Dr. Maller’s Blog

What? The title is spelled wrong? And you noticed! You must have gone to an expensive private school.

The state of education is like the weather. Everyone talks about it but no one has any idea how to fix it. But it is too important to ignore.

I’ve been more than a spectator but less than an expert. I’ve been taught by unforgettable teachers in grade and high schools; I’ve graduated from an Ivy League college and an even better medical school. My children have ranged from college dropout to law school, all of them doing well with no correlation to their academic status. My oldest grandson is a freshman in college, I hope for education and not indoctrination.

I read recently that a school superintendent somewhere (?North Carolina?) decided that American History should be taught henceforth starting after the Civil War. In that spirit, let’s drop the first two years of medical school and law school. Wanna learn to fly? Skip ground school – just take the keys and try it out. Is this the dumbest idea you’ve heard in a while? Or do you agree with the lady that nothing important happened in America before 1865? Or is it just that our children would be too stressed out having to learn what happened before then, or why America is exceptional, or what the Constitution and Declaration say or mean?

An impertinent reporter recently toured the campus of Berkeley asking random students who their favorite president was and why. Lincoln was first (but no one could say why) followed by
Obama and Benjamin Franklin (who was never president); the actual winner was “I can’t think of anyone.” Half of the freshmen entering elite schools like Berkeley require remedial English and math. Spelling is no longer considered important; to correct one’s spelling might damage his or her self-esteem, you see.

My practice has been impacted directly by the sad state of our education system in the San Fernando Valley, which is part of the sprawling and underperforming LA Unified School District. Those families with the means choose private or parochial schools, which generally turn out a far better “product” at less cost. For most families those options are out of reach. Over the years I’ve seen hundreds of families move to the outer valleys with better schools, or even go back home to places with frigid winters and muggy summers, just to get their kids out of LA. But more and more have opted for home-schooling, including some of my largest and highest-achieving families. It’s a wonderful choice for those parents who can handle it. But it is not without its critics, who as far as I can see care more about teachers’ unions and bureaucratic jobs than about our kids.

We usually describe special interest groups such as unions and government employees as “liberal” because that’s usually how they vote, but they are the true reactionaries in our society, standing in the way of innovation and free choice and leaving our kids short-changed and less able to compete in the global economy. Indeed the only “choice” these folks usually support is abortion; everything else is to be decided by “experts”. The most outrageous example I can think of is the betrayal of a popular school voucher program for the poor, almost 100% black kids in D.C. by the Obama administration.

There are many reasons why some kids fail. In our minority cultures, education is often derided as “turning white” or some such rubbish. I’m very proud of a young Latino friend who has become an engineer despite his family’s efforts to dissuade him. A protegé of mine, a young black pediatrician whom I’ve known since she was 11, thrived at Stanford and UCLA because she is super-bright and committed – but she also had the wind at her back because everyone in her family expected great things from her. And she had more than that – an intact, devout family that would have been typical of American blacks through most of their history until the sixties.

In the last two generations we have seen chaotic changes in our society, largely attributable to government’s clumsy attempts to address social problems that are not part of their constitutional mandate. One of the greatest of these failures has been the teaching of our children. Liberal programs generally sound good on paper but rarely work out that way, nor are they even looked at critically. Head Start, which seems to exist largely to employ thousands of busybodies to make nonsensical rules like “every 3-year-old needs a TB test”, has been evaluated recently and found to be an abject failure; by second or third grade there is no difference between their graduates and other children who didn’t participate. We have been inhaling diesel exhaust by the ton for 40 years so kids can be bussed all over town to achieve absolutely nothing. Basic skill classes, tough subjects that make stronger minds, classic works of literature are too often set aside so that the ever-present “self-esteem” merchants can peddle their psychobabble and our munchkins can learn about all the “-isms” and go on to major in pseudo-sciences like Diversity, Ethnic Studies, Gay-Lesbian-Transgender-Whatever Studies, or pursue the phantom of man-made global warming.

Over a hundred years ago my grandparents, teenagers without means, bravely came to America to escape persecution and to enjoy the blessings of freedom. My generation of Jewish kids excelled in school because we were expected to! The Asian immigrants of today are so like us. So are many of the Latino and African children, but their climb is harder.

