Archive for the ‘“Healthcare” Reform’ Category

Prostatic Cancer: One Man’s Story (Part Three)

Monday, January 31st, 2011

It had been one year since Don’s last visit to the local urologist. During the interim, he had been free of genital-urinary signs or symptoms except having noted diminishing, slight discomfort with ejaculation.

Two days prior to his follow-up, Don appeared on time for a phlebotomist to draw a sample to determine his PSA-level. He felt relaxed and optimistic. Three days later, the urologist’s receptionist telephoned with the report. His level had increased to slightly above where it had been when the nightmare had begun.

At the follow-up, the local surgeon reported that Don’s urinalysis was clear and that the DRE revealed no new abnormalities. He recommended a repeated determination of the PSA in four months. As the weeks passed, Don’s anxiety increased. Finally, two months later, Don himself requested a repeat. The repeat essentially was the same as its predecessor . . . high-normal.

Continuing to feel mounting anxiety, Don inquired about a repeated determination of his PCA-3. No, the local urologist did not provide that service. In desperation, Don telephoned Nurse Karen. His wife made arrangements for Don and her again to travel to “the big city”, which, as a consequence of respondent conditioning, Don had come to loathe.

Several weeks later in an examining room, Nurse Karen reported that Don’s PSA-level had risen a tad above the magical, normal level of 4.0 ng/ml. (Actually, depending upon the referential source, the upper limit of normal for men his age can run as high as 7.2.) Don’s anxiety felt as though it were shooting through the top of his head. Even so, he was there to measure his PCA-3 not his PSA. Nurse Karen obliged with a prostatic massage with Don contributing a sample of urine. He made an appointment to see the famous urologist while there.

“Why?” he later asked himself. He had no answer.

Two days passed. The result of the PCA-3 would not be available for several more days. It was mid-morning when a middle-aged physician’s assistant escorted Don to a different examining room. The anxious patient sat alone waiting. Then, the urologist entered, appearing less harried than previously.

“Six patients probably cancelled this morning,” Don silently joked to himself.

Given the patient’s refusal to undergo another biopsy, the urologist recommended a repeated determination of the PCA-3, employing a substantially more vigorous prostatic massage; and, in addition, obtaining an MRI of the prostate using the most advanced equipment. Don agreed. The MRI was completed late that afternoon. The following day, Don and his wife departed for home.

It took almost a week of leaving telephonic messages before Don made contact with Nurse Karen. The PCA-3 from her massage had risen from three years previously but still was less than half the upper limit of normal. The more vigorous massage by the urologist produced a result only a tad higher. The MRI showed some non-specific areas of concern; possibly an area of low-grade prostatitis but no definitive cancer. Nurse Karen suggested a repeated MRI in one year. Don felt relieved.

The following day shattered whatever equanimity that he had mustered. Nurse Karen telephoned. She had spoken with “the boss”. Instead of waiting a year, the famous urologist recommended an immediate biopsy. She offered no reason.

Anxious and confused yet again, Don made an appointment with the local urologist. After reviewing the results from “the big city”, the surgeon shook his head with a frown, informing Don that he was unimpressed with the validity of either the PCA-3 or the MRI. He recommended waiting and watching with a repeated PSA-determination in three months.

Three months of mental anguish later, Don again returned to visit the phlebotomist at the local surgeon’s office. Returning home, he took his own blood pressure . . . 180/100 mm; the upper limit of normal being 140/90, recently revised downward by some to 130/80. (The consequence of that downward revision has been to rob thousands of people who previously would have considered themselves to be enjoying normal pressures of their sense of well-being; place them onto expensive anti-hypertensive medications; and elicit chronic anxiety, depression, or a combination of both . . . all likely to aggravate their newly re-defined malady.)

Don went to the cabinet, fetched a blue vial, then swallowed a five mg.-tablet of Valium to relieve his own anxiety. Two hours later, he swallowed another. He felt like Hell. “Maybe, the old, paternalistic model of letting your M.D. decide what you need to hear wasn’t so bad,” he commented to himself.

