There was an interesting editorial written by Rita Redberg MD yesterday in the Archives of Internal Medicine about President Barack Obama’ latest physical. Sure, we all think that the Commander-in-Chief should pull out the stops to make sure he is healthy, but should we doctors condone his use of expensive technologies that have not been shown to add anything to health except cost? Especially when he is advocating healthcare reform that will cut costs?

Consider what this healthy middle aged under 50 male went through. Electron Beam Computed Tomography (EBCT) for measurement of the calcium in his coronary arteries, a super hyped procedure whose costs go into the hundreds if not thousands of dollars, and that has not been shown to have any beneficial effect on health outcomes. Next, a virtual colonoscopy, in a man who is recommended to get a one dollar stool guac test for early detection of colon cancer.
It’ not that these useless and expensive medical tests are so benign. The EBCT increased his risk of cancer by 9 out of 100,000 possible cases. The chairman of radiology here at Emory famously had a “routine” CT screening and ended up in the ICU because of all the tests that followed (in the end he had no disease).

So if Obama can’t give us a rational example of how to approach healthcare, who can?
Discuss!

I justed posted a guest blog on the Dear Thyroid website, which is a advocacy group for patients with thyroid disease here.

A local FOX Atlanta show, you can see me and read about it here.

Reported By: Beth Galvin | Edited By: Leigha Baugham

Nearly 20 percent of American doctors get paid by drug companies to be consultants or speakers, and in some cases, they’re making quite a lot of money. So does that influence the decisions your doctor makes about your care?

Doctors earn money by giving professional talks to their peers about the latest research and the practice is pretty common.

For years it’s been unclear how much money physicians were actually earning for these speeches. Now, three major drug companies are going public revealing who is on their payrolls and how much money they’re making.

On Eli Lilly’s website, the company lists faculty on the drug company’s payrolls, including educators, advisors and contractors.

Nearly 200 Georgia doctors are on the list and they pulled in over $2.2 million dollars last year.

Some of Georgia’s highest paid physicians on the list are Emory urologist Dr. Muta Issa, who earned $ 91,000 from GlaxoSmithKline. Atlanta endocrinologist Dr. David Robertson cashed in over $78,000 from Eli Lilly and Roswell psychiatrist Dr. Michael Banov banked over $68,000 from Eli Lilly.

Some healthcare providers are earning much more by working for several companies at the same time.

“It’s common, that people who are very active, can make several hundred thousand dollars or more,” said Emory psychiatrist, Dr. Doug Bremner.

“We don’t sell medications. We simply educate physicians about data, and they make their own mind up,” said Dr. Banov.

Dr. Banov, a private practice psychiatrist, was paid over $68,000 by Eli Lilly. The Roswell doctor said he gives speeches for about five companies with competing medications.

“I think my patients welcome the fact they have a doctor who is meeting other doctors, actively involved in research, actively communicating with other physicians, someone who’s on top of the game,” Dr. Banov said.

Dr. Banov said the drug company, not him, creates the materials used in his speeches, and he also said there’s a reason for that. “We are only able to present the data. We’re not able to present our personal opinions, our personal preferences, how we use the medication off label, any of that. So we’re held to a very tight standard by the FDA.”

Emory’s Dr. Bremner said he thought paying doctors to speak for drug makers was a bad idea. Bremner said he used to do it, until he got a wakeup call about six years ago.

“I was going out to give a talk and the sales, the marketing guy like, slapped me on the back and said, ‘Go on out there and sell some,’ I’m not going to say the name of the drug. ‘Sell some of that drug,’” said Dr. Bremner.

Dr. Bremner said he worried that even the most independent doctor can get hooked on all that extra cash coming in. “Doctors are human, and once you get into this routine of making outside income, you become dependent on it.”

When asked how receiving money from the drug companies could from influencing how a doctor treats a patient, Dr. Banov said, “When I close that door, and I’m with a patient, my 100 percent interest is in getting that patient better.”

Last fall, Emory University’s School of Medicine banned staffers from making promotional talks for drug companies after congressional investigators accused the school’s chief of psychiatry, Dr. Charles Nemeroff of failing to report to the university over a million dollars he got from pharmaceutical and medical device manufacturers.

Dr. Nemeroff resigned his chairmanship, and has since left the school.

