If you are a listener, then you know that I am frightened about the safety of you and your family with regard to ANY product that comes from The Peoples Republic of China- foods, teas, toys, jewelry, furniture, sports equipment, etc. The U.S. government for what I believe is political and economic reasons has downplayed the transcendence of this issue in our daily lives and has done essentially nothing to insure the safety of your family in this regard. No medical show (radio or TV) has truly divulged the extent of this danger but I will and I will not stop exposing the dangers and helping you avoid them.

1. What really is poisoned milk?

It is the milk powder mixed with ‘MELAMINE’

What is melamine used for? It is an industrial chemical used in the production of melawares. It is also used in home decoration. ‘US resistant board’ melamine is used in industrial production & it cannot be eaten.

2. Why is melamine added in milk powder?

The most important nutrient in milk is protein. And melamine has a comparable protein that contains ‘NITROGEN’. Adding melamine to milk is cheaper and more profitable. It doesn’t have any smell, so cannot be detected and it looks like milk and can pass simple screening tests for milk.

3. When was it discovered as a contaminant?

In 2007, US cats and dogs died suddenly, they found that pet food from China contained melamine. Starting 2008, in China, an unusual increase in infant cases of kidney stones was noted. In August 2008, China Sanlu Milk Powder was tested for Melamine and found to contain it and at very high levels. Chinese children started being admitted to hospitals with kidney disease. In Sept. 2008, the New Zealand government asked China to check this problem as Chinese products that were contaminated appeared in that country. On Sept. 21, 2008, lots of food products in Taiwan - imported from the Peoples Republic of China tested positive for melamine.

4. What happens when melamine is digested?

Melamine remains inside the kidney where it forms stones. Typically, there is excruciating pain, there may be obstruction of the ureters with subsequent inability to urinate and what is termed hydronephrosis of the kidneys (swelling) and ultimately kidney failure. This can lead to dialysis for the rest of the individual’s life! This occurred to babies in China. There are currently a reported 13,000 babies hospitalized with various stages of kidney disease in China. Who knows how many are really affected and how many have died because there is no real unbiased and uncensored information from either the Chinese press OR about Chinese health agencies.

5. What are the foods to be avoided?

Foods that contain dairy products should be avoided. Remember: foods with creamer or milk should be avoided.

6. Which companies are affected?

Anything that says it is from China must be avoided. Your retail outlet has NO idea of what is safe and what is not! Next, products that you take for granted everyday and that may not say that they have milk products from China: Starbucks ,Coffee Mate, Nestle, Maxwell House, Unilever, Pizza Hut, Dove Bars, Snickers- to name but a few products..The extent of the possible danger is far greater than we have been led to believe and it is a sign of the continuing safety issue that we face from the Chinese (lead, mercury, dangerous construction of consumer products, botanical supplement contamination, etc.)

7. What do we do next?

If you eat in snack bar, restaurant or coffee shops (and who doesn’t?), stop buying foods if they use CHINESE goods. Make them nervous! CONSTANTLY ask them. Do not be afraid to be repetitious or feel that you are being obnoxious, this is your life and the lives of your families. Put the store owners on notice that you will hold them responsible if anything happens to your family as a result of contaminated goods from China (or elsewhere for that matter). Call and write your Congressmen, Senators as well as Arizona state officials with letters of concern.Most are afraid to”upset the apple cart” what with China being our major creditor.Tell your school district that they MUST screen food products for your kids. Buy milk and milk products made right here in Arizona. This is safer and helps opur economy. Times are tough and we should not pay for products with our hard earned money that is contaminated.

BUY AMERICAN WHENEVER AND WHEREEVER YOU CAN!

You can you differentiate which products are made in the USA, Philippines, Taiwan or China. Let me tell you how… The first 3 digits of the bar code is the country code wherein the product was manufactured.

ALL barcodes that start with 690.691.692 until 695 are all MADE IN CHINA.

471 is Made in Taiwan. Nowadays, Chinese businessmen and those who do business with China (EVERYONE - WHAT HAS HAPPENED TO US?) know that consumers are more concerned about products ‘Made In China’, so they carefully avoid displaying where their products are produced! However, you may now refer to the barcode, remember if the first 3 digits are 690-695 then it is Made in China.

00 ~ 13 USA & CANADA
30 ~ 37 FRANCE
40 ~ 44 GERMANY

49 ~ JAPAN

50 ~ UK
57 ~ DENMARK
64 ~ FINLAND
76 ~ SWITZERLAND AND LICHTENSTEIN
628 ~ SAUDI ARABIA
629 ~ UNITED ARAB EMIGRATES
740 ~ 745 – CENTRAL AMERICA
480 - PHILLIPINES

We are facing some very tough times and health care will not be immune from changes dictated by economic necessity. Drastic macroeconomic revisions need to be made in our health care system soaring in cost (nearly 20 % of the GDP-gross domestic product so far) and coupled to a rapidly growing ageing population that will require increasing increments of care on the one hand and some *49 million uninsured and underinsured , in effect, without access to care.

