientists reported progress blood test90
    percent accurate in distinguishing 80 percent
    accurate in predicting
  • Outside experts called the results promising but
  • At present, treatments for Alzheimers disease
    are not very effective
  • when drugs are developed that slow or halt
  • Alzheimers sent out signals to the bodys immune
    systemcommunication between cells
  • paid for by and Satoris, a company co-foundedto
    commercialize the test.
  • Progress Cited in Alzheimers Diagnosis,
    NY Times, October 15, 2007

  • Alzheimers Prevention Forgotten

  • Not one word about a cure!
  • Not one word about prevention!
  • Not one word about what the body is missing!
  • Not one word about using the cells
  • Not one word about the role of the immune system!
  • Progress Cited in Alzheimers Diagnosis, NY
    Times, October 15, 2007

  • Four Red Dots?
  • Science 313 670-673 (August 4, 2006)

  • Research Finding What Is Known
  • Place Rockefeller Universitys Leonard Wagner
    Laboratory of Molecular Genetics and Immunology
  • Problem The IgG paradox! IgG antibodies can
    prevent or cause autoimmune disorders (lupus,
    arthritis, asthma)
  • Findings Terminal sialic acid on the Fc portions
    of the IgG molecule stopped inflammation
  • Explanation IgG can shift from a state that is
    quite inflammatory to a state that is actively
    anti-inflammatory by just changing a sugar
  • Solution Want to develop another drug
  • Issue Natural remedy already exists
  • Science 313 670-673 (August 4, 2006)
  • Harpers Biochemistry, 25th Edition,
    Chapter 56, Page 675, McGraw-Hill, 2000

  • An Educated Consumer Is Our Best Customer
  • Once paid 11.60 per month for Blue Cross
  • In one week, received three pieces of mail
  • 43 pages about Medicare drug plan options
  • Letter from company What happens if
    selected plan
  • is dropped
  • Letter from a politician saying how great
    drug plan is
  • Had to research 30 plans to get doctor/hospital,
    drug and cost info
  • Times Herald-Record, Letter to Editor,
    November 8, 2007, Page 27

  • We Are Rated By How We Treat
  • The Least Among US
  • 1974 - 1975 House Staff physicians go on strike
    at 25 hospitals
  • Demands include end of abusive work schedules
  • Demands for more nursing, lab, messenger staff
  • Most strikes settlements are inconclusive
  • Some reductions in work hours and temporary staff
  • 1984 - one patient dies after ER admission at New
    York Hospital
  • Grand Jury finds overworked and under supervised
    house staff
  • New laws and professional GME guidelines are
  • GME groups concerned that training and patient
    care suffer
  • Intern and Resident Organizations in the
    United States 1934-1977, Robert G. Harmon, M.D.,
    The Milbank Memorial Fund Quarterly. Health and
    Society, V. 56, No. 4 (Autumn 1978), pp. 500-530,
    supplemented by the presenter

  • Even The Pros Have
  • Trouble With Handoffs!
  • Improved patient care conditions are less
    evident than improved house staff conditions.(1)
  • But do these benefits mean that today's
    interns and residents have it better? Are they
    learning more? Probably not.(2)
  • In addition to problems with handoffs, house
    staff are particularly vulnerable to medical
    errors owing to teamwork failures, especially
    lack of supervision. Graduate medical education
    reform should focus on strengthening these
    aspects of training(3)Serious consequences 33
    or 889 cases resulted in deaths.(4)
  • (1) Intern and Resident Organizations in
    the United States 1934-1977, Robert G. Harmon,
    M.D., The Milbank Memorial Fund Quarterly. Health
    and Society, Vol. 56, No. 4 (Autumn, 1978), pp.
  • (2) Do today's medical residents really
    have it better? Cleveland Clinic Journal of
    Medicine, Frank Michota, MD
  • (3) Medical Errors Involving Trainees, A
    Study of Closed Malpractice Claims From 5
    Insurers, Arch Intern Med, 20071672030-2036.
  • (4) Lack of communication tied to errors
    report, Modern Healthcares Daily Dose, October
    10, 2007

