Linda Burke-Galloway, M.D.--

The case of Samantha Burton v. Florida, No. ID09-1958 is a perfect example of how to get on the Six O’clock News.   

Burton was a 26-year-old mother of two who was pregnant with her third child at 25 weeks and had less than desirable habits. She was a smoker, had two toddlers and was at risk for premature labor.

Burton was under the professional care of Jana M. Bures-Forsthoefel, M.D., a board certified ob-gyn physician with over 27 years of experience. She completed her residency training at Emory University which is one of the best in the country.  However, there was an obvious disconnect of professional judgment when Bures-Forsthoefel and Tallahassee Memorial Hospital obtained a court order to have Burton confined to the hospital involuntarily against her will. Burton was allegedly informed she’d have to remain in the hospital for three months and refused. But the Circuit Court of Leon County forced her to stay in the hospital and three days later, Burton delivered a dead baby by a cesarean section.  So, what was the point?

Let’s rewind the tape, and then hit replay so we can see what SHOULD have happened.

The patient is at risk for preterm labor at 25-weeks gestation so obtain a high-risk consultation from the Maternal Fetal Medicine specialists who also practice at Tallahassee Memorial Hospital. They are the specialists, let them manage the patient.

If the patient refused treatment, contact risk management, have the patient sign informed refusal of treatment consent, list every possible complication that she could encounter, including the possibility of death, then DOCUMENT everything.

When she goes home, give her a list of explicit instructions with emergency phone numbers to call.

No hospital or physician is exempt from getting a patient who’s a royal pain in the neck.  There will always one who will not follow medical advice. However, the days of paternalism are over. Burton was within her right to refuse the hospital admission but would have also been responsible for whatever consequences occurred. Confining her only exacerbated the problem by increasing her adrenaline and elevating her stress.

“Pride goeth before a fall.” Physicians don’t walk on water. When arrogance takes precedence over common sense, count on triggering a disaster.

Linda Burke-Galloway, MD, MS, FACOG is a board-certified ob-gyn physician who is a champion of patient safety and is on a mission to keep pregnant women from falling through the cracks of our imperfect healthcare system.  For over twenty years she has provided clinical services to high-risk pregnant women in medically underserved communities. She served our country through the National Health Service Corp, is a medical malpractice consultant for the U.S. Human Health Services and the federal government has also sought her expertise in reducing obstetrical malpractice cases in high-risk communities.  Dr. Burke-Galloway has worked for the State of Florida Department of Health for over thirteen years in direct patient care.  She is the author of The Smart Mothers Guide to a Better Pregnancy and is the Pregnancy Expert for LifeScript.com. She is a graduate of City College of the City University of New York, Columbia University School of Social Work and Boston University School of Medicine.  She lives with her husband in Central Florida and is the proud mother of two sons. Dr. Galloway is the author of The Smart Mother's Guide to a Better Pregnancy (Red Flags Pub/ 2008). You'll find Dr. Galloway online at www.smartmothersguide.com

Michelle Duggar 2010: 19 Kids--3 Tips From An OBGYN

Copyright © 2006-2010, Basil & Spice. All rights reserved.

Review By Arthur Rosenfeld

Surgeons tend to be “up-and-at-‘em” kind of guys, and Marc Wallack, M.D., Chief of Surgery at Metropolitan Hospital and Vice-Chair of the Department of Surgery at New York Medical College is evidently no exception. Back To Life After a Heart Crisis, written with his wife, Fox News host/anchor Jamie Colby, details his experience with quadruple bypass surgery. The book is an honest, detailed account of the surgical, rehabilitative and emotional dimensions of coming close to death, putting your life in the hands of people you don’t know, and then attempting to rebuild that (active, accomplished, stressed, and full) life once out of the hospital.

The book is written by a “power couple” and presents advice in sports/military fashion, even using chapter headings such as “Conquer the Night," “Arm Yourself for Career Issues” and “Train for a Huge Physical Challenge.” Wallack was a runner before the surgery, and to his great credit managed to run a marathon afterward. He details his training plan not only for those with that particular ambition, but to show it can be done. That results in one of the book’s most powerful themes, namely the amazing resilience of the human body. The chest is cracked open, heart vessels are cleared, the breastbone is wired together, eventually knits, and there’s a marathon at the finish line (another chapter header).

Far more than a memoir, the volume is an action plan for others facing the same challenges. It rises above a medical recipe by virtue of the yin/yang advice and perspective offered by this husband/wife team. Wallack’s emphasis on getting back to the place you were before a major illness, while Colby takes aim at the caregiver, offering counsel on everything from screening get-well cards (she nixed anything that oozed sympathy) to using a nickname for her husband (Rambo) to help him feel like a superman. She also chose movies like Rocky for him (he likes action films) because they have an upbeat, “I-shall-overcome” message.

