“Baby shots” used to be a boring subject, and taken for granted. As the number of vaccines grew from seven in the 1980s to 16 requiring 70 doses now, most parents obediently brought their children to the doctor when shots were “due.” The compliance rate was more than 90 percent. Parents who objected for one reason or another just got an exemption from school-attendance mandates and kept quiet. Every state had a medical exemption, most had a religious exemption, and many had easily obtained philosophical or personal-belief exemptions.

Now that states are repealing exemptions, parents are descending on state capitals en masse, many with severely injured children in tow. Thousands rallied outside an Albany courthouse as a lawsuit challenging an end to religious exemptions was heard.

Despite vociferous objections and attempts to disrupt hearings, the California legislature passed a law (SB 276) severely limiting medical exemptions, the only kind available. “Rogue doctors” were allegedly selling exemptions.

The bill’s author, Sen. Richard Pan, M.D., said that everybody who really needed an exemption would get one. However, 882 out of 882 pediatric practices told a mother that they would not write an exemption for a child who had had anaphylactic shock. This life-threatening allergic reaction, which kills rapidly by closing off the airway, is one of the few allowable indications for an exemption. But now, a parent not willing to risk recurrence cannot send her child to school.

Doctors are no doubt afraid of being targeted by the medical licensure board. SB 276 mandates scrutiny of doctors who have issued more than five exemptions, including exemptions made before the bill takes effect.

Parents are besieging legislators with reports of children who died or experienced devastating illnesses or disability after getting their shots. Interchanges on Twitter are passionate. One juxtaposed a sign saying “Vaccinate your f****** children” with a photograph of a gravestone and the message “We did.”

Whatever happened to hundreds of once-healthy children—it’s impossible to prove that the shot did it—the public-health dogma is: “Vaccines are safe and effective.” So safe and so effective that vaccines should be the exception to the rule that medical interventions are illegal and unethical without informed consent?

Two articles in the fall issue of the Journal of American Physicians and Surgeons challenge the orthodoxy that vaccines should be mandated, overriding patients’ liberties in an effort to eradicate vaccine-preventable diseases.

How much risk can a person be compelled to take, even to save the life of another? In other contexts, such as exposure to radiation or lead, a risk of 1 in 10,000 or even less is considered unacceptable. Yet a much higher risk from vaccines cannot be ruled out. According to the most current information available, only 1 percent of serious side effects (such as death or permanent disability) are likely reported to the government’s Vaccine Adverse Event Reporting System (VAERS).

The 1905 Supreme Court precedent for upholding mandates, Jacobson v. Massachusetts, concerned a raging, deadly smallpox epidemic. Later courts have ignored warnings about the potential abuse of state police power, and permitted mandates to prevent possible future epidemics of much milder diseases. Now, a measles outbreak of some 1,200 cases—thankfully no deaths so far—has triggered the demand for stricter laws, suppression of “anti-vaxxer” information, and harsh measures including $1,000 fines for refusing vaccination in Brooklyn.

Even if at least a few of the tragedies are caused by a vaccine, isn’t it worth it to wipe out dread diseases?

In the 20th century, mankind seemed to be winning the war on microbes. Smallpox was eradicated, and antibiotics were vanquishing infectious diseases. The growing threat of microbial resistance has caused senior public health officials in the UK and the U.S. to be concerned about the “post-antibiotic apocalypse” and the “end of modern medicine."

Parental outrage might cause reexamination of vaccine orthodoxy. It also raises the question of where to draw the line against encroachment of our freedom.

 

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Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. Her views and opinions are her own and do not necessarily reflect the opinions of GCN.  Her column can often be found at www.pennypressnv.com. This is an edited version of her column, reprinted with permission.

 

 

Published in Opinion
%PM, %28 %934 %2019 %21:%Aug

Medicare At Bernie's

Bernie Sanders is strongly promoting “Medicare for All,” and claims to be its father (“I wrote the damn bill,” he proclaimed to the nation during the second round of Democratic Presidential debates).

