Monday, August 31, 2009

The Problem of the AMA

Discredited AMA with 'knight' Harvey Wiley pushed cocaine hysteria to protect cigarettes- the AMA has a long shameful history of increasing health care costs

The Evil-Mongering Of The American Medical Association
Shikha Dalmia, 08.26.09, 12:00 AM ET

In his war against terrorism, President George W. Bush declared a simple, binary formula to judge the world: "Either you are with us, or you are with the terrorists." Now, Obama and the Democratic leadership have borrowed the same formula to draw the battle lines over health care reform, dividing the country into those who are for ObamaCare and those who are evil-mongers.

But the entities that will be most injurious to the nation's health are not so much in the evil-mongers' group but the first group, including the American Medical Association--a doctors' cartel that has controlled the medical labor market in the U.S. like its personal fiefdom for a century. Instead of "palling up" with it, President Obama should do everything in his power to break its choke-hold and bring physician salaries--among the biggest drivers of health care costs--back down to Earth.

The association has managed so far to escape the wrath of and other Democratic apparatchiks by muting its opposition to their beloved public option--the proposed government-run health care plan--and joining a coalition of industry groups pledging to cut $80 billion in health care costs over the next decade. The president has been touting these savings as if they have been signed, sealed and delivered to the bank. But anyone who buys--even for a nano-second--that anything good can come for taxpayers or patients from an alliance between Big Government and Big Medicine should see a doctor.

The fact of the matter is that even if the AMA delivered its share of these "savings," it wouldn't begin to make up for the costs it imposes on the country--both in lost dollars and poorer patient care.

According to a 2007 study by McKinsey&Company, physician compensation bumps up health care spending in America by $58 billion annually,on average, because U.S. doctors make twice as much as their OECD peers. And even the poorest in specializations like radiology and surgery routinely rake in around $400,000 annually.

Doctors--and many Republicans--constantly carp about the costs of "defensive medicine" because it forces providers to perform unnecessary procedures and tests to insulate them from potential lawsuits. But excessive physician salaries contribute nearly three times more to wasteful health care spending than the $20 billion or so that defensive medicine does. "While the U.S. malpractice system is extraordinary," the study notes, "it is only a small contributor to the higher cost of health care in the United States." Meanwhile, other studies have found that doctors' salaries contribute more to soaring medical costs than the $40 billion or so that the uninsured cost in uncompensated care--the president's bete noir.

But how has the AMA managed to get away with such princely remuneration that ordinary mortals in other professions--even ones such as law and engineering that also require arduous training--can only dream of? After all, in a functioning market, a profession offering such handsome returns would become a magnet for more people who, over time, would bid down "excess" wages.

But that's not how it has worked in medicine since 1910 when the Flexner report, commissioned by the AMA, declared that a surplus of substandard medical schools in the country were producing a surplus of substandard doctors. The AMA convinced lawmakers to shut down "deficient" medical schools, drastically paring back the supply of doctors almost 30% over 30 years. No new medical schools have been allowed to open since the 1980s.

Still, the AMA along with other industry organizations until recently had issued dire warnings of an impending physician "glut" (whatever that means beyond depressing member wages), even convincing Congress to limit the number of residencies it funds to about 100,000 a year. This imposes a de facto cap on new doctors every year given that without completing their residencies from accredited medical schools, physicians cannot obtain a license to legally practice medicine in the U.S. Even foreign doctors with years of experience in their home countries have to redo their residencies--along with taking a slew of exams--before they are allowed to practice here.

The upshot of all this is that now the country is facing an acute shortage of doctors that even the AMA and its sister organizations cannot deny anymore. Indeed, the Association of American Medical Colleges, a private nonprofit industry advisory group whose forecasts effectively determine how many new doctors will be allowed at any given time, reversed itself in 2002 issuing this belated apology: "It now appears that those predictions [of a glut] may be in error."

One way to relieve the shortage of providers that the medical industry has created would be for the AMA to abandon its aggressive game of turf-protection and allow nurses, midwives, physician assistants and practitioners of alternative therapies such as chiropractors, to offer standard treatments for routine illnesses without physician supervision. For instance, midwifery, once a robust industry in this country, has been virtually destroyed, thanks to the intense lobbying against it by the medical industry. In 1995, 36 states restricted or outright banned midwifery, even though studies have found that it delivers equally safe care at far lower prices than standard hospital births.

Similarly, the AMA long regarded chiropractory as tantamount to "quakery," and barred doctors from professionally associating with chiropractors or making referrals to them, something that the courts overturned as an illegal violation of antitrust laws in 1987. But the AMA is undeterred. Three years ago it launched something called the "Scope of Practice Partnership," a self-appointed watch-dog group, whose express purpose is to ensure that chiropractors don't offer any services that might be remotely considered outside their legal scope.

