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Biblical Reflections on Modern Medicine

Vol. 10, No. 3 (57) 

Contents:


Survival of the Fittest in a Just Society
or
The Poor Will Always Be with Us

There is a downside to the huge welfare state that neither I nor anyone else (that I know of) has written about: the survival of the less fit in an unbiblical society. By contrast, those who are Biblically obedient in a just society would be the greater survivors. Actually, by "surviving" I mean that they would have better health and live longer. However, "survival of the fittest" should tweak some interest and maybe even some outrage. 

A Biblical lifestyle or more accurately, being Biblically obedient, is the most healthy choices that a person can make. The one exception is becoming a missionary in third-world countries (and today, even that risk has been reduced considerably). First, a Biblical lifestyle must be healthy because God commands only what is good for us--nay, He commands the best for us.

Secondarily, "scientific" studies show that Christians are more healthy than those who are not. There is less drug use, lower blood pressure, less heart disease and cancer, and greater longevity, to name only a few. Certainly, we ought to be Biblically obedient regardless of the consequences, but it is comforting to know that right choices are also healthy choices.

Jesus said, "The poor will always be with you." The New Deal, The Great Society, and other such state- (i.e., taxpayer-) subsidized programs have believed that "The poor* will not always be with us." That is, these programs can educate, improve housing, provide medical care, etc. to the extent that the poor will no longer be poor. Everyone can share in the American dream.

That goal has not been achieved. For more than 30 years, huge sums of money have been spent to prove that Jesus was wrong--He was not. The same percentage of "poor" are still with us as there was at the beginning of this transfer of more wealth than exists in the current Fortune 500 companies.

But, the poor are with us in greater numbers than they would otherwise be. Mandatory immunizations, public schooling, Medicaid, specialty medical clinics and programs (sexually transmitted diseases, AIDS, drug "rehabilitation, etc.), and the Veterans Administration** have increased their health and survival. Without this public assistance, they live longer, are able to have more children, and spread more of their diseases. In a real sense, then, the poor have increased.

If everyone were allowed to suffer the consequences of their choices, many of the poor would no longer be with us. Drug addicts and alcoholics would die sooner. People with AIDS would die sooner and have less opportunity to spread diseases. Children without immunizations would die of more childhood diseases. Etc.

Some readers may be boiling by this point. Others may be confused. What about Christian charity to reach out and help these "poor"? Gotcha!

There is a worldview of difference between government programs and Christian charity. What Mother Theresa did and her nuns continue to do is Christian charity. What governments in the United States do is forced taxation and redistribution masquerading as "charity." It is tyranny. 

Worse, the best choices are not even made to help this segment of society. What is free is never as valued as what is earned. Few of these programs requires that people extend themselves and become better in some way to earn benefits. 

So, our society continues to be dragged down by the survival, even the promotion, of degrading and disease-causing lifestyles. In a just society, the fit (Biblically obedient) would be the greater survivors. The lawless would be punished and the immoral allowed to face the consequences of their actions. True Christian charity would proliferate, offering better and more healthy choices to the "poor." 

The problem is that the concept of the "poor" is primarily moral and spiritual, not physical. While some people temporarily find themselves poor for bad investment decisions, job loss, etc., these are not the chronically poor. And, there are some poor with Biblical values or moral character: mothers (mostly) and fathers who work long hours at low pay to provide so that their children will no longer be poor

But, the majority of the poor will always be what they are. Without conversion of their hearts or a moral willingness to forego immediate gratification, they will be the poor always among us. 

A consequence of a just society is the survival of the fittest. By this (super)natural outworking of Biblical obedience, their example shines more clearly (on a hill), a beacon to the "poor."

The "poor" are not only those with little or no money, poor housing, and clothing. Many monetarily rich people are poor, especially in modern America. They live immorally, yet have "money." They are able to avoid some of the consequences that the monetarily poor cannot. Interestingly, however, the morally poor often end up monetarily poor: the just consequences of their choices! (See Proverbs 5:10, 6:26 and others.)

A country ought to provide whatever is needed for its injured and diseased veterans of war. However, the current VA system virtually admits anyone who served in the armed forces whether they saw action or not. Also, "service-connected" injuries and diseases form the minority of what the VA treats. A great deal of their budget goes to the treatment of immoral lifestyle choices, especially tobacco and alcohol abuse.

