Aug
5
The Doors Of Perception: Why Americans Will Believe Almost Anything
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by Dr. Tim O’Shea
We are the most conditioned, programmed beings the world has ever known. Not only are our thoughts and attitudes continually being shaped and molded; our very awareness of the whole design seems like it is being subtly and inexorably erased.
The doors of our perception are carefully and precisely regulated. Who cares, right?
It is an exhausting and endless task to keep explaining to people how most issues of conventional wisdom are scientifically implanted in the public consciousness by a thousand media clips per day. In an effort to save time, I would like to provide just a little background on the handling of information in this country.
Once the basic principles are illustrated about how our current system of media control arose historically, the reader might be more apt to question any given story in today’s news.
If everybody believes something, it’s probably wrong. We call that Conventional Wisdom.
In America, conventional wisdom that has mass acceptance is usually contrived: somebody paid for it. Examples:
* Pharmaceuticals restore health
* Vaccination brings immunity
* The cure for cancer is just around the corner
* When a child is sick, he needs immediate antibiotics
* When a child has a fever he needs Tylenol
* Hospitals are safe and clean.
* America has the best health care in the world.
* And many many more
This is a list of illusions, that have cost billions and billions to conjure up. Did you ever wonder why you never see the President speaking publicly unless he is reading? Or why most people in this country think generally the same about most of the above issues?
How This Set-Up Got Started
In Trust Us We’re Experts, Stauber and Rampton pull together some compelling data describing the science of creating public opinion in America.
They trace modern public influence back to the early part of the last century, highlighting the work of guys like Edward L. Bernays, the Father of Spin. From his own amazing chronicle Propaganda, we learn how Edward L. Bernays took the ideas of his famous uncle Sigmund Freud himself, and applied them to the emerging science of mass persuasion.
The only difference was that instead of using these principles to uncover hidden themes in the human unconscious, the way Freudian psychology does, Bernays used these same ideas to mask agendas and to create illusions that deceive and misrepresent, for marketing purposes.
The Father Of Spin
Bernays dominated the PR industry until the 1940s, and was a significant force for another 40 years after that. (Tye) During all that time, Bernays took on hundreds of diverse assignments to create a public perception about some idea or product. A few examples:
As a neophyte with the Committee on Public Information, one of Bernays’ first assignments was to help sell the First World War to the American public with the idea to “Make the World Safe for Democracy.” (Ewen)
A few years later, Bernays set up a stunt to popularize the notion of women smoking cigarettes. In organizing the 1929 Easter Parade in New York City, Bernays showed himself as a force to be reckoned with.
He organized the Torches of Liberty Brigade in which suffragettes marched in the parade smoking cigarettes as a mark of women’s liberation. Such publicity followed from that one event that from then on women have felt secure about destroying their own lungs in public, the same way that men have always done.
Bernays popularized the idea of bacon for breakfast.
Not one to turn down a challenge, he set up the advertising format along with the AMA that lasted for nearly 50 years proving that cigarettes are beneficial to health. Just look at ads in issues of Life or Time from the 40s and 50s.
Smoke And Mirrors
Bernay’s job was to reframe an issue; to create a desired image that would put a particular product or concept in a desirable light. Bernays described the public as a ‘herd that needed to be led.’ And this herdlike thinking makes people “susceptible to leadership.”
Bernays never deviated from his fundamental axiom to “control the masses without their knowing it.” The best PR happens with the people unaware that they are being manipulated.
Stauber describes Bernays’ rationale like this:
“the scientific manipulation of public opinion was necessary to overcome chaos and conflict in a democratic society.” Trust Us p 42
These early mass persuaders postured themselves as performing a moral service for humanity in general - democracy was too good for people; they needed to be told what to think, because they were incapable of rational thought by themselves. Here’s a paragraph from Bernays’ Propaganda:
“Those who manipulate the unseen mechanism of society constitute an invisible government which is the true ruling power of our country. We are governed, our minds molded, our tastes formed, our ideas suggested largely by men we have never heard of.
This is a logical result of the way in which our democratic society is organized. Vast numbers of human beings must cooperate in this manner if they are to live together as a smoothly functioning society.
In almost every act of our lives whether in the sphere of politics or business in our social conduct or our ethical thinking, we are dominated by the relatively small number of persons who understand the mental processes and social patterns of the masses. It is they who pull the wires that control the public mind.”
