More Quotes & excerpts, mostly from my writing, many referring to AMA
More Quotes & excerpts, mainly from my own writing
May 02, 2009 Ideas:
We need Miracle Workers to balance of the intrinsic and disproportionate advantage the AMA has compared to member of the midwifery profession. f^O^
The AMA, as with all organizations that depend in membership dues, has to have something to entice prospective members to join and pay substantial dues by convincing them that such expenditures are warranted. That means the AMA must figure out how to make the lives of its physician members better – more profitable, higher status, and to indulge its fantasies of putting their competitors – midwives — out of business and them wipe them off the fact of the earth and then getting a new set of laws passed that provide substantial advantages to the obstetrical profession and also prevents passage of any law that would burden physicians with onerous regulation or paperwork or reduce reimbursement levels.
AMA should oppose the use of payment and coverage decisions by the federal government and private payers to establish the standard of care for medical practice, especially with regard to payment decisions that are erroneously predicated on the notion that a medical condition is reasonably preventable, when in fact, that condition may occur even when evidence-based guidelines are met
Example of politics/special interest Choke-point AMA-defined healthcare
Mining practice known as mt. top removal – blast off the top and let all dirt fill in the valley streams
Ecology subtle systems – old growth forests
Rev#102 – 04-17-09 @ 4pm ~ April 17, 2009 — TOWSOH:
Edit Line
The only Hollywood film to deal with the powerful behind-the-scenes effect of organized medicine was a 1948 film about the life of “Sister Kenny”. As a nurse in 1910 she provided primary care in the Australian ‘out back’ in an isolated farming area with little or no access to physician care. Overwhelmed during a polio epidemic by dozens of children sick with the horrific symptoms of ‘infantile paralysis’, she made the most important discovery of the 20th century about the treatment of polio. At that time, the medical profession believed nothing could be done in the acute phase to prevent the paralysis from becoming permanent. The accepted medical treatment of the debilitating effects was .
On her own, she developed the which was in effect the use of hot packs and physical therapy. famous “Sister Kenny treatments”,
The political aspect of medicine is something never seen or talked about in public. Over the last 50 years we have all watched many film and television stories about the heroic practice of medicine, the social intrigue that occurs between hospital staff or the tragic lives of brilliant but socially-destructive physicians. What isn’t acknowledged is 150 years of concerted efforts by doctors to organize themselves into medical associations for the purpose of influencing public opinions about doctors or lobbying the government for the benefit of the medical profession.
Records of early medical societies show a formal organization with a constitution, by-law, mandatory fees and an emphasis on a group identity as ‘regular’ doctors. This was defined by a medical degree and strict adherence to medical society rules. Like a county club, membership was exclusive, making it easy to keep out those who didn’t comply. Once in, anyone who didn’t follow the orthodoxy as set by the leadership could and often were ousted. Being cut off at the knees meant having one’s reputation actively trashed, getting no more referrals and finding that many times your referrals were spurned. Using any ‘healing art’ not in current favor got you labeled a quack and charlatan or worse.
Public distrust with MDs-organized medicine: What this seemingly negative description of the inner world of medical practice actually reveal is just the basic humanness of humans. The fault is not with individuals or groups that want to take control of their lives, better their circumstances thru some united group effort, but the idea that simply being a doctor, in particular a ‘regular’ – i.e., MD-physician trained in bio-medicine and equipped with academic credential – meant that you were no longer an ordinary mortal, that the basic humanness no longer applied. This is a set up for the rest of us, the ‘lay’ pubic to expect too much and when our unrealistic expectations are not met, to feel let down and betrayed. The next step on this irrational path is righteous anger and indignation, whether our disappointment arises from a personal experience with our own doctor or news stories about doctors as agents for organized medicine.
