From: "Steve Harris" <firstname.lastname@example.org>
Subject: Doctor Strike Mortality (wasRe: Philip E. Binzel, Jr., M.D. on
Date: Fri, 15 Jun 2001 17:57:26 -0600
"DRCEEPHD" <"mailto:email@example.com"> wrote in message "
> >Subject: Re: Philip E. Binzel, Jr., M.D. on laetrile toxicity
> >From: Alex Brands "mailto:firstname.lastname@example.org"
> >Date: 6/15/01 11:17 AM Central Daylight Time
> >In case you haven't figured this out yet, your claim will carry more
> >weight if you provide such documentation.
> In the book, Confessions of a Medical Heretic, Robert S. Mnndelsohn,
> M.D. wrote: "In 1976 in Bogota, Colombia, doctors went on strike during
> a 52-day period. The death rate went down 35% during that time. In Los
> Angeles in 1976, doctors went on strike to protest increasing costs of
> malpractice insurance. The death rate decreased by 18%. When the strike
> ended, the death rate returned to pre-strike proportions. In Israel in
> 1973, during a month-long strike, the death rate dropped 50%. The last
> time the death rate had been that low was when there was a doctor's
> strike 20 years before."
First of all, a quote in a Mendelsohn book is not "documentation." No
more than any statement of fact made by anybody here. How does Mendelsohn
know? Did he read it in the newspaper? What reference does HE give? What
peer-reviewed publication? How were the statistics done? What were the
data sources? The usual stuff we demand when somebody says something like
this. It's not nuclear physics.
> Now let us see the "urban myth" documentation.
You're asking me to prove a negative, which is harder. On medline I did
find a careful treatment in one of the best stat journals (Am. J. Public
Health, a publication of epidemiologists, not particularly medical
doctors) of the 1976 doctor's strike in Los Angeles. It was only a
partial strike by private doctors, and patients were dumped onto the
county system. Total county mortality did not change, so that's the end
of Mendolsohn's claim. Analysis of less than a quarter of the few deaths
which occured in this time interval suggested that some were due to LOSS
of medical care, and some due to worse care due to patient dumping from
private to country (on the basis of 21 deaths cases analyzed out of 88).
I see no suggestion that mortality rate dropped except the authors
calculate a THEORETICAL drop which should have happened due to less
elective surgery being done (this was not actually observed, however).
Remember that elective operation deaths that don't occur in strikes, just
occur when they get shifted to later days. Both the theoretical effects
here. Thus, no net decrease in deaths. If you're going to use this
theory, you have to use the whole theory, not just the parts you want.
I can find no other doctor strikes in the US in 1976 but this one.
Therefore you're basically wrong about the only fact you assert which can
be directly checked in the literature. Batting 0 for 1, DRCEEPHD. There's
no evidence that people died of fewer medical mistakes in this strike.
There's not even evidence that fewer people died in medical emergencies
total, although there was theoretical reason to think that fewer might
have died for a short time, followed by more later. But this is a
theoretical decrease in deaths, followed by a theoretical increase, and
neither part actually ever observed. What was actually seen was a
*possible* increase in deaths attributable to lack of good medical care,
but it could not be proven.
BTW, do you wish to make the argument that we save patients' lives by
simply canceling all elective surgery permanently? We don't put a pin in
granny's hip when she breaks it, because she has 1 chance in 1000 of
dying from the anaesthesia, or from a heart attack? Fine, but now she's
a cripple, and stuck n bed. The mortality from breaking a hip is 25% at
least in the first year, and part of that is from pneumonia and
consequences of being bed-bound. It won't happen this week or next, but
it will happen soon. So you don't get to make people immortal by NOT
operating on them, if that's what you're suggesting. These decisions have
mortality consequences also. The fall operative death rate in doctor's
strikes is a temporary thing, but you can't fool mother nature.
Let me present the DRCEEPHD solution to traffic mortality: simply close
all highways and roads. We can adequately prove that nobody dies in car
accidents on temporarily closed highways where nobody is allowed to
travel. Therefore if we close all highways and roads permanently, we'll
save all these lives. What's wrong with this scenario?
Am J Public Health 1979 May;69(5):437-43
Impacts of the medical malpractice slowdown in Los Angeles County: January
The Los Angeles County (California) physician strike of January 1976
resulted in a partial withdrawal of physician services. Among recorded
impacts were a $17.5 million loss in hospital revenues and an $8.5
million pay loss for hospital employees. Several surveys revealed no
evidence of a significant impact on the general public in finding medical
care. Analysis of emergency room visits and paramedical ambulance calls
showed no significant increases during the strike. County mortality
statistics for the strike were not affected. Eighty-eight fatalities
among 2,171 patients transferred during the strike were analyzed; a Case
Attributable Mortality Probability generated on 21 cases selected for
final review by a five-physician multispecialist panel indicated that 29
per cent of the Attributable Mortality could be ascribed to the strike
itself and 71 per cent to ongoing "patient dumping" from private sector
to County hospitals. Even if sample attributable mortality rates were
generalized to overall county deaths, the resultant figures are below the
estimated range of 55 to 153 deaths that did not occur because of the
number of elective operations not performed secondary to the strike.