Last week a proud father brought in his 12-year-old son, just arrived from Ecuador, for his first visit. His father had come here a couple of years ago and worked to make it happen. He said without irony, “My son is here to live the American dream.” And he teared up.

That dream didn’t start in 1865, and I hope it never ends. Do our parents of today know what their children are not learning? I don’t know who first said it but I love this quotation: “To know nothing of what happened before you were born is to remain ever a child.” Indeed.

This time of year it’s hard on us Southern Californians to bear the slings and arrows of our friends and family living almost anywhere else, watching not one but two Rose Bowl games played in glorious warm weather while they shiver and sulk, shovel and skid through an unusually harsh winter.

I’m feeling pretty smug about the weather, but not because of where I live. The Climategate scandal was our Christmas present du jour and wasn’t it a beaut?

Just before the Al-Gore crowd was to assemble in Copenhagen it came out that major weather “experts” on both sides of the pond had been systematically excluding data that questioned their so-called “settled science” that the earth was warming alarmingly and that human activity was to blame. Editors had been fired and careers destroyed. The intent of the Denmark conclave, which required 1200 limousines and innumerable private jets to populate, was to transfer billions of dollars in wealth from rich nations (us) to needy nations (the other 190) in the name of controlling CO2 emissions. (Of course India and China are too busy becoming prosperous to be bothered). Didn’t we learn in school that CO2 was what plants breathed in? I guess that went the way of school prayer and dress codes. Anyway, Al Gore won some awards for a movie ironically called “An Inconvenient Truth” that our schoolchildren have to suffer through, and CO2 got a bum rap, especially since everything we enjoy doing (driving, eating, farting, breathing for example) added more CO2 to our atmosphere. And if Mr. Gore’s mansion in Tennessee produced 20 times as much as your house, well HE is saving the planet and you’re not.

Age has its benefits, one of which is remembering when the script was different. Back in the 70s the earth was cooling dangerously. Time’s cover blared “The Coming Ice Age.” Some clown with a PhD predicted that we’d run out of food by the 80s. He’s still around, getting fat fees for lectures and books paid for by the hardy few who survived. The intellectuals instinctively blame all our ills on ourselves – there are just too many people, we’re running out of everything, blah blah blah. Unfortunately the western world seems bent on demographic self-destruction; most countries have barely half the necessary birth rate to maintain themselves.

My interest in so-called global warming started in earnest several years ago when I read “The Skeptical Environmentalist” by Danish statistician and Greenpeace member Bjørn Lomborg, who showed with meticulous research that money spent on reducing carbon emissions would have no measurable effect on climate change and would better be spent on meaningful reforms like sanitation. It is still his mission through the Copenhagen Project to influence the rich countries to spend wisely, and his impact is growing. Since then I have pursued the subject with growing concern because of the clear political poisoning of the debate. Should you choose to do so you can read or watch such works as “Unstoppable Global Warming – Every 15,000 Years”, which show that the earth is always warming or cooling, that industrial activity was nonexistent when the greatest warm periods occurred, that the Little Ice Age did far more damage than could conceivably occur with a degree or two of warming, and all sorts of other good news. An Arctic melting is happening but the polar bears will survive; meanwhile the opening of the Northwest Passage will save the environment enormous amounts of pollution by shortening shipping routes in the summertime. More food can grow; less fuel will be needed to heat homes. Did you know that Greenland was once green? Vikings farmed there for a few hundred years! There are fossils of palm trees in Siberia. Antarctica was almost surely once free of ice. The planet, like our own bodies, has an amazing capacity to regulate itself, When oceans warm, clouds increase and more sunlight is reflected away from earth. Water vapor, not CO2, is the primary greenhouse gas (excluding what emanates from the mouths of politicians).

In my first blog I cautioned not to confuse science, the pursuit of truth, with truth. Too many scientists have swallowed the Kool-aid and allowed their principles to be compromised. The nineteenth-century philsopher G. K. Chesterton famously warned, “When men cease to believe in God, they do not believe in nothing; they believe in anything. This failure of faith often leads men to overestimate their own power. “Man-made global warming” is such a conceit.

The course I most enjoyed in college was Greek Drama. It was a rare treat to choose an elective, pre-med being the challenge it is. It was also the one class I shared with my wife-to-be.

