From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Conflicts Of Interest
Date: 27 Apr 1997
Newsgroups: misc.health.aids

In <5jtvkj$668@news0-alterdial.uu.net> DR MEAR <drmaer@sky.com>
writes:

   >What of the F.D.A which is the government strong arm of the
medical establishment. Should we continue to allow it to be a
regulatory agency so that it regulate away competition and
threats to the pharmaceutical and medical establishments?
Shouldn't we make it an advisory committee and let the informed
consumer make a choice and stop the monopoly on medicine?<

    Sure.  The only problem is that what you say about the FDA
being an arm of the medical establishment is total bullshit.  The
FDA exists for one reason and one reason only:  your neighbors
(you know, the nice people who live next door) don't really
trust you to have access to most drugs without a doctor's
permission.  If you don't believe this, I suggest a quick reality
check.  Go next door and ask them.  It'll be really educational
for you.  And it will absolve you of some of your guilt as an
M.D., if that is what you really are.

    I'm a libertarian myself, though also a physician licensed in
two states (which pieces of paper cost me about $1000 a year, all
told, to maintain).  I'd rather there was no such thing as
medical licensure, but I don't really get that choice.  I really
would allow people free access to any drug they wanted, with the
possible exception of antibiotics, for public health reasons
(since antibiotic resistant bugs are a kind of pollution, there
should be controls there.  It doesn't affect me much if my
neighbor wants to get drunk in the privacy of his home or (for
that matter) shoot heroin, but it does affect me if he wants to
breed rats in his garbage pile, or antibiotic resistant germs in
his kids).  But I'm outvoted.

    >I was privy (a rather brief glance) to a study done by
members of the pharmaceutical industry as to the potential impact
on profits as a result of wide scale usage of vitamin C and other
supplements. The numbers were shocking,  $900 billion per year in
losses if individuals were to take 1 gram of vitamin C 3 times a
day along with B, E, A, and several anti-oxidants. It was
estimated that 70% of disease would be eliminated over a 7 year
period.<<

    More bullshit.  I suppose said report is unpublished and went
back into the safe, where it sits next to the suppressed 100 mpg
carburetor?

    How could a pharmaceutical company have any idea on the
impact of vitamins on common diseases when the studies haven't
been done?


   >To speak of this in many of my circles is taboo,  so should I
push the issue and risk being ostracized by my peers? Do I take a
stand  and risk the wrath of The Pharmaceutical and
Medical Industry?<


    ROFL.  What are the drug companies going to do to you, doc?
Refuse to send out the Sandoz (excuse me, Novartis) rep?


   >>What about all the industries tied to profits resulting from
disease? <<


    What about em?  You ever see any of this money?  If you think
pharmaceutical companies make such obscene profits, there's
nothing to prevent you buying stock in them, is there?

   Say, do you think if people took vitamins they'd become
immortal?  Never get old?  Never get frail?  I've got horrible
news for you: doctors will never be out of a job until people ARE
immortal, so don't hold your breath.  Vitamins are not gunna do
it, though I'm sure many vitamin salemen thing so.

   >I once talked to and Insurance Industry executive about this
subject. I would of thought that they would want  to  promote the
usage of vitamins etc. to reduce their payouts. On the contrary
if disease were reduced it would decrease the amount  of  the
premiums they could charge.<

    Yes, but so what?  The industry profit is on the DIFFERENCE
between charges and payouts.  That can be adjusted to be the same
amount no matter what.  The insurance industry also gets the same
profit, please notice, unless people become immortal.  Think
about it.

   It would be nice if insurance companies had more competition,
but again, that's due to your neighbors, and the people they vote
for, and the laws those people pass.  If you don't like it, I
suggest involvement in the political process.  Failing that, you
can buy insurance company stock, too.

  >> Another important point made was that a large portion of
their revenue comes from the medical industry insuring
themselves. Any decrease in medical industry profits is a
decrease in insurance industry profits.<<

    What an idiot.  If this is true, that money comes from
doctors.  So if doctors are part of this conspiracy, how come
they haven't figured that part out?