Another Emory staffer, urologist Dr. Issa listed his earnings as $91,000 in the first three months of 2009 from GlaxoSmithKline. Dr. Issa declined to comment on this story. A school spokesperson said Dr. Issa left the speaker’s bureau when Emory changed its policies.

Atlanta diabetes specialist Dr. David Robertson, who earned $78,000 for giving 47 promotional talks for Eli Lilly, said he only speaks about medications he actually prescribes.

“I think a presentation a physician makes should represent their own practice,” said Dr. Robertson. The doctor did admit that some physicians spend too much time promoting too many products. “That’s bad for everyone. That’s bad for the pharmaceutical companies, that’s bad for physicians as a profession and that’s bad probably for physicians as recipients of information because they become mistrustful.”

So are public lists like this a good thing?

Doctors on both sides say yes.

“I think it’s gotten to the point where the public is looking at it for what it is and they’re saying, ‘What’s going on here?’” said Dr. Bremner.

“Why not let the public know? There is nothing to hide. There is no shame. We’re not doing anything illegal,” said Dr. Banov. “I think it’s terrific. [It] should be completely open.”

So far, GlaxoSmithKline, Eli Lilly and Merck have published online lists of who’s on their payroll. Pfizer will be doing the same this spring.

Related Links: statements and public registries for Eli Lilly, Merck (also see here) and

GlaxoSmithKline (also see here).

Complete statement from Emory University School of Medicine regarding its new Conflict of Interest policy.

“In June of 2009, Emory’s School of Medicine adopted a comprehensive new policy governing faculty relationships with industry. The policy meets the recommendations of the Association of American Medical Colleges, the Association of American Universities, and the Institute of Medicine. Professors Issa, Pacifici, and Schulman are respected faculty members who are in compliance with that policy. Dr. Nemeroff resigned his position at Emory in fall of 2009 to become chair of psychiatry at another medical school.”

The situation at Grady Hospital in Atlanta of cutting off dialysis for poor patients without insurance (which will make them, um, die) is an echo of the national political farse of throwing out public option health insurance and throwing more good money after bad (Karen Ignagni and her group of health insurance criminals). I am glad to see that Max Baucus (D-Mont) who was the author of the bogus healthcare reform bill (and a top recipient of pharma contributions) was able to get some extra healthcare money for some miners from Libby, Montana, as well as shell out even more profits to the pharmaceutical industry, health insurance, etc. Here he is in action shelling out the pork.

Here is an update on the Grady story from Neil Shulman MD:

IT IS SAD.  I had a meeting with the woman who wrote the book THE GRADY BABIES and a woman who works at Channel 11 and the nurse from Nigeria who has been here ten years, Is married to an American and just got her Green card.  SHE NEEDS TO BE HERE 5 MORE YEARS BEFORE GEORGIA MEDICAID PAYS FOR HER DIALYSIS.  The Channel 11 lady and the author (WROTE A GREAT BOOK WITH DICK GREGORY) are connecting with Dorothy to get the book on the dialysis crisis rolling (30 people who may lose their lives after Jan 3rd when the inner city hospital stops supporting dialysis for their kidney failure.)  They are planning on putting personal stories about the patients on the internet.

In the meantime,  there is a movement by some docs within Grady Hospital to change things such that humanization takes precedence over monetazation. ALSO,  THERE IS A PLAN TO TAKE A BUS LOAD  OF THE DIALYSIS PATIENTS TO A HOSPITAL EMERGENCY ROOM ……….ALL AT ONCE…EVERY FEW DAYS ……after Jan 3rd.

 ON another front,  the medical volunteerism conference WWW.EMORYIMVC.ORG  is MOVING ALONG VERY WELL…………..we have some fantastic presenters,  the first edition of the book about  these heroes is almost ready,  the White House is sending folks………….AN OUTPOURING OF SUPPORT FROM HUMANIZERS.

IF YOU HAVE SOME TIME,  WE SHOULD AT LEAST CHAT ON THE PHONE TODAY.  I AM AT 404-321-0126.  IF NO ANSWER,  JUST LEAVE YOUR NUMBER AND I WILL RETURN YOUR CALL SHORTLY.