Three days later, the telephone rang. His PSA-level had risen to 4.05 ng/ml. The receptionist advised him that the local urologist now concurred with his famous colleague. Don’s prostate required a second biopsy. Would he like to schedule the procedure for the following week? Don declined the offer.

“What if it’s benign again?” he later asked his wife in a pleading tone. “How many biopsies should I have? The DRE is unchanged. The PCA-3 is normal. The MRI reveals nothing . . . well, maybe, some slight prostatitis, which, by the way, could account for my fluctuating PSA. What should I do? Damn . . . damn . . . damn! Tell me, what should I do?”

His wife listened silently but sympathetically. She sensed that her husband’s negative emotional strain was spiraling beyond his cognitive control.

Not waiting for an answer, Don continued, “Maybe, I’ll discuss it with the internist.”

That last comment exceeded his wife’s tolerance. “Don’t be ridiculous!” she exploded. “Your entire visit will last less than ten minutes, at most. Are you totally obtuse? Look at the consequences of his behavior . . . for him not for you. What does he get out of giving you the time and attention you want and need? Medicare pays him a mere pittance. He’ll have you telling your story to some low-paid nursing assistant.”

“I’ll offer to pay him more . . . out-of-pocket.”

“You know he can’t accept it. It’s illegal! You’re lucky he’ll see you, at all. You know, someday the few competent physicians remaining won’t be accepting Medicare anymore.”

“Well, I need to talk to somebody today not someday . . . somebody knowledgeable.”

“Don, face it! The days of the concerned physician giving his patients time to air their complaints are dead. The federal government began murdering them slowly in 1964 with Medicare and Medicaid. ObamaCare will put the final nail into the coffin. Can you imagine politicians’ voting for a radical change in American medicine without having read the legislation?”

“Yes. Anyway, what should we do . . . shoot them?” Don muttered.

“I’d not be surprised if people do,” her voice rising with exasperation.

“Hopefully not,” he replied seemingly without conviction.

Calming herself, she continued, “Politics aside, forget about seeing the internist. Nineteen seconds . . . nineteen seconds, Don. That’s how long the average physician listens to the average patient. The federal government has turned patients into customers. Like any other customer, you’ll be choosing your brand of treatment on your own.”

Don looked at her dumbly. He lifted the handset and pushed the numbers.

“You have reached our medical offices. Your call is very important to us. All personnel are busy helping other patients. Please remain on the line, and your call will be answered in the order it was received. If you have a life-threatening emergency, hang up and dial 911.”

After waiting ten minutes, he slammed the handset into the belly of the telephone. His wife watched as her husband began pacing the room between the window and the wall opposite. Her eyes filled with tears, which overflowed when he began mumbling to himself in an anguished, rhetorical perseveration, “What should I do . . . What should I do?”

Rising from her seat, she wiped her eyes. She walked toward her husband, blocking his path. With a smile, she approached him. She placed her arms around his neck and hugged him tightly. She released her grip and stepped back. Her smile vanished, replaced by a look of grim determination. Then, the force of her voice struck him like a slap in the face.

“Forget about seeing the internist. Forget about the biopsy. Forget about them! You don’t have cancer. Just schedule your next PCA-3 and MRI in six months. If there’s a definitive change, deal with it then. Are you blind? You’re a dentist. You have a medical background. Can’t you see? The real question is less what you should do about your prostate and more what America should do about its medical system.”

Don looked at her sorrowfully and muttered, “You’re right. I am a dentist.”

“So, Doctor Dentist, what’s your answer?”

“Science.”

“What?”

“Science. Employ science to reform the medical system [See Chapter Seventeen in the novel, Inescapable Consequences (www.inescapableconsequences.com).]”

“Science not politics . . . interesting idea. You may have something there, Doctor Donald.”

“Yes, but it won’t happen. ”

“Maybe not, but it can.”

