Memo to the Medical Profession: 34,450

Hey Docs, you’re killing us!  Let’s talk about iatrogenic problems in our country.  'Iatrogenic' as defined by Dorland's Medical Dictionary means “resulting from the activity of physicians; said of any adverse condition in a patient resulting from treatment by a physician or surgeon.”

Before I present facts regarding the second leading cause of death in our country, I think it’s important to place some perspective on my comments.  Think of  9/11 and the death of three thousand of our fellow citizens. Think of the consequences of those deaths; two wars and the deaths of several thousands of young men and women fighting those wars on our behalf.  Yet, these tragic figures (I do not want anyone reading this thinking for one second that I am minimizing the deaths of  9/11 victims, the brave firefighters police officers or soldiers) actually pale in comparison to the annual deaths caused by three percent of the doctors in our country who over-prescribe narcotics to patients. 

The CDC issued a report late last year and, admittedly, I have cherry-picked the findings of that report to emphasize the seriousness of the problem.  The report states (in part):

"Prescription drug overdoses in the United States has worsened over the last decade.  In 2008, drug overdose deaths (36,450) were approaching the number of deaths from motor vehicle crashes (39,973), the leading cause of injury death in the United States. By 2010, enough narcotic opioid-type drugs, including the ever popular Xanax were sold to medicate every American adult with a typical dose of 5 mg of hydrocodone every 4 hours for 1 month. Three percent (3%) of physicians accounted for 62% of the opioids prescribed in one study.  For example, large increases in overdoses involving the types of drugs sold by illegitimate pain clinics (i.e., "pill mills") have been reported in Florida  and Texas. Such clinics provide opioid-type drugs to large volumes of patients without adequate evaluation or follow-up."  Source (Morbidity and Mortality Weekly Report (MMWR) Vital Signs: Overdoses of Prescription Opioid Pain Relievers --- United States, 1999—2008 November 4, 2011 / 60(43);1487-1492

Please note that I am emphasizing only the prescription of narcotic-type drugs in this writing.  The problem of iatrogeny is actually much greater.  For example, in 1995, a report in JAMA said, "Over a million patients are injured in U.S. hospitals each year, and approximately 280,000 die annually as a result of these injuries. Therefore, the iatrogenic death rate dwarfs the annual automobile accident mortality rate of 45,000 and accounts for more deaths than all other accidents combined."  

Hey Docs.  Remember the number; 36,540

Just saying . . .

A Return to Frontier Justice

When I was a kid one of my favorite activities was to go to the movies on Saturday afternoon where a ticket cost twelve cents and justice was meted out Western-style without consequences by those who (thought they) were doing right.   Probably the best phrase to understand the justice of the old cowboy movies is ‘kill or be killed.’  We don’t see much of that in the movies anymore, but who can forget the signature part of each Western movie where the good guy rides into town and takes on the bad guy in a shoot-out on Main Street in full view on the entire town’s occupants?

I experienced a severe case of déjà vu about these childhood experiences this morning when I read that the Tampa Bay Times has identified nearly 200 "stand your ground'' cases and their outcomes in Florida.  For those of you who may have been spending time on another planet the past four months and, as a result, been unaware of happenings in Florida, a self-anointed executor named George Zimmerman took it upon himself to follow and shoot to death an unarmed young black kid who was walking through a gated community carrying a bag of Skittles he bought for his step-brother.  Zimmerman now claims as his defense a ‘stand your ground’ law   

People have had the right to defend themselves from a threat as far back as English common law. The key in Florida and many other states was that they could not use deadly force if it was reasonably possible to retreat.  In 2005  Gov. Jeb Bush signed into law a significant change of the common law.  The new law says a person "has no duty to retreat and has the right to stand his or her ground'' if he or she thinks deadly force is necessary to prevent death, great bodily harm or commission of a forcible felony like robbery.  "Now it's lawful to stand there like Matt Dillon at high noon, pull the gun and shoot back,'' a University of Florida law professor and former prosecutor in North Florida is quoted in the Times article.  Hence my déjà vu.