NOW A SHORT OVERVIEW OF THE CURRENT CIVIL WAR IN THIS COUNTRY:

We are in the middle of a war in this coutry between the monetizers and the humanizers.  Sadly,  the victims of this war are poor sick people.  IF everybody was a humanizer as the folks involved in the medical volunteer activites………….there would be no problem.  We would have peace and poor sick people would not suffer and die……. One of the major obstacles to winnning this war is the barrier between the poor sick patients and everybody else.  The caring nurses and doctors AND LAY FOLKS who are on the front lines Understand the current atrocitIES.  The further one is away from connecting with poor sick people,  the less likely you can empathize with them.  It is easy to use words like “ILLEGAL ALIENS”  OR “LIMITED RESOURCES FOR POOR SICK AMERICANS”  and just let people suffer and die when you don’t have to look in the eyes of these people or hear their stories. 

One of the free clinics in South Atlanta struggles with getting patientsurgent health care by specialists every day.  Recently, there was a case of a man needing back surgery before “he became paralyzed.”  The community clinic (docs, nurses, and pastors) FOUGHT HARD AND got the patient into Grady Hospital for the surgery.  On the other hand, there are folks like the 23 year old woman who recently died in Grady because she was shut out of her access to steroids for her Lupus.  She did know how to overcome the new barriers (more paperwork and more upfront fees to be seen for a few minutes so she could get her refills).  She ended up in Grady’s ER very very sick. She was admitted and died. Medical students and staff docs told me the story.  Many folks are familiar with this recent tragedy.  There are many folks in similar situations every day who die at home without even getting to the emergency rooms.

In developing countries where there is lack of access to health care………..at least there is not a COVER-UP.  When we brought a little girl from Kenya to Univ of Alabama Med Center for heart surgery…………..the Kenya media, the local Kenya politicians,  the local roatary club,  THE HAVES AND THE HAVE NOTS…..ALL JOINED TOGETHER AND HELPED SAVE THIS LITTLE GIRL’S LIFE.  IT WAS AN ENTIRELY DIFFERENT CULTURE.  THERE WAS NO HIDING OF “THE FACTS.”  THERE WAS NO INTIMIDATION OF THE CARING FOLKS BY  MONETIZERS.  We are experiencing a larger and larger class of HAVE-NOTS in this country because of the economy.

DAILY MEDIA ATTENTION SHOULD BE FOCUSED ON EFFORTS OF THE HUMANIZERS TO HELP POOR SICK PEOPLE.  THIS WOULD GALVANIZE EVEN MORE PEOPLE TO JOIN IN.  THIS WOULD GALVANIZE MORE PEOPLE TO ADVOCATE FOR LEGISLATION TO ELIMINATE THESE ATROCITIES.  Maybe we could even get the Georgia Legislature to allow poor people to get medicaid coverage BEFORE THEIR CANCER SPREADS.  THE MEDIA WILL NOT INFOMORM THE PUBLIC THAT IF YOU HAVE A MALIGNANT MELANOMA ON YOUR SKIN AND YOU ARE POOR…………..THE STATE MEDICAID EMPLOYEES ARE FORCED TO TELL YOU “SORRY MEDICAID DOES NOT COVER YOU UNTIL YOUR CANCER SPREADS THROUGHOUT YOUR BODY.” 

 We need more media attention, legal action, and MORE folks EDUCATED AND involved.  IT IS A STRUGGLE WHICH CAN ONLY BE WON WITH AN ARMY OF HUMANIZERS.  I have found that people with resources who are humanizers are MUCH HAPPIER than people with resources who are monetizers.  You are surely one of the humanizers.

 IF THE MAJORITY OF MEMBERS OF THE US CONGRESS WERE NOT MONETIZERS………….THEN TRULY MEANINGFUL NEW LEGISLATION WOULD BE PASSED TO ELIMINATE THE BASIC HEALTH DISPARITIES BETWEEN  THE HAVES AND THE HAVE-NOTS.  WE CAN STILL HAVE PEOPLE WITH BIG HOUSES AND SMALL HOUSES, PEOPLE EATING AT FANCY RESTAURANTS AND PEOPLE EATING BASIC HEALTHY FOOD AT HOME,  PEOPLE GOING ON  EXPENSIVE VACATIONS AND FAMILIES DOING MEDICAL MISSIONS………..BUT AT LEAST WE WOULD HAVE A COUNTRY WHERE POOR SICK PEOPLE HAD ACCESS TO BASIC HEALTH SERVICES AND BASIC MEDICAL THERAPIES……….WHICH ARE AVAILABLE TO MOST PEOPLE IN EUROPE, CANADA, JAPAN, KOREA, ETC.

