Cutting out the insurer

While I am not a fan of the AMA in its current structure, I do think that the idea of eliminating Big Insurance is something whose time has come many years ago, but now AMA is noticing.  It is certainly long overdue.

This has been around in some parts of the country for a dozen or more years.  Doctors and patients like it.

For those who don't get it or refuse to consider it, thrid party billing is more damaging to health care than tort reform: it is the root problem.

By Doug Trapp, amednews staff. Aug. 1, 2011.

A small but enthusiastic minority of primary care physicians believe they have found a practice model that can save money, improve patients' long-term health and drastically reduce administrative hassles: direct primary care.

Direct primary care practices are an offshoot of the retainer care model, which provides unlimited or less-restricted access to physicians for a set fee. Under direct primary care, patients pay a monthly fee -- sometimes less than $100 -- for unlimited access to a range of primary care services, possibly as complex as minor surgeries and x-rays. Patients at these practices are encouraged to have basic health insurance to pay for specialist and hospital care, otherwise uninsured patients pay out of pocket for care outside the practice.  read more

Selection from Natural Health News

http://naturalhealthnews.blogspot.com/2011/03/insurance-fraud-big-phrma.html

http://naturalhealthnews.blogspot.com/2007/10/doctors-checking-out-early.html

http://naturalhealthnews.blogspot.com/2008/11/doctors-to-quit.html

US Health Care: Why We Rank Low

I have yet to see the AMA do anything that has stopped or changed these obstructions.

What's wrong with U.S. healthcare

NEW YORK, March 8 (UPI) -- U.S. healthcare is determined by a myriad of large and powerful interconnected organizations that have dictated the "rules of the game," researchers said. 

Study authors Salinder Supri of Anderung Consulting in New York and Karen Malone of the University of Medicine and Dentistry of New Jersey in Newark, characterize the U.S. institution of medicine as not as a single, comprehensive and cohesive system of healthcare, but instead, a myriad of powerful organizations. 

The researchers said these powerful organizations have determined the rules of the game:

-- Insurance companies have set the rule "restrict choice and coverage" by using an elaborate system of co-payments and deductibles, exclusion clauses and loopholes.

-- HMOs have set the rule "manage care" to limit the number of treatments patients receive, the days spent in a hospital and their choice of provider. 

-- The pharmaceutical industry has set the rule "charge as much as we want, because insurance will pay," resulting in prescription drug prices nearly 60 percent higher than in Canada and patients being prescribed sometimes "unnecessary, often useless and even potentially dangerous drugs."

-- Corporate hospital chains have set the rule "test (patients) as much as we want because insurance will pay," even when excessive or unnecessary.

"The sum of the 'rules of the game' devised by these organizations has resulted in a fragmented, haphazard and broken system of healthcare," the authors said. 

The article is published in The American Journal of Medicine.

Read more: http://www.upi.com/Health_News/2011/03/08/Whats-wrong-with-US-healthcare/UPI-14881299589178/print/#ixzz1G3HKOCPm

Medical News: Florida Medical Association Votes 'No Confidence' in AMA

Medical News: Florida Medical Association Votes 'No Confidence' in AMA - in Washington-Watch, Reform from MedPage Today

No flu shot mandate for doctors

Dcotors no being mandated to take H1N1 vaccine.  A good move, but not sure I agree with the reliance on hand sanitizer.  Soap and Water washing frequently is vital.

AMA meeting: No flu shot mandate for doctors; hand sanitizer pushed


The AMA will study if there's any benefit from requiring all health professionals to receive influenza vaccine.

By KEVIN B. O'REILLY AND DAMON ADAMS, amednews staff. Posted Nov. 23, 2009.
Houston -- The AMA House of Delegates rejected a proposal to mandate vaccinations for health care professionals but approved other policy to prevent the spread of seasonal flu and influenza A(H1N1).

A resolution by the Infectious Diseases Society of America said the AMA should back universal seasonal and H1N1 flu immunizations unless health professionals have medical contraindications or religious objections. In October, New York state announced that it was requiring all health professionals to get the H1N1 immunization, but the mandate was suspended later that month due to vaccine shortages.

