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Medical Propaganda Films

David Gorski suggested I expand on a comment I left recently on one of his November posts. His subject was the then new documentary movie, “A Beautiful Truth.“ “Truth” is about the Gerson method – the dietary deprivation cum coffee enema cancer treatment developed by Dr. Max Gerson, a refugeee from Germany I the 1930s. His daughter, Charlotte now runs the Gerson Institute in Tijuana, Mexico. Gerson is one of the models for the Gonzales method recently reviewed by Kim Atwood.

I had previously referred to the movie in a prior post (1) (but in a different context. Here I’ll explore the movie from a different angle – with its partners, propaganda documentaries.

David called my attention to “Truth” plus another by the same producer – with trailers on You Tube. When I watched the trailers last year I saw myself interviewed briefly, but could not recall being filmed, or even identify where the scene took place. I had to email Steve Barrett, also in the movie, who reminded me about filmmaker Steve Kroschel’s visits 2-3 years before, although neither did he have strong memory of the interview.

I slowly began to recall. Kroschel had called for an interview saying he had previously made a movie about Gerson but felt he should make more objective one, presenting “both sides.“ He pitched himself as having been misled in making the first one. He spoke and asked as though he was being critical of Gerson. After he left I did not think about it again.

Before critiquing such documentaries, some words about the Gerson method. According to the American Cancer Society’s “Unproven Methods” pamphlet, the Gerson regimen, includes eating large amounts of fruits and vegetables, limiting fat and meat; consuming only fresh, raw juices prepared in a special way, eliminating salt, and “detoxifying” the liver through coffee enemas, and taking injected liver extracts. (2)

Saul Green also wrote a definitive description of coffee enemas and the Gerson method (Green S. A critique of the rationale for cancer treatment with coffee enemas and diet.(3) JAMA. 1992;268:3224-3227.)

Other components of the Gerson regimen, include consuming only fresh, raw juices prepared in a special way, eliminating salt. and “detoxifying” the liver through coffee enemas and injected liver extracts. Years earlier, Eisele reported in JAMA deaths from potassium deficiency induced by frequent coffee enemas. (4) Other complications include colon perforation and ulceration.

A sad and poignant small book about Gerson’s method is “Death be Not Proud” by former (and late) writer, John Gunther. His young son had a brain tumor and was sent to Gerson where for his last months on earth he submitted to the dietary torture that is Gerson‘s method. It’s a trying read.

As for efficacy, G. Hildenbrand, the Gerson publicist for years, his son, and a statistician reported prolonged survival of a group of melanoma patients treated by Gerson as a “nested” group – of their patients, in this case, a group selected from within a larger group, retrospective and without concurrent control.(5) Other reports of success have been single testimonials, or studies invalidated by large dropout rates, lack of controls, and other deficits.

When I viewed the “Truth” trailer I concluded the film was a push piece advertisement for Gerson, and as my memory re-formed, I concluded I had been had. The film had been edited – a lot. I had said more things than shown, and probably so had Steve and Dean. Edell (who also had been interviewed and had not recalled Kroschel when I emailed him.)

Kroschel did not mention to me he was also interviewing Barrett and Edell. Want to ask why?

The lesson is that we have been shown an edited propaganda film made by a probable contract advertiser, likely financed by the Gerson Clinic itself or a support organization, who presented false or incomplete credentials and misrepresented his approach.

This is even more important: We do not know the whole stories of any of the patients. The patient testimonials were filmed and the records “shown” to the camera, but were not shown to us, the critical docs. Why were our opinions not requested?

Kroschel made no reference to any specific case to me, although he already knew of cases, used in the prior film or a prior one. The trailers present the sequences of us first and then the interviews, making it seem that the cases are evidence in opposition to our statements. The order should have been reversed.

Moreover, the film does not mention what if any, other standard treatments the patients had received. So I reviewed the trailer again for statements of other treatments or denial of them.

Kroschel selects two cases “at random.” I do not believe that. If the clinic had so many successes, they could have written them up and presented the report to a scientific forum or journal like the rest of us do. They have not done so. Those were probably setup – selected cases. Selected from a group of 100? Out of thousands of people who have gone there, dating to before WW II?

Second, Gerson Clinic is not a primary care institution – people go there for a few weeks at most, return home and records there are not complete. They often do not know what other treatments the people get. Now for the two patients shown .

