Volume 66, No. 1 January 2010
HIDE THE DECLINE
ClimateGate hit as 1,200 stretch limousines were converging
on Copenhagen, some from hundreds of miles away, to accommodate
world dignitaries arriving by private jet. Their mission: to save
the Planet through a global carbon budget, with global wealth
redistribution to achieve social justice and "climate equity."
Their justification: complex computer models predicting
Apocalytic global warming.
Their game plan resembles the one for radical "healthcare
reform" written by Robert Creamer while serving time in prison
for bank fraud: generate a crisis fueled by emotion. "This will
require an ongoing highly integrated earned-media messaging
program" that converts opinion into stipulated fact
(Joel Pollak, www.biggovernment.com 12/7/09).
The slogan for what may be the greatest scientific fraud in
history "hide the decline" comes from a recently exposed email
from Phil Jones, former CRU (Climate Research Unit) chief. The
method: "Mike's (Michael Mann's) Nature Trick."
That decline is unrelated to temperatures since 1998. The
trick was to graft recent instrumental data onto a set of proxy
data from 1000 A.D. to 1980 A.D. that wipes out both the Medieval
Warm Period and the Little Ice Age. Proxy data after 1980 was
scrapped, explains Marc Sheppard, because it showed a continuing
decline, casting doubt on the whole series which was needed to
send inconvenient climate history down the memory hole
(American Thinker 12/6/09).
The "hockey stick" pattern of unprecedented recent rapid
warming is an artifact that can be generated by cherry-picked
data from Siberian pine YAD061, the "most influential tree in the
world," or by Mike's computer model, which generates such a
pattern when fed random data (Telegraph 12/5/09).
Trillions of dollars are to be spent on this basis.
Copenhagen and Washington
On the global and national level, proposed crisis-driven
radical changes, which centralize and greatly expand governmental
power, would have the effect of establishing a new mandarin
class. Computer technology, with the potential to be as
liberating as the alphabet and the printing press, could be used
as a tool of intrusive monitoring and oppressive control of
masses dependent on government for energy and medical care.
Computers can complicate, mystify, and obstruct, as well as
simplify, elucidate, or expedite.
Similar tactics are being used on climate, energy, health,
and other issues: (1) Appoint Peers and sanctify their work in
the mainstream media and elite publications such as
Science, Nature, JAMA, and the New
England Journal of Medicine. (2) Marginalize, discredit,
gag, or even demonize dissenters. (3) Hide the computer code and
In Copenhagen, Lord Christopher Monckton, former adviser to
Margaret Thatcher, plans to present his case against the UN
IPCC's climate models to Russians, but not to Western Europeans.
The Russian parliament still makes laws; 90% of the laws
governing the European Union are made by unelected, non-removable
commissars in Brussels.
By transferring its power to the executive branch as to the
Environmental Protection Agency (EPA) for energy
rationing Congress is moving the U.S. toward an EU model of
government. Proposed health reform would create at least 111 new
bureaucracies and delegate hundreds of decisions to the Secretary
of Health and Human Services. Even if it fails, there's a backup:
the MedPAC Reform of 2009, which would transfer Medicare
guideline and rule-setting processes from Congress to the White
House and executive agencies, writes SusanAnne Hiller (www.biggovernment.com 12/8/09).
Hiding the Bust
Sen. Reid has proposed expanding Medicare to 55-64 year-
olds, despite the program's unfunded liabilities. Single-payer
advocates brush off Medicare's insolvency possibly thinking that
it is just crying wolf. Social Security, after all, has been
bankrupt twice, and it just took a little tweaking and tax
increase to fix it. That was before the demographic tsunami.
According to the Congressional Budget office (CBO), 2009
Social Security outgo is expected to be $670 billion. Revenues
from FICA are projected to be $653 billion. Total income of $801
billion, Gary North points out, includes $21 billion from taxes
on benefits, $14 billion from federal employee share, and $120
billion from interest on the off-budget IOUs in the
"trust fund." By 2010, Social Security will be a net drain on the
Treasury, and Medicare is even more "seriously challenging."
