News Capsules (September/October 1998)

Compiled by Medical Sentinel Editors
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News Capsules
September/October 1998
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Kudos to Dr. Curtis Caine

The Mississippi Society of Anesthesiologists recently honored Dr. Curtis Caine, a long time AAPS member and Medical Sentinel editorial board member. On May 1, 1998, Dr. Caine celebrated the 50th anniversary of his practice of anesthesiology in Jackson, Mississippi. His colleague and AAPS member, Dr. Alan R. Peeples writes: “This is a monumental achievement, and in recognition of this occasion, I would like to invite all of Dr. Caine’s friends and colleagues to attend a reception in honor of this milestone.”

Documents have also come into our possession that reveal that Dr. Caine has been fighting collectivism in medicine for almost as long! He deserves our warmest congratulations and our thanks for helping to derail the one-size-fits-all bandwagon of socialized medicine through all these years.


Federal Compliance

In case you missed this in AAPS News: Due to expanded law enforcement powers in Kassebaum-Kennedy (the Health Insurance Portability and Accountability Act or HIPAA of 1996), the federal government has collected more than $1 billion in fines and settlements in health care fraud cases during the last year, a seven-fold increase over fiscal 1996. Federal prosecutors have opened more than 4,000 civil health care matters (an increase of 61%) and filed 282 criminal indictments. The number of defendants convicted for health care related crimes rose from 307 to 363.

The Clinton 1999 budget will include a plan to double the number of provider audits. Fees would be assessed to cover all audits and cost settlement activities (BNA’s HCPR 2/2/98).

Prosecutors see more staffing, more funding, and more legal tools: “They’re going to continue mining the current ore until it’s depleted.” (BNA’s Health Care Fraud Report 01/14/98).

“Providers” can expect:

• Increased use of the mail-fraud statute to freeze assets before indictment.

• Use of the new attorney general subpoena power. Unlike grand jury subpoenas, which have secrecy requirements, AG subpoenas facilitate cooperation among agencies.

• Increased involvement of local prosecutors in defining what constitutes fraud.

• Dramatically increased enforcement of new E&M coding, “You now have a 50-page set of guidelines to follow to document a 45-minute office visit.” More than 6,000 possible combinations for documenting the coding for an office visit have been identified by the ACP.

• More RICO actions brought by private insurers.

• More qui tam actions, especially since the decision in Hudson v. U.S., which ease qui tam relators’ concerns that big penalties might be called double jeopardy.

• More traps, such as HHS hospital compliance guidelines, which get providers to waive attorney-client privilege through voluntary disclosures.

• More trained senior citizen informers.

• More private contractors hired by HCFA to conduct aggressive anti-fraud programs, including the detection of “medical unnecessary services” (BNA’s HCFR 03/25/98). HCFA expects the Medicare Integrity Program (MIP) private contractors to garner a return of 8 to 1 for every dollar spent on Part A audits and 14 to 1 for Part B (Medicare Compliance Alert 03/23/98). [AAPS News, May 1998]


South Dakota to Celebrate Bill of Rights Day

On Friday, March 13, with Governor William Janklow’s signature, South Dakota became the first state in the Union to set aside a special day to celebrate this nation’s Bill of Rights. Bill of Rights Day is dedicated to remembrance of and reflection on the ratification of the first ten amendments to the United States Constitution and their significance for all Americans. State Representative Dana John Windhorst, M.D. (R-Sioux Falls and AAPS member), the prime sponsor of HR1200, said the bill had support from a broad coalition of state and national groups representing the entire political spectrum, as well as individuals with all three South Dakota political parties. “Ideological differences were not an issue as this bill moved through the legislative process,” Windhorst said. “Our differences surface as we try to interpret precisely what the Bill of Rights means, in a nation where too many citizens lack a basic comprehension of this critical part of our government framework.

“Hopefully, this bill will increase understanding of the Bill of Rights by stimulating discussion and debate in our homes, schools, and workplaces every December 15.” The supporting resolution, HCR1016, also encourages South Dakotans to fly the Stars and Stripes on that day.