The AMA does all this in the name of patient protection. But Milton Friedman, the late Nobel laureate, noted in 1961 that the AMA's licensure and other efforts to control the supply of doctors and services had produced a net diminution of care. "Licensure has reduced both the quantity and quality of medical practice," he wrote in Capitalism and Freedom. "It has retarded technological development both in medicine itself and in the organization of medical practice."

Although Friedman's views were controversial at the time, they now enjoy an overwhelming consensus among economists. That's because it has become painfully clear that the net effect of AMA-type restrictions hasn't been to make better quality doctors available to more people, but to reduce existing options, especially in rural and other under-served areas.

Obama and his fellow Democrats blame the current health care mess on the free market. But a free market can't exist when a cartel with the ear of the government is allowed to control a key input for its own self-aggrandizement. If the president is serious about lowering health care costs instead of advancing an ideologically driven government takeover of the industry, he should be doing everything in his power to disband it--not cozy up to it.

Shikha Dalmia is a senior analyst at Reason Foundation and a biweekly Forbes columnist. Ben Tonkin provided valuable research assistance for this column.

Thursday, August 13, 2009

Bolivia Pro-Coca Campaign Inches Ahead

Via initiating process to maintain status quo
against yet another U.N. scheduled elimination of coca leaf chewing

From Drug War Rant:
Bolivian coca amendment to Single Convention

The Bolivian government has successfully commenced the formal process for amending the UN's Single Convention on Narcotic Drugs (1961) to eliminate the provision that would require all countries to prohibit coca leaf chewing within 25 years (for Bolivia, that was 2001).

Interesting amendment process. If no country objects within 18 months, then the amendment passes (a nice, if time consuming, way to do it - countries need not get on the record to approve it). Countries most likely to object: United States and Sweden. If that happens, then there's a conference to consider it.

The proposal has a very nice argument as to why this provision should be removed from the Single Convention.
As reported by the International Drug Control Consortium:

Bolivia commences process to allow coca-leaf chewing under international drug control scheme

At the Substantive Session of the Economic and Social Council on Thursday, 30th July 2009 in Geneva, Bolivia commenced the formal process by which they hope to delete article 49, paragraphs 1(c) and 2(e) of the Single Convention on Narcotic Drugs, 1961, as amended by the Protocol amending the Single convention on Narcotic Drugs, 1961.

Article 49, paragraph 2(e) states that ‘coca leaf chewing must be abolished within twenty-five years from the coming into force of this Convention as provided in paragraph 1 of article 41’; paragraph 1(c) states that a Party to the Convention may reserve the right to permit coca leaf chewing temporarily in any one of its territories, subject to the restrictions established in paragraph 2(e), that is, for a period of no more than 25years.

The Bolivian proposal was supported by a letter from the President of Bolivia, Evo Morales, which explains that coca leaf chewing is a non-harmful and ancient socio-cultural practice and ritual of the Andean indigenous peoples closely linked to their history and cultural identity practised today by millions of people in Bolivia, Peru, northern Argentina and Chile, Ecuador, and Colombia. The Bolivian delegate to ECOSOC assured other delegates that ‘we are not talking about free growing of coca so as not to feed the narco trade’ and explained that the proposed amendment to the Convention would allow countries to ‘make up their own minds’ on coca-leaf chewing and would not require any change in the domestic law of other countries, she said ‘this is a full application of the principle for non-intervention and non-meddling in the sovereignty of states’. The delegate further stated that the Bolivian government plans to hold a seminar for interested parties on coca leaf chewing in October of this year. Read the Bolivian proposal below.

The United States of America and Sweden both raised their flags on this agenda item but the resulting dramatic tension was quickly abated by a procedural question with regards to the consultation process. The question was answered as follows: if the proposed amendment is not rejected by any Party within eighteen months of 30th July 2009, it shall enter into force. If any rejection is forthcoming, however, a conference shall be called to consider the amendment.

Accompanying the USA with its promotion of Virginia Bright Leaf cigarettes adulterated with numerous chemicals to increase the burn (increasing health problems and house fires in order to sell more), and misbranded (with no labeling of the additives), is Sweden, with the following suggestion for Bolivians to abandon Coca in favor of Ice Cream!

Better income from ice cream than coca cultivation

Felipe and Mabel Vera Loza have started an ice cream factory and got the farmers to grow passion fruit instead of coca leaves. This is just what the Bolivian economy needs -- modern enterprise and profitable alternatives to the drug production that results from coca cultivation.