Colby’s advice is interwoven, in boxed format, throughout the book. She addresses such varied topics as how to get a recovering heart patient to get out of the house for a walk (“You’re still in this world, Let’s go see it.”) and how to get to know hospital staff and routine before surgery. She even gives very frank and intimate advice for becoming sexually active again after surgery. When it comes to achieving or maintaining an erection, for instance, she suggests saying something like: “You have more circulation than you’ve ever had. How did you do it before when you had so little blood flow? I can’t wait to see what it will be like now that your heart and blood vessels are so healthy.”

Wallack does mention how much serious illness changes a person, and there is a lot of detail about the feelings of anxiety and loss of control, even loathing the body that accompanies major heart surgery. Much of this may be helpful to recovering patients, but it might have been satisfying to see more about finding balance after such a life-altering event and less about achievement. Still, the author is smart to augment his own insights with those of others who have gone through similar experiences. These “Unbeatables” include Yvonne Payne, who was diagnosed with a heart rhythm disorder when she was a teenager, Larry Mart, who has a genetic disorder that raises his cholesterol and has caused multiple heart attacks, and Chase Carter, who “died for the first time at twenty-nine”. Carter wrote music—called the Chase Carter Method—used in healing therapy, and offers the opinion that “Dying really isn’t that bad. It’s just the next phase of our consciousness. You just go to another place, a wonderful place, so don’t fear it.”

Back To Life After a Heart Crisis is chock-full of useful information, including explanations of medical terms, tests and procedures from the proverbial “horse’s mouth.” There are good notes at the back of the book, a useful index, and a chapter full of “Back-To-Life resources worth the price of admission. These include ways to assess a hospital or physician’s track record, inspiring books and audio series, support groups, charity events, even funny movies. More, Colby has a section brimming with imaginative recipes for healthy versions of popular foods. Included are Oven “Fried” Chicken Fingers with Apricot Curry Dipping Sauce, (which uses buttermilk, Japanese-syle breadcrumbs, ground flaxseed and Multi-Bran Chex cereal), and Old-Fashioned Mac and Cheese made from whole-grain pasta, Benecol and skim milk.

Readers are unlikely to find another book quite like this one. It’s unique and important for those who need it, and certainly a clarion call to those readers who need to turn their health around, but are avoiding the tough decisions required to do so.

Arthur Rosenfeld is an authority on the spiritual dimensions of Eastern thinking for a Western world. A novelist, martial arts master and philosopher, Rosenfeld is a contributor to national magazines, including Vogue, Vanity Fair, and Parade, has been seen on national tv and radio networks. The author of eleven acclaimed books and the creator of the fiction genre "Kung Fu Noir," he combines stories with Eastern wisdom drawn from nearly 30 years of martial arts study. His latest title is Quiet Teacher.

A Yale graduate, Rosenfeld combines scientific background and communication skills gained through post-graduate studies at the University of California with real-world savvy gleaned from high-level corporate positions. Drawing on his background in medicine and science he has been cited in national media, including Newsweek, Ebony, and Parade. He has also written The Truth About Chronic Pain.

The Biology of Belief

Book Review: Doctor Of The Heart By Isadore Rosenfeld

Copyright © 2006-2010, Basil & Spice. All rights reserved.

Carole Carson--

Innovation in the prevention of disease―not improved treatment―will be the key factor in realizing affordable healthcare.

The emerging shift in paradigms is the result of maddening increases in medical insurance expenses over the past decade. From 1999 to 2008, medical insurance costs for a family of four increased 119 percent. And if future projections materialize, the annual premium for a family of four ($13,375 in 2009) will climb to $23,842 in 2020.

Treating illness, particularly medical conditions that are triggered by lifestyle, is fast becoming prohibitively expensive. As a consequence, a century-long tradition of employer-subsidized medical insurance intended to treat illness is being supplemented with practical programs designed to prevent illness.

Reinforcing the need for intervention is George Blackburn, MD, PhD, associate director of the Division of Nutrition at Harvard Medical School and author of 12 books and over 500 articles. While acknowledging the remarkable advancements in the treatment of diseases in the 20th century, Dr. Blackburn asserts that the defining task of the 21st century is “creating similar breakthroughs in prevention.”

The financial implication of paying for lifestyle-induced medical care is not lost on employers. In particular, surplus pounds lead to medical conditions and injuries that trigger significant increases in the cost of medical care, workers’ compensation claims and absenteeism. Reducing the girth of employees is key to maintaining profitability.

According to the Centers for Disease Control and Prevention (CDC), “Medical expenses for obese employees are estimated to be between 29 percent and 117 percent greater than medical expenses for employees with a healthy weight.^” In addition, obese employees spend 77 percent more on necessary medication than do their healthy-weight counterparts.

I can vouch for the accuracy of these statistics, based on my own experience. At 59, I was obese. My medical file expanded in tandem with my body: doctor’s visits and hospitalizations for an assortment of lifestyle―related problems, from chest pain to gallbladder disease, were frequent. I joked that my medical insurer stored my 5-inch claim file under the letter C not because my name is Carson but rather because I was chronically ill. My devoted husband, who married me in sickness and in health, started asking, “Where’s the health?”

