nos-trum. pronunciation: \nos'-trum\. noun. Etymology: Latin, neuter of noster our, ours.
1. a medicine of secret composition recommended by its preparer but usually without scientific proof of its effectiveness.
2. a usually questionable remedy or scheme.
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Thursday, March 19, 2009


Obama backs away from plan to bill veterans' private insurance.

In continuing coverage, NBC Nightly News (3/18, story 7, 2:05, Gregory) broadcast, "A White House plan" to bill veterans' private insurance for war or service-related injuries "came under intense fire" Wednesday "in Washington and in American Legion halls across the country." Veteran "sources tell NBC News even the new head" of the Department of Veterans Affairs, General Eric Shinseki, "was strongly opposed. And late today, faced with another political firestorm, the White House put out this statement, saying the President had retreated and dropped the proposal."

        …veterans' groups "complained that the proposal would reverse government policy of taking responsibility for caring for the war wounded and said it could cause difficulties for veterans in getting future insurance or even jobs. Members of Congress leapt in to join the criticism."


Doc D:  This is a disgrace.  As the American Legion leader said in an interview, the President deflected every question about the moral commitment to care for our wounded, and re-directed the conversation to how much money could be saved:


“It became apparent during our discussion today that the President intends to move forward with this unreasonable plan, …He says he is looking to generate $540-million by this method, but refused to hear arguments about the moral and government-avowed obligations that would be compromised by it.”


At first, I hoped that this proposal was the product of some White House staff, politico, bean-counter…but apparently not.  The president saw no problem with it.  At the least, this is incredibly stupid, and out of touch.  He can sign legislation on swine odor, but war wounded need to find their own coverage.  As the American Legion wrote, sarcastically, on their website:


"If you were injured in Iraq or Afghanistan and you have not paid your co-pay, please press 1. If you were injured during military training and you have not yet reached your deductible, please press 2. If your family has reached its maximum insurance benefit, please call back after you have purchased additional coverage. Thank you for your service."


The response to this proposal was the first sign of bi-partisanship I’ve seen this year.


Clearly, this is a hot button with me.


Obama defends budget, healthcare provisions against Republican criticism.

The New York Times (3/18, A16, Cooper, Hulse) reports the White House "has begun a full frontal assault to get President Obama's first budget through Congress.  During an appearance on Tuesday at the Eisenhower Executive Office Building, Mr. Obama took a swipe at Republican critics of his $3.6 trillion budget and its agenda for healthcare."  Obama asked that "members of Congress who object to specific policies and ready and willing to propose constructive, alternative solutions.”


Doc D:  Unfortunately, this is a hollow challenge.  As we’ve seen, House and Senate majorities are of sufficient magnitude to make sure that no other alternatives see the light of day.  However, a plan is being hammered out by the so-called Gang of Nine, which is a bipartisan group of Senators, in concert with the administration.  I believe that there is widespread support for reform.  We don’t have any details of the Gang’s plan, so “what kind” of reform remains to be seen. 


Two problems I see:  first, the Gang of Nine met in secrecy for the last nine months.  This was fatal to the Clinton healthcare plan…where is the “transparency” that was talked about in the campaign.  Second, the President’s campaign mix of government and private insurance choice is not sustainable.  We saw this with the military’s TRICARE plan:  it allowed people to choose between several plans, but dis-incentivized all but the government-controlled, managed care option.  NOBODY has the deep pockets that the government has, and any private insurer that hopes to compete for business may be doomed to failure.   The government can, and does, take a loss wherever it feels the need to:  private insurers can’t.  I believe that it is likely that such a mixed system will inevitably move to a single-payer government system.  Americans have traditionally placed “choice” among their priorities, and I don’t think they will see this coming.


Over and above all this, my previous objections still stand:  nobody has come up with a way, short of rationing and controlling the types of care that can be offered, that will significantly control costs.  Even those nations with these mechanisms in place are experiencing rising costs.


Task force recommends daily use of aspirin for men over 45, women over 55.

ABC World News (3/16, story 7, 2:15, Gibson) reported that "a highly regarded medical group has solid evidence that men at risk for heart attacks and stroke should take a daily dose of aspirin beginning at age 45. Women should do it at age 55."

        On its website, ABC News (3/16, Potter) added that the new guidelines by the US Preventive Services Task Force, "an independent panel convened by the Department of Health and Human Services," also notes that "for both sexes, a baby aspirin -- typically 81 milligrams a day -- will do the job. There is no evidence that a larger dose makes a difference." And, "both sexes should stop by age 80, unless their doctors say otherwise. As you get older, there's a greater risk of bleeding in the brain or the digestive system -- a risk that is small, but can be fatal in some cases."


