- Letter to Our Readers: The AMA
- Zinc Prevents Macular Degeneration
- Model System Would Reform Malpractice Law
- Rant 'o The Month -- Glossy Brochures
- Monroe Street Clinic news - Free Information
Letter to Our Readers
Section titled “Letter to Our Readers”American media give us the impression that the American Medical Association is the voice of physicians. Did you know that the AMA represents only 21 percent of doctors -- its membership is that small? And yet its proclamations carry weight that can stifle innovation, actually impeding the advance of medicine in this country. The articles in this month's newsletter all touch on this problem. In one article we tell about a safe way to prevent the blindness of macular degeneration, a way that's been known for 15 years but only recently received the AMA's imprimatur. We also update you on a needed health insurance reform, one the AMA appears too shortsighted to endorse.
-- Douwe Rienstra, MD
Zinc Prevents Macular Degeneration
Section titled “Zinc Prevents Macular Degeneration”In September, the National Eye Institute reported the results of a ten year study showing that macular degeneration, the most common cause of blindness in people over 60, can be prevented with diet and dietary supplements. Macular degeneration begins as hazy, shadowy images and can progress to blindness. Macular degeneration affects 25-30 million people worldwide. In the US, cases are expected to triple by 2025 as the baby boomers age. For more details, check out American Medical News published by the American Medical Association.
Macular degeneration is caused by excessive aging of the macula in the eye due to oxidation of the sensitive visual tissues. Once the damage is done, there is no generally accepted cure. (Reports that intravenous minerals can restore some vision have not been verified by published studies.) However with early diagnosis, further degeneration can often be prevented. A new study reports that a combination of antioxidants (500 milligrams of vitamin C, 400 IU of Vitamin E, 15 milligrams of beta carotene, 80 milligrams of zinc, and 2 milligrams of copper) prevents the destructive oxidation. There's also abundant evidence that consumption of fresh vegetables contributes to health of the eye.
Although it's wonderful that antioxidants and zinc can prevent macular degeneration, it's distressing that it took 15 years for the news to get out. In 1988 a study on zinc and macular degeneration was published in a reputable medical journal (Archives of Ophthalmology 1988 Feb;106(2):192-8.) That study showed that -- guess what-- oral zinc prevents macular degeneration.
Why did it take the American Medical Association 15 years to put its imprimatur on this simple, safe preventive measure? The authors of the original study warned of "possible complications" of taking oral zinc. The most common "complication" of oral zinc administration is nausea. Too, oral zinc can interfere with the absorption of copper, so most of us give copper along with it. There are a few more minor caveats, but -bottom line- zinc is safer than aspirin!
So, to the AMA, we award a rose for finally publicizing a safe and effective means of preventing a common cause of blindness, and a raspberry for waiting fifteen years to get around to it.
Model System Would Reform Malpractice Law
Section titled “Model System Would Reform Malpractice Law”When I started in practice I could buy an intrauterine contraceptive device for a few dollars and insert it for less than fifty dollars. Today the IUD costs over $300, and insertion correspondingly more. This is a sad example of what litigation has done to medicine.
Malpractice suits are one of the primary causes of the rising cost of medical care. In the past several decades, trial attorneys have become skilled at winning money from juries. Millions of dollars were extracted from the companies that made breast implants, even after studies showed that the implants were not responsible for the injuries claimed by plaintiffs. The result has been the bankruptcy of companies, loss of American jobs, and rising costs of medical devices.
The chief beneficiaries of these "winner take all" lawsuits are the attorneys. One particularly successful anti-tobacco attorney sought compensation of $30,000 an hour for temporary assistant attorneys he had hired for $21 an hour. For more about this kind of abuse, check out this Los Angeles Times review of the book The Rule of Lawyers: How the New Litigation Elite Threatens America's Rule of Law at the Los Angeles Times
Attention to the Root of the Problem
Legislatures have acknowledged this problem, but so far they have only considered putting a limit on awards for pain and suffering (no one proposes limits on damages such as loss of income, disability, and other economic losses). Recently, however, Senator Mike Enzi (R, Wyo.) introduced an innovative bill to reform malpractice law. Enzi proposes to test three model programs in up to seven states. Here are his ideas.
Health Care Court
People making a claim about substandard care would seek redress at a special health care court. The judges of this court would specialize in medical practices and standards. They would apply their knowledge to each individual situation and determine a remedy. Judges would award restitution to all patients who suffered from medical malpractice, not just those who could attract the attention of attorneys looking for the certain payoff. They would also have the power to limit the practice of incompetent physicians.
Standardized System
Another solution would have an administrative board classify injuries and set a schedule of payment to the patient to cover economic loss as well as pain and suffering.
Fair Compensation
An alternative to the above systems would allow a physician to admit his mistake and, in a timely manner, offer the patient fair compensation for economic loss and pain and suffering due to an injury. In such a case, the physician would be immune from a lawsuit. This would allow a physician to make amends for an honest mistake and keep suits that shouldn't be litigated out of the system.
The Result
In other countries, 99 percent of the malpractice payment dollar goes to the patient. In the United States, only 50 percent gets to the patient, and only after a long, tortuous process. Enzi's proposals would make sure most of the money got to the patient. It would also eliminate the "big money" lawsuit lottery, whereby a few patients obtain huge awards and most patients get nothing.
Although both physicians and patients pay a huge price for our current system, the AMA does not endorse Enzi's proposal. The reason, according to AMA president Donald J. Palmisano MD, is that "we don't have time to wait for the demonstration models to happen." Instead the AMA endorses a short-term fix, the cap on pain and suffering compensation. Unfortunately, putting a cap on part of the malpractice awards will do nothing to prevent future mistakes and simply avoids the real problems, both legal and medical.
For the AMA's statement click here.
To read about better ways to compensate injured patients, download the booklet "Elements of a System of Medical Justice".
Rant o' the Month - Glossy brochures
Section titled “Rant o' the Month - Glossy brochures”If you are on certain mailing lists, you receive glossy color brochures from nutritional retailers. People bring these with them on office visits all the time. Then they ask me if the advertised product really will grow hair, retard aging, restore lost manhood, whatever.
Usually there is a grain of truth in there somewhere, but 95 percent of the time retailers have blown it all out of proportion and overpriced it. How else are they going to cover the cost of the mailing? To make matters worse, it's hard to be sure the supplement actually contains full measure and good quality of the nutrient or herb.
One result is a hue and cry from organizations such as the AMA to "protect the consumer and have the medical establishment regulate supplements." I don't believe regulating supplements would solve the problem.
Here are better solutions.
1. Throw the glossy brochure in the trash.
2. Ask your physician.
3. Check some of the excellent on-line health websites such as Medline Plus. The Pacific North West regional medical library has an Internet article "Is this information good for me?". These links and many more health-related ones are available on the Port Townsend Library Web Site.
4. Check with sites such as Consumer Lab, which tests and verifies supplement content.
5. Plug the vendor's name into your favorite search engine and see if there is any third-party comment about it. Add the word "scam," "complaint," or something similar to get links to critics. As an example, try "coral calcium scam" on Google and you'll find a couple of whistle-blowers within the first ten hits.
6. Be Your Own Expert. We always want to learn from those who know more than we do. This commentary on the "scientific experts" by this emeritus professor at Cornell University reminds that we always need to use our own intelligence as well.
Monroe Street Medical Clinic News
Section titled “Monroe Street Medical Clinic News”We have free handouts on a number of self-care topics that you can pick up at the front desk. These cover everything from dry skin to prostate problems to the winter Blahs. They are not available by telephone.