The word I refer to is hubris, the hero’s fatal flaw, the arrogance, the lustful pride that would be his undoing. Nemesis was the instrument of his destruction. There are some forty surviving Greek plays by Aeschylus, Sophocles and Euripides. A few were funny (e.g. Lysistrata) wherein the wives band together to withhold matrimonial pleasures from their husbands until they stop fighting wars, but most were tragic. Some of the names are familiar: Oedipus, Electra, Medea. The “Greek chorus” acted as a sort of narrator. Special effects were primitive but powerful; the climax often involved a deus ex machina, quite literally a god (the Greeks had many) who arrived via a sort of trapeze to inflict the hero’s punishment or salvation.

The past year we have witnessed hubris all around us with truly tragic effects. Tiger Woods was surely the most admired and blessed athlete in the world; his beautiful wife and children rounded out a picture that shattered months ago with the disclosure of his sordid sexual behavior. The corporate world has taken an estimated $12 billion hit, but that’s not what makes it a tragedy. Bill Clinton got away with it (except for that impeachment thing) but no one ever confused him with an Olympian figure. No, this was the self-destruction of a man of mythic stature.

I do believe that history will show a similar downfall for another man of mixed heritage who had it all, who was worshipped, who transcended all barriers to arrive at the figurative Olympus of our world, the White House, but whose fatal flaw was the greatest aphrodisiac of all, power. Mr. Obama has mistaken his 53% win as an invitation to undo 232 years of unparalleled democracy and prosperity and put in place a Chicago-style thugocracy with his hand-picked cronies in power, spending recklessly and helping to destroy our children’s future. His aim seems to be to create so many government-controlled ventures and voters that his power cannot be challenged. Meanwhile his #1 job, keeping our nation safe from its enemies, is apparently “above his pay grade”.

There have been so many other examples of hubris: Mark Sanford, Republican governor of South Carolina, who has make “hiking the Appalachian trail” the latest euphemism for having sex with one’s mistress; the former vice-presidential candidate and presidential wannabe, John Edwards, he of the trial lawyer billions and $1250 haircuts who fathered a child with his mistress while his wife was recovering from breast cancer therapy, then tried to blame it on one of his aides (who had had a vasectomy).

The inevitable question is Why? The answer seems to be “Because they can.” Shame on them. But shame on us too, for elevating celebrity beyond all reason, for allowing ourselves to be seduced by ordinary mortals who promise us gratification without cost.

That’s “wring” with a “w”, not a typo. 2009 was a sloppy mess of a year and I say “good riddance.”

It’s been two years since I started blogging and I’ve been looking back at my off-and-on efforts with a mixture of pride and embarrassment. Forty posts plus some instructional entries aren’t as much as I’d hoped. But my readers tell me to keep at it. Tomorrow is two years since Gucci, then a one-pound fuzzball, appeared unexpectedly at my front door tucked into my wife’s cleavage, which is still her favorite hangout. Now she’s a seven-pound wonder dog whom most of you know. Getting through 2009 might have been impossible without her.

On a personal level this has been the toughest transition I’ve made in many a year and many of you have suffered through it as well. Going from a proudly independent solo doctor to part of a group, trading my beloved Mac computers for the Brand X variety and having to march to a different drummer haven’t come easily. The old charts are gone and the computer rules the roost. Claudia had her baby boy Daniel on October 17 and will be working elsewhere soon. Brenda has been with me for 15 months now and I hope she continues, but I’m not the boss any more (don’t tell her that!)

Faces are long and tempers short in the doctors’ lounge these days. We had a terrible blow in April when our CEO Al Greene, who had arrived in 2006 and turned Valley Pres around dramatically, died of pancreatic cancer at age 58. Practices built up ethically and deservedly over the years are under siege. The center of the Valley has been hammered economically, not just lately but for decades by the loss of its tax base and the disappearance of thousands of jobs as GM, Hughes, Lockheed and so many others have moved on.

When I began this effort at communication, I hoped to keep politics to a minimum. No chance! What we are witnessing in our beloved USA is an unprecedented assault on our very way of life – not just by zealots of the “religion of peace” but by our own duly elected (with help from the ACORN thugs) government. We have at its head a narcissistic graduate student who has never run a lemonade stand, surrounded by sycophants who answer to no one but him. Our grandchildren are being saddled with trillions of dollars in debt; the dollar is becoming a joke; prostitution is apparently legal as long as it is between consenting congresspersons – and of course the global warming hysterics march on despite the disgrace heaped upon them.

