Click on the title:
"Informed" When Alternatives are not Discussed? 2010
A viable model for U.S. Healthcare Reform? 2009
AN ANCIENT GREEK SHORT STORY
Myths, Magic and Medicine
April 4, 2011
A Creative Writing Assignment illustrating
Hipocraates Death Mask
from Healthcare in Antiquity
“Grandmother!” the children shouted.
“Please tell us a story about when you visited the land of the men who wear dresses.”
It's recess and it's raining. Since they cannot go outside, I expect this familiar request. They just cannot hear enough about my “trip” to Cos.
So I start speaking to a room full of wide, curious eyes ….
“Gather in a circle, children, and listen carefully.”
I do not tell them how I was captured and enslaved. I leave out details of the hardships I endured while transported to Cos. I will save that until they are older. I will also save how women, instead of being wise leaders and priestesses as in our society, are treated as chattel and kept sequestered in Cos society. Yes, and there is much more of my story that I must save for much later. If I can bring myself to tell it.
I start the story in a familiar way before telling of new things.
“Each man of Cos wears a dress.
Why, I do not know.
I leave it to you all to guess.”
This always brings giggles.
“But for some men
their legs just should not show.
Fortunately, the wiser the man,
the longer his dress.”
More giggles. I continue:
“The women of Cos also wear dresses.
They, however, as all can tell
Are beautiful with their golden tresses,
But, smaller than we … and weaker as well.
They do not train with weapons.
They are innocent and ignorant as can be.
They concern themselves with their possessions
and minding and feeding their beauty.
Wisdom has no value for a woman in Cos
To each man's loss.
There is a sad waste of womanhood going on in Cos.”
“Sad, sad,” say the children on cue.
Then they remain quiet, as they always do, until I signal the story's end.
The opening ritual now over, I begin the tale …
I was lost for some years and did not know my way home. For a time I lived in the land of Cos. The people of Cos are known as Greeks. I led them to believe I was mute. Through time I learned their language, but kept this a secret. I knew any accent would give me away. If they knew my origin I would stand a chance of being killed. We are considered their enemy. Skilled women are sometimes seen as a threat outside our land.
The home in which I lived was owned by an older widow, Janus. She had little knowledge but much wisdom, which she wisely hid when strangers were about. Still, I did not trust my origin with her. I kept my eyes lowered and quietly helped about in the house. I watched and I learned.
After I had lived there for several months, the son of Janus was sent home from the front. He was a warrior and his dress served him well as he was a handsome figure. He had been wounded in his left leg and treated on the battle field. Not well treated, however. It was discussed as to how rough and hasty a battlefield dressing could be. Even though the Greeks have some knowledge of healing, as we know, sometimes things go wrong.
Janus sent for a healer. I was excited to once again be in the company of a healer. I wanted just to be near another who was like me, and watch … and, perhaps, learn.
I did not tend to the boy, it would give me away. But, I would have done so had there been no access to another healer. I went outside to prevent the temptation to take charge of his care.
I was tending the herb garden when a figure appeared in the distance. We seldom receive visitors so I knew this must be the healer. I watched the figure silhouetted against the dusk and felt a strong affinity toward it. The dress did not have a feminine shape or attitude. It was tall, straight and walked with a strong confidence. Although this is the common attitude for our women, it is not the attitude of a woman of Cos.
I realized, to my surprise, that it was a man. This was my first experience with Greek healers. I don't know why I was surprised, in Cos men control everything. I learned that Greek men healers are called physicians. Men healers of other lands have the reputation for being rough, arrogant and indifferent to the comfort of their patients. I worried for Janus' boy.
I only saw his back as he checked the boy. Janus had specifically requested a healer from a tradition called Hippocratic. “They are different,” she had said, and she was right. He was gentle and thorough in his inspection of the wound. He saw to it that the boy was kept warm and given water. He wisely ordered a soup to help the strength return to the boy's body. And, he commented on the smell coming from the wound, thus showing a degree of experience with the seriousness of rotting flesh.
I was happy to hear that he ordered a maid to acquire fresh rosemary, oregano and garlic from the garden. It was apparent that this physician knew the plants needed to treat the pus-making, blackened flesh. I kept my eyes down and my mouth shut. He did not notice me as he cut away some of the dead flesh and cleaned the wound with fresh water from the spring. He did everything as I would have, including stepping aside at the correct time to let nature work its miracle.
He explained to Janus that the Hippocratic physician practices by using passive treatments, trusting the body to use its own natural healing qualities. He justly decided that the best for the boy now would be to let him rest and we should wait to see what the body could do to repair itself. Apparently, as he explained it to Janus, it would be the practice of other physicians, not trained in the Hippocratic tradition, to simply chop the leg off without giving it the chance to right itself. She replied that the military doctors wanted to do so but her son forbade it. He does not choose to live the rest of his life with one leg.
After all was accomplished that could be for the time being, the physician requested that someone stay by the boy's side during the night to keep watch. I raised my hand to volunteer. Before he left to be shown to his room, the physician turned to me to give me directions but, instead he stared. I kept my head down and tried to pull in my essence, but he must have sensed it anyway for he walked up to me. His fingers went under my chin lifting my eyes to meet his. Then his eyes looked deeply into mine. He said, “I am Philinus of Cos, what is your name?”
A woman of Cos would have blushed and looked away at being so directly addressed by a man. I did not. Our eyes were locked. Equal to equal.
Janus, being obviously discomforted by our exchange, blurted out, “She has never spoken. We call her `the goddess'.” Then even more distressed she rushed to explain, “it is from fun we call her such - because of her way, her stance, her walk… well she is unlike ordinary women. She takes charge and handles well all that she does. Like a goddess would. It is just in jest we silly women call her so ….”
Philinus replied, “Your choice would appear to be apt, madam,” then he turned and walked to his room without giving me any instruction whatsoever. Truly, I am left shaken without knowing why.
Through the night the boy's heat worsens. The herbs, it appears, may be too little, too late for the advanced purification of the leg. The mother keeps returning. She knows it is not going well. My heart goes out to her in her distress. She brings the physician back to the room.
“Madam,” says Philinus, “it appears your son has reached what Hippocrates would call a crisis. The choices are few as the boy's body will decide if it is to live or die. I have done all that can be done, save take his leg.” The mother crumbled to the floor sobbing. Said she, “his desire to keep his leg must be respected even though he surely will die.”
“Yes, that may be so.” says Philinus, “His face does have the look of what is referred to as the Hippocratic death face." Hippocrates, as I learned later, documented such as face as being one with a sharp nose, sunken eyes, a pale, dusky, dry pallor, temples sunken in and ears cold and drawn with lobes distorted. When seeing this face one knows that if no improvement is seen soon, death is imminent.
I cannot bear it any longer I step up and quietly say, “He does have one more chance.” To my surprise I speak in perfect Greek without an accent. They look to me as if it were normal for me to speak and in fact, were expecting me to do so. Then they simply wait for my direction as there will be no other help coming. Saying nothing more, I walk to Philinus and unhook the silver broach holding his cloak. When the cloak falls to the floor I glance at his legs and note that the dress suits this man well.
They watch as if in a spell while I put the broach in the herb mortar and crush the silver like the herbs that were crushed before it. When the consistency is right, a fine dust is all that remains of the broach. I sprinkle the dust in the boy's festering wound and then wrap it back up for protection. “Now we wait,” said I.
With the crow of the cock our wait paid off. Color and shape had returned to the boy's face. When unwrapped, the leg no longer smelled of rotting flesh and pink appeared where black had been. “The boy has survived the crisis,” said Philinus, “thanks to your goddess.” He turned to me and asked, “Where are you from? Where did you learn the healing power of metal.”
“I am from the ones you call `the Silver Makers,' where women are healers, warriors and priestesses, who Greeks call the enemy,” answered I, “and the herbs you provided probably did half the job, the silver simply completed it.” I turned to Janus and said, “Madam, in exchange for what little help I may have been to your son, I ask that you do not turn me over to the authorities.”
“Never will I,” said she, “but we must see you safely home, you are in danger here.”
I signaled the children and on cue they chant in unison:
Priestess Zare was given aid to end her Cos stay
By the physician Philinus who led the way
And who has stayed with us to this day.
I look over to the side of the room and return the knowing smile I find on the face of the gentle Hippocratic physician, Philinus of Cos, who has now made his home with me in the land of the Silver Makers.
Can the Medical Directive Of Informed Consent be Considered
“Informed” When Alternative Therapies Are Not Discussed?
April 19, 2010
“I will apply dietetic measures for the benefit of the sick according to my ability and judgment…
I will neither give a deadly drug to anybody if asked for it,
nor will I make a suggestion to this effect”
From: The Hippocratic Oath1
The course catalog for the Harvard Medical School (HMS) does not list one course on nutrition as being required for completion.2 There are only four courses listed under the heading “HMS Elective Courses: Nutrition” with three of these entitled, “Nutrition and Rural Medicine in Latin America,” while the other is entitled Pediatric Nutrition,” which is described as covering nutritional needs of hospitalized patients and general pediatric nutrition.3
Harvard Medical School is arguably the most prestigious medical school in the United States and sets the standard for other medical schools, yet nutritional training is not required of those who would be physicians. It logically follows that is unlikely that there will be training in nutritional supplementation or other drugless and alternative therapies in medical schools. Without this training can a physician consider himself to be informed about all available treatments for medical conditions? This and more questions beg to be answered:
1. Are nutritional supplements and other alternatives to medical protocols popular and effective enough to be included when advising a patient of his treatment options?
2. Does the medical community's mistrust of nutritional supplements and alternative therapies ethically excuse the physician from offering nutritional alternatives for informed consent?
3. Given a physician's lack of training in alternative therapies and disregard for their therapeutic value can ignoring alternative options be considered morally acceptable?
It is common knowledge that the vast majority of those in the medical community disregard alternative practices and products and are taught that they are not a viable alternative to medical practices and pharmaceutical drug use. This paper will explore if this attitude best serves the patient in every instance and, can the act of denying a patient all choices of treatment options result in a form of paternalism that can not only be considered immoral and unethical but can lead to needless suffering and death.
1. Are nutritional supplements and other alternatives to medical protocols popular and effective enough to be included when advising a patient of his treatment options?
As recently as the early twentieth century, people in the United States have been served by practitioners who were trained in using nutrition and nutritional supplementation as alternatives to pharmaceutical and surgical protocols. Physicians through the 1940's and 1950's used vitamins, herbs and other dietary supplements as “medicine.”4 The fact that these natural remedies helped people get better was not questioned. Until recently. The United States Food and Drug Administration (FDA) now forbids claims that natural remedies and supplements have any health benefits even though many of theses natural remedies and supplements are listed as effective medicine for a physician's use in the Physicians Desk Reference (PDR) in the 1940's through much of the 1960's. This repression of free speech has not met its challenge in court thus, today, if dietary supplements, which are considered “food” by the FDA, are said to improve health in any way, that supplement is then considered a “drug” and thus must be tested for efficacy through exhaustive and expensive clinical trials like a pharmaceutical drug. This FDA dictate ignores the fact that many of the same supplements were used to treat and even to cure disease successfully by physicians for literally thousands of years and continue to be used successfully by natural practitioners today.
