Patients are expressing alarm about anthropogenic climate change (“global warming”); the most prominent medical journals apparently accept it as fact; and the American Thoracic Society introduced a resolution to the 2008 AMA House of Delegates meeting to endorse the findings of the 4th United Nations Intergovernmental Panel on Climate Change (IPCC).

Nonetheless, “there appears to be little evidence in the learned journals to justify the climate-change alarm that now harms patients,” writes Klaus-Martin Schulte of the Department of Endocrine Surgery, King’s College, London.

An editorial in the British Medical Journal of Dec 1, 2007, threatens that “the impact of climate change will get much worse, and predictions of a hundred million climate refugees is no longer fanciful.” Indeed, “unless we cap carbon emissions in ways that ensure transfer of resources to the poorer nations, we may all go the way of the dinosaurs” (Gill M, et al. BMJ 2007;335:1104-1105).

“We consider this to be the greatest public health disaster facing us today and one that requires…radical action to reduce CO2 emissions as a matter of extreme urgency,” write Alan Maryon-Davis and Patricia Hamilton (BMJ 2007;335:1110).

The New England Journal of Medicine offers free public access to an alarmist 2005 article by Paul R. Epstein on “Climate Change and Human Health” (N Engl J Med 2005;353:1433-1436), along with an audio interview.

JAMA features predictions by World Health Organization Director-General Margaret Chan of food insecurity and increasing disease burdens, owing to “rising temperatures and the effects of extreme weather events” (JAMA 2008;299:2267).

But what is the evidence? Schulte reviewed 539 abstracts of scientific papers published between 2004–mid February 2007 from ISI Web of Science, using the same methodology as Naomi Oreskes. In her oft-cited review of 928 abstracts of papers published between 1993 and 2003, Oreskes asserted that none of the papers had rejected the “consensus view” that most warming over the past 50 years was related to increasing concentrations of greenhouse gases.

The percentage of papers with an “explicit or implicit endorsement” of the consensus view fell from 75% to 45%, Schulte states. Only 7% contained an “explicit endorsement,” and 6% had an “explicit or implicit rejection.” Although the political pressure for energy rationing has intensified, only 24% of recent papers contain new data or observations on climate change, only 2% offer new data or observations relevant to anthropogenic v. natural change, and none had quantitative evidence for the consensus. Only one paper mentioned “catastrophic” climate change.

“The prediction of consequences of changes that are only predicted to happen is burdened with serious methodologic problems,” Schulte concludes. “This inherent degree of uncertainty and the herein shown lack of consensus do not support a further induction of fears of climate related illness and death in the medical world and its patients” (Schulte KM. Energy & Environment 2008;19(2)).

What Schulte does not mention is the serious critique of Oreskes and the censorship of the discussion. Benny Peiser of Liverpool John Moores University reviewed Oreskes’s set of nearly 1,000 documents and concluded that only one-third backed the consensus view, and only 1% explicitly (Sunday Telegraph 5/1/05).

Additional information:

• “Lieberman-Warner Climate Security Act Costs Opposed by 90% of Americans, as Tax Revolt Spreads in Europe,” AAPS News of the Day 6/5/08.
• Nongovernmental International Panel on Climate Change (NIPCC). Nature, Not Human Activity, Rules Climate, ed by S. Fred Singer, Heartland Institute, 2008.
• “The New Totalitarians,” Civil Defense Perspectives, July 2007.

Ostensibly, the vote was against pay cuts for doctors. But it was really about “creeping privatization of Medicare,” writes left-wing columnist Paul Krugman.

Krugman blames Medicare deficits on the Medicare Modernization Act. Not Part D, but Medicare Advantage private fee-for-service plans. He asserts that these rapidly growing plans cost the government 17% more per beneficiary, while threatening to “undermine Medicare’s universality.” Insurance companies “cherry-pick healthier and more affluent older Americans, leaving the sicker and poorer behind”—in the wonderful “traditional” Medicare system that leftists want all Americans to have.

Krugman notes, correctly, that previously payments to doctors were maintained through “bipartisan fudging.” That is, “politicians from both parties got together to waive the rules. In effect, Congress kept Medicare functioning by expanding the federal budget deficit” (NY Times 7/11/08).

