US Healthcare System vs The US Postal Service, a presentation by Dr. George
D. Lundberg, from Medscape.com.
gun violence with patients, ACP (American College of Physicians) Says.
===AAMC STAT===, News from the Association of
American Medical Colleges, April 28, 2014 issue.
Autónoma de Guadalajara (Mexico) offers a
4-week Medical Spanish course where students will learn Spanish medical
terminology, experience a new culture, and enjoy the delights of Mexico.
5. The University
of Vermont offers a Summer Medical Program to provide foundational knowledge
in key medical science courses.
Nature Conservancy encourages you to observe Arbor Day by planting a tree.
7. Marginalia: It’s amazing how EXTREMELY OLD technology still influences today’s society.
The video of his presentation and its transcript can be
accessed at http://www.medscape.com/viewarticle/823721
Here’s the transcript:
The US Healthcare System vs The US Postal Service
and welcome. I am Dr. George Lundberg, and this is At Large at Medscape.
the old days of discussion about healthcare reform, leaders of the American
Medical Association used to warn about a government takeover of medicine by
sarcastically describing such a system as combining the "efficiency of
the US Postal Service (USPS) with the compassion of the Internal Revenue
Service." Such rhetoric was received with loud guffaws by appreciative
such as that, combined with hefty lobbying, helped prevent significant
American healthcare reform for the entire 20th century, except for Medicare
and Medicaid. Indeed, that metaphor remains in wide use among certain
decided to take the 11-factor grid that I have used for comparing healthcare
systems since 1993 and apply it to the current US healthcare (USHC) system
and the USPS. A perfect score for each item is 9; a perfect total would be
Provides access to basic care for all. USHC: 5; USPS: 9. Some 40
million Americans remain uninsured; another 40 million are underinsured.
Everyone can access the post office; it has walk-in service, no appointment
Produces real cost control. USHC: 3; USPS: 7. Healthcare
costs remain out of control in the United States; they are the most expensive
in the world. A first-class stamp costs 49 cents, well below the cost in most
Promotes continuing quality and safety. USHC: 3; USPS: 7. Errors in
medicine kill some 400,000 Americans a year; undeliverable mail totals about
4%. Dead letters are very different from dead people.
Reduces administrative hassle and cost. USHC: 3; USPS: 8. Obamacare
makes it an even bigger hassle. Stick a stamp on a correctly addressed
envelope and drop it into a box, and more than 99% get to where they belong.
Enhances disease prevention. USHC: 4; USPS: NA. Medicine
is improving on this one.
Encourages primary care. USHC: 3; USPS: 9. To make big money, docs
must specialize. Postal employees have no such perverse incentives, and they
make house calls 6 day a week.
Considers long-term care. USHC: 3; USPS: 7. Unsolved for medicine;
a political football for the postal service.
Provides necessary patient autonomy. USHC: 4; USPS: 9. Insurance
companies, Medicare, health systems, and physicians still tell patients what
to do. By contrast, you can use the USPS, FedEx, UPS, DHL, email, text
messaging, Facebook, Twitter, phone calls, Skype, WhatsApp. You decide.
Safeguards physician autonomy. USHC: 4; USPS: NA.
Limits professional liability. USHC: 3; USPS: 9. Almost all physicians
still run scared of malpractice allegations, and defensive medicine rules.
Suing the postal service is a non-starter.
Possesses staying power. USHC: 3; USPS: 9. Do any of you believe
that Obamacare will fix the broken system? Will it prevent more needed health
system reform? For the postal service, "Neither snow nor rain nor heat
nor gloom of night stays these couriers from swift completion of their
that 99 is a perfect score, USHC scores 38 -- pretty awful, but consistent
with earlier rankings. USPS scores 74 -- not great; a gentleman's C. But it
is a blowout. If this were Little League, the mercy rule would stop the game
at 4 innings; if this were boxing, a TKO would be called at about round 3.