Here Comes The Money
Once the possibilities of applying Freudian psychology to mass media were glimpsed, Bernays soon had more corporate clients than he could handle. Global corporations fell all over themselves courting the new Image Makers. There were dozens of goods and services and ideas to be sold to a susceptible public. Over the years, these players have had the money to make their images happen. A few examples:
Philip Morris Pfizer Union Carbide
Allstate Monsanto Eli Lilly
tobacco industry Ciba Geigy lead industry
Coors DuPont Chlorox
Shell Oil Standard Oil Procter & Gamble
Boeing General Motors Dow Chemical
General Mills Goodyear
The Players
Though world-famous within the PR industry, the companies have names we don’t know, and for good reason.
The best PR goes unnoticed.
For decades they have created the opinions that most of us were raised with, on virtually any issue which has the remotest commercial value, including:
pharmaceutical drugs vaccines
medicine as a profession alternative medicine
fluoridation of city water chlorine
household cleaning products tobacco
dioxin global warming
leaded gasoline cancer research and treatment
pollution of the oceans forests and lumber
images of celebrities, including damage control crisis and disaster management
genetically modified foods aspartame
food additives; processed foods dental amalgams
Lesson #1
Bernays learned early on that the most effective way to create credibility for a product or an image was by “independent third-party” endorsement.
For example, if General Motors were to come out and say that global warming is a hoax thought up by some liberal tree-huggers, people would suspect GM’s motives, since GM’s fortune is made by selling automobiles.
If however some independent research institute with a very credible sounding name like the Global Climate Coalition comes out with a scientific report that says global warming is really a fiction, people begin to get confused and to have doubts about the original issue.
So that’s exactly what Bernays did. With a policy inspired by genius, he set up “more institutes and foundations than Rockefeller and Carnegie combined.” (Stauber p 45)
Quietly financed by the industries whose products were being evaluated, these “independent” research agencies would churn out “scientific” studies and press materials that could create any image their handlers wanted. Such front groups are given high-sounding names like:
Temperature Research Foundation Manhattan Institute
International Food Information Council Center for Produce Quality
Consumer Alert Tobacco Institute Research Council
The Advancement of Sound Science Coalition Cato Institute
Air Hygiene Foundation
American Council on Science and Health
Industrial Health Federation Global Climate Coalition
International Food Information Council Alliance for Better Foods
Sound pretty legit don’t they?
Canned News Releases
As Stauber explains, these organizations and hundreds of others like them are front groups whose sole mission is to advance the image of the global corporations who fund them, like those listed on page 2 above.
This is accomplished in part by an endless stream of ‘press releases’ announcing “breakthrough” research to every radio station and newspaper in the country. (Robbins) Many of these canned reports read like straight news, and indeed are purposely molded in the news format.
This saves journalists the trouble of researching the subjects on their own, especially on topics about which they know very little. Entire sections of the release or in the case of video news releases, the whole thing can be just lifted intact, with no editing, given the byline of the reporter or newspaper or TV station - and voilá;! Instant news - copy and paste. Written by corporate PR firms.
Does this really happen? Every single day, since the 1920s when the idea of the News Release was first invented by Ivy Lee. (Stauber, p 22) Sometimes as many as half the stories appearing in an issue of the Wall St. Journal are based solely on such PR press releases.. (22)
These types of stories are mixed right in with legitimately researched stories. Unless you have done the research yourself, you won’t be able to tell the difference.
The Language Of Spin
As 1920s spin pioneers like Ivy Lee and Edward Bernays gained more experience, they began to formulate rules and guidelines for creating public opinion. They learned quickly that mob psychology must focus on emotion, not facts. Since the mob is incapable of rational thought, motivation must be based not on logic but on presentation. Here are some of the axioms of the new science of PR:
*
technology is a religion unto itself
*
if people are incapable of rational thought, real democracy is dangerous
*
important decisions should be left to experts
*
when reframing issues, stay away from substance; create images
*
never state a clearly demonstrable lie
Words are very carefully chosen for their emotional impact. Here’s an example. A front group called the International Food Information Council handles the public’s natural aversion to genetically modified foods.