President Bush vetoed the bill preventing a 10.6% cut in Medicare fees because it was attached to payment cuts to Medicare Advantage plans. In addition, in his veto message he stated: “[The bill] would imperil the long-term fiscal soundness of Medicare by using short-term budgetary gimmicks that do not solve the problem; the result would be a steep and unrealistic payment cut for physicians—roughly 20% in 2010—likely leading to another expensive temporary fix” (Iglehart JK, N Engl J Med 10.1056/NEJMp0805760).

Krugman is exultant because the Democrats’ ability to stop a filibuster and override a veto make “the odds of achieving universal health care, soon,…look a lot higher than they did just a couple weeks ago.”

The AMA also celebrated, calling the legislation a significant victory. Through paid advertisements, the AMA exerted intense pressure on Republican senators initially opposed to the measure, Iglehart noted. The bill also staves off the scheduled 2009 cut.

“Good job, AMA leadership,” writes Dr. Thomas LaGrelius, president of the Society for Innovative Medical Practice Design (SIMPD). “You made the enemy very happy.”

The bill also killed competitive bidding for new equipment, which reportedly would have saved the program billions of dollars. For example, copayments for an oxygen concentrator for Medicare beneficiaries now total $1,428 over 36 months—more than double the purchase price. Medicare rents it for $198.40/mon, and the copayment is 20%. Medical equipment suppliers lobbied fiercely against this provision (Consumer Power Report #136, 7/18/08, citing Michael Leavitt, “Will Congress Continue a Medicare Scam?” Wall St J 7/9/08). (DME suppliers posted numerous comments in response to this article, regarding the value of the follow-up services they provide, and the Medicare rules and regulations.)

Additional information:

• “About the Money,” AAPS News, August 2008.
• “Medicare Fee Cut Threatened; AMA to Fight for Balance Billing,” AAPS News of the Day 12/20/07.
• “Doctors Oppose AMA Effort to Halt Pay Cut: It’s Not about the Money,” AAPS Press Release 9/13/06.

Florida Governor Charlie Crist got the legislature to approve—unanimously—innovative reform that could dramatically affect Florida’s number of uninsured, now running at 21% of the population, the fourth highest rate in the nation.

The “Cover Florida” plan will allow insurers to offer plans exempted from the 50-some mandates that Florida imposes. The new plans will cost as little as $150/month, or less. Plans will enroll only those who have gone without coverage for six months. It also creates a clearinghouse through which small businesses that can’t afford coverage can offer their employees similar plans (Wall St J 5/29/08).

In New Jersey, Republican Assemblyman Jay Webber of Trenton will introduce legislation, modeled on the Shadegg plan, allowing any state resident to buy low-cost insurance from any registered policy in any of the 50 states. A family health plan that costs an average of $5,799/yr elsewhere costs $10,398 in New Jersey.

Democrats, however, are rallying behind a plan to require every uninsured person in New Jersey to buy a plan from a new state-administered program. “So a state that is already so broke that its politicians are contemplating mortgaging its highways might now add a $1.7 million health subsidy (Wall St J/ 5/29/08).

Massachusetts should have tried a similar idea, suggests Greg Scandlen. The average cost in Commonwealth Care is $4,994 per person. Next door in Hartford, Conn., the most expensive policy for a 35-year-old male, for a zero-deductible, zero-coinsurance HMO, is $2,744. Other plans cost half that, or less. “Massachusetts would have been better served if it simply allowed its residents to buy coverage next door and paid all of their premium” (Consumer Power Report #130, 6/6/08).

Manitowoc County, Wisconsin, saved the taxpayers nearly $2,600 per family plan by providing its employees a high-deductible health plan (HDHP) with a health savings account (HSA). The county fully funded the $3,000 deductible, and eliminated more than $4,000 in employee costs for premiums and copayments (ibid.).

State governments, including Georgia and Indiana, are beginning to turn to HDHPs and HSAs, to the consternation of opponents such as Niko Karvounis. He writes: “HDHPs and HSAs are actually thriving—and in fact penetrating our health care system at a relatively brisk rate.” This is a problem because “their proliferation weakens the political viability of the health reform we really need” (Consumer Power Report #128, 5/21/08).

Additional information:

• “Sabotaging Health Savings Accounts,” AAPS News of the Day
• “HSA Enrollments to Reach 30 Million by 2009, Mintel Predicts,” AAPS News of the Day 6/29/07.

Perhaps hearing the complaints about the remote locations for its initial town hall meetings, the Texas Medical Board has finally agreed to hold one in Texas’s largest city, Houston, and hold others in additional central locations.