A medical assessment placed me in the 90th percentile for risk of cancer, diabetes, stroke and heart disease. After losing 62 pounds through lifestyle changes, I was retested: my risk had dropped to the normal range. My decision to lose weight and get fit spared my insurance provider thousands of dollars in medical expenses, improved the quality of my life and most likely extended the quantity of my remaining days.

In retrospect, I can see that a sedentary lifestyle combined with increasing weight made my medical problems and expenses predictable. Employers, faced with the reality of hundreds of employees like me, are introducing programs promoting wellness―with a particular emphasis on weight loss―despite hard economic times. In one recent survey of 450 employers with 1,000 or more full-time employees, over 300 had introduced weight-management plans.

Small-business employers are also taking action. According to Dr. Blackburn, the work force in small businesses tends to be younger and healthier, and it enjoys fewer benefits. Because resources are limited in a small company, the productivity of each employee counts more than ever; hence, the need to offer programs that encourage healthful behavior and weight maintenance is crucial.

The CDC is encouraging this trend by launching an online resource site called LEAN Works! (Leading Employees to Activity and Nutrition). The site features a calculator that computes the cost of employee obesity in higher medical bills and absenteeism and allows employers to measure their return on investment in employee health.

The site does not recommend specific interventions, predict the estimated weight loss of employees or provide estimates on the cost of implementation. Employers are also cautioned not to use LEAN Works! in making personnel decisions involving hiring, firing, promotion and demotion.

Critics of LEAN Works! worry that the calculations will be used to discriminate against obese employees. Some also feel that collecting information about one’s body is a violation of privacy. Peggy Howell, member and public relations director of the National Association to Advance Fat Acceptance, expresses this viewpoint: "They are my employer. They are paying for my time to work for them. They are not my owner. They do not have a right to my personal information such as my height, my weight or my BMI.”

Despite these concerns, employers are proceeding to introduce weight-loss programs based on the three-pronged model developed by LEAN Works! The recommended strategies involve making changes in the work environment, offering education to individuals and groups and introducing intervention programs designed to teach skills so employees can make choices that are more healthful. Depending upon the budget of the employer, programs can be integrated or offered separately. Wellness programs may be offered for as little as $1 per employee. A comprehensive program typically costs between $100 and $150 per employee. This investment typically produces $300 to $450 in savings.

Changes in the environment might include offering healthier options in the company cafeteria, decorating stairwells to encourage their use and providing “stretch” breaks led by a personal trainer. Some companies are adding gyms for employee use.

Educational efforts might involve free exercise videos from the company library, personal exercise prescriptions and health-education classes. Health and risk assessments are also used to educate overweight employees about their higher risk for type 2 diabetes, heart disease, certain cancers, joint problems and depression.

In structuring interventions, some companies are providing financial incentives for losing weight and adopting healthier habits rather than assigning penalties for failing to lose weight. Employers report that organized weight-loss competitions between departments, teams and locations work well.

Employers are also promoting fitness outside the workplace. Employees’ families and the surrounding community are frequently encouraged to participate in weight-loss programs. Given the increasing awareness of the importance of socialization in modeling behavior, employers are involving family and the larger community in promoting healthier lifestyles.

Perhaps the best example of this approach is found in Rochester, New York. Wegmans Food Markets recruited six local employers (Bausch & Lomb, Eastman Kodak, Xerox and others) along with the Rochester Business Alliance to orchestrate a health and fitness program for the surrounding community. The campaign, Eat Well. Live Well, currently involves over 44,000 employees, family members and customers.

In adopting these strategies, companies are embracing two relatively new ideas. The first is that the workaholic who devotes his or her entire waking hours to the job―leaving little or no time for family or social life, exercise or healthful eating―no longer represents the ideal employee. Work is no longer the be-all for the perfect employee. Today’s model employee leads a balanced life—enjoying work but also taking time to be nourished by healthful food, strong family and social relationships and regular exercise.

The second idea is that an investment in prevention produces big savings in reduced medical costs and the costs associated with absenteeism. While some researchers argue that their studies of treatments by physicians show that 80 percent of preventive measures cost more than waiting and treating the disease later, others are convinced the opposite is true, particularly when the larger picture is considered.

In a 2008 report from Trust for America's Health, researchers confidently claimed that “some disease prevention measures can pay off. Antismoking campaigns and exercise programs, often needing only small investments, can yield major savings.” Ron Z. Goetzel, a research professor at Emory University in Atlanta, adds, “In many cases, if not most cases, prevention activities are more cost effective than treatment."

For companies, employees and families suffering from the emotional and financial cost of surplus pounds, the prevention of obesity can’t arrive a day too soon.

Good news seems to be on the horizon. After climbing for 30 years, the increasing girth of Americans is leveling off. Although two-thirds of Americans remain overweight or obese, the number is no longer expanding.

The jury is out on whether this unexpected development is a temporary pause before expansion resumes or the beginning of an overdue shift downward, similar to the leveling off and subsequent decline in the number of smokers since 1965.