The law has had some definite unintended consequences.  As the Times reports:

• Those who invoke "stand your ground" to avoid prosecution have been extremely successful. Nearly 70 percent have gone free.

• Defendants claiming "stand your ground" are more likely to prevail if the victim is black. Seventy-three percent of those who killed a black person faced no penalty compared to 59 percent of those who killed a white.

• The number of cases is increasing, largely because defense attorneys are using "stand your ground" in ways state legislators never envisioned. The defense has been invoked in dozens of cases with minor or no injuries. It has also been used by a self-described "vampire" in Pinellas County, a Miami man arrested with a single marijuana cigarette, a Fort Myers homeowner who shot a bear and a West Palm Beach jogger who beat a Jack Russell terrier.

• People often go free under "stand your ground" in cases that seem to make a mockery of what lawmakers intended. One man killed two unarmed people and walked out of jail. Another shot a man as he lay on the ground. Others went free after shooting their victims in the back. In nearly a third of the cases the Times analyzed, defendants initiated the fight, shot an unarmed person or pursued their victim — and still went free.

It has always seemed to me that the goal of a civilized society is to move forward in the direction of  more humane conduct among and between individuals and groups and, indeed, one of the inherent strengths of these United States is that we are a nation of laws binding us all together in that goal.  Laws, such as the ‘stand your ground’ law, defeat that very purpose.  Just saying . . .

Corporations are People?

Corporations are people?  No, it is obvious that they are not.  For example, a corporation cannot walk into a voting booth and vote for a candidate of its choosing.  Instead, it takes a very different mindset to understand the illogic of our rabidly-activist current panel of supreme court judges in elevating corporations to the modern equivalent of feudal masters.  In the Citizens Union decision, as the analysis goes, corporations should be permitted to participate in the democratic process of electing public officials with no limits placed on the amounts of money given to candidates because these corporations have, like individuals, the first amendment right of freedom of speech.  And, as everyone knows, money talks so I guess it’s a form of speech.

Let me digress for a moment.  Very recently, the Waltons family’s major gold mine, the international chain of Walmart stores, was exposed for paying huge bribes to countless Mexican politicians that gained Walmart unfettered access to the Mexican economy. Twenty per cent of active Walmart stores are now found in Mexico.  These bribes meet the very definition of corruption.

In the Citizens United decision, Justice Kennedy danced around the definition of corruption when discussing the now unlimited funding of candidates and issues permitted by that decision.  If I were teaching civics in a high school class right now, I would have my students read Swift’s Gulliver Travels and the Citizens Union decision and compare the thoughts processes of the two pieces of literary fiction.  In converting its fantasy of corporations being people into reality, the Supremes legitimized bribery by corporations in the United States. Kennedy’s detailed discussion of the definition of ‘corruption’ could result in a hilarious skit on Saturday Night Live if the net result hadn’t been so serious; i.e., the hijacking of the American political system by permitting exactly the same type of conduct exercised by Walmart in Mexico.  Just saying . . .

Something Good about Romney?

Romney demonstrated a special sensitivity to underdogs in our society when he indicated this week he would support a radical change in our educational system that would benefit inner city children.  For the first time in more than fifty years, contrary to current political posturing and judicial rulings, Romney says that he will propose an overhaul of the educational system that will allow and pay for inner city kids to be bused into suburban communities and to choose the schools of their choices in suburban districts, and not be limited to selecting just another school in their same district.  In his position paper on education Mr. Romney offers two radical changes to our current educational status.  These changes are:

Allow Low Income And Special Needs Students To Choose Which School To Attend. Make Title I and IDEA funds portable so that eligible students can choose which school to attend and bring funding with them. This plan will allow the student to choose from any district or public charter school, or a private school where permitted by state law, or to use funds toward a tutoring provider or digital course.

 Provide Incentives For States To Increase Choices For Parents And Develop Quality Alternatives. Require states to adopt open-enrollment policies for students receiving Title I and IDEA funds, and to eliminate caps on charter and digital schools.