   >In fact  he went on to  state that the medical and insurance
industries have a mutually beneficial relationship.<<

   Not hardly.  Insurance increases the amounts doctors have to
charge-- money that just goes into building skyscapers downtown
(not owned by doctors, you will notice).  And the market market
price-demand curve is not perfectly elastic.  If doctors actually
had lower overhead (insurance costs) we actually could make MORE
money, not less.  As it is, some people simply cannot afford the
combination, and go without medical care they might have been
able to afford without the insurance addition.

   > The medical industry can charge exorbitant amounts because
of the insurance industry, people need to buy  insurance because
of the high cost of health care.<

   No, people need to buy most insurance (save perhaps for the
very most catastrophic plans) because they refuse to save for
expensive but non-catastrophic medical problems.  Because every
person thinks he's healthier than his neighbors, and doesn't want
to save for problems he thinks he'll never have.  The government
knows better, and REQUIRES employers to fund empoyee medical
insurance (and taxpayers to fund old-age and indigent medical
insurance).  So there you are.  Medical insurance at every level
is a creation of human denial and stupidity, mostly. If the
average person had the discipline to self-insure for all but the
very most catastrophic medical expenses, most of the the money
insurance companies make would be returned to the consumer for
direct use in purchasing medical care.  But that amount of
self-discipline doesn't exist in the general public.  Hell, the
average consumer doesn't even have the self-discipline not to use
credit cards at exorbitant interest rates to buy a *couch.*  Do
you think medical care is any different?

    >So who will stand behind the doctors that go against the
establishment and do the right thing?<

    Nobody, since it's not clear what the right thing to do is.
Nevertheless, we live in a democracy, and if you can't convince
your neighbor to vote for the things you want, then why can't
you?  That's my question for YOU.

                                  Steve Harris, M.D.

From: sbharris@ix.netcom.com(Steven B. Harris)
Subject: Re: Legal Use of term "M.D."
Date: 21 May 1997
Newsgroups: misc.education.medical,sci.med

In <33822936.92C@uslink.net> Howard McCollister <hmac@uslink.net>
writes:

>"M.D." stands for Doctor of Medicine, which is an academic degree. While
>it may be unethical for these people to claim an academic title they
>didn't earn, it's not illegal, as long as they don't claim it to their
>particular state licensing board.
>
>Howard McCollister, MD, FACS



Comment:

   Yep.  It's the medical license which gives you the legal right to
practice (a rather silly law, but I didn't invent it).  And they don't
automatically give out a medical license with your M.D. degree (which
is basically a diploma saying you've graduated from medical school).
Rather, you have to do more.  In all states you have to do at least a
year of hospital training ("internship," where you're "interned" ala
Poe, now more often referred to as first year of "residency") and
submit this and your medical degree to the state, along with your
fingerprints (in a lot of states), testamonials, requests signed by you
to the national bad doctor database (I forget just what they call
this), some money, your certifications that you passed your national
board tests in your 2nd and 4th years of medical school, and at the end
of your internship, and a lot of other junk which I forget, and which
may or may not be germane (some states need a photo, don't ask me what
for; do they not give you a license if you're too ugly?).   Eventually,
if they like all this and your check does not bounce, they send you
your licence to practice, which is sort of like a plumbers or
contractor's license (and in Utah looks exactly like them, except for
the print-- Utah has no class at all).  Or it can be a big parchment
certificate, ala California (and should be, considering how much they
charge for it in California).

   To be able to prescribe controlled substances (addictive drugs), you
also have to apply to the DEA in Washington for a DEA license, which
has become sort of like a national doctor's license (all most
pharmacies want is your DEA number, even if you're not prescribing a
controlled substance).  Some states, like Utah, require a DEA license
PLUS their own state drug license, which costs addititional money, and
for which you have to pass yet another written test (didn't I say they
had no class?).  But not a drug test (they haven't gone THAT far in
classlessness; but you wait...)