[Press Release: 1912 South Main, Sioux Falls, SD 57105. 605-333-0700,]


The AMA and End-of-Life Care

The AMA is launching a new initiative, the Patient End-of-Life Care (EPEC), intended to reach all practicing physicians throughout the country within the next two years. As you will recall, the Medical Sentinel editors received a letter from Georgia Health Decisions, which we published in the Correspondence section of the Medical Sentinel (“Preparing Us to Die?” May/June 1998, p. 69), inviting us to participate in an eerily, similar “initiative” funded by the Robert Wood Johnson Foundation.

A press release from the AMA (Chicago, June 15, 1998) expounds: “ ‘For decades the medical profession has focused on the growth of medical technology as a means to preserving and extending life, with death being viewed as the ultimate enemy,’ said Dr. Reardon.

“Through the EPEC Project, the AMA is committed to equipping the physicians of America with the knowledge and skills necessary to ensure that dying patients are comfortable and that their remaining life has value and dignity...

“The educational program will use a ‘train-the-trainer’ model. The train-the-trainer approach will provide education at a host of national and regional conferences and workshops. Physicians selected to attend one of the conferences will be expected to take the knowledge they gain and share it with the many practicing physicians who may never before have received this type of training.

“The program will distribute specially developed continuing medical education materials to all physicians involved directly in patient care. The curriculum will address issues such as: Treating the common symptoms of dying patients; Making decisions about life-sustaining treatment; Delivering the news of a life-threatening diagnosis; Conducting

a basic patient assessment in end-of-life care; Managing imminent dying and bereavement; Handling prognostic uncertainty; Approaching futility situations; and Responding to requests for physician-assisted suicide.”

Andrew Schlafly, General Counsel for AAPS, commented: “This issue of physician-assisted suicide could ruin the medical profession...The AMA is headed towards supporting it, although covertly at first.”

The reader is invited to also check the News and Analysis, “A Medical Duty to Die?” in the January/February 1998 issue of the Medical Sentinel.


Chinagate — Opinion

Although some of the pieces of the Chinagate puzzle were initially provided by The New York Times (May 15 and 17), the mainstream media — including the major TV networks, ABC, CBS, NBC, CNN, and the weekly news magazines, e.g., Newsweek, Time, and U.S. News and World Report —have virtually ignored Chinagate! We now know that while our president in October 1996 was proclaiming, “There is not a single, solitary nuclear missile pointed at an American child tonight, not a single one,” as usual, using the cause of children to advance his political agenda, behind the scene, American corporations were transferring satellite launching and missile guidance technology to Red China. Both the People’s Liberation Army (PLA; $300,000 via Johnny Chung) and Loral Space Technologies and Hughes Electronics ($2.5 million via their CEOs), in typical quid pro quo fashion, as columnist William Safire reports, were donating heavily to the president and the DNC to affect this transfer of technological information while undermining our national security.

Tragically, for the 21st Century, China has now obtained super computer and missile guidance technology to now more accurately aim 13 of their long-range strategic nuclear missiles (CSS-4) at U.S. cities, as recently divulged in a CIA report.

Concerned, on May 20, the U.S. House of Representatives voted overwhelmingly to prohibit the further exportation of satellite technology to communist China (by a lopsided vote of 364 to 54). The mainstream media, as the supposed watchdog of our Republican form of government, has a duty and obligation to investigate and report on these most serious breaches of our national security. Can the media justify the trivialization of the presidential sex scandals and the extensive coverage of Monica Lewinsky, while ignoring the far more serious Chinagate?

If these allegations that supposedly involve the Commerce Department and President Clinton, as described in such reliable publications as The Washington Times, Human Events, and The New American, are proved to be true, the U.S. House of Representatives will have no choice but to fulfill its constitutional responsibility, unsavory as that task may be, and proceed with Representative Bob Barr’s Inquiry of Impeachment. The survival of the Republic hangs in the balance.