The USPS, a frequent scapegoat, wins by a landslide. And here is the dagger:
The USPS receives no -- zero -- tax dollars for operations. Oh my.
my opinion. I am Dr. George Lundberg, at large at Medscape.
Internal Medicine © 2014 WebMD,
Cite this article: The US Healthcare System vs
The US Postal Service. Medscape. Apr 23, 2014.
gun violence with patients, ACP (American College of Physicians)
Discuss Gun Violence With Patients, ACP Says
Physicians have a right
and responsibility to discuss gun violence with their patients, according to
a new position paper from the American College of Physicians (ACP).
have long trusted their physicians to advise them on issues that affect their
health," ACP president Molly Cooke, MD, FACP, said in a statement.
"Physicians can play a critical role in educating the public on the
risks of firearm ownership and the need for firearm safety through their
encounters with their patients."
position paper was released today at the Internal Medicine 2014 in Orlando,
Florida, and was published simultaneously in the Annals
of Internal Medicine.
its policy position, the ACP Health and Public Policy Committee reviewed
available data on the impact of access to firearms, mental health, state and
federal firearms laws, and efforts to reduce firearms violence. The policy
outlines 9 strategies to address the societal, healthcare, and regulatory
barriers to reducing firearm-related violence, injuries, and deaths in the
Supports Universal Background Checks
recommends that firearm safety be approached as a public health issue so that
policy decisions are based on scientific evidence.
such, ACP strongly supports universal criminal background checks to keep guns
out of the hands of felons, persons with mental illnesses that put them at
greater risk of harming themselves or others, people with substance use
disorders, and others who current regulations prohibit from owning
guns," according to an ACP statement.
United States has the highest firearm-related mortality rate among
industrialized nations," Dr. Cooke said during a media briefing.
"ACP believes that a comprehensive, multifaceted approach is necessary
to reduce this epidemic of gun violence and that physicians
play a vital role."
supports appropriate regulation on the purchase of legal firearms to reduce
firearm-related injuries and deaths, acknowledging that any such regulation
must be consistent with the Supreme Court ruling establishing that
individual ownership of firearms is a constitutional right under the Second
Amendment of the Bill of Rights.
recommends that guns be subject to consumer product regulations regarding
access, safety, and design. In addition, the College supports
law-enforcement measures to aid in the identification of weapons used in
believes that firearm owners should adhere to best practices to reduce the
risk for accidental or intentional injuries or deaths from firearms.
cautions against broadly including those with mental illness in a category
of dangerous individuals. ACP recommends that every effort be made to
reduce the risk for suicide and violence through the prevention and
treatment of the subset of individuals with mental illness who are at risk
of harming themselves or others. ACP believes that diagnosis, access to
care and treatment, and appropriate follow-up are essential.
believes there is enough evidence to enact legislation banning the sale and
manufacture for civilian use of firearms that have features designed to
increase their rapid killing capacity (often called "assault" or
semiautomatic weapons) and of large capacity ammunition, and retaining the
current ban on automatic weapons for civilian use.
supports efforts to improve and modify firearms to make them as safe as
possible, including the incorporation of built-in safety devices.
believes that more research needs to be funded on firearm violence and on
intervention and prevention strategies to reduce injuries caused by
firearms. Access to data should not be restricted.
Public Health Threat
is "very broad support" among internists for the ACP position on
gun violence, Robert Doherty, BA, senior vice president for government
affairs and public policy at ACP, said during a press briefing.
nationally representative sample of 573 internists surveyed by ACP, 85% said
they believe that firearm injury is a public health issue and 71% believe
that it is a bigger problem today than it was a decade ago.
addition, 66% of respondents said they believe that stricter gun control
legislation would help reduce the risk for gun-related injuries or deaths.