– End –

Prostatic Cancer: One Man’s Story (Part Two)

Monday, January 24th, 2011

Don’s wife had instructed the driver to deliver them to the hospital where the biopsy had been performed. Initially, the driver refused, demanding delivery to the hospital from which the ambulance had come; there would be no financial advantage in his doing otherwise.

In a calm but determined voice, Don’s wife replied, “If you don’t take us where I told you, I’ll have you prosecuted for kidnapping.” The driver merely acquiesced with a nod. As he reluctantly headed toward where he had been directed, he took a wrong turn down a dead-end street. Reversing course, he tried again.

Eventually arriving at the ER, the driver and his assistant wheeled Don into the midst of mayhem. Patients lying on gurneys were lined down the long hallway. Staff rushed here, there, and everywhere. After some discussion and completion of paperwork, Don’s stretcher became added to the line.

Given his age, the immediate concern, such as there was, focused upon his heart and brain; secondarily upon his badly bruised left rib-cage. He had fallen against the porcelain-bathtub, fortunately striking his chest not his skull. Periodically throughout the night, someone moved him to perform another diagnostic test. With foresight, his wife had brought with her his medical records. A copy of his previous, normal but peculiar EKG saved him from admission to the Cardiac Care Unit. With no place to sit, let alone to sleep, sometime during the early hours of the morning, his exhausted wife returned to their hotel.

A few hours later with the arrival of the Day-Shift came the appearance of his urologist. By then, Don’s dizziness largely had dissipated, and he was urinating normally. The urologist asked how his patient was feeling. He offered no apology for the events of the previous night. He did advise his patient that he would arrange for discharge. He further advised Don that he would notify him when the results of the biopsy became available.

Two days later, after the usual demeaning experience with so-called airport security followed by an especially uncomfortable trip squeezed into a tight seat into which overflowed a morbidly obese, obviously ill, older woman, Don arrived home with his wife. The following day, Don spiked a fever accompanied by sore throat and cough productive of white sputum. Unable to clear his airways adequately without experiencing severe pain in his ribs, he watched anxiously as his white sputum began turning an ugly yellowish-brown and his fever continued rising. He telephoned his internist.

“You have reached our medical offices. Your call is very important to us. All personnel are busy helping other patients. Please remain on the line, and your call will be answered in the order it was received. If you have a life-threatening emergency, hang up and dial 911.”

After waiting ten minutes, a receptionist answered only to transfer Don to the “voice-mail” of the internist’s nurse. Hours later, she returned Don’s call. The internist had prescribed an antibiotic, which Don began taking immediately and which probably saved his life. By the next day, his cough was diminishing as was his fever. “Sometimes, diagnosis by telephone can be effective . . . statitical Law of Averages, I suppose,” he commented to himself.

As he did monthly, he telephoned his elderly aunt in England. Her younger sister had been taken to hospital with a “heart-condition”. She had returned home with the recommendation for a cardiac monitor. The British National Health Service could furnish none from the public trough for at least three weeks. On the other hand, were she willing to pay from her own private pocketbook, one would be available immediately.

One week later, Don’s telephone rang. “You’re free of cancer,” said the famous urologist. He advised follow-up in six months.

After the wave of relief had passed, Don reflected on his experience. He realized that the consequences of his diagnostic biopsy, which had proven normal, were that he almost had died twice . . . once from the syncope in the hotel and once from the respiratory infection.

When the documents containing “Explanation of Benefits” arrived, Don was surprised by the small percentage of the total billing that Medicare and his supplementary plan were paying both hospital and physician. He himself owed nothing. “Time spent as a function of money earned . . .  less money, less time,” Don mused, “and haste makes waste.”

Don’s wife was more outspoken. “Politicians buying patients’ votes at the expense of physicians and hospitals,” she commented.

Six months later, he returned to “the big city” for his follow-up. With his blood having been drawn the previous day for a PSA-level, Nurse Karen was advising him of the result. It had fallen somewhat. The nurse performed a DRE of his prostate, finding no new abnormalities.