Trigger words are repeated all through the text. Now in the case of GM foods, the public is instinctively afraid of these experimental new creations which have suddenly popped up on our grocery shelves which are said to have DNA alterations. The IFIC wants to reassure the public of the safety of GM foods, so it avoids words like:
Frankenfoods Hitler biotech
chemical DNA experiments
manipulate money safety
scientists radiation roulette
gene-splicing gene gun random
Instead, good PR for GM foods contains words like:
hybrids natural order beauty
choice bounty cross-breeding
diversity earth farmer
organic wholesome
It’s basic Freudian/Tony Robbins word association. The fact that GM foods are not hybrids that have been subjected to the slow and careful scientific methods of real crossbreeding doesn’t really matter. This is pseudoscience, not science. Form is everything and substance just a passing myth. (Trevanian)
Who do you think funds the International Food Information Council? Take a wild guess. Right - Monsanto, DuPont, Frito-Lay, Coca Cola, Nutrasweet - those in a position to make fortunes from GM foods. (Stauber p 20)
Characteristics Of Good Propaganda
As the science of mass control evolved, PR firms developed further guidelines for effective copy. Here are some of the gems:
*
dehumanize the attacked party by labeling and name calling
*
speak in glittering generalities using emotionally positive words
*
when covering something up, don’t use plain English; stall for time; distract
*
get endorsements from celebrities, churches, sports figures, street people - anyone who has no expertise in the subject at hand
*
the ‘plain folks’ ruse: us billionaires are just like you
*
when minimizing outrage, don’t say anything memorable, point out the benefits of what just happened, and avoid moral issues
Keep this list. Start watching for these techniques. Not hard to find - look at today’s paper or tonight’s TV news. See what they’re doing; these guys are good!
Science For Hire
PR firms have become very sophisticated in the preparation of news releases. They have learned how to attach the names of famous scientists to research that those scientists have not even looked at. (Stauber, p 201)
This is a common occurrence. In this way the editors of newspapers and TV news shows are often not even aware that an individual release is a total PR fabrication. Or at least they have “deniability,” right?
Stauber tells the amazing story of how leaded gas came into the picture. In 1922, General Motors discovered that adding lead to gasoline gave cars more horsepower.
When there was some concern about safety, GM paid the Bureau of Mines to do some fake “testing” and publish spurious research that ‘proved’ that inhalation of lead was harmless. Enter Charles Kettering.
Founder of the world famous Sloan-Kettering Memorial Institute for medical research, Charles Kettering also happened to be an executive with General Motors.
By some strange coincidence, we soon have the Sloan Kettering institute issuing reports stating that lead occurs naturally in the body and that the body has a way of eliminating low level exposure.
Through its association with The Industrial Hygiene Foundation and PR giant Hill & Knowlton, Sloane Kettering opposed all anti-lead research for years. (Stauber p 92). Without organized scientific opposition, for the next 60 years more and more gasoline became leaded, until by the 1970s, 90% of our gasoline was leaded.
Finally it became too obvious to hide that lead was a major carcinogen, and leaded gas was phased out in the late 1980s. But during those 60 years, it is estimated that some 30 million tons of lead were released in vapor form onto American streets and highways. 30 million tons.
That is PR, my friends.
Junk Science
In 1993 a guy named Peter Huber wrote a new book and coined a new term. The book was Galileo’s Revenge and the term was junk science. Huber’s shallow thesis was that real science supports technology, industry, and progress.
Anything else was suddenly junk science. Not surprisingly, Stauber explains how Huber’s book was supported by the industry-backed Manhattan Institute.
Huber’s book was generally dismissed not only because it was so poorly written, but because it failed to realize one fact: true scientific research begins with no conclusions. Real scientists are seeking the truth because they do not yet know what the truth is.
True scientific method goes like this:
1. Form a hypothesis
2. Make predictions for that hypothesis
3. Test the predictions
4. Reject or revise the hypothesis based on the research findings
Boston University scientist Dr. David Ozonoff explains that ideas in science are themselves like “living organisms, that must be nourished, supported, and cultivated with resources for making them grow and flourish.” (Stauber p 205)
Great ideas that don’t get this financial support because the commercial angles are not immediately obvious - these ideas wither and die.
Another way you can often distinguish real science from phony is that real science points out flaws in its own research. Phony science pretends there were no flaws.