The first woman with melanoma. The diagnosis was apparently confirmed by biopsy. Good. But melanoma is one of the 4-5 most common tumors that regress “spontaneously“. This single episode is credible, but cannot be used as a proof of Gerson effectiveness.

The second, a man with testis cancer, referred to receiving chemotherapy. Chemotherapy is 90 percent effective in producing complete remissions, and about 80 percent of those are considered cures. As for the doc’s surprise, I also usually showed surprise and enthusiasm when a person had a good response. People often considered their responses as “miraculous” or a least special – an assumption I did not discourage.

The third, the Japanese professor, relates an ultrasound as the evidence for the colon cancer metastases. In absence of a biopsy proof, we do not know what the ultrasound finding really was.

So I cannot believe that all three had the respective cancers and had complete responses to the diet and coffee enemas. I do not know what evidence was withheld. And why was a third film made or recreated out of material made for the second one? Were the cases collected since the “Beautiful Truth” film was made? Why not call us back to review the cases? Kroschel considers himself the arbiter of what constitutes review, evidence, and the validity of his own inexpert conclusions. Kroschel’s principles for validity- replication, confirmation, and publication – some sort of journalistic scale of things. Replication was apparently the presence of three cases; confirmation was apparently done by interviewing the patients, and publication – the making of a promotional film. The viewers are supposed to accept that as proof.

Promotional documentaries misrepresenting pseudo-scientific subjects and quacks have become a neat route to public opinion molding. David Gorski in his post took on “Expelled”, with Ben Stein, the pop economist turned education expert who promotes the concept of equal time for Intelligent Design with Evolution in the public education science classroom. Makes me wonder if in fairness, the ID people would allow biology teachers to show one of the excellent films on evolution after every sermon in fundamentalist churches. Stein’s motive seems to be intellectual freedom in education, but in expressing it, how come he has to render Evolution a smack aside the head? Well, that seems to go along with quack claims doesn’t it? Demeaning of what we know to be valid is a convenient and apparently powerful tool.

In 1988 a main attraction was “Hoxsey: Quacks Who Cure Cancer?“ It is a classic promotional piece for a quack. Hoxsey’s history and battles with the FDA and the AMA’s Morris Fishbein spanned three decades, as Hoxsey’s fortunes went from clinics in 27 states to his ignominious end in a storefront clinic in Tijuana and his own death from cancer. But not before he had won a defamation suit against Dr. Fishbein and was awarded $1 for his trouble and reputation. Incidentally, Hoxsey’s cure was a mix of herbs and common backyard weeds.

“Quacks” was not just a retro on an interesting pseudosci – folk hero episode in American history. The film concentrated on the presumed greed and power of the medical-pharmaceutical industry, and the evils of the FDA, all presented as a conspiracy against the public. Reviewers (Vincent Canby) from the NY Times (http://movies.nytimes.com/movie/review?_r=1&res=940DE5DD153BF930A35751C0A96E948260) to the SF Chronicle were moved enough by the movie to accept its content as accurate, and to give favorable reviews. “Quacks” was a political propaganda piece with a heavy ideological agenda, evident to us, but which took in the unknowledgeable.

“Quacks‘s” release was hyped over national news networks (I have a tape of the NPR segment) and was timed to coincide with the launching of the Office of Technoogy Assessment’s investigation of “Unorthodox Cancer Treatments” ordered by Congressman Molinari (D, New Jersey,) whose chief of staff was also an employee of the Lawrence Burton “Immuno-augmentive therapy” in the Bahamas – where Burton set up shop after being successfully prosecuted in New York. This clinic was found to be infusing plasma contaminated with HBV and HIV. Molinari’s abuse of office in ordering an investigation of off-beat quack cancer claims was the precedent for Senator Harkin’s (D, Iowa) equally offensive surge into “CAM“ resulting in the NCCAM and our present history in the making. The film was also the center for a rally on the steps of the Capitol.

And no collection would be complete without a mention of “Sicko!” by film propagandist Michael Moore. Lots of people got taken in by his driveling and drooling hailing to the chief medical system of Castro’s Cuba. Sicko won Moore a special Oscar and an award at Cannes. Sicko was exposed as an edited, biased promotion for a revolution in the medical and health system in the US, and yet another out-of-court indictment and conviction of the evils of physicians and the US medical system.