Readying himself to leave, Don watched as the door to the examining room swung open followed by the entrance of the urologist. Expecting congratulations on his status, Don was shocked when the urologist advised an immediate, fifty-point, saturation-biopsy under general anesthesia. Apparently during the interim since his fourteen-point biopsy, a study had indicated that men with fluctuating levels of PSA were at higher risk for cancer than others. With that recommendation, the urologist abruptly departed.

Shaken, his wife and he headed toward the elevators. In the hallway, Don noticed the urologist conversing with a small group of other physicians. He approached the group and asked to speak with the man privately. Standing in the open hallway, the seemingly distracted surgeon advised him that there remained a twelve percent chance that Don was not free of cancer but agreed that he could wait three more months before the recommended, radical biopsy; however, he suggested that Don have a new test called a PCA-3 that supposedly would be more specific for prostatic cancer than the test for PSA. Don agreed.

Technically, prostate cancer antigen 3 (PCA-3) is a gene that produces a non-coding messenger-ribonucleic acid (m-RNA). M-RNA instructs cells to produce particular proteins. PCA-3 is overly expressed in prostatic cancer. Technicalities aside, some experts now claim specificity of the test for cancer is as high as ninety-eight percent. At the time of Don’s test, however, they regarded it as experimental.

As recommended, Don returned to the clinic the following day. Nurse Karen performed a moderately uncomfortable, prostatic massage followed by Don’s donating a sample of urine for the test. The next day, his wife and he departed for home.

Several days later, Nurse Karen telephoned to report that the results of the PCA-3 were well within normal limits. What to do?

Don decided to consult the local urologist. After reviewing the records, the surgeon recommended a conservative approach. Over the following two years, Don’s PSA decreased to its level pre-biopsy. The local urologist pronounced, “You don’t have prostate-cancer.”

Don recalled a similar, previous pronouncement from the urologist in “the big city”. He wondered whether he should feel relieved or worried.

To be continued.

Prostatic Cancer: One Man’s Story (Part One)

Monday, January 17th, 2011

The following tale is based upon a true story:

“Your lab-work looks fine except . . . .,” the internist said to his patient. The internist was one of a growing number of “primary care physicians” who refuse to follow their patients in hospital. Instead, they leave that care to a group of “hospitalists”, none of whom knows the patients, and none of whom do the patients know.

The year previous, this particular patient had presented in the Emergency Department in acute distress following minor surgery earlier that day at the same hospital; yet, his medical record was unavailable. He appeared mildly confused and complained of inability to urinate since leaving the outpatient surgical center there. A battery of “stat” lab-tests revealed a serum-sodium dangerously low. Hearing that the patient had been catheterized, the hospitalist summoned from the Medical Unit misdiagnosed him as suffering from septicemia secondary to chronic prostatitis. He admitted the patient to the hospital and compounded his diagnostic error by prescribing an antibiotic inappropriate to his misdiagnosis. A day later, the correct diagnosis came from a young oncologist, an acquaintance of the patient, as the two passed in the hallway; the bloated patient pushing his IV-stand in front of him. In fact, whether he might have had a mild case of chronic prostatitis from which there were no signs or symptoms, acutely he was suffering from Syndrome of Inappropriate ADH (a hormone from the brain that controls urinary output from the kidneys). SIADH is a self-resolving, acute condition that can be the consequence of general anesthesia. Although notified several times by the patient’s wife, the patient’s internist never responded in person or by telephone.

One year later, facing the same internist, the patient asked with an alarmed expression, “Fine . . . except what?”

“Your PSA.”

PSA is an acronym for Prostate-Specific Antigen, a marker for prostatic cancer. Specific to the prostate, it actually is rather non-specific with regard to prostatic cancer, rising and even falling as a consequence of a number of possible factors from transitory inflammation to normal ageing. It, nevertheless, remains a routine, screening test in the USA but largely has been discontinued as such in the UK.

