By Richard Amerling, MD
Barack Obama’s recess appointment of Dr. Donald Berwick as head of the Center for Medicare and Medicaid Services (CMS) marks a new low in his destructive presidency, and that is saying something!
After forcing the Orwellian Patient Protection and Affordable Care Act (PPACA) onto an unwilling populace and through a reluctant Congress, he installs an elitist who admits to being “in love” with Britain’s National Health Service into a position of incredible power without so much as a hearing.
This is an affront to the American people, and to Constitutional government. It also completely confirms our predictions regarding the true nature of ObamaCare. It will be modeled after the NHS with rigid budgets, income redistribution, command-and-control structure, “death panels” (The National Institute for Clinical Excellence, or NICE), and a weighty bureaucracy. Ironically, this comes at a time when the British are struggling with the bureaucratic morass of the NHS authority.
How does Dr. Berwick hope to control the billions of decisions made by practicing physicians every day? Daniel Henninger, in his Wonder Land column, has some revealing, and frightening, quotations:
“The unaided human mind, and the acts of the individual, cannot assure excellence. Health care is a system, and its performance is a systemic property.”
“I would place a commitment to excellence—standardization to the best-known method—above clinician autonomy as a rule for care.”
“Young doctors and nurses should emerge from training understanding the values of standardization and the risks of too great an emphasis on individual autonomy.”
The mechanisms for this are already in place. A central board, our version of the NICE, was already legislated into existence by the stimulus bill. Payment-for-performance (P4P) is already being used in certain areas to enforce compliance with clinical practice guidelines. Language in PPACA gives the secretary of Health and Human Services (which oversees CMS) authority to bar from participation doctors who do not comply with certain quality standards, i.e. conform to guidelines.
Physicians are currently being bribed by CMS to purchase electronic health records, which will be used to insert algorithms to “guide” the physician to the “correct” plan of care. Where do practice guidelines come from?
Practice guidelines are a recent fad and have proliferated to cover virtually all areas of medicine. They are funded either by government, insurance and pharmaceutical cartels, or medical organizations such as the American Medical Association. While billed as “evidence-based,” for the most part they are consensus opinions of a panel of “experts.” These experts invariably have extensive financial ties to industry. This may explain why practice guidelines are almost always biased towards greater levels of drug treatment targeting ever-wider patient populations.
Guidelines are sluggishly produced and often superseded by new information when finally published. As an example, tight control of blood sugar has been pushed by guidelines for Type II diabetes for years. Four studies published in 2008 showed either no benefit or increased death rates with this approach. Guidelines discourage innovative thinking and encourage the “one-size-fits-all” approach so loved by Dr. Berwick. If practice guidelines were in existence in the 18th century, bloodletting might still be the standard of care!
The problem with trying to implement guidelines as public policy is that we are all unique individuals and individual differences really do matter. Only a personal physician has the local knowledge of the patient that permits tailoring of treatment for maximum benefit at lowest risk.
Central control of medical care, which is the predictable endpoint of centralized payment for care, will wreak havoc on the medical profession and harm thousands, if not millions, of patients. Since PPACA effectively nationalizes the private health insurance industry, the Berwick appointment affects everyone.
Patients need to seize control of their medical destinies by setting up Health Savings Accounts and paying for their medical care themselves. Seniors should strongly consider opting out of Medicare Part B. For doctors, it has never been more urgent to sign the Physicians’ Declaration of Independence and sever third party relationships. The future of an independent medical profession is at stake.
LISTEN TO INTERVIEW WITH DR. AMERLING
Richard Amerling, MD, is a nephrologist practicing in New York City. He is an Associate Professor of at Albert Einstein College of Medicine in New York, and the Director of Outpatient Dialysis at the Beth Israel Medical Center. Dr. Amerling studied medicine at the Catholic University of Louvain in Belgium, graduating cum laude in 1981. He completed a medical residency at the New York Hospital Queens and a nephrology fellowship at the Hospital of the University of Pennsylvania. He has written and lectured extensively on health care issues and is a Director of the Association of American Physicians and Surgeons. Dr. Amerling is the author of the Physicians’ Declaration of Independence (http://www.aapsonline.org/medicare/doi.htm).
The recess appointment of Dr. Berwick is very disappointing. It endangers the treatment and lives of American Seniors, given that he is in favor of rationing, and more people will be included in Medicare now and the govt. has already cut back funding of Medicare & Medicaid by $500 Billion. We won’t stand a chance of getting good care with the implementation of Standardization of practices, billing & treatment. The movement is to do away with more US Citizens.