The Real Junk Science
Contrast this with modern PR and its constant pretensions to sound science. Corporate sponsored research, whether it’s in the area of drugs, GM foods, or chemistry begins with predetermined conclusions.
It is the job of the scientists then to prove that these conclusions are true, because of the economic upside that proof will bring to the industries paying for that research. This invidious approach to science has shifted the entire focus of research in America during the past 50 years, as any true scientist is likely to admit.
Stauber documents the increasing amount of corporate sponsorship of university research. (206) This has nothing to do with the pursuit of knowledge. Scientists lament that research has become just another commodity, something bought and sold. (Crossen)
The Two Main Targets Of “Sound Science”
It is shocking when Stauber shows how the vast majority of corporate PR today opposes any research that seeks to protect
* public health
* the environment
It’s a funny thing that most of the time when we see the phrase “junk science,” it is in a context of defending something that may threaten either the environment or our health.
This makes sense when one realizes that money changes hands only by selling the illusion of health and the illusion of environmental protection. True public health and real preservation of the earth’s environment have very low market value.
Stauber thinks it ironic that industry’s self-proclaimed debunkers of junk science are usually non-scientists themselves. (255) Here again they can do this because the issue is not science, but the creation of images.
The Language Of Attack
When PR firms attack legitimate environmental groups and alternative medicine people, they again use special words which will carry an emotional punch:
outraged sound science junk science sensible scaremongering responsible
phobia hoax alarmist hysteria
The next time you are reading a newspaper article about an environmental or health issue, note how the author shows bias by using the above terms. This is the result of very specialized training.
Another standard PR tactic is to use the rhetoric of the environmentalists themselves to defend a dangerous and untested product that poses an actual threat to the environment. This we see constantly in the PR smokescreen that surrounds genetically modified foods.
They talk about how GM foods are necessary to grow more food and to end world hunger, when the reality is that GM foods actually have lower yields per acre than natural crops. (Stauber p 173)
The grand design sort of comes into focus once you realize that almost all GM foods have been created by the sellers of herbicides and pesticides so that those plants can withstand greater amounts of herbicides and pesticides. (The Magic Bean)
Kill Your TV?
Hope this chapter has given you a hint to start reading newspaper and magazine articles a little differently, and perhaps start watching TV news shows with a slightly different attitude than you had before.
Always ask, what are they selling here, and who’s selling it? And if you actually follow up on Stauber & Rampton’s book and check out some of the other resources below, you might even glimpse the possibility of advancing your life one quantum simply by ceasing to subject your brain to mass media.
That’s right - no more newspapers, no more TV news, no more Time magazine or Newsweek. You could actually do that. Just think what you could do with the extra time alone.
Really feel like you need to “relax” or find out “what’s going on in the world” for a few hours every day? Think about the news of the past couple of years for a minute.
Do you really suppose the major stories that have dominated headlines and TV news have been “what is going on in the world?” Do you actually think there’s been nothing going on besides the contrived tech slump, the contrived power shortages, the re-filtered accounts of foreign violence and disaster, and all the other non-stories that the puppeteers dangle before us every day?
What about when they get a big one, like with OJ or Monica Lewinsky or the Oklahoma city bombing? Do we really need to know all that detail, day after day? Do we have any way of verifying all that detail, even if we wanted to? What is the purpose of news?
To inform the public? Hardly. The sole purpose of news is to keep the public in a state of fear and uncertainty so that they’ll watch again tomorrow and be subjected to the same advertising.
Oversimplification? Of course. That’s the mark of mass media mastery - simplicity. The invisible hand. Like Edward Bernays said, the people must be controlled without them knowing it.
Consider this: what was really going on in the world all that time they were distracting us with all that stupid vexatious daily smokescreen? Fear and uncertainty — that’s what keeps people coming back for more.
If this seems like a radical outlook, let’s take it one step further:
What would you lose from your life if you stopped watching TV and stopped reading newspapers altogether?
Would your life really suffer any financial, moral, intellectual or academic loss from such a decision?
Do you really need to have your family continually absorbing the illiterate, amoral, phony, uncultivated, desperately brainless values of the people featured in the average nightly TV program? Are these fake, programmed robots “normal”?
Do you need to have your life values constantly spoon-fed to you?