Expert systems: The problem is a system that has for a century operated without any of the checks and balances that protect us most areas of society. Many aspects of public life benefit from the skills and experience of ‘expert systems’ – the military, the government, the classic professions (law, medicine and theology), 20th century science including nuclear physics and electronic technologies and new situations such as professional sports and the motion-picture industry. The issue here is whether we relate to ‘expert’ systems as a law or universe unto themselves, blindly accepting it dictates (or its refusal to respond) without question. History books and daily news both abound with stories about the consequences of absolute power – they virtually all end with
OR as a society, we retain the mental awareness of our right and duty to exercise “oversight”
Separate the legitimate above-board goals from illigetimate ones, either as special interests promoting their own advantage at the expense of the public good (reduce # med sch to reduce # practicing doctors, to make the cost of med sch education so high that only the ‘best’ could afford it (i.e., whealthy, white and male)
– honest improvement and useful standardization of bio-medical education leading to the better, safer, more scientific practice’ of modern’ medicine.
Historical records document, in black and white, the manipulation of public opinion in which the AMA’s Council on Medical Education asked the Carnegie Foundation President Henry Prittchard to accept its documents and carry out its recommendations while purposefully obsecuring their origins. There are extant minutes of the April 1908 meeting at the AMA’s headquarter between the AMA’s CME committee members, Prittchard and Abraham Flexner. The conversation between this individuals acknowledges the obvious conflict of interest and the AMA’s desire to side-stepping any charges of insider manipulation while still achieveing it s goal – the implementation of its recommendations accepted. Dr. Colwell, chair of the AMA’s CME, ask Carnegie president Prittchard appeared to come from a ‘neutral’ source dedicated to promoting the public welfare.
The one word that comes to mind is ‘oversight’ – the idea that
Buzz word list
Choke Point Medicine:
— a Successful Strategy of Control but a Failed National Policy
In order to create a safe, effective, affordable, assessable healthcare system, we have to break away from a pervasive system imposed by a numerically small group of people with disproportionate amount of economic power and political influence in the early 1900s. Historically the AMA used its influence to create this system and in present times, it continues to use this cumulative power to block any effort at reform.
To make the necessary changes in our healthcare system we all – lay public, investigative journalists, public health officials, and policy makers alike — have to understand what works well in the current medicalized system, why these methods are so successful (ex. acute care, emergency medicine, etc) and what areas of healthcare do not benefit from medicalization (ex. non-acute and preventative care) and why not.
Much in this book has focused on the artificial choke-point created by the MD-centric nature of healthcare in the US. This describes a system implemented in 1910 by the AMA that requires every health-related issue to first be ‘diagnosed’ by an MD. At the time, this was described by insiders as taking control of the “medical business” and resulted in an educational preparation that was extraordinarily long and expensive – from 8 to 15 years of medical schools.
That lengthy and arduous medical education is focused on one specific type of healthcare – allopathic medicine. By law, by training and by custom, medical students are taught the skillful use of drugs, medical treatments and surgical procedures to the virtual exclusion of all other aspects of the bigger topic of “health care”. However, the high end of this allopathic system is not a good match for the 80% of self-limiting conditions – that whole spectrum of functional biology that includes appropriate response by the healthy immune system. An and desirable way for a healthy human body inherently responds to a mild illness by developing fever, malaise, muscle aches and enough pain to put someone to bed for a few days.
It comes as no surprise us that the choke point also equates to a scarcity of the physician’s time and an abundance of drugs and procedures. These methods are heart of what we think of as ‘the miracles of modern medicine’ – the ability to save lives under drastic circumstance that would have been lost in other times and other places.
Choke Point Charlie as an Economic Issue
The main criticism so far is the unproductive expense
The ‘cost-effective’ use of an allopathic physician’s time is tied to billable units in which the physician ‘performs’ some act that would be illegal for a non-MD, for example, to prescribe drugs, personally perform or to authorized non-physician designates (such as nurses or nurse-practitioners) to perform medical treatments or surgical procedures. The all-allopathic, all-the-time nature of our healthcare system builds in medicalization as the norm.
