Biblical Reflections on Modern Medicine
Vol. 10, No. 3 (57)
Contents:
There is a downside to the huge welfare state that
neither I nor anyone else (that I know of) has written about: the
survival of the less fit in an unbiblical society. By contrast,
those who are Biblically obedient in a just society would be the
greater survivors. Actually, by "surviving" I mean that they would
have better health and live longer. However, "survival of the
fittest" should tweak some interest and maybe even some outrage.
A Biblical lifestyle or more accurately, being
Biblically obedient, is the most healthy choices that a person can
make. The one exception is becoming a missionary in third-world
countries (and today, even that risk has been reduced considerably).
First, a Biblical lifestyle must be healthy because God commands
only what is good for us--nay, He commands the best for us.
Secondarily, "scientific" studies show that
Christians are more healthy than those who are not. There is less
drug use, lower blood pressure, less heart disease and cancer, and
greater longevity, to name only a few. Certainly, we ought to be
Biblically obedient regardless of the consequences, but it is
comforting to know that right choices are also healthy choices.
Jesus said, "The poor will always be with you." The
New Deal, The Great Society, and other such state- (i.e., taxpayer-)
subsidized programs have believed that "The poor* will not always be
with us." That is, these programs can educate, improve housing,
provide medical care, etc. to the extent that the poor will no
longer be poor. Everyone can share in the American dream.
That goal has not been achieved. For more than 30
years, huge sums of money have been spent to prove that Jesus was
wrong--He was not. The same percentage of "poor" are still with us
as there was at the beginning of this transfer of more wealth than
exists in the current Fortune 500 companies.
But, the poor are with us in greater numbers than
they would otherwise be. Mandatory immunizations, public schooling,
Medicaid, specialty medical clinics and programs (sexually
transmitted diseases, AIDS, drug "rehabilitation, etc.), and the
Veterans Administration** have increased their health and survival.
Without this public assistance, they live longer, are able to have
more children, and spread more of their diseases. In a real sense,
then, the poor have increased.
If everyone were allowed to suffer the consequences
of their choices, many of the poor would no longer be with us. Drug
addicts and alcoholics would die sooner. People with AIDS would die
sooner and have less opportunity to spread diseases. Children
without immunizations would die of more childhood diseases. Etc.
Some readers may be boiling by this point. Others
may be confused. What about Christian charity to reach out and
help these "poor"? Gotcha!
There is a worldview of difference between
government programs and Christian charity. What Mother Theresa did
and her nuns continue to do is Christian charity. What governments
in the United States do is forced taxation and redistribution
masquerading as "charity." It is tyranny.
Worse, the best choices are not even made to help
this segment of society. What is free is never as valued as what is
earned. Few of these programs requires that people extend themselves
and become better in some way to earn benefits.
So, our society continues to be dragged down by the
survival, even the promotion, of degrading and disease-causing
lifestyles. In a just society, the fit (Biblically obedient) would
be the greater survivors. The lawless would be punished and the
immoral allowed to face the consequences of their actions. True
Christian charity would proliferate, offering better and more
healthy choices to the "poor."
The problem is that the concept of the "poor" is
primarily moral and spiritual, not physical. While some people
temporarily find themselves poor for bad investment decisions, job
loss, etc., these are not the chronically poor. And, there are some
poor with Biblical values or moral character: mothers (mostly) and
fathers who work long hours at low pay to provide so that their
children will no longer be poor!
But, the majority of the poor will always be what
they are. Without conversion of their hearts or a moral willingness
to forego immediate gratification, they will be the poor always
among us.
A consequence of a just society is the survival of
the fittest. By this (super)natural outworking of Biblical
obedience, their example shines more clearly (on a hill), a beacon
to the "poor."
The "poor" are not only those with little or no
money, poor housing, and clothing. Many monetarily rich people are
poor, especially in modern America. They live immorally, yet have
"money." They are able to avoid some of the consequences that the
monetarily poor cannot. Interestingly, however, the morally poor
often end up monetarily poor: the just consequences of their
choices! (See Proverbs 5:10, 6:26 and others.)
A country ought to provide whatever is needed for
its injured and diseased veterans of war. However, the current VA
system virtually admits anyone who served in the armed forces
whether they saw action or not. Also, "service-connected" injuries
and diseases form the minority of what the VA treats. A great deal
of their budget goes to the treatment of immoral lifestyle choices,
especially tobacco and alcohol abuse.