Are those shows really amusing, or just a necessary distraction to keep you from looking at reality, or trying to figure things out yourself by doing a little independent reading?
Name one example of how your life is improved by watching TV news and reading the evening paper.
What measurable gain is there for you?
Planet of the Apes?
There’s no question that as a nation, we’re getting dumber year by year. Look at the presidents we’ve been choosing lately. Ever notice the blatant grammar mistakes so ubiquitous in today’s advertising and billboards?
Literacy is marginal in most American secondary schools. Three fourths of California high school seniors can’t read well enough to pass their exit exams. (SJ Mercury 20 Jul 01)
If you think other parts of the country are smarter, try this one: hand any high school senior a book by Dumas or Jane Austen, and ask them to open to any random page and just read one paragraph out loud. Go ahead, do it. SAT scales are arbitrarily shifted lower and lower to disguise how dumb kids are getting year by year.
At least 10% have documented “learning disabilities,” which are reinforced and rewarded by special treatment and special drugs. Ever hear of anyone failing a grade any more?
Or observe the intellectual level of the average movie which these days may only last one or two weeks in the theatres, especially if it has insufficient explosions, chase scenes, silicone, fake martial arts, and cretinesque dialogue.
Radio? Consider the low mental qualifications of the falsely animated corporate simians they hire as DJs — they’re only allowed to have 50 thoughts, which they just repeat at random.
And at what point did popular music cease to require the study of any musical instrument or theory whatsoever, not to mention lyric? Perhaps we just don’t understand this emerging art form, right? The Darwinism of MTV - apes descended from man.
Ever notice how most articles in any of the glossy magazines sound like they were all written by the same guy? And this guy just graduated from junior college? And yet he has all the correct opinions on social issues, no original ideas, and that shallow, smug, homogenized corporate omniscience, which enables him to assure us that everything is going to be fine…
All this is great news for the PR industry - makes their job that much easier. Not only are very few paying attention to the process of conditioning; fewer are capable of understanding it even if somebody explained it to them.
Tea In the Cafeteria
Let’s say you’re in a crowded cafeteria, and you buy a cup of tea. And as you’re about to sit down you see your friend way across the room. So you put the tea down and walk across the room and talk to your friend for a few minutes.
Now, coming back to your tea, are you just going to pick it up and drink it? Remember, this is a crowded place and you’ve just left your tea unattended for several minutes. You’ve given anybody in that room access to your tea.
Why should your mind be any different? Turning on the TV, or uncritically absorbing mass publications every day - these activities allow access to our minds by “just anyone” - anyone who has an agenda, anyone with the resources to create a public image via popular media.
As we’ve seen above, just because we read something or see something on TV doesn’t mean it’s true or worth knowing. So the idea here is, like the tea, the mind is also worth guarding, worth limiting access to it.
This is the only life we get. Time is our total capital. Why waste it allowing our potential, our personality, our values to be shaped, crafted, and limited according to the whims of the mass panderers?
There are many important issues that are crucial to our physical, mental, and spiritual well-being. If it’s an issue where money is involved, objective data won’t be so easy to obtain. Remember, if everybody knows something, that image has been bought and paid for.
Real knowledge takes a little effort, a little excavation down at least one level below what “everybody knows.”
References
Stauber & Rampton, “Trust Us, We’re Experts”, Tarcher/Putnam 2001
Ewen, Stuart PR!: A Social History of Spin 1996 ISBN: 0-465-06168-0 Published by Basic Books, A Division of Harper Collins
Tye, Larry The Father of Spin: Edward L. Bernays and the Birth of Public Relations Crown Publishers, Inc. 2001
King, R Medical journals rarely disclose researchers’ ties Wall St. Journal, 2 Feb 99.
Engler, R et al. Misrepresentation and Responsibility in Medical Research New England Journal of Medicine v 317 p 1383 26 Nov 1987
Black, D PhD Health At the Crossroads Tapestry 1988. revanian Shibumi 1983.
Crossen, C Tainted Truth: The Manipulation of Fact in America 1996.
Robbins, J Reclaiming Our Health Kramer 1996.
O’Shea T The Magic Bean 2000.