Researchers cite no single cause for the temporary pause; however, the amount of public-health education surrounding lifestyle issues and the introduction of community-based weight-loss programs have increased exponentially over the past decade, as has the increasing stridency of voices urging lifestyle changes—particularly given the increase in childhood obesity, which tripled during the same 30 years.

Will all of these forces, combined with practical interventions at the workplace, create a synergy that will eventually result in a return to healthier lifestyles and appropriate weight? The answer is yes because we can’t afford anything less.

Dubbed “An Apostle for Fitness” by the Wall Street Journal, Carole Carson was the inspiration behind the Nevada County Meltdown, where more than 1,000 people lost nearly 8,000 pounds. Carole is the author of From Fat to Fit: Turn Yourself into a Weapon of Mass Reduction and serves as the national coach for the AARP Fat to Fit Community Challenge, a free weight-loss program welcoming all ages.

Vegetarians Live 6 To 10 Years Longer, 50% Lower Heart Disease Rate

Healing: Eat A Plant-Based Diet

Interview: Into the Wilderness With Paul Auerbach

Copyright © 2006-2010, Basil & Spice. All rights reserved.



Jeffrey B. English, M.D.--

Do you still believe you will get to keep your doctor if you so choose under the “reformed”  health care system?

Under the House health care bill, the Secretary of the Health and Human Services is granted the power to force physicians to decline private health insurance (and their patients) as a condition to participate in the public offered insurance plans.  That is to say, a Government official has the power to force physicians to take patients with public insurance and exclude them from seeing anyone who has private insurance.  Also, a health care official will be able to decide which doctors can participate in the private and public provider networks.  In summary, the Government, not the patient, will decide on the physicians available to both privately and publicly insured patients.

This is troublesome for many reasons.  First of all, it goes against one of President Obama’s first promises and requirements for the new health care system.  The American people were specifically told that we would be able to keep their insurance and physicians if they so choose.  The House must have missed that promise in the many speeches I heard.

Secondly, this drastically changes the way physicians and patients interact.  No longer will decisions be made in the best interest of the patient, they will be made based on Government protocols.  As I have mentioned before in blogs, the health care bills set up requirements for all health care providers.  If the doctor does not conform to these requirements, the appointed Government officials have the power to remove the physician from both the private and the public insurance network.  The physician can be removed from taking care of patients.  Since the Government requirements may not follow recommendations set up by physician experts but for political or financial reasons, a physician may be faced with an ethical problem.  Doing what is best for their patients may not conform with the rules.  Deviating from those rules could lead to the physicians removal from patient care.

What you will see in the next 2-3 years is large numbers of physicians removing themselves from all insurance contracts, public or private.  This will enable them to practice in the patient's best interest, still under the Hippocratic Oath, in order to avoid this ethical problem.  With the exception of physicians who require surgical centers or hospitals to practice their care, most physicians would do better taking cash only.  The physician would benefit by removing these restrictions (and paperwork) that escalate costs of providing care, while preserving the doctor-patient relationship.  Patients will benefit as the cost of care would go way down and make doctor visits affordable.

As with most speeches and campaign promises, the final product never looks like the ones laid out in the beginning.  Health care reform is no different.  In the end, the most powerful special interest groups wrote the bills and made the campaign promises hollow.  Unfortunately, patients don’t have a powerful special interest group, so they lost.  As the American Medical Association (AMA) is supported by 17% of all physicians, the physicians also lost as they had no special interest group.

The health care bills create more uniform, inferior health care.  The future system will look like Medicaid for everyone.  Medicaid is slow, inefficient, inferior, and (unfortunately) bankrupt.  Maybe next time we can vote in politicians who will actually try to do what the majority of the people asked for: a level playing field where one can purchase affordable, excellent health care.  This is achievable if only the Government would get out of the way.

Dr. Jeffrey B. English is a Board Certified Neurologist with sub-specialty training in Clinical Neurophysiology.  He is in private practice in Atlanta, Georgia.  Dr. English is the Clinical Research Director at the Multiple Sclerosis Center of Atlanta, a non-profit organization for the treatment of patients with multiple sclerosis.  He helped develop and helps run the Center.  He is also a national speaker on multiple sclerosis and on the economics of health care delivery.  He admits to having “no formal economic background,” just extensive “real life, in the field” experience.

HealthCare 2010: UK's Example Would Be Bad For African Americans

HealthCare 2010: 85% Are Not Members Of The AMA

Copyright © 2006-2010, Basil & Spice. All rights reserved.

Jeffrey B. English, M.D.--

When your health becomes a political agenda.

The health care bills proposed by the House and Senate will end private insurance if they are passed.  The bills either set up a public insurance program run by the Federal Government or they regulate all private policies.  The rules will be completely controlled by the Government with detailed requirements set forth by politicians. Panels set up by politicians will decide exactly what care is covered, which services will be provided with no additional payment, and which providers or hospitals can provide each service.  The public plans will be competing against those offered by private insurance companies who have the same requirements and restrictions.