Response and Balance from Dr. Terrell

Since I was entering new and perilous waters, I asked Dr. Terrell to review my article. His response balances and expands my voyage. He writes:"

1) Biblical poverty seems to me to be, in a physical sense, is a lack of material necessities of life such that one either lives without or lives from hand to mouth. There is no reserve for exigencies. I do not see much true poverty in the United States in the sense of doing without, and I work in a position where I would tend to see it. I rarely ever see a truly undernourished child. I do see living from hand to mouth, and that seems to be increasing. Poor people once lived from paycheck to paycheck.

Then, they lived from paying the credit card minimum to paying the credit card minimum. Now, they live from advanced check cashing to advanced check cashing, so that they can pay their credit cards (if they have any left) or buy daily necessities. Annualized interest rates on these check cashing operations run well upwards of 40 percent. Where there are two parents in the household, they are often maxed out on jobs, so there is no reserve there. Welfare, too, seems to be at a maximum for the unemployed single heads of household. We are ripe for this over-stretched system to come down, and it will require only an economic hiccup to cause it.

2) The popular definition of poverty today, one which does not match with Jesus' definition, is that group which has less than other groups. That definition is merely one of envy. He was speaking of those who truly had a deficit of a daily need. We have the Biblical image of the poor man leaving his cloak in hock for the day. The "poor" in the U.S. enjoy material assets beyond the dream of even of the rich a couple of centuries ago or in some other nations today.

3) We have to look either to other nations today or to the generations on either side of ours to see larger-scale Biblical poverty. As a nation, the U.S. has first out-produced (first three-fourths of the 20th century) and now out-maneuvers much of the rest of the world, such that the poor "neighborhoods" tend to be whole nations, archipelagoes, or even continents. There is not much real poverty down the street, so we have to look to Asia and Africa. When the economic "snap" comes here, it will be next door, and our whole definition will change, along with our methodology for dealing with it. I look for the changes to be both painful and salutary. Through debt-based currency, backed up by aggressive military and trade policies, the U.S. has helped to create poverty elsewhere both geographically and generationally. Our debt and tyrannical practices have guaranteed poverty for large segments of our children's and grandchildren's generations. We have sold them into slavery.

4) Therefore, the "poor ... with you always" are with us, but generally speaking, less often next door than on the next continent.

5) A modern definition of poverty might need to include some features which were not appropriate a century ago. Does one "need" electricity, running water, or a car? If one lives on the 17th floor of a low-income apartment building in a large city, yes. No electricity means no elevators, no light, perhaps no heat. You cannot drink the roof water run-off or dig a well or a privy. You might not survive a trip to the market without some kind of vehicle.

Even with such an expanded definition of poverty, there is not nearly as much of it in the U.S., as there was only a generation and a half ago. There may not be proportionately as much physical poverty in the world as a whole. I have been reading H. Bruce Lincoln's histories of the U.S.S.R. and have been appalled at the physical living conditions normal in that empire a century ago. China has had a similar change.

However, even if the accounting this year showed considerable progress in material terms, it is easy to see that it has been accomplished largely through theft from future generations, including even the theft of their very life (in particular, China which forces abortion and sterilization), and the theft of Revealed Truth. As such, the prosperity cannot be maintained since the Gospel is the only basis for a sustainable and just material sufficiency.

6) Jesus assured us that there would always be poor with us. He did not say that they would always exist in even roughly similar numbers of proportions. Are not the poor a reminder of our dependence upon God and His requirement of a like administration of mercy? We have put material poverty into retreat in the U.S., but have forgotten the original more nearly God-honoring means by which the job is to be done. Our forgetfulness is fertilizing an incremental repeat harvest of material poverty.

7) We have been applying a complete, balanced fertilizer for the coming bumper crop of material poverty. We have an ungodly monetary and credit system, an aggressive and arrogant military, alliances with the ungodly, widespread ungodly business practices, denigration of the family unit (especially fathers), wholesale sexual immorality, gross and rapidly rising ignorance (the Geraldo "talk" shows alone are terrifying in their implications), and a misbegotten belief that material providence is possible irrespective of obedience to God.

8) The sheer size of our economic units has approached Tower of Babel heights. We have trans-national military and business empires. A farmer in Indiana, however industrious and prudent, can be "done in" by a coterie of international financiers and politicians, who use a soybean farmer in Argentina to "do him in," only to return the favor on the Argentinean in a few years. We need, and shall have, smaller economic units. It will mean having the truly poor nearer to us geographically. Our present-day units cannot get very much smaller before there are any considerable losses in the "economies of scale."