This is surprising news, indeed, from this man who until now has presented a very public and consistent insensitivity to the plight of the poor and underprivileged.  The grossest inequalities in educational opportunity today exist between school districts, not inside them.  To allow kids from the east side of Detroit to select Cranbrook Academy, Romney’s alma mater, for example, in affluent Bloomfield Hills or other virtually all-white private schools in the suburbs for their grade school and high school experiences is a strong move in the right direction to correct decades of de facto segregation in our public school system.  Federal court rulings in the early 1970s refused to permit busing of children across district lines creating the current situation which traps kids inside of city school districts while other kids, throughout the suburban communities enjoy superior facilities and educations.  Forced busing became a hot potato issue in the early 70s and one wonders if Romney is really serious abo0ut taking on the potential wrath of suburbanites on this issue.  It would be a terrible and callow trick on poor people if Romney says he will do this only to garner their potential votes while having no real intent to demonstrate the character and integrity to follow through with this promise.

We Are All Puppets

I have learned to like ‘hard conversations.’  A ‘hard’ conversation is something I would define as me sitting down and talking politics, healthcare, moral issues, etc., with anybody who claims to be a conservative.  In my own little world, the conservative cause is claimed by nearly everyone with whom I come into contact.  Nearly all of these people demonstrate a hatred either for Obama himself, something they think he has done to harm them, or both.  Over the last four years, my default thought during these conversations has been ‘Where do they get these ideas?’  I have always thought of myself as a fair person.  In the context of the present discussion, I would define ‘fair’ as being willing to listen to the arguments of the other side without rancor, disgust, or ridicule.  This fairness concept has generally not been extended to me by others who disagree with me over the past few years.  I am just now beginning to understand why.  A recent Republican nominee for U.S. Senate has just declared that his idea of compromise is to take a position on an issue and wait until Democrats cave in, i.e. no compromise whatsoever in the sport of politics in which compromise, in the vision of our founding fathers, is the heart of the system.  I listen to Fox and Rushbo on a regular basis to try to understand the hatred aspect of the conservatives, and I have thought and listened long enough to now put everything into place. 

What now comes thorough loud and clear to me, an epiphany if you will, is that we are all puppets.  We, liberal and conservative alike, think we have a participatory society in which our opinions (and votes) matter.   Folks, I have a hot news flash for you (and me).  What we say or think or do doesn’t matter one whit.  Money talks.  What happens in our society is what the big boys (I use the masculine reference, because in actual fact very few women participate effectively in the big picture which is larger than we can imagine).   This Jamie-guy who runs Morgan Stanley is a good example.  The bank suffers a three billion dollar (and counting) loss and he still has the temerity to suggest that there is too much regulation of banks.  The amount of taxpayer money to bail his sorry ass out, as well as those of his small investors,  is greater than the cost of some smaller social programs to temporarily aid the needy in our society.  This all happens while Obama is in office, so whose fault is it according to the average Fox-watching Rushbo-listening conservative?  Obama’s of course.  We, the small people, deal collectively with our frustrations at big money run amok by getting mad.  Obama is the biggest target, but I notice that conservatives, when pressed for details about his alleged shortcomings, shift the topic to Barney Frank or Nancy Pelosi.  My object lesson in this rant is to suggest that all of our collective anger is, indeed, misplaced.  We are angry because we are frustrated.  Kicking Obama is like kicking the dog for something the wife or kids have done.  Republicans are good at this. Democrats not so much, but those who tend to be centrist in their leanings and disappointed in Obama because he, in the face of an intransigent and uncompromising Congress, has been unable to pull off the miracle of ‘change’ also have developed an intolerance to this good and honorable man.  In truth, we are all puppets.  This 99% routine currently being hotly debated has focused on the inequality of income between us and the one percenters.  This is misplaced anger because what is really at issue is the control that this big money provides.  Democrat and Republicans alike, we have zero control, nothing, nada, but the system is counting on us to think we do, in effect, creating a straw man for what is really going on. Money not only buys influence, but buys control.  Control is where its at.  And we have none.  Corporations rule and set the rules for us all.  We are all puppets on strings being pulled, controlled and manipulated by those at the top of the money game who understand that by fanning the flames of anger, they can control us all.  Simple as that, just saying . . .