Inhibitory effect of conjugated dienoic derivatives of linoleic acid and beta-carotene on the in vitro growth of human cancer cells CANCER LETT. (Ireland) , 1992, 63/2 (125-133)
Inhibition of Listeria monocytogenes by fatty acids and monoglycerides APPL. ENVIRON. MICROBIOL. (USA) , 1992, 58/2 (624-629)
Jun
30
JAMA study rocks hospital RFID users
Filed Under Health IT, Hospitals | Leave a Comment
A new study published last week in the Journal of the American Medical Association is rocking the hospital world–which has begun to adopt RFID for a wide range of device and patient-tracking functions–by suggesting that such tagging can wreak havoc with critical-care equipment. Researchers in Amsterdam concluded that electromagnetic interference from RFID systems could cause unintended changes in equipment functioning. Researchers detected such changes in 34 out of 123 tests of 41 different medical devices. Of those 34 incidents, 22 were “hazardous,” including total switch-offs and restarts of mechanical ventilators, complete stopping of syringe pumps and renal replacement devices and interruption of external pacemakers. In conducting the tests, researchers randomly used both passive and active RFID systems. Oddly enough, it was the passive tags, which don’t have internal power and must be activated by readers that led to 63 percent of total incidents and 41 percent of the hazardous events. Active tags, which include battery power and don’t require activation, don’t seem to be as likely to affect other systems, researchers found.
Jun
30
AT&T, Covisint and Microsoft plan to expand health network nationwide
Filed Under Health IT | Leave a Comment
AT&T, Microsoft and Compuware subsidiary Covisint have announced plans to create a nationwide health information exchange which expands on a smaller network already in place state-wide in Tennessee. In Tennessee, the MidSouth eHealth Alliance and the Governor’s eHealth Council had already been running an electronic health network for doctors across the state, running on Covisint’s On-Demand Healthcare Platform.
The broader eHealth network will use Covisint’s platform and run over AT&T’s MPLS network. The new network will give consumers access to records based on Microsoft’s HealthVault PHR technology, while giving them the ability to share that information with all providers who connect to AT&T’s Healthcare Community Online. The Healthcare Community Online is a virtual private networking-based portal which allows electronic health data exchange between existing systems used by providers and physicians, including large files such as X-ray images, MRIs and CT scans. The AT&T network allows doctors, hospitals, labs, pharmacies and patients to access test results, prescription records and medical histories. It also offers physicians the ability to use e-prescribing functions.
What’s interesting here is that the parties involved don’t mention what their services will cost, or even what pricing model they’ll use (a connectivity charge, a flat fee, a fee per transaction, some other option?). I wonder if this model will be any more affordable than the costly, largely unsustainable RHIOs/HIEs not-for-profit groups and governments have attempted to bring together.
Jun
30
Private vendors may be the HIE solution
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I’m very skeptical that non-profit healthcare information exchanges or RHIOs can sustain themselves. In fact, I’ve argued vigorously that such entities are unlikely to keep their doors open, given that no one seems to have found a financial model that works for everyone involved. Neither government projects, not-for-profits nor partnerships between the two seem to have what it takes to create workable HIE businesses.
But now, looking one item in today’s newsletter, I find myself wondering if I’ve been missing the obvious. The story, which describes how AT&T, Microsoft and Compuware subsidiary Covisint are building out a national health information exchange, reminded me that private vendors may have compelling reasons of their own to build out HIEs. And it makes sense that they should quarterback such a large network-development effort.
If you look back in history, after all, few industries have been able to spontaneously create networks of their own. The automobile and retail industry, for example, put an electronic data exchanges in place many years ago, but they relied on value-added network vendors to do much of the data carriage and establish connectivity.
And even with their VAN taken care of, those retailers and automakers took a while to get rolling, though they had much better business cases for data sharing. After all, industry officials had clear-cut supply-chain savings they could demonstrate from building out new networks–or in the case of retailers, increased sales through just-in-time distribution of hot products.
Healthcare officials, on the other hand, aren’t going to jump-start HIE efforts easily by attempting to make a financial case for them. While everyone’s pretty sure that outcomes can be improved by better access to patient medical records, it’s just not that easy to pin down HIEs’ dollars-and-cents benefits over the short term.