9) The one-to-one personal relationship of primary care medicine made it, for years, peculiarly refractory to "factory farming" methodology. Now that we have it in the form of heavy regulation, "managed care organizations," and governmental medicine, we are feeling what the farmers and factory workers have felt for decades. The quality of the care delivered has, in the process, become impoverished at the same time that the degree of material provision for medicine has increased. 

The persons in the patients have been lost. Many physicians (by their actions) believe that getting the right diagnosis and prescription constitutes practically the whole of their job. "Hand-holding," lamenting, teaching, listening, and other features are given only lip-service, if not actually derided. When there are few ACE-inhibitors to dispense or few operating rooms for valve-replacements, will any physicians know how to behave? The best economy of scale for medicine is one-to-one.

In summary, we have moved from a (relative) spiritual richness and material limitation to material abundance with spiritual poverty. Without the reminder of as many poor nearby, we have lost our reminder. We are going to move back toward a spiritual appreciation under discipline of material want."


Terrell's Treatises

Hilton P. Terrell, Ph.D., M.D.

A Million Termites Eat the Heart Out of the Tree of Medicine

Medicine is increasingly taken up with efforts completely out of view of the patients we are supposed to serve. Regulatory agencies of the government and insurance considerations consume immense resources. Since it is a "zero-sum game," whatever time and money is spent on satisfying these monsters is not available to spend on patients. A partial list of things out of view of my patients includes the following.

1) Thirteen pounds of mail arrived in an eight month interval, sent by government and private insurance, telling me of various rules: how to code bills, what drugs have been removed from their approved lists, how to get "authorization" for various procedures, a form to satisfy the Hyde amendment for government payment for an abortion, immunization schedules, and so on. It amounts to thousands of pages. I can do no more than scan it, hope that my decision that it does not apply to me is correct (it usually does not), and trash it. The penalty to me as physician for not complying can run as high as ruinous fines, destruction of reputation, and prison time. Every moment spent with this trash heap is deducted from patient care. Every moment not spent is risk to me.

2) So far this week, three faxes from the "fitness center" of a local hospital have sought my blessing on participation by patients of mine in their programs. Prominently displayed on the faxed form is a notice that the American Academy of Sports Medicine believes it appropriate that patients who resemble mine should have a cardiac stress test prior to participation. The fitness people, which include a physician, will not sign off on the miniscule risk. They want me to do it. I have not seen the patients in two years. 

I did not address cardiac fitness with them when I did, since the agenda was otherwise. Why am I "in the loop"? The real agenda here is professional self-protection, since the incidence of acute myocardial infarction (sudden heart attack) during a supervised exercise regimen for a 42-year-old woman with lower body obesity is perhaps lower than the incidence of 42-year-old women who will be involved in an auto accident driving to the physician for a cardiac stress test!

3) Ralph's son leaves me a form to "sign" for him to get a $3000 motorized wheelchair paid for by the government. Someone who called at his door last week told Ralph that he "qualified," since he had had a stroke and was weak on the left side of his body. The fact that Ralph answered the door on his own two feet seems lost on Ralph. He is weak since the stroke, for sure, but access to an electric ride might accelerate deconditioning. 

Furthermore, the form makes it clear that Ralph, in fact, does not qualify. A nameless neighborhood wheelchair sales canvasser, therefore, has elected me to be "goat" in having to disabuse Ralph of the error. The sales-man was more convincing than I am, and I can see the doubt in Ralph's face the next time in my office when the matter comes up.

4) The hospital wants me to sit before a computer terminal and be "trained" in looking up MSDS's ("material safety data sheets"). It seems that the Joint Commission on the Accreditation of Health Organizations will be coming soon, and everyone is subject to being asked to demonstrate the capacity to do this. In nearly 25 years of medicine, I have never had one of these federally-required data sheets to be of any real help in solving a patient's problems.

And so it goes, behind the scenes, faster and faster with little useful output except to the job security of the regulator. Learn the new codes to all the locked interior doors of the hospital. The hospital is becoming as internally "locked-down," as the prison I once worked in. (So is mine--Ed.) Get a photo for a new ID card for the hospital. I might be an intruder and the tag on my pocket will prove to all that I am not. 

Turn down the out-of-state pharmacy's FAX wanting to switch Mr. Brown's blood pressure medicine. They'll just keep faxing until you tell them "no." Read and sign the five page form of rules about the hospital's networked computer and e-mail system. No, I won't tap into pornography sites on the Internet. No, I won't disparage someone's race. Yes, I know you can read everything that I type into it. (That is why I use my own laptop for nearly everything.) Re-do my hospital privilege form. Prove (again) that I am immune to hepatitis B.