“It’s still within normal limits at 3.46 ng/ml, but it’s risen during the past year from 2.81. Given the velocity of the rise, it looks suspicious. I suggest that you consult a urologist. Take a copy of the lab-work with you.” The internist bid the patient a hasty good-bye with no further comment; other patients in other examining rooms were waiting. The internist would never discuss the case with the local urologist or any urologist.

The sixty-nine year-old dentist departed filled with anxiety. Prostatic cancer not only is the most common cancer among men, it is universal. By age seventy, thirty percent of men at autopsy have it. By age one hundred, one hundred percent do. Was he, Don Ferguson, one of the thirty percent?

One week later, a local urologist in the small city in which Don resided removed his finger from Don’s rectum with a sigh. “Well, you’ve got a small, non-tender nodule in the left apex of the prostate.”

“Cancer?”

“Only a biopsy will tell us with certainty. Remember, most men die with their prostatic cancers not from them.”

Unfortunately, the urologist’s comments were only partially true. Actually, pathologists read thirty percent of prostatic biopsies as false negatives, meaning that the sample is malignant but mistakenly reported as benign.

Don Ferguson was not a physician, but, being a newly retired dentist, he possessed a medical background. His immediate response was to do what many others in his situation do . . . he consulted websites on the Internet. Fearful of requiring surgery, he investigated what might be the best surgical centers in the country, should he require it. He selected a prestigious one in “the big city”, where lived a number of his friends. Then, after many telephonic calls speaking to receptionists, one finally connected him with a surgeon renown for his work with prostatic cancer. Given Don’s history, the urologist re-assured him that the odds were in his favor that he did not have cancer; nevertheless, he did require a biopsy. Feeling somewhat relieved, Don scheduled a biopsy for two weeks hence and dispatched his medical records via facsimile to the urologist.

Two weeks later in the mid-afternoon, having prepared himself as directed for the biopsy and having completed the required forms, he sat with his wife in the crowded waiting room. Two hours had passed since the scheduled time for the biopsy when a pleasant-looking woman of middle-age wearing a white coat summoned him into the hallway. She introduced herself as Nurse Karen, a “Nurse Practitioner”. Almost in a whisper, she advised him that the urologist himself had been delayed in surgery, requiring cancellation of all patients waiting in the office . . . all patients but him. Don thanked her for her consideration and returned to the half-emptied waiting room.

One hour later, a young man in “scrubs” summoned Don and led him into a room filled with equipment. Nauseated by anxiety, Don changed into a hospital-gown then placed himself onto the operating table. As instructed, he turned onto his left side. A few minutes later, the obviously harried urologist entered, introducing himself almost as a formality. He quickly performed a digital rectal examination (DRE) of Don’s prostate, after which he told Don that the nodule did not feel cancerous and that the odds were better than eighty percent that the biopsy would prove benign. Don sighed with relief.

Shortly thereafter, having completed the essentially painless procedure, the surgeon abruptly left his patient to the care of the Physician’s Assistant. The young man instructed Don about what to expect in terms of blood in his urine and semen. Should he experience urinary retention as a consequence of prostatic swelling from the biopsy, the man handed him a bottle of pills, a commonly used medication that would block the alpha-sympathetic nervous system, presumably relieving the retention. No member of the large, busy staff had noticed the entry in the medical record that Don already was taking a medication that blocked the beta-sympathetic nervous system in order to prevent infrequent, brief bouts of a cardiac arrhythmia known as Paroxysmal Atrial Fibrillation. The combination of the two medications could block completely Don’s ability to maintain adequate blood-pressure, especially when standing.

In fairly good spirits, Don and his wife returned via taxi to their room at a local hotel. The hour was getting late, so they ordered sandwiches delivered from a local delicatessen and decided to pay to watch a movie on television. Don tried to urinate, but only a few drops of bloody fluid dripped into the toilet. He decided to take one of the pills given him that afternoon.