I saw “Quacks”, and still have a tape of it. I have not seen “Sicko“ or “Truth” or its one or two predecessors, nor, like David, do I plan to cross Kroschel’s palms with as much as two cents for it. So I can be criticized for critiquing films I have not seen, right? OK, but I’m satisfied that I’ve seen enough of “Truth” to suspect it contains nothing that would warm my heart or brain.

1. http://www.sciencebasedmedicine.org/?p=352#more-352)

2. http://www.cancer.org/docroot/ETO/content/ETO_5_3X_Gerson_Therapy.asp?sitearea=ETO.

3. Green S Cancer treated with Diet and Coffee Enemas. JAMA 1992

4.) (Deaths related to coffee enemas. Eisele JW, Reay DT. JAMA. 1980 Oct 3;244(14):1608-9.

5. (Hildenbrand GL, Hildenbrand LC, Bradford K, Cavin SW. Five-year survival rates of melanoma patients treated by diet therapy after the manner of Gerson: a retrospective review. Altern Ther Health Med. 1995;1:29-37. )

Posted in: Cancer, Clinical Trials, Energy Medicine, General, Health Fraud, Herbs & Supplements, Nutrition, Science and Medicine, Science and the Media

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24 thoughts on “Medical Propaganda Films

  1. Eric Jackson says:

    I recall an investigation of a Hoxsey clinic, where a large number of the patients they treated had never actually had cancer. No biopsies, bloodwork done, not a shred of actual diagnostic cancer. And the ones who actually did have verified cancer? Well. They were all dead. From cancer, or dying. (http://www.quackwatch.org/01QuackeryRelatedTopics/OTA/ota04.html)

    Apparently the clinic was in the practice of simply telling whoever that came in that they had cancer: http://select.nytimes.com/gst/abstract.html?res=F20C17FF3455177B93C0A8178BD95F428585F9 (NYTimes archives)

    As an aside, what is it with this utter fixation on the bowels as the source of all human ailments?

  2. djsampson says:

    Good post… Dad.

    I did a quick search and found an interview where the writer/director implies he did this on his own, so not backed by Gerson or anyone, which seems credible.

    Oh, he also says Sarah Palin’s drinking Diet Dr. Pepper made her dumber. So he’s not all bad.

    http://www.nycmovieguru.com/stevekroschel.html

  3. David Gorski says:

    Jumpin’ Jesus on a pogo stick! Get a load of this quote by Kroschel:

    Firefly Productions in the UK is making a $40 million movie [about it]. They want Daniel Craig to play Dr. Max Gerson, they’re approaching Rachel Weisz to play Charlotte Gerson and they’re pushing Ron Howard to direct it. The production company is so afraid that they’re going to be accused of bias by contacting the Gerson family or giving us a single penny. The Gerson family has warned them that they are in for quite the ride if they tackle this movie.

    I’m guessing he’s not making much progress. Let’s hope it stays that way.

  4. Noadi says:

    This type of quack always starts out with some sensible advice and then trails off into crazy land. Lots of fruits and vegetables: good, limit meat consumption: good, special juice, coffee enemas, and liver injections: insane, not seeking proper medical treatment for cancer: suicidal insanity.

  5. tmac57 says:

    Erik Jackson-”As an aside, what is it with this utter fixation on the bowels as the source of all human ailments?”
    Ailments…alimentary….. hmmmm.

  6. dcardani says:

    Dr. Sampson – thanks for the update! I had a feeling that they had pulled the same kind of shenanigans as the Expelled people.

  7. clipedwingangel says:

    First off, you should honestly see Sicko so that you can correct the maligning you’ve just committed. It is NOT a propaganda film but a serious indictment of the disastrous insurance scams this country has allowed to exist.

    I say this with complete knowledge of how this scam exists since I participated in Sicko’s Cuban segment and HAVE to live with a death sentence made worse by the money greedy system we have in the US.

    Since you are obviously brain impaired and clearly prefer to malign with your acid tongue rather than engage in true fact finding, let me fill you in.

    On 9/11 many responders, over 70,000 in the course of the entire rescue operation which ended on May 17, 2002, I became contaminated. I have pulmonary fibrosis now, which is a death sentence.

    I had a job but could not afford the cobra benefits. Feeding my 2 children and housing them was a priority.