Despite the out-of-the way location, the meeting in Midland/Odessa attracted some 45 physicians. The board officials there reportedly dodged a question about doctors not coming because they feared retaliation.

In Fort Worth, about 65 persons attended. In response to a question from a recently retired family physician, Mari Robinson, director of enforcement for the Board, indicated that she felt, in her own mind, that the process was fair to physicians. The doctor responded that Texas physicians don’t think so (Fort Worth Star-Telegram 7/3/08).

A physician who attended the Fort Worth meeting said the atmosphere was charged, but the TMB maintained control. The minutes that the TMB secretary was writing, which were projected on a screen but apparently not available for review, bore no resemblance to the proceedings, the physician reported. While doctors were asking about unfair, inquisitorial hearings by the TMB, the secretary was writing: “Over concerns of patients being led to the bathroom undressed.”

Board members could not explain why there had been an explosion of complaints, 1,700 more in 2007 than in 2006. According to documents obtained by AAPS, the next largest source of complaints, after patients and their friends and relatives, is the TMB itself. Newspaper reports are one source of TMB-generated complaints.

A physician complained that the Board’s “experts” are less qualified than targeted physicians. The secretary typed: “Doctors want to have the nonmedical person of the board be trained and become an expert opinion.”

To a question about competitors of a targeted physician recusing themselves, the Board responded that this did not occur; competitors would know more about the case. The secretary typed: “The competition is welcomed by doctors as expert witness.”

This physician attendee concluded that “TMB never got the message.” Physicians are fearful of Board injustice, evidently with good cause.

The additional meetings are scheduled for:

July 15/16 Houston. The Town Hall will be in Room MSB 1.006 (first floor lecture hall) at the University of Texas Medical School, 6431 Fannin St.

July 29/30 Lubbock. The Town Hall will be at Texas Tech University Health Sciences Center, 3601 4th Street (4th St and Indiana Ave), Room ACB100.

Aug 5/6 Tyler. Biomedical Research Auditorium, UTHSC, 11937 U.S. Highway 271.

Aug 12/13 Dallas. T Boone Pickens Biomedial Building Auditorium, Room NG3.112 on the third floor, UT Southwestern Medical Center, 6001 Forest Park Rd.

Aug 19/20 El Paso. Auditorium B, second floor, Administration Building, Texas Tech University Health Sciences Center, 4800 Alberta Ave.

Aug 25/26 San Antonio. The Town Hall will be in Lecture Room MED 309L, School of Medicine, Joe R. and Teresa Lozano Long Campus, UTHSC, 7703 Floyd Curl Drive.

Sept 3/4 Galveston. University of Texas Medical Branch, TBA.

Sept 9/10 Amarillo. Texas Tech University Health Science Center, TBA.

Town Halls are at 7 p.m. the first date. Time and location of seminars may vary. Check www.tmb.state.tx.us under “News,” or call (512) 305-7030.

It would be desirable for as many physicians as possible to attend for mutual support, and take notes. You may wish to make a lawful tape recording. We are interested in your report on the meeting: how many attended, who was there from the TMB, any press coverage, questions or answers of note.

Here are some of the questions that have been suggested:

Which board members resigned and why?

Why do you think the board is perceived as being hostile, abusive, and disrespectful to physicians, and what might be done to change this?

How are board members chosen? What effort is made to avoid conflicts of interest? What is considered to be a conflict of interest? Serving as expert witness for plaintiff in malpractice cases? Working for insurance companies that may wish to remove doctors who submit “too many” claims?

Are board members who are competitors of a targeted physician asked to recuse themselves from investigating, presenting, or voting on a case?

Why should defense against a complaint by a patient who paid $15 for an office visit cost $100,000, even when there is no evidence of harm to the patient?

Why should the process be so complex, so opaque, and so threatening that physicians feel they must hire high-priced counsel at the outset? Why is there not a preliminary process to settle most cases quickly and efficiently, without compromising the doctors’ rights?

Is there any penalty for complainants who lie to the board? If not, why not? Is there some process to determine the plausibility and veracity of complaints before the doctor has to spend time and money defending himself against malicious or frivolous complaints?

What are the qualifications of investigators? How much authority do they have?

If the Board delays processing an application does the physician end up having to pay another fee and start all over again after a certain time has elapsed?