When modern physicians became more and more dependant on the use of pharmaceutical drugs, people who wished to avoid such medical therapies created a demand for more alternative practitioners who could address health concerns in a more natural and traditional way. For many people, “nutritionals” (nutritional supplements) are preferable to “pharmaceuticals” (legal drugs). This preference continues to be a growing trend. MarketResearch.com reports that supplement sales for 2008 were heading for “healthy growth, with sales forecast to climb 39% from 2007 to 2012 to reach $8.5 billion.” Certainly $8.5 billion is a drop in the bucket compared to pharmaceutical sales which largely depend upon tens or hundreds of millions of marketing dollars spent to influence doctors and patients toward their use. In the absence of similar marketing dollars being spent on promoting supplements , the popularity of these products depend largely upon word-of- mouth recommendations relating positive experiences and outcomes. Irregardless of the dollars spent on supplements vs drugs, a 39% growth in sales for supplements is definitely a strong trend reflecting a popular belief in the effectiveness for the use of nutritional supplements for medical treatment and disease prevention.
Beyond the fact that medical doctors have used natural remedies and nutritional supplementation as medicine for centuries, there are also recent medical doctors who seek training in nutrition and use supplements in their practices. Some of these doctors have written the books that are used as text books in courses for certification in various drugless healing modalities.
Melvyn R. Werbach, M.D. is one the most prolific authors of text books that are both “how-to” books and sourcebooks of clinical research on the efficacy of nutritional supplements. Dr. Werbach was an Assistant Clinical Professor at the School of Medicine, UCLA, in Los Angeles, California and his book, Nutritional Influences on Illness is required reading in many certification courses for those modalities of natural (drugless) healing. Werbach's book lists dozens of the most prevalent diseases or conditions along with the clinically researched natural remedy best used for its treatment. Instead of recommending a treatment for each conditionn he lists the abstracts and conclusions of studies using nutritional supplements as successful treatment for that condition. These studies have been compiled by Dr. Werbach from independent research labs, university studies and peer review magazines like The New England Journal of Medicine, Lancet, Townsend Letter for Doctors, American Journal of Nutrition, Preventative Medicine, Journal of Lipid Research, and the Journal of the American Medical Association (JAMA). Medical doctors cannot say honestly there have not been studies showing the benefits of supplementation because medical science journals have printed them for years.
Among volumes of other medical doctors whose books have been traditionally used for nutritional training are several books by Dr. Robert Atkins whose Vita Nutrient Solutions is an especially valued textbook. Currently, for people who wish to be designated as a Certified Nutritional Counselor (CNC) it is required to take an exam made up of eleven tests that cover eleven books. Of these books, most are written by medical doctors including one co-authored by the father of Orthomolecular Nutrition, Abram Hoffer, M.D.,Ph.D. The forward of Hoffer's book is written by two-time Nobel Prize winner Linus Pauling who founded Orthomolecular Behavior for the treatment of mental illness. Orthomolecular Nutrition, which evolved into the field called Clinical Nutrition today, and Orthomolecular Behavior, are based on a non-drug route to curing disease and a non-analysis treatment of mental diseases. Both orthomolecular schools advocate the use of nutritional supplements in different optimal dosage for each condition to be individualized for each person. Their philosophy of treating the body as a whole by replacing missing vital nutrients is one that has continued to be shared by those practicing in the natural holistic health field today.
The use of nutritional supplementation, diet and lifestyle changes to prevent and treat disease has become to be seen by the general public as the role of nutritionists and holistic healers. Nutritional training is dependant upon the body of work and clinical studies complied by nutritional authors who have received acceptance in scientific journals. This same training is obtained by the medical doctors who have chosen to expand their medical education to include clinical nutrition. Alternative products and practices are so commonly used today that to have their efficacy challenged at this late date seems both ludicrous and disingenuous. A large part of the population has experienced many successful health results from the use of alternative options and those who say they have not are look on with incredulity.
As valuable as the multitude of books on the use of nutritional supplements are to understanding alternative and holistic practices and products, main-stream colleges and university, in an apparent nod to the food and pharmaceutical industries and thus, the FDA, no longer allow these textbook to be used in what they now refer to as nutrition degrees. The text books about nutrition, largely written by dieticians and not nutritionists, used in accredited schools today warn against the use of supplements (beyond what a medical doctor would recommend) and promote the use ofmedical drugs, fast food, high fructose corn syrup and pharmaceutical drugs. These books on “nutrition” are not written by those experienced in the tradition of drugless and holistic nutritional practitioners but by registered dieticians who claim to be trained as “medical nutritionist.” This is a title that a few short years ago would have been a great source of amusement to nutritionists and viewed as a blatant oxymoron. Today, nutritionists are no longer laughing as this marketing spin on nutrition is becoming more accepted and politically correct, with pharmaceutical and food industry money backing the fraud.
When physicians are challenged to explain why they do not support dietary supplement usage and other alternative therapies they usually cite the fact that the FDA has not approved their use for addressing symptoms of illness or disease. The FDA does not allow such claims. This would seem to be a classic case of “Catch-22” except for the fact that medical doctors are equipped with an ability to think for themselves; the ability to question the FDA, a government entity that notoriously has not a good track record for policing either food or drugs, and the ability, if not the duty, to listen to their patients who often tell them of the good results they received from following nutritional protocols that resulted in their no longer requiring the medical treatment initially recommended by their doctor. For medical doctors to pretend to be unaware of the mountain of evidence available on the benefits of nutritional supplements is incredible.
It is understandable if a medical doctor would not want to take on the study of and an understanding of a whole new area of healing. To their credit, some have chosen to do so, but for the others to deny its existence is to deny valuable information and choice to their patients. For medical doctors who do not wish to learn natural practices and products, a referral to practitioners whose specialty is in alternative treatments would seem logical. Suggesting a second opinion is a common medical practice recommended and supported by medical ethicists. For example, there are many doctors who may not think chemotherapy an effective treatment for cancer, but that does not prevent them from recommending the choice of an oncologist to their patients. Healthcare should include many options. Choices should not be eliminated by the medical community simply because of a doctors ignorance of and prejudice against a specialty.
Other medical doctors who shirk the responsibility of reading or listening to the evidence about alternatives always fall back on FDA decisions. They use “safety” as an excuse to deny effective alternative health options to their patients. This is not a very good excuse. Especially if the recommended medical treatment is invasive, life-altering or life threatening and when less draconian, more natural measures might prevent injury or the loss of life. The patient's welfare should come first. The very fact that the FDA is dependant on the pharmaceutical industry for many of its clinical studies and trials; most of its education on drugs and their use; its very bureaucratic leadership and much of its funding, calls the impartiality of FDA decisions and competence into question. For medical doctors to base their personal and professional reputation, their livelihood and the lives of their patients on biased science and big business may do the medical community more harm than good in the long run.
Thus, creditably being the question, Big Brother steps in again. In order to settle the matter seemingly once and for all about the efficacy of the many alternative products and modalities, the National Institute of Health (NIH) has recently developed a division to study dietary supplements and natural modalities. The National Center for Complementary and Alternative Medicine (NCCAM), one of the 27 divisions of the NIH, describes its function is to conduct and support research, to train Complementary and Alternative Medicine (CAM) researchers, and provide information about CAM.
The Public Broadcasting Service's (PBS) TV show, Frontline, chose to cover the practices of this new branch of the NIH in one of its segments. Among the areas explored by this broadcast was a clinical trial measuring the efficacy of acupuncture. The show only covered those who were in the group not receiving acupuncture for their pain but who still claimed receiving great relief. Much was made of this placebo effect to the denigration of the practice being tested. In another segment an interview with an herbalist who was challenged on the benefits of Echinacea was so badly edited that it was obvious the answer she was giving was totally disjointed from the questions that was aired. The effect was to discredit her. From what was exhibited by PBS' hatchet-job of the holistic industry, it is doubtful that alternative and complementary medicine will be getting a fair shake at the NIH, or many in the media for that matter. These facts combined with the FDA's stance on dietary supplements, medical doctors can rationalize and tout a total disregard of the efficacy of alternative practices and products, but ethically the facts to the opposite cannot be denied.
Interestingly enough, this topic is not covered in the basic body of study for those who discuss and determine medical ethics in academia today, which may be the real explanation of the medical and academic communities' total disregard for non-medical alternatives to medical treatments. With a track record of hospital deaths from iatrogenic causes being the third cause of death in the United States (as reported in JAMA), to not include the option of nutrition and natural products as alternative avenues of health care is unconscionable. When one is not doing very well with his tools it makes sense to add a few new ones to the tool box.
2. Does the medical community's mistrust of nutritional supplements and alternative therapies ethically excuse the physician from offering nutritional alternatives for informed consent?
Medicine has a long history of distrust of non-medical healing therapies. In the 16th century Paracelsus, who is now known as the “Father of Modern Medicine” was vilified in his day by the medical elite for his departure from a failed medical system, his devotion to Hippocratic wisdom and his search for remedies to treat disorders and disease was considered both dangerous and heretical in his day. The science of his day was not based in chemistry and remedies but had, for over 1200 years, been based upon a Galenist belief in elements and humors.
Paracelsus, with metallurgy knowledge learned from his father, believed chemistry (alchemy) combined with healing “experience, even if it was acquired by a lowly quack or “witch,” are the essential element from which to build medicine.” It is the departure from the science and medical elites of his day and the inclusion of the alternative methods and remedies of local non-medical healers that led the way to the new thinking and research of modern medicine. The medical hierarchy of his day was threatened by Paracelsus' successes and popularity. His treatments worked better than theirs which rocked the very foundations on which they based their life and trust. Is it possible that the elites in medicine today are again considering the remedies and modalities that are outside of its “science” as both dangerous and heretical? Could they feel similarly threatened? If so, therein may lie an explanation of why physicians do not recommend the inclusion of alternative methods and practitioners. But, does this age-old aversion to non-mainstream practices justify denying patients access to its many options? Could such a practice not appear paternalistic at the least and immoral at the most?
In the early dark age of Europe the dichotomy was not between natural healers and doctors but the church against the wise woman or herbal healer (who they regularly burned at the stake as witches). Healing was seen as the exclusive domain of the church and God. In later European history the aversion of medical doctors towards healers and herbalists is often seen as science vs. nature. They are two sides of the same coin but in history, and even today, those sides are prevented from mixing by the governing healing elites. In 1542 England, Henry the VIII found it necessary to protect herbalists from doctors and surgeons by issuing an Herbalist Charter allowing herbalists to practice their trade unencumbered by medical harassment. This document is part of British and American common law to this day.