Health v. Guns

Before I go further with the information I have to provide for you, I would ask that you sit back and think about what might be the reaction if our Michigan state legislators were to pass a bill banning all guns in the state.  The uproar would be instantaneous and loud, if not explosive.  Gun enthusiasts would literally be up in arms over the violation of their second amendment right to bear arms and they would be right.  My blog this morning is to alert you to an equally improper attempt to eliminate effectively the seventh amendment to the same constitution that grants the right to bear arms.  I am speaking of the right to jury trial in the state of Michigan insofar as it pertains to claims of medical negligence.

There are several bills recently introduced in the Michigan legislature by, among others, one doctor-legislator who has been the subject of multiple malpractice claims. In my 35 years of handling claims of professional negligence, my doctor/clients whose family members have been killed or maimed by other doctors have been the most vocal in asserting their right to sue and have doctors who commit professional negligence be held accountable for the damage they cause.  One of the reasons for these doctor/clients of mine in asserting their constitutional right to civil jury trial has been that they know and understand full well the concept of professional negligence. That standard, quite simply, requires that a physician do what a physician of equal learning and training would or would not due under similar circumstances. In other words, the medical profession itself sets the standard of expected conduct.

Pending Senate Bill 1116 (SB1116) would change the standard to which a doctor will be held accountable.  It changes the standard from what the reasonable doctor should do to whether or not a doctor "believed" he/she was acting in your best interest. If the doctor testifies that he/she believed he/she was acting in the patient’s best interest, the case would be dismissed; end of story. The Michigan doctor will not be held accountable for cutting off the wrong leg if he “believed” he was cutting off the right leg.  Greg Bereznoff, a good friend and excellent trial lawyer, describes this intended result as “pure Insanity” for Michigan patients. If this bill is passed and if the House and Senate give the bill immediate effect it will  apply it to all pending cases.  This law will be a gold plated invitation to incompetent doctors to come to the state of Michigan where they can't be sued again. No other state has such a rule. Please call your state senator and representative and tell them to vote no on all malpractice reform bills. The link to the complete bill is http://legislature.mi.gov/doc.aspx?2012-SB-1116.  You can contact your local state representatives and ask them to defeat this pending disaster.  http://www.aaa1b.com/advocacy/contact-your-lawmaker/

 How the people of our state should be treated should not be decided by special interest groups or vindictive physicians.

The health and safety of our citizens in Michigan is an important constitutional right as the right to bear arms, if not more so.  Just saying . . . 

Back to the Future

Let’s talk about … homosexuality.  Very early in my legal career I became involved in litigation revolving around the administration of massive amount of a synthetic female hormone, DES, to hundreds of thousands of pregnant women from the late 1940s through the mid-1960s.  A chance discussion in an elevator in early 1970 between two physicians, overheard by a third, resulted in an astounding scientific study demonstrating unequivocally that this hormone-like drug caused vaginal cancer in the female offspring of those exposed pregnant women.  News of this study swept through the scientific world and, eventually, the public as it was confirmed by study after study that not only did the drug cause cancer, but significant damage to the reproductive tracts of nearly every young woman whose mother ingested the drug during pregnancy.  It should also be noted that by the early 1950s, DES was administered routinely to beef cattle and poultry to fatten the animals up for slaughter and human consumption.  In the late 1950s, DES was declared a human carcinogen and farmers were forced, after considerable delay, to discontinue the use of DES in animals for several days before slaughter on the assumption that the drug would be cleared from the animal tissues before being slaughtered and sold to millions upon millions of unsuspecting consumers.  The questionable value of this bandaid attempt to keep the entire meating-eating population of the United States from being exposed to this carcinogen was underscored when Canada placed an embargo on U.S. imported beef during Nixon’s presidency causing Tricky Dick to consider treating that Canadian gesture as an act of war.  (No, I am not making this stuff up). Throughout this hoopla, there was very little thought about what the impact of DES, whether in the massive doses used by pregnant women or the continuous daily exposure in meat-eaters (including pregnant women), might be on male embryos and fetuses, most particularly when exposed during critical periods of development.