  • House Staff Training Fatigue Errors

  • Number of
    Extended Duration Shifts/Month
  • Event Base/None
    One-Four Five
  • Reported-Fatigue
  • Related Significant
  • Medical Error 100
    300 700
  • Adverse Event 100
    700 800
  • Preventable
  • Adverse Event 100
    100 300
  • Interns were also more likely to fall
    asleep during lectures, rounds, and clinical
    activities, even surgeryIn our survey,
    extended-duration work shifts were associated
    with an increased risk of significant medical
    errors, adverse events, and attentional failures
    in interns across the United States. These
    results have important public policy implications
    for postgraduate medical education
  • Impact of
    Extended-Duration Shifts on Medical Errors,
    Adverse Events, and Attentional Failures,
    National Institute for Occupational Safety and
    Health within the US Centers for Disease Control
    (Grant R01OH07567) and the Agency for Healthcare
    Research and Quality (AHRQ) (Grant R01 HS12032)

  • Stents Sugar or Diet
  • No clear comparative evidence studies to show
    which treatment is best, best over time, best in
    terms of disease type, level, and cost and how
    each treatment compares to other treatments,
    including prescription drugs, angioplasty alone,
    by-pass surgery, and changes in nutrition,
    supplements and other life style modifications.
    (Edward Gluckmann, Health Matters, Inc.)
  • Its striking that we do so little to evaluate
    what were getting in return for it, (CBO
    Director Peter Orszag)
  • A Heart Stent Gets a Reprieve From
    Doctors, New York Times, November 13, 2007
  • Aging population isnt the real threat,
    says CBO, Modern Healthcares Daily Dose,
    November 13, 2007
  • The type of funding may have determinant effects
    on the design of studies and on the
    interpretation of findings funding by the
    industry is associated with design features less
    likely to lead to finding statistically
    significant adverse effects and with a more
    favorable clinical interpretation of such
    findings. Disclosure of conflicts of interest
    should be strengthened for a more balanced
    opinion on the safety of drugs.
  • Adverse Effects of Inhaled
    Corticosteroids in Funded and Non-funded Studies,
    Arch Intern Med. 
  • 20071672047-2053
  • For the Record In Tests of Inhalers,
    Results May Depend on Who Pays, New York Times,
    November 13, 2007

  • Devices, Implants And
  • Either This Guy Is Dead Or My Watch

  • Nations largest maker of implanted heart devices
    to docs stop using a crucial component of our
    most recent defibrillator models.
  • These devises caused malfunctions in hundreds of
    patients and may have contributed to five deaths.
  • 235,000 patients have these devices that can make
    them misread heart-rhythm data.
  • Cost 30,000/device
  • Cost per year 7,050,000,000
  • Patients Warned as Maker Halts Sale of
    Heart Implant Part, New York Times, October 15,

  • Florida Land Of Opportunity
  • The wheelchair billed for 5 million
  • Millions billed by an air conditioning repairman
    for specially formulated asthma medication
  • High level of AIDS billing with no clinical
  • Criminal entrepreneurship funded by public
  • Fraud penalties much less severe than they are
    for narcotics trafficking
  • Fraud and Florida's multimillion-dollar
    wheelchair, Reuters, October 22, 2007

  • Visions of Medical Care-Ideal
  • Group medicine is not a financial arrangement
  • ..(do) we take sufficient care to make a
    thorough physical examination..? 
  • ..some loss in appreciation of the individuality
    of the patient.. 
  • the main purpose to be served by the Clinic is
    the care of the sick.
  • Operate ..intended not to create wealth but to
    provide a financial return sufficient for present
    and future needs. 
  • 30 of less fortunate patients received hand
    written bills marked paid in full. (They werent
    paid. They were just written off!)
  • No one charged more than 10 of his or her annual
    income, no matter how expensive the treatment.
  • Every dollar on bills over 1,000 went to help
    other sick people
  • Mayo Clinic Foundation Website and The
    Value of Sharing, The Story of the Mayo Brothers,
    by Spencer Johnson, M.D. (Education includes a
    psychology degree from the University of Southern
    California, an M.D. from the Royal College of
    Surgeons and medical clerkships at Harvard
    Medical School and the Mayo Clinic)

  • Visions of Medical Care-Investment Opportunity
  • HCA buyers got 175 million in fees
  • The group that bought HCA, will receive 175
    million in transaction fees, and other fees down
    the road. Thomas Frist, Jr., a relative of the
    former Republican Party (Congressional leader)
    and members of his family, and top-level HCA
    executives, will also get 15 million annually
    under a management contract with HCA, which
    includes possible increases based on the new
    companys profits. The buyout was for 33
    billion. Several executives are guaranteed board
    seats as part of their employment agreements.
  • Modern Healths Daily Dose, a daily e-mail
    report on current healthcare events. The exact
    date is not crucial. This is a sample of many
    such reports that run into the billions
    nationwide over the course of any year.