His plan does not look like Medicare at all. It appears that he hardly knows anything about Medicare. He probably has no experience with it. Despite his advanced age, he does not need to depend on it. Members of Congress are allowed to receive Medicare benefits, but unlike most other Americans, they can receive other benefits in addition.

Sitting members of Congress can get routine examinations and consultations from the attending physician in the U.S. Capitol for an annual fee. And military treatment facilities in the Washington area offer free emergency medical and dental care for outpatient services.

Members are also eligible for the Federal Employees Health Insurance Program, and they won’t be kicked off as soon as they reach Medicare age. They do have to go through an Obamacare exchange, but it is a small one, the DC Health Link, which reportedly functions well. There are 57 gold-tier plans to choose from, not one or two as in many states. Their portion of the premiums could be as little as 25 percent of the total premiums. Apparently, subsidies for senators don’t run out just because their salary exceeds 400 percent of the federal poverty level.

Funding for Medicare for All will apparently be vacuumed up from all other sources of payment for “healthcare,” and will go into the big collective pot. Then people can get everything without premiums, copays, or deductibles—so they say. This is not at all like Medicare.

Medicare Part A, for hospital care, is funded through the Medicare payroll tax: a 2.9% first-dollar tax—no deductions--on all employment income, half of which is paid by the employer. Seniors believe that they have been funding this through their working years, as they are constantly told. They have indeed paid, but their taxes were immediately used to pay for the care of older retirees. So, their hospital bill today will be paid from the wages of about 2.5 workers (say the persons pumping their gas, collecting their trash, and repairing their plumbing). Already that is not enough, so the IOUs in the “trust fund” are being redeemed from general tax revenues. That fund will soon be gone, according to the Medicare trustees, as Baby Boomers are flooding into the system. It would vanish in a nanosecond if we loaded in everybody, with or without illegal immigrants.

Medicare has long been implementing ways to curb runaway expenditures. From the mid 1980s comes the Prospective Payment System, or Diagnosis Related Groups (DRGs), under which payment has nothing to do with services rendered to a particular patient. According to my 1985 “Ode to DRG Creep”:

“Now the pay’s by the head, if alive or if dead,

Diagnosis determines the money,…

We need costs less than average, and discharges quicker

We will get no advantage -- For care of the sicker.”

Since “quicker and sicker” discharges might cause a need for readmission, the government penalizes hospitals for readmission. One way to prevent readmission is to discharge to hospice or directly to the morgue. If Bernie were an anonymous Medicare patient, he’d get a consultation on POLST. That’s Physicians Orders for Life-Sustaining Treatment, which translates in the Newspeak Dictionary to “Legally Enforceable Orders to Terminate Life-Sustaining Treatment Including Food and Water.”

Bernie might think he had been admitted—say he had an IV in a hospital room. But if he gets discharged before his second midnight, he might be classified as an outpatient, which is covered under Medicare Part B, and get a “surprise” bill for thousands of dollars, because of the “Two-Midnight Rule.”

Or Bernie might expect to have a little rehab after an orthopedic procedure, but if he is in hospital for fewer than three midnights, rehab isn’t covered. He might have the choice of paying out of pocket, or going home where he will be alone, unable to get out of bed.

Yes, Bernie on Medicare will have free choice of doctors—except for the ones who aren’t accepting Medicare patients.

If Bernie himself were stuck on Medicare with no way out, he might think it not so wonderful. Has anyone heard him tell people about these Medicare problems?

Maybe he means the Canadian Medicare system. It does have a way out for non-senators—called the United States.

 

Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. Her views and opinions are her own and do not necessarily reflect the opinions of GCN.  Her column can often be found at www.pennypressnv.com. Her column has been reprinted in full, with permission.