Modern alternative practitioners are trained in the use of traditional remedies mixed with modern vitamins and other man made “nutraceuticals thus, mixing nature with science. Traditional forms of healing, those practiced by herbalists and Doctors of Homeopathy, Traditional Chinese Medicine (TCM) and Ayurveda are based upon the use of the tools from nature that were derived and developed throughout the ages. The foundation of these practices go back to pre-history. The human race, arguably, would not have survived without 'practitioners' mastering the healing tools found in nature. TMC dates back over 3500 years and Ayurveda records show its use is almost as old. Remains of stone age over 5,000 years old people show successful surgeries and healing withouit evidence of trauma or infection. Most Holistic Healers use a mix of both new and traditional remedies and practices, including activating the placebo (as in energy work and Shamanism), to both treat and prevent disease.
Modern medicine, using highly developed drugs, diagnostic technology and surgery, is a product of the twentieth century with most of its momentum developed in the later half of the twentieth century - coinciding with the expansion of the pharmaceutical industry. It is understandable from an utilitarian point of view that the pharmaceutical industry would wish to destroy its competition, the dietary supplement industry, because business has its own ethic and morality not considered, by many, as its strong suit. But, medical doctors, who are viewed as having a higher standard should not buy into their tactics. Medicine risks hurting its creditability by doing so.
As large as the pharmaceutical industry is, greed knows no bounds. Dietary supplements and other natural healing products and procedures are the only competition to medical treatments which are based almost solely upon pharmaceutical products. Natural practitioners have a rather large arsenal of healing tools and the growth of their industry is a testament to their effectiveness. People rarely repeatedly use that which does not work. Family and friends do not recommend to one another that which is bogus.
Although mistrust and fear are common human reactions to a perceived threat to ones livelihood, and doctors are defensive in this area, denying the existance of alternative healing tools is not an ethical justification for depriving patients of possible alternatives or even complementary options to medical practices. Patients traditionally expect that their doctor would feel ethically bound to seek the best outcomes for their patients.
3. Given a physician's lack of training in alternative therapies and disregard for their therapeutic value can ignoring alternative options be considered morally acceptable?
If evaluating current practice, this would appear to be an accepted route for doctors to take. But, maybe that view can be changed through the study of medical humanities. Today doctors have not been charged with the obligation to share information on alternative options. When researching medical ethics, there is no mention of CAM being linked with the subject of informed consent. If ethicists in a field are not discussing a subject, that subject is likely to be overlooked by those in that field. It appears the biggest debate in medical humanities is between a patient's right to individualized medical treatment vs a standardized medical treatment program for all based upon statistical outcomes. .
Robert Veatch in his book, The Basics of Bioethics, writes that in medicine, the Hippocratic and Confucian virtues of compassion, humanness, and filial piety have “more or less disappeared …in the last decades of the twentieth century.” He thinks this is due to the practicalities of managing today's big business of medicine. Veatch describes the debate among modern medical administrators and ethicists as questioning whether medical care should be geared towards treating patients as individuals with personalized humane care or, treating them by using statistics as the guide. Standardized care depends upon statistical outcomes and standardized care is more agreeable to insurers and defendable by lawyers. This is the basis of the standardization vs individualized humane care argument in medical humanities today. “It is of real substantive importance whether a physician or nurse should give primary attention to being `caring' or `benevolent'.” If this be a true debate in the medical field, perhaps someone should tell the patients who still trust their doctors to be caring, benevolent and to have their (the patient's) best interest at heart.
As more patients are becoming aware that a caring ethic is no longer important to many doctors, the more those patients are seeking out alternative practitioners who do take Hippocratic and Confucian values to heart. It can be argued that if a medical doctor does not have the patients best interest at heart, but is a slave to statistical and procedural dictates, then it would be understandable that the doctor would not to see any value in acquiring a patient's consent. In such a case it is only the doctor's opinion and the accepted procedure that would matter. The one-size-fits-all proscribed medical treatment for each condition and disease is now being referred to in medicine as 'competent medicine.' Which seems to be another politically correct term in the tradition of Orwellian double-speak.
However, for those medical doctors with an innate sense of compassion who have chosen their field for the express purpose to “care” for the sick, this new ethic must be the cause of a great moral dilemma. If a patient is not treated as an individual whose care and needs are different from all other patients, can not the true competency of the physician be called in question ? Albert Jonsen writes on the history of the moral reflection in healthcare. His study has led him to this conclusion: “In modern medicine, competence [using its politically correct definition] has become more than the first virtue, it is the essential, the comprehensive virtue….so-called humanistic virtues are treated as ancillary to the central core of competence.” Competence is seen as treatment based upon statistical outcomes, i.e. if such and such drug or procedure works most of the time on most of the people, then it must be used all the time on all the people. Sadly, Jonsen is discussing competence as the mastery of the methods and science of medicine resulting in an adherence to what has been shown to give the best outcome over the long term. However, how competent can medicine be in the long run if all patients are treated in the same way without consideration as to their wishes or their best interest? If the doctor's treatment choice is based on the science and relative outcomes and the patient's care and individual best interest are not a consideration, who has the most to lose?
Today a patient may think he has no choice but to be untreated by medicine or consent to a one-size-fits-all treatment because other options are not discussed. The immeasurable variables within the human body and within the human condition have not come into play in the “competent” medical doctor's decision. Such a physician can justify this behavior by seeing himself as playing by the rules of medical science which guarantees he will receive insurance payment and will leave him well covered in a potential lawsuit. He is depending on the oversight of a morally bankrupted governmental body, the FDA, and an ethically challenged industry, the pharmaceutical industry, to provides him with the very tools he depends on to be used safely. This can and does lead to a higher than expected death rate among those whose lives are given over to the 'care' of the modern medical establishment.
Patients cannot be well served by such treatment and lack of choice. Eventually the patient, if he lives, may come to the conclusion that he has been treated like a number and not a person. Informed choice, not offered to the patient, often results in the patient's choice to leave the doctor for more personal and benevolent care from the very holistic practitioner that the doctor was trying to deny to that patient.
Footnotes would not transfer to this website. For footnotes and sourcing, please request a copy of the original paper
The Physician's Role in Drug Liability Lawsuits
Implicit or Complicit?
Clinical Ethics 401
Dr. John Middleton
December 9, 2009
Experts estimate that a staggering 98,000 people die from preventable medical
errors each year. More Americans die each month of preventable medical
injuries than died in the terrorist attacks of Sept. 11, 2001.
In addition, a federal Centers for Disease Control and Prevention study
concluded that 99,000 patients a year succumb to hospital-acquired infections.
Almost all of those deaths, experts say, also are preventable.
Source: Within health care hides massive, avoidable death toll
CATHLEEN F. CROWLEY & ERIC NALDER
HEARST NEWSPAPERS, Aug. 10, 2009
Ethics, medical and biological journals abound with articles exploring the doctor/pharmaceutical industry relationship. Much has been addressed about the ethics of doctors receiving gifts from the industry, “Big Pharma's” influence over medical practices and the liability of the pharmaceutical industry for adverse drug reactions and deaths. Few, if any, imply that the physician be held equally accountable with drug manufacturers for prescribing drugs to patients that are determined later to have caused the patient personal injury or death.
Is not the prescribing doctor as complicit in that injury or death as the manufacturer of the drug? Without a doctor to prescribe it, a prescription drug is as benign as a gun without a bullet in the chamber or a finger on the trigger. In response, this paper questions: 1) Are deaths from adverse drug reactions statistically significant enough to warrant a discussion about culpability? 2) Are physicians overly dependant on pharmaceutical claims and the Food and Drug Administration's (FDA) approval for the relevancy and safety of prescription drugs? 3) Should doctors share the blame when prescribed drugs injure a patient?
Are deaths from adverse drug reactions statistically significant?
A Scientific American article by Katherine Harmon in August of 2009 reports that “deaths from preventable medical mistakes and infections in hospitals have doubled in the last 10 years and are responsible for about 200,000 deaths last year, which is “higher than for fatal car crashes.” This article bases its information on a Hearst News investigation by a team of 35 television and print reporters from across the country. At the Hearst News website, Dead by Mistake, these reporters reveal that they “compiled and analyzed collectively nine databases, including hospital discharge records in four states, hospital administrative penalties, healthcare project research and whatever other available information we could find for the most comprehensive look at the issue undertaken to date.” The investigation and resulting public news stories border on the sensational. Horrific stores are recounted of countless hospital errors, including drug related errors. Reports in popular magazines and on websites are important because they can shape public perceptions and such perceptions often makes policy.
The statistics gathered by the Hearst team were compared to those compiled by an Institute of Medicine (IOM) report of 1999 entitled “To Err is Human: Building a Safer Health System.” The IOM report was covered initially in an article by Barbara Starfield, MD, in the July, 2000, issue of the Journal of the American Medical Association (JAMA). JAMA, being a magazine for medical doctors, has less popular exposure than those carrying the more recent Hearst reports of medical errors. Starfield points out that “of 13 countries in a recent comparison, the United States ranks an average of 12th (second from the bottom) for 16 available indicators.” She compiled data from several medical studies and sources to conclude that of the estimated 225,000 to 284,000 deaths per year due to iatrogenic causes, 7,000 were from medication errors in hospitals and 106,000 were from non-error, adverse effects of medications in hospitals. She was careful to point out that this data was derived from hospital reports and did not include outpatient iatrogenic deaths. The fact that between 200,000 and 300,000 hospital deaths in 1999 were due to iatrogenic causes and constituted “the third leading cause of death in the United States after deaths of heart disease and cancer” was not widely publicized at the time. The medical establishment was given an opportunity to take the advice of the IOM to start “building a safer health system” before the scandalous “iatrogenic death” numbers were brought to public light.
Surely the lesson was learned and medical systems worked diligently to make policy that would lower those dismal hospital death statistics. Not so, according to The Institute for Safe Medication Practices, which, in 2008, reported the number of medical deaths associated with drug therapy at 4,824 (as reported to the FDA in the first quarter of 2008) which was “a 2.6 fold increase from the previous quarter.” This number is below statistical estimates “because reporting is voluntary, only a small fraction of adverse drug events are ever reported to the FDA or to drug manufacturers.” The Safe Patient Project of Consumer Reports of May, 2009, goes even further by writing, “Ten years later, a million lives lost, billions of dollars wasted.” They give the country a failing grade on progress made since the IOM report ten years earlier had called for the medical establishment to “create a health care system free of preventable medical harm.” Given the millions of lives lost and billions of dollars wasted, it is apparent that deaths from adverse drug reactions are statistically significant enough to start a dialogue as to culpability.
Are physicians overly dependant on pharmaceutical claims and FDA approval for the relevancy and safety of prescription drugs?