“So,” you might ask, “if the Government health plans are so bad, won’t the private plans thrive with patients flocking to the better private system?”  Well, that answer of course would be yes if the Government was competing on an even playing field. Not only does the Government not have to pay taxes, it also does not have to break even financially.  Only the Government can run a program where the revenue it brings in is far less than its expenses.  Why?  Because the Federal Government is backed by the tax payers and can keep raising the ceiling on the debt it incurs.  (Well, at least they can do this until China and India refuse to lend any more.)  If a private company makes less money than it spends, it ceases to exist.

When health care requirements become political, as they will by the necessity of politics, this will become an even greater uneven playing field.  A politician only sees a 2-6 year horizon; they look as far into the future as the next election.  They will keep adding more and more requirements covered for “free” in order to appease the voters for the next election cycle.  The Government run programs will be able to support these added benefits because they can continue to survive with a deficit.

So what’s the problem here?  After all, Dr. English, you want the reader to be afraid that the Government run program will cover too many procedures and too much health care for free?  Sounds like a great deal, right?  The reality of this future is that nothing is free.  Once the health care system squashes the private insurance companies, the American people will  have no choice and everyone will be in the Federal health care system which has built up a huge deficit.  We already have an experiment to learn from, it is called Medicare.  Medicare is now scrambling to ration care, cut patient’s abilities to find a provider, and limit what services are covered because it has amassed a $35 billion deficit in unrealized liabilities, ie. it is bankrupt!

At some point, the Federal health care plan will have to decrease its deficit as free money can’t go on forever.  How will it do that?  There will only be 2 options.  It will raise the prices (or taxes in this case) and it will ration care.  Rationing means that the politicians will dictate all of your health care and you will have no choices.

Rationing based on political affiliation leads to gender, class, and age war (and may even lead to genocide).  Take hemodialysis for example.  Currently, 25% of all Medicare expenses go to hemodialysis.  The average life expectancy of someone on hemodialysis is 3 years (not exactly a great prognosis).  A cancer therapy with a 3 year survival rate would be considered a failure and I doubt very much that the Government would support a cancer drug with such poor results.  Is it any wonder that in Great Britain hemodialysis is refused for anyone over the age of 55?  Makes sense, right?  We would save a lot of money that could be put towards diseases with greater outcomes, or at least reduce the Medicare debt by 25%. 

President Obama has stated several times that Great Britain has a health care system that we should emulate.  I wonder if he took hemodialysis into consideration.  In the case of hemodialysis in the United States, if we followed our friends in the UK, we would be committing genocide against the African American population.  It just so happens that the African American population is twice as likely as others to need hemodialysis.  In certain age groups the ratio is more like 5:1.  Now, which politician do you think will suggest we save money by removing a service that preferentially will shorten the lives of African Americans?  How about you, Mr. President;?  Do you support this?

Get ready patients with diabetes and hypertension.  Get ready if you have cancer or have had a stroke.  Everyone with arthritis, lung disease, or any other known medical condition better start their lobbying efforts now.

Dr. Jeffrey B. English is a Board Certified Neurologist with sub-specialty training in Clinical Neurophysiology.  He is in private practice in Atlanta, Georgia.  Dr. English is the Clinical Research Director at the Multiple Sclerosis Center of Atlanta, a non-profit organization for the treatment of patients with multiple sclerosis.  He helped develop and helps run the Center.  He is also a national speaker on multiple sclerosis and on the economics of health care delivery.  He admits to having “no formal economic background,” just extensive “real life, in the field” experience.

HealthCare 2010: 85% Are Not Members Of The AMA

Copyright © 2006-2010, Basil & Spice. All rights reserved.

Robyn O'Brien--

“The less we spend on food, the more we spend on health care,” said Michael Pollan on Oprah.

Today, Americans spend almost 20 cents of every dollar managing disease -  diabetes, allergies, asthma, cancer, obesity – and only 10 cents of every dollar on food.

The jury is still out on what exactly may be causing all of these epidemics, but genetics don’t change that quickly, the environment does.  And increasing evidence points to the role that diet is playing in the onset of disease. 

In a perfect world, we’d all be growing our own organic vegetable garden, but most of us don’t yet live in that world.  With picky eaters, limited time and a limited budget, we are trying to do the best we can with what we’ve got and are frustrated by the price discrepancy between conventional food and “organic” food at the grocery store.

But have you ever wondered why organic food costs more?

Organic food costs more than its conventional counterparts because our taxpayer dollars are not used to support organic farms to the same extent that our dollars are used to support conventional farms.  Under our current system, it is more profitable for farmers to grow crops laced with chemicals than organic ones because they will receive larger government handouts from the USDA Farm Subsidy program, more marketing assistance and stronger crop insurance programs. 

If farmers do choose to grow organic crops, it costs them more because not only do they not receive the same level of financial handouts from the government, but they are also charged a fee to prove that their crops are safe and then on top of that, they are then charged a fee to label their crops as “organic.”  As a result, organic farmers have a higher cost structure – with added fees and expenditures required to bring their products to market – while our taxpayer dollars are used to subsidize the crops with the chemicals.