AND BY THE WAY,  IT WOULDN’T HURT IF MEDICAL LITERACY WAS AN INTEGRAL PART OF OUR EDUCATIONAL SYSTEM………..WHY DO JUST DOCTORS AND NURSES LEARN HOW TO EXAM THE HUMAN BODY, WHAT SYMPMTOMS ARE IMPORTANT, HOW TO PERFORM SIMPLE PROCEDURES LIKE TAKING BLOOD PRESSURES?……………..WHY NOT EMPOWER CONSUMERS SO THEY CAN USE THE HEALTH CARE SYSTEM MORE EFFICIENTLY.  READING, WRITING AND ARITHMETIC ARE IMPORTANT BUT YOU CAN’T DO ANY OF THOSE IF YOU ARE DEAD.  MARTIN LUTHER KING EMPOWERED FOLKS BY TEACHING THEM HOW TO VOTE.

LET’S EMPOWER AMERICANS BY TEACHING THEM MEDICAL LITERACY………….LET’S EDUCATE THE SCIENCE TEACHERS SO THEY ARE MEDICALLY LITERATE, SO THEY CAN TEACH OUR FUTURE GENERATIONS ON HOW TO EFFICIENTLY USE THE HEALTH CARE SYSTEM.

BEST,

NEIL SHULMAN

INFRINGEMENT: FREEDOM OF SPEECH: MEDICAL PROFESSIONALS

The United States is a country where freedom of speech is supposed to be a basic right. Administrative power and personal wealth should not give any American the right to infringe on one’s freedom of speech. MANY DOCTORS FEEL THAT a downturn in the economy can create an UPSWING IN VOLUNTEERISM. LACK OF MONEY DOES NOT HAVE TO MEAN A LACK OF SERVICES. MANY OF THESE DOCTORS
ARE VERY CRITICAL OF BLATANTLY INSANE POLICIES BUT ARE AFRAID TO SPEAK OUT FOR FEAR OF PERSONAL REPERCUSIONS.

There are many caring doctors and other health care professionals who intentionally take lower paying jobs and/or volunteer their services because their goal in life in NOT TO MAXIMIZE THEIR BANK ACCOUNT OF MONEY BUT RATHER TO MAXIMIZE THEIR BANK ACCOUNT OF GOOD DEEDS. Many of these people have more global insights into the life-threatening impact and economic inefficiences of certain institutional and political policies. HOWEVER, IN MANY INSTANCES, THERE ARE ATTEMPTS TO INFRINGE ON THE FREEDOM OF SPEECH OF THESE HEALTH CARE PROFESSIONALS. Even well meaning journalists who wish to expose certain inefficiencies in humane health policies are often restricted from reporting.these stories. The executives of these media outlets are too often fearful of “losing revenue” from advertisers when such ‘CONTROVERSIAL” news stories are reported.

THE FOLLOWING ARE A FEW EXSAMPLES OF INSANE POLICIES WHICH FRUSTATE MANY “CARING” HEALTH CARE PROFESSIONALS EVERY DAY:

1. Medicaid rules which DO NOT ALLOW COVERAGE TO REMOVE AN EARLY CANCER BUT REQUIRE PATIENTS TO WAIT UNTIL IT SPREADS THROUGHOUT THEIR BODY.

2. Managers of health care institutions who prohibit cooperative institutional volunteeerism in order to address health care needs of the poor. Example: Executives of dialysis clinics NOT JOINING TOGETHER to keep uninsured patients with kidney failure alive.

3. Executives of hospitals not joining together to provide a few weeks supply of free essential medications to hospitalized uninsured poor patients upon discharge. The reality is often that these patients DO NOT HAVE INSTANT ACCESS TO MONEY OR TRANSPORTATION TO OBTAIN THESE MEDS thus they bounce back to hospital emergency rooms …………uneccesary personal suffering and avoidable expensive rehospitalizations.

4. Incremental increases in upfront fees for outpatient visits with NO EXCEPTIONS.
Therefore patients with VERY LIMITED RESOURCES can’t get essential refills of medications thus they suffer/bouncing back for expensive emergency room visits when their chronic illnesses become life-threatening.

5. Pharmaceutical companies often blast the public with PR CAMPAIGNS about
free medication programs for the poor HOWEVER the companies often create so many time-consuming roadblocks for instant access to these medications that health care professionals cannot get the meds to the patients in a timely manner.