On the Altiplano, high above Bolivia's capital La Paz, 700,000 people live in poverty, but behind the first impressions of misery hides another reality - enterprise and ingenuity, a Bolivian "Gnosjö spirit" (distinctive enterprising spirit in Gnosjö, Sweden) that has turned the Altiplano into one of the fastest growing economic regions in Bolivia. One of many resourceful entrepreneurs is Felipe Vera Loza. Fifteen years ago, Felipe and his wife Mabel bought an Italian ice cream machine of the make Catabriga, which was placed in the family's kitchen. From there they built the company Delizia, which is now the second-biggest producer of yoghurt, ice cream and Juice in La Paz. Today, the facility is worth 40 million SEK and has an annual turnover of as much, and the company continues to grow.

"You have to grow slowly in pace with demand and always adapt to the market," says Felipe, "the Bolivian economy is unpredictable. You must be prepared for quick changes but still have a long-term perspective."

Inside the Delizia factory, the shiny aluminum machines whirr and hiss day and night. At the back, between the white tiled walls, there is a conveyor belt with plastic bottles filled with juice the colour of orange peel.

"No, it's not orange, it is passion fruit juice, our latest product," explains Felipe, "today farmers grow passion fruit on 2000 hectares of land, which is delivered to Delizia. Many of these farmers previously grew coca."

Swedish support allows the company to adapt its production to meet the strict international environmental requirements. This makes Delizia and other Bolivian companies more competitive. It offers long-term opportunities to reduce poverty and, at the same time, more coca farmers the opportunity to change their cultivations to other products and build a sound basis for the Bolivian economy.


Sida has supported industry in Bolivia since 1992 with a number of contributions. Sida cooperates with NGOs, which are in the best position to identify demands and solutions to problems. Sida also works with business development.

Updated 05 Nov 2007

To its credit, Swedish policy has at times favored the concept of harm reduction:

On the other side of the debate were UN agencies and much of the international community. The European Union and several of its member states voiced explicit support for harm reduction. Even staunchly prohibitionist Sweden "fully associated itself" with the EU's pro-harm reduction statement. Australia, Brazil, Norway, and Switzerland also supported harm reduction efforts, according to on-the-scene reports from Hungary's Peter Sarosi and England's Andria Efthimiou-Mordaunt, who were representing the Hungarian Civil Liberties Union and the European Coalition for Safe and Effective Drug Policies, respectively. In contrast to previous years, harm reduction also drew support from Moslem countries, with Iran and Morocco reporting they were working together to forge a response to injection drug use. China reported that methadone maintenance programs were underway and that "exchange of needles and syringes is expanding step by step."

Wednesday, August 12, 2009

Insurance Company to MJ User- Drop Dead!

Lawyer: Woman denied transplant due to pot use
by Chelsea Jensen
Stephens Media
Published: Saturday, August 8, 2009 7:37 AM HST

Kimberly Reyes dies after HMSA declines to cover liver transplant
Taking a hit off a marijuana cigarette may cost your life -- literally.

Waimea resident Kimberly Reyes, who was diagnosed with hepatitis - in March 2008, had been told in July that she had less than 30 days to live. Her family claimed she had followed doctor's orders, but her insurance carrier, Hawaii Medical Service Association, denied the liver transplant she needed to survive because three toxicology tests showed trace amounts of cannabis in her system.

According to Reyes' attorney, Ted Herhold of the San Francisco-based Townsend and Townsend, toxicology tests from June 14, July 3 and July 14 were the sole basis for HMSA's denial of coverage for the 51-year-old mother of five.

Reyes' husband, Robin, and her mother, Noni Kuhns, said HMSA's decision was based upon a failure to comply with the insurer's policy strictly forbidding [illegal] drug use. However, both maintain that neither HMSA nor her doctors told them of HMSA's policy on drug use.

Following at least five phone calls from Stephens Media over a one-week period, HMSA Public Information Officer Chuck Marshall replied through an e-mail that HMSA would not comment. HMSA also declined to provide the insurance carrier's policies on drug use or transplant approval.

Reyes died July 27 at Hilo Medical Center, 16 months after being diagnosed. She suffered cirrhosis of the liver, chronic hepatitis - infection, and end-stage kidney disease.

"Just because someone takes a hit off of a joint doesn't mean that it should be the end of their life -- this is not a reason to deny life," said Reyes' mother.

The hepatitis - virus attacks the liver and interferes with its function, leading to liver failure and cirrhosis, or fatal scarring of the liver, according to the Mayo Clinic.

Reyes was twice denied a transplant by HMSA for "technical reasons," such as missing required Alcoholics Anonymous meetings -- because, Kuhns says, she was too weak. However, on July 17, HMSA approved Reyes' request for a liver transplant. That approval signaled the Reyes family and HMSA had apparently resolved compliance issues, Herhold said.