Wouldn’t it make more sense to use our taxpayer dollars to subsidize the crops without chemicals given the increasing evidence pointing to the impact that these environmental insults are having on our health? What if our most powerful weapon in the war on health care is a farm subsidy?

Health care reform could begin at the USDA, with an equal allocation of our taxpayer dollars between organic and conventional farming.  The USDA could continue health care reform by providing equivalent marketing assistance and crop insurance programs for organic crops and by eliminating the organic certification fee farmers are required to pay in order to label their crops as “USDA Organic.”

If we invite the US Department of Agriculture to be part of health care reform, the USDA could level the economic playing field for the farmers, enabling more farms to grow crops free of chemicals, synthetic and genetically engineered ingredients which would, in turn, increase the supply of these crops in the marketplace – which, as any good economist knows, would drive down costs.  Organic food would be more affordable to more of us. 

Safe food is a social justice issue that our taxpayer dollars could be used to support.  Perhaps it’s time to invite the USDA into the health care debate and address the current system under which our taxpayer dollars are being used to externalize the costs of these chemicals onto the health of our families.  With the USDA at the table, health care reform could begin on the farm allowing the most powerful weapon in the health care debate to be a grocery cart.

According to the New York Times, Robyn O’Brien is “Food’s Erin Brockovich.” Robyn is the founder of AllergyKids, an organization designed to protect the 1 in 3 American children with autism, allergies, ADHD and asthma. Robyn has appeared on the Today Show, Good Morning America, CBS Evening News with Katie Couric and CNN highlighting the role that chemicals in our food supply are having on our health. O'Brien is the author of The Unhealthy Truth: How Our Food Is Making Us Sick and What We Can Do About It (Random House/ May 2009) and it exposes the role that money plays in our federal food policy.  Born and raised in Texas, Robyn earned a Fulbright Fellowship, an MBA and served as an equity analyst on a multibillion dollar fund prior to moving to Boulder, Colorado with her husband and four children. Additional resources, articles and information are available at www.robynobrien.com and www.allergykids.com

90% Of World's ADHD Meds Prescribed To American Kids

Autism Rises: 1 In 91 Children, Life-Time Med Cost At $1.6 Million

Copyright © 2006-2010, Basil & Spice. All rights reserved.

Istanbul, Turkey - Vehbi Koc Foundation (VKF) American Hospital and The University of Texas M. D. Anderson Cancer Center today announced that they are expanding cancer care services in Istanbul and Turkey through a new radiation treatment center located in the VKF American Hospital.

The M. D. Anderson Radiation Treatment Center in Istanbul at American Hospital is open today, offering a full range of radiation therapies. It is the first M. D. Anderson radiation treatment facility outside of the United States that fully replicates M. D. Anderson standards of therapies, delivered by physicians trained in Houston, Texas.

M. D. Anderson is currently ranked the number one cancer hospital in the United States by U.S. News & World Report's "America's Best Hospitals Survey."

"American Hospital has been offering outstanding medical and surgical oncology services to patients in Turkey," said Evren Keles, M.D., CEO of American Hospital. "Through our work with M. D. Anderson on advanced radiation therapy, we will continue to raise the bar and deliver the full spectrum of cancer care related services to patients close to home."

M. D. Anderson and American Hospital are collaborating to meet a critical need in Turkey for expertise in radiation therapy that addresses the rising incidence of cancer, especially in lung and breast cancers.

"Cancer is as devastating a health problem in Turkey as it is in the United States," said John Mendelsohn, M.D., president of M. D. Anderson Cancer Center. "We are proud to unite efforts with American Hospital to offer cancer patients in Turkey the best possible radiation treatment."

Designed by M. D. Anderson radiation oncologists, physicists and consultants, this new Center of Excellence in cancer care will provide patients in Turkey with access to top experts and state-of-the-art technologies to assist them with their fight against cancer. The center has the capacity to serve approximately 400 patients annually and is the result of a $15 million capital investment by American Hospital.

M. D. Anderson has clinical oversight of all radiation treatment delivery, ensuring that patients receive therapy using the same guidelines, standards, process and procedures established for M. D. Anderson patients. Services at the M. D. Anderson Radiation Treatment Center in Istanbul at American Hospital will be delivered using a team approach. The physician leading the team will work with colleagues in the Division of Radiation Oncology at M. D. Anderson to determine therapy protocols.

The center will be directed by Ugur Selek M.D., a former M. D. Anderson fellow and currently an adjunct associate professor at M. D. Anderson. All physicians, physicists, therapists and nurses at the new center have received training at M. D. Anderson.

Approximately 130,000 people in Turkey are diagnosed with cancer each year, according to available data, with lung cancer as the leading cause of cancer deaths overall. Cancers of the respiratory system constitute nearly one-third of all reported cancers in men. In women, breast cancer comprises more than a quarter of reported cancers and was the second leading cause of cancer death.