 

 

Published in Opinion

The truth has been acknowledged by Alexandria Ocasio Cortez’s own chief of staff, Saikat Chakrabarti The Green New Deal is not primarily about greening the planet or controlling the climate. It’s about socialism, as the people from whom she plagiarized it have said all along. It’s a fundamental transformation of our way of life.

Since everything you do leaves a “carbon footprint,” the GND encompasses literally everything—especially your medical care.

The first question is whether you should be alive at all. In his sensational 1968 book, The Population Bomb, entomologist (insect specialist) Paul Ehrlich predicted that hundreds of millions of people would starve to death in the 1970s. That bomb fizzled, but he still believes that civilization is doomed within decades, as humanity places inexorable burdens on our Planet’s life support systems. The optimum population of the planet is less than 2 billion, he thinks, or 5.6 billion fewer than we have now.

Once you’re here, Ehrlich and his acolytes would apparently tolerate your presence, although the decline in U.S. life expectancy for the third consecutive year would likely be good news. But having children is another matter. The demographic legacy of one person, calculated over the average time for that person’s lineage to die out, is about 6 person-lifetimes in the U.S., with eventual emission of 9,441 tons of carbon dioxide. So, “reproductive health” ideally means no reproduction for most people, and many millennials (and celebrities) seem to embrace that idea. Predictably, unrestricted or even free abortion is an article of faith among Democrat candidates. And the LGBTQ agenda, also favored by all, tends to contribute to the goal of population reduction.

Ironically, politicians still talk about “our children and our grandchildren,” though they may work to assure that many of us don’t have any.

The U.S. health care sector is said to account for around 10 percent of the CO2 generated in the U.S. and thus “could be implicated” in 10 percent (20,000) of the nearly 200,000 premature deaths attributable to air pollution annually in the United States. (There are about 3 million annual deaths in the U.S., and it is impossible to identify even one as being premature because of air pollution; the argument is purely statistical.) Thus, hospitals are supposedly killing people, albeit indirectly, by using carbon-based energy for heating, air conditioning, elevators, lighting, ventilators, etc.

Surgery is a special problem, beyond the use of electricity, because anesthetic gases that might have a greenhouse effect are vented to the atmosphere. So, are anesthesiologists to worry about a hypothetical tiny effect on the climate 50 years from now, instead of the best treatment for the patient?

“Social determinants of health” are the trendiest subject in “healthcare reform.” GND prescriptions would profoundly affect those. Diet would be mostly plant-based foods, with meat limited, ultimately to 1 oz per day. Living space would be restricted, some propose to 320 sq ft per person, with no single-family homes allowed except for trailers. Energy efficiency standards would entail restrictions on entry of outside air, without regard to effects on indoor air pollution, including bacteria and viruses. (More than 300 people in a huge Hong Kong apartment building were infected with severe acute respiratory distress syndrome [SARS] because of this.) Transportation would be mostly walking, bicycling, or public transport. Private vehicles, except possibly electric, might be banned entirely, with roads converted to parks and walkways. It is not clear what emergency responders would do. If electricity came mostly from wind and solar it would be scarce, unreliable, and many times more expensive than now. (Already tens of thousands of deaths in the UK are attributed to inability to afford adequate heating, as costs of “renewable” electricity soared.)

The Democratic presidential debates, except for some squabbling over things like alleged racism, were a display of groupthink. Everybody raised a hand in favor of the GND and universal health care. Some are more radical than others; Kamala Harris insists that we have a “climate crisis,” not just “climate change.” What Americans need to know is the gritty detail behind the virtuous-sounding platitudes. How will their choices be constrained? How much will costs go up—for rent, utilities, fuel, food, and, of course, taxes? How will their standard of living be affected? And how will their actual medical care and health—as opposed to their health insurance card—be affected?

 

Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. Her views and opinions are her own and do not necessarily reflect the opinions of GCN.  Her column can often be found at www.pennypressnv.com. Her column has been reprinted in full, with permission.