Perhaps then, the mainstream media will be forced to provide coverage commensurate with the presidential escapades.


Canadian Doctors Going on Strike or Fleeing the Country

Protesting the government cap on their income and the $90 million gap between it and the value of their services, doctors in British Columbia were going on strike, joining an “epidemic” of similar outbreaks throughout Canada from rural Alberta to eastern urban Quebec. In Quebec, nurses are joining in, complaining they are “burned out.”

A June 19, 1998, Wall Street Journal editorial entitled, “Doctors Who Go on Strike,” reports: “‘Free’ medical care provided by a monopoly supplier predictably creates demand that outstrips supply, feverishly pushing up prices. Provincial budgets cannot pay for unrestricted medical care unless health care providers take the hit; enter wage and price controls. The distorted market creates shortages. According to British Columbia’s medical association, the wait for coronary bypass surgery in the province is now 30 weeks — not 15 as the province claims — and patients are dying because of the delay. The end result is that in a system that is supposed to treat everyone the same, only the rich can get good service — out of the country.”

The Canadian Medical Association (CMA), which cooperated with the government in socializing the Canadian health care system, is now urging the government to “find a way to heed Canadian physicians in Canada...According to the president of the CMA, Dr. Victor Dirnfeld, the country had a net loss of 513 doctors in 1996. ‘We are losing not only our best and brightest, but often our most committed physicians.’ ”

Moreover, the Canadian government is also “concerned about a serious shortage of nurses, who are also fleeing the country.”


Risks in the Home

Writing in Risk in Perspective, a publication of the Harvard Center for Risk Analysis (April 1998), Jennifer L. DeAscentis and John D. Graham, PhD, rank the ten potential unintentional hazards in the home, based on the available scientific evidence and risk analysis data:

1. Inhaling Radon Gas — Inhalation of this gas can cause fatal lung cancer, and most of this risk is incurred by smokers. The average annual risk to the general population is 5.8 per 100,000 persons; 2. Falling — The average risk is 3.1 per 100,000 persons. Older citizens are particularly at risk (head injuries from falling down stairways); 3. Poisoning — Corresponds to an average risk of 3.1 per 100,000 persons; 4. Fires and Burns — The annual risk is 1.1 per 100,000 persons; 5. Suffocation (obstruction of respiratory passages) — The average annual risk is 0.8 per 100,000 persons; 6. Firearms — Accidental discharge of firearms results in a risk of 0.3 per 100,000; 7. Environmental Tobacco Smoke — The evidence is not entirely convincing, but it suggests that women who never smoked but live with heavy smokers are at elevated risk; 8. Formaldehyde Gas and 9. Insulation Fibers — The weight of scientific evidence is plausible, but not definitive; 10. Electric and Magnetic Fields from Power Lines — Over 10 years of epidemiological and scientific research worldwide has provided weak support for the hypothesis that exposure to these agents are a risk factor for cancer.

I suspect this data will not be warmly received by the CDC/NCIPC researchers who, with their pre-ordained research, seek to make guns an “epidemic” and the number one public health enemy.

Dr. John Graham is the former Director of the Harvard Injury Control Research Center.


PRK Lasers and the FDA

In a Fall 1996 Medical Sentinel News Capsule (“Warning!” p. 5), we disclosed that the FDA and FTC had approved only two lasers for use in PRK eye surgery, e.g., those manufactured by Summit Technology and VISX. The FDA warned surgeons they must use FDA-approved lasers — namely, those by Summit and VISX — or, “We will take action against illegal products in the market place.”

As the state is wont to do (and those mega-corporations that seek monopolistic government protection for their services and products, beware), the FTC has turned around to bite those it formerly favored and protected in the “marketplace.” The FTC has now reversed itself and alleges price-fixing by makers of PRK lasers — you guessed it: the Massachusetts-based Summit Technology, Inc., and the Santa Clara, California-based, VISX. They are charged “with conspiring to exclude rivals and fix prices for laser eye surgery by pooling their competing patents and imposing an above-market, per-procedure royalty on physicians and optometrists who purchased their equipment,” writes Sarah A. Klein in AMNews, April 13, 1998.