While there are usually logical connections to patient welfare evident in most of these activities, there is no sense of priority. It is not possible to cover all the bases. Some activities with conceivable benefit when considered in isolation will have to be omitted. Time was, when I was trusted to make reasonable decisions about such matters. 

No one is watching the whole of what I do, except me. Now, various central authorities want to make those decisions, and not one of them is looking at more than a small part. Physicians and patients are on the periphery, and the center is eating up the prerogatives of the periphery. Things which can be easily coded and quantified have begun to rule over things which cannot.

In the midst of writing this, I was called to see a 6-year-old child in follow-up for pneumonia. She is still ill, but improving. The true nub of the visit, however, was that the child's first cousin died suddenly six weeks ago in her mother's arms. Even an autopsy was not completely conclusive. It was probably Reye's syndrome. My 6-year-old patient's illness, to a layman's eye, includes certain features similar to those few symptoms which preceded the sudden death. How to you enumerate for central controllers the time and value of discussing this matter with the parents in this context? There is no way. Yet, it was the main point today.

The appetite of the centrists for data and control is insatiable. It will not stop until it has brought down the very system it was supposed to help. So be it. When that occurs, there will be nothing left at the center and no choice but to have the periphery resume all the control, cost, and risk. In medicine, that is as it should be. 

In the meantime, and it is a mean time indeed, physicians, hospital, pharmacies, and other elements in the medical "system," will continue to be creative in achieving results for patients despite the centrists' grasping tyranny. I sense, though, that even creative people on the periphery are becoming unable to keep ahead of the deluge of controls. The termite colony of central controllers has eaten so much of the invisible heart of the tree of medicine that it is due to fall to earth soon.


Collateral Damage in the Tobacco Wars

The spray of gunfire aimed at tobacco has hit not only that industry but seriously wounded a bystander--TRUTH. One does not have to be a friend of tobacco to know that in the long term, a disrespect for truth has a wider and more powerful adverse effect upon health even than the noxious weed. Robert Levy, a college professor, and Rosalind Marimont, a retired National Institute of Health (NIH) mathematician, teamed up to write about the wounds that truth has received in the tobacco wars (Regulation, Vol. 20, 1998, pp. 24-29). Their targets are the greatly inflated numbers of death attributed to tobacco. The most common figure bandied about is 400,000 deaths per year in the United States. They maintain that this number is greatly overstated, and they make their case well.

There are many tricks to inflate the harm done by tobacco. Levy and Marimont cite a 1998 World Health Organization (WHO) release which misrepresented the risk of second-hand tobacco smoke. The difference in lung cancer between the more exposed and the less exposed were not statistically significant. 

The excess risk to lung cancer for those exposed to second-hand tobacco smoke is less than the excess risk to lung cancer among those who drink whole milk. Connections of this small degree usually occur because of some noncausal connection between the measures being compared. My hat size is related to my head diameter, but my hats do not cause my head to be the size that it is. There are numerous such connections which are better known as "markers" than as "factors." A "factor" is a cause.

The authors find that the Environmental Protection Agency (EPA) "cherry-picks" its data on second-hand tobacco smoke, selecting studies with results preferred to their political ends and leaving out studies with contrary findings. They find comparison groups that are clearly not comparable, attribute deaths with multiple contributing factors to smoking alone, and omit the powerful effect of competing causes of death. 

Since the illnesses caused by tobacco use mostly kill toward the end of the average life expectancy, the total number of years of potential life lost to tobacco is surprisingly small, less than what is caused by accidents and alcohol. The actual risk of tobacco use may not be half of what is commonly stated. The numbers have achieved acceptance through repetition.

Since tobacco use is dangerous, why should we be concerned? We should be concerned because the maneuvers used against tobacco dull everyone's senses of accuracy and fairness, including those whose business it is to know better. Demon tobacco has only had its dangers greatly exaggerated, but the same methods can demonize anything. 

Privately owned firearms, which bought our independence from a tyrant, are being demonized, while the criminal demons who murder with them are often excused on "mental health" grounds. Some "alternative medicine" practices are demonized by the powerful mainstream of medicine, while other truly demonic medical methods are being incorporated into "orthodox" medicine. Similar distortions of truth are being used to demonize those who disapprove of homosexual practice. 