Choke Point Charlie as a Humanitarian Issue
[added thought – The interactive relationship between caregiver and patient that the current system does well is the two extremes. At one end of the spectrum is the classic ER drama with one patient at death’s door from a heart attack or car accident, surrounded by a whole room full of doctors and nurses and x-ray techs. After the acute crisis has passed, the patient is admitted to hospital under the direct care of the nursing staff. A specific physician or perhaps two if there are different medical problems to be handled, will come by his room for 5 minutes every day to check on him. During the other 23 hours and 55 minutes of each day, a different staff nurse for each 8 hours shift will be simultaneously responsible him and for other several patients. The one-on-one ratio of most human interaction is the one number that is rarely seen outside of TV dramas – instances in which a healthcare practitioners comes into the patient’s presence, sits down and simply stays for awhile, watching, asking questions, talking, taking time as if it (time) were itself a therapeutic agent of great value.
An example of this in the realm of normal biology is typical care during labor and birth. As a L&D nurse, I provided care simultaneously to 2 to 4 labor patients. When the mother was pushing and the birth imminent, I notified the obstetricians who came in an officiated at the birth, with me present as a spare pair of hands. After the baby was born, it was either handed to a special baby nurse. If there was a problem, the baby was taken to the nursery, if not, it was handed back to the parents. After the placenta was delivered and any other birth-related care by the obstetrician concluded, he or she left. Then the care of the mother and baby reverted temporary back to me. As a labor room nurse, I was still responsible patient and hospital needs in other parts for the L&D unit. Finally, I moved the mother and baby to the maternity floor of the hospital to be care for by other nursing staff.
Compare this with traditional midwifery care. As a midwife I am providing labor and birth care to women that I have already know well, since I cared for during their pregnancy. I am present full time during active labor, I personally manage the pushing stage and the birth and the immediate after the birth. As a midwife birth attendant, I remain in the room and continue to care for both new mother and new baby for at least 2 hours afterwards, while the mother learns to breastfeed for the first time. Then I weigh, measure and examine the baby and provide the parents with directions on how to care for their newborn for the first 24 hours of its life. Before leaving their presence, I arrange to return the next day to check on the new mother and baby, a one-on-one visit that is usually about an hour in length.
But the greater expense in this system is an unconscious deal with the devil that trades the simple present of an MD – his or her professional time – for the unnecessary use of drugs and procedures. Given the expensive of preparing a MD, the use of an allopathic physician’s time has becomes extraordinarily and disproportionately expensive since 1910.
Every MD starts his or her professional career under a mountain of educational debt. Starting an independent practice is to amass a small avalanche of bills for fixed expenses (salaries, malpractice insurance premiums, rent, etc) that come at the end of every month. To be hired by a big corporation is to take on the responsibility of making a profit for their shareholders.
Paying off that debt is a first priority that puts a price tag on every minute of the physician’s time. Very quickly it become obvious that an MD’s time — being empathetically present, listening, talking, asking questions, sympathizing, making suggestions, educating the patient or the parent –is “too expensive” in the current system. NO employer , no health insurance plan, no government policy is willing or able to compensate an MD fairly for the ‘simple’ use of his time.
When all you have is a hammer, everything looks like a nail, so we jump on every aspect of human biology and every minor illness with the big guns of allopathy –expensive, often invasive interventions associated with side effects and sometime medical errors. This inevitably results in the overuse of prescription drugs and medical and surgical procedures. This does create a employment for a very long list of ‘physician extenders’ – nurses and many others in the allied health professions and it certain is profitable for pharmaceutical companies and hospital administrators. But it is not cost-effective when judge by wider social standards, which must ask the question of sustainability – can we support a drug and procedure-centric system that is already twice as expensive (compared to GDP) as any other developed country AND is growing at twice the rate of any other sector of the economy AND gets less bang for its buck than counties that spend far less?