The Climate Change Petition Project

Many publications have misled and scared the public into believing, not only that global warming is occurring via the greenhouse effect of human activity (namely, the burning of fossil fuels and release of carbon dioxide into the atmosphere) with cataclysmic consequences for our planet, but also into believing that there is a global warming scientific “consensus,” as proclaimed erroneously by the UN-sponsored, Inter-governmental Panel on Climate Change (IPCC).

While last fall, the Union of Concerned Scientists (UCS) compiled a list of 1,093 scientists (the IPCC list) which featured prominently on ABC‘s World News Tonight and in newspapers (e.g., The New York Times), the more recent Petition Project, stating there is no such global consensus on global warming, and signed to date by ten times as many scientists (16,000 scientists), has not been given the same publicity. The Petition Project reads:

“We urge the United States government to reject the global warming agreement that was written in Kyoto, Japan in December 1997, and any other similar proposal. The proposed limits on greenhouse gases would harm the environment, hinder the advance of science and technology, and damage the health and welfare of mankind.

“There is no convincing scientific evidence that human release of carbon dioxide, methane, or other greenhouse gases is causing or will, in the foreseeable future, cause catastrophic heating of the Earth’s atmosphere and disruption of the Earth’s climate. Moreover, there is substantial scientific evidence that increases in atmospheric carbon dioxide produce many beneficial effects upon the natural plant and animal environments of the Earth.”

The scientific review article supporting the substance of this petition — which was written by the well-respected scientists Arthur Robinson, PhD, Sallie Baliunas, PhD, and associates at the Oregon Institute of Science and Medicine and circulated by Doctors for Disaster Preparedness (DDP) — was funded only by the after-tax dollars of concerned Americans. (See the lead article on this topic beginning on page 171 of this issue.)

The reader may also want to peruse the News and Analysis, “Global Warming,” in the March/April 1998 issue of the Medical Sentinel, as well as the Correspondence exchange on this topic beginning on page 156 of this issue.


Chinese Organ Transplantation

President Clinton began his 9-day tour of Red China on June 24, 1998. We wonder whether within the context of human rights he discussed the detestable practice of forced abortions and the less known but equally atrocious practice of trafficking in human organs for transplantation to those who can pay with hard, cold, capitalist cash.

On March 6, 1998, Human Events reported how two Chinese men were arrested in New York City (February 20) for allegedly plotting to sell organs extracted from executed Chinese prisoners to U.S. hospitals. More recently, authorities have discovered the PLA has made millions of dollars in profits from the sale of organs of executed Chinese prisoners, many for petty thievery.

One of the men arrested, a former prosecutor, was responsible for securing organs for transplant and coordinating services with the Chinese government. Much of this information came to light, ironically, while the president was being wined and dined amidst the pomp and pageantry of his Red China tour.


Autos vs. Guns

And talking about relative risks: A CDC anti-gun study (Morbidity and Mortality Weekly Report, January 28, 1994) claimed gun deaths would surpass automobile fatalities by the year 2003 unless “the multifaceted, science-based approach to reduce mortality from motor-vehicle accidents” were applied to guns and violence. This, of course, would mean mandatory trigger locks; locked, unloaded guns with separate storage of ammunition in the home and in your car; that is, until the ultimate goal of banning and confiscation is achieved.

To the CDC’s chagrin, writes The New American writer, Robert W. Lee (Sept. 15, 1997), “the National Center for Health Statistics recently reported that while gun deaths peaked in 1993, then declined in 1994 and 1995, automobile-related deaths increased in 1993, 1994, and 1995.”