    I ask you, what gives you the right to sentence me and others to death because you dont believe we are entitled to access to health care for my condition. Remember, it came about from rescue others, as a volunteer emergency medical technician.

    So before you continue to say that its a propaganda film, when all it promotes is Universal Health Care, go watch it. When you are done, send a check to FealGoodFoundation to help purchase medication for a dying responder.

    In the mean time, grow a heart!
    The next life I save might be yours.

    Reggie Cervantes
    ClipedWingAngel@yahoo.com
    WTC Survivor Rescue Worker
    Sicko

  8. mandydax says:

    It may be a sad truth about scientists being interviewed that they should insist on their own full recording of the interviews they give, along with copying credentials, etc. It’s not paranoia if there are people out there presenting false documents and presenting themselves as pro-science when they are actually propagandists. :(

  9. Harriet Hall says:

    I saw Sicko. It made some excellent points about how people who had health insurance could still end up bankrupt and about other failures of the American insurance system, but it was so obviously biased and polemical that it undermined its own message. It was a terrible propaganda film.

  10. weing says:

    I didn’t see Sicko. I stopped watching propaganda films as soon as I was no longer forced to. A death sentence is not any better in a socialist system.

  11. David Gorski says:

    I saw Sicko. It made some excellent points about how people who had health insurance could still end up bankrupt and about other failures of the American insurance system, but it was so obviously biased and polemical that it undermined its own message. It was a terrible propaganda film.

    It sounds a lot like Bowling for Columbine, which also made some good points about gun violence and easy access to guns in this country but undermined its message with its bias and polemics.

    Of course, propaganda films are what Michael Moore does. He is not in any way an objective documentarian or even a documentarian with a point of view but some room for a fair airing of opposing views. Farenheit 9/11 was good evidence of that. What Moore is a master of is cherry picking facts and presenting them in a highly biased, selective manner in order to make his point. Then he defends himself by challenging critics to prove any of his facts wrong, which they usually can’t because it’s not the individual facts presented that are false or deceptive. Rather, it’s what facts are left out and how the facts that arepresented are woven together deceptively.

  12. hatch_xanadu says:

    Noadi: Quite right. And in promoting the methods to the general public, they put the emphasis on the fruits and vegetables and sort of gloss over the crazy stuff. And when challenged they say things like “Why, what’s so wrong about fruits and vegetables? Your doctor just wants to pump you full of dangerous chemicals . . . we treat the *whole person* with a balanced diet and a healthy lifestyle! We promote wellness!”

  13. Diane says:

    I submit that “Sicko” (which I’ve seen) does not belong in the same category as the rest. It is politically propagandist, and pro-public health care, but is not anti-science. It is not strictly anti-medical propaganda, therefore.
    It appears to me that you may have committed a category error, by creating (then conflating “Sicko” into) a new and less meaningful category, Medical Propaganda Films.

  14. Wallace Sampson says:

    Eric Jackson: Thanks. The bowel fascination dates back at least to Kellogg and his 19th/20th century theory of the bowel site of putrefaction, mostly from animal products, requiring vetation diet, cleansing enemas and all that (P.J O’Rourke’s novel and the movie, Road to Wellville were based on that history. It may date back further to beginnings of Naturopathy here as outlined by Kim Atwood, and before that?

    DJSampson : Kroschel “did this on his own.” Closely examine his wording – no implying, no inferring
    allowed. He was not asked and he did not say whether he received advances to cover his expenses as is usually the case, and if so, from whom or what. A reclusive Alaskan living in a rural log cabin funds his own travels across the US, employs a cameraman and probably others, presumably on his own funds. . Again, one has to “see” what is not openly revealed.
    I recommend readers look at your link http://www.nycmovieguru.com/stevekroschel.html . He already
    misrepresented himself to us and repeats it in the interview, attempts to see officials of Monsanto and other corporations to do “a balanced film.” They were smarter than we.
    Several of his answers reveal he is an environmental extremist who sees poisons in the soil and natural cures by quacks and a right wing nut with AMA/FDA/Pharma/chemical industry conspiracy ideation. So thanks for the link – verrry interesting. If he denies support by Gerson, there is a bridge on the bay without supports that…

    D. Gorski: Daniel Craig as Gerson. Oy.

    Noadi:: Yup, and he claimed to be making an objective film.