Doctors cannot help but be aware of the prevalence of dangerous and deadly adverse affects from prescription medications. They have heard about malpractice lawsuits against pharmaceutical companies, the numerous drug recalls and the FDA's admitted shortcomings in upholding their mandate to insure the safety of the public from deadly drugs. Even though these subjects have not been well covered publicly given media dependence on the pharmaceutical industry's advertising dollars, there are a growing number of reports that are questioning drug safety and doctors can not help but be aware of their existence. It is true that most pharmaceutical lawsuits are settled before they see the light of day and many drug recalls are undertaken quietly so to not alarm the public, but doctors do have clinical experience, medical journals and common sense from which they can deduce for themselves the facts about the growing numbers of adverse drugs events.
Deadly hospital medication errors may be addressed in statistics, but outpatient medication errors, which are not even addressed in these statistics, are so prevalent that the Mayo Clinic recently has published a paper entitled, “Medication Errors: Cut Your Risk With These Tips”. This paper warns that “medication errors may sound harmless, but mistakes in prescribing, dispensing and administering medications injure more than 1 million people a year in the United States.” Patients are encouraged to report any injuries from medications to the FDA's safety and adverse event reporting program, MedWatch, because the patient is the “final defense against medication errors.”
So, then, what should we consider as the first defense: the pharmaceutical companies, the FDA or the doctor? Should it not be all three? To explore the growing public perception about the credibility of these three entities as they pertain to protecting patients from deadly medications, we will start with the pharmaceutical industry. Being a capitalistic country, the average American would expect each pharmaceutical company to compete for the larger share of the market. Wall Street quakes with every pharmaceutical stock downturn, likely because of the enormous amount of pension money invested in “Big Pharma.” Would the average American, if asked to think about it, say that they expect the pharmaceutical industry to be more concerned with patient safety than with stock returns? Perhaps not.
Hypothetically, to question such logic, if the greater perception of the American people is that this industry would choose safety over profits, fearing lawsuits, one would only have to read the growing number of news reports about the vastness of pharmaceutical profits as compared to the relatively low court settlements awarded to drug injured parties. In 2005, Pharmacy Times reported that “currently, US sales of prescription drugs total $230 billion, or 43% of the worldwide market for these products.” The article continues with, “US sales of prescription drugs are projected to grow by between 8% and 9% in 2006-an increase almost 50% greater than the worldwide rise in demand for medicines.” Similar figures and claims are echoed throughout the business media. Such reports are not hard to find given that the health of the U.S. economy depends heavily upon the health of the pharmaceutical and related chemical industries.
When comparing pharmaceutical malpractice lawsuit settlements that are reported in the millions of dollars to the yearly pharmaceutical profits of hundreds of billions of dollars, one could suspect pharmaceutical profits to trump safety in the minds of physicians as well as the American public. In November of 2009, The New York Times reported that $103 million in punitive damages was awarded from the drug company Pfizer to two women with breast cancer after using hormone drugs. “Punitive damages in Pennsylvania require a finding of `wanton and reckless' conduct,” reports the New York Times article, which continued: “some of the jurors in Philadelphia told…defense lawyers Monday that the evidence showed that the companies had clearly put profits over safety.” Stock shares for Pfizer went up after the news of the small award. Pfizer's attorneys claimed that they “are winning the overall legal battle over hormone therapy, contending they have secured financial settlements for undisclosed amounts in at least 10 other cases before the suits went to trial.” This claim may please stock holders, but it also should be a warning to physicians and the public. We should question whether the industry is putting “profits over safety.” Left unanswered, placing one's trust (and life) wholly in the hands of the pharmaceutical industry may be unwise for both doctor and the public.
If we cannot trust the pharmaceutical industry to provide the protection needed against damaging drugs, then will not the FDA do the job? Again, perhaps not. The hormone drugs that are mentioned in the lawsuits above were and still are approved by the FDA. Should the FDA have been named in the suit? Interestingly, a U. S. bureaucracy is rarely called to task for their incompetence or “mistakes.” Perhaps, this is because they are ever expanding entities that are not elected by the people, not responsible to the people and not accountable to the people. Without accountability, can there be trust?
The mandate of the FDA is to protect the public health, yet, in 2008, the FDA's own Science Board admitted that the agency was incapable of fulfilling its mandate, that it “cannot keep up with the advances in science” and has been unable to do so for many years. The Wall Street Journal reports that the FDA admits that its “evaluation methods have remained largely unchanged over the last half century” and that “we live amid a revolution in biology, but the FDA still thinks like it did when Sputnik landed.” “The real scandal,” continues the Wall Street Journal, “is that these policies are the product of the FDA's institutional culture, which puts political incentives and bureaucratic procedure above patient's results.” This scandal is the largest of the many FDA scandals reported in recent years. Was it widely covered? No, but doctors should have been aware of it as they have been the ones in the trenches firing at the enemy with pharmaceutical ordnance that have not passed quality control. Experience is the best learning tool.
However, clinical experience has not seemed to have made much headway with physicians when it comes to not prescribing drugs with possible adverse effects, combining drugs that should not be combined or not considering the age, size and condition of a patient before following dosage guidelines. It would appear that if a drug is listed in the Merck Manual or the Physician's Desk Reference (PDR), it will be prescribed as recommended in those volumes by a majority of doctors, seemingly without any personal thought as to its necessity, safety or to possible long-term problems that could be caused by use of the drug.
Yes, of course, there are “wonder drugs” that have saved millions of lives. One would be wise, however, not to apply that status to all drugs. Many common, seemingly benign drugs for “simple” conditions can be causing damage that could be prevented by a practitioner with nutritional training, and a basic knowledge of organic chemistry should alert a doctor to possible adverse ramifications from even commonly prescribed drugs
For example, let us take the lowly antacid. When noting the function of an antacid (prescription or over-the-counter), warning bells should go off in the head of the physician prompting caution when recommending such drugs. Were doctors not taught as undergraduates in organic chemistry that minerals cannot be broken down by digestive enzymes? Were they not taught further that it takes hydrochloric acid (HCL) to dissolve minerals for absorption and use by the body? Cannot an antacid then be considered as nothing more than osteoporosis in a pill?
In addition, there are many uncomfortable conditions and even full blown diseases that are either exacerbated by or are the direct result of mineral deficiency. An educated patient suffering from a hip fracture may one day soon be suing those who manufactured, approved and prescribed the antacid medication that disallowed her body to absorb its bone building minerals.
If early training about minerals and stomach acid has been forgotten by physicians, current research should also sound warning bells when it comes to recommending the seemingly benign and simple antacid. In 2004, JAMA reported that “reduction of gastric acid secretion by acid-suppressive therapy allows pathogen colonization from the upper gastrointestinal tract.” A study of 364,683 patients concluded that “use of gastric acid-suppressive therapy was associated with an increased risk of community-acquired pneumonia.” Natural healers and chefs throughout the ages have been taught to enhance stomach acidity for adequate digestion and that gastric acidity is our first line of defense against ingested pathogens. It is the design of the human body to kill ingested pathogens with HCL to prevent infestations and infections. Raising stomach acid instead of lowering it may be one way to reduce the high rate of infections acquired in hospitals and to insure complete digestion of necessary body-building protein and minerals. Sadly, however, common sense often fades in the face of pharmaceutical wooing.
An editorial in Lancet, September, 2000, explains the doctor/pharmaceutical relationship this way: “It begins on the first day of medical school and lasts through to retirement, and it is the only reliable "cradle to grave" benefit that doctors can truly count on any more… there is little evidence to expect it will ever end. In fact, it may even be growing.” “What is of the most concern here,” writes the Lancet editor, “is the fact that so much continuing medical education comes through the filter of industry.”
If the editor of Lancet is correct and pharmaceutical influence over doctors is growing, we may continue to see rising statistics for adverse medication events in this country, unless drastic measures are taken to break this bond. One such measure was instituted in Great Britain.
Medscape Medical News reported in November 2003 that, “Physicians who make a medical mistake can be charged with a criminal act in the U.K., and the frequency of such charges is increasing.” Under such conditions one would expect that a physician in the U. K. will be very careful before recommending or administering a drug to a patient.
Pharmaceutical influence has even expanded into the area of clinical research where physicians are “selling” their names to lend creditability to pharmaceutical studies. This practice is referred to as “ghostwriting.” JAMA Editor-in-Chief, Dr. Catherine D. DeAngelis, in an April, 2008, editorial points out the dangers of the misrepresentation of research data, articles and reviews is that, “such information and articles influence the education and clinical practice of physicians and other health professionals.” She writes: “The profession of medicine, in every aspect - clinical, education, and research - has been inundated with profound influence from the pharmaceutical and medical device industries. This has occurred because physicians have allowed it to happen, and it is time to stop.” Amen to that.
Until drastic measures are taken, it would appear that many physicians will continue bonding with and being educated by the pharmaceutical industry. It is also apparent that no matter how many drugs are banned, how many lawsuits are settled or how incompetent the FDA claims it is, doctors are going to trust the drugs that are approved by the FDA. These facts have not changed, or improved over time and it would appear that doctors in general are completely dependent on the pharmaceutical industry and the FDA for the tools of their trade and even for the education in how to use them.
Should doctors share the blame when prescribed drugs injure a patient?
The pharmaceutical industry, the medical community and the FDA are so grossly interdependent and intertwined that it is becoming difficult for the average person to tell where one ends and the other begins. If the medical community is viewed as joined with or subservient to profit motivated industry giants and dependent upon an incompetent government agency, a toll will be taken in the area of credibility, respect and trust.
Although it appears that the law protects the doctor and punishes the pharmaceutical industry when drugs do harm, we cannot always rely on this outcome. What is legal does not always trump what is ethical. And, public perception can change policy. It is possible that if iatrogenic injuries continue to escalate that the perception of the public may cause a change from blaming “Big Pharma” alone for harmful drugs and begin to include the purveyor of those drugs, the doctor. Thus, a warning to physicians from Dr. DeAngelis, “People are being hurt. We've given away our profession….We've got to stop this.”
1 Steinbok, Bonnie, John D Arras, Alex John London. Ethical Issues In Modern Medicine. New York, New York, McGraw
Hill, 2009. pg. 61.
2 Harvard Medical School Course Catalog, Preclinical Courses Year 1 and Year 2, April 9, 2010.
The Massachusetts Healthcare System
A Viable Model For U. S. Healthcare Reform?
Clinical Ethics 401
Dr. John Middleton
October 14, 2009
“Access to health care is a basic human need.
Massachusetts became the first state to put in a practical plan to expand affordable
health care when it passed comprehensive health reform in 2006.”
When questioning whether the healthcare model currently used in the state of Massachusetts is a viable model for national healthcare reform, one must ask if the goals of the Massachusetts model match the goals of those currently working toward federal health care reform. If these goals match, one must next discover if the Massachusetts plan has been successful in meeting its goals before using it as an example for the federal government to follow.
Since the contending “powers that be” in Washington still disagree on the exact goals each wishes to achieve by a national healthcare bill, there is one goal common to most of the players, universal coverage.
This also is the stated goal of the 2006 reform of the Massachusetts health care system.