The reality is that when you compare apples to apples, that is, accidental motor vehicle deaths to accidental gun-related fatalities, the figures for 1995 are 43,900 vs. 1,400 deaths (or over 30 times as many automobile deaths as gun deaths). Other major causes of accidental death were falls 12,800; poisoning 10,600; drowning 4,500; fires/burns 4,100; suffocation with ingested foods or objects 2,800, etc.


The Private Sector and Government Control

Continued review of Task Force documents, the new initiatives of major Task Force players such as the RWJF, and the incremental bills being enacted at both state and federal levels, suggest that the agenda is possibly much broader: a reinvention of American society, with foundational principles cloaked in “public health.”

The Task Force clearly recognized that the Clinton Plan would face legal challenges. Some of the most troubling documents at the National Archives concern the use of the private sector and limited opt-out provisions to overcome these obstacles.

Excerpts from a memorandum to Walter Zelman from members of the Department of Justice, found in Box 1796 of Task Force documents at the National Archives:

...“Where the treatment sought is medically necessary — and particularly where a life-threatening condition is involved — it is entirely possible that the courts would impose some constitutional limits on the Government’s ability to impose, for economic reasons, restrictions on a patient’s ability to obtain treatment for which he or she is willing to pay...

“[S]erious issues are presented if the system operates to deny or limit the opportunity of some doctors to all...These difficulties are reduced in a system that utilizes private entities as the health care cooperatives or HMOs. The Supreme Court has allowed private entities to become very heavily involved in federal regulatory schemes without becoming governmental actors subject to due process restrictions....There appear to be few substantive limits on the nature of the authority that Congress may vest [in private entities].” (AAPS News, May 1998)


Connect to the “Net”

Interesting websites:

Waco: The Rules of Engagement videotape, discussion and critiques available at

E&M Documentation Guidelines [Medicare Dept.], the Zelman memorandum and other Task Force documents [Clinton HC Task Force]:

Access the Thomas Home Page at for a multitude of free and up-to-the-minute full text and status of all legislation and the Congressional Record.


U.S. Sentate Vote Regarding Private Contracting Concerns Georgia Physicians

 By a narrow vote of 51 to 47, members of the U.S. Senate on April 1, 1998, expressed support for a resolution stating that senior citizens should be able to spend their own money on medical services that they want from a doctor of their choice, whether or not Medicare covers those services.

The resolution was a nonbinding “Sense of the Congress” resolution offered by Senator Jon Kyl (R-AZ) as an amendment to the Budget Resolution (Sen. Con. Res. 186) and cosponsored by Senators Phil Gramm (R-TX), Ernest Hollings (D-SC), Bill Frist (R-TX), Pete Domenici (R- NM), Slade Gorton (R-WA), and Majority Leader Trent Lott (R-MS).

The key language of the Kyl amendment reads as follows: “It is the sense of the Congress that seniors have the right to see the physician or health care provider of their choice, and not be limited in such a right by the imposition of unreasonable conditions on providers who are willing to treat seniors on a private basis.” Amazingly, this is what 47 Senators voted against. (AAPS News, May 1998)

At a recent meeting in Macon, Georgia, AAPS member, Dr. Terrill Schneider of Warner-Robins, Georgia, exclaimed: “What is clearly and deeply disturbing is that 47 Senators, in socialistic fashion, voted against this freedom of choice proposition.”


Dr. Michael Gloth for U.S. Senate

The Maryland race for U.S. Senate has a very different candidate this year. F. Michael Gloth, III, M.D., an AAPS member and a physician who works primarily with the elderly in Baltimore and as Medical Director of Carroll Hospice, has filed as a Republican challenger for the upcoming U.S. Senate race. He is currently Chief of Geriatrics at Union Memorial Hospital and on faculty at both Johns Hopkins and the University of Maryland medical schools.

The Gloth for “U.S. Senate campaign” is focusing on health care, education, juvenile crime and drug abuse, and taxation as key issues against an entrenched Democratic incumbent.

More information can be obtained from his website at And, good luck to Dr. Gloth!