"It is our ethical duty to do no harm and prevent transmission of disease to patients," said Michael L. Butera, MD, an alternate delegate who spoke on behalf of IDSA. "Despite educational efforts, we have 40% to 70% immunization rates that are woefully inadequate." Mandates may be "the only way to achieve" the goal of universal vaccination, he said.

But delegates balked at the idea of a vaccination mandate, saying that requirements should be a last resort and can be counterproductive if implemented poorly. The house directed the AMA to study the ethical and scientific intricacies of the issue further.

Delegates said hand sanitizer dispensers should be available in well-trafficked areas and urged large gathering places to develop plans in line with Centers for Disease Control and Prevention recommendations.

Physicians briefed on H1N1

During a session at the Interim Meeting, two CDC officials briefed delegates on the latest epidemiological data on H1N1 and how best to manage the disease. They addressed hospitalization rates, vaccine availability, dosing and vaccine testing.
Most cases of H1N1 have not required hospital care. But the highest hospitalization rates have been for children through age 4, said Anthony E. Fiore, MD, MPH, a medical epidemiologist in the CDC Influenza Division. Among hospitalized adults, 70% have an underlying medical condition. If a patient appears to have the virus, treatment should be started as soon as possible. "We encourage people not to delay treatment awaiting laboratory confirmation."

Physicians and other health care professionals need to take precautions to make sure they don't get sick, said Michael Bell, MD, associate director for infection control at the CDC Division of Healthcare Quality Promotion. Most exposure risk in hospitals is from sick workers, not patients. He cited an example of a resident at an Ohio hospital who infected 166 people with the virus.
To prevent the spread of H1N1 in physician practices, sick workers should stay home, and ill patients should be kept away from noninfected patients. Dr. Bell recommended vaccination for doctors and their staffs, saying it doesn't make sense to put patients at risk by skipping shots.

Health care personnel who develop a fever and respiratory symptoms should be excluded from work for at least 24 hours after the fever subsides, the CDC said. Workers who develop acute respiratory symptoms without fever should be allowed to work unless assigned to areas with severely immunocompromised patients. In those cases, workers should be reassigned temporarily or excluded from work for seven days from the onset of symptoms.

Meanwhile, CDC officials on Nov. 12 said about 22 million Americans had been sickened by H1N1 and about 4,000 had died, including 540 children. About 42 million doses of vaccine have been created.
"The amount coming out will increase rapidly in the next few weeks," Dr. Fiore said.

In a Nov. 10 letter to doctors, Food and Drug Administration Commissioner Margaret A. Hamburg, MD, said no serious adverse events attributed to the vaccine had emerged in clinical trials on more than 3,600 patients. She encouraged physicians to report any vaccine-related problems to the Vaccine Adverse Event Reporting System.

Colette R. Willins, MD, a family physician in Westlake, Ohio, and a delegate for the American Academy of Family Physicians, was among the physicians at the AMA Interim Meeting who voiced frustration about not receiving H1N1 vaccines yet.

"They keep telling us to watch for it," she said. "I can't even get my staff vaccinated."

The print version of this content appeared in the Nov 30, 2009 issue of American Medical News.

I Must Be In B Vitamin Heaven

I recall vividly the many times I accompanied my father to AMA Conventions while growing up. I am sure now it was a part of his plan to make sure I was brainwashed enough to go to med school and follow along his path.

At one convention, in Atlantic City, when I was about eleven years old, I brought home a treasured back scratcher (an advertising tool from Dome Chemicals, Inc. - ala Merck, Sharp and Dome in the old days) and a shot glass from Phospho-Soda (a shot glass was pretty important in this circle because of all the cocktail parties, especially good for a child with a proctologist father).

I still have these treasures and the memories.

Medicine in those days was less frenzied and treatments were more straight forward and simpler.

And certainly vitamins were not looked upon as voodoo.

Even B12 shots were a regular occurrence and no one needed a blood test to decide if you could get them. Of course now the blood test used - really to get a billable charge and avoid acting outside standards of care - is not the correct test. Remember you can't get hurt by B12 shots but if your provider demands a test it is the INTRACELLULAR B12 that is required.