The University of Texas M. D. Anderson Cancer Center in Houston ranks as one of the world's most respected centers focused on cancer patient care, research, education and prevention. M. D. Anderson is one of only 40 comprehensive cancer centers designated by the National Cancer Institute. For six of the past eight years, including 2009, M. D. Anderson has ranked No. 1 in cancer care in "America's Best Hospitals," a survey published annually in U.S. News & World Report.

(c)2010 The University of Texas M. D. Anderson Cancer Center

MD Anderson To Oversee $360,000 Grant For Childhood Anti-Obesity Initiative

It appears that the American Dream is dead as the Democrats have essentially no chance in passing some sort of healthcare reform package. The stunning loss of the senate seat held by the late Ted Kennedy has now given the Republicans the ability to filibuster any significant healthcare legislation.

More disappointing is that Americans seem willing to accept the fact that they can live without healthcare. In a blog at US News and World Report titled "21 Things We're Learning to Live Without," besides abstaining from cable TV, a home phone, prepared foods, and lattes, healthcare was also on the list. Millions of Americans are apparently "simply hoping they don't get seriously ill or hurt." How can this happen is supposedly the wealthiest nation in the world? Too many Americans as a result are literally one illness or accident away from financial ruin as medical costs are the leading cause of personal bankruptcy.

While President Obama and the Democrats no doubt will try to salvage what they can from their hard work over the past year, they need to be thoughtful about their future proposals. Though the public doesn't like the thought of insurance companies turning away those with pre-existing conditions, the fact is that this practice exists because we don't mandate everyone have health insurance. As George Halvorson, CEO of Kaiser Permanente, noted to make healthcare affordable a double mandate must apply - everyone must sell (that is health insurers must sell coverage to everyone who desires it) and everyone must buy (all consumers must purchase). Otherwise, those who are healthy would not participate and instead would wait until they needed it. Those who are already ill will purchase health insurance. As a result, insurance companies would only receive payments from those who need medical care, which can't possibly cover costs of chemotherapies and hospital stays which are in the tens of thousands per treatment. Since the healthy don't subsidize the sick, insurance companies would simply go bankrupt.

With the President and his Democratic party concerned about a Republican resurgence, he has already refocused his attention on large institutions like banks and redirecting the populace anger there rather than working on meaningful change. He may try the same tactic on insurers in an effort to get some healthcare reform passed.

In doing so, he may simply ignore the truth of the double mandate and make insurers not only cover everyone but also have the federal government set the rates. President Obama knows of course that it would only be a matter of time that the government would take over healthcare as insurers would have no choice but to pull out in this financially unsustainable model. If a single payer system occurs be prepared for rationing of medical care. Imagine long waiting lists to see a specialist, getting surgery done, or wondering if a treatment might be approved. Certainly some of these problems occur already with private insurers, but envision if the healthcare system was run by the DMV. Is this actually better?

It's equally as unfortunate and more disappointing that the Republican party over the past year essentially only had one mission - derail any proposals from the Obama administration. Without healthcare reform to make insurance coverage more affordable to employers, families, and individuals, America will no longer be viewed as the vibrant superpower nation it has been over the past couple of decades but a country unable to provide the basic healthcare needs to its populace because its politicians were too paralyzed to do anything but score political points for the next election. Because of their failure to lead, it is increasingly clear that in the United States healthcare coverage isn't a right but a luxury.

If Americans and employers are constantly worried about saving money for a future expensive illnesses or medical problems, then when will they ever feel secure enough or freed enough to take risks, invest, and dream?

Davis Liu, MD, is a respected family physician, a healthcare educator and writer, and the author of Stay Healthy, Live Longer, Spend Wisely: Making Intelligent Choices in America's Healthcare System. He is a practicing board-certified family physician with the Permanente Medical Group in Northern California since 2000. Dr. Liu received his medical degree from the University of Connecticut School of Medicine, and graduated summa cum laude and Phi Beta Kappa from the Wharton School of Business at the University of Pennsylvania. He completed his residency training at the Glendale Adventist Family Practice Residency Program.

Jeffrey B. English, M.D.--

I need to set the record straight on a topic that often comes up during discussion and in responses to my blogs.

Doctors unanimously support health care reform.  Most physicians, however, do not support the bills that are currently in the House and Senate.  We do not support these bills because they will hurt patient care and will destroy the doctor-patient relationship.   

In that relationship, the doctor has only one objective, to do what is best for the health of that one patient.  The current reform bills will end that relationship as we know it.  The bills are government centered, not patient centered.  Physicians will be treating patients in a manner dictated by bureaucracy and government officials who decide on patient care based solely on economics. 

Physicians now take guidance from expert panels of physicians that set recommendations for care based on patient outcomes, not from bureaucrats setting recommendations based on costs.  The bills actually give government panels the right to decide which physicians get to treat which group of patients. They have the right to deny physicians the right to see patients if they do not conform to the standards (and in my opinion sub-standards) set up by the government.  