Debt service for the on-budget national debt was $202
billion this year, at rock-bottom interest rates, and could
exceed $700 billion/year by 2019 (see AAPS Mythbuster 27).
While alarmists fret about hypothetical global warming to
re-emerge in a few years, the real disaster that is truly "in the
pipeline" is the hyperinflation to which Federal Reserve policy
has committed us, writes John Williams. Though the Treasury has
delayed releasing the 2009 GAAP-based financial statements until
February, by which time health reform is supposed to have been
passed, he estimates a GAAP-based annual deficit of $9 trillion.
Foreigners hold more than $10 trillion of liquid, dollar-
denominated assets that could be dumped into the market at will
Some business accounting software, Williams writes, can
handle any number of digits. No software, however, can generate
electricity, fuel trucks, feed people, make drugs, or perform
surgery. Exchanging paper or digital entries for real goods and
services will work only until it doesn't.
World trade: The collapse of 15% YoY is less than in
the Great Depression, but much steeper (www.zerohedge.com).
Stock values: Over the past 10 years, the Dow Jones
Industrial Average has dropped 5-fold in terms of pounds of
copper, platinum, silver, or gold per Dow unit. Dow-oil has
dropped 7-fold, and Dow-wheat 3-fold (Access to Energy
Confidence in the dollar: The difference in yields
between Treasury bonds and Treasury Inflation Protected
Securities (TIPS spreads) has exploded. The 10-year TIPS spread
has increased from 4 basis points in November 2008 to 222 basis
points, indicating that inflation fears are 55-fold higher
(Martin Weiss, Safe Money Report, December 2009).
Support for ObamaCare. After the Reid compromise,
support for ObamaCare dropped below 39%, with more than 51%
opposed. At this point in the Clinton presidency, 47% backed
HillaryCare, and 32% opposed it (Wall St J 12/11/09).
Tax revenues. The decline in state tax revenues is the
steepest in 46 years: compared to 2008, the decline was 10.7% in
nominal terms, or 11.3% when adjusted for inflation (NYT-
Education. Productivity of public schools has plummeted
71% in 40 years, as measured by test scores in relation to public
per-pupil spending (Craig Cantoni).
Will Doctors Quit?
In September, Investors Business Daily reported
that 45% of physicians responding to a mail-in poll would
consider "leaving their practice or taking an early retirement"
if the Democrats' proposal passed (IBD 9/15/09). Are
they cryng wolf? A White House spokesman said, "Congress has
implemented even larger savings in Medicare in the past, and no
access problems materialized" (Wash Post 12/12/09).
Mayo Clinic lost $840 million treating Medicare patients
last year, stated Jeffrey Korsmo. The Reid proposal for 55-64
year-olds to "buy into" Medicare and its price controls would
"push the best...hospitals and physicians closer to the brink of
financial ruin" (WSJ 12/10/09). The Mayo Family Medicine
Clinic in Glendale, AZ, has notified patients that it will no
longer be a Medicare provider as of Jan 1. Total annual costs for
patients who continue there will be around $1,500; they will not
be able to transfer to another Mayo facility.
Patients are opting out also. More than 750,000 Americans
went offshore in 2008 for elective surgery, a number expected to
grow to 6 million by 2010 (Reuters 7/30/08).
Mississippi State Medical Assn Quits AMA
In October, "an energized, invigorated MSMA House of
Delegates engaged in discourse addressing...autonomy, self-
determination, and the right, if not the occasional obligation,
to express dissent," writes Kenn Beeman, M.D., of Tupelo. MSMA
has de-unified, and non-AMA members may join.
Dr. Beeman attributes the action to the "imperial
presumption and imperious action of a virtually unaccountable AMA
leadership and its collaboration with majority party leadership
in the Congress and White House." The AMA Board of Trustees
rushed to exercise its "executive privilege" to endorse H.R. 3962
just two days before the interim meeting of the House of
Delegates convened, thus preempting its membership. To the AMA,
Dr. Beeman, "conciliation" means "acquiescence" or "capitulation"
by the rank and file.