Doc D:  No politics here (thank goodness, huh?).  The evidence for aspirin as a prevention for heart attack and stroke has been suggestive for decades.  I’m convinced at this point, but it’s important to clarify EXACTLY what we are talking about.  Aspirin stops the platelets in the blood from sticking together when they sense that a clot needs to be formed.  How this works to prevent risk is not exactly clear, but evidence suggests that it reduces the likelihood that fatty deposits in the arteries can make the platelets think they need to stick together to “heal” the deposit.  This is a long-term process.  They also keep platelets from attaching to a clot, contributing to complete blockage of a narrowed artery  (it’s more complicated, this explanation works for my simple mind).  BUT, it doesn’t do a thing to prevent the fatty deposits that are the result of cholesterol, bad diet, no exercise, and family history.  You can’t take a baby aspirin and overcome all the rest.  Take an aspirin, but exercise your mind and body, eat right, get your rest, and have fun.  I’ll write you a prescription for that.


Medical quote of the Day:

He hath abandon’d his physicians, madam; under whose practices he hath persecuted time with hope, and finds no other advantage in the process but only the losing of hope by time.—William Shakespeare [1564-1616]  All’s Well That Ends Well



Nature Note:    STEM CELL RESEARCH.  As I said some months ago, in a previous newsletter, this whole stem cell issue is a tempest in a teapot.   You and I, all of us, have stem cells in our bodies.  They’re few and far between, but they can be harvested and used to treat serious disease.  In fact, it’s done regularly for certain types of cancer cures.  Stem cell research using these cells was not prohibited, and has skyrocketed during the so-called ban.  For instance, several months ago researchers produced a multi-potent stem cell (able to transform and grow into multiple kinds of cell) from adult human skin cells.    

The moral argument, except for people who see any tinkering with human genetic material as taboo, comes from the use of human embryo stem cells.  As you might guess the human embryo requires stem cells to develop…a lot of them.  Obtaining human embryo stem cells means grinding up human fetal material to obtain large amounts of ready-made stem cells that could be made into whatever tissue is needed.  It was disingenuous of some scientists to insist that only this method would result in steady advances in the treatment of disease.  It was actually just convenient, and less costly (with a few ego and ideological issues on the side).  Stem cell research has actually skyrocketed under the ban, and new treatments have been appearing monthly.

The President’s executive order lifting the ban is repugnant to a large percentage of the public.  Why court this moral controversy unnecessarily?  I don’t get it.

I don’t have any hard and fast philosophical belief on the status of human embryos.  But there is something life-demeaning about such a cavalier attitude.

I’ll give the President this, though.  He preserved the ban on cultivating human embryos for the purpose of harvesting their stem cells (which the advocates wanted).  Can you imagine women hiring out as stem cell farms?  And, of course it will be the poorest among us who would be the most vulnerable.

In summary, then, an unnecessary ideological struggle over a non-problem.


Recommended Reading:

See No Evil, The True Story of a Ground Soldier in the CIA's War on Terrorism, by Robert Baer.  We live in a time when CIA agents have needed to purchase personal liability insurance.  I wanted to know why we have had intelligence failures, alongside some successes.  Robert Baer served in foreign countries from the seventies through the nineties.  His theme is that the country has dismantled its “human” intelligence systematically for several decades.  What began with a turning away from overt acts in foreign countries under Carter, became a shutting off of sources and posts around the world under Reagan and Bush, that culminated in cuts in intelligence resources across the board as a result of the Peace Dividend in the Clinton Administration.  The nineties alone saw a 25% reduction in funding for intelligence gathering, little replacement of retiring case officers, and an over-reliance on satellites and imagery (SIGINT) over face-to-face work with people in unfriendly countries (HUMINT).  His argument that imagery says nothing to you about what is going on inside buildings, and inside people’s heads, is strong.  The result was intelligence services that were incapable of meeting the demands of the 21st Century.  The book is an exciting boots-on-the-ground view, detailing famous attacks, what we know about them, and the part he played in uncovering the information.

The Next 100 Years – A Forecast for the 21st Century, by George Friedman. Friedman is something of a maverick thinker.  He makes the case that in every twenty year period over the last 100 years, what everybody thought was important and enduring, was wrong…and he marches through the years illustrating his points.  That means, he says, that in twenty years we won’t even remember Islamic Jihadism.  Further, the US, as the single superpower, needs only to make sure that other nations don’t form a coalition that could challenge it, and we have done that so far.  Winning and losing wars, of which he believes there will be many, is only secondary.  The book challenges common assumptions on population growth, computers, culture, and warfare on almost every page.  If you’re looking to shake up your thinking, even if you don’t change it, this book will do the job. 


Doc D

Opinions are entirely my own.  Quotations from Kaiser Daily Health Policy Report ( © Kaiser Family Foundation), PND News Briefs – Texas Edition ( © 2008, Physician's News Digest, Inc.), AMA Morning Rounds (© U S News Custom Briefings), and other sources in the public domain.  As always, you may share this column, with appropriate attribution (here and in the text) included.


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