   You can practice medicine in all states with a D.O. degree in place
of an M.D. also, so long as you go through the rigmarole above.  I
believe it's the same license.  Other degrees (like an N.D. degree from
certain schools) will get you limited priveleges to practice medicine
in some states.

   After licensure, you're on your own, subject only to the whim of the
state medical board, your friendly hospital staff rules (lots more
hoops to jump through there), and the occasional circling malpractice
attorney.  The State can take away your license to practise for all
kinds of reasons, from drug abuse to felony to being Jack Kavorkian.
But they can't ever take away the M.D. degree.


                                      Steve Harris, M.D.
                                      California # G52760
                                      Utah # 95-310666-1205

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: sci.med,alt.activism,talk.politics.medicine
Subject: Re: Resident Training Costs and Subsidies (was: The Patients' Bill of 
	Rights (was Backlash against HMOs: a declaration of war)
Date: 15 Apr 1999 08:15:18 GMT

In <7f2ljp$jl8$1@nina.pagesz.net> henryj@nina.pagesz.net (George
Conklin) writes:

>   MD means knowledge limitation.  As Herman says, the
>professor of nutrition cannot discuss the subject legally
>with someone but a half-trained MD with a 30-year-old
>half-hour lecture on the subject is fully licensed.


    Freedom of speech lets anybody discuss anything with anyone they
want, George.  The Constitution, you know.  You can even sell
information on general topics, as a consultant.   In many states,
however, unless you're a doctor or a child's mommy, it's illegal for
you to diagnose or treat a disease in anybody else.  Even for free.
However, what is meant by "diagnose" and "treat" are really rather
vague.  In practice, the only things that will be sure to nail you in
the treatment department are pills and quack machines.

   So long as a nutritionist doesn't tell a person he has a disease, he
or she can tell him anything at all.  And without a disease, any
nutrional advice cannot be said to be a treatment for a disease.  Thus,
"You're obese.  This is what you must do to fix it," is practice of
medicine by definition in California, whether money changes hands or
not.  "What can I do for you?"  "I'd like to lose weight."  "Many
people the following diet effective..." is not.  Even if you charge big
bucks for it, like Jenny Craig.   A nutritionist would have to do
something quite incredible and harmful to get convicted by a jury on
this, even in California.  Like sell Ma Huang pills that caused
somebody to have a stroke.

From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: MacDonalds verdict was VERY justified WAS Medicare and Bret's
Date: 31 May 1999 12:41:00 GMT

In <375269A6.938E0351@cs.uoregon.edu> Bret Wood
<bretwood@cs.uoregon.edu> writes:

>"Steven B. Harris" wrote:
>>
>>    But there are already mechanisms for acountability.  There are
>> professional boards (the state medical boards) which investigate
>> instances of professional malfeasance.
>
>I lost my faith in the efficacy of this type of remedy based on the case
>of "Dr." Laura Schlessinger.  She has a Master's degree in Marriage
>and Family Counseling.  She has a PhD in physiology.  California state
>law clearly states that a practicing counselor CANNOT refer to
>themselves as "Doctor" unless they are a licensed psychiatrist or
>psychologist.  But when people complained about "Dr." Schlessinger,
>the board (under pressure from the state Attourney General) said that
>her radio show doesn't count as "counseling."  Even though it used to
>be frequently advertised as a "mental health" show, and she _still_
>frequently refers to herself as a "therapist" on the show.  (At which
>time her lawyers apparently have a fit and remind her that she can't
>do that.)  BTW, it's even illegal for her to call herself a therapist
>too, since she isn't a licensed psychologist.  But, the law on that
>issue is changing in just the next couple of weeks acutally.  MFCCs
>will have their title changed to Marriage Family and Child Therapists.
>
>The reason she isn't prosecuted?  Because the AG of California at the
>time of the complaints was a notorious Party-Line Republican, and the
>Republicans like her.  She's "on their side," so we'll let her break
>the law.  It's repulsive.  I wonder how much of that type of stuff
>happens in less public cases.  A doctor calls in a few favors, or
>he's a big campaign contributor to the AG or the Governor, and next
>thing you know, he just gets a slap on the wrist instead of having
>his license suspended.