500,000 Doctors Oppose "Reform," McCain Says
Sen. John McCain entered into the Congressional
Record, Senate S12857, a statement that more than 40 state,
county, and national medical societies, including AAPS,
representing more than half a million physicians, have stated
their public opposition to H.R. 3590, the Patient Protection and
Affordable Care Act. Also signing were three former AMA
presidents, Donald Palmisano, Daniel Johnson Jr., and William
Hiding the Quality Decline
The Mammogram Recommendation Guidelines by the U.S.
Preventive Task Force perhaps show best how our society has been
hiding the decline in quality in the name of alleged cost
savings, writes Scot Silverstein, M.D. The method of meta-
analysis assumes that studies were unbiased. Yet there are
numerous cases of manipulation of clinical research and
suppression of inconvenient results.
As with global warming, when I see "computer modeling" in
medicine, I recall that Richard Feynmann called it a "disease,"
and that Michael Crichton called the arrogance of the model
makers breath-taking. The output of such black boxes is seriously
affected by slight changes in the variables and the weights and
algorithms employed inside the box. Applying them to complex
systems in medicine is at best informed speculation. (See hcrenewal.blogspot.com.)
The NICE Model
The British National Institute of Clinical Excellence (NICE)
was designed in 1998 to "ensure that every treatment... used is
the proven best. It will root out under-performing doctors and
useless treatments, spreading best practices everywhere." In
practice, it is a rationing board (WSJ 7/8/09).
NICE is the world leader in comparative effectiveness
research, on which the U.S. has made a "down payment" of
$1 billion (Ann Intern Med 2009;151:203-211). NICE
synthesizes evidence and builds models that assign hard values to
the quality and cost of an additional month of life. Assumptions
include the possibility of separating time and health, and are
influenced by many social, economic, and political factors. There
was a huge backlash when NICE refused to approve any drugs for
advanced renal cell carcinoma. When it modified its guidelines
for these patients, there was concern that it would make it
harder to draw the line in the future (Nature 2009;461:
315-316, 336-339). A global budget for Medicare would probably be
enforced by a NICE method (WSJ 11/16/09).
Feb 5, 2010. Thrive Not Just Survive workshop, Houston,
Feb 6, 2010. Board of Directors meeting, Houston, TX
Sep 15-18, 2010. 67th annual meeting, Salt Lake City,
Sep 28-Oct 1, 2011. 68th annual meeting, Atlanta, GA
Winners, Losers, and Frauds
While users of fuel ("polluters") and providers of medical
services can expect to be squeezed with taxes and price controls,
or prosecuted for ever growing numbers of regulatory crimes,
there are fortunes to be made.
The UK's richest resident, Lakshmi Mittal, CEO of the steel
giant ArcelorMittal, could make nearly œ1 billion between now and
2012 from participation in the EU's carbon trading scheme (www.dailypaul.com
12/10/09). Al Gore could become the world's first carbon
billionaire, profiteering from government policies he supports
that will direct billions to "green" enterprises he has invested
in. Like Sen. Mary Landrieu (D-LA), who got $300 million for her
state in return for voting for cloture on the Senate health
reform proposal (Wash Post 11/22/09), Gore is proud of
himself (Telegraph 11/3/09).
According to the European law enforcement agency Europol,
carbon trading fraudsters may account for up to 90% of all market
activity in some European countries, endangering the credibility
of the entire scheme (Telegraph 12/10/09).
The Mafia and violent criminals are turning to Medicare
fraud, as scammers can net up to $25,000 a day. A cocaine dealer
could take weeks to net that amount, and faces much higher risks
(Kelli Kennedy, AP 10/6/09).
84% of CMS Management Controls Deficient
Based on a random sample of 2008 contract actions by the
Centers for Medicare and Medicaid Services, the Government
Accountability Office (GAO) found that at least 84.3% had
involved failure to implement at least one key control. In more
than 37%, at least three lapses were found. Of nine 2007 GAO
recommendations to improve internal controls over contracting and
payments to contractors, only two were substantially addressed.
One key defect is lack of quality control over data entry
procedures. Faulty CMS contracting puts billions of taxpayer
dollars at risk (GAO-10-60).