I DO NOT SPEAK FOR MYSELF ALONE BUT FOR MANY HEALTH CARE PROFESSIONALS WHO ARE AFRAID OF NEGATIVE PERSONAL CONSEQUENCES IF THEY SPEAK OUT ON THESE ISSUES.

Neil Shulman MD
Atlanta,Georgia

Indeed. Words spoken today by Lindsay Jones, attorney representing the dialysis patients who have been given a death sentence by the decision to close Grady Dialysis Clinic in Atlanta, GA (see “Do I Have the Right To Live?” and the original post on this story “Grady Hospital Tells Dialysis Patients to Leave or Die.”). Last week the judge in the case ruled that the patients didn’t have any constitutional rights (what about the ones with green cards? You have to be a citizen to have rights? Oh really? What about the right to LIVE?) and pulled the temporary restraining order. Today at the Fulton-DeKalb Hospital Authority (which oversees the Grady Memorial Hospital Corporation, which runs the hospital) run by Pamela Stephenson the Authority announced that it supported the decision to pay for three months of dialysis and then cut themselves loose from patients without insurance or Medicaid. One of them made a little speech about how we should get the other counties in Georgia to help pay for Grady. They said that they were going to make sure that everyone would get appropriate transition, and when we said that the patients had not been told that, Michael Young the CEO of Grady started shouting at us. But then four women stood up who said that they had not even been informed that they got three more months let alone would get help transitioning to other care! (whatever that might be). One of them had already bought her ticket back to Honduras. Last week A.D. “Pete” Correll, ex-head of Georgia Pacific Corporation, shouted at us that Grady was losing too much money. All of this is of course cruel and inhumane and makes me ashamed to be part of a community that just tosses human beings aside like so much garbage. As Dorothy Leone-Glasser of the Grady Advocates for Responsible Care, said, “I don’t know how anyone involved in Grady can sleep at night because I can tell you that none of the patients that we know about — 34 of them — and their families will be able to sleep at night. I dont’ know how they can do it.”

Today in Fulton County court the courtroom was packed with dialysis patients and advocates who were scheduled to have their dialysis turned off last week but for whom a temporary restraining order had kept the Grady clinic in Atlanta GA open until today, I guess. Lawyers for Grady Hospital argued that the patients don’t have a right to healthcare (that one made me kind of wonder) and that Grady (whose mission is to care for the sick and indigent poor) didn’t have any obligation to them. They provided an affidavit saying that 88 patients had been provided with followup. Now I am not a math major, but originally there were 95 patients and there were at least 25 in the court and 95 minus 25 equals…

Oh, and their “followup” was to send at least two to Mexico which doesn’t have long term dialysis, and therefore they will die there.

The lawyer for the patients argued that closing the clinic was sentencing them to death, therefore depriving them of the right to live. I mean, doesn’t the US Constitution give us the right to live? If we have someone on death row for killing someone we spend millions to give them due process, but if they are a Grady dialysis patient we just turn off the plug. People go nuts over pulling the plug on brain dead Terry Schiavo but we have no compunction turning off dialysis.

One of the patients has a green card and is short of one year to qualify for Medicaid. But, I guess, she must die. One was sent to Florida because they said he could get dialysis there but couldn’t get it, had a stroke and came back to Atlanta.

There is something seriously messed up with a country that allows people to die like this. The Judge is supposed to give a ruling today or tomorrow.

Join the FB cause “Protest Grady Hospital’s Death Sentence for Dialysis Patients” here.

Last week I wrote about the situation of the Grady dialysis clinic which the Grady Board voted to close last week. This means certain death for patients treated there without insurance as the private dialysis clinics won’t treat the patients, and emergency rooms will only treat them if they are within two days of death (see “I Need the Dialysis. I Think I will Die.”) This struck some of us in the healing professions as particularly cruel and inhumane, and some of our readers from other countries said we didn’t have the right to call ourselves a civilization if we treated people like that. The 90 or so patients represent a mix of undocumented aliens, people waiting for their green cards, and those who haven’t lived in Georgia for five years and don’t qualify for Medicaid. So far efforts to get private clinics and local teaching hospitals to provide compasionate care have been to no avail.

Last Wednesday local attorney Lindsay Jones, working pro bono, was able to get a court injunction to keep the clinic open. Last Friday the local AJC did some slam dash journalism by picking up the phone and getting someone from the New Jersey Medicaid department who said that they did not provide care for undocumented aliens, in spite of what a spokesman for Grady said. His response was “Nah-ah”.