    Dcardini: Yes, David Gorski made the connection.

    Clippedwingangel: I agree I really should see Sicko, and I yet may. If I do, and see “Truth” also, I promise to write a five page analysis of each one listing and enlarging on each falsehood, warp, omission, and libel. That is, unless David G wants to undertake it first.
    You participated in Sicko? Please let us in on the experience and where you have recoded it. I’d love to see it.
    You participated in Ground Zero and now have pulmonary fibrosis? A Pubmed search for “ground zero pulmonary fibrosis yielded one report on PF but without G-Zero, and search for PF 9/11 yielded three reports of PF unrelated to 9/11. Please give reference for PF being related to anything released at GZero. While your situation is unfortunate, your answer seems to me disjointed, generally accusatory, and seems contaminated with unrelated emotional issues.

    Mandydax: Yes, we should record interviews. Hard to do it while walking, being filmed. We take our chances and our lumps, but the results are often more indictments of the reporter.

    Harriet H: Yes and thanks. Medical care is expensive, but other schemes will be and are just as or moreso, or less “classy” and paid via higher taxes and more limited access and service. Big debate.

    Weing: Enticing comment.

    D. Gorski: Good point, clarifying how they do it.

    Hatch_Xanadu: Yup, and read the Kroschel interview. He comes forth with plenty of it.

    Diane: ““Sicko” …does not belong in the same category as the rest. It is politically propagandist, and pro-public health care, but is not anti-science. It is not strictly anti-medical propaganda, therefore. It appears to me that you may have committed a category error, by creating (then conflating “Sicko” into) a new and less meaningful category, Medical Propaganda Films.”

    Hmmm. I see what you mean, but does it matter? Looks to me that categorization is not a problem. You see the films as species, I saw them as a genus. Both medial and propaganda. From what I have heard of Sicko, it is at least unscientific in its approach and technique.

    Great comments. WS

  15. Eric Jackson says:

    Wallace Sampson: Thank you. I was somewhat aware of Kellogg, and his numerous bizarre theories, the fact that he extolled the virtues of various enemas, particularly yogurt. His fixation on masturbation, sexual activity and circumcision seems on the verge of hysterical, at least as presented by most modern sources on the man. He certainly seems to have been the first, at least in America, to fixate on the bowels and promote the idea on a large scale. The prevalence of the idea, and vigor with which people go after it seems to tap into some sort of Freudian neuroticism though. I’ve received the impression that the idea goes back quite a bit further, though not as such a dominant one.

    The comments on Michael Moore are rather accurate. While he does collect valid points and information, these are subsumed within the overwhelming drive of his films to present a certain political view. What information he presents is largely secondary to advocating that view.

    That there are a great deal of flaws within the US health care system is without question, from exploitive CAM advocates, to the insurance policies themselves. The widespread policy of a ‘pre-existing condition’ is one that’s received a great deal of criticism, and one that is frequently used to deny compensation for a variety of illnesses. Mental health is one area where this is particularly prevalent, and I believe in oncology as well.

    There are flaws within any health care system however. I have an acquiantance or two working for the NHS in the UK, though at a low level. The amount of mismanagement and incompetence his stories reveal are simply appalling. Likewise, several friends who live in Canada have told me stories about it being simply impossible to get certain services – yearlong waits for certain specialists and imaging services. These are anecdotes of course, but interesting anyway.

    The simple fact of it is, the resources to provide perfect and exemplary medical care, equal to the highest standards we would hope for do not exist. Any system of providing health care is going to have to reach a compromise with that fact at one point or another.

  16. David Gorski says:

    The simple fact of it is, the resources to provide perfect and exemplary medical care, equal to the highest standards we would hope for do not exist. Any system of providing health care is going to have to reach a compromise with that fact at one point or another.

    Indeed.

    Here in the U.S. we currently have the worst of both worlds. We have in essence a government-run health system but without the one benefit of a government-run health system: Universal care. You see, the federal government sets the rates of reimbursement through Medicare and Medicaid for nearly all non-cosmetic medical services. Because insurance companies and third party payers use Medicare rates as the starting point for negotiations with hospitals and medical groups, this means what we have is de facto government price control. On the other hand, we do not have mandated universal care, where either the government itself pays or pays through third parties, and therefore we do not have anything close to universal coverage. Again, it’s the worst of both worlds. There is no free market in the U.S., and I’m very skeptical that the free market could ever get us out. This is not the early 1960s, when physicians fought Medicare, and much of health care is not something that people can shop around for and make reasoned, rational decisions. If you’re having an MI, you don’t have time for that.

