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NEWS EXTRA: Tim Radford Top scientist warns of "sickness" in US health system BMJ 2003; 326: 416b [Full text]

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Thought Paradigm Shift Needed

Ned Hoke   (21 February 2003)

American Health Care System Promotes Iatrogenic Illness

George Hill   (23 February 2003)

Profoundly Weak Public Health/Citizen Ignorance

Ned Hoke   (24 February 2003)

Absurdity in Conventional American Medicine

Lawrence J. O'Brien   (9 March 2003)

Thought Paradigm Shift Needed 21 February 2003
Ned Hoke, Ecological Medicine, private Western USA Send response to journal: Re: Thought Paradigm Shift Needed	Today's U.S. healthcare as an industrial product is often utterly lost in narrow worlds of commercial imperialism absent a basis in positive biology that is central to a genuine health-care that values a natural radiance of living. Healthcare as a supportive and restorative social process, instead of a commodity industrial product, needs more than a commission to support it's living presence in today's enviroment. The breakdown of commerce complaints reportedly by Dr. Bloom give no mention to this and offers further vain complaint towards unmet care requirements the industrial system is unable to confront due to it's orientation as a "reactive" (procedure code/get paid) activity when the horse is already out of the barn.. Competing interests:   None declared
American Health Care System Promotes Iatrogenic Illness 23 February 2003
George Hill, Executive Secretary Doctors Opposing Circumcision, Suite 42, 2442 NW Market Street, Seattle, Washington 98107,USA Send response to journal: Re: American Health Care System Promotes Iatrogenic Illness	EDITOR--Doctors Opposing Circumcision wholeheartedly agrees with Dr. Bloom’s remarks about the sickness in the American health care system.1       The American health care system is unique in its dependence on fee-for-service in the compensation of physicians. This means that the more procedures performed, the more pay the doctors get. This incentive drives up health care costs and promotes unnecessary surgery.       One such unnecessary surgery is non-therapeutic circumcision of infant males. The United States has a higher percentage of infant males circumcised than any other country is the world, except perhaps Israel (where it is a religious requirement).       Dr Bloom expressed concern about high stress in infancy generating diseases later in life.1 Doctors Opposing Circumcision also concurs with those remarks. Neonatal circumcision is a high stress generator. Rhinehart reported PTSD in adult males; the stressor was neonatal circumcision.2 Neonatal circumcision causes a huge rise in serum cortisol.3,4 Heart rates rise to alarming levels during circumcisions.4 Blood oxygen pressure declines.5 Salk and Jacobsen associate trauma in the perinatal period with self-destructive behavior in later life.6-8       Legato has called for a “searching look” at circumcision of the newborn and “wide-ranging debate.”9 That has yet to happen. In the present, the American health care industry in America still circumcises about 55 percent of newborn boys, so we can look forward to many decades of iatrogenic physical and emotional illness in America. George Hill Executive Secretary Doctors Opposing Circumcision Suite 42 2442 NW Market Street Seattle, Washington 98107 USA Web: http://www.doctorsopposingcircumcision.org/ References: Radford T. Top scientist warns of "sickness" in US health system. BMJ 2003;326:416. Rhinehart J. Neonatal circumcision reconsidered. Transactional Analysis Journal 1999;29(3):215-221. Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981; 6(3)269-275. Williamson PS, Williamson ML. Physiologic stress reduction by a local anesthetic during newborn circumcision. Pediatrics 1983; 71(1):36-40. Rawlings DJ, Miller PA, Engel RR. The effect of circumcision on transcutaneous PO2 in term infants.Am J Dis Child 1980;134(7):676-8. Salk L, Lipsitt LP, Sturner WQ, et al. Relationship of maternal and perinatal conditions to eventual adolescent suicide. Lancet 1985;i:624-627. Jacobson B, Eklund G, Hamberger L, et al. Perinatal origin of adult self-destructive behavior. Acta Psychiatr Scand 1987;76(4):364-71. Jacobson B, Bygdeman M. Obstetric care and proneness of offspring to suicide . BMJ 1998; 317:1346-49. Legato MJ. Rethinking Circumcision: Medical Intervention, Religious Ceremony, or Genital Mutilation? J Gend Specif Med 2002;5(4):8-10. Competing interests:   None declared
Profoundly Weak Public Health/Citizen Ignorance 24 February 2003
Ned Hoke, Ecological Medicine/private Western US Send response to journal: Re: Profoundly Weak Public Health/Citizen Ignorance	Like it or not it is a "do it yourself" world. The magical inputs of the machine-ages haven't overcome the human needs for primary self-care. After cleaning one's teeth, getting enough rest, eating a good breakfest and getting a little exercise a great many people appear to feel their job is done. All the remainder has been professionalized, put to the hands of "experts". The care and servicing of the human form is left to manufactured elements which commonly dull or eliminate legitimate responsiveness the body provides and this signal manipulation is considered the rightful and principal activity of a sensible medicine. Without seeking in any way to denigrate the enormous contributions these capacities have provided by giving such singular attention to these considerations of health and well-being way too much has been forgotten, undervalued and unsupported. A society that valued it's citizens could provide an enormous variety of useful educations, guidances and means to help people deal with the enormous complexities of living healthy, functional and useful lives. Homeland security could become a successfully individualized matter as well and we could stop imagining we had to keep killing people to save ourselves.. Competing interests:   None declared