Roughly two-thirds believe that physicians should have the right to counsel
patients on preventing deaths and injuries from firearms, yet 58% reported
never asking whether patients have guns in their homes.
survey was published today in the Annals
of Internal Medicine.
concluded that firearm violence is not just a criminal justice issue, but
also a public health threat that requires the nation's immediate
attention," Thomas Tape, MD, FACP, chair of ACP Health and Public Policy
Committee, said in a statement.
an organization representing physicians who have first-hand experience with
the devastating impact of firearm-related violence, ACP has a responsibility
to participate in efforts to mitigate needless tragedies," he added.
Intern Med. Published online April 10, 2014. Position paper, Survey
Medical News © 2014 WebMD,
comments and news tips to email@example.com.
Cite this article: Discuss Gun Violence
With Patients, ACP Says. Medscape. Apr 10, 2014.
===AAMC STAT===, News from the Association of
American Medical Colleges, April 28, 2014 issue.
News from the
Association of American Medical Colleges
Court Upholds Ban on Race-Conscious Admissions in Michigan
• Certain Groups of Medical Students Disproportionately Affected by
• Competition Seeks Educators to Prepare Next Generation of
• LCME Publishes Reformatted Accreditation Standards
• NIH Research Funding Benefits By State
• On the Move
Supreme Court Upholds Ban on
Race-Conscious Admissions in Michigan
The U.S. Supreme Court upheld a referendum by Michigan voters that
prohibits state universities and colleges from considering race in the
admissions process. In a statement,
AAMC President and CEO Darrell G. Kirch, M.D.,
expressed disappointment in the ruling but was grateful that it was limited
to Michigan. “We are pleased that Justice Kennedy emphasized that the case
is not about the constitutionality of race-based admissions policies in
higher education,” he stated. “Using a holistic consideration of each
applicant’s background and experiences, medical schools are working toward
a more culturally competent physician workforce that can meet the health
needs of an increasingly diverse nation.” The AAMC joined the American
Council of Education and 47 other organizations in submitting an amicus
brief on the case to the Supreme Court in August 2013.
Certain Groups of Medical Students
Disproportionately Affected by Stress
A recent AAMC pilot study examined medical student well-being and whether
or not specific populations of students are disproportionately vulnerable
to psychological distress. Reported in an April Analysis in
Brief, the results showed significant group differences across
five measures of well-being. For example, higher levels of stress were
reported among first generation college status, female, LGB, Asian
(compared to white), and students underrepresented in medicine (compared to
white) respondents. The results showed that well-being is associated with
students’ quality of life, which can alter perceptions of the learning
environment and student outcomes, such as changes in empathy, academic
achievement, and attrition.
Competition Seeks Educators to Prepare
Next Generation of Physicians
The AAMC, in collaboration with the Khan Academy and Robert Wood Johnson
Foundation, is seeking talented medical students, residents, and faculty to
help complete the MCAT® Collection, which offers free tutorials to help
students prepare for the new MCAT exam. The competition seeks talented
video-based educators and innovative question and article writers. Winners
will receive hands-on training with Khan Academy leaders as well as the
opportunity to create free pre-health and medical education resources for a
global audience. The entry deadline is June 13, 2014. For competition
details and entry information, visit www.khanacademy.org/test-prep/mcat/mcat-competition-details.
The AAMC will host a free webinar about the competition on May 12. To
register, visit http://bit.ly/mcatkhanwebinar.
LCME Publishes Reformatted
Following completion of a multi-step revision process that began in July
2012, the Liaison Committee on Medical Education (LCME) has published a
substantially reformatted set of accreditation standards in the 2014
edition of Functions and Structure of a Medical School. Among the
more notable changes are the consolidation of 132
individual areas of compliance into a set of 12 comprehensive standards,
each comprising multiple related elements, and the data collection
instrument used by schools to collect data for the self-study. The new
format will continue to promote the highest standards for quality medical
education, while streamlining existing accreditation processes and
facilitating use of the LCME standards for continuous quality improvement
efforts. The 2014 standards are in effect for all accreditation activities taking place after July 2015. More information is
available at www.lcme.org.