And - for women only - the correct form and correct dose of injectable B12 can lower your blood pressure.

Pretty much, natural thyroid and B12 were very good at keeping aging folks from dementia, and no one flapped an eyelash over it.

I use B Complex daily and in a food form. I give the same to my animals and we all use organic nutritional yeast which is a fermented product. I think the aroma is to die for, it is such a heavenly aroma that wafts from the container when I open it in the morning at at dinner time.

I certainly am sure I get doses well beyond the fallacy of the RDA, but them I'm more of a follower of nutrition and orthomolecular health models so I'm not frightened that water soluble vitamins will harm me in any way.

I sort of look at the Big Pharma approach to make you think they are on top of things when B3 is added to a dangerous cholesterol drug as odd. Why don't they just admit that the whole cholesterol lowering thing is a scam. B3 does just fine to lower cholesterol on its own, and much less expensively.

I made the mistake of turning on to orthomolecular medicine when I began working in psychiatry as an RN in the early 1970s. With people like Carl C. Pfeiffer, Abrahm Hoffer and Melvin Werbach (all MDs) educating me along the way, added to to great integrated nutrition I had while studying nursing in college, I was way ahead of the pack.

Now after all these years we see maybe the first wave of a turning tide. The AMA reports that B vitamins are good to help older women prevent breast cancer.

Will wonders never cease.....

B vitamins may protect elderly women from cancerDecember 2008

Daily supplementation with B vitamins may reduce the risk of breast cancer and other invasive cancers in women over the age of 65. That’s what a study published in the Journal of the American Medical Association has to say.

Over 5,000 women at a high risk of cardiovascular disease took part in the study, which investigated the effects of a daily supplement of folic acid, vitamin B-6 and vitamin B-12 on cancer risk.

“If the finding [that cancer risk in women over 65 is decreased] is real and substantiated, the results may have public health significance because the incidence rates of cancer are high in elderly persons. The finding is biologically plausible because elderly individuals have increased requirements for these B vitamins,” wrote lead author Shumin Zhang from Brigham and Women’s Hospital and Harvard Medical School.

Folate, vitamin B-6 and vitamin B-12 are thought to play an important role in cancer prevention. This is because the vitamins play an important role in maintaining the integrity of DNA and regulating gene expression, both critical processes in healthy cell function.

Another positive to take from the results is that they appear to support the safety of B vitamins, and particularly folic acid. Since 1998 the U.S. has required mandatory fortification of all grain products with folic acid—the synthetic, bioavailable form of folate—in order to reduce the incidence of neural tube defects—most commonly spina bifida and anencephaly.

Zhang and co-workers looked at the risk of cancer and B-vitamin consumption among the 5,442 participants (average age 62.8) of the Women’s Antioxidant and Folic Acid Cardiovascular Study. The women either had cardiovascular disease or three or more coronary risk factors.

Over the course of 7.3 years, half of the women received a daily supplement of folic acid (2.5 mg), vitamin B-6 (50 mg) and vitamin B-12 (1 mg), while the other half of the women received a placebo. The study began in 1998—the same year as mandatory folic acid fortification was introduced in the U.S.

During the study, 379 cases of invasive cancer were diagnosed—187 in the B-vitamin group and 192 in the placebo group. No differences were seen in the risk of developing total invasive cancer or breast cancer, when the participants were viewed in their entirety. However, in women over the age of 65 the supplementation was associated with significant 25% and 38% reductions in the risk of invasive and breast cancer, respectively.

Journal of the American Medical Association 300(17):2012-2021, 2008

Placebo Effect Benefits Health

I always like to quote Andy Weil's statement when it comes to placebo naysayers. Weil believes placebo to be one of the most underused tools in medicine. Probably he's referring to the 'art' of medicine as it used to be when placebo was commonly used without being damned by the AMA.

From my perspective the use of placebo often deals directly with the emotional component of health care. And it is this component that has fallen by the wayside, leading to a tremendous loss of confidence in the system by patients.