Published in Opinion

People are dying all over the country from opioid overdoses. There’s a movement to have the antidote naloxone available in all ambulances and even over the counter. This temporarily reverses the fatal effect of opioids, which stop the patient’s breathing. First responders themselves may need a dose because of contact with a tiny amount of fentanyl, an extremely potent narcotic, while attending a patient.

No, the fentanyl does not come from the patient’s bottle of legal prescription drugs.

Rep. Bill Foster (D-Ill.) introduced a proposal that he claims would “go a long way to fight the practice of doctor shopping for more prescription pain pills amid a deadly opioid crisis.” Doctor shopping “involves visiting multiple doctors.” Hardly new, this proposal, now passed by the House of Representatives as an amendment to a $99.4 billion Health and Human Services appropriations bill, lifts the ban on funding a Unique Patient Identifier (UPI).

The UPI is part of the Health Insurance Portability and Accountability Act (HIPAA) of 1996. You don’t have one yet because former congressman Ron Paul, M.D., (R-Tex,) sponsored a prohibition on funding it as part of a 1999 appropriations bill. Rep. Foster’s amendment repeals Dr. Paul’s prohibition.

So how is this 1996 idea supposed to work? And why would it be better than the Prescription Drug Monitoring Programs (PDMPs) now in effect in nearly every state? Every prescription for a controlled substance must be reported to the PDMP, and the doctor must check it before writing a prescription, to be sure the patient is not lying about having prescriptions from other doctors. This costly program that creates time-consuming hassles for doctors has not prevented opioid deaths.

PDMPs are ineffective because doctor shopping is not the cause of the problem. Only 2.5 percent of misused prescription pain medicine was obtained by doctor shopping. And this small percentage apparently increased after PDMPs. More than 97% of misused medications are obtained from a single physician—or from an illicit source. The spike in opioid deaths after 2013 was caused by illicit fentanyl, as Dr. John Lilly concludes from painstaking analysis of official data.

If Rep. Foster’s amendment is not removed, you might have to have a UPI to get legitimate medical care—“no card, no care”—but the drug cartel won’t mind. You can shop drug dealers as much as you like. There is a flood of fentanyl, mostly from Mexico or China, coming across our borders. Rep. Foster is apparently unaware of the armed lookouts protecting the smuggling routes in the Tucson sector. And once here, the drugs go to distributors—such as illegal aliens protected in sanctuary cities.

So, what about the other touted benefits of the UPI? “Specifically, assigning a unique number to a patient would give doctors a way to immediately identify a patient’s medical history,” said Rep. Mike Kelly (R-Pa.). He says it “would lower the cost of medical mix-ups due to misidentification.” His elderly father was nearly given the wrong medication.

To prevent medical errors, you need alert nurses and doctors—and the UPI is not going to fix the hazards of the electronic health record. The EHR, touted as the solution that will bring efficient, quality care, has created its own type of errors.

There is no guarantee that a UPI will improve access to the record, and critical information will still be buried in voluminous, repetitious data of dubious reliability, some of which may have been cut-and-pasted from another patient’s record. There may be critical gaps as patients withhold information they don’t want in a federal database. The new problem that brings the patient to the hospital won’t be in the old record—but may be the result of an old misdiagnosis that should be corrected instead of copied.

Patients need to be able to shop for doctors, especially if the one they have has not solved their problems. Some of them desperately need opioids, which are increasingly difficult to obtain. They do not need a UPI, and neither does their doctor.

The UPI is ideally suited for government tracking and control of all citizens. People like J. Edgar Hoover or Lois Lerner might find it very useful. But it would be the end of privacy, and the foundation for a national health data system.

 

Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. Her views and opinions are her own and do not necessarily reflect the opinions of GCN.  Her column can often be found at www.pennypressnv.com. Her column has been reprinted in full, with permission.

 

 

Published in Opinion
%PM, %08 %944 %2019 %21:%May

Should we panic over Measels?