    That’s not to say that our system doesn’t have some great things about it. The technology and innovation in the U.S. in terms of developing new treatments lead the world in many, if not most areas. However, all of that is very expensive, and health care has truly gotten to the point in the U.S. where without insurance none but the wealthy can afford to get seriously ill. Even with insurance, a lot of people can’t afford it because of high deductibles, etc.

    Living and practicing where I do, along with Dr. Lipson, in southeast Michigan, I see what’s going on. Thousands upon thousands in just our area alone are losing their jobs and health insurance, and the state and various other charity mechanisms are a hodge-podge, a Band Aid. Women with a diagnosis of breast cancer can get Medicaid, but Medicaid won’t pay for the biopsy that will determine whether or not they have cancer. Truly a Catch-22. Fortunately, the Susan J. Komen Foundation has a fund that will pay for such biopsies, at least at our institution, but it’s a private charity and its funds are limited. It can’t afford to pay for anything else. A while back, I saw a woman with both an abnormal mammogram (for which the Komen Foundation would pay for the necessary biopsy) but also a suspicious enlarged cervical (neck) lymph node that needed evaluation. I could not get an ultrasound (I wasn’t sure from the physical exam that it wasn’t contiguous with the thyroid and thus a thyroid nodule); so I suggested just doing a fine needle biopsy in the office. I was told that an FNA wouldn’t be paid for. Even if I waived my feed, the pathology department would have to read the slides. If her breast biopsy comes back cancer, then I might be able to get the cervical lymph node biopsy covered, because then I could argue that it might be metastatic breast cancer and we need to find out. Otherwise, this patient’s on her own. I was forced to send this poor woman to a free clinic and hope that she could manage to get that cervical lymph node looked at and biopsied using other resources. Waiving my fee wouldn’t make a difference, because the institution can’t afford to waive its fees. It’s already suffering a major decline in patient volume, along with virtually every other hospital in the area. We don’t know why, but this decline began to become very noticeable January and we suspect it’s because so many people in the area have lost their insurance and are delaying or foregoing care. Things are likely to get a lot worse here before they start to recover, too.

    So, even though I recognize Sicko as a propaganda film, I am no longer as opposed to or afraid of a single payer plan as I used to be. (Believe me, I used to be a lot more like Wally in this.) I only want to figure out if the ratio of benefits to disadvantages would be more favorable than our current system, where the downside is becoming more and more pronounced. I guess you could say I’ve become less dogmatic and more pragmatic with age.

  17. weing says:

    I don’t think we’ll get a single payer plan, although I would prefer it as it would lower overhead costs. The insurance lobby is just too powerful for that. We’ll more likely get universal care with multi-payer plans.

  18. Diane says:

    Wallace,

    From what I have heard of Sicko, it is at least unscientific in its approach and technique.

    Well, if it WERE “scientific” “in its approach and technique,” it wouldn’t be political propaganda, would it? It fits the definition of propaganda by highlighting/propagating a certain (political) point of view. All “politics” (of any persuasion) is spin, i.e., propaganda, when boiled down.

    I still do not think “Sicko” is an appropriate target for this blog, or belongs with the other films, in that it is not anti-medical. In fact, it’s pro-medical. It may not have been scientific in its approach and technique, but no political propaganda piece ever is, and it is not promoting anything anti-scientific, or pseudo-scientific, as the rest do. Therefore, I would still submit this as having been possible category error.

  19. Eric Jackson says:

    David Gorski:

    I can comment with respect to events that happened in the small town I grew up in. The entirety of the medical services available to this community of about thirty thousand were provided by a small Catholic medical center, and a small clinic. The clinic was set up to provide medical services to the large local migrant and immigrant population, most of whom were without health insurance, and fees were assessed based on an ability to pay. Because it was essentially the only source of local medical care, most of the community patronized it. Its primary source of funding was the county, and due to the increase in uninsured patients, it totally outstripped that funding and shut down overnight. This basically left the entire community without any medical care bar the small Catholic facility, within about 45 minutes to an hour of driving. They were simply too far in debt to even open their doors anymore.