Response and Balance
from Dr. Terrell
Since I was entering new and perilous waters, I
asked Dr. Terrell to review my article. His response balances and
expands my voyage. He writes:"
1) Biblical poverty seems to me to be, in a physical
sense, is a lack of material necessities of life such that one
either lives without or lives from hand to mouth. There is no
reserve for exigencies. I do not see much true poverty in the United
States in the sense of doing without, and I work in a position where
I would tend to see it. I rarely ever see a truly undernourished
child. I do see living from hand to mouth, and that seems to be
increasing. Poor people once lived from paycheck to paycheck.
Then, they lived from paying the credit card minimum
to paying the credit card minimum. Now, they live from advanced
check cashing to advanced check cashing, so that they can pay their
credit cards (if they have any left) or buy daily necessities.
Annualized interest rates on these check cashing operations run well
upwards of 40 percent. Where there are two parents in the household,
they are often maxed out on jobs, so there is no reserve there.
Welfare, too, seems to be at a maximum for the unemployed single
heads of household. We are ripe for this over-stretched system to
come down, and it will require only an economic hiccup to cause it.
2) The popular definition of poverty today, one
which does not match with Jesus' definition, is that group which has
less than other groups. That definition is merely one of envy. He
was speaking of those who truly had a deficit of a daily need. We
have the Biblical image of the poor man leaving his cloak in hock
for the day. The "poor" in the U.S. enjoy material assets beyond the
dream of even of the rich a couple of centuries ago or in some other
nations today.
3) We have to look either to other nations today or
to the generations on either side of ours to see larger-scale
Biblical poverty. As a nation, the U.S. has first out-produced
(first three-fourths of the 20th century) and now out-maneuvers much
of the rest of the world, such that the poor "neighborhoods" tend to
be whole nations, archipelagoes, or even continents. There is not
much real poverty down the street, so we have to look to Asia and
Africa. When the economic "snap" comes here, it will be next door,
and our whole definition will change, along with our methodology for
dealing with it. I look for the changes to be both painful and
salutary. Through debt-based currency, backed up by aggressive
military and trade policies, the U.S. has helped to create poverty
elsewhere both geographically and generationally. Our debt and
tyrannical practices have guaranteed poverty for large segments of
our children's and grandchildren's generations. We have sold them
into slavery.
4) Therefore, the "poor ... with you always" are
with us, but generally speaking, less often next door than on the
next continent.
5) A modern definition of poverty might need to
include some features which were not appropriate a century ago. Does
one "need" electricity, running water, or a car? If one lives on the
17th floor of a low-income apartment building in a large city, yes.
No electricity means no elevators, no light, perhaps no heat. You
cannot drink the roof water run-off or dig a well or a privy. You
might not survive a trip to the market without some kind of vehicle.
Even with such an expanded definition of poverty,
there is not nearly as much of it in the U.S., as there was only a
generation and a half ago. There may not be proportionately as much
physical poverty in the world as a whole. I have been reading H.
Bruce Lincoln's histories of the U.S.S.R. and have been appalled at
the physical living conditions normal in that empire a century ago.
China has had a similar change.
However, even if the accounting this year showed
considerable progress in material terms, it is easy to see that it
has been accomplished largely through theft from future generations,
including even the theft of their very life (in particular, China
which forces abortion and sterilization), and the theft of Revealed
Truth. As such, the prosperity cannot be maintained since the Gospel
is the only basis for a sustainable and just material sufficiency.
6) Jesus assured us that there would always be poor
with us. He did not say that they would always exist in even roughly
similar numbers of proportions. Are not the poor a reminder of our
dependence upon God and His requirement of a like administration of
mercy? We have put material poverty into retreat in the U.S., but
have forgotten the original more nearly God-honoring means by which
the job is to be done. Our forgetfulness is fertilizing an
incremental repeat harvest of material poverty.
7) We have been applying a complete, balanced
fertilizer for the coming bumper crop of material poverty. We have
an ungodly monetary and credit system, an aggressive and arrogant
military, alliances with the ungodly, widespread ungodly business
practices, denigration of the family unit (especially fathers),
wholesale sexual immorality, gross and rapidly rising ignorance (the
Geraldo "talk" shows alone are terrifying in their implications),
and a misbegotten belief that material providence is possible
irrespective of obedience to God.
8) The sheer size of our economic units has
approached Tower of Babel heights. We have trans-national military
and business empires. A farmer in Indiana, however industrious and
prudent, can be "done in" by a coterie of international financiers
and politicians, who use a soybean farmer in Argentina to "do him
in," only to return the favor on the Argentinean in a few years. We
need, and shall have, smaller economic units. It will mean having
the truly poor nearer to us geographically. Our present-day units
cannot get very much smaller before there are any considerable
losses in the "economies of scale."