Later with the movie ended and feeling gastronomically satisfied, Don felt some urge to urinate. He stood to walk to the bathroom. As he did so, he noted feeling a bit light-headed. Closing the door behind him, he sat on the commode and began urinating. The dizziness abated a bit. When he went to stand, his world ended without warning.

Moments later, opening his eyes, he looked up at the ceiling. He felt the door pushing hard against his right chest and heard his wife yelling repeatedly .”Don, are you all right? Are you all right? I heard a crash.” Lying on the tiled floor in silence, he turned to his left in order to allow the door to open, sending a jolt of pain throughout his left rib-cage. His wife looked horrified. She helped him to his feet, causing some recurrence of the light-headedness. Together, they stumbled to the bed. Lying down, he felt better although he recognized his thinking was fuzzy.

“We’re going to the Emergency-Room,” his wife announced. “I’m calling an ambulance.”

“Don’t be silly. We can take a taxi. I’ll be all right.” Don lifted himself from the bed. Feeling only slightly dizzy, he put on his coat. As he began walking toward the door, his world ended again.

Some minutes later, opening his eyes, he looked up. A group of men stood over his body sprawled on the carpeted floor. He heard them talking amongst themselves.

“Let’s move him onto the bed,” one said.

As they helped him to his feet, the dizziness recurred. Lying on the bed, he watched a paramedic, recently arrived, insert a large needle into a vein in his left arm. The needle connected to a tube that connected to a bag of clear fluid. Several men then placed him onto a stretcher and wheeled him to an elevator then through the lobby to an ambulance waiting at the curb. His wife followed. She sat next to him as the vehicle pulled away from the curb, its siren deafening pedestrians nearby.

To be continued.

“HEALTHCARE” IS NOT MEDICINE

Monday, September 6th, 2010

Walter Reed Army Medical Center (WRAMC) has several divisions, one of which is Walter Reed Army Institute of Research (WRAIR). Entering the Army as a Captain in the late 1960’s, I was assigned to WRAIR as a Research Psychiatrist.

Instead of being stationed at “The Main Section” in D.C., I was stationed at “The Annex” in Silver Spring, Maryland. The facility had been a girls’ school expropriated by the Army during WWII. Dedicated to research, unlike at The Main Section, the atmosphere among officers and enlisted men was relatively cordial and informal.

One afternoon, I stood chatting with Gerry, a draftee assigned to the Department of Psychiatry, one part of the Division of Neuropsychiatry. The young man obviously was quite intelligent and well-educated. We’d been chatting about nothing in particular when the conversation drifted to our respective, future plans.

“What are yours when you leave?” he asked.

“Academia,” I replied. “Continue my research . . . UCLA, in fact. Yours?”

“Harvard School of Public Health.”

“Really? Why not medical school?”

“I can see that you can’t.”

“Can’t see? Can’t see what?”

“The future! It’s right in front of you. In fact, it’s already begun . . . Medicare and Medicaid. I’m here to tell you, Doctor, that, someday soon, the federal government is going to control you guys, and I’m going to be one of the controllers. You’ll be saluting me, so to speak.”

“Yeah, right!” I replied, dismissing his prediction.

“That is right. Guys like me will be controlling guys like you . . . physicians, I mean . . . and all the rest in medicine, as well. I’ll be one of the experts doing the controlling. Who knows? Maybe, I’ll even be in Congress. With all due respect, you’ll be doing exactly what I tell you to do . . . Sir.”

His arrogance notwithstanding, I wandered to my office wondering if Gerry could be right. Some years later, I learned how right he was.

How did it happen? How did self-styled, bureaucratic “experts”, few with any medical training, become the controllers and physicians the controlled?

The causes have been multi-dimensional. One was via the manipulation of language. Words became politicians and bureaucrats’ weapons against physicians and patients. Words have power. Words can kill.