Couple this secret appointment with the proposed appointment of Elena Kagan to the US Supreme Court. She is already on record as being in favor of Partial Birth Abortion, which is out & out INFANTICIDE. While working with the Clinton Admin., she changed the reports of medical experts who said that there were better options for mothers than Partial Birth Abortion. She changed the meaning of their reports to support PBA, so that the committees would vote in favor of it. Do we want a person like this on our Supreme Court? Pres. Obama does, because he is on record of being in favor or Partial Birth Abortion, when he was on the Illinois Senate.
It seems that Pres. Obama is in favor of killing the unborn and the elderly. This is very very scary!!
Re: guidelines and EBM:
Per “Pseudo-Evidence Based Medicine Threatens Health Care Reform Based on What Works” (http://hcrenewal.blogspot.com/2009/07/pseudo-evidence-based-medicine.html )
As Dr David Sackett, and colleagues wrote [Sackett DL, Rosenberg WM, Muir Gray JA, Haynes RB, Richardson WS. Evidence-based medicine; what it is and what it isn't. BMJ 1996; 312: 71-72, http://www.bmj.com/cgi/content/full/312/7023/71 ]:
“Evidence based medicine is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. The practice of evidence based medicine means integrating individual clinical expertise with the best available external clinical evidence from systematic research. By individual clinical expertise we mean the proficiency and judgment that individual clinicians acquire through clinical experience and clinical practice. Increased expertise is reflected in many ways, but especially in more effective and efficient diagnosis and in the more thoughtful identification and compassionate use of individual patients’ predicaments, rights, and preferences in making clinical decisions about their care. By best available external clinical evidence we mean clinically relevant research, often from the basic sciences of medicine, but especially from patient centred clinical research into the accuracy and precision of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens.”
Furthermore,
“Evidence based medicine is not ‘cookbook’ medicine. Because it requires a bottom up approach that integrates the best external evidence with individual clinical expertise and patients’ choice, it cannot result in slavish, cookbook approaches to individual patient care. External clinical evidence can inform, but can never replace, individual clinical expertise, and it is this expertise that decides whether the external evidence applies to the individual patient at all and, if so, how it should be integrated into a clinical decision.”
One can find other definitions of EBM, but nearly all emphasize that the approach is designed to appropriately apply results from the best clinical research, critically reviewed, to the individual patient, taking into account that patient’s clinical characteristics and personal values.
Berwick is another elitist bent on central planning and control. Freedom to these people is viewed as a quaint 17th century idea whose time has passed.
I quit clinical practice in heme/onc 2 years ago at age 52 when I sold my practice, because of this kind of erosion of our professional autonomy. It’s intolerable but apparently relentless.
Healthcare will be a joke if more people don’t open their eyes and get involved in fighting this ridiculous Obamacare.
Evidence-based medicine is limited by availability of high quality evidence, i.e., randomized controlled trials. Even where they exist, questions and debates arise about how to interpret them. The problem is not so much EBM, but guidelines that purport to be evidence-based, but are mostly opinions. They tend to entrench practices, many of which become outdated, fall out of favor, or are frankly wrong and potentially harmful. They can also be used by payers to control practice via P4P and other measures.
Pray for our country, our healthcare, and our future. And Vote these BASTARDS OUT OF OFFICE!! Remember- we can underfund a healthcare plan. We need to get this Berwick Maggot out of his current post-this needs to be declared an unconstitiutional appointment. The man is an unmitigated Communist//he has No business running CMS; he probably needs to inhabit a deserted island near the Arctic circle where he can write irrelevant communist papers and release them into the ocean in bottles. These to be used by the Navy for target practice.
EBM is inherently flawed as Dr. Amerling correctly states. There is so much information being generated faster than the “guidelines” can integrate them that what you get are really opinions from some source, usually academicians. Many of them go to clinic `1-2 days/week, are young, inexperienced and do not appreciate the flaws inherent in clinical trials. Selection bias, time lead bias, the influence of the drug companies etc.
Berwick is a tyrant dressed up as a college professsor.