CMS Reports 7.8% Error Rate in FFS Payments
The error rate in making fee-for-service payments doubled
since 2008, said White House budget chief Peter Orszag, largely
because of changed counting methods. Items such as an illegible
signature on the claim, or insufficient documentation, are now
likely to be called errors. The administration is planning to
impose penalties for failure to return payments made in error
(Modern Healthcare 11/17/09).
Consultation Codes Deleted
In the 2010 CMS Physician Fee Schedule, outpatient or
inpatient consultations, codes 99241-99245 and 99251-99255, will
no longer be paid. Physicians who have billed for consults need
to learn the finer points of evaluation and management (E/M)
visit codes for Medicare patients (MPCA 11/16/09).
More Rules, Stiffer Penalties
HIPAA. For violations going back to Feb 18, 2009, even
an "innocent" violation could cost you up to $1.5 million.
Comments are open on the interim rule implementing the HITECH Act
until Dec 29. Read the rule and submit comments at http://tinyurl.com/HIPAA-
Unclaimed funds. States are beginning to target
physicians under escheat laws that require businesses to turn
over unclaimed credits, paychecks, or other property to the state
after a certain dormancy period. Some states require an annual
report even if you don't have property to hand over, with
interest, penalties, and fines for failure to report. Keep
complete records of attempts to return unclaimed funds, and get
written confirmation from any person who receives them.
Information is available from the National Association of
Unclaimed Property Administrators (MPCA 11/30/09).
Cybercrime. In a national survey of small and medium
businesses, 44% report having been the victim of hackers,
viruses, or spyware. Medical practices are attractive targets,
and have greater legal liability, from both state breach
notification laws and HIPAA. "Smaller [providers] are hopelessly
exposed," warns Cliff Baker of Health Information Trust Alliance.
A small hospital had to close its cardiovascular unit and divert
patients when attacked by a computer worm. Note that one infected
provider can spread the problem to any others who access
information (MPCA 11/30/09).
Required fraud and abuse course. CMS now requires all
participating and nonparticipating physicians, licensed medical
personnel, and billing staff to complete an 85-minute module
annually. Go to http://www.cms.gov/MLNGenInfo/, scroll down "Related Links Inside CMS," click on "WBT
Modules" and then on "Medicare Fraud and Abuse April 2007."
Doctor Pays $400,000 to Settle Tricare Case
The only gastroenterologist at Fort Huachuca, AZ, settled
allegations of less than $100,000 in overpayments. Fines could
have amounted to tens of millions of dollars. In a 2007 Tricare
audit, the physician was not informed of any billing errors.
"This case is a warning...that even the best and most
ethical physicians face potential financial ruin for
unintentional and unknown errors," said Dan Cavett, attorney to
Dr. Jaya Maddur. The system involves "complex and confusing codes
that could fill a phone book" (Ariz Daily Star
Swine-flu Bribe Fever
World Health Organization (WHO) scientists are accused of
accepting secret bribes from vaccine manufacturers to influence
the H1N1 pandemic declaration. Many countries are required to
purchase vaccine in the event of a pandemic. Many WHO advisers
have financial ties with pharmaceutical companies, which are not
publicly disclosed (WND 12/7/09).
Challenging Bad Science
The Competitive Enterprise Institute (CEI) is filing suit to
block the EPA finding that greenhouse gas emissions endanger
public health and must therefore be regulated under the Clean Air
Act. CEI states that EPA has ignored major scientific issues,
including those raised in the Climategate fraud scandal.
AAPS general counsel Andrew Schlafly notes that the Mar 9,
2009, White House memorandum ordering "scientific integrity" in
the federal government "gives a solid basis to file a complaint
every time the bureaucrats or their grantees lie, cheat, or steal
in connection with the use or abuse of research for the purpose
Junk Science Has Consequences. It has been revealed
that certain prominent climate scientists sought to hide data
that did not fit their theory of man-made catastrophic global
warming. Still, the junk science is being used by the Obama
Administration to bypass Congress and impose ruinous restrictions
on Americans. The Environmental Protection Agency's (EPA) "health
threat" announcement came just before Obama is scheduled to
address the Copenhagen conference on climate change. Junk science
is the key ingredient in what could be an economic bomb of epic
proportions. What better way to destroy America than to harm an
already struggling economy? Believe it or not, some people are
working to save the planet by reducing the number of cow burps.