9) The one-to-one personal relationship of primary
care medicine made it, for years, peculiarly refractory to "factory
farming" methodology. Now that we have it in the form of heavy
regulation, "managed care organizations," and governmental medicine,
we are feeling what the farmers and factory workers have felt for
decades. The quality of the care delivered has, in the process,
become impoverished at the same time that the degree of material
provision for medicine has increased.
The persons in the patients have been lost. Many
physicians (by their actions) believe that getting the right
diagnosis and prescription constitutes practically the whole of
their job. "Hand-holding," lamenting, teaching, listening, and other
features are given only lip-service, if not actually derided. When
there are few ACE-inhibitors to dispense or few operating rooms for
valve-replacements, will any physicians know how to behave? The best
economy of scale for medicine is one-to-one.
In summary, we have moved from a (relative)
spiritual richness and material limitation to material abundance
with spiritual poverty. Without the reminder of as many poor nearby,
we have lost our reminder. We are going to move back toward a
spiritual appreciation under discipline of material want."
Hilton P. Terrell, Ph.D., M.D.
A Million Termites Eat the Heart Out of the Tree of Medicine
Medicine is increasingly taken up with efforts
completely out of view of the patients we are supposed to serve.
Regulatory agencies of the government and insurance considerations
consume immense resources. Since it is a "zero-sum game," whatever
time and money is spent on satisfying these monsters is not
available to spend on patients. A partial list of things out of view
of my patients includes the following.
1) Thirteen pounds of mail arrived in an eight month
interval, sent by government and private insurance, telling me of
various rules: how to code bills, what drugs have been removed from
their approved lists, how to get "authorization" for various
procedures, a form to satisfy the Hyde amendment for government
payment for an abortion, immunization schedules, and so on. It
amounts to thousands of pages. I can do no more than scan it, hope
that my decision that it does not apply to me is correct (it usually
does not), and trash it. The penalty to me as physician for not
complying can run as high as ruinous fines, destruction of
reputation, and prison time. Every moment spent with this trash heap
is deducted from patient care. Every moment not spent is risk to me.
2) So far this week, three faxes from the "fitness
center" of a local hospital have sought my blessing on participation
by patients of mine in their programs. Prominently displayed on the
faxed form is a notice that the American Academy of Sports Medicine
believes it appropriate that patients who resemble mine should have
a cardiac stress test prior to participation. The fitness people,
which include a physician, will not sign off on the miniscule risk.
They want me to do it. I have not seen the patients in two years.
I did not address cardiac fitness with them when I
did, since the agenda was otherwise. Why am I "in the loop"? The
real agenda here is professional self-protection, since the
incidence of acute myocardial infarction (sudden heart attack)
during a supervised exercise regimen for a 42-year-old woman with
lower body obesity is perhaps lower than the incidence of
42-year-old women who will be involved in an auto accident driving
to the physician for a cardiac stress test!
3) Ralph's son leaves me a form to "sign" for him to
get a $3000 motorized wheelchair paid for by the government. Someone
who called at his door last week told Ralph that he "qualified,"
since he had had a stroke and was weak on the left side of his body.
The fact that Ralph answered the door on his own two feet seems lost
on Ralph. He is weak since the stroke, for sure, but access to an
electric ride might accelerate deconditioning.
Furthermore, the form makes it clear that Ralph, in
fact, does not qualify. A nameless neighborhood wheelchair sales
canvasser, therefore, has elected me to be "goat" in having to
disabuse Ralph of the error. The sales-man was more convincing than
I am, and I can see the doubt in Ralph's face the next time in my
office when the matter comes up.
4) The hospital wants me to sit before a computer
terminal and be "trained" in looking up MSDS's ("material safety
data sheets"). It seems that the Joint Commission on the
Accreditation of Health Organizations will be coming soon, and
everyone is subject to being asked to demonstrate the capacity to do
this. In nearly 25 years of medicine, I have never had one of these
federally-required data sheets to be of any real help in solving a
patient's problems.
And so it goes, behind the scenes, faster and faster
with little useful output except to the job security of the
regulator. Learn the new codes to all the locked interior doors of
the hospital. The hospital is becoming as internally "locked-down,"
as the prison I once worked in. (So is mine--Ed.) Get a photo for a
new ID card for the hospital. I might be an intruder and the tag on
my pocket will prove to all that I am not.
Turn down the out-of-state pharmacy's FAX wanting to
switch Mr. Brown's blood pressure medicine. They'll just keep faxing
until you tell them "no." Read and sign the five page form of rules
about the hospital's networked computer and e-mail system. No, I
won't tap into pornography sites on the Internet. No, I won't
disparage someone's race. Yes, I know you can read everything that I
type into it. (That is why I use my own laptop for nearly
everything.) Re-do my hospital privilege form. Prove (again) that I
am immune to hepatitis B.