In his classic novel, 1984, George Orwell eloquently described how governments simplify language and pervert it to fulfill their own, tyrannical goals. He called it “newspeak”. Those in the federal government have borrowed a page from Mr. Orwell’s book and applied his ominous depiction to all four cornerstones of American society . . . government itself, law, education, and medicine.

Prior to Medicare/Medicaid, the federal politicians exerted little control over physicians. Medicine was a “cottage-industry” with hundreds of thousands of independent offices. These independent physicians collectively held too much power over too large a segment of the economy to suit the politicians. Smashing that power became a top priority for vote-hungry politicians; make voters dependent upon politicians not physicians for medical care. One element of their strategy would be through words . . . propaganda. Through words, reduce the prestige of physicians; thereby, reducing their power. How? Lump physicians together with everyone else in medicine from nurses and technicians then include outright charlatans such as chiropractors.(1) Instead of physicians practicing medicine, medical doctors would be merely one category of “providers” among many delivering “healthcare”. The strategy succeeded.

Ask yourself the following, three questions: 1)What comprises “healthcare”? In Webster’s New Collegiate Dictionary (1977), the term, healthcare or health care, doesn’t appear even. Whence came it?  2) How does “healthcare” differ from medicine?  3) Does the distinction matter?

1) As the term denotes, “healthcare” refers to caring for one’s health. It’s amorphous, is largely a personal responsibility, and  includes everything from washing your hair to brushing your teeth to cutting your toenails. Accordingly, a “healthcare-provider” includes anyone or everyone who promotes himself or herself as rendering advice, assistance, or instruction in the care of one’s own health. Simply put, “healthcare” is not medicine.

2) In contrast, medicine is the healing art based upon science the mission of which is the relief of suffering caused by disease and trauma. Its practitioners are known as physicians; those whom they diagnose and treat are known as patients. Traditionally but not currently, physicians must have gained a Doctor of Medicine and be licensed as such in the state in which they practice. Traditionally, para-medical personnel included nurses, technicians, and certain classes of therapists. Medicine was among the learned professions. At its best, for its practitioners it was to be more a calling than a business . . . something akin to the priesthood. The sole obligation of the physician was to the patient not to a third-party such as the government or a “healthcare plan” or even society as a whole. Communication between physician and patient was to be sacred and kept confidential except in cases of malpractice litigation.

3) The distinction is not mere semantics. If not coined by them, the term, healthcare, was seized by politicians, bureaucrats, and profiteers to concoct a deliberately confusing, inconsistent system of medical delivery that they themselves could control for their own respective, pecuniary benefits. The consequence has been that, instead of becoming scientifically-based and scientifically-driven, the medical system has become politically-motivated and politically-manipulated with money and power as the controlling variables. The nightmare of ObamaCare represents Gerry’s dream come true. It brings with it a new host of euphemisms guaranteed to confuse. As I described in the non-fictional Healthcare Reform D.O.A. (now out-of-print; 1994)* and more recently in the fictional/non-fictional Inescapable Consequences (2009), there is a better way.

So, in any discussion of medical services, let us force the politicians and bureaucrats to define their terms. Let us remember always . . . words can kill; and, in this case, you, the patients, are the victims.

* Nominated for two national awards by The American Risk & Insurance Association.

1.  Theoretically, the underlying principles of chiropractic are nonsensical. Operationally, chiropractors injure 30% of their customers, on average (See, for example, Hurwitz, EL, et al: “Frequency and clinical predictors of adverse reactions to chiropractic care in the UCLA neck pain study.” Spine 30:1477, 2005.). Worse, some of these injuries are fatal; chiropractic “manipulation” has been documented to cause death from dissection of the vertebral artery (See, for example, Chen, WL, et al: “Vertebral artery dissection and cerebellar infarction following chiropractic manipulation”. Emergency Medicine Journal 23: e1, 2006.). Re-labeled “chiropractic physicians”, these “healthcare providers” receive the same governmentally-mandated prestige as genuine medical doctors.