If a complaint is eventually dismissed, can the Board reopen it at any time, or keep using it against a physician? Are dismissed complaints expunged from the record made available to the public?

Has a sitting Board member ever been disciplined?

If an administrative law judge or a court rules that the Board ruled inappropriately, does the Board have to change its disposition of a case? Has it ever undone a sanction based on the findings of a court or a judge on appeal?

Not content with holding $32 billion in unclaimed property in trust while tapping the interest, some states are aggressively seizing property that isn’t really unclaimed and using it to balance their budgets.

Carla Ruff of San Francisco found her safety deposit box had been drilled, its contents seized and turned over to the State of California marked “owner unknown”—even though she had a checking account at the bank and regularly paid for the box. Important paperwork needed because her husband was dying had been shredded, and her great-grandmother’s heirloom jewelry had been auctioned off for about 2% of its value.

Bank of America is “deeply regretful.”

Banks and other businesses are supposed to turn over unclaimed property to the state for safekeeping. Less than one-fourth is ever returned to its rightful owners. California stopped sending notices to owners, dumped the money into the general fund rather than a special trust fund—and spent it. Last year, courts issued injunctions to keep it from seizing any more property until it made reforms.

California is not the only state to be criticized for its handling of unclaimed property. In Delaware, unclaimed property is the third largest source of state revenue. Idaho just passed a law saying that the state can permanently keep all property not claimed with 10 years. All states pay commissions of 10–12% to contractors to locate and seize accounts (Elisabeth Leamy, ABC News 5/12/08).

Some suggestions for protecting yourself:

Contact your bank or brokerage firm at least once a year in a way that leaves a paper trail—say by making a deposit or a withdrawal. Vote stock proxies occasionally. Write a list of all accounts and keep it with your will so your heirs will know where to look. Insure valuables kept in a safety-deposit box. For help in searching for unclaimed property you may own, contact the National Association of Unclaimed Property Administrators, or visit www.missingmoney.com.

The state might escheat your property if two statements are returned as undeliverable by the U.S. Postal Service, so pay attention to whether you receive your statements.

Politicians and others usually list the funding of prevention and chronic disease management programs as a key method of achieving cost containment. Smoking and obesity are most frequently mentioned as risk factors to target. In the long run, however, removing these risk factors would probably increase medical costs—even assuming that preventive interventions cost nothing.

Using a simulation model, researchers found that never-smokers of normal weight actually incurred higher lifetime medical costs than obese nonsmokers. Smokers of normal weight had the lowest costs. Life years gained through prevention are not lived in full health. Reduction of risky behavior resulted in substituting expensive, chronic diseases of aging for cheap, lethal ones.

Healthy living is still a good thing, researchers conclude, considering that “the aim of health care is not to save money but to save people from preventable suffering and death” (van Ball PHM, et al., PLoS Medicine 2008;5(2):e29).

The Japanese Ministry of Health, however, believes that a new law to reduce waistlines will rein in ballooning medical costs. Companies and local governments are now required to measure the waistlines of all persons between the ages of 40 and 74 as part of their annual checkups. If the target of a 10% reduction in the number of overweight people in 4 years, and 25% in 7 years, is not met, the national government will impose penalties on the companies or local governments.

Japanese are not noted for being overweight. But a flower-shop owner who got measured during an aggressive special check-up campaign was dismayed to learn that his waist measured 33.6 inches, 0.1 inch over the limit. The average for white American men is 39 inches.

“Strikeout,” said the defeated flower-shop owner .

Critics say that more than half of all Japanese men will be considered overweight. They think the campaign will encourage overmedication and ultimately increase medical costs (NY Times 6/13/08).

Childhood obesity is a major funding area for the Robert Wood Johnson Foundation (RWJF). Based on a World Bank study, RWJF claims obesity costs 12% of the U.S. healthcare budget. Tens of millions of dollars worth of studies on obesity have found, among other things, that poor minorities are more likely to be fat than wealthy whites, and that there are three times as many supermarkets in wealthy neighborhoods as in poor ones, and four times as many in white neighborhoods as in black ones. Proposed interventions to reduce both fat and disparities are not spelled out.

Additional information:

• “The Perils of “Health Care,’” AAPS News, December 2006.
• “ ‘No. 2 Preventable Killer’ Debunked,” AAPS News, August 2006, p. 2.
• “The Tyranny of Public Health,” by Jacob Sullum, Med Sentinel May/June 1999.