Massachusetts has claimed that this goal has been met successfully by achieving near-universal coverage. However, this paper will show that the Massachusetts achievement of near universal coverage is unlikely to continue to be met in the future unless ongoing changes are made in its current path. The increasingly limited access to provider care for the newly insured, the citizen abuse of the mandate vs. penalty clause, the sky rocketing cost of healthcare and the sagging state economy are sabotaging the coverage gains championed by advocates of the plan. Further, to use the Massachusetts health care system as a model for national health care reform would lead the entire country toward the same disastrous economic results that we see unfolding in Massachusetts.
The Massachusetts model currently imposes a mandate that requires all residents to purchase health insurance or pay a tax penalty for not doing so. All but the smallest businesses also must pay a penalty if they do not offer coverage to their employees, or the employer can apply for state assistance through the Insurance Partnership. Individuals who cannot afford insurance are offered state subsidized insurance plans on a sliding cost basis through a newly formed state run organization, the Commonwealth Connector.
At www.Masshealthreform.org, assistance is available for residents wading through the various routes one can take to obtain coverage. They report that “an individual with an income of around $30,000 or less and a family of four with an income of up to about $60,000 can receive help from the state through the Commonwealth Connector.” The Commonwealth Connector matches each individual with the correct state subsidized plan that fits their financial circumstances.
The Commonwealth Connector website is put together by the Massachusetts Health Care Reform Coalition, a partnership of business, labor, providers, insurers, advocates and consumers whose website is devoted to explaining and promoting the Massachusetts Health Care Reform law. They define the goals of this reform as to offer affordable healthcare to those who have little or no coverage. The coalition reasons that such reform is necessary because the steady rise in the cost of health insurance is “a drag on business and is hurting our economy.”
The escalating costs of pre-reform health care in Massachusetts are explained by this coalition, in part, “because too many people don't have health insurance and get their medical care at the emergency room, where the costs are the highest. By moving toward near universal health coverage individuals and families will be able to see a doctor on a regular basis and have access to preventive care.” The goal of health care reform as seen by this coalition is to help businesses bear their insurance burden, thereby improving the economy while at the same time providing insurance for all.
Even though this coalition would have us believe that the health care system of Massachusetts' reform was initiated in part, to relieve a “drag on business” that is “hurting our economy,” these goals do not appear to be a shared concern of all. The Kaiser Commission, representatives of the California based Kaiser Family Foundation, a self professed “non-partisan source of facts, information, and analysis for policymakers, the media, the health care community, and the public,” states that the goal of the Massachusetts reform is to bring health insurance to those previously not covered. There is no other intent or goal stated or implied in their analysis of the success derived in the three years since the health care law came into effect in 2006. They assert that this law is intended to impose “an individual mandate for the purchase of health insurance” that calls for “shared responsibility in financing coverage.”
It would appear from reading this report that the Kaiser Commission believes that the Massachusetts health care reform law has become a resounding success by achieving near-universal coverage. They estimate that “two-thirds of the estimated 650,000 people who were previously uninsured” are now covered, touting this as an unprecedented increase. Media coverage places the number of uninsured in Massachusetts now at 2.6 percent while the national average for the uninsured is 15 percent.
The Kaiser Commission makes no mention of the Massachusetts Health Care Reform Coalition's professed goals of mitigating the upwardly spiraling health care costs that caused the previous health care system to be a “drag on businesses,” nor did they refer to any improvement of the economy as a result of the new plan. The fact that the Kaiser Commission describes one of the intentions of Massachusetts' health care law as mandating “shared responsibility in financing coverage,” a practice otherwise quite fairly referred to as “redistribution of wealth,” may explain how the new plan could place even more of what the Massachusetts Health Care Reform Coalition calls a “drag” on business and the economy. As recent history informs us, government mandated redistribution of wealth has repeatedly been unlikely to provide incentives or encouragement for business growth or lead to a more viable economy.
If the goal of the Massachusetts health care reform law were to obtain near universal coverage Robin Hood style by taking money from one element of society to pay toward the coverage of another element of society, then the Massachusetts experiment, indeed, can be considered a success. But, at what cost? It has become apparent that fines and redistribution of wealth together will not be able to sustain the Massachusetts plan.
Initially, the Massachusetts plan was designed not to link access with cost. In other words, the goal of achieving universal access to coverage was unencumbered by economic concerns. Costs of the plan that were not met by revenue generated by two income streams - the people who purchased this mandated coverage and the fines from the people who chose not to be covered - were to be subsidized by state and federal funds. Kevin Sack, who covers the health care issue for the New York Times, writes that “predictably, rising costs now threaten the viability of the Massachusetts plan.” Sack writes, “Yet even now, the lawmakers and strategists behind the Massachusetts plan strongly defend their incremental approach. Only by deferring the big decisions on cost containment…was it possible to build a consensus among doctors, hospitals, insurers, consumers, employers and workers for the requirement that all residents have health insurance.”
When the law went into effect in 2006, former Republican Governor Mitt Romney helped to shepherd it through the legislative process. For fifteen years prior to this law, Massachusetts had insurance mandates in place that were driving up health care cost. According to the Wall Street Journal, the insurance companies were mandated to “cover anyone who applies, regardless of health or pre-existing conditions and also must charge everyone the same premium (or close to it).”
Health care costs were being driven ever higher because a number of residents would not purchase coverage until just before or during a health crisis. They would then drop the insurance when the crisis passed. The current health plan, which mandates the purchase of health insurance on a continuing basis, i.e., in times of good health as well as crisis, was seen as the solution to this problem. The on-again/off-again approach by some consumers caused the insurance industry to raise premiums because the practice did not allow for the necessary balance of assets and liability that the insurance industry requires for solvency, i. e., the premiums paid by those not needing services (the healthy) are used to pay for the medical services of those who require them.
Unfortunately, in the current Massachusetts plan, low penalties for not having insurance coverage allow for this practice to continue. A penalty that costs a fraction of an insurance premium is seen as a viable choice by many. The Wall Street Journal quotes Charlie Baker, the CEO of the community based health plan, Harvard Pilgrim, as saying that “between April 2008 and March 2009, about 40% of its new enrollees stayed with it for fewer than five months and on average incurred about $2,400 per person in monthly medical expenses. That's about 600% higher” than expected. Baker continues, “people seem to be gaming the Massachusetts system…It is raising the prices paid by individuals and small businesses who are doing the right thing by purchasing twelve months of health insurance, and its turning the whole notion of shared responsibility on its ear.” This structural loophole could be one reason for the plan's overwhelming popularity among the residents of Massachusetts and one reason for the continuation of spiraling health care costs that were not anticipated by the plan's designers.
So far, the state of Massachusetts and the federal government have been paying most of the bills for the Massachusetts healthcare plan. In October of last year, Massachusetts was awarded a three year extension for federal financing of the Massachusetts experiment. The New York Times reports that the state of Massachusetts expects to “spend $869 million on subsidized coverage” in 2008 alone. In that same year, an agreement with the federal government awarded $21.2 billion of Medicaid monies to be spent on the Massachusetts program over the next three years, which is an increase of $4.3 billion over what was spent on the plan in the previous three years.
Based on these figures, a conservative estimate of combined state and federal funding of the first six years of the Massachusetts' plan is around $42.3 billion. This figure does not include the monies paid by the people and businesses that purchased health insurance as mandated. It is a wonder that there has been no one in either the state or federal governments or, for that matter, in the media who would question why the state of Massachusetts, prior to reform, simply did not choose to pay for the insurance of the 650,000 people they claimed were uninsured.
Catherine Arnst, in an article for Business Week, writes that “the average yearly insurance premium for an individual policy is around $5,000.” With this cost basis in mind, had Massachusetts paid the insurance companies the annual premium of $5000 for each of the 650,000 people whom they claimed were uninsured, the state would have spent only $19.5 billion over six years, representing a cost savings of over $22 billion (assuming the state did not negotiate a better deal with the insurance companies for these policies). Had Massachusetts adopted the option of simply paying into the existing traditional insurance network to purchase coverage for those financially incapable of procuring insurance, the taxpayers of Massachusetts and the rest of the country would have been spared a significant tax burden.
In this scenario, the goal of seeing health cost not rise due to non-emergency visits to emergency rooms at hospitals could have a better chance of being met, especially if penalties for not buying insurance were raised to prevent abuse of the system's mandate/penalty option. This scenario would also achieve the goals of the Massachusetts Health Care Reform Coalition by helping business and the economy.
Since this option was not used by Massachusetts and despite near-universal coverage, health care costs continue to rise. Sack explains that one reason for a re-emergence of upward-spiraling health care costs is that the emergency room treatments for non-emergency cases have returned to pre-reform numbers. This is explained, in part, as due to low income adults refusing to pay for state coverage, choosing instead to use hospital emergency rooms for care. Of equal or, perhaps, greater significance, Sack reveals further that the Massachusetts annual state survey found that “one in five adults said that they had been told in the last 12 months that a doctor or clinic was not accepting new patients or would not see patients with their type of insurance.” It would appear that near universal coverage does not mean near universal access to providers.
There are several other directions from which sustainability woes are bearing down on the Massachusetts plan. The nation-wide economic downturn has caused job losses that, in turn, has increased the number of individuals and families no longer paying into the system but enrolling in the state funded insurance program.
Although it can be argued that the plan was a success because it achieved its goal of near universal coverage, it obviously has not managed to address mounting problems of mandate/penalty abuse, improper emergency room usage, lack of access to providers, cost containment or sustainability. These problems are currently leading to a cut-back in coverage. Near universal coverage is becoming less and less a reality.
In 2009, to maintain quality coverage and not to cut vital programs for its legal residents, Massachusetts has determined the fiscal necessity to eliminate the state Commonwealth Care coverage of 30,000 legal immigrants who are awaiting citizenship. Caving in to pressure from Governor Deval Patrick, the Massachusetts legislature added back some coverage for these immigrants. The budget for their coverage has gone from $130 million to $40 million a year which is, apparently enough to keep them counted on the “insured” list. The reported justification to add this low figure back for the immigrants is in the hope that “immigrants would at least remain eligible for some preventive care.”
Goodnough writes that “The affected immigrants are covered under Commonwealth Care, a subsidized insurance program for low-income residents that is central to the state's landmark universal health care law.” This cut will take effect in September 2009 at which time these residents are scheduled to lose Commonwealth Care. The state has found that it must cut coverage among a demographic that was one of the very reasons given for needing this program, i. e., health care for the state's low income and most needy residents.
The state's cut on care for the needy again became apparent earlier this year when the Boston Medical Center, facing a $38 million deficit for the fiscal year, found it necessary to file a lawsuit against the state for cutting reimbursement to the hospital for residents covered by Commonwealth Care. The New York Times quotes Elaine Ullian, the hospital's chief executive, as saying, “We believe in health care reform to the bottom of our toes, but it was never, ever supposed to be financed on the backs of the poor, and that's what has happened in Massachusetts.” The New York Times paraphrases Wendy E. Parmet, who teaches at the Northeastern University School of Law, explaining the lawsuit by saying that “the hospital's dissatisfaction with the new law should be a warning to Congress that `insurance alone doesn't solve the problems' of the healthcare system. In fact, she said, it might exacerbate the financial problems of safety-net hospitals in the short term.”