Choke Point Charlie as an Employment Issue
Only after being evaluated and treated by the MD is any other aspect of the traditional healthcare system authorized to provide additional or on-going care. Legal access to drugs requires a physician’s prescription, the legal ability of nurses or other healthcare professionals to take a specific action requires a specific “doctor’s order” (or standing order) and the ability of nurse practitioners, midwives and physician assistants to provide care requires ‘physician supervision’. The medical world refers to this last category of non-autonomous professionals who do the same work as a physician in specific circumstances (such as routine care or normal childbirth) as ‘physician extenders’. Non-physician practitioners are not legally allowed to provide the same type of healthcare as an independent professional and sequential attempt by this subset of professionals to be acknowledged as primary practitioners is seen as an economic intrusion on the sacred soil of MD-centric medical practice.
RNC, nurse clinicians, physician assistants and in some states, professional midwives are all legally required to have a contract for physician supervision before being able to practice,. However, these laws — ones passed at the insistence of organized medicine — do not in any way require physicians to provide this legally mandated service or in any way reward doctors who do. While being mandatory for the RNC, CNM or LM, they are purely voluntary of the physician. This dysfunctional arrangement creates ‘vicarious’ liability for the physician, which is to say it unnecessarily and unnaturally increases the cost of the physician’s malpractice insurance and gives the insurance company the right to determine if the physician is ‘permitted’ to supervise a particular category of non-physician practitioner and if so, exactly what kind of care and under what conditions that practitioner is allowed to provide. For the last 60 years, all attempts to repeal this oppressive legislation have all been promptly killed by organized medicine, whose campaign contributions have become necessary to every politician’s political aspirations. This is achieved by offers of generous contributions to the re-election campaign of legislators who agree to support organized medicine’s position and the symmetrical threat that an equally generous contribution will be given to your opponent if you refuse to cooperate with organized medicine’s goals.
Choke Point Charlie as an Iatrogenic – Nosocomial Issue
Choke Point Charlie as a Gender Issue
When the AMA-engineered closing of medical schools that did not meet the AMA’s criteria in 1910, this policy fell asymmetrically on schools that accepted women and anyone of limited economic means. Closing of half of the medical schools skewed entrance policies of the remaining programs asymmetrically toward males of the upper class. The consequence of gender-influenced policies in medicine mirrored those in other professions in 1910 – lawyers, politicians, school administrators – all areas of public life that required lengthy university-based education and resulted in employment situations of higher status, both in income and influence.
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In the first decade of the 20th century, a series of events coalesced into a perfect storm, one that destroyed our traditional healthcare system. A broad-based and inclusive model was replaced by a hierarchical and exclusive system of defined by a small number of individuals who were representatives of a special interest group.
The driving energy for this was organized medicine but this ultimate goal could only have come about with the enthusiastic assistance of others – in this case, the people who were in charge of the biggest philanthropic organization as the day – Carnegie and Rockefeller Foundations.