*This number is going to increase dramatically as our economy continues into an even stormier economy while businesses fail- leaving employees with no medical coverage. The number underinsured will skyrocket as those companies that survive the financial crisis struggle with plummeting revenues and are saddled with rising benefit costs that they can no longer sustain. Insurance companies will (as they have been doing) engineer new plans that attempt (unsuccessfully may I add) to control unbridled medical costs. Managed care will show its ugly head again, deductibles and co pays will continue to increase and the percent of coverage as well as what is covered will decrease. All of this will add up to worse health care in the U.S.

How medicine will and should be financed aside, I am quite concerned about how effective any of the changes that might come down the road will be if we do not commit to more than a economic restructure of medicine (i.e. single payor, tax credit based, etc.), but a paradigm shift in how medicine is practiced in the U.S. I am not suggesting that we should throw out the baby with the bathwater. There are some things that are simply outstanding about U.S. medicine:

1. U.S. diagnostic technology (lab testing, radiology, etc.) is the world leader.

2. U.S. trained specialists and primary care providers are beyond reproach, and,

3. U.S. medical standards and health facilities are the best in the world.

However:

1. U.S. medicine is the most expensive in the world (even when adjusted for currencies). Yet, we have some of the worst health care statistics- shamefully comparable to the health in a third world country.

2. In countries that spend a fraction on health care, you would live longer and arguably enjoy a much better quality of life.

3. We have been adversely affected by a legal system that encourages “defensive medicine” whereby physicians in order to avoid often frivolous lawsuits and awards that are excessively high for medical negligence; over utilize testing, specialty consultations and therapies. The resultant misuse of resources plus the outrageous cost of medical malpractice for health care providers as a consequence has contributed to elevated medical care costs.

4. Pharmaceutical, medical device and diagnostic testing equipment companies have unduly influenced medical training, research institutions, faculty members and their students creating a cadre of professionals virtually brainwashed in the over use of unproven and unnecessary technology that itself is one of the key causes of morbidity and mortality and escalating health care costs in the U.S.

5. These same, powerful companies have successfully driven a disinformation and marketing campaign that has reached almost every segment of our society- selling Americans on often unneeded tests, medications, tests, etc.

6. The major source of drug addiction in the U.S. is not from Latin American “cartels” but, in fact, from prescriptions written by doctors.
7. Resource allocation in preventive services is relatively limited because treatments and testing is much more profitable (if not as practical and cost effective as prevention).

8. Very little has been done to address clear environmental dangers that impact directly on the health of American families and their children.

9. Regulatory agencies such as the FDA (Food and Drug Administration) and the EPA (Environmental Protection Agency) have dangerously conflicted relations with the very industries that they are charged to oversee- receiving funds from private industry, often exchanging employees and allowing industry and lobbying representatives to write and/or influence public policy.

10. Federal government officials enjoy excellent health insurance, available to them for life- even if they are no longer a government employee so they are immune to issues of affordable health insurance and insurability- problems for most Americans.

11. Specialists spend most of the dollars in health care on testing, treatments, procedures and drugs and yet the more specialists in a community, the HIGHER the mortality because more technology bears NO relationship to better health. Yet, specialists are the heroes of medicine- paid the most and the most influential politically within the medical profession.

12. Specialists, as a rule, earn much more than primary care providers (family physicians, general internists, pediatricians) and yet communities that enjoy a greater number of primary care doctors have LESS mortality and less expensive care. Modern medicine in the U.S. does not reward cognition (thought and reasoning) as much as it prizes procedures, testing and medications. Why? Thinking might cause health care to be more rational, more cost effective and therefore- LESS PROFITABLE!!! Primary care doctors who think utilize fewer resources and contribute positively to the length of life as well as its quality. (There are few who perceive of medical care today as contributing substantively to quality of life. There are few who see their physicians as even interested in the quality of their lives.)

The answer clearly requires creative and clever financing that can drive a paradigm change that favors optimal health for Americans first- not maximizing profits for health care related industries as the first priority. But, much more is needed when we talk of real change:

1. First, income of specialists should be substantially reduced while the incomes of primary care providers should be proportionately increased so that more young physicians will be encouraged to enter primary care careers which support cognition, caring and commitment to patient care. This would allow primary care providers to afford to spend time with patients, listen to patient needs and devote more efforts to empowering patients and decreasing their dependence on drugs and tests.

2. Immediately, all physicians and their staffs should be freed from the overwhelming burden of having to fill out different forms for different insurance companies on a daily basis. The amount of paperwork is overwhelming and absurd- adding to practice overhead which is passed on to the health care consumer and taking precious time away from patient care.