    It’s an awkward situation. COBRA, which is the normal source of continued coverage when employment based health insurance is lost, is not always viable. A friend of mine from high school recently graduated from college, and found that getting COBRA based on his parent’s insurance would run over $800 a month – simply not possible at all.

    I suppose the only real alternative to some sort of single payer system is a complete overhaul of how medical care is provided – from prioritizing access to certain services, down to the snarled, tangled mess that is the development and sale of pharmaceuticals. Even with single payer systems, some of that is inevitable.

  20. Great comment thread here.

    Regarding the history of bowel fascination, I have thought of it (perhaps incorrectly) as dating back at least to pre-scientific ‘regular’ European medicine, with its laxatives and purgatives; thus probably at least 200 years old, possibly much older. I’ve also thought of its origins as probably having pre-dated some of the early understandings of vertebrate anatomy and physiology: namely that the body is most simply represented as a tube, rather than as a solid cylinder. Thus the lumen of the tube, ie, the digestive tract, is outside the body.

    I suspect that most people who don’t know this, which includes everyone prior to the blossoming of biology in the last 200 years or so, think (erroneously) that what we swallow goes inside our bodies at the moment that it disappears down the gullet. When they see what comes out the other end, it looks (and smells) pretty scary. Thus the urge to detoxify, as it were. A good thesis for some historian with more time than I.

    Regarding the single payer plan discussion, the evolution of my thoughts has been similar to Dr. Gorski’s. At this point I’d reluctantly welcome single payer in the US, just to get it over with: get universal coverage, simplify paperwork, and reduce administrative costs. I’d also like to see a lot less advertising of everything health-care-related, which I find incredibly phony and distasteful as well as misleading in most cases (woo or not), and there’s no reason that a single payer system shouldn’t accomplish this—for the very reason, alas, that it would also be mediocre in many ways: no competition.

    For years I also argued, if the topic came up, with those who blamed the woes of the American ‘system’ on the ‘free market’: there is not a free market in health care here; there is a very skewed market, skewed by the state. I used to think that we should at least try a true free market before accepting a system controlled by the same government that gave us the Vietnam War, Guantanamo, the Drug War, FEMA, a prohibition on stem cell research, and all the rest. I don’t want the doctor-patient relationship poisoned by people who both believe in magic (that a zygote has a soul or that god hates fags and fucking or that homeopathy can prevent Anthrax) and have the coercive power of government at their beckoning. I know, I know: there’s already some of that. I’d argue that a true free market would be more likely to break it down than would complete state control.

    Even Medicare, presumably our model for a single-payer system, is loaded with politically-spawned problems, some obvious (it isn’t allowed to bargain with pharmaceutical firms, which is why US citizens want to buy US-made drugs from Canada) and some subtle and unmentioned (it is heavily subsidized by private insurance). Just how in the hell are we going to do it right with a generalized single payer system?

    Nevertheless, I don’t see any other practical way forward. We ain’t gonna try the real free market experiment, no way, no how, and we have the worst of both worlds now. So bring on single payer and be ready to fight it out in the halls of congress. The details, that is. Over and over again, forever.

    Wally:

    It warms my heart to see a comment from wunna your kids. I hope DJ doesn’t mind that I corrected a typo. :-)

  21. Wallace Sampson says:

    Eric Jackson: Thanks, Points taken.
    Diane: The title of the piece is Medical Propaganda Films.
    David Goski: Points taken. Yours stand as vision from the position of the institutional system, valid arguments for a unifying system. That wasn’t the topic, but…
    Having functioned on both sides (practicing in public and private sectors, and also setting practice guidelines, standards, and judging other docs…I no longer trust even myself to be objective and fair, and do not see one physician or a committee of them as objective, fair, consistent, sensible, and universal. There is something dysfunctional with just about every guideline set – to the doc or to the patient. Cost is due to more factors than have been commonly bashed. Most prominent is not machine technology but the increase in personnel costs – from hospital housekeeping and aides to highest trained RNs and tech people. These costs would be present in either single payer/single guideline system or multiple private ones. As Kim Atwood says, the government carries a coercive force. It allows little room for private negotiations and compromise. At one point decades ago, MediCare, to discourage unnecessary pre-op EKGs, levied something like a $500 fine and six months in prison for physician violations of the regulation. The universal howls caused a “re-positioning” but other unyielding regs remain in a system deaf to individual cries for wiggle room. A single payer will likely mean a single set of payment guidelines, with constant friction over sharing of the constricting pie. I‘ll take a private competing system with universal forms. Dysfunctional and more expensive but that‘s one cost for a free society. “Hey, nobody’s perfect.”
    Kimball Atwood: Good points all around on major issues. I’m in no mood to argue others if I even disagreed. DJ got here through me I think, but he found RI on his own – which is one of his fave sites.