Perhaps the AMA pundits might want to take a refresher course in medical history and brush up on their patient interaction skills. They might begin with Listening 101.

Survey: Half of US doctors use placebo treatmentsBy MARIA CHENG, AP Medical Writer

LONDON – About half of American doctors in a new survey say they regularly give patients placebo treatments — usually drugs or vitamins that won't really help their condition. And many of these doctors are not honest with their patients about what they are doing, the survey found.

That contradicts advice from the American Medical Association, which recommends doctors use treatments with the full knowledge of their patients.

"It's a disturbing finding," said Franklin G. Miller, director of the research ethics program at the U.S. National Institutes Health and one of the study authors. "There is an element of deception here which is contrary to the principle of informed consent."

The study was being published online in Friday's issue of BMJ, formerly the British Medical Journal.

Placebos as defined in the survey went beyond the typical sugar pill commonly used in medical studies. A placebo was any treatment that wouldn't necessarily help the patient.

Scientists have long known of the "placebo effect," in which patients given a fake or ineffective treatment often improve anyway, simply because they expected to get better.

"Doctors may be under a lot of pressure to help their patients, but this is not an acceptable shortcut," said Irving Kirsch, a professor of psychology at the University of Hull in Britain who has studied the use of placebos.

Researchers at the NIH sent surveys to a random sample of 1,200 internists and rheumatologists — doctors who treat arthritis and other joint problems. They received 679 responses. Of those doctors, 62 percent believed that using a placebo treatment was ethically acceptable.

Half the doctors reported using placebos several times a month, nearly 70 percent of those described the treatment to their patients as "a potentially beneficial medicine not typically used for your condition." Only 5 percent of doctors explicitly called it a placebo treatment.

Most doctors used actual medicines as a placebo treatment: 41 percent used painkillers, 38 percent used vitamins, 13 percent used antibiotics, 13 percent used sedatives, 3 percent used saline injections, and 2 percent used sugar pills.

In the survey, doctors were asked if they would recommend a sugar pill for patients with chronic pain if it had been shown to be more effective than no treatment. Nearly 60 percent said they would.

Smaller studies done elsewhere, including Britain, Denmark and Sweden, have found similar results.

Jon Tilburt, the lead author of the U.S. study, who is with NIH's bioethics department, said he believes the doctors surveyed were representative of internists and rheumatologists across the U.S. No statistical work was done to establish whether the survey results would apply to other medical specialists, such as pediatricians or surgeons.

The research was paid for by NIH's bioethics department and the National Center for Complementary and Alternative Medicine.

The authors said most doctors probably reasoned that doing something was better than doing nothing.

In some cases, placebos were given to patients with conditions such as chronic fatigue syndrome. Doctors also gave antibiotics to patients with viral bronchitis, knowing full well that a virus is impervious to antibiotics, which fight bacteria. Experts believe overuse of antibiotics promotes the development of drug-resistant strains of bacteria.

Some doctors believe placebos are a good treatment in certain situations, as long as patients are told what they are being given. Dr. Walter Brown, a professor of psychiatry at Brown and Tufts universities, said people with insomnia, depression or high blood pressure often respond well to placebo treatments.

"You could tell those patients that this is something that doesn't have any medicine in it but has been shown to work in people with your condition," he suggested.

However, experts don't know if the placebo effect would be undermined if patients were explicitly told they were getting a dummy pill.

Brown said that while he hasn't prescribed sugar pills, he has given people with anxiety problems pills that had extremely low doses of medication. "The dose was so low that whatever effect the patients were getting was probably a placebo effect," he said.

Kirsch, the psychologist, said it might be possible to get the psychological impact without using a fake pill. "If doctors just spent more time with their patients so they felt more reassured, that might help," he said.

Some patients who had just seen their doctors at a clinic in London said the truth was paramount.

"I would feel very cheated if I was given a placebo," said Ruth Schachter, an 86-year-old Londoner with skin cancer. "I like to have my eyes wide open, even if it's bad news," she said. "If I'm given something without being warned what it is, I certainly would not trust the doctor again."

On the Net: http://www.bmj.com