Now, it’s possible that AT&T, Microsoft and Covisint’s services will be too pricey for some providers (perhaps even most). However, even if big players like these don’t end up being the commercial entities leading the private HIE development industry, I’m confident some vendors in the networking and enterprise software space will find a way to deliver up such networks at a price point and on a basis that makes sense. Why am I so sure? Because there’s just too much money to be made on hooking up health data exchanges if the right solution comes along.
Don’t get me wrong, I know there are plenty of issues that can come up with an ad-hoc network of private HIEs. Questions of who owns the data, how one network connects to another and how providers switch if they’re not pleased with their current HIE are just the tip of the iceberg. But that being said, if this is an instance in which private commercial interests can move more quickly than non-profits, I say, “More power to them.” Perhaps profit-driven vendors, at long last, can get this job done.
Jun
30
US could face shortage of 44,000 primary care physicians by 2025
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MU researcher calls for incentives to increase numbers of primary care practitioners
COLUMBIA, Mo.- By 2025, the wait to see a doctor could get a lot longer if the current number of students training to be primary care physicians doesn’t increase soon, according to a new University of Missouri study. Jack Colwill, professor emeritus of family and community medicine in the MU School of Medicine, and his research team found that the U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years, due to a skewed compensation system that rewards specialists increasingly more than primary care practitioners. The researchers are more optimistic about the future supply of general pediatricians.
Today, generalist physicians are a third of the U.S. physician workforce and are responsible for more than half of all patient visits at doctors’ offices.
“Concern about the supply of generalists is not new,” said Colwill, who also is a member of the National Academy of Sciences Institute of Medicine. “It has been with us since the 1960s and was gradually improving. However, during the past decade, the number of generalist graduates has fallen by 22 percent and declines continue as medical school graduates enter other specialties. At the same time, the U.S. population is increasing by about one percent each year, and the baby boomer generation will significantly increase the number of Americans older than 65 by 2025.
In the study, which was published in a recent edition of Health Affairs, Colwill and co-researchers, James Cultice from the U.S. Health Resources and Services Administration and Robin Kruse from the University of Missouri, used data from the National Ambulatory Medical Care Survey to estimate the future demand for generalist care. The Census Bureau predicts that the number of adults will increase 21 percent by 2025, and the number of Americans older than 65 will rise by 73 percent.
Typically, older adults seek care from generalists nearly three times each year, double the rate of adults younger than 65. Because of this, Colwill and his researchers expect the number of doctor visits to increase by 29 percent by 2025. At the same time, they project that the supply of general internists and family physicians will increase less than 5 percent.
“As patient numbers rise, these practitioners will be doing more ‘urgent care’ and will have less time for preventive services, coordinating care with other specialists, and getting to the depth of their patients’ problems,” Colwill said. “This will increase the load on other, already overloaded specialists and lead to even more referrals and increased costs of care. We need to change the incentives by making primary care practice more manageable and income comparable with that in other specialties.”
Colwill strongly endorsed development of new models of primary care called “medical homes” where teams of physicians, nurse practitioners, physician assistants and others provide comprehensive primary care services that also focus on management of patients with chronic illnesses. These models promote more access through expanded hours and use of telephone, e-mail and electronic medical records. If appropriately reimbursed, these models should increase quality, reduce overall costs and improve both patient and physician satisfaction.
“At the same time, numbers of graduates must be increased,” Colwill said. “Students’ interest in generalist careers can be enhanced if medical schools renew their commitment to the education of generalists as they have done earlier. Further, incentives such as forgiveness of loans for primary care practice would tip the scales for many medical students and residents as they select a specialty and type of practice.”
The Association of American Medical Colleges recommends that medical schools increase their enrollment by 30 percent, but have not indicated specific specialty areas for the increase. Colwill said this enrollment increase could result in more specialists, but little increase in primary care physicians if the incentive for becoming generalists is not examined soon.
Jun
30
Private insurers in PA fight mandated coverage for autism
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Thirteen states require private insurers to cover mandated autism treatments. Pennsylvania is poised to be the fourteenth to offer such coverage. Today the state’s private insurers denied coverage for autism treatments, including speech therapy and applied behavioral analysis. The carriers claim that such treatments lack measurable achievements and that a state mandate would increase insurance costs for every customer, even those without autistic children, by as much as 6 percent, and cause budget problems for businesses that employ 50 or fewer people. However, according to a report published earlier this year by the Pennsylvania Cost Containment Council, the average monthly cost to consumers with private insurance–should an autism insurance mandate become law–would be $1 per month.