The Massachusetts legislature currently is hearing testimony on alternate ways to fund the state's health care reform law. The Massachusetts Medical Devices Journal, reports that one suggestion being heard by the health care reform financing committee centers around switching “from a fee-for-service model - in which doctors are paid per procedure by insurance companies - to a global payment system, whereby physicians are paid an annual fee per patient by insurance companies.” Many in the industry have grave concerns about this switch. A July, 2009, report by the Health Care Payment System Commission calls for the creation of account care organizations which would be “made up of hospitals, physicians, and non-clinician providers” The concerns of the medical device industry center around, “Who decides the amount of money each patient is allocated? Can providers still choose which medical devices they deem necessary? Will the incentives move from providing more procedures to rewarding the use of the cheapest product?”
Liz Kowalczyk of the Boston Globe explains the suggested global payment system this way:
Accountable care organizations, would provide most of the care for individual
patients and divvy up the payments. Doctors would try to coordinate patients' care
within these networks, which would share electronic medical records and treatment
plans. And to manage costs, they would try to direct patients to the hospital within
the network that could provide good-quality care at the lowest cost, while
generally using teaching hospitals for advanced care.
In answer to what Kowalczyk considers the likelihood that this system “may require residents to give up their nearly unlimited freedom to go to any hospital and specialist they want to, ” many Massachusetts health care executives are lobbying against the plan due to fears that this payment system, “could bankrupt some providers and compromise patient care.”
Not only do the health care executives and industry representatives have concerns about the suggested global payment system, the World Socialists have concerns as well. On their web site is an article entitled, “A Model for Obama's Health Care Plan, Massachusetts Proposes Rationing for Workers,” that attacks the Massachusetts plan in general and the global payment plan in particular. The article, written by Kate Randall, claims that a global payment system will “impose dollar limits on health care for working people….[and] will have a devastating effect on the quality and attainability of quality health care for the vast majority of Massachusetts residents” When a government regulated system cannot even count on the support of a socialist organization then that system is surely doomed.
However, there are supporters who argue that “This new system of global payments' would discourage overuse of expensive medical services, force providers to live within a budget, and improve coordination of care for patients.” In other words it will be putting a committee in charge of deciding how best to dispense limited healthcare funds, a process that could be considered `health care rationing'.
The Boston Globe, a fervent supporter of a global payment system, editorializes that, “No health payment system is viable over the long haul if it rewards doctors for ordering unnecessary tests, or if it rewards hospitals for such shoddy care of patients that they must be readmitted within weeks. Yet that's what happens now, because providers receive a set fee for each service they order. And that's one reason health costs rise at two or three times the overall rate of inflation.”
This rationale may sound reasonable on the surface, but, the reverse can be argued as well. A system that makes heath care decisions by committee and rewards providers for offering less care can never be considered an adequate health care system because it causes both the loss of patient's and doctor's freedom of choice and encourages treatment now considered `normal' to be reconsidered in light of its cost.
Multiple ethical issues will undoubtedly abound with the implementation of a global payment plan. Its proponents would do well to accompany such a plan with stringent caps on medical malpractice lawsuits. It is likely that under such a plan the majority of future healthcare costs will be spent more on the defense of the decisions made by accountable care organizations than on actual patient care.
The global payment plan is not the only option currently on the table. Other options being considered are listed in the Boston Globe editorial as: “extra payments for quality, fixed bundled payments for complex treatments, the creation of so-called medical homes - teams of doctors and physician assistants - for more coordinated care. But, [continues the editor] the need for bolder steps is urgent. Rising medical costs are crushing families and businesses and threatening to undermine public support for the state's pioneering universal coverage.” The preferred solution of this editor to the failure of Massachusetts' state regulated health care is to add even more stringent state regulations.
However Massachusetts decides to try to pay for its heath care plan those in the U. S. Congress should take note of its failures. It would be premature, if not patently false, for proponents to claim this health care experiment a success by citing the achievement of near universal health care coverage while, at the same time, admitting this coverage has resulted in rising insurance costs, higher taxes, limited access to providers by those who are covered, 30,000 of its neediest residents dropped from full coverage and has, thus far, proven the inability to sustain itself financially.
Without state and federal funds resuscitating it annually, the Massachusetts plan would have expired due to lack of funds. Blaming a weak economy, Massachusetts is becoming less and less able to contribute to a plan that was supposed to not only pay for itself but bring health care costs down, as well. Its only true hope to survive is a federal bailout. If Congress elects to implement a similar health care plan nationwide, who will be around to bail out the federal government? Only The People, through the payment of higher and higher taxes, will be.
If the federal government simply paid for the insurance (at the $5,000 average yearly rate) of the 45 million people ostensibly uninsured in the United States, the cost to tax payers would be a mere pittance ($225 billion yearly) compared to the trillions of dollars of projected cost associated with any of the current national health care proposal plans.
We can be grateful to Massachusetts for illustrating the unintended negative consequences associated with care mandates and regulation. It is a failed model of what the federal government should do for national health care reform as far as access to providers, cost containment and sustainability. As there has been no clear definition from the federal government as to what is considered important to include in national health care reform and as there are several competing health plans being bandied about in Congress, it is difficult to discern what the true goals of national healthcare reform are.
This makes a comparison with the Massachusetts plan difficult. However, if the federal government's sole goal is to achieve near universal health care coverage for U. S. citizens, then the Massachusetts plan is one to emulate. If, however, the federal government's goals also include universal access to providers, cost containment and sustainability, then the Massachusetts plan, as it stands today, would not be a plan for the federal government to emulate.
In addition, if Congress is considering a version of the Massachusetts plan that would include a global payment system, well, the jury is still out as to whether this system can maintain sustainability through cost containment. The global payment system may be able to address the Massachusetts plan's lack of universal access to providers successfully, but with dubious and highly debatable degrees of health care quality.
Perhaps, the Wall Street Journal has said it best by writing: “In a rational world, the prognosis for ObamaCare would wait on the evidence in Massachusetts, given that the commonwealth's 2006 program closely resembles what Democrats are trying to do in Washington. If the results were widely known, it might be dead on arrival.”
Footnotes would not transfer to this website. For footnotes and sourcing, please request a copy of the original paper
The Vaccine Choice Controversy
The Cultural History of Medicine
December 17, 2008
Mothers from all over the country have brought pictures of their autistic children to Washington this weekend. Most of these children were born normal and lost to “autistic regression.”
Look into their eyes and you will hear their silence.
Mary N. Megson, MD
Testimony to the House Government Reform Committee on Autism and Vaccines
April 6, 2000
Whether or not there should be one, there is a controversy in the United States over whether childhood vaccines should be mandated. Those opposed to government mandated vaccines are usually the parents of children requiring vaccines. Many have older children, family members or friends with children who, they believe, have been killed or injured by vaccines. They question the ethics of a medical establishment that mandates medications which could cause harm and even death.
These opponents to government mandated vaccines argue their case with great passion. They believe, not without significant justification, that today's vaccines are, in actuality, a pathogenic and chemical soup that, when administered on schedule as mandated by the Center for Disease Control (CDC), can cause major neurological damage to and even result in the death of the babies they are intended to protect.
The issue as they see it relates to parental choice, i.e., to their right as a parent to choose the modalities of medical care that they wish to afford their children. They believe that it is not the job of a democratic government to interfere in this choice by mandating that potentially hazardous protocols such as vaccination be undertaken. It appears to the opponents of vaccines that it is the medical establishment's and CDC's view that it is important to bring benefit to the most children at the sacrifice of the few. This viewpoint is one that those opposed to mandated vaccines see as the very antithesis of that expected in a free society. Many parents would rather their babies take their chances with childhood diseases like the measels or mumps than to risk their little lives to avoid them.
This is the argument that manifests a heated emotional reaction in the hearts of those who believe in the ideals of the American forefathers who fought and died for the equalization of the rights of the few with the rights of the many. This country has its very roots wrapped around individual rights…except, apparently, when it comes to medical practices.
In contrast, those who support government mandated vaccines appear cold and superior in their government supported stance. They have the full force of the law behind them. And, they have been shown to be willing to use it against parents unwilling to subject their children to the game of mandated vaccine Russian Roulette. The paternalistic attitude of doctors and government does nothing to help bring the two opposing views together or nothing to ease parental concern. However, it is a subject hard for doctors and government to address without their being defensive given the numbers of babies damaged and dead by vaccines. It is difficult to be warm and fuzzy when defending such numbers, all the while promoting the very thing that could cause farther damage.
The framers of the United States Constitution did not anticipate the extraordinary need for protecting a citizen from being forced by the government to have numerous chemicals and pathogens injected into their bodies and the bodies of their babies. Had they foreseen such an option would they have neglected specifying among the innate rights of man the freedom from mandated medical intervention?
Given the lack of specificity of our forefathers on the types of freedoms we should expect as our God-given and inalienable rights, the freedom from medical mandates was finally delineated in the 20th century (1949) multilateral global document entitled the Nuremberg Code. This universal document was drafted by the United States and was signed by all of the Western countries of its day. It opens with the statement: “The voluntary consent of the human subject is absolutely essential”.
Although the Nuremberg Code addresses the prohibition of medical experiments upon prisoners of war it can be argued that it is applicable to government mandated vaccines, as well. The argument goes like this: when a vaccine is introduced and is administered there are no data insuring its safety. No long term experimental human trials are performed before vaccines are released for use; the experimentee is the person being vaccinated. Even over the time of its use, there are no data given in order for informed consent requirements to be satisfied - as consent is not wanted. In the case of childhood vaccines, there is no discussion with a parent as to the numbers of injuries that have been caused by the vaccine, the possible side effects of the vaccine, the amount of chemicals included in the vaccine, of the importance in evaluating the status of a baby's immune system as to its ability to properly handle the pathogens and chemicals in the vaccine and there is no information freely given by the medical establishment as to the possible effects of multiple vaccines injected simultaneously into a tiny body.
There do not appear to be any valid studies with comprehensive data on any of these subjects. If there are, they are not being made public. Myriad researchers have looked long and hard for them. A parent is only told that the baby must be vaccinated. There is no discussion of associated dangers and no parental permission is required.
It is easy to see how parents could interpret this governmental action as no less an infringement upon personal rights than when a captured prisoner is forced to be a human guinea pig for drug experimentation. These are difficult issues to come to terms with no matter which side one is on.