I and a person whom was a Law Enforcement officer, and was hurt in the line of duty. I have lost most of the use of my kidneys. I am on diaslysis, and the centers are having to roll all charges for everything into one charge. They are ordering cheaper supplies, filters, tape, and everything else. And the amount paid is being decreased to the centers, We are now seeing monthly charges that the person on diaslysis MY owe in the $33,000.00 plus, after what medicare and secondary insurance pays. Getting a transplant I guess will not happen, They keep coming up with new guild lines. You meet one and then they have something else.
My father was a Doctor, and I glad he is not here to see this happening. He was from the old school and made house calls for little or no pay. And he spent 38 years a a Doctor in the U.S. Army, serving in three war zones. This fight we need to fight and get every person well or sick helping to get this law removed, and the people who want this type of control removed from office, no matter what party they belong to.
I’m just an average citizen trying to get by every day. I’m in good health but my husband has Type II Diabetes. Dr. Berwick’s “one size fits all” approach to medicine is inappropriate. I blame our president for this appointment. Obama hates this country enough to appoint this man for the job. I have news for you, Mr. President, no bureaucrat will come in between us and our doctors. I will vigorously fight any attempts from any govt. official to force substandard care on us. You can keep your guidelines. We’ll keep our currently excellent health care.
By the way, I pay attention to current events and I vote. I will not be told to shut up on this or any other issue currently threatening this country.
Each day, there seems to be more bad news for patients. ObamaCare, Dr. Berwick’s recess appointment, federal dollars for abortion in Pennsylvania despite the executive order signed by President Obama preventing it to obtain the votes of Bart Stupak and other anti-abortion Democrats.
Do not spend too much of your time reading websites, blogs, and other sources about the bad news, as it will continue until Conservatives control the US House and US Senate. Spend your time educating your patients about the problems with ObamaCare, and volunteer your time to support and elect conservative candidates in November 2010 and 2012. Each physician has only one vote, but each determined physician can potentially influence at least a thousand votes between now and the November 2010 elections. Getting votes is what really matters if the goal is to defund, repeal, replace Obamacare and Dr. Berwick.
Most likely the following links are too massive — but please review this list for anything that might help in urging people to vote/demand a return to capitalism, and reverse the seek and destroy mission that is current underway by the far left in Congress.
-smartvoter-org/ Our goal is to provide the best nonpartisan information about all contests on your ballot to help you make an informed decision.
—-*At Thomas.gov website click on House of Representatives/Congress to get e-mail, phone, address of reps for zip code entered.
-American Solutions-com American Solutions is a citizen action network of over 1.5 Million members, including 30,000 small business owners. Our goal is to unite a majority of Republicans, Democrats, and Independents in support of the next generation of solutions that will ensure that the United States remains the safest, freest, and most prosperous country in the world. Our General Chairman and founder is former Speaker Newt Gingrich.
-friendsoftheuschamber-com The greatest challenge we now face as a nation is reviving our economy, restoring the 7 million jobs lost to the current recession, and creating the 13 million new jobs our growing nation will need over the next decade. Only a vibrant American free enterprise system can accomplish this goal.
-Center for Individual Freedom not-for-profit constitutional advocacy organization with the mission to protect and defend individual freedoms and individual rights. “In fact, the rationale behind the push for “Net Neutrality” is summed up by Marxist media theorist (and we don’t use that description loosely) Robert McChesney, perhaps “Net Neutrality’s” most ardent supporter.”
-lwvohio.org/ The League of Women Voters of Ohio, founded in 1920, is a non-partisan political organization that encourages the informed and active participation of citizens in government, works to increase understanding of major public policy issues, and influences public policy through education and advocacy.
- theohioproject.com – The Ohio Liberty Council is a nonpartisan coalition of like-minded grassroots organizations throughout Ohio. The council strives to achieve these strategic objectives: Foster accountability of elected officials and government; Grow awareness of the movement;Promote state sovereignty;Educate citizens;Affect elections.