NIH Research Funding Benefits by State
The Federation of American Societies for Experimental Biology recently
released updated factsheets for fiscal year 2013 on how funding from the
National Institutes of Health (NIH) benefits each of the 50 states,
Washington, D.C., and Puerto Rico. Each factsheet demonstrates how NIH
research grants add value to local communities by improving health,
training the next generation of scientists, and boosting the economy
through the creation of new businesses and higher paying jobs. Information
about how much NIH funding each state lost due to sequestration also is
On the Move
David J. Cole, M.D., chair of the Medical College of South Carolina (MUSC)
Department of Surgery and president of MUSC Physicians, has been named the
college's next president. He succeeds Raymond S. Greenberg, M.D., Ph.D.,
who left to become executive vice chancellor for health affairs of the
University of Texas System.
Jonathan Blum has stepped down as Medicare director and principal deputy
administrator for the Centers for Medicare and Medicaid Services. He has
served in the position since March 2009.
4. The Universidad
Autónoma de Guadalajara (Mexico) offers a 4-week Medical Spanish course
where students will learn Spanish medical terminology, experience a new
culture, and enjoy the delights of Mexico.
your students looking for a great summer opportunity? The UAG Medical
Spanish program offers a 4-week course where students will learn Spanish
medical terminology, experience a new culture, and enjoy the delights of
Activities & Benefits include:
in the theory and practice of medical Spanish terminology.
of medical skills in Spanish at the UAG community clinics.
insights and knowledge from native Spanish speaking doctors.
to venture into the many cultural sights Guadalajara has to offer.
Please share this with your students and clubs. It’s a great opportunity to
learn Spanish, engage with patients, and enjoy the summer!
Course dates summer 2014: June 16, June 30, July 14, and July 28.
Students may be eligible for a $100 USD discount on groups
of 3 or more.
-Group discount form should be endorsed by
Pre-med/Pre-Health Advisors (firstname.lastname@example.org)
receiving the discount must be enrolled in the same college or university.
UAG Medical Spanish
Advisor: Stan Eisen
110 Gallery Cir | San Antonio, TX 78258 | Tel:
1-800-531-5494 | Fax: (210) 377-2975
© Copyright 2014
- Universidad Autónoma de Guadalajara
University of Vermont offers a Summer Medical Program to provide
foundational knowledge in key medical science courses.
College of Medicine courses for medical, graduate,
post-baccalaureate, and undergraduate students.
The Summer Medical Program offered by the UVM College of Medicine is designed
to provide foundational knowledge in key medical science courses. UVM
College of Medicine faculty provide students
the opportunity to immerse themselves in a specific content area,
guided by experts in their field. This program has a long track record
of academic excellence and draws an international population.
Medical Pharmacology - PHRM 301 (60154)
John McCormack - John.McCormack@uvm.edu
Course Dates: May 28 - June 25, 2014
Courses in biochemistry, physiology, and microbiology. Requires
Medical Physiology - MPBP 306 (60039)
Low - Bob.Low@uvm.edu
June 16 - July 21, 2014
must obtain the permission of the Department of Molecular
Physiology and Biophysics to enroll.
Summer Medical Program Housing is available. Find out more on
To request more
information about our Summer Medical courses or other related
programs available through the UVM College of Medicine and UVM
Continuing and Distance Education, contact the Healthcare Advisor, Jennifer
Lian, at 800.639.3210.
Nature Conservancy encourages you to observe Arbor Day by planting a
do more than plant a seedling in the ground; you'll plant roots for
tomorrow. One gift. One Tree. One Planet.
Dear Stan Eisen,
you know that trees provide life-giving benefits to everyone
on our planet? They regulate our climate, filter our water, give us shade
and shelter, provide a home to millions of plants and animals, and even
help support local economies.