Lawrence R. Huntoon, M.D., Ph.D., Lake View, NY
Junk Economics. When General Motors was bleeding cash
and wanted to offload its health benefits commitments, it floated
the bogus number that it paid more to provide health care than to
make cars. It fit the media template perfectly, and all sorts of
outlets ran with it. Several problems: (1) They conveniently left
out the profits of GMAC, then the most profitable part of the
company. (2) You could make a similar statement about other
things such as "we spend more on taxes than on steel." (3) Unions
bargained for ridiculous benefits; heavily unionized companies
spend much more on health benefits than others do.
Linda Gorman, Ph.D., Independence Institute, Golden,
Coming to America? Samizdat was the clandestine copying
and distribution of government-suppressed literature in Soviet-
bloc countries. Copies were made a few at a time, and those who
received copies were expected to make more, as by handwriting or
typing. People caught possessing or copying such materials were
William K. Summers, M.D., Albuquerque, NM
The New M.D. Successful implementation of a universal
electronic health record will require a new breed of doctor for
the brave new world of medicine. The current generation of
physicians are not suited for the new Age of Enlightenment. They
neither need nor want something that disrupts their thought
processes, fill charts with clots of irrelevant verbiage, and
impedes their normal work flow. The new model M.D.s, however,
will need an EHR to guide their decisions and monitor their
practice; they will be trained as functionaries to serve the
system. Independent thinkers who remain will be purged. We are
seeing the vanguard of the new M.D.s, many of whom express
anxiety about functioning without an EHR.
R. Wayne Porter, M.D., Terrell, TX
Still Using Paper. Admittedly, I don't have the ability
to quickly determine what percentage of my patients are being
prescribed Zoloft, or how many patients missed their appointments
this week. But these are administrative tasks, and they are
questions that I rarely want answers for. I'm still quite happy
using blank sheets of white paper for my patient notes. It's
cheap, easy, and works when the power fails.
Stuart Gitlow, M.D., M.P.H., M.B.A., New York, NY
Hospital EHR Systems. I spent 45 minutes trying
unsuccessfully to enter orders. The system asked irrelevant
questions, such as who was my maid of honor! The "computer
expert" finally arrived, and he couldn't figure it out either. At
another hospital, I asked for a lower extremity angiogram, but
somebody entered the order inappropriately for a vertebral
angiogram! Fortunately, an alert radiologist saved the patient
from the wrong test. These computers are expensive, time-
consuming, and dangerous. They should be discarded promptly.
Kenneth Christman, M.D., Dayton, OH
Obstacles to Care. To act, you have to know a new
system, with cryptic headings and little icons. What if firemen
couldn't run to a fire without facing a bank of computers, keying
in when the alarm sounded, what they were doing at the time, what
kind of fire it is supposed to be, etc., while the fire rages on!
Doctors are like Gulliver, tied down with thousands of tiny ropes
by Lilliputians. It's a national epidemic of obsessive-compulsive
disorder. Congress ought to have to use Cerner!
Tamzin A. Rosenwasser, M.D., Lafayette, IN
It's War. We are being distracted by minute details in
the healthcare reform bills, and that is part of the artillery
being used against us. We are in the midst of an intense culture
war that our Constitution was formulated to prevent. The reform
effort is a sweeping attempt for one culture to dominate
morally, politically, and economically.
Janice Michaud, Manhattan Beach, CA
The Real Agenda. The congressional battles are not
about healthcare reform or "saving the planet" with cap and
trade. Instead it is really about changing the American culture
from one of basic independence to one of dependence, with the
politically elite in charge in a kingly way. "Healthcare" is a
tool to trick the Great Unwashed into neutering themselves.
Frank Timmins, Dallas, TX
P4P = Penalize for Practice. We should perhaps call the
Secretary "Her Royal Majesty." One of her vast new powers is to
decide on "differential payments" for cost and quality.
David McKalip, M.D., St. Petersburg, FL