-ohioconstitution.org – About The 1851 Center for Constitutional Law-
–*newsmax-com Debt Commission Leaders Paint Gloomy Picture 11 Jul 2010
-chaffetz-house-gov The Omnibus Bill: Bad Government at its Worst Dec 10 2009
-*heritage-org Why Government Spending Does Not Stimulate Economic Growth: Answering the Critics, and how taxes affect economic growth January 5, 2010
-Heritage-org Value-Added Tax: No Easy Fix for the Deficit January 21, 2010
-survey-pollilngpont-com — READ ABOUT POLITICAL ISSES AND TAKE SURVEYS
-rightvoices-com/2008/10/16/On Obama: Big Lies And What Must Be The Largest Rug To Sweep Them Under Oct/16/08
-politico.com Dems seek cover to boost debt limit
-Money-cnn.com-2009/09/16-U.S. about to hit debt ceiling – again
-articles.sfgate.com/2010-03-04/Renewable-power stimulus funds spent overseas
-propublic-.org/one-third-of-stimulus-money-spent-february-2010-update Eye on the Stimulus
-From Bob Latta’s website 10 More Things Every American Should Know About President Obama’s Job-Killing Budget Posted by Staff on February 03, 2010
-examiner-com June 3 2010 President Obama and the DOW: Both the Destruction of Wealth; both truly unbelievable’
-townhallmob-com 8 12 2009 was democrats’ health care strategy written in federal prison?
-townhallmob-com 12 2009 A White House Power Grab that Congress and America Doesn’t See
-chaffetz.house-gov 12 10 2009 The Omnibus Bill: Bad Government at its Worst
-http://www.nytimes.com/2010/03/16/Moody’s Says U.S. Debt Could Test Triple-A Rating
-tiahrt.house-gov national debt clock
-resitsnet-com
-house-gov ryan issuepapers creating jobs and generating economic growth congressman Paul Ryan
IS OBAMA SOCIALIST?
Family, Friends, Advisers & Administration
*Wife Michelle Obama said “The truth is, in order to get things like universal health care and a revamped education system, then someone is going to have to give up a piece of their pie so that someone else can have more.”
*Jim Wallis; Obama’s spiritual advisor & forced redistribution of wealth advocate
*Anita Dunn, the White House Communications Director, admitted that one of favorite political Philosophers, one that she “turns to the most”, is Mao Tse-Tung, the demonic communist dictator responsible for the starvation, torture, and murder of 70 million Chinese. -orthodoxytoday-org/blog/2009/10/16/anita-dunn-favorite-philosopher-mao-tse-tung/
*Reverend Wright stated inflammatory rhetoric against America Obama attended his church for 20 years and was married by this preacher, who taught Black Liberation Theology which is the ideology of The Black Panthers.
-npr.org Black Liberation Theology, in its Founder’s Words March 31, 2008
*Elena Kagan – Obama’s Supreme Court Nominee; Argued for Government ‘Redistribution of Speech’;has a history of association with people tied to three interrelated organizations, the Communist Party USA, Democratic Socialist Organizing Committee/Democratic Socialists of America and the far left Washington DC “think tank” Institute for Policy Studies.[1]
*Van Jones, disgraced Green Jobs Czar & Communist [2]
*Ron Bloom, Manufacturing Czar & anti-free market
*Donald Berwick Obama administration nominee to run Medicare and Medicaid [3]
* Craig Becker Obama administration nominee to the National Labor Relations Board [4]
*John Holdren, pro-redistribution of wealth; White House Science ‘Czar’ Tells Students: U.S. Can’t Expect to Be Number One in Science and Technology Forever; Called for Carbon Tax to Redistribute Wealth from Global ‘North’ to ‘South’; Advocated FCC Forcing Broadcasters to Air Enviro-Population Control Ads; Called for ‘Zero Economic Growth; [5]
*Andy Stern, SEIU President & redistribution of wealth fan
*Mark Lloyd, FCC ‘Diversity Czar,’ and Idolizes Hugo Chavez
*Carol Browner, socialist
*Robert Creamer, socialist
*Eric Holder Attorney General evidently has disregarded the law as applied by his predecessors because he disagree es with their politics[6]
* Dr Tara O’Toole Obama’s nominee at the Department of Homeland Security overseeing bioterrorism defense; apparently revealed she belonged to a study group called the Northeast Feminist Scholars, originally known as the Marxist-Feminist Group [7]