But the big enchilada is health care, one-sixth of our economy and to millions a most personal and painful part of their lives. At this moment Congress is home, I hope hearing the American public loud and clear about the toxic brew they’re trying to make us swallow. I am still hopeful that this overreaching, lying, unread and unreadable 2000+ page monstrosity will die. Hillarycare was less unpopular at this point in 1993 than Obamacare is now, and yet 1994 happened and a lot of the bums were sent packing. I believe that will happen again. There is a lot that needs fixing in health care, as I’ve alluded to earlier. Three real reforms aren’t being dealt with because of political back-scratching – separating health insurance from employment, creating a competitive national health insurance marketplace, and getting rid of the lottery of a runaway malpractice system as California did in 1976.

2009 saw its share of medical advances, mainly in technology. New drugs are few and far-between however. One of the aftereffects of Obamacare would be a worldwide dearth of meaningful research. It costs a billion dollars to develop a new drug or vaccine and the risks of doing so are huge – but that’s the essence of capitalism. In the world of the socialists in D.C. profit is evil – unless it comes in the form of a bribe or a speaker’s fee or whatever else passes for “business as usual” in the seamy back rooms of our nation’s capitol (or Sacramento, etc.)

Every generation seems to have to re-learn Milton Friedman’s famous warning: “There’s no free lunch.” Government never creates wealth, it redistributes it from the earners and creators to those who do neither, keeping a hefty piece for itself. But I see Americans pouring out all over the country, in town hall meetings and “tea parties” and I feel renewed hope that ordinary folks will take back our country and preserve our freedoms.

Our Founding Fathers were courageous and brilliant, but they probably could not have imagined a permanent political class. Service to the public was like PTA meetings – you did it for your children and your community, not to replace work or to enrich yourself. Now we have an administration whose members have had, in 92% of cases, NO private sector experience! We have a tax cheat as Secretary of Treasury, an Attorney General who will, if he gets away with it, commit treason by giving aid and comfort to the enemy, namely KSM, who admitted masterminding 9-11 and asked to be executed. We have 32 unelected czars of dubious allegiance and ability running roughshod over our Constitution. We treat our allies with contempt and bow to dictators and rogues.

We need a slogan for the year ahead. I propose:
LIBERTY AGAIN
IN TWO THOUSAND TEN

Are you still with me? Need a pick-me-up? Read Sarah Palin’s book!

The influenza strain formerly known as swine flu has now been with us for about five months and the first vaccines are arriving, so it’s time for an update.

We are experiencing several unusual events. The last pandemic was in 1968. Influenza rarely occurs during the summer, but this pandemic has continued throughout the hot months. Will it replace the seasonal flu which generally appears about now, or will they occur side by side? We continue to vaccinate high-risk patients with the ordinary flu vaccine but it offers no protection against H1N1. Folks over 60 are immune. Deaths have been uncommon, perhaps 1000 in the U.S. compared to 36,000 in an average influenza year, but the highest rates have been in young adults and infants. So whom to vaccinate?

CDC suggests focus on priority groups, the first being pregnant women, then those caring for infants under 6 months, followed by kids 6 months to 4 years. Vaccine clinics have sprung up with long waiting lines; so far they are the only option. Safety should not be an issue with the killed injectable vaccine, given the better technology we have compared to the 1976 fiasco. I would not consider the live intranasal vaccine safe. The wild card is that by the time we could even vaccinate all those groups, almost all patients will have been exposed to the actual disease. H1N1 is also odd in that it causes more vomiting and diarrhea than other strains and therefore may not be recognized. Moreover, at least 40% of infected people have no symptoms at all. Computer models show that the best we could hope for with a mass vaccination program is a 6% reduction in cases.

Treatment with drugs such as Tamiflu is available but overrated in that it shortens the illness by just a day, and I believe the toxicity in children makes its use unacceptable.

I don’t expect the above information to change much over the next few months. The decision to vaccinate or not is one we need to make together. Clearly the threat of this new virus is more economic than medical. Government mandates to vaccinate have been tried and will backfire, given the mood in the country. We should have some vaccine within the next two weeks (that’s not a promise). In the meantime stay out of crowds, wash hands and store up some herbal tea, chicken soup and your favorite headache remedy.