While there are usually logical connections to
patient welfare evident in most of these activities, there is no
sense of priority. It is not possible to cover all the bases. Some
activities with conceivable benefit when considered in isolation
will have to be omitted. Time was, when I was trusted to make
reasonable decisions about such matters.
No one is watching the whole of what I do, except
me. Now, various central authorities want to make those decisions,
and not one of them is looking at more than a small part. Physicians
and patients are on the periphery, and the center is eating up the
prerogatives of the periphery. Things which can be easily coded and
quantified have begun to rule over things which cannot.
In the midst of writing this, I was called to see a
6-year-old child in follow-up for pneumonia. She is still ill, but
improving. The true nub of the visit, however, was that the child's
first cousin died suddenly six weeks ago in her mother's arms. Even
an autopsy was not completely conclusive. It was probably Reye's
syndrome. My 6-year-old patient's illness, to a layman's eye,
includes certain features similar to those few symptoms which
preceded the sudden death. How to you enumerate for central
controllers the time and value of discussing this matter with the
parents in this context? There is no way. Yet, it was the main point
today.
The appetite of the centrists for data and control
is insatiable. It will not stop until it has brought down the very
system it was supposed to help. So be it. When that occurs,
there will be nothing left at the center and no choice but to have
the periphery resume all the control, cost, and risk. In medicine,
that is as it should be.
In the meantime, and it is a mean time indeed,
physicians, hospital, pharmacies, and other elements in the medical
"system," will continue to be creative in achieving results for
patients despite the centrists' grasping tyranny. I sense, though,
that even creative people on the periphery are becoming unable to
keep ahead of the deluge of controls. The termite colony of central
controllers has eaten so much of the invisible heart of the tree of
medicine that it is due to fall to earth soon.
Collateral Damage in
the Tobacco Wars
The spray of gunfire aimed at tobacco has hit not
only that industry but seriously wounded a bystander--TRUTH. One
does not have to be a friend of tobacco to know that in the long
term, a disrespect for truth has a wider and more powerful adverse
effect upon health even than the noxious weed. Robert Levy, a
college professor, and Rosalind Marimont, a retired National
Institute of Health (NIH) mathematician, teamed up to write about
the wounds that truth has received in the tobacco wars (Regulation,
Vol. 20, 1998, pp. 24-29). Their targets are the greatly inflated
numbers of death attributed to tobacco. The most common figure
bandied about is 400,000 deaths per year in the United States. They
maintain that this number is greatly overstated, and they make their
case well.
There are many tricks to inflate the harm done by
tobacco. Levy and Marimont cite a 1998 World Health Organization
(WHO) release which misrepresented the risk of second-hand tobacco
smoke. The difference in lung cancer between the more exposed and
the less exposed were not statistically significant.
The excess risk to lung cancer for those exposed to
second-hand tobacco smoke is less than the excess risk to lung
cancer among those who drink whole milk. Connections of this small
degree usually occur because of some noncausal connection between
the measures being compared. My hat size is related to my head
diameter, but my hats do not cause my head to be the size that it
is. There are numerous such connections which are better known as
"markers" than as "factors." A "factor" is a cause.
The authors find that the Environmental Protection
Agency (EPA) "cherry-picks" its data on second-hand tobacco smoke,
selecting studies with results preferred to their political ends and
leaving out studies with contrary findings. They find comparison
groups that are clearly not comparable, attribute deaths with
multiple contributing factors to smoking alone, and omit the
powerful effect of competing causes of death.
Since the illnesses caused by tobacco use mostly
kill toward the end of the average life expectancy, the total number
of years of potential life lost to tobacco is surprisingly small,
less than what is caused by accidents and alcohol. The actual risk
of tobacco use may not be half of what is commonly stated. The
numbers have achieved acceptance through repetition.
Since tobacco use is dangerous, why should we be
concerned? We should be concerned because the maneuvers used against
tobacco dull everyone's senses of accuracy and fairness, including
those whose business it is to know better. Demon tobacco has only
had its dangers greatly exaggerated, but the same methods can
demonize anything.
Privately owned firearms, which bought our
independence from a tyrant, are being demonized, while the criminal
demons who murder with them are often excused on "mental health"
grounds. Some "alternative medicine" practices are demonized by the
powerful mainstream of medicine, while other truly demonic medical
methods are being incorporated into "orthodox" medicine. Similar
distortions of truth are being used to demonize those who disapprove
of homosexual practice.