     There's politics involved in everything, including criminal
prosecution.  The board hands out letters of reprimand which go in
one's file for a few years, and can tip you over into suspention if
you're not squeeky clean for that time. Generally the most common
causes of getting a valid license suspended with conditions, or
revoked, or being made to practice with supervision, or heavy stuff
stuff like that, is the following:

(As I read it in my quarterly report from the board, which contains all
the suspensions for that quarter, which is generally 50-100):

1) Commit a fairly nasty other felony, eg felony embezzlement or felony
battery.

2) Get substance dependent, or grossly violate drug prescribing laws
(which you generally need to do if you're dependent), and then fail
limited and supervised practice and rehab at least once.

3) Do something eggregious, and/or cruel, and deliberate to a patient--
like sexual assault under anaesthesia.

  As an aside, I note that even engaging in consensual sex with a
competent person of adult age can now get a doctor suspended or
de-licensed if that person is also being seen AS a patient. Though this
only happens generally if the doctor persists in seeing the person as a
patient, OR if it happens with a second patient after a warning letter,
OR if there is for some reason a big scandle.  This is a recent law,
which the feminists of California lobbied hard for, passed in order to
protect, women of age from themselves by using the weapon of a
professional license to place blame for any heartache on the other
partner, who is generally a man.  Why this behavior is a no-no for
doctors, but not lawyers or plumbers or mailmen, or for that matter
rockclimbing or skydiving instructors is, of course, a symptom of
failing political clout of doctors.  Women imagine being hypnotized;
men imagine their wives with George Clooney.  Yes--- but what gives
just now, one wonders?  We do not live in the world of the ancient
hypocratic oath, where doctors could not perform abortions or remove
bladder stones, and in which they made housecalls and were expected to
treat the master's women and his female slaves as they would his
jewelry.  Instead, we live in an age where women want to be treated as
adults.  Without bearing responsibility for choices they later regret,
of course, but otherwise with full adult privileges <g>.

   To be sure, we all understand that the power and dependency
relationships in medicine are different and some of them are unusually
subject to abuse (particularly in psychiatry), but it seems to me that
this kind of thing should be dealt with on a case-by-case basis
accoding to other ethical criteria having nothing to do with sex, not
pushed as a general law.  Not that, as a geriatrician, I personally am
much tempted by this kind of thing; but I do really hate hypocrisy.  As
it stands, an allergist having an affair with a woman he's ragweed
shots to, is in far bigger trouble with the state of California than an
attorney having sex with a client he's defending on some major felony
charge, who is utterly dependent on him to keep from going to prison
for 30 years.  This is nothing to sneeze at.  And I would like someone
to explain to me please why a women sleeping with her internist or even
psychiatrist is deemed to be more emotionally vulnerable than one
seeing her divorce attorney during a nasty divorce-- which I've
concluded from many a story is not uncommon (no, I've not experienced
this one personally, either-- boy have I missed out on a lot of sordid
stuff).

4) Commit some series of eggregious medical errors demonstrating poor
judgement, at least one of which results in some harm, physical or
mental, coming to someone (does not need to be major harm).

5) Opperate some really flagrantly quack device, like an electro
diagnostic machine.  Lots of M.D.s in California get away with
astonishing alternative stuff, tho, so long as they keep their noses
clean and no patient complains.

6) Last but not least: defy the California Medical Board on some more
minor disciplinary issue.  As always, and as with any organization, the
only _real_ true and cardinal sin is failure to kiss up to authority,
bow to the hat on the pole, make obessance to the pope, etc, etc.