As many of you already know, important changes are occurring in my office these days. The good news is that I’m not retiring. The bad news is that I’m not retiring. Just kidding – really.

Kids & Teens Medical Group Inc. in the person of Dr. Janesri DeSilva is absorbing my practice, which will be one of three locations. I will continue at Suite 102 (that’s Practice 5.0) as I have been since 2004. Her office is at 10550 Sepulveda in Mission Hills, and the other is nearby at 14608 Victory Blvd. This will allow growth and modernization that would not be feasible on my own. The group has two other physicians and a nurse practitioner and plans continuing expansion under Dr. DeSilva’s husband Sunil, who has an extensive business background. Claudia and Brenda will continue to greet and care for your children (except for some maternity time off for Claudia who refuses to have her baby on her lunch hour).

The benefits of this change include conversion to electronic medical records, about which I have mixed feelings (loathing and hatred). Mostly it’s difficult to give up my beloved Mac computers, plus I need to learn to type with the other eight fingers. But I take heart in that I practiced before there were computers, faxes, cell phones, MRI’s and CT scans, or for that matter HMO’s, PPO’s, Facebook or Twitter. On to the future!

By the way Practice 1.0 was the first 12 years in a rapidly growing solo practice with over 200 new babies every year, sometimes 200 visits a week, teaching rounds at Childrens plus the children’s games, recitals, Back-to-School nights, etc. The second phase was a 6-year stab at group practice with taking on two young pediatricians and opening a second office in Valencia. Good idea, wrong people. Then followed 15 years back at solo practice from 1984-99 during which managed care whittled away at doctors’ livelihoods and sanity. That was 3.0; the next five years sharing space with Dr. Menzer upstairs was 4.0 followed by the phase that’s phasing into the new phase, to coin a phase – I mean phrase.

Thank you all for your loyalty. I hope to sneak a day off now and then but try not to notice, OK?

At the suggestion of a new mom who has sent me a list of some 11 “old wives’ tales”, I shall try to shed some light in these dusty corners.

1. Doubling your toddler’s height at age 2 will give you their adult height.
That’s the rule for boys; for girls it’s eighteen months. I’ve had hundreds of patients grow up to adulthood, and it’s a pretty good estimate. But everything in biology falls on a bell curve. The eventual height can be influenced by early or late puberty; “late-bloomers” may keep growing through their teens. One caveat: measuring a toddler accurately can be like nailing Jello to a wall. It is also sadly true that our maximum height is achieved around 19 and thereafter we shrink as our vertebral cushions deteriorate. I’ve lost an inch and a half since 19.

2. My newborn had a high Apgar score; should I start saving up for Harvard?
The Apgar score, especially at 5 minutes, is a great help to the medical team in that a high score (8-10) means little intervention is needed, whereas a low score calls for drastic measures. However, the eventual outcome for the baby correlates very poorly with the score and is more influenced by heredity, nutrition and other factors. Besides why would you want your kid to go to Harvard?
I actually met Dr. Apgar once when I arrived at Columbia-Presbyterian for my training; she was retiring as chief of anesthesiology. How simple the most elegant contributions to science can be!

3. Bundle up your child or they will get a cold.
This is not only nonsense but worse. If your baby actually gets sick, layers of blankets will trap heat and make fever harder to manage.

4. Shaving a baby bald will cause the hair to grow back thicker.
Nope – and it won’t work for Dad either!

5. Girls develop faster than boys.
Yes, although because of the bell curve you see large variations. Baby boys are larger on average than girls but puberty usually happens at a younger age in girls, as any junior high boy can tell you. If by development you mean social and intellectual skills, girls are faster. Did you know that 58% of today’s college kids are women?

6. If your baby skips crawling and goes right into walking they will be clumsy.
Crawling was thought until recently to be crucial to proper development, not only in physical skills but learning as well. Since the “back to sleep” push to prevent SIDS we have seen a generation of babies resist learning to crawl, but with no discernible impact on later outcomes. “Tummy time” is important for muscle development, so get down and dirty with your baby.