designed by same narrative error in which the broadly acknowledge benefit of scientific education of medical doctors
How could that be? In 1899, the AMA hired its first full-time employee, Dr. George Simmons as its new general manager. Simmons had an extensive background in the newspaper and publishing business before he became a set out to promote the ‘regular’ or allopathic practice of medicine, created the Council of Medical Education and assigned a few like-minded physician-members of the AMA to come up with a the ideal medical school curriculum
with a goal of reducing the number of medical schools, increasing the cost of a medical education and new graduates so as to
is our current romance with computer technology, the internet or automobile travel
We can imagine how easily a well-connected, well-financed organization committed to promoting computer and internet technology could convinced the public of the ‘obvious’ superiority of these methods and successfully promote passage of laws the required all previous methods to be replaced by computer technology – no more would we be permitted to teach penmanship or permit any to sell pencils – everyone would be required to purchase a computer and a printer. Anyone who could not afford such a purchase would have
Culture is thousands of years of accumulated, coded wisdom. Taking Root: Green Belt of Kenya –life of Wangari Maathia – workshop in political activism – people list the problems as they experienced them. Initially they blame most of the problems on the ‘authorities’ but very important for people to see that many problems this have listed have actually come from themselves. Use the metaphor of traveling — Take wrong steps, get on the wrong bus, wind up wrong place and likely to encounter lot of problem – teachable moment to explore just how they are part of the that matrix of ‘dysfunction’
Why get on / stay on the wrong bus? Confusion by your thoughts, by not asking questions, people don’t ask question because of fear, confused because those they ask mislead them, give them wrong answers – so should you just sit there on the wrong bus and sing “keeping silent, keeping silent in all ways and for all times just stay were you are and put up with what every happens — until Christ returns and he will find you where you are and deliver you from your suffering, so you just wait
Have to get off the bus and engage the driver with
The Bolonia process – granting college degree based on skill and knowledge not just on ‘credits’ – classes taken and passed
transparacy in education, called ‘turning’ as a European concept started 10 years ago to identify what the student learned (rather than what is taught) as the basis for academic credentials, thus making it transferable between academic institutions and give potential employers and policy makers a stable platform.
Coordinate educational process with job market – example as applied to the role of a primary practitioner whose role is to take people into the health care system. The organic function of primary care falls in three general categories: (1) – an elemental form triage to distinquish those with acute or urgent medical needs from those who are not experiencing a medical crisis – a role current filled to some degree by nurses in ERs, clinics and doctor’s offices (2) to examine and identify the patient’s basic non-urgent needs and employ evidence-based science to treat those with
Lumana Foundation
Operative obstetrics
Preemptive strike
The post-obstetrical world
Physiologically=based care for healthy women as the universal standard of care use by all categories of birth attendants – physicians, obstetricians and midwives – when providing care to healthy women with normal pregnancies. The form of maternity care always remains articulated with comprehensive obstetrical services and utilizes medical care whenever required or requested by the mother.
Characterizations of Issues – 3+ word phases and one liners that characterize principles or policies
The problem with obstetrics is that it is all about obstetricians.
Defining, conducting and billing for normal childbirth as a surgical procedure is a happenstance, a fluke of history that can be traced back to 1910 and policy decision made by the founders of American obstetrics. Before the discover of antibiotics, conducting normal birth as a surgical procedure was an experimental attempt to prevent puerperal sepsis in hospitalized maternity patients. ‘Childbed fever’, as it was called the early 20th century, was a life-threating hospital-acquired infection. Until the discovery of Pasterur’s germ theory of infectious disease in 1881, it responsibility for repeated epidemics that killed from 5 to 50% of
Since 1910 the obstetrical profession has defined the terms for all childbirth practices and all forms of maternity care. Their characterization of childbirth as a dangerous and dysfunctional form of biology has in isolation driven nationally adopted policies and practices, generated laws and legislation. This happened without input from the wider scientific disciplines, the public health community. Childbearing women were treated like objects and their families and the midwifery profession reduced to the role of mere observers without a voice or opportunity to .
This narrow focus on operative obstetrics generated by the biased definition of childbirth biology turned the 20th century into Dark Ages for the principles of physiological management of normal labor and birth, which seek not to disturb the normal process. The philosophy, principle and practice that permit the wise management of childbirth – minimal use of interventions for maximum results – to flourish. Instead, it criminalized the care of midwives and eliminated the teaching of physiological management in obstetrical training programs. Eventually these prejudiced policies were institutionalized as a medicalized standard of care, which legally restrict s the scope of practice for hospital based obstetrics (which includes the care of nurse midwives) to an obstetrically-defined protocols call for the routine use of interventive technology (EFM, IVs, etc) and restrictve policies that limit the mother’s mobility during active and 2nd stage labor, the impose artificial time restraints and otherwise,