In preparing for a DES trial for a young woman with vaginal cancer in 1985, John-Gunnar Forsberg, an internationally acclaimed physician and scientist from Sweden, told me how he had demonstrated in his animal studies why cancer had occurred in the young women whose mothers took the drug.  Quite simply, he stated, the offspring of animals whose mothers were exposed to synthetic estrogens developed cancer because the drug damaged and drastically reduced T-cell lymphocyte levels.  Both in animals and humans, T-cells serve as a major component of the body’s immune system.  If T-cells are depleted, the individual is at risk for infection and/or cancer.  Forsberg gave me examples of individuals who suffered from T-cell depletion;  young gay males who suffered from AIDS (the definition of AIDS is a person with a T-cell population lower than 200/cu.mm) and died from an infection (pneumonia) secondary to cancer (Kaposi’s sarcoma).

By that time in 1985 I had interviewed nearly a thousand DES-daughters and taken more than four hundred of these women into litigation.  I had also interviewed about fifty young men who were also DES-babies, so to speak.  The science was sparse then on any damage the males had suffered from DES exposure.  There was very little litigation.  A young lawyer in Los Angeles filed suit against a DES manufacturer contending that his testicular cancer was caused by the drug.  I was asked to be involved with the case but turned it down because the science, unlike the scientific confirmation in women, seemed insufficient to justify litigation against drug companies.  Then too, I must regrettably admit, there was another reason lurking beneath the surface for my rejecting of these mens’ cases.  The first few guys I interviewed were either admittedly gay or acted like they were.  In my own god-like manner as an imperious trial lawyer, I decided that, unlike the DES-daughters, these men would not arouse the sympathy of jurors. It must be remembered that at the time most of our country, including me, was homophobic.  Outings were not a major factor in our society unless occurring to destroy a person’s reputation or career.  (More about that in a moment). Following these experiences and my conversation with Doctor Forsberg, I began considering the possibility that something (DES) in our environment may be a factor in causing some persons to be gay.  Stated perhaps more scientifically, were there any environmental factors that may influence gender selection in genetically susceptible individuals?   Because the role of DES in this possibility, I researched the issue and wrote a novel “Rx for Mass Murder” based on the supposition that both AIDS and homosexuality were caused by hormonal influences during pregnancy.  There is a remarkable volume of animal literature supporting the hypothesis that gender selection is mediated through hormonal influence during gestation.  While  certainly not 100% proof, the evidence is strong enough, in my judgment, to conclude that many gay men are gay because of exposure to high amounts of estrogen to their mothers during pregnancy.

To put it another way, contrary to the teaching of religious fundamentalists throughout this great country of ours, it is my belief that homosexuality is not a mortal sin or moral degradation, but the result of a intrauterine experience of chemicals floating through the blood stream shaping the hearts and minds of developing innocent babies.   The transformation of my thinking since 1985 has gone from simply thinking about this as a possibility to firmly believing that it is so.  

Ric Grenell, until yesterday, was the foreign policy advisor to Mitt Romney.  He is gay and notified the Romney team about his gayness prior to his appointment.  He was told, to Romney’s credit, that his gayness was not an issue.  Grenell had an impressive resume and, as reported in today’s New York Times, received “sterling recommendations from Bush-era foreign policy figures.  He had served as a United States spokesman at the United Nations under four ambassadors during the Bush administration.”  Additionally, the Times reported that “Mr. Grenell’s hiring three weeks ago, prompted an outcry from some Christian conservatives, and it became clear that the appointment of the former Bush administration official with pristine Republican credentials had become entangled in the unforgiving churn of election-year politics, leading to his resignation on Tuesday.”  The anti-science, anti-evolution, anti-global warming crowd is already having its say in what kind of presidency Romney will offer us.

We are going back to the future, just saying . . .