7. Children grow more quickly in the spring (hence the term “growth spurts”).
There’s no reliable evidence that it’s true, but in places with long winters the arrival of more sun may work with vitamin D to hasten bone development. Some say babies grow more during sleep. Imagine trying to prove that!

8. A baby who drools will experience a delay in talking.
This one is new to me, which in itself is quite remarkable. I can’t remember many babies who didn’t drool at times. Delayed speech is on everyone’s mind these days. Clipping a tied tongue has come back into fashion, but for breastfeeding problems rather than speech.

9. Putting breast milk in a baby’s eye will cure conjunctivitis.
I love this one because I recommend it all the time. Most goopy eyes in the early months are caused by blocked tear ducts, and massage with mother’s milk on a regular basis will often clean up the discharge and prevent future surgery. A full-blown conjunctivitis may call for topical antibiotics, however.

10. Mixing rice cereal into a bottle of milk or formula will help your baby sleep through the night.
NOT! Cereal will slow the absorption of the milk somewhat but sleep is controlled by the brain, not the stomach. Eighty percent of new babies sleep “through” the night (really six hours or so) by three months; the others are factory rejects who should be returned – as if! Actually the term “sleeping through the night” is inaccurate. Like adults, babies have a sleep cycle of 45-55 minutes. If you’re lucky they self-soothe and go back to sleep, as we do. If not, it must be Dad’s fault. Why? Isn’t the man always to blame? But I digress…

11. Vaccines are related to autism.
This was the subject of my first blog, Since then the evidence has piled up totally putting this silly idea to rest. Almost all the authors of the original report have renounced it and admitted they were duped; the “study” was financed by trial lawyers and never had the slightest validity in the first place.

12. A wide space between the upper incisors is a sign of superior intelligence.
I added this one because I’ve heard it often. It must be true – check my smile some time!

This all reminds me of a time when I saw an old wives’ tale develop before my eyes. My internship was served at the ancient general hospital in Philadelphia. The nursery had those enormous factory-style windows. The head nurse was an elegant and wise lady named Priscilla Parke (her family was the Parke of Parke-Davis; it used to be common for rich ladies to become nurses). Her insight was that at certain seasons babies were jaundiced more or less than at other times, and she thought it might be the amount of sunshine coming via those windows. It wasn’t but a few years later that phototherapy was discovered as effective for treating jaundice.

With over 40 countries represented in my practice lifetime, I’d probably be able to collect much more folk wisdom from around the globe. Feel free to send me your favorites.

You probably missed it but our president gave a pep talk last week to the recalcitrant public on why his health care takeover must happen ASAP. Viewership was notably poor despite the usual tailwind provided by his friends in the government-controlled media.

An example he chose to underscore what he sees as the problem with our current system was a slap in the face to every practicing physician. To paraphrase it, if your child is brought to his pediatrician with a succession or sore throats, the doctor might decide to take out the child’s tonsils because he’d make more money that way.

Here we have the spectacle of a man who can’t wait to take control of one-sixth of the US economy and he is as ignorant of medicine as he is of building cars or running a bank. As Homer Simpson would say, “Doh.” Tonsils are not removed by pediatricians. Moreover, the going rate for the procedure goes down every year and no one will ever get rich that way. The really infuriating thing, though, is to have one’s entire profession insulted by a politician, someone who has never held a job in the private sector, never done anything to create wealth, who won’t release any school or personal papers, who consorts with radicals and terrorists.

Does he really believe that doctors are in it for the money? Maybe there are such people but I’d be hard-pressed to name any. On the other hand, have you ever known of a politician who didn’t get rich in office (or richer)? OK, not counting the ones in prison.

“What is the use of discussing a man’s abstract right to food or to medicine? The question is on the method of procuring and administering them. In that deliberation I shall always advise to call in the mind of the farmer and the physician, rather than the professor of metaphysics.”

So said Edmund Burke in 1790. It is not a new debate. As the most influential philosopher of our American Revolution, his counsel should be heeded.

Our Declaration of Independence assures each of us the rights of “life, liberty, and the pursuit of happiness.” It may seem indisputable that health care is a “right” in that it may affect life or its loss. But there is a problem assigning a right to the public which entails servitude on the part of those entrusted to dispense it. The question was academic until the last 75 or so years, before which time medicine had little to offer the afflicted or dying. Now practitioners of the healing arts fix ill and broken patients every day, because they can and should. But that is done by contract, and whenever possible the practitioner deserves payment. Our social systems have evolved in the direction of a safety net for all, and few would argue otherwise. But to our political class a “right” to medical care means total takeover by the tax collectors of both the means of care and its payment. The contract is no longer between patient and caregiver. Already much care is mediated by insurance companies and there is continual conflict of interest among patients, employers, government and them.