There are forces which would misrepresent data to
destroy home schooling. Like a synagogue of Satan, casting out those
who do not submit to its false worldview, demonic powers in our
dying culture shrewdly choose to harm some bad things while with the
same stroke, installing a worse practice by means of which the good
may be later driven out.
Russian Public Health Follows Russian Public Morals
Included in the ongoing political, social, and
economic collapse in Russia are medical disasters. Diphtheria is up
more than 50-fold in a recent 5-year period, and tuberculosis "...
is a disaster" (Family Practice News, May 1, 1999, p. 41).
The lesson from these disasters urged upon us by our own medical
establishment is that we should continue supporting our public
health services so that we can be protected against such infectious
monsters. This is the wrong lesson. The lesson is that the health of
a population cannot be separated from the belief systems of that
population. Not all beliefs are consistent with good health.
For a century or more, Russians have passed off to
their civil rulers responsibilities for many things which are
neither legitimate nor feasible for a ruler to manage. They have
insisted that the government run the economy, and they have no
adequate history or experience with the personal industry, honesty,
and frugality foundational to a free market economy. When their
centrally planned economy openly failed, they had nothing to fall
back on. In the collapse, medical care has been dragged down from
its previously low level to an abysmal state. For us, the lesson is
not so much medical, as it is moral, economic, and political.
("Moral," of course, includes economic and political--Ed.) There is
literally no way to organize public health instruments which can
insulate a people from the health of such misbeliefs.
As we in the U.S.A. transfer our liberties to a
mother-state, we should expect that state to be inept. For a medical
view of the U.S. in the future, look at Russia today. We are hard at
work nurturing a peasant mentality among the subjects of our
sovereign rulers. We look to our masters in Washington for relief
when we are ill. We zealously protect our entitlements to
drunkenness, sloth, fornication, and gossip. We refuse to see any
connection between our beliefs and our health. We, too, will reap a
whirlwind.
"Third Party" Medicine Acquires a New Meaning in New Jersey
In addition to medical insurance companies and the
medical "insurance" programs of the federal and state governments,
we have a new player on the field calling the plays in the treatment
of patients--automobile insurance carriers! In order to fight high
automobile insurance rates, New Jersey has enacted regulations which
dictate treatment protocols for vehicular accident victims (American
Medical News, May 10, 1999, pp. 1, 51).
By virtue of the wisdom that descends upon it,
perhaps from Mount Olympus, the state insurance department has
produced what are called "care paths" expected in the treatment of
six injuries stemming from car crashes. The auto insurance carriers
look at treatment plans submitted to them on individual patients and
decide whether to approve them or not. The usual assurances are
being handed out by the state that these regulations are really only
to catch all those bad guys who are abusing the system, in the fine
tradition that limited the RICO law to real racketeers.
There is an ever tightening circuit that traps
central managers of matters not amenable to central management.
Attempts at central management of intrinsically peripheral details
leads to new problems which lead to new attempts at central
management. Like health insurance companies, auto insurance
companies are caught. Insurance, of course, is not a feasible plan
to manage risks which are not objective.
Back pain or neck pain following an auto accident is
not objective. Using their ability to trump objective tests,
unscrupulous patients and their attorneys have a large diameter
pipeline sucking funds from auto insurance. These two groups often
team up with unscrupulous physicians. Singing their part is an
ignorant peasant jury, trained in school and by television to
evaluate emotionally, orchestrated by a legal profession that long
ago explicitly reject the belief that all of our human laws should
be based upon "God's law.
Medical insurance is a concept with very limited
applicability. Until we are forced by economic necessity to release
this concept, no amount of organizational writhing will correct it.
Indeed, it only worsens the situation. Preaching of the Gospel is
the means by which we peasants become able to serve more than human
and dark angelic masters. Born again into God's Kingdom, we can then
begin to apprehend God's law and desire to please Him in it. We can
begin to move from peasantry to being rulers in the spheres of
influence that are suited to our stations and callings in life. It
follows that preachers of the Gospel in New Jersey have more
potential to lower automobile insurance rates than insurance
regulators.
Medicaid Swamps in North Carolina
The Medicaid program of North Carolina is receiving
protests over its policy of refusing to pay for many emergency
hospital visits, according to the American Medical News
(March 22/29, 1999, p. 25). Trying to reduce expensive emergency
department visits, the state program first ushered nearly a half
million Medicaid "recipients" into the practices of primary care
physicians.