There are forces which would misrepresent data to destroy home schooling. Like a synagogue of Satan, casting out those who do not submit to its false worldview, demonic powers in our dying culture shrewdly choose to harm some bad things while with the same stroke, installing a worse practice by means of which the good may be later driven out.


Medical News Jetsam

Russian Public Health Follows Russian Public Morals

Included in the ongoing political, social, and economic collapse in Russia are medical disasters. Diphtheria is up more than 50-fold in a recent 5-year period, and tuberculosis "... is a disaster" (Family Practice News, May 1, 1999, p. 41). The lesson from these disasters urged upon us by our own medical establishment is that we should continue supporting our public health services so that we can be protected against such infectious monsters. This is the wrong lesson. The lesson is that the health of a population cannot be separated from the belief systems of that population. Not all beliefs are consistent with good health.

For a century or more, Russians have passed off to their civil rulers responsibilities for many things which are neither legitimate nor feasible for a ruler to manage. They have insisted that the government run the economy, and they have no adequate history or experience with the personal industry, honesty, and frugality foundational to a free market economy. When their centrally planned economy openly failed, they had nothing to fall back on. In the collapse, medical care has been dragged down from its previously low level to an abysmal state. For us, the lesson is not so much medical, as it is moral, economic, and political. ("Moral," of course, includes economic and political--Ed.) There is literally no way to organize public health instruments which can insulate a people from the health of such misbeliefs.

As we in the U.S.A. transfer our liberties to a mother-state, we should expect that state to be inept. For a medical view of the U.S. in the future, look at Russia today. We are hard at work nurturing a peasant mentality among the subjects of our sovereign rulers. We look to our masters in Washington for relief when we are ill. We zealously protect our entitlements to drunkenness, sloth, fornication, and gossip. We refuse to see any connection between our beliefs and our health. We, too, will reap a whirlwind.

"Third Party" Medicine Acquires a New Meaning in New Jersey

In addition to medical insurance companies and the medical "insurance" programs of the federal and state governments, we have a new player on the field calling the plays in the treatment of patients--automobile insurance carriers! In order to fight high automobile insurance rates, New Jersey has enacted regulations which dictate treatment protocols for vehicular accident victims (American Medical News, May 10, 1999, pp. 1, 51). 

By virtue of the wisdom that descends upon it, perhaps from Mount Olympus, the state insurance department has produced what are called "care paths" expected in the treatment of six injuries stemming from car crashes. The auto insurance carriers look at treatment plans submitted to them on individual patients and decide whether to approve them or not. The usual assurances are being handed out by the state that these regulations are really only to catch all those bad guys who are abusing the system, in the fine tradition that limited the RICO law to real racketeers.

There is an ever tightening circuit that traps central managers of matters not amenable to central management. Attempts at central management of intrinsically peripheral details leads to new problems which lead to new attempts at central management. Like health insurance companies, auto insurance companies are caught. Insurance, of course, is not a feasible plan to manage risks which are not objective. 

Back pain or neck pain following an auto accident is not objective. Using their ability to trump objective tests, unscrupulous patients and their attorneys have a large diameter pipeline sucking funds from auto insurance. These two groups often team up with unscrupulous physicians. Singing their part is an ignorant peasant jury, trained in school and by television to evaluate emotionally, orchestrated by a legal profession that long ago explicitly reject the belief that all of our human laws should be based upon "God's law.

Medical insurance is a concept with very limited applicability. Until we are forced by economic necessity to release this concept, no amount of organizational writhing will correct it. Indeed, it only worsens the situation. Preaching of the Gospel is the means by which we peasants become able to serve more than human and dark angelic masters. Born again into God's Kingdom, we can then begin to apprehend God's law and desire to please Him in it. We can begin to move from peasantry to being rulers in the spheres of influence that are suited to our stations and callings in life. It follows that preachers of the Gospel in New Jersey have more potential to lower automobile insurance rates than insurance regulators.

Medicaid Swamps in North Carolina

The Medicaid program of North Carolina is receiving protests over its policy of refusing to pay for many emergency hospital visits, according to the American Medical News (March 22/29, 1999, p. 25). Trying to reduce expensive emergency department visits, the state program first ushered nearly a half million Medicaid "recipients" into the practices of primary care physicians.

These physicians are the logical alternatives to the use of emergency rooms for non-emergency problems. Later, the state program began to review the records for visits billed as emergencies, applying a standard of the so-called "prudent layperson." If an imaginary "prudent layperson" would have thought that a problem was an emergency, Medicaid will pay the bill. If not, it won't.

