The Northridge 6.6 Earthquake at 4:31 a.m. on January 17, 1994, was not the “Big One.” But it did have a death toll of over 60 with16 of those deaths occurring in one apartment building. That building not only had parking spaces on the first floor but living units as well, making them death traps. Hospitals were severely damaged and physician’s office buildings were destroyed including all patient and financial records. It was suggested that physicians begin computerizing patient records in addition to their financial records so medical files will be not be lost. Local TV stations received calls to quit covering the quake and get back to broadcasting the “soaps.”

Two hospitals collapsed during the 1971 Sylmar quake killing 50 people. Two-thirds of California’s hospital buildings don’t comply with the current seismic safety code. When the coming “Big One” predicted as a “Big 8” arrives, will physicians and the health care industry be ready? Do our hospitals have earthquake insurance? Do we as physicians have earthquake insurance on our homes? Can you imagine paying for two mortgages for 15 to 30 years, one on a house in which you live and one on a house that you lived in previously on the same lot?

The National Cancer Institute has now changed its stance on mammograms, saying their benefits for women under age 50 are not documented and women should look at the facts and make up their own minds. (Is the government really recommending that patients should be involved in their own health care decisions?) Reminds me of Dr. Eugene Robin, Stanford Professor of Medicine and Physiology Emeritus, who wrote a weekly column, “Second Opinion,” in the SF Examiner. When he presented evidence in his column in February and March 1991 that mammograms below age 50 were not helpful and routine mammograms below age 40 was actually detrimental to the woman’s mammary health, his column was pulled on June 24, 1991. Now, it looks like he was ahead of his time. The public couldn’t accept something that was shaking its faith in medical technology.

When Dr. Robin testified in a Peer Review hearing in this town, a physician stated, “He was just an out-of-date old fogey.” The same physician also stated, “Can’t we decide that there is some blood gas where we would all agree that everyone should be intubated? Like a PO2 of 55?” Any respectable pulmonary practice will probably have 5% of its patients with a PO2 below 55, many refusing oxygen even into the 40s. Taking this physician literally, would we put these ambulatory patients on life support? How would they eat? How could they go to work or shopping or drive a car pulling a cart with a ventilator behind them?

Art Hoppe’s parody on Managed Care: When smoke wafted from his basement, he called the local fire station. When asked if he had called them before and had insurance, he said “no” and “yes, Sweetpea Mutual.” Then he got the response, “Oh, that’s an FMO–a Fire Maintenance Organization. I’m afraid we’re a fee-for-service engine company. Let me give you another number.” As the smoke was getting thicker, Hoppe complained he didn’t think he had time. “Well, perhaps we can help. Do you have a referral form from your primary fire care provider?”

Inflation is down to less than 3% this year. SF Chronicle reports that California State University campus presidents received salary increases of $9,000-$22,000. Meanwhile, student fees will increase by another 24%. Enrollment will decrease by 8%.

The University of California Regents, having completed the controversial hospital administrators salary increases, embarked on retroactive increases for other administrators and vice-chancellors, and approved a sabbatical leave worth $181,000 for departing UCD chancellor. The president of the University Professional and Technical Employees called this move “morally reprehensible and fiscally irresponsible.” The Regents raised undergraduate fees by $620, from $3727 to $4347, a 17% increase. In addition they imposed an additional fee of $2000 for the 9000 students attending UC’s professional schools in law, medicine, business, dentistry, and veterinary sciences. For the first time these fees for 163,000 students will officially be called “tuition.” It looks like everything that is or was “free” to the user, will eventually have costs that go out of control and exceed the taxpayers’ ability to pay.

SF Chronicle reports that liberal and conservative economists knock the Clinton Record for many different reasons. MIT’s Dornbush, who supported Clinton on most major issues, did not spare his biggest agenda item for 1994: his national health plan, with it’s emphasis on price controls and bureaucratic mandates instead of competition. He charged, “It’s recklessly expensive and murderously ineffective. It’s so far from good economics, it’s frightening.”

Gun-related deaths are approaching those from motor vehicles. Since hand guns are now registered, and there are 200 million weapons in this country, maybe we should combine the two and change the DMVs to DMVWs, Department of Motor Vehicles and (other dangerous) Weapons?

After 70 years of secret research on Lenin’s brain, dissection into thousands of slices, with extensive studies by the scientists of the Moscow Brain Institute, the director stated “In the anatomical structure of Lenin’s brain there is nothing sensational.” He also stated, “In Stalin’s brain, we didn’t find any special features at all.” Government control is certainly efficient in directing 70 years of research into such important endeavors. But we have our own subterfuge with the cold war radiation experiments by our own federal government, the one that a lot of people seem to trust, some even to manage their health care.

Larry Burkett, author of The Coming Economic Earthquake, was in town recently. He states the entitlement programs as they continue to expand send “tremors” into the economic world. It took 150 years to build up the first $1 trillion debt, only 8 years to get the second trillion, and now a trillion every three years. He points out that increasing taxes only brings in extra money the first year or two after which people, having less purchasing power, slow the economy and then decrease government income. All tax increases have to be coupled with spending decreases to be effective.

Burkett continues that with 70% of the budget being entitlements, and a move to increase the entitlements with the take over of the $800 billion health industry, we will feel more “tremors” until one day the government’s spending will exceed it’s economic ability to fund its deficit. Just as one can’t predict an earthquake, except the tremors remind us that it’s coming, he feels The Economic Earthquake will come in the next decade unless the government reduces spending across the board including entitlements which, he feels, Congress is unable to do. When Burkett polled people to see if they were willing to reduce their entitlements to assure their children of an equivalent lifestyle, they said no. They felt they had earned them.

The average American’s net worth decreased another $5000 to $36,000. The national debt per American has increased to over $15,000. Won’t be long before the inheritance we leave our children will be a debt instead of assets.

During the Northridge earthquake tragedy it was heartening to see the TV cameras pick up on the children in the tent cities playing and enjoying their “camping out.” Before long the parents were getting involved. Parents began meeting people that they lived near. Neighbors that never met were being neighborly and enjoying establishing new bonds of friendships. Every tragedy has a positive side.

Oh yes, just what did Senator Barbara Boxer mean when making a pitch for federal tax funds for quake relief when she declaimed, “California deserves a fair shake?”

Mr. Burkett’s books will never reach the masses probably because he ties in a call to religious re-awakening with his call for economic re-awakening. Even so there have been over a half million copies of this book sold. But as the Wall Street Journal stated in their review of his book, his statistics are valid. Burkett talks about the Economic QUAKE which he feels will bring about the biggest riots and crime wave we’ve ever experience. We can’t stop the big QUAKE. But will we be able to stop the more destructive economic earthquake? The current national dialogue on what’s happening to our patients is a good start. Let’s keep it going on behalf of those we serve.

Everybody wants to right the world; nobody wants to help his neighbor.  -Henry Miller

Doctors on the whole desire to cure the sick, and if they are good doctors, and this choice were fairly put to them–would rather cure their patients and lose their fee than to lose the patient and get their fee.  -John Ruskin

Did you know that lobbyists outnumber our Senators 74 to 1? -Boyd’s Grab Bag

Professionals least like to abandon their careers for other lines of work are doctors, lawyers, dentists, pharmacists, architects, engineers and physicists. Research suggests that bill collecting is most likely to be abandoned. One debt detective said, “I couldn’t make enough money, so quit when I was inadvertently assigned to go after myself.” -L.M.Boyd