Absurdity in Conventional American Medicine 9 March 2003
Lawrence J. O'Brien, retired health care exec n/a Send response to journal: Re: Absurdity in Conventional American Medicine	Many other nations have been following the American lead in medicine, not recognizing that they thereby enter into a box canyon of the intellect from which escape may not be possible. Conventional medical theory and practice in the United States are shot through with startling absurdities. As one example, more medicine can and does endanger the lives of patients. A recent report by physicians who publish the Dartmouth Atlas documents the fact that average longevity for Medicare beneficiaries is significantly reduced in those areas of the USA that have a higher-than- average supply of physicians in so-called "supply sensitive" medical specialties. Situations in which suppliers of medical care regulate the demand for their own services have been proven to result in adverse effects on health status, quality of life, and length of survival for the affected patients. In its final report before shutting down operations in January 2000, the Pew Commission on the Health Professions, chaired by Senator George S. Mitchell, found that the nation had more than twice as many active physicians as would be optimal for the society as a whole. Since then, the numbers have increased, with most of the newly licensed physicians joining the ranks of "supply sensitive" specialties. If you can situate yourself in a position to determine the level of demand for your own services, this is obviously where the big money can be made. What else can be expected? Conventional American physicians now consider their profession to be just another business in which "market forces" can be counted on to resolve all problems. The trouble is that there can be no legitimate market force at work when supply regulates demand, instead of the converse. There is a quotation in Abraham Flexner’s book, "I Remember," in which the philanthropist Frederick Gates said: "[W]here commercial methods are fair the two parties must both know the value of the article or service…If you want to buy potatoes, an agreed price is fair, because you and the grocer both know about potatoes. But as to the value or skill of a doctor’s services, one of the two parties knows nothing; he has got to take it at the word of the other. And that other, the doctor, makes more of his services or his individual skill than they would be worth if they could be appraised competitively." In his Carnegie Foundation report issued in 1910, Flexner warned the society and the medical profession against ever allowing "the commercial point of view" to influence the world of medicine: "In modern life the medical profession is an organ differentiated by society for its own highest purposes, not a business to be exploited by individuals according to their own fancy. [The physician] is a social instrument [and the medical school] is a public service corporation." To the great detriment of the citizens of the United States, and the great financial reward of specialist physicians, Flexner’s warning has gone unheeded. The commercial point of view is now dominant in conventional American medicine. In the USA, Hippocrates has been trumped. "Modern" medicine holds that harming patients is simply inevitable. As one academic physician has put it, "If there are no adverse side effects, there will be no effects." The current price of medical progress is that physicians must be permitted to do some harm to their patients. A "Commentary" published in the June 2000 issue of the Journal of the American Medical Association by Barbara Starfield, MD, who is on the faculty of the Johns Hopkins School of Public Health, documents just how much harm is being done. Each year, 225,000 deaths are being caused, directly or indirectly, by physician error, making this the third leading cause of death for the population. Of course, this is never reported in the federal accounting of leading causes. On average, six hundred and sixteen persons die daily because their physicians were not concentrating sufficiently on the matters at hand. How many people would ever purchase an airline ticket if, every day of every year, two airliners each carrying three hundred passengers crashed with no survivors? Total US national expenditures for medical care for 2001 equaled $1.3 billion. The current annual rate of increase in these expenditures is eight percent. The per capita expenditure number is now $4643 per year, representing forty-three percent of the income of someone working full time at the federal minimum wage. If the minimum wage keeps pace with general inflation and medical expenditures grow at eight percent per year, by 2018 the entire annual income of a minimum-wage worker would equal the per capita cost of medical care. By 2039, per capita expenditures will reach $80,000 per year--four times the income of a full-time employee earning the minimum wage for that year. If not already declared by that point, national bankruptcy will not then be avoidable. It is important to recognize that this is expenditure inflation and not cost inflation. The physician oversupply, coupled with a perverse supply-demand relationship, constitute the key factors driving expenditures off the chart, while the costs of established medical services have tended to inflate with the general economy. Pundits, planners, and experts all regularly miss this fundamental distinction. Conventional medicine currently lacks a conceptual framework that could enable it to recognize these absurdities, much less to integrate ideas for transformation and amelioration into conventional medical theory and practice. Therefore, innocent people will continue to be victimized by "the best medical care in the world." There is plenty of "sickness" in the American medical care system, but I believe that "absurd" is the most apt word to adequately describe the current situation. Competing interests:   None declared