In the cool light of day, during regular hours, without much threat of medical malpractice, without having actually to see a patient, after the fact, perhaps munching crackers and tea, a centrally situated Medicaid expert second-guesses the patient and the physician on the scene. One Medicaid reviewer weights the precise wording chosen by the emergency physician. What happened matters not at all, only what was written.

The physician seeing the patient cannot be trusted to bill correctly, since he has an obvious financial incentive to skew his decision. (We are to believe that the central reviewing physician has no financial incentive to deny payment?) Medical training may need to add rotations in creative or technical writing, to displace training in mere diagnostics. When a reviewer finds that it was not an emergency, he has in effect determined that the patient was not prudent. The treating physician is likewise determined to be less than objective by the mere fact that his work is being (de)valued by the reviewer.

The reviewer who denied every Medicaid visit would be correct on a sheer probability basis, since the majority of visits to emergency visits are not for emergencies by any reasonable standard. (Relax and enjoy! I will be your "prudent layperson" guide for the rest of the tour.)

The treating physician at least knows that he has been devalued in this system. Note, though, the way the system conceals the criticism from the person who needs to know it most--the patient. The patient is treated like a cipher, a null, another cow in the herd. Those whom Medicaid employs to "help" him with his medical needs are canceling him as a responsible person. 

Those emergency physicians who would be in a position to admonish him are quite thoroughly muzzled by the threat of malpractice. Our nation, having been convinced of the infallibility of modern medicine, treats any medical error with harshness. A physician who attends 6000 patients visits a year need make only one error in 25,000 encounters to have this harshness visited upon him 7 times in a 30-year career. Thus, we see the exquisite functioning of Centrally Regulated Medicine: an imprudent patient expects infallibility when he is seen for a non-emergency by a fallible and cowed physician. The cowed physician investigates the patient's complaint at inordinate length out of fear of malpractice, producing a large bill in the process. A physician distant in time, space, and responsibility determines that the visit was imprudent. He refuses payment to the cowed physician.

The large bills of other patients are doubled and tripled to cover the costs of the unpaid ones. These immense bills convince nearly everyone that medical insurance is essential. Few realize that the existence of the insurance is a large part of the problem. Because bills are large, the insurance is expensive and some cannot afford it. Those who cannot are herded into Medicaid. Neither can Medicaid handle all the bills, so it tries central regulatory review and control of issues that are intractably variable, and the circle is closed.

The idea that having a primary care physician assigned is going to fix the problem is flawed. The suggestion is made that the emergency physician telephone the primary care physician when an imprudent visit is being attempted, so as to shift the visit to a less expensive venue with the primary care physician. The primary care physician is now being asked to help make the prudent-imprudent decision, while not at the scene, with the added fillip that he will have liability, unlike the central regulator physician.

Further, he will have the increased costs associated with providing care outside of the usual time, place, and scheduling considerations. These differences serve to make his care like that of the emergency physician in cost, achieving little. Medicaid patients seek non-urgent medical care in emergency departments for a variety of reasons, not all related to imprudence. 

Some lack transportation. Dependent upon family members who work last-hired, first-fired jobs and cannot get off when the primary physicians' offices are open, they come in when their aunt gets off her shift at 11:00 P.M.

This newsletter will offer a prize for the first person who can discover a safe, painless escape from the swamps of our medical "system." You can win one all-expenses-paid trip to the emergency department of your choice with the complaint of your choice.*

*Provided that the newsletter's physician reviewer determines that your visit was a prudent one, based solely upon what was written by the emergency physician, and only after he finishes his tea and crumpets. The Guide to Uniform Lazy Lay Person's Bureaucratic Larceny, Edition 2 (GULLIBLE2), will be used to determine prudence. Payment will conform to the Newsletter standard fee scale. Proper coding and electronic submission of claim required. Offer void where prohibited.

Dr. Terrell's Treatises ends here.


AIDS: Issues and Answers

Vol. 13, No. 3 (82) May 1999

The Numbers

Through December 1998, 688,200 cases of AIDS had been reported to the Centers for Disease Control and Prevention (CDCP, formerly CDC). Of these, 679,739 were in adults (over 13 years of age) and 8,461 in children (under 13). Of these, 405,816 adults (59.7 percent) and 4,724 (58.9 percent) children have died.