  • Visions of Medical Care-Wellness
  • A Drug Makers Views of What Ails
    American Health Care
  • Holstein
  • What should Americans be doing to fix the
  • Vasella
  • One aspect is better patient education and
    better nutritionwe should look at how to give
    incentives to people to avoid disease-prone
  • Saturday Interview of Daniel L. Vasella,
    chief executive of Novartis by William Holstein,
    New York Times, September 8, 2007

  • Myths Deconstruction
  • Another way of saying, we are doing nothing to
    save money. If all these claims actually worked,
    medical care would be free. Total costs would be
    going down. They are not.
  • Maybe for one patient here and there, but not
    overall. (See above.)
  • Almost without exception, buying and selling (M
    A) or just gross transfers from one investment
    group to another is a business transaction loaded
    with costly stock options, profit/loss
    considerations, market positioning, golden
    parachutes, lucrative broker and other fees and
    has nothing to do with improving care or quality.
  • Putting an investigation or litigation behind
    without any acceptance of wrong doing is just
    another way of saying We got caught (acceptable
    business risk) with our hands in the cookie jar,
    and we got away with it (as we thought we would)
    by buying off prosecution with pennies on the
    dollar settlement, (another acceptable business
    cost). Now we can get on to make more money
    claiming to care about saving lives while
    agreeing to keep our hands out of the cookie
    jars, (but just for a while) and making more

  • Myths Deconstruction
  • Cost shifting is just that, the shifting of costs
    from the insurer, to the insured and among the
    insured and underinsured. It costs more not less.
  • Consumer empowerment started in the 1970s and
    failed then. Everyone speaks for the consumer,
    yet no one really does. Consumers have few
    choices and options. Most consumers have time to
    surf the Internet, but few understand the
    implications of what is going on when told they
    have cancer, or have had a serious heart attack
    or experiencing a stroke.
  • Ditto Alzheimers, autism, emotional and mental
  • People with diabetes, are overweight, or obese
    are facing information that is contradictory,
    unproven and often not supported in a variety of
    ways, not least of which, is that the
    recommendations of what to do and what will be
    done have no consistent pattern of working.
    Proof Look around. Read the statistics. See
    Americas world comparative rankings.

  • Health insurance companies cited ..for violation
    of Medicare standards...(said) they were
    addressing the deficiencies and would improve
    service to patients, who will be able to switch
    plans in the last six weeks of the year.
  • ...WellPoint, one of the nations largest
    insurers, said the company had hired additional
    employees to answer telephones and pay claims
    filed by or for Medicare beneficiaries..WellPoint
    was reducing its claims backlog and telephone
    waiting times and expected to be in compliance
    with federal standards by the end of this month.
  • Coventry Health Care, which recently had a civil
    penalty of 264,000 assessed for violation of
    Medicare marketing standards, said it had taken
    steps to prevent a repetition of the problems.
  • After Audit, Insurers Vow to Improve
    Medicare Service, New York Times, 10/10/2007

  • ..a spokeswoman for Coventry, said the company
    had retrained its agents and changed the timing
    of commission payment to discourage inappropriate
  • ..(a) public policy director at CareOregon, based
    in Portland, said her company was very serious
    about correcting deficiencies and was revising
    its procedures.
  • ..CareOregon, which serves low-income people
    enrolled in both Medicare and Medicaid,
    questioned the wisdom of one recommendation,
    involving notices to beneficiaries about the
    denial of claims. To send all these notices
    could confuse and scare our patients,..
  • After Audit, Insurers Vow to Improve
    Medicare Service, New York Times, October 10, 2007