*William Ayers – wnd.com Obama worked closely with terrorist Bill Ayers – Records show collaboration on funding leftists despite claim he’s just ‘a guy’ in neighborhood (2008 09 23)[8]
*ACORN – “…Among other involvements, Obama trained ACORN activists and while working on the board of the Woods Fund, channeled millions of dollars to ACORN”… [9]
[1]-cnsnews -com Kagan Argued for Government ‘Redistribution of Speech’ May 12, 2010
-newzeal-blogspot-com Obama File 106 Obama’s Supreme Court Nominee, Elena Kagan’s Socialist Associations (the Middle Years) July 01, 2010
[2] -Van Jones’ Legacy Lives On: DOL Doles Out $100M in Green Jobs Grants to Unions January 7, 2010
-thelibertyjournal tides foundation; Van Jones
-Washingtonpost-com White House Adviser Van Jones Resigns Amid Controversy Over Past Activism
[3]-redstate-comn Obama nominee Donald Berwick’s radical agenda May 12 2010
–nypost-com O’s radical pick for Medicare June 16, 2010
-aapsonline.org (Association of American Physicians and Surgeons) How Dr. Berwick Will Control Your Doctor & You July 18th, 2010
[4]–nrtwc-org (the national right to work committee) The NLRB Becker Fight “Shakes and Bakes” Again
-shopfloor.org Senate Confirms NLRB Nominees Pearce and Hayes, not Becker June 22, 2010
-washingtonexaminer.com/opinion/blogs/Controversial National Labor Relations Board nominee Craig Becker shot down in Senate 02/09/10
-Senator Orrin Hatch Utah concerned by NLRB Nominee Craig Becker
-nationalaborblog-com 2010 02 Controversy Over Nlrb Nominee Craig Becker Heats Up
[5] -zombietime-com/John Holdren, Obama’s Science Czar, says: Forced abortions and mass sterilization needed to save the planet
-cnsnews -com White House Science ‘Czar’ Tells Students: U.S. Can’t Expect to Be Number One in Science and Technology Forever April 12, 2010
-cnsnews -com Obama Science Czar Called for Carbon Tax to Redistribute Wealth from Global ‘North’ to ‘South’
July 07, 2010
-cnsnews-com White House Science Czar Advocated FCC Forcing Broadcasters to Air Enviro-Population Control Ads October 16, 2009
-cnsnews-com Obama’s Science Adviser Called for ‘Zero Economic Growth’ July 31, 2009
[6]-washingtonexaminer-com Newt Gingrich: President Obama should fire Attorney General Eric Holder 08 28 2009
-demint-senate-gov DeMint, Enzi Introduce Secret Ballot Protection Act (SBTA) February 25, 2009
-detroit news healthcare bill includes 10 billion earmarked for union retirees
-http://michellemalkin.com/2010/01/07/green-jobs-seiuunion-jobs
[7] -dickdestiny-com/blog BAD PUBLICITY CAUSES SPLIT IN BIOTERROR DEFENSE LOBBY 01 20, 2010
-washingtontimes-com Hot Button 9 9 2009
-washingtontimes-com/news/Obama nominee omitted ties to biotech 09 08, 2009
-pacificfreepress-com/news Meet Homeland Security’s New Bioterror Czarina 23 Aug 2009
[8] -verumserum-com Ayers and Obama: Follow the Money 10 11 2008
-zombietime-com William Ayers’ forgotten communist manifesto: Prairie Fire 10 22 2008
-wnd-com Obama lies in debate about ties to ACORN — Record shows Democrat, group at center of vote scandal ‘old friends’ 2008 10 16
-wnd -com Evidence reveals role Barack played in transforming Dems into socialists (2010 07 11)
-gettingpaidtowatch-com Obama-Ayers channeled Annenberg money to Acorn to advance leftist agenda in Chicago schools
[9]*brainshavings com THE ONLY LINK YOU REALLY NEED to Follow The Corruption of ROTTEN ACORN: America’s Bad Seed
-brainshavings com ACORN Is A Multi-Million-Dollar Multinational Conglomerate
-wnd.com ACORN ‘shock troops’ tied to election crimes 2008 03 10
–democracynow.org/2010/3/23/headlines/acorn_to_cease_existence_as_national_organization
-liveshots.blogs.foxnews.com/2010/03/23/acorn-swap/
-washingtonexaminer.com opinion Stimulus bill funds ACORN despite its history of corruption
-michellemalkin.com/2009/09/09/acorn-watch-welcome-to-miami
-therealbarackobama.wordpress.com/2008/09/26/time-to-crack-obamas-acorn
-biggovernment.com/2009/10/12/From the Archives II: ACORN Corruption Runs Deep
-newsbusters.org/blogs/2009/09/28/ACORN Question for Local Media: What in the World Are These People Really Doing?