For the 12 months ending with December 1998, there were a total of 47,887 cases of AIDS in adults and 382 cases in children. The numbers for the year ending December 1997 were 60,161 adults and 473 children.

Also, for adults in the 12 months ending with December 1998, 35 percent of AIDS cases occurred in "men who have sex with men" (MSM), 23 percent in "injecting drug use" (IDU), 4 percent in MSM and IDU, 0.34 percent in hemophiliacs, 14 percent by "heterosexual contact," 0.61 by blood products or tissue, and 23 percent with "other/risk not reported or identified." (Except for MSM and MSM/IDU, these percentages include women.) 

Commentary: These numbers are taken from the "Year-end Edition" of the HIV/AIDS Surveillance Report for 1998.* It is a 44-page booklet with 30 Tables, 11 Figures, and pages of footnotes and explanations of presented data. So, I have presented a miniscule portion of the data therein.

Mostly, the current data are only confirmation of previous information that I have presented. The total numbers continue to decline. Homosexuals ("MSM") still account for the largest number of cases. (Remember that "heterosexual" comprises high risk exposure to HIV/AIDS: "sex with injecting drug user," "... bisexual male," "... person with hemophilia," "... transfusion recipient with HIV infection," and "... HIV-infected person, risk not specified." These are not your everyday fornications and adulteries! They have their own risks of sexually transmitted diseases, but rarely HIV/AIDS.)

"'Other/risk not reported or identified' cases include persons who are currently under investigation by local health department officials; persons whose exposure history is incomplete because they died, declined to be interviewed, or were lost to follow-up; and persons who were interviewed or for whom other follow-up information was available and no exposure mode was identified. Persons who have an exposure mode identified at the time of follow-up are re-classified into the appropriate exposure category."

The death rate for AIDS patients has indeed fallen. The total number of deaths were 36,194 in 1996 and 19,996 in 1997. (The numbers for 1998 are not available.) Deaths are placed within the year that they occurred, so the numbers for each year listed will continue to grow. Thus, the exact decline is cannot be measured, but the evidence of a significant decline is there. The significance is such that the total percentage of deaths has decreased from 61.0 percent in 1997 to 59.7 percent (above). The number itself seems small, but it is a cumulative number for the entire period of reporting (18 years).

Thus, the new treatments for AIDS are prolonging life in AIDS patients, but there are many unanswered questions. Will the dramatic effect of these new agents last? Will more virulent and resistant strains emerge? Will the survival of more patients with AIDS and a slowed progression of HIV-infected patients (who have not reached the AIDS stage) result in an increased incidence of HIV/AIDS cases? The drama of the HIV/AIDS epidemic continues!

* A single copy may be obtained by writing the CDC National Clearing House, P. O. Box 6003, Rockville, MD 20849-6003 or viewed/downloaded at <www.cdc.gov>, selecting "Publications, Software, and Products."

AIDS in the "Golden Years"

Generally, AIDS is thought of a young person's disease. "Prevention" and diagnosis has been aimed at this younger population. However, about 10 percent (69,257, as of June 30, 1998) of AIDS patients were over 50 years of age (American Medical News, May 10, 1999, pp. 29-30). While three-fourths were likely infected prior to age 50, physicians must keep this diagnosis in mind for this population of patients.

Some "experts" worry that there might be an increasing incidence in this population. In women, vaginal tissues become thinner and more easily damaged, even during "routine" heterosexual intercourse. Bleeding during menopause could be a risk for the male partner, as well. Then, there is the possible increase in sexual activity due to ViagraTM. Also, the general health and body's defense mechanisms decline with age.

So far, the percentage of AIDS patients in this population has remained relatively constant. I think that it will remain so. While this population is sexually active, it is not as promiscuous as younger populations. Further, many of the more promiscuous people, especially homosexuals, do not live into this age group. So, the exposure remains relatively low. Nevertheless, HIV/AIDS must be a possible diagnosis at any age. The elderly are certainly not immune (literally and figuratively).


Access to Life-Saving Medications Now!

Recently, I wrote about the possibility that both prescription and over-the-counter (OTC) medications are at risk due to the Year 2000 Computer (Y2K) problem. You can stock up on OTC drugs on your own. Have you?

Also, realize that many OTC medications are the same as those by prescription, only the dosage is smaller. So, even though you are on prescription medication, you may be able to obtain the same drugs OTC. 

After I wrote on Y2K, one reader wrote me that he could not get his physician to write for larger supplies. I also heard that some pharmacies will not fill larger orders. What to do?