In the past, the value of vaccines has been demonstrated by the epidemics that have been thwarted through their timely use. Edward Jenner is attributed the discovery of the first vaccine, which was based on infecting a patient with a low dose of a pathogen similar to the deadly target pathogen. In this first-time instance of vaccination, inoculating a patient with low-dose cowpox was found to render the patient immune to the more damaging disease of smallpox. Previous attempts at inoculation required live disease bacteria to be introduced into the body with the risk that the patient could contract the disease instead of developing immunity to it. Through the work of Louis Pasteur and his advances in the field of bacteriology (in which it was learned that bacteria and viruses are the cause of disease), the practice of preparing vaccines using bacteria to build an immune response against a disease became refined over time. Pasteur discovered that aged and weakened disease bacteria could be injected into a patient resulting in that patient not contracting the disease and becoming immune to it. His progress in providing immunity to diphtheria and in treating rabies led the way for vaccines to be developed against many of the worlds most dreaded diseases. Many of those diseases have all but been totally eradicated today.
Opponents of today's vaccine applications and vaccine mandates are neither opposed to the premise of vaccine usage nor its beneficial history, rather, they are opposed to the way vaccines are manufactured and used today and the less than deadly diseases they target. The concern also centers on what is contained in modern vaccines, the 'chemical soup', other than the dose of the intended bacteria or anti-toxin; the deleterious effects of the vaccines on those whose bodies are too tiny and unhealthy to gain immunity from them; those who are healthy enough to gain immunity from one or two vaccines but unable to tolerate the tremendous load of multi-dose vaccines, and the damaging results from the aggressive vaccine schedule of today. The response from the CDC is that vaccines are safe for every child.
There is a growing number of doctors today who are ardently opposed to the current immunization mandates, and none more so than Robert S. Mendelsohn, M.D., who is retired from 30 years as a practicing pediatrician. Sadly. Dr. Mendelsohn is an outcast in his field for his books that expose the deleterious effects resulting from certain practices of the modern medical establishment. Dr. Mendelsohn has a great following among those opposing vaccines and among those in the holistic heath field. In his book, How to Raise a Child in Spite of Your Doctor, Dr Mendelsohn states, “The greatest threat of childhood diseases lies in the dangerous and ineffectual efforts made to prevent them through mass immunization.” He explains this statement by pointing out that immunization has become the “bread and butter” of pediatric practices, directly implying that monetary considerations are the primary justification for mass inoculations. He urges parents to reject all vaccines because of the “myriad hazards they present.” He singles out the diphtheria-pertussis-tetanus (DPT) vaccine as being especially harmful and reports that in the 1980's it was the subject of many lawsuits that resulted in millions of dollars in settlements.
Dr. Mendelsohn's concern over the DPT vaccine is still relevant. In 1998, Gannett News service reports that a federal court ruled that the DPT shot caused the brain damage of Christopher Gray, a child who had daily seizures and horrific birth defects. Taxpayer dollars will be directed to pay the estimated two million dollars “to help him through the few years that medical science says he has left.”
For the last ten years or so, there have been no news reports of parents arrested for shaken baby syndrome because, due to cases like Christopher's, police officials have been made aware that through court testimony from medical doctors that “the DPT shot could do similar damage”. A pediatric neurologist testified that Christopher's “brain damage from interior bleeding was likely triggered by the DPT shot.” In that same Gannet article it is pointed out that of the almost one billion dollars awarded in tax payer money to parents of vaccine-injured and dead children by the National Vaccine Injury Compensation Program (VICP), “81 percent have been for DTP cases.” The fact that the VICP was established to reimburse parents of vaccine damaged and dead babies belies the claim by the medical community that vaccines are safe for every child.
The fact that compensation for vaccine injuries is paid for by U.S. taxpayers and not by the pharmaceutical companies who manufactured the vaccines is a raw subject for those opposed to vaccine mandates. The need for a national compensation program at all is a fact used by mandate opponents as proof of vaccine dangers, the need for more vaccine safety review and, especially, informed parental consent. If vaccines are safe, as claimed by the CDC, there would be no need for a National Vaccine Injury Compensation Program.
Not only are the news stories covering “shaken baby syndrome” absent in the media today, but it has been many years since the mysterious syndrome called “sudden infant death syndrome” (SIDS) or “crib death” has been covered. There are between five to ten thousand cases of SIDS reported each year, but since the link has been made between SIDS and vaccines there are few news reports being written on the subject. In the book, What Your Doctor May Not Tell You About Children's Vaccinations, Dr. Mendelsohn writes that “each year three thousand infants die within four days of vaccination.” This information is not widely disseminated. It is the view of mandate opponents that a pharmaceutical moratorium on anti-vaccine information is honored by many in the news media who depend upon that industry's dollars for a vast majority of their advertising dollars..
There is also a glaring absence of news coverage on the organizations and doctors who oppose mandatory vaccinations. Dr. Mendelsohn is not the only M.D. who has had the courage to speak out against the vaccine mandate. The Association of American Physicians and Surgeons (AAPS), at their 2000 annual meeting which addressed ethical medicine, submitted a resolution for member approval. The resolution that addresses mandatory vaccines concludes with the statement that “AAPS calls for a moratorium on vaccine mandates and for physicians to insist upon truly informed consent for the use of vaccines.” They state that their concern is less about the safety of vaccines than in “Patients' freedoms…to refuse medical treatment even if it is recommended by their physician…”
Even though AAPS did not emphasize questions surrounding vaccine safety as much their concern for a patient's freedom, safety is the core reason that parents fight for their freedom to choose vaccines or not. The DPT shot is not the only vaccine controversy. Until a mercury-based preservative, thimerosal, was phased out of most children's vaccines after the year 2000, the autism rate had steadily climbed and with it the mercury/autism debate grew at the same rate.
The CDC stance supporting the safety of thimerosal has not changed to date. However, it is admitted that “recent estimates from the CDC Autism and Development Disabilities Monitoring network found that about 1 in 150 children have ASD (autism spectrum disorder)”…however, “evidence favors rejection of a causal relationship between thimerosal-containing vaccines and autism.”
Mary Megsen, M.D., in her April, 2000, testimony before the House Government Reform Committee on Autism and Vaccines stated, “Over the last ten years I have watched the incidence of autism skyrocket to 1/300-1/600 children.” She continues by telling the committee that:
"These children are physically ill, immunosuppressed with a chronic autoimmune disorder affecting multiple organ systems. Funding to look at the etiology of autism, to identify children at risk prior to “autistic regression,” and to prevent this disorder is imperative. Implementing vaccine policies that are safe for all children should become our first priority."
Representative Dan Burton, whose grandson was stricken with autism after receiving a measles-mumps-rubella (MMR) shot, spent several years holding congressional hearings exploring vaccine safety and the link between vaccines laced with mercury and autism. As a result of these hearings and pressure from the public in 2001, the vaccine industry stopped adding mercury in most childhood vaccines. By 2006 sources reported by Dr. Mercola, a natural health “Guru” and an advocate for patients' rights, claim that autism rates fell for the first time in history with the removal of mercury from many childhood vaccines. However, thimerosal remains in many vaccines. According to the Institute for Vaccine Safety, thimerosal, being a preservative, has not been eliminated in multi-dose vaccines. These are the vaccines given in most pediatricians' offices.
In response to these statistics, the CDC has not changed its stance. The CDC reported in 1999 that the vaccine/autism link cannot “…really be taken to provide any evidence one way or the other.” The fact that 1 in 150 children have autism today may not speak to the CDC and the medical community as evidence of a mercury autism connection- but it carries a lot of weight for those who already believe autism is caused by thimerosal preserved vaccines and for many of those who prior to this admission had been on the fence.
In an International Medical News Group article, Miriam Tucker writes that the MMR vaccine was on trial at the Congressional Hearing. She dismissed the autism hearings as “Congressman Dan Burton's quest for evidence to back his belief that the measles-mumps-rubella vaccine a major culprit.” She parroted the views of the CDC and mainstream medicine by quoting the testimony of Colleen A. Boyle: “Currently available scientific evidence does not support a link between vaccination and autism or any other behavior disorder.” Scientific evidence, being of great disappointment to those with injured and dead children, is losing its creditability among the number of Americans who are questioning the safety of vaccines.
Miriam Tucker quotes Dr. Taylor as saying that, “Uptake of vaccines has fallen dangerously low in the U.K. because of the publicity associated with poor science suggesting that there is a relationship between MMR vaccine and autism and/or inflammatory bowel disease. Supportive statements from bodies like this (Rep. Burton's Congressional Hearings) could prevent the same thing happening in the U.S.A.” Dr. Taylor did not get his wish, none of the Burton Hearings supported either the safety of vaccines or the right of government to mandate them. In 2005, Rep. Burrton said in a speech on the house floor concerning thimerosal and mercury on childhood vaccines, “…we found from scientists who testified before the committee over the years that there was no doubt that one of the major contributing factors to neurological problems, including autism among children, was the mercury in vaccines under the title of Thimerosal.”
Rep. Burton also stated on record:
“Thimerosal used as a preservative in vaccines is directly related to the autism
epidemic….This epidemic in all probability may have been prevented or
curtailed had the FDA not been asleep at the switch regarding a lack of safety
data on injected thimerosal, a known neurotoxin...Our health agencies' failure
to act is indicative of institutional malfeasance for self protection and
misplaced protectionism of the pharmaceutical industry.”
Until 2007, there was little to no national media coverage of the vaccine controversy. This changed in August of 2007 when an article appeared advising parents and girls against the cervical cancer vaccine Gardasil. It was printed nationally by a new, small magazine called Natural Awakenings and the article, More Venomous Vaccines? , by Dian Freeman, made its way to Oprah Winfrey's website. A month later, Oprah had a show on the mercury/autism controversy. The vaccine debate had now gone national and the controversy was out in the open.
In October, 2007, a new organization, Generation Rescue, was allowed to advertise in USA Today. The ad simply asked, “Are we over vaccinating our kids?” It had graphics showing that the children's vaccine schedule had jumped from 10 mandatory vaccines in 1983 to 36 mandatory vaccines in 2007. This ad had an extraordinary impact on highlighting the vaccine opposition movement and exposing a national dialogue on the subject. Previously, ads opposing vaccines were denied by the media and to date USA Today is the only national media outlet that has allowed such ads. A month later, in November, 2007, USA Today published another Generation Rescue ad. The question this time: “Are We Poisoning Our Kids in the Name Of Protecting Their Health?” This ad also took up a full page (as the first ad had) and, again, it added much to the momentum of the anti-vaccine movement as the numbers of people who began questioning the safety and mandatory schedule for childhood vaccines began to rise steadily.
The governmental response to parental concerns? In New Jersey, more vaccines, not less. The CDC began testing the waters in New Jersey for more mandatory vaccines to be added to a schedule already seen as scandalous by opponents. In 2008, the New Jersey Health Department ordered that three vaccines, including the flu vaccine, be added to the schedule of school children, even those attending daycare and nursery school. This mandate would affect babies as young as six months of age.
The New Jersey Health Department's expanded mandate resulted in a huge revolt on the part of New Jersey citizens which culminated in a rally at the state house protesting all mandated vaccines. A New Jersey newspaper, The Star Ledger, covered the emotional rally. Parents carried signs with pictures of their injured or dead babies. One such sign showed a large picture of the face of a baby who could have been mistaken for a “Gerber Baby” wearing a white lace bonnet with big blue eyes. Under the picture in large letters was the word: “Murdered.”