Education may also be considered a “right” rather than a privilege, and generations ago we turned most of it over to the public sector but the product turned out by our schools has become a national scandal. Politicians rarely send their kids to public schools, just as they have no intention of forgoing their excellent health plan if they accomplish their intended takeover of our present health care system.

Please remember when you need a highly trained physician with rare skills, a trauma surgeon, oncologist, neurosurgeon or ICU doctor that he or she went into practice after a dozen or more years of training, probably in a great deal of debt, possibly with a family, and that you do not have a right to demand the services he or she offers, but in our great country you will get the care you need and more than likely the doctor will be paid, usually far less than deserved.

Do you think $1000 is too much for an MRI or CT scan? Is $5000 too much for an eye operation or cancer surgery? I’ve had them all and knowing the best and brightest were on the other side of the curtain was priceless. I hope our future generations have the same.

When I started blogging a year and a half ago I promised myself I’d steer clear of politics. But politics is coming after me, and you, and everyone who dispenses or consumes that 15% of our economy known as health care. I have enough faith in the common sense of Americans to trust that we can fix what’s dislocated without breaking every bone in our structure as a society.
But the heat is on again from Washington, and the lies and distortions are drowning out more temperate and rational debate. In no particular order, here are ten of the most common lies with some historical references.

1. There is a crisis that must be solved before Labor Day or Halloween or whenever. Really? Since Hillarycare was defeated 16 years ago, what has changed? The figure of “47 million uninsured” is repeated so often but what does it mean? Polls show that 70-80% of Americans are satisfied with their current plan and do not want their taxes raised to make coverage universal. Twenty percent of the uninsured are illegals. Another 20% make over $75,000 a year and choose to do without health insurance. Another fifth are eligible for existing programs but haven’t signed up, and millions of others are young people between jobs or in school. The real “crisis” may be too much care; every emergency department is overloaded with routine cases who can’t or won’t go to a doctor’s office. If the swine flu has its way with us this fall we’ll have a true mess on our hands, but don’t expect the honchos in Washington to help. They’ve got the best insurance plan on the planet, but it’s not for us common folk.

2. Electronic medical records will save tons of money and may save your life.
As they say in the computer world, GIGO. There is no proof that EMR saves money or lives. The VA system uses bar codes to identify IV solutions. Sounds brilliant, except that it took four months for a human to note that the bottles were mislabeled. Nobody died so you didn’t hear about it. Reluctantly I’m beginning to enter that paperless world in my practice. Since I type like I dance, it’ll be slow going. Every minute at the keyboard is a minute not engaging the patient and family. Is that really progress? On the other hand I will recoup my investment in this system by about 2030, Of course the system will be obsolete long before then. I’m not a Luddite; I realize that computerizing a patient’s medical record may reap benefits down the line. But growing pains have been so bad in this area that some hospitals have already scrapped their systems. If you show up in an ER in bad shape don’t expect the doctor to wade through hundreds of pages of mostly unimportant stuff AND save your life. Can’t have both!

3. A public plan will bring down costs. Has that ever happened? We have public plans that account for half of our current “system”of care – Medicare, MedicAid, VA and so on. They are breaking banks in every state capitol as well as Washington, so just what lesson can we take from that? Do you believe that the US Postal Service would perform better if we made FedEx and UPS go away?

4. American business can’t compete with other countries because they have socialized medicine and we don’t. We are suffering to some degree in the world economic arena because of our high taxes, burdensome regulation, and government incompetence. Health care accounts for more of our GDP because we choose to buy it and because it’s usually good.

5. Infant mortality is lower in many other countries with socialized medicine. This lie is perhaps the oldest of the top ten. Other countries don’t count a “birth” until 28-30 days (e.g. Scandinavia) and others exclude the smallest babies. We also have a hard-core mostly inner city underclass of drug-addicted parents, illegal aliens with no prenatal care and other problems that no government scheme has yet unraveled. In fact because Congress is mostly lawyers, no real tort reform is likely and there are increasing areas of the nation with no qualified MD’s to deliver babies. (See Edwards, John).