Books in Brief — Guns and Violence and Public Health Issues

 More Guns, Less Crime — Understanding Crime and Gun Control Laws by John R. Lott, Jr., PhD, The University of Chicago Press, Chicago, IL 60637, 1998, 225 pp., Index, ISBN: 0-226-49363-6, $23.00 (Hardcover), Fax (773) 702-9756, web site:

In this most momentous book, Professor John R. Lott, Jr., studied the FBI’s massive yearly crime statistics for all 3,054 U.S. counties over 18 years (1977-1994), the largest national survey on gun ownership and state police documentation in illegal gun use, and comes to some startling conclusions:

1. While neither state waiting periods nor the federal Brady Law is associated with a reduction in crime rates, adopting concealed carry gun laws cut death rates from public, multiple shootings (e.g., as those which took place in Jonesboro, Arkansas, and Springfield, Oregon, this year, or the 1993 shooting on the Long Island Railroad) — by 69 percent.

2. For each additional year that concealed carry gun laws have been in effect, the murder rate declines by 3 percent, robberies by over 2 percent, and rape by 1 percent.

3. Children 14 to 15 years of age are 14.5 times more likely to die from automobile injuries, 5 times more likely to die from drowning or fire and burns, and 3 times more likely to die from bicycle accidents than they are to die from gun accidents.

This book debunks much of the sensationalized mythology surrounding what has been published in the medical literature based on the politicized, results-oriented gun (control) research of the public health model, and supports and elaborates on Profs. Don B. Kates’ and Gary Kleck’s previous research about the benefits of gun ownership by ordinary citizens, albeit from different perspectives.


Guns — Who Should Have Them? Edited by David B. Kopel, JD, Prometheus Books, Amherst, New York 14228-2197, 1995, 475 pp., Index, ISBN:0-87975-958-5, $25.95 (Hardcover), (716) 691-0133, Fax (716) 691-0137.

Each chapter in this powerful volume will help the readers cut through the rhetoric and sensationalism that frequently surrounds the gun control debate, and get to the heart of the matter as supported by the available data.

Written by the leading experts in law, criminology and medicine, this volume includes such headings as “Arms and the Woman”; “Doctors and Guns,” further rebutting the arguments that guns are a public health menace; and “Children and Guns,” dissecting the contentious and timely issue of guns and violence in our schools. It compliments David Kopel’s previous masterpiece, The Samurai, the Mountie, and the Cowboy: Should America Adopt the Gun Controls of Other Democracies? honored as the 1993 Book of the Year by the American Society of Criminology’s Division of International Criminology.


Safeguarding Liberty — The Constitution and Citizen Militias Edited by Larry Pratt, Gun Owners Foundation and Legacy Communications, P.O. Box 680365, Franklin, Tennessee, 37068, 1995, 362 pp., Index, ISBN: 1-880692-18-X, $14.00 (Softcover) plus $3.00 shipping and handling.

This book is a collection of 15 essays on the constitutional rights associated with the Second Amendment. Larry Pratt, Executive Director of Gun Owners of America (8001 Forbes Place, Suite 102, Springfield, VA 22151, 703-321-8558, has assembled a collection of writings for Americans who are concerned with the erosion of their basic civil liberties, providing a historic background on how these fundamental rights can be protected from an ever-increasing government. This book is a welcomed addition to Larry Pratt’s 1990 little jewel, Armed People Victorious, that recounts the stories of how two countries as dissimilar as Guatemala and the Philippines, teetering on the brink of disaster, turned defeat into victory when the governments recognized the need of the people to form armed militia to protect themselves from communist insurgents in the 1980s.

The first two volumes will enlighten you as to the theme of guns and violence as a public health issue. The third book, Safeguarding Liberty, will point out the relevancy of the Second Amendment in modern society. All three of these volumes are must read tomes that belong in the library of all concerned citizens who abhor violence and crime, and cherish the freedom enshrined in the Second Amendment.


Originally published in the Medical Sentinel 1998;3(5):158-163. Copyright © 1998 Association of American Physicians and Surgeons (AAPS).





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