-pajamasmedia com/blog/acorns-latest-lawbreaking/
-americanthinker com July 07, 2008 Obama and the Woods Fund of Chicago
-workinglife-org/blogs/ SEIU corruption scandal spreads as Stern escalates attacks on opposition 8 26 2008 “…numerous ACORN agents were caught on camera giving advice to undercover journalists on how to open an illegal brothel, launder its profits, defraud banks and the IRS, and commit a host of other illegal activities…”
– Type in search box – NEA and SEIU Diverted Forced Union Dues to Corrupt ACORN Offices – Aug 25 20008 – 100 caregivers of the SEIU Local 6434 gathered today at the Oakland and Los Angeles offices to demand an independent investigation into corruption – Type in search box – Caregivers Call for Justice in SEIU corruption scandal
-foxnews-com ACORN Still Eligible for Donations Through Government’s Combined Federal Campaign
-wsj.com-article Obama and Acorn Is there a case for a special prosecutor?
-desertconservative-com Now we know why acorn backs Obama! Where’s our mainstream media Aug 20 2009
—-For insight into Obama’s views on the courts and the Constitution, see the AT piece, “Obama the Justifier”, by Selwyn Duke, 10/3/08
-rightvoices-com/2008/10/16/On Obama: Big Lies And What Must Be The Largest Rug To Sweep Them Under Oct/16/08
-wnd-com ELECTION 2008 Newspaper shows Obama belonged to socialist party Democrat’s campaign denied allegations, but new evidence indicates membership October 24, 2008
-nationalreview.com/post/ Tuesday, August 19, 2008 Confiscatory Tax Rate Dreams from my Father 08 19 2008 (referring to Barack Obama)
-westernfrontamerica-com Socialism and Obama 09 15 2008
-telegraph.co.uk/news/worldnews/northamerica/usa/barackobama/22 Aug 2008/alleged-Communist-was-early-influence-on-Barack-Obama.
-westernfrontamerica-com The Tale of Two Obama Minions-2010/05/16 – socialism & mandated health care
-*worldtribune-com February 14, 2008 change Obama can believe in:Socialism?
-foxnews-com opinion Obama: Real Debate Please, Not Maoist Reeducation 3 29 2010
-weeklystandard-com/weblogs/Why Did Obama Attend Socialist Conferences?July 18, 2008
Why Did Obama Attend Socialist Conferences?
-acton-org/commentary/The Marxist Roots of Black Liberation Theology April 2, 2008
-newsbusters-org/blogs/Record Shows Obama Was on Board With TARP in September, and Every Bit As Socialist As He Claims Bush Was Fri, 03/13/200
-hotairpundit-blogspot-com/2010/03/March 17, 2010 – Flashback Recap: Obama Envisions ‘Costly and Lengthy’ Health Care ‘Transition’ to Single Payer
-washingtonpost.com/Obama readies steps to fight foreclosures, particularly for unemployed Friday, March 26, 2010
-William Ayers questionable history-zombietime-com/prairie_fire William Ayers’ forgotten communist manifesto: Prairie Fire October 22, 2008
-newsbusters.org/blogs/04/05/2010 Glimmer of Hope: CNN Suggests Democratic Economic Policy Could Create ‘Jobless Welfare State’
-apolloalliance-org Clean Energy Is Foundation of Proposed Stimulus January 15, 2009
-hotair-com 8 25 2009 who really wrote obamas stimulus bill
-www.youtube-com/watch Joe the Plumber’ Becomes Focus of Debate AssociatedPress — October 15, 2008 — Who is ‘Joe the Plumber’?
-discoverthenetworks-org apollo alliance
-examiner-com June 3 2010 President Obama and the DOW: Both the Destruction of Wealth; both truly unbelievable’
-townhallmob-com 8 12 2009 was democrats’ health care strategy written in federal prison?
-townhallmob-com 12 2009 A White House Power Grab that Congress and America Doesn’t See
-townhallmob-com search unions SEIU! SEIU! SEIU! Obama Pledges to “Paint the nation purple”…This is not your typical political pandering. This is someone who feels at home, talking to close friends and family.
-cnsnews-com May 28 2010 Barack Obama in Crisis: Zzzz
-cnsnews-com May 28 2010 Something Rotten in the State?
-washingtontimes-com 9 9 2009 Hot Button More scrutiny
-chaffetz.house-gov 12 10 2009 The Omnibus Bill: Bad Government at its Worst
-http://www.nytimes.com/2010/03/16/Moody’s Says U.S. Debt Could Test Triple-A Rating
-americanthinker com July 07, 2008 Obama and the Woods Fund of Chicago
-grist.org/article/2010-01-07-transpor tation-bill-environment-green-jobs/All roads lead to green?