Tomorrow there is a court date at Fulton County court on Central Ave between Prior and Martin Luther King Blvd in downtown Atlanta. There will be a protest at 8:15 am on the courthouse steps.

This afternoon we met with the lawyer and the dialysis patients.

I spoke with a woman from Nigeria named Ade Abner. She is 43 years old and has been on dialysis for 10 years. She is married to an American who was born in Georgia who is also on dialysis. She works as a registered nurse and is waiting for a green card. She is therefore not an undocumented alien.

Ade Abner
Some of the patients from Mexico said that some people had already gone back to Mexico. The Mexican Consulate, who Grady has been working with, told one woman that she had to leave now or she wouldn’t be able to return later. Feeling pressured to leave she went back. One woman went to Birmingham AL and is currently getting dialyzed in an ER. Others had been offered $2,000 to go back to Mexico, where they would be dialyzed for only three months.

Our friend Senator Max Baucus (D-Mont.) came out with the bill that we had long been anticipating that Judas traitor and bed partner of healthcare industry “stakeholders” would come out with, namely dumping public option healthcare insurance and eliminating the chance that the government could negotiate prices of prescription medications. His plan calls for an expansion of Medicaid and financial penalties to induce individuals and their employers to sign up for healthcare insurance. This will be paid for by cutting Medicare spending to hospitals, taxing family healthcare insurance plans that cost over $21,000 a year, and getting some concessions from industry. This continues his pattern of serving up the grub for his industry partners who contributed so handsomely to his campaign. Too bad for us little guys.

This development caused the stock in insurance companies to rise and led to the comment that the insurance companies had “ducked a bullet”. I thought that was an interesting choice of, well, animals, since we had previously noticed that a congressman had observed that introducing a public health insurance option into the health insurance mix would be like having an “alligator compete with a duck.”

And Billy Tauzin of PhRMA negotiated supposedly negotiated an 80 billion “payment” from drug companies which is essentially the “doughnut hole” between when Medicare stops paying for prescription drugs and when it kicks in again for super high bills. In concession the government gives up the right to negotiate prices, so it really isn’t much of a concession to give up the doughnut hole for drugs that are way overpriced anyway.

Those healthcare industry guys must all be high fiving each other right now. Without a public option and without the government retaining the right to negotiate prices the costs of healthcare will only continue to rise and there will continue to be individuals who are not covered, perpetuating an inhumane and immoral system, that will eventually lead to an implosion of the economy.

Having read the Open Letter to Dr. J Douglas Bremner of Emory University published on September 12, 2009 by Dr. David Gorski in Science-Based Medicine Blog in defense of Dr. Peter Lipson’s criticism of Dr Bremner I was immediately brought back to three articles all published in the 1999 medical literature.

One was by Dr Elliot Fisher from Dartmouth who was among the very first to dare to ask the basic question about “more possibly being worse” in US bio-medicine in JAMA. The second and third articles were from Dr Larry Dossey who then edited The Journal of Alternative and Complementary Medicine who wrote eloquently about intolerance among bio-medical scientists toward even considering Alternative Medicine. (see references below)

I would ask Drs Gorski and Lipson if an iconoclast like Dr Bremner might be serving a valuable role as gadfly to an entrenched failing status quo in bio-medicine who have made the mistake of deifying science? I would posit that the very essence of science is always and incessantly asking the question- “is it possible that I may be wrong?”. And I strongly support the return of narrative- the patient’s individual story- to the practice of medicine. The incomparable Sir William Osler, one of my heros in medicine, knew that well.

I believe that of all the determinants of successful US bio-medicine medicine going forward that a strong dose of humility is in very tall order.

To make progress our egos must die first- a basic psychiatric principle. It is much better and much more important to be tolerant and kind than to be right.

I support Dr Doug Bremner’s role as a colorful and passionate iconoclast. We need more like him.

Dr.Rick Lippin
Southampton,Pa
http://medicalcrises.blogspot.com

Ref-

-Fisher ES, Welch HG. Avoiding the unintended consequences
of growth in medical care: how might more be worse? JAMA 1999;
281:446-53.11.

— Dossey, Larry‘You people’: intolerance and alternative medicine. 1999;5(2):12-
17,109-112