3. All administrative physicians working in federal, state and private for and not for profit companies such as insurance companies should be required to return to the practice of medicine full time in their specialty periodically so that :

a. They help out with a national physician shortage and

b. They become more sensitive to the actual needs of patients and health care providers. (Perhaps managed care medical directors would not be as insensitive were they reminded periodically of their responsibilities in actual patient care.)

This is entirely justifiable and not a form of forced servitude (Docs can and should be paid for their services) because all physicians have willfully been trained in programs funded by federal and state dollars (all public funds). Their personal loans that in some cases paid for part of their medical school education covered only a fraction of the actual cost of their education. In essence they owe the taxpayer! Both their employers and the communities they serve as part of their rotation should reimburse them while engaged in clinical care.

4. All members of the federal and state governments should NOT be guaranteed health insurance that is any different that that available to the American public while employed or after employment. A Congressman, for example, should be no more privileged with regard to health care benefits than anyone else. This would light a fire under bureaucrats to truly address our health care crisis since then they and their families might actually be affected by coverage issues.

5. The FDA should not be able to accept any funding from the very same private industry that it regulates and its employees should be required to have longer periods of time once they leave government employment to work within the pharmaceutical and medical device industry or related political action groups designed to lobby in behalf of these industries.

6. EPA operations should be restructured so that it is a regulatory agency governed by science and much better insulated from politicians and lobbying groups such as the chemical industry.

7. Americans should have a choice with regard to the kinds of practitioners they choose and the kinds of medical care they seek. Funding whether single payor or private insurance based should not discriminate against some forms of complementary and alternative medicine (CAM) and qualified medical doctors(M.D.), osteopaths (D.O), naturopaths (N.D.), chiropractors (D.C) and licensed acupuncturists (L.Ac.) as bona fide providers giving reimbursable care. Although called “unproven medicine” many CAM therapies (such as acupuncture, nutritional medicine, etc.) can be supported by a credible body of literature and have never been demonstrated to be anywhere near as harmful as conventional medicine ( Remember Vioxx?) and yet enjoys more outpatient visits annually and more out of pocket patient expenditures. The American public has expressed its desire for more CAM, but, conventional medicine politics has kept it in abeyance. This is not acceptable any longer. However, national and/or state standards credentialing alternative providers must be put in place and strictly enforced and the scope of practice of each class of provider should be clearly defined.

8. More safeguards should be placed on claims made by pharmaceutical and natural remedy producers and the quality of production should be improved by funding regulatory agencies to adequately enforce codes already on the books.

9. The U.S. Department of Agriculture (USDA) in collaboration with the FDA, EPA and U.S. Customs should be adequately funded, better organized and better insulated from the politics of beef growers or dairyman (for example) so that our food supply can be better protected and that children and pregnant women are not subject to the dangers becoming increasingly prevalent in domestic, but especially imported foods.

10. Much better collaboration between agencies is required to especially monitor products arriving from countries such as China, Mexico, India, etc. which have consistently and adversely affected the health of Americans (e.g lead laden toys, melamine contaminated candies, lollipops with lead, unsanitary and mislabeled pharmaceuticals such as heparin etc.)

11. A national commission should be convened to explore the extraordinary implications for our nation of what many believe to be the excessive use of behavioral pharmaceuticals- which I believe has established a level of drug dependence (anti anxiety, sleeping and anti depressant pills that could affect national productivity, political and military decisions. Recently, it has come to our attention that many of the national leaders who have promoted these drugs have received large financial rewards from the very companies that produce the drugs and yet have not disclosed their conflicts of interest to the public or other health care professionals. This, at the very least, makes one wonder about the credibility of their research which has influenced physicians and nurse practitioners across the nation. In the military alone it has been suggested that nearly 20% of our armed forces engaged in active duty in Iraq and Afghanistan are using such drugs. College students seeking help at student health centers are routinely prescribed these drugs because of convenience and the decreased intensity of resources required when compared to group and/or psychotherapy. The effectiveness of these drugs when compared to placebo, exercise, dietary changes, some nutritional supplements, psychotherapy and group intervention is questionable at best. Health insurers have found it expedient to pay for drugs rather than psychotherapy which is more costly. Yet, both in the U.S. and around the world warnings related to increase suicide risk with these drugs and possibly an increased rate of cancers with prescribed methamphetamines, for example, has been described. We need objective clarification- free of pharmaceutical company interests before an entire generation end up using possibly unproven mind altering drugs without a clear long term track record.