These physicians are the logical alternatives to the
use of emergency rooms for non-emergency problems. Later, the state
program began to review the records for visits billed as
emergencies, applying a standard of the so-called "prudent
layperson." If an imaginary "prudent layperson" would have thought
that a problem was an emergency, Medicaid will pay the bill. If not,
it won't.
In the cool light of day, during regular hours,
without much threat of medical malpractice, without having actually
to see a patient, after the fact, perhaps munching crackers and tea,
a centrally situated Medicaid expert second-guesses the patient and
the physician on the scene. One Medicaid reviewer weights the
precise wording chosen by the emergency physician. What happened
matters not at all, only what was written.
The physician seeing the patient cannot be trusted
to bill correctly, since he has an obvious financial incentive to
skew his decision. (We are to believe that the central reviewing
physician has no financial incentive to deny payment?) Medical
training may need to add rotations in creative or technical writing,
to displace training in mere diagnostics. When a reviewer finds that
it was not an emergency, he has in effect determined that the
patient was not prudent. The treating physician is likewise
determined to be less than objective by the mere fact that his work
is being (de)valued by the reviewer.
The reviewer who denied every Medicaid visit would
be correct on a sheer probability basis, since the majority of
visits to emergency visits are not for emergencies by any reasonable
standard. (Relax and enjoy! I will be your "prudent layperson" guide
for the rest of the tour.)
The treating physician at least knows that he has
been devalued in this system. Note, though, the way the system
conceals the criticism from the person who needs to know it
most--the patient. The patient is treated like a cipher, a null,
another cow in the herd. Those whom Medicaid employs to "help" him
with his medical needs are canceling him as a responsible person.
Those emergency physicians who would be in a
position to admonish him are quite thoroughly muzzled by the threat
of malpractice. Our nation, having been convinced of the
infallibility of modern medicine, treats any medical error with
harshness. A physician who attends 6000 patients visits a year need
make only one error in 25,000 encounters to have this harshness
visited upon him 7 times in a 30-year career. Thus, we see the
exquisite functioning of Centrally Regulated Medicine: an imprudent
patient expects infallibility when he is seen for a non-emergency by
a fallible and cowed physician. The cowed physician investigates the
patient's complaint at inordinate length out of fear of malpractice,
producing a large bill in the process. A physician distant in time,
space, and responsibility determines that the visit was imprudent.
He refuses payment to the cowed physician.
The large bills of other patients are doubled and
tripled to cover the costs of the unpaid ones. These immense bills
convince nearly everyone that medical insurance is essential. Few
realize that the existence of the insurance is a large part of the
problem. Because bills are large, the insurance is expensive and
some cannot afford it. Those who cannot are herded into Medicaid.
Neither can Medicaid handle all the bills, so it tries central
regulatory review and control of issues that are intractably
variable, and the circle is closed.
The idea that having a primary care physician
assigned is going to fix the problem is flawed. The suggestion is
made that the emergency physician telephone the primary care
physician when an imprudent visit is being attempted, so as to shift
the visit to a less expensive venue with the primary care physician.
The primary care physician is now being asked to help make the
prudent-imprudent decision, while not at the scene, with the added
fillip that he will have liability, unlike the central regulator
physician.
Further, he will have the increased costs associated
with providing care outside of the usual time, place, and scheduling
considerations. These differences serve to make his care like that
of the emergency physician in cost, achieving little. Medicaid
patients seek non-urgent medical care in emergency departments for a
variety of reasons, not all related to imprudence.
Some lack transportation. Dependent upon family
members who work last-hired, first-fired jobs and cannot get off
when the primary physicians' offices are open, they come in when
their aunt gets off her shift at 11:00 P.M.
This newsletter will offer a prize for the first
person who can discover a safe, painless escape from the swamps of
our medical "system." You can win one all-expenses-paid trip to the
emergency department of your choice with the complaint of your
choice.*
*Provided that the newsletter's physician reviewer
determines that your visit was a prudent one, based solely upon what
was written by the emergency physician, and only after he finishes
his tea and crumpets. The Guide to Uniform Lazy Lay Person's
Bureaucratic Larceny, Edition 2 (GULLIBLE2), will be used to
determine prudence. Payment will conform to the Newsletter standard
fee scale. Proper coding and electronic submission of claim
required. Offer void where prohibited.
Dr. Terrell's Treatises ends here.
Vol. 13, No. 3 (82) May 1999
The Numbers
Through December 1998, 688,200 cases of AIDS had
been reported to the Centers for Disease Control and Prevention
(CDCP, formerly CDC). Of these, 679,739 were in adults (over 13
years of age) and 8,461 in children (under 13). Of these, 405,816
adults (59.7 percent) and 4,724 (58.9 percent) children have died.