Michael Hyatt, one of the most informed and practical experts on Y2K and survival, has recommended a source of obtaining medications from overseas. These are supposed to be the same medications (both brand name and generic) that Americans take on a regular basis. You don't need a prescription, and you can have your medication within two weeks. And, there is usually considerable savings over typical drugstore prices.

I do not have time to investigate this source. Neither do I have time not to tell you about it. Y2K is close! Investigate and buy at your own risk! This "Y2K Prescription Survival Guide" sells for $159.00.

But, consider this! Some medications are truly life-saving, in spite of all that I have said on these pages. Is yours? If so, you must get a supply of your medications before Y2K. What if Y2K fizzles? You would have had to buy this medication anyway, so you have lost nothing except perhaps a little time.

Website: <www.y2kmedicines.com/order.htm>
Phone: 1 (800) 350-0676
Mailing address: Prescription Medicine Information Bureau, L.L.C., 
1874 S. Pacific Hwy., Suite 729, 
Redondo Beach, CA 90277.

Michael Hyatt Website: 
<www.mhyatt@michaelhyatt.com>


From Aunt Bet: An Unexpected Blessing!

"The purpose of this note is to thank you for your book (Biblical Healing for Modern Medicine), and to tell you I read it over and over, and found it most helpful. Although it may have been (written) for young med students, you gave me your answers borne out by the Scriptures to many questions I have never had answered.

"So, I continue to use it for references. I want to thank you for helping me with these sticky questions. They came at a very appropriate time and give me the words I need. Thank you so much. With love and appreciation, Bet" (Emphases hers, dated March 30, 1999.)

I almost cried when I received this note. It was totally unexpected. On my mother's side, there were 7 children, and on my father's side, 4. Thus, I had at one time 22 aunts and uncles. Aunt Bet is the last. She is not in good health and probably will not live much longer.

I was in North Carolina a year ago for a conference and went by to see Aunt Bet. Actually, I left the book for her daughter, who is married to a minister, but I suppose Aunt Bet latched on to it and never let go!

I cannot momentarily recall any compliment that has meant more. I would have written the book for this response alone!

I share this note with readers, because many of you are truly dear to me, and I want you to know something of my struggles and joys. God may sometimes touch us in our deepest being. He did that with this note from Aunt Bet.


Will Hospitals Close?

"More than 45 percent of charges billed by hospitals in Georgia are never paid," says Joseph A. Parker, President of Georgia Hospital Association. Almost half of this short-fall has occurred since 1990. The uninsured and Medicaid patients account for one-third of all Georgians. Reimbursements from both Medicare and Medicaid to hospitals have contributed considerably to this short-fall.

Grady Health System, which has for decades provided the primary medical system for Atlanta's inner-city residents, will now charge patients $5 each time they visit a clinic and a minimum of $10 for each prescription filled at a Grady pharmacy. Patients will also have to provide their own travel and will no longer have the Grady shuttle. (Healthcare Business News - Ga. Edition, March '99, p. 5)

Commentary: In the November 1998 Reflections, I discussed how hospitals were being squeezed by the current financing structure of health (medical) care. These numbers show how severe this problem is. As I said then, there are major competing forces that cannot be reconciled. Patients want everything for little or no cost. Health-care organizations (e.g., HMOs) promise to deliver this "everything," but must also show a profit at their bottom line. State and federal governments with their liberal attitudes want to provide "everything" for the "poor" and uninsured, but are already exceeding their budgets.

The medical marketplace is in a meltdown! Hospitals will close (some already have). Legislators and liberals are screaming about cuts to the poor and uninsured, such as those announced by Grady. Physicians are prescribing expensive treatments that have little or no proven benefit. Managed-care companies are pressured to provide more and more for less and less. Everyone involved is trying to grab as large a piece of the pie as they can.

At first glance, such a meltdown might appear frightening: an image of millions of patients going untreated and dying right and left. Not at all! As I have discussed so often, modern medicine is more a detriment to good health and medical care than a benefit. 

For the most part, emergency services will still be available, and that is what is most needed today. There will be a few patients who will fall through the cracks and suffer, but most will just avoid treatment that will not change their medical condition significantly.

If eventually more Biblical principles could be applied to the medical payment system, as well as other areas of society and government, then this meltdown could have a very positive outcome. The meltdown is here, but those Biblical principles are not on the horizon of acceptance. Pray that they will appear.


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