12. The cost of drugs must be addressed. Americans should be allowed to purchase prescription and over the counter drugs from other countries- especially Canada where the quality of production is as good (if not better than) ours. Vehicles must be established to allow for inspection of pharmaceutical manufacturing facilities in other countries so that we can open up yet further the doors of free trade and competition for these products. The notion that by so doing we will discourage R&D (research and development) for new drugs is ludicrous. Most research supported by drug companies is to replicate the product of another company already under patent and so to compete they must develop a similar family of product but different enough so that there will be no patent infringement. This is called a “me too” drug research program and does not necessarily add incrementally more to public health- just to drug expense. Yet other research is to find another use for an already existing drug so that it will have new indications. This allows the pharmaceutical company to milk more money from an already existent product. Since the majority of new drugs annually approved by the FDA fall into these categories, one could hardly argue that the exorbitant cost that we pay for drugs as a result of this research is justifiable. Truly new drug development that can benefit society will not be inhibited by competition.

13. The ethics of advertising of pharmaceutical and natural product manufacturers as well as corresponding service providers needs to be explored. National and regional standards should be developed to protect the consumer and they should be enforced. The public needs to be protected against false claims and misrepresentations in advertising. The health care consumer needs more, objective and understandable information in order to make wise choices that effects the health of themselves and their families and more often than not this is just not the case right now. Consumers need to know a lot more about risk/benefit, cost and side effects.

14. State professional licensing agencies should become more insulated from local and regional political influences and the undue influence of attorneys representing professionals who slow down the process of protecting the public. Alternative and conventional medicine licensing boards should be streamlined, possibly merged and at the very least have close coordination to ensure public safety. Continuing education requirements must become more stringent and the number of hours increased. More public funds should be made available for this purpose.

15. Hospitals need to be better regulated. Regional planning must once again be instituted to avoid replication of expensive services such as heart surgery, gamma knives, etc. Hospitals should receive financial incentives for providing services that are needed in their communities – rather than choosing clinical services needed by their doctors to increase income which leads to duplication. In other words every cardiologist (heart doctor) in Phoenix might want to do heart catheterizations in the hospital- rather than travel to a regional center of excellence. The hospital wants to fill its beds and keep the doctor (who admits patients) happy and increase revenues and so a new catheterization center is born. In fact, it would be more cost effective and efficient to have but a few centers of excellence regionally for heart caths. They become more efficient and have better quality because of well trained teams, handling higher volumes of patients and practice does make perfect generally speaking.

16. Doctors and hospitals should be subject to competitive government and consumer scrutiny. Healthgrades.com is a good first attempt at ranking doctors and hospitals by both consumers and in this case CMS (Medicare) rankings of hospitals for certain procedures and diseases. This concept of transparency needs to be enlarged and made more available to the public.

Money and effort expended in the “right” directions can contribute to the kind of changes in health care that we all seek. Just changing how we finance health care alone will not achieve our goals. The upcoming months after the elections (whomever is elected and whatever their political philosophy) will bring health care yet further in our sights. You should be thinking about health care because it affects you and your family and just getting “covered” is simply not enough!

Billy Joel wrote a great song about pressure and I can’t seem to get it out of my mind as I write this piece. In fact, I have delayed a while in updating my blog because I am trying to be creative in terms of how we Americans can get the best value for our health care dollar. I have decided that I will add on more ideas each time I write because there is so much that we all need and so much that we can do.

Whether we will have a national health plan as Obama talks about or an unplan that McCain espouses, we will still need some good old competition to improve health care efficiency. That means that doctors, hospitals, medical device manufacturers, pharmaceutical companies and insurance carriers must be exposed to REAL competition.

Under the Bush administration they have all enjoyed varying degrees of protectionism. For example, drugs from Canada which are much cheaper cannot be imported legally “for our safety” - a true example of rubbish if I have ever heard it. I would like to start a discussion that is ongoing regarding competition and I want to take an example from my very own practice. If times are harder, then we physicians need to be available to you at hours that are convenient to those who are working - struggling - to make ends meet. That means that we need to be more accessible.

Now, I am not “tooting my horn” but I have hours to see patients on one evening a week until 8 p.m., Saturdays before my radio show in the morning and my staff knows that if my patients need me to come in earlier or stay later on other days, well, I will do so.

Further, when called on Sundays, I would rather see my patients in my office if need be, rather then send them to an emergency room where the cost is higher and they will undoubtedly get more tests than they require.

Why do I do this? Because I love being a doctor and I truly enjoy my patients BUT I also know that if I am not competitive in difficult times then like me or not, my patients will seek care elsewhere if I cannot accommodate them. Yet, most doctors still do not “get it.” What can you do? Tell them!!!!! “If you can’t see me when I need you, then I do not need you anymore.” Tell the staff and the physicians and be sure that you are not shy about this. Tell the insurer that covers you if you have one that they need to get on the ball and pay more to doctors who meet your need for accessibility and hold them responsible if they can’t find a doctor to meet your needs. Let’s start showing my colleagues who is the real boss of their practice - YOU!!!!!