For the 12 months ending with December 1998, there
were a total of 47,887 cases of AIDS in adults and 382 cases in
children. The numbers for the year ending December 1997 were 60,161
adults and 473 children.
Also, for adults in the 12 months ending with
December 1998, 35 percent of AIDS cases occurred in "men who have
sex with men" (MSM), 23 percent in "injecting drug use" (IDU), 4
percent in MSM and IDU, 0.34 percent in hemophiliacs, 14 percent by
"heterosexual contact," 0.61 by blood products or tissue, and 23
percent with "other/risk not reported or identified." (Except for
MSM and MSM/IDU, these percentages include women.)
Commentary: These numbers are taken from the
"Year-end Edition" of the HIV/AIDS Surveillance Report for
1998.* It is a 44-page booklet with 30 Tables, 11 Figures, and pages
of footnotes and explanations of presented data. So, I have
presented a miniscule portion of the data therein.
Mostly, the current data are only confirmation of
previous information that I have presented. The total numbers
continue to decline. Homosexuals ("MSM") still account for the
largest number of cases. (Remember that "heterosexual" comprises
high risk exposure to HIV/AIDS: "sex with injecting drug user," "...
bisexual male," "... person with hemophilia," "... transfusion
recipient with HIV infection," and "... HIV-infected person, risk
not specified." These are not your everyday fornications and
adulteries! They have their own risks of sexually transmitted
diseases, but rarely HIV/AIDS.)
"'Other/risk not reported or identified' cases
include persons who are currently under investigation by local
health department officials; persons whose exposure history is
incomplete because they died, declined to be interviewed, or were
lost to follow-up; and persons who were interviewed or for whom
other follow-up information was available and no exposure mode was
identified. Persons who have an exposure mode identified at the time
of follow-up are re-classified into the appropriate exposure
category."
The death rate for AIDS patients has indeed
fallen. The total number of deaths were 36,194 in 1996 and
19,996 in 1997. (The numbers for 1998 are not available.) Deaths are
placed within the year that they occurred, so the numbers for each
year listed will continue to grow. Thus, the exact decline is cannot
be measured, but the evidence of a significant decline is there. The
significance is such that the total percentage of deaths has
decreased from 61.0 percent in 1997 to 59.7 percent (above). The
number itself seems small, but it is a cumulative number for the
entire period of reporting (18 years).
Thus, the new treatments for AIDS are prolonging
life in AIDS patients, but there are many unanswered questions. Will
the dramatic effect of these new agents last? Will more virulent and
resistant strains emerge? Will the survival of more patients with
AIDS and a slowed progression of HIV-infected patients (who have not
reached the AIDS stage) result in an increased incidence of HIV/AIDS
cases? The drama of the HIV/AIDS epidemic continues!
* A single copy may be obtained by writing the CDC
National Clearing House, P. O. Box 6003, Rockville, MD 20849-6003 or
viewed/downloaded at <www.cdc.gov>,
selecting "Publications, Software, and Products."
AIDS in the "Golden Years"
Generally, AIDS is thought of a young person's
disease. "Prevention" and diagnosis has been aimed at this younger
population. However, about 10 percent (69,257, as of June 30, 1998)
of AIDS patients were over 50 years of age (American Medical News,
May 10, 1999, pp. 29-30). While three-fourths were likely infected
prior to age 50, physicians must keep this diagnosis in mind for
this population of patients.
Some "experts" worry that there might be an
increasing incidence in this population. In women, vaginal tissues
become thinner and more easily damaged, even during "routine"
heterosexual intercourse. Bleeding during menopause could be a risk
for the male partner, as well. Then, there is the possible increase
in sexual activity due to ViagraTM. Also, the general
health and body's defense mechanisms decline with age.
So far, the percentage of AIDS patients in this
population has remained relatively constant. I think that it will
remain so. While this population is sexually active, it is not
as promiscuous as younger populations. Further, many of the more
promiscuous people, especially homosexuals, do not live into this
age group. So, the exposure remains relatively low. Nevertheless,
HIV/AIDS must be a possible diagnosis at any age. The elderly
are certainly not immune (literally and figuratively).
Recently, I wrote about the possibility that both
prescription and over-the-counter (OTC) medications are at risk due
to the Year 2000 Computer (Y2K) problem. You can stock up on OTC
drugs on your own. Have you?
Also, realize that many OTC medications are the
same as those by prescription, only the dosage is smaller. So,
even though you are on prescription medication, you may be able to
obtain the same drugs OTC.