In general, it is not a good idea to panic about anything. The panic itself often causes more harm than the original threat.

Crisis situations, real or contrived, lead to new intrusive laws that the public would never accept otherwise. We supposedly cherish freedom, but if we believe that the world will end if we don’t act NOW, then we may clamor for the government to save us. Cynical politicians bent on increasing their power never let a crisis go to waste.

Something like the Green New Deal—the end of our comfortable, prosperous lifestyle—takes a truly apocalyptic threat. But to eliminate our freedom to decline a medical treatment, the threat that “millions will die” of measles is evidently enough. Or if not millions (most older people had measles and recovered fully), a few especially vulnerable children, who can’t be vaccinated themselves, might catch measles and die.

There are several hundred cases of measles nationwide, more than in 2014, and bills are being pushed through state legislatures to eliminate all but very narrow exemptions to the 60 shots now mandated for school attendance.

In New York City, people are receiving summonses based on Mayor Bill de Blasio’s emergency order. Everybody, adult or child, who lives in four ZIP code areas must get an MMR shot or prove immunity, or face the prospect of a $1,000 fine ($2,000 if you don’t appear as ordered). Your religious exemption is overridden. The threat of 6 months in prison and the prospect of forcible vaccination were removed before a hearing on a lawsuit brought by five mothers. The judge dismissed the case.

Health Commissioner Oxiris Barbot said that the purpose of the fines is not to punish but to encourage more people to proclaim the message that vaccines are safe and effective. Get it? If you say something to avoid a fine, that makes it true.

It’s about the need for herd immunity, they say. We need a 95 percent vaccination rate for herd immunity to measles. With only 91 percent or so we are having outbreaks! If we could just vaccinate another 4 or 5 percent!

Mayor De Blasio has a point about vaccinating everyone. Adults are getting measles because their shots have worn off. It is likely that we have survived for decades with a large part of the adult population vaccinated—but not immune. So where do the mandates stop?

Outbreaks have occurred in populations with a near-100 percent vaccination rate. Was it vaccine failure? Or was the vaccine not refrigerated properly? Or was a claimed outbreak real? One in Ann Arbor, Michigan, was called off when a special test, a reverse transcriptase polymerase chain reaction (RT-PCR) showed a vaccine-strain measles virus rather than a wild-strain measles virus. Some 5 percent of vaccinees may get an illness that looks like measles, but it is just a “vaccine reaction.” Can they shed live virus? Yes. Should you keep your immunocompromised child away from recently vaccinated people? Just asking.

Like all medical treatments, vaccines are neither 100 percent effective, nor 100 percent safe. Read the FDA-required, FDA-approved package inserts. Arizona defeated a law that would have required making these available to parents in obtaining informed consent. (You can get them on the internet.) Vaccine Court has paid out about $4 billion in damages—recently for two children with severe brain damage from encephalopathy (that’s brain inflammation) after a fight lasting about 15 years. Just incidentally, they had an autism diagnosis also. Parents bring their severely injured children to hearings. You won’t see these children on tv, only pictures of babies with measles. No “fear-mongering” allowed about “rare,” possibly coincidental problems from vaccines.

There are trade-offs with vaccines: risks and benefits. But in the panic about measles, the right to give or withhold informed consent—fundamental in medical ethics as well as U.S. and international law—is being sacrificed. And so is free speech. The AMA wants to censor “anti-vaccine” information on social media. I happened on a factual article by investigative reporter Sharyl Attkisson, but was not able to retweet it because it had been removed.

The threat of infectious diseases is real and increasing. We need more robust public health measures, better vaccines, and improved public knowledge and awareness. Deploying vaccine police and shutting down debate will erode trust in health authorities and physicians, although more people may get their shots. But such heavy-handed measures will not defeat the enemy—measles and worse diseases.

Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. Her views and opinions, if expressed, are her own and do not necessarily reflect the opinions of GCN.  Her column can often be found at www.pennypressnv.com. Her column has been reprinted in full, with permission.