I have not heard a single physician argue against health care reform based on concern for their income.  I have never given a talk on medical economics that was focused on physician reimbursement.  My talks, and my talking points to politicians, deal only with the finances of patient access to care. 

I joined Docs 4 Patient Care (see docs4patientcare.org) because they are promoting patient-centered reform, not government-centered reform.  In my opinion, the American Medical Association (AMA) and the American Association of Retired Persons (AARP) supported the current bills entirely based on their financial gain once the bills are passed. That’s why I, like 85% of physicians, am not a member of the AMA.

The need for health care reform is not a new issue.  When Presidential candidates, Mr. Obama and Mr. McCain did not invent the issue.  Many of us have been involved in reform for many years.  For me, it has been a passion for about 8 years.  I am in a unique position.  I not only am a member of a private practice group (which makes me a small business owner), I also help set up and run a non profit organization for the treatment of patients with multiple sclerosis.  I have experience with all the anti-trust issues that drive up costs and regulate physician interaction with hospitals. 

From a simple financial standpoint, patient care in the hospital and the care of patients with multiple sclerosis is a “money loser.”  Why do you think most of your primary care physicians no longer go the see you in the hospital and why do general neurologists send MS patients away to specialty centers like ours?.  They are not greedy doctors.  They simply can’t afford to keep their doors open if they provide care that costs far more than they are reimbursed.  The same can be said as to why most patients with Medicare can no longer find a primary care physician.

Health care reform is achievable with ideas from the Democrats and Republicans working together.  I reject the current bills as they are written with extreme, one-sided agendas.  I reject the current bills because they will cost more and will hurt my patients.  My opinion is educated, comes from vast experience, and is based on my desire to continue the best care for my patients.  My rejection has nothing to do with a concern for physician income.  Again, I have not spoken to a single physician yet who is opposed to the bills based on their income.

We need reform that will give health care access to all patients without a great deal of bureaucracy in between the doctor and patient.  We need insurance reform to promote competition by insurance companies for patients across state lines.  We need to end ceilings on care and denials based on pre-existing conditions.  This is all achievable without ruining the best features of our system.  This is achievable with patients, not businesses, owning their tax deductible insurance and  by having an open market nationally.  We need to promote efficient care that will drive down costs and improve access.  I am sorry to say, the current bills do absolutely none of this.  They drive up costs and limit access.
I encourage you to continue to talk with your Senators and Representatives to encourage a bipartisan bill that will incrementally fix the problems of the system while preserving the excellence that currently exists.

Dr. Jeffrey B. English is a Board Certified Neurologist with sub-specialty training in Clinical Neurophysiology.  He is in private practice in Atlanta, Georgia.  Dr. English is the Clinical Research Director at the Multiple Sclerosis Center of Atlanta, a non-profit organization for the treatment of patients with multiple sclerosis.  He helped develop and helps run the Center.  He is also a national speaker on multiple sclerosis and on the economics of health care delivery.  He admits to having “no formal economic background,” just extensive “real life, in the field” experience.

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Review By Loyd Eskildson

Atul Gawande M.D., a general surgeon and associate professor at Harvard Medical School, uses The Checklist Manifesto: How To Get Things Right (Metropolitan Books/Dec 2009) to briefly report the need for improvement in surgery, the use of checklists by pilots and their potential applicability to medicine, lessons learned in developing his own checklists, initial improvement results, and examples of potential other areas of use (eg. investments). The Checklist Manifesto is easy general reading, yet also provides detailed hands-on suggestions for practitioners and sources for more guidance. It is must reading for anyone interested in performance improvement.
 
Gawande reports that studies have found that 30% or more of stroke patients receive inappropriate or incomplete care from doctors, as well as 45% of those with asthma and 60% of patients with pneumonia. Experience, training, and specialization all help ('practice makes perfect'), but are no guarantee of perfection either. The basic problem is medicine's underlying complexity - there are some 13,000 different diseases, syndromes, and types of injury, 6,000+ drugs, and 4,000 some medical and surgical procedures - and the numbers in all three areas grow steadily. Even day-to-day care can be problematic - a study of ICU patients found the average patient required 178 individual actions/day, each with risks of potential error. (Emotional family members, distractions by questions about other patients, patients throwing up, etc. don't help.) Fortunately, checklists can provide significant improvement in patient outcomes - from diagnosis to day-to-care, while also lowering costs.
 
Gawande then provides a brief history of checklists in aviation and illustrations of their use. Drawing upon these experience, as well as suggestions from experts within Boeing that develop such lists, Gawande then details his initial stumbles in developing similar tools for surgery. Fortunately, his openness to suggestions from others (both in the operating room, and outside) soon led to a successful trial across 8 hospitals that dropped major surgical complications by 36%, and deaths by 45%, and gained strong enthusiasm from the staff and physicians involved.


Loyd Eskildson is retired from a life of computer programming, teaching economics and finance, education and health care administration, and cross-country truck driving.  He's now a reviewer for Basil & Spice.

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