After I wrote on Y2K, one reader wrote me that he
could not get his physician to write for larger supplies. I also
heard that some pharmacies will not fill larger orders. What to do?
Michael Hyatt, one of the most informed and
practical experts on Y2K and survival, has recommended a source of
obtaining medications from overseas. These are supposed to be the
same medications (both brand name and generic) that Americans take
on a regular basis. You don't need a prescription, and you can have
your medication within two weeks. And, there is usually considerable
savings over typical drugstore prices.
I do not have time to investigate this source.
Neither do I have time not to tell you about it. Y2K is close!
Investigate and buy at your own risk! This "Y2K Prescription
Survival Guide" sells for $159.00.
But, consider this! Some medications are truly
life-saving, in spite of all that I have said on these pages.
Is yours? If so, you must get a supply of your medications
before Y2K. What if Y2K fizzles? You would have had to buy this
medication anyway, so you have lost nothing except perhaps a little
time.
Website: <www.y2kmedicines.com/order.htm>
Phone: 1 (800) 350-0676
Mailing address: Prescription Medicine Information Bureau,
L.L.C.,
1874 S. Pacific Hwy., Suite 729,
Redondo Beach, CA 90277.
Michael Hyatt Website:
<www.mhyatt@michaelhyatt.com>
"The purpose of this note is to thank you
for your book (Biblical Healing for Modern Medicine), and
to tell you I read it over and over, and found it most
helpful. Although it may have been (written) for young med
students, you gave me your answers borne out by the Scriptures
to many questions I have never had answered.
"So, I continue to use it for references. I want
to thank you for helping me with these sticky questions. They
came at a very appropriate time and give me the words I need.
Thank you so much. With love and appreciation, Bet" (Emphases
hers, dated March 30, 1999.)
I almost cried when I received this note. It was
totally unexpected. On my mother's side, there were 7 children, and
on my father's side, 4. Thus, I had at one time 22 aunts and uncles.
Aunt Bet is the last. She is not in good health and probably will
not live much longer.
I was in North Carolina a year ago for a conference
and went by to see Aunt Bet. Actually, I left the book for her
daughter, who is married to a minister, but I suppose Aunt Bet
latched on to it and never let go!
I cannot momentarily recall any compliment that has
meant more. I would have written the book for this response alone!
I share this note with readers, because many of you
are truly dear to me, and I want you to know something of my
struggles and joys. God may sometimes touch us in our deepest
being. He did that with this note from Aunt Bet.
"More than 45 percent of charges billed by hospitals
in Georgia are never paid," says Joseph A. Parker, President of
Georgia Hospital Association. Almost half of this short-fall has
occurred since 1990. The uninsured and Medicaid patients account for
one-third of all Georgians. Reimbursements from both Medicare and
Medicaid to hospitals have contributed considerably to this
short-fall.
Grady Health System, which has for decades provided
the primary medical system for Atlanta's inner-city residents, will
now charge patients $5 each time they visit a clinic and a minimum
of $10 for each prescription filled at a Grady pharmacy. Patients
will also have to provide their own travel and will no longer have
the Grady shuttle. (Healthcare Business News - Ga. Edition,
March '99, p. 5)
Commentary: In the November 1998 Reflections,
I discussed how hospitals were being squeezed by the current
financing structure of health (medical) care. These numbers show how
severe this problem is. As I said then, there are major competing
forces that cannot be reconciled. Patients want everything for
little or no cost. Health-care organizations (e.g., HMOs) promise to
deliver this "everything," but must also show a profit at their
bottom line. State and federal governments with their liberal
attitudes want to provide "everything" for the "poor" and uninsured,
but are already exceeding their budgets.
The medical marketplace is in a meltdown!
Hospitals will close (some already have). Legislators and liberals
are screaming about cuts to the poor and uninsured, such as those
announced by Grady. Physicians are prescribing expensive treatments
that have little or no proven benefit. Managed-care companies are
pressured to provide more and more for less and less. Everyone
involved is trying to grab as large a piece of the pie as they can.
At first glance, such a meltdown might appear
frightening: an image of millions of patients going untreated and
dying right and left. Not at all! As I have discussed so often,
modern medicine is more a detriment to good health and medical care
than a benefit.
For the most part, emergency services will still be
available, and that is what is most needed today. There will be a
few patients who will fall through the cracks and suffer, but most
will just avoid treatment that will not change their medical
condition significantly.
If eventually more Biblical principles could be
applied to the medical payment system, as well as other areas of
society and government, then this meltdown could have a very
positive outcome. The meltdown is here, but those Biblical
principles are not on the horizon of acceptance. Pray that they will
appear.
|