Published in Health
%PM, %10 %968 %2019 %22:%Apr

Who, exactly, is your doctor?

People used to know who their doctor was. His name and phone number were on the wall or the refrigerator next to the telephone. He was there for you and could manage most of your problems.

When I was about 13, my mom took me to our pediatrician for belly pain. He was on his way out the door, but he stopped to take care of me. He diagnosed appendicitis based on history and physical examination. He called his favorite surgeon (“Billy,” a Tucson legend), who came from the golf course to meet me in the emergency room. Within hours, my red-hot appendix was in a jar. My parents paid the hospital bill ($150—10 days’ pay for a construction laborer) as I was discharged a few days later.

Today, the patient with abdominal pain could wait for hours to see the ER provider—possibly a nurse practitioner or physician assistant who had never seen a case of acute appendicitis. She’ll probably get a CT scan, after another wait. Eventually, Dr. On-call may take her to the operating room, hopefully before the appendix ruptures. And the bill will be beyond the means of ordinary people.

I used to be able to direct-admit patients from my office and send them with a set of orders to the hospital admitting office. For years, this has been impossible. The hospital is decidedly unfriendly to independent doctors. There’s now a gatekeeper in the emergency room, and most patients are under the control of a hospitalist.

This hospital, still Catholic at least in name, is now owned by a huge national conglomerate. Recently, it thwarted all efforts to keep it from dehydrating a patient to death despite lack of an advance directive or permission from next of kin. The patient’s mother disputed the diagnosis of brain death. The gastroenterologist of her choice was willing and able to place a feeding tube, needed in order to transfer the patient to a skilled nursing facility, but the hospital would not permit it. An outside physician whom the mother had called on was removed from the patient’s room by security, when she was merely praying with the mother. The mother could not get a phone call returned from an attending physician. Who was the doctor? Apparently, the hospital system.

Recently, a physician called me about her mother, who was seemingly a captive in a world-renowned hospital. She was concerned about her mother’s nutritional status and falling oxygen level. She could not speak to the attending physician. “They play musical doctors.”

Largely driven by government policy, the System is increasingly in control. A new level of intrusion is being proposed in California in a bill (SB 276) that would outlaw all medical exemptions for vaccines, unless a public health officer approves each one, based on the very narrow list of contraindications accepted by the Centers for Disease Control and Prevention (CDC).

Doctors traditionally swore an oath not to harm patients, and are liable if they do. But government officials are immune from liability, even if they overrule a physician’s judgment that a particular patient faces an unacceptable risk of harm from a vaccine.

If you disagree with your private doctor, you can fire him or simply decline to follow his advice. But what if the government is your doctor?

In Arizona, law enforcement officers in tactical gear broke down the door to a home where children were sleeping, entered with guns drawn, and took three little children away from their parents. The stated reason: the mother had decided not to follow a doctor’s advice to take her two-year-old to the emergency room for a fever, because the fever broke and the child got much better soon after leaving the office. The main concern seemed to be that the child was not vaccinated.

Americans need to defend their right to have an independent physician, to choose their physician and type of care, and to give or withhold informed consent to medical treatments. Otherwise, their “doctor” will be a protocol in a system staffed by interchangeable automatons. Treatments will be inaccessible or required, tailored to meet the needs and beliefs of the system.

If the government is the ultimate authority on your “health care,” remember that its tools for checking whether a child has a life-threatening disease such as meningitis include battering rams and assault rifles.

Jane M. Orient, M.D. obtained her undergraduate degrees in chemistry and mathematics from the University of Arizona in Tucson, and her M.D. from Columbia University College of Physicians and Surgeons in 1974. Her views and opinions, if expressed, are her own and do not necessarily reflect the opinions of GCN.  Her column can often be found here at www.pennypressnv.com. Her column has been reprinted in full, with permission.

Published in Health