This Arbor Day, you can support forests around the globe when you give to our Plant a Billion Trees program.
Established in 2008 to restore Brazil's Atlantic Forest, we're now working
to restore vital forests the United States and China as well -- forests
that are essential to the livelihood of people and nature around the globe.
Forests like Longleaf and Shortleaf Pine forests, the forests of the
Central Appalachians, and Mississippi River Bottomland Hardwood forests in
the United States, where our work has resulted in great successes. The West Virginia Flying Squirrel,
native to the Central Appalachians, is no longer endangered as of 2013,
thanks to efforts to restore its forest habitat.
Or the forests of the Yunnan and Sichuan Province -- forests that are home
to the iconic panda and Yunnan golden monkey -- where Plant a Billion
restoration efforts will connect small fragments of trees to create a
larger habitat for these species, as well as support local communities with
jobs and training in forest management.
Trees give us life -- they provide us with clean water, air and food -- all
of the things we need to thrive. Celebrate Arbor Day this year by giving back to the forests
that give so much to us.
Conservation Lead for Plant a Billion Trees
The Nature Conservancy
PHOTO: Longleaf, planted
pines and native grasses at The Nature Conservancy's Green Swamp Preserve,
North Carolina © Mark Godfrey/TNC.
© 2014 | The Nature Conservancy
4245 North Fairfax Drive, Suite 100,
Arlington, Virginia 22203-1606
Questions or Comments? Call us toll-free at (800) 628-6860
7. Marginalia: It’s amazing how EXTREMELY OLD technology
still influences today’s
4 Feet 8.5 Inches - true and
You'll love the logic here.
The U.S. Standard Railroad
Gauge (distance between the rails) is 4 feet, 8.5 inches. That's an
exceedingly odd number. Why was that gauge used? Because
that's the way they built them in England, and English expatriates designed
the U.S. Railroads. Why did the English build them like that? Because
the first rail lines were built by the same people who built the Pre-Railroad
Tramways, and that's the gauge they used. Why did 'they' use
that gauge then? Because the people who built the tramways used
the same jigs and tools that they had used for building wagons, which used
that wheel spacing.
Why did the wagons have that particular odd wheel spacing? Well,
if they tried to use any other spacing, the wagon wheels would break on some
of the old, long distance roads in England, because
spacing of the wheel ruts. So, who built those old
rutted roads? Imperial Rome built the first long distance roads in Europe
(including England) for their legions. Those roads have been used ever since.
And the ruts in the roads? Roman war chariots formed the
initial ruts, which everyone else had to match for fear of destroying their
Since the chariots were made for Imperial Rome, they were all alike in the
matter of wheel spacing. Therefore, the United States standard Railroad gauge
of 4 feet, 8.5 inches is derived from the original specifications for an
Imperial Roman war chariot.
In other words, bureaucracies live forever. So the next time you
are handed a specification, procedure, or process, and wonder, 'What horse's
ass came up with this?', you may be exactly right.
Imperial Roman army chariots were made just wide enough to accommodate the
rear ends of two war horses.
Now, the twist to
When you see a Space Shuttle sitting on its launch pad, you will notice that
there are two big booster rockets attached to the sides of the main fuel
tank. These are Solid Rocket Boosters, or SRBs. The SRBs are made by Thiokol
at their factory in Utah.
The engineers who designed
the SRBs would have preferred to make them a bit larger, but the SRBs had to
be shipped by train
from the factory to the launch site. The Railroad line from the factory
happens to run through a tunnel in the mountains, and the SRBs had to fit
through that tunnel.
The tunnel is slightly wider than the Railroad track, and the Railroad track,
as you now know, is about as wide as two horses' behinds.
So, a major space shuttle
design feature of what is arguably the world's most advanced transportation
system was determined more than two thousand years ago by the width of a
Now you know: Horses' asses control almost everything ... Explains
a whole lot of stuff, doesn't it?