Until one faces the emotionalism of this issue, one cannot come to terms with the purported scientific underpinnings. Perception is a large portion of what people come to believe as truth. It was a great strategic error on the part of the CDC and the New Jersey health officials to pick this time to expand the vaccine schedule. They have given their opponents more fuel to fan the flames of discord and an additional new reason to unite.
The result of the new vaccines being added unilaterally in New Jersey, i.e., without state-wide debate, is that the debate is going forward now and it is doing so without the participation of the CDC or New Jersey health officials. A bill has been written that would remove mandatory vaccines from N.J. altogether. This bill, A260, would allow for a conscientious exemption to mandatory vaccines. Currently, the only exemption in the state of New Jersey is based on religious objections.
The Star Ledger reports that the new bill is sponsored by Assemblywoman Charlotte Vandervalk who is quoted as saying, “We have a right to informed consent. This was once a closet fear that has now become a public outcry.” The outcry is gaining momentum and it will be interesting to watch this battle play out. If this bill is passed in New Jersey, it will set a strong precedent for the rest of the states in the U.S.
This controversy will not be settled soon as both sides are digging in for battle. But for those who have faith in the freedoms guaranteed in the U.S. Constitution, the fight will prevail on the side of parents' right to choose and result in a review of the dangerous additives contained in vaccines. In the meantime, the fight continues between those who wish to protect the masses and the masses who think they can best decide how to protect themselves.
Footnotes would not transfer to this website. For footnotes and sourcing, please request a copy of the original paper
The Father of Modern Medicine
The Father of Holistic Medicine
The Cultural History of Medicine
Dr Donald Kent
November 20, 2008
The nature of the man called Paracelsus lay in obscurity for almost three hundred years after his death in 1541. Until the 19th century, what was revealed about him was written by his contemporaries; i. e., doctors who were his most ardent foes or those who wished to interpret his science rather than his courage and contribution to the modern era. In The Life of Paracelsus, Anna Stoddart states that he “was dismissed from serious consideration as a bibulous braggart, uneducated, quarrelsome, self assertive and disreputable.” It is the way of history that it be written by the elites and authorities of an era. Much of the achievements of the common people or their champions is lost to history because it is the mainstream and the educated who are the tellers of the times.
This was the case for Paracelsus until Robert Browning acquired some of Paracelsus' personal writings and was inspired to romanticize his life in a 1833 ode called “Paracelsus.” Stoddart, a member of the Browning Society, describes the effect of this poem was to inspire 19th century students of medicine in Germany to re-evaluate the life and to estimate the importance to science the works of Philippus Aureolus Theophrastus Bombast von Hoheneim, the man who called himself Paracelsus. From this investigation Stoddart set forth to “set the record straight” for readers in England by writing a book about Paracelsus that was “unprejudiced by outworn theory, uninfluenced by the purposes of an exotic cult.” A mission that has been echoed by all subsequent writers of medical history.
Paracelsus, reevaluated, is now known as the “Father of Modern Medicine” most specifically for his departure from a failed medical system based on Galenist principles of elements and humors and for his addition of chemistry (called alchemy in his day) as medical remedy. Even though the chemistry he used does not resemble that of today, he was its first proponent. He did not stress anatomy as he believed that most disease theories were chemical in nature and he initiated the use of specific remedies for specific diseases more like would be done in the modern era than the 16th century. In what is now considered an early version of the germ theory, he believed that disease sprang from seeds.
Though lauded as the first medical scientist, historians point out that Paracelsus did not lay out a system of medicine as would be required in science but instead he gave us a blueprint for healing. Science requires theoretical structure and Paracelsus was, if nothing else, a rebel against structure. His approach was less scientific and theoretical than natural and esoteric.
For that reason, one could also consider Paracelsus the Father of Holistic Medicine as he embodied the precepts that are now those of holistic practitioners. Akerknecht, in A Short History of Medicine, describes Paracelsian philosophy as being based on “neoplatonic idea that stressed intuition instead of Aristotelian rationalism, which led to confused thinking.” His thinking may have seemed confused, in the eyes of a scientist who would deny intuition, but logical in the minds of many holistic healers who depend upon intuition.
Paracelsus believed in independent study and private judgment, not in medicine practiced by authoritarian dictate. He chose to not sacrifice his truth in the service of self-interest. Due to an early exposure to medicine from his botanist father, an impoverished country doctor in a mining town, he choose natural products for treatment. Paracelsus learned botany from his father and started his study and life long interest in alchemy and metals while living and observing the mines. Alchemy was the chemistry of the day and it was one of Paracelsus tools for healing.
Paracelsus is not considered a scientist in the modern sense of the word because he connected the workings of the human body with both the cosmos and spiritual energy. He showed a binding respect for human life by writing that “the essential need was to sustain the life force.” Like most holistic healers, Paracelsus stated that spirituality and love predominated in healing and that “only a virtuous, unselfish man could hope to be a good physician.” He shared many of the same beliefs used in holistic healing today which also promotes healing by connecting the mind, body and spirit.
Paracelsus was also highly influenced by the humanism of the Renaissance and the teachings of the Reformation. He believed especially in the right of each person to personal freedom. He was also inspired by the nature philosophy of Celsus, whose name he chose to acquire. His ostracization was partially due to his blatant and loud ridicule of the authoritarian medical structure of his day. This was a structure that had not changed for over twelve hundred years and was one where authority was paramount. Medical doctors, for hundreds of years, had relied upon theory, rules and elaborate concoctions to prescribe to patients they often never did even see. Their edicts were handed down to minions who relayed them to the patients. Such august men never touched and rarely saw or counseled a patient unless one of high rank. Healing was kept as a mystery and was by and large painful, deadly and unsuccessful.
Like those who practice traditional holistic modalities Paracelsus demystified medicine and, unlike the medical practitioners of his day, he personally met with his patients, gave them the time they needed and shared his knowledge thus empowering them with the gift of self-reliance. He would only speak and write in the language of the people while physicians of his day believed in the the Hippocratic principal to not share medical information with any but physicians. Paracelsus did not set himself apart or above those he healed. His egalitarian nature and popularity with the people was the source of great contempt and jealousy from his medical contemporaries.
Browning described Paracelsus as a “man of fire.” He wrote that Paracelsus was bold in his stance in favor of enlightening the common man who shunned the use of the Latin used by educated men. In A History of Modern Medicine, Brian Inglis describes Paracelsus as a man who “was sickened by ineffectual practices of the doctors of his day. “ After his medical education, he chose to seek the truth by wandering Europe and the Middle East for ten years.
While wandering, he learned remedies and practices from common people, medicine men, wise women and from other healers who were called `quacks' by the medical establishment. With this accumulated information, combined with his experiences with botany and metalurgy, Paracelsus came up with a blueprint for natural healing that scorned the practices used by the medical authorities of his day.
When he returned to Germany he was received well by the people with whom his charisma and talent gained him a great reputation as a healer. He was also popular for sharing with his patients how their healing was done. This did not endear him to the medical establishment. When he lectured to medical students in Basile against accepted medical practices and burned the books of Galen and Aviecenna, he was shunned by the medical establishment to the point that with bitterness on both side, he had to move on.
In the history of medicine, Paracelsus is famous for distinguishing between symptoms to describe and name diseases not yet recognized. He connected the presence of a goiter with cretinism. Gout he described as a build up of that which should have been voided and for him, as for many natural practitioners of today, the stomach was of prime importance. Ackerknacht reports that he named metabolic diseases “tartaric diseases” and kept coming up with new diseases and new remedies for them.
In his day, he was refered to as the “Luther of medicine.” Though some historians believe this title a philosophical description, others claim it was given to him by his enemies in the effort to have Paracelsus associated with the ideals of Luther in order to have him burned as a heretic along with Luther. In his biography of Paracelsus, Andrew weeks speculates that, “Paracelsus' works originated in a crisis of authority which motivated other doctrinal, philosophical and political disputes occurring in his surroundings.” Weeks states that in spite of Paracelsus' affinity for the Reformation, he was not closely aligned with Luther because “his idiosyncratic character and ideas and his tendency toward moral generalization and frontal opposition prevented such involvement." Paracelsus was not a joiner nor one to follow another.
Historians have tried to deduce the character of Paracelsus from his many available writings. Few of them were published in his day so unpopular were his ideas among those controlling publishing. In the latter part of the 16th century a large number of his texts were printed which resulted in the growth of a following by a fringe group of described as "chemical" physicians. This lead them to an attempt to synthesize a system from his work thet led to many disputes as to the true essence of the Paracelsian approach to medicine. In Chemists, Physicians, and Changing Perspectives on the Scientific Revolution, Allen G. Debus writes,
“Of special importance in the sixteenth and seventeenth centuries was the chemistry
found in the writings of Paracelsus and his followers. These "chemical philosophers"
offered a new philosophy based on chemistry and chemical analogies that was to
replace the works of the ancients."
Ole Peter Grell's biography of Paracelsus pinpoints the origin of the “Paracelsian medico-chemical sect” as have originated in Central Europe but reports that it quickly took root in France where debates on the proper Paracelsain uses of chemical and plants filled medical halls . Until unearthed by Browning in the 19th centurey, the nature of the man, Paracelsus, became less important than his discoveries and remedies due to years of disputes over their use and intent.18
Grell explains the elusiveness of Paracelsus' nature as due to the fact that he “proved so important in such a variety of fields.“ Philip Ball in his book, The Devil's Doctor, explored Paracelsus from a psychological point of view and reports that Jung claimed that after the loss of his mother at an early age, the only two women allowed in Paracelsus' life was the church and mother nature. Writers and experts in each field have their own perspective through which to evaluate Paracelsus and often they can seem to be drawing a picture of a character entirely different than one might find in another field of study.
His character is often described as rough, course, bombastic and arrogant while at the same time he is seen as fair, compassionate, charismatic, bold and independent. Others saw him as “raw and urgent and seemingly unconcerned about the conflicts and contradictions they present."
Paracelsus was certainly a man of extreme opposites who showed a different side of his personality depending upon whether he was being challenged or supported. And, no matter the attacks on him, Stoddart writes that, “the sick believed in him and his ignorant rivals were powerless to rob him of his skill or his patients of their faith in him.”
Had Browning not acquired writings by Paracelsus and had not portrayed him in such heroic terms, his life might never had been rescued from contemptuous obscurity. Paracelsus' one downfall, and a great source of his bitterness, was due to his desire to win the respect of the medical hierarchy of the day and to be seen by them as a success. Again we witness a dichotomy in his nature. He wanted acceptance by the very people he cited as beneath his contempt. The reality of it was that he had no peers in his era and thus no one qualified to judge his work, his courage or his brilliance. The real determinate of his success lay in the fact that the bigger value of his work lay in the gratitude and respect he earned from those who he treated and cured.
Footnotes would not transfer to this website. For footnotes and sourcing, please request a copy of the original paper