-wdiny.org/ A New “New Deal” Approach to the Challenge of Climate Crisis
-discoverthenetworks-org groupProfile apollo alliance
-investors-com/NewsAndAnalysis/Article The $10 Trillion Climate Fraud 04/28/2010
-”We are five days away from fundamentally transforming the United States of America” — Barack Obama at the University of Missouri, Columbia, MO, October 31, 2008.
THIS IS THE FIRST TIME IN MY ADULT LIFE THAT I’M TRULY AFRAID FOR MY COUNTRY because of the Marxist subversives in control of our government and their un-American activities.
All this fear is sort of pitiful. Listen to yourself, frightened little con$ervative$.
All of the things I have read here can be proven and I beleive that all of the stuff listed by what the say are grounds for impeachment ,all of it proves that their president is nothing but a shill for the communist,socialist,and the Muslim Jihadist. This half breed son of a white trash communist whore hates the US and what we stand for ,even those that voted for him are starting to turn on him ,only those that are still on the take stand behind him.I am tom Trancedo this sorry excuse for a president should be impeached for side steping the constitution and the laws of this country.Him and is illegal czars are running the country by bypassing congress and appointing communist ,socialist and those that go against eveything our country stands for.He and his carz need to be put out by what EVER means need and I mean EVER MEANS
This a really needed thing to do IMPEACH THE PRESIDENT. I was a Nuclear Medicine Tech. for over 30 years and then came down ither M.S.
I was not able to continue working but if I could I would. All of you know what to do and I really would LOVE to work with doing any thing I can from the OLD workers side. This President needs to be STRIPPED of anything he has done ans is trying to do to OUR GRFEAT COUNTRY.
THANK YOU for doing this.
EBM is not the answer. Dr. Amerling hits the proverbial nail on the head when he mentions the lack of high quality comparative data across trials. Most meta analyses come up short because the trial designs are so different that a clear comparison is impossible. Like trying to compare oranges to apples. It is clear that a paradigm shift in care is taking place. The concept of a one-size-fits-all protocol just doesn’t provide efficacious outcomes. Each person responds in a different fashion to drugs, physical medicine, psychotherapy, nonpharmacologic interventions, etc. As the silos of medical specialties are slowly deconstructing, it is becoming abundantly clear that many of the previously held beliefs surrounding best-practice care are false and not providing positive outcomes. For example: low sugar and diabetes. Diabetes is for the most part a disease,of the microvasculature, resulting in endothelial dysfunction. Most disease is a result of this physiologic event. Soon we will be treating diabetics as if they have CVD and perhaps outcomes will improve.
Donald Berwick is a money man. I mean, for real, when was the last time he practiced medicine? He was positioned to make specific changes to make money for the insurance companies and banks that own them. If none of you have heard of the Medicine Bank initiative, I’d suggest you research it. Not only do the insurance companies and banks want to control all billing operations, but they also want to provide patient and physician education and triage your patients. If people were worried about pharmaceutical influence on continuing medical education, watch out when the managed care business takes control. Oh, that patient of yours…you know the one…65 years old, chronic pain…poor hepatic function…COPD…well, take him off that expensive opioid and just give him some methadone. Its cheap! Oh! Your patient died? Oh well. Too bad. Tear.
Get Ready. This little scenario is becoming the reality thanks to Obama’s handlers, et al.
Without access to medical care many people will suffer and die needlessly. Health care is out of the reach of many Americans now. Health insurance companies are in business to make money. They care nothing for patients. The less health care they approve the more money they make for their shareholders.
Medical Mind brings up a good point. He says, “…well, take him off that expensive opioid and just give him some methadone. Its cheap! Oh! Your patient died? Oh well. Too bad. Tear.” Then he goes on to blame the recently passed health care bill. Too bad he does not say that his scenario has been repeated as nauseum by the health insurance companies so that they can make more money. The health insurance companies have made tens of billions of profits lately. Let caring doctors do what’s right for their patients, treating them correctly, and not puppets on a string dancing at the whim of some CSR at Wellpoint or Anthem. I’ve been on both sides and I love Medicare. I say give all Americans Medicare and profit be damned. It’s the healthy thing to do.
November is coming soon, and I remain hopeful a republican-led congress will simply de-fund Dr. Berwick’s position. If I get there, that’s what I know I’ll try to do!