  • When Dealing With The Insane, It Is Best To
    Pretend To Be Sane

  • Senator Max Baucus, Democrat of Montana, chair,
    Finance Committee
  • The unscrupulous tactics of some plans have led
    me to be skeptical about how well this market
    works for seniors.
  • And Representative Pete Stark, California
    Democrat, chair of the Ways and Means
    Subcommittee on Health that the Bush
    administration had been reluctant to regulate
    or offend these large companies.
  • But Kerry N. Weems, acting administrator of the
    Centers for Medicare and Medicaid Services
    contract compliance and beneficiary protection
    had been among his top priorities since he took
    office last month.
  • Karen M. Ignagni, president of Americas Health
    Insurance Plans said the audits did not reflect
    the fact that private plans generally offer
    better benefits than original Medicare.
  • The answer is yes. They all know
    how to play this game.
  • After Audit, Insurers Vow to Improve
    Medicare Service, New York Times, October 10,

  • Does He Or Does He Not?
  • A Senator says his disease had progressed
  • a very tough disease, it could progress
    rapidly.. Its possible the diagnosis is
    wrong, Bruce Miller, Neurologist, UC
  • .tests can monitor the progression of the
  • In some cases Ive followed patients for many
  • Norman Relkind, Neurologist, Cornell
    Medical Center
  • And they need regular medical visits to monitor
    the progression of the disease
  • The larger question for societywill be figuring
    out how and by whom decisions should be made
    about other peoples mental capacity to work,
    vote and make choices for themselves. Often, he
    said, doctors will have to be involved (Dr.
    Karlawish, Medicine Medical Ethics, U of P)
  • Senators Illness Requires Monitoring,
    New York Times, October 7, 2007

Politics is the art of looking for trouble,
finding it everywhere, diagnosing it incorrectly
and applying the wrong remedies.
Grouch Marx
  • Politicians Emotional Statement and Some Facts
  • Dialogue Dispute vs Dishonest Discourse
  • -A Case Study
  • Politicians emotional statement I am alive
    because I am free to choose my doctor (free
    enterprise), where as in other countries
    (socialized medicine) I cannot.
  • He claims these facts support his position
    USA prostrate cancer survival rate is 82 and UK
    prostate cancer survival rate is 44. But the
    facts involved are The 44 figure is bogus,
    called crude by the politicians own consultant
    and disavowed by the Commonwealth Fund, the
    original source.
  • Giulianis Prostate Cancer Figure Is
    Disputed, New York Times, October 31, 2007

  • No, no, you're not thinking
  • you're just being logical.

  • Niels Bohr

  • Cancer A First and Last Word
  • Because no cancer cell exists, the respiration
    of which is intact, it cannot be disputed that
    cancer could be prevented if the respiration of
    the body cells would be kept intact.
  • For cancer formation there is necessary not only
    an irreversible damaging of the respiration but
    also an increase in the fermentation.
    (Fermentation is a way that cells with impaired
    respiration try to survive by converting body
    sugars glucose into a weak form of ATP energy.)
  • The most important fact in this field is that
    there is no physical or chemical agent with which
    the fermentation of cells in the body can be
    increased directly for increasing fermentation,
    a long time and many cell divisions are always
  • The mysterious latency period of the production
    of cancer is, therefore, nothing more than the
    time in which the fermentation increases after a
    damaging of the respiration.
  • There would be no cancers if there were no
    fermentation of normal body cells.
  • Carcinogenesis by x-rays is obviously nothing
    else than destruction of respiration by
    elimination of the respiring grana. You kill
    cancer cells with radiation but you weaken
    healthier cells at the same time, so the
    descendents of the surviving normal cells may in
    the course of the latent period compensate the
    respiration decrease by the fermentation increase
    and thence become cancer cells.
  • The Prime Cause and Prevention of Cancer, Revised
    Lindau Lecture, 1966, Otto Warburg, M.D., PhD
    (Chemistry), Noble Laureate, 1931, 1944
    Director, Max Planck Institute for Cell
    Physiology, Berlin-Dahlem, Germany

  • Solutions-change the thinking
  • Solutions-eliminate profit and advertising
  • Solutions-establish independent body-a public
    trust that approves only what can be platinum
    standard validated
  • Solutions-convert everything that starts with or
    contains the word medical into wellness and then
    make its parts comport to that goal
  • Compensate based on results to prevent first and
    treat later
  • Criminalize all activity that benefits an
    individual, institution or entity that is or
    appears as a conflict
  • Make them wash their hands
  • Create a National Wellness Service
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