PMID: 434272 [PubMed - indexed for MEDLINE]
From: "Steve Harris" <email@example.com>
Subject: Re: Doctor Strike Mortality (wasRe: Philip E. Binzel, Jr., M.D. on
Date: Fri, 15 Jun 2001 18:21:16 -0600
"Steve Harris" <firstname.lastname@example.org> wrote in message
Actually, available data on doctor's strikes is pretty boring. Mostly
because doctors continue services for life threatening illnesses, and the
rest don't kill people. I can't find a single epidemiologic study which
actually measures a mortality decrease during a doctor's strike. I'd love to
review one. There are several letters in the literature about Israeli
strikes, but these aren't available on medline.
Maybe the most interesting article is the one below from the early 80's,
which suggests that loss of a lot of high tech obstetric care didn't affect
perinatal outcomes. But I think we all suspected that at the time. Possibly
it remains true now. People don't like to take risks with their kids, and a
lot of what's done is probably unnecessary, and wastes money (without being,
on net, dangerous). But just try cutting it back. You'll be sued into
oblivion at your first bad outcome, no matter that the number of bad
outcomes won't change.
Isr J Med Sci 1990 Oct;26(10):559-63
Effects of the Israel physicians' strike on the treatment and outcome of
acute appendicitis in Jerusalem.
Ellencweig AY, Ginat-Israeli T.
Department of Medical Ecology, School of Public Health and Community
Medicine, Hebrew University-Hadassah Medical School, Jerusalem, Israel.
We sought to determine whether a prolonged physicians' strike causes
changes in the delivery of health care and in the behavior of health care
seekers? We compared appendectomy patients during the 1983 physicians'
strike in Israel and during a control period in 1984, by analyzing the
records of 171 patients in two Jerusalem hospitals. Patients had similar
demographic characteristics and disease manifestation, but differed in
their health care seeking behavior. The 1983 patients tended to postpone
their first contact with the health system and frequently failed to
present themselves for a follow-up visit after discharge. Control group
patients were more likely to receive preoperative antibiotics and less
likely to develop postoperative fever than the strike group patients.
The findings confirmed that the differences between the strike and
control groups were caused by administrative barriers resulting from the
strike rather than by differences in actual medical treatment.
PMID: 2249930 [PubMed - indexed for MEDLINE]
Scand J Prim Health Care 1987 Nov;5(4):245-51
Effects of a doctors' strike on primary care utilization in Varkaus,
Aro S, Hosia P.
Health Services Research Group, National Public Health Institute, Helsinki,
Changes in out-patient medical care utilization at the health centre of
Varkaus were studied during the Finnish doctors' strike in spring, 1984.
In this urban and semi-urban area, about 80% of the out-patient medical
services to the population are provided by the municipal health centre.
Visits to the physicians decreased by 70% during the strike, and for
urgent visits the decrease was 55%. The private sector compensated only
a very small share of this "deficit". Of the common urgent illnesses the
relative decrease was greatest for "cold" and ill-defined "abdominal
pains". Open wounds were treated normally although there was some
indication that the wounds treated were more serious than normally. The
post-strike increase in visits suggests an increase in unmet needs. For
all face-to-face encounters the increase was eight per cent, but for low
back pain, urinary infection and hypertension the observed post-strike
rates were more than 40% higher than expected by pre-strike rates. A
marked reduction in various other activities of the health centre, such
as telephone calls and home visits, was observed. The present study gave
no evidence of harmful effects of the strike. This was the impression of
the health care personnel, too. There were no public claims of reduced
access to care or its delay. The distress among patients or other
experiences of the population were, however, not measured. The strike
was fairly short and any conclusions concerning the effects of a more
prolonged or extensive strike on health care are unwarranted.
PMID: 3423495 [PubMed - indexed for MEDLINE]
Isr J Med Sci 1985 Oct;21(10):804-7
Perinatal outcome following physicians' strike of 1983.
Bukovsky I, Herman A, Sherman D, Schreyer P, Arieli S, Caspi E.
Organized public medical services were profoundly disturbed during the 4
months of the physicians' strike in 1983. An unknown proportion of
patients were referred to private services, but only a minority of them
attended the alternative centers. The findings during the strike and the
following 6 months were compared with those of the year 1982. The
incidence of high-risk cases and of multiple and premature deliveries
were unchanged. There was a significant rise (P less than 0.01) in the
rate of cesarean sections during the strike, 10.8%, compared with 7.8% in
1982. Also, a significant reduction in instrumental deliveries and labor
inductions was observed during the strike and for 4 months afterwards.
There was no change in the perinatal mortality (total and corrected) or
in Apgar scores. This indicates that good perinatal results were achieved
despite drastic disturbances in organized perinatal care.
PMID: 4077470 [PubMed - indexed for MEDLINE]