The state’s House of Representatives recently passed legislation that would require private carriers to cover treatment for autism, and the bill awaits a Senate vote.
Jun
30
Philanthropy challenges nursing homes to improve facilities
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The Robert Wood Johnson Foundation says it wants to shutter America’s nursing homes in order to save them. The foundation has already started to fund the construction of Green Houses, small environmentally friendly homes that store 10 to 12 seniors currently living in large, more conventional nursing facilities.
The philanthropy, spurred in 2003 by a grant proposal presented by Dr. Bill Thomas, will build these new alternatives to conventional nursing homes in all 50 states. So far, RWJF grantees have erected 41 houses in 10 states. Although a modest number of seniors have moved out of their old nursing homes, if the foundation has its way, all 16,000 of the nation’s conventional senior facilities will be replaced. The American Health Care Association, a lobby that represents the $122 billion nursing home industry, believes the foundations criticism of conventional nursing homes is overly harsh and claims that providers are making an effort to improve their facilities. RWJF has delegated management of the Green House projects to NCB Capital Impact, a Washington, D.C.-based not-for-profit that has been offering help in consulting, education, architecture and other areas, to organizations interested in establishing and operating the new homes.
Jun
30
Carriers and patients are at odds over what treatments and procedures are medically appropriate, and why access is denied in some cases and not in others. Patients in California are finding themselves in the precarious position of having to fight for access to services they assumed were covered. The state has established patient and consumer advocacy services to address the growing problem. Last year, the state’s HMO Help Center received nearly 90,000 calls from consumers asking for help in resolving their health plan woes. About 7,000 Californians have taken advantage of third-party medical reviews since 2001, when the state Department of Managed Health Care started offering them. Last year, the department resolved 1,716 independent medical review, or IMR, cases. The Department of Insurance, which regulates a smaller number of plans, received 35,280 complaints and resolved 262 IMRs in 2007.
Jun
30
While some communities wonder if they can afford to build just one proton beam cancer center, providers have proposed roughly five such centers in Michigan. Final rulings on state certificate of need applications later this year will determine just how many centers may be approved.
Two rival providers–William Beaumont Hospitals and a cancer treatment consortium established by the University of Michigan–originally planned to jointly fund a single center and applied for a certificate of need to get state approval of the plan. Last week, Michigan Governor Jennifer Granholm changed all that when she vetoed the now former partners’ Certificate of Need application that had already won approval from the Michigan CON Commission. In her veto letter to the commission, Granholm stated that a single collaborative approach could violate antitrust laws under the federal Sherman Act and that the U.S. Department of Justice had raised similar concerns.
Each of the former partners plans to re-apply for a separate certificate of need approval. In fact, Beaumont Hospitals has already re-applied, having teamed with Indiana-based ProCure Treatment Centers to build its new for-profit proton beam cancer center. The University of Michigan Health Center’s proton beam consortium has only filed a letter of intent, and plans to make a presentation to the state to make its case for the center in early September. The state is expected to rule on the Beaumont application by July 1. Other providers have also submitted applications that the state is expected to rule on by the end of July and the end of September.
State business and labor leaders worry that two or more multi-million dollar cancer treatment centers could drive up health care costs for employers and individuals. Many oncologists, cancer centers, carriers and policymakers around the country also are evaluating the pros and cons of making such high-ticket investments. Proton beam therapy is a relatively new alternative to aggressive cancer treatments such as chemotherapy and more established uses of radiation. Each facility can cost as much as $200 million.
Jun
30
A new patient safety bill signed into law yesterday by New York Governor David Paterson will require that the names of doctors charged with misconduct be made public. Infection control was a key piece of the bill because of the case of Dr. Harvey Finkelstein, a doctor whose failure to follow infection control procedures exposed a number of his patients to hepatitis C.
Finkelstein, a pain-management doctor who treated patients from his Plainview office, infected at least one patient with hepatitis C by reusing syringes in multi-dose vials. More than 10,000 patients were eventually notified of possible exposure to tainted syringes. The bill allows the names of doctors formally charged by the state’s Board of Medical Professional Conduct to be made public if the three-person panel–two doctors and a lay member–vote to do so unanimously.