6. Government experts can decide on the basis of “comparative effectiveness research” that only their approved treatments will be paid for. In England they have such a committee known as NICE (George Orwell must have made that one up!). Like the secret Hillary task force of 1993, it includes not one practicing physician. It is, first and last, a rationing board. Over 65? Kidneys on the way out? Uremic poisoning isn’t so bad – you go into a coma and die quietly, and you’ll be saving the taxpayers oodles of money. Need a bypass? Take a number. MRI? How’s nine months from yesterday work for you?

7. Life expectancy is better in some countries with socialized medicine. Yes, and worse in others. Japan’s is better than ours. They eat more fish, they’re less obese (maybe because they smoke!?), they’re less diverse. Russia’s life expectancy keeps going down; why not blame socialism? Or is it the vodka, the assassinations, the weather, or the sheer misery of living in a nation with so little hope. Point is, life expectancy in the USA is getting better all the time; since 1900 it has jumped an entire generation. All that with no government-controlled “system.” Take away the incentive to develop new cures, vaccines, biotech wonders which only America can do, and the world will pay a huge price.

8. Mandatory health insurance will provide universal access and lower costs. Hawaii tried it – for seven months. Massachusetts continues to try it but the state and hospitals are going broke, and there remains a stubborn minority of folks in John Adams country who just won’t board that train. We’ve had mandatory auto insurance for years now. Ever been in an accident with an INSURED driver? And just what “access” are we talking about. Every squeeze on the provider community costs the public more doctors and hospitals. “Boutique” and “concierge” offices are multiplying all over our once-free country. For old-fashioned cash, usually reasonable without all the third-party interference, care is offered as simply as getting a haircut. But the D.C. crowd won’t let that go unchallenged. It would have been illegal under Hillarycare to give or receive care privately, and I suppose the current incarnation will be no different. It is ironic that countries with socialized care are looking to increased privatization to lessen the strains on their antiquated systems, as in Canada, England and elsewhere.

9. Emphasizing prevention will lower costs. It pains me greatly to deny this because as a pediatrician I spend more time and resources on prevention than any other type of doctor, but there is no evidence that such care really saves money. We do it because it’s right and we will continue to do so. Remember when the cigarette honchos actually reminded Congress that they were saving the country millions in social security benefits by selling their wares? It’s true! Besides, government has always said prevention was great but the reimbursement paradigm is upside-down. As a primary care physician I have no incentive but my personal honor to talk to patients about changes in lifestyle, emotional stresses and a host of other non-diseases. English and Canadian doctors are given ever-increasing rosters of patients to see. Each encounter is so short as to be meaningless; no one gets undressed or properly examined. English dentists (yes they do exist) have a quota of patients to see. If they finish, they go on vacation because they will not be paid another quid (whatever that is) for working longer.

10. A public option is needed to spur greater competition. We already have 1300 companies selling health insurance. As the American Association of Physicians and Surgeons (of which I am a member) has said, adding #1301 doesn’t figure to change the playing field. But of course if it’s “I’m from the government and I’m here to help” those other companies are toast. Now neither I nor any doctor I know will defend the insurance companies. In fact they are so unpopular that most doctors want the government to take over and get rid of them. But be careful what you wish for. Because the government already skews the market so badly in controlling half the market, the private sector cost-shifts by overcharging everyone else. But remember, the government cares not a fig about your health. It is your vote they covet. As a believer in free market principles, I recognize that health care can’t be as unfettered as car or furniture sales (perhaps cars are a poor example right now). But I’d rather see a truly competitive private system that answers to a more enlightened public than one that’s run by the crooks in Washington who are on the power trip to end all power trips.

Just today I read that buried in the thousand pages of the health care bill that no one has likely read is a program to enforce vaccination requirements, including going into private homes with the legal authority to overcome parental objection. If you’ve been following my blog or coming to my office you know how dedicated I am to the goals of vaccination. But have Americans allowed their freedoms to erode to this degree?

On the cover of my favorite political magazine this week is a caricature of our president, grinning menacingly as he slips on a green latex glove, saying “Just relax.”

Please do NOT bend over.