  22. worknfool says:

    Re: Leni Riefenstahl is alive and well

    I’ll preface this by stating that I am new here and am ex-military, libertarian / moderate and not employed or trained in medicine other than emergency survival techniques learned in the service as a survival instructor.

    I have seen Sicko and a Beautiful Truth and found both to be quite entertaining and thought provoking. This of course being relative since I am also entertained by the 3 Stooges and find the contemplation of my naval to provoke thought.

    The point of documentary film makers is precisely that they have a point…and they want to use their production to further it. Leni made quite a name for herself promoting Adolph back in the 30′s and 40′s and she’s still regarded as a documentarian. Accepting that as a premise does make it easier to separate the fact from the fanciful, and these films appear to contain a fair portion of both. This is unfortunate since the editorial license that they take in order to support their views ultimately detracts from the worthy facts and perspectives that we should still find a way to discuss and evaluate.

    Not to shill for Netflix but their base subscription makes a tremendous amount of documentary film, including both of these, available for immediate viewing for just a few dollars a month if you’re free market pay or principals won’t allow for a trip to the cineplex. A good counterpoint to Mr. Moore’s approach to propaganda is to be seen in the Canadian documentary “Manufacturing Dissent”.

    My attitudes about the Gerston methods were already heavily flavored by my morning ritual of listening to Dr. Edell on the radio and hearing him preach the benefits of common sense and moderation on my way to work each day. I also get a very similar kind of message from my very practical and sensible health advocate and family Dr., Theo Houk. http://healingtheworld.com/

    Dr. Houk wears a pony tail and uses Macs, I am a crew cut with a PC. He is an ardent liberal who runs to work and doesn’t watch T.V., while I land a little closer to Goldwater, drive a V-8 pick-up and watch too much T.V,…got the picture. That however has not stopped me from coming to grips with the state of our current health care and agreeing with him that whether it’s called socialized or not, we need a major change in the status quo sooner rather than later.

    Mr. Moore’s staged drama aside, the facts and figures are staggering. Roughly 18,000 a year will perish in America due to inadequate health care access. Health insurers and malpractice insurers will generate almost 2 trillion dollars in revenue this year while almost half of our population will be faced with no coverage or coverage that they can’t afford.

    My family spends $15,000 a year on medical insurance and another $3-5,000 each year on deductibles and co-pays. None of us had any serious illnesses in the past and we’re still lucky enough to say that cancer and diabetes have as yet left us alone. My wife and I have done better than average for ourselves and appreciate that even more since I was recently injured on the job and can no longer work.

    BTW, the 2 trillion figure doesn’t include a few things…like Medicare, V.A. system care and Workers’ Compensation Claims. It also doesn’t include the ripple effects of lost time and the ultimate social costs of supporting people who loose their ability to support themselves. We can also add to that the burden of hundreds of millions paid out through SSI for disabilities.

    The reason I mention the money is because the usual argument that I encounter from status quo supporters is “where’s the money gonna come from?”. Well those trillions are what we already spend, and when our world class health care is evaluated on the basis of what portion of it the average citizen receives…it’s really crap. All of the nuclear medecine and transplants in the world aren’t worth shit if your insurance won’t cover them…and they do everything that they can to avoid it, especially cancer treatment and transplants.

    That’s not meant to be a condemnation care givers but rather the coin grabbers. Who is the ass that decided that profits and health care can coexist. I’m not interested in Congress deciding whether or not I’m gonna get my MRI, but it sure beats the heck out of a claim adjuster, who gets paid more for refusing care, being the adjudicator. And that’s what we have to deal with now.

    So we pay a higher tax…BFD! So I save 15-20% of my pay check on the other hand. Hell, if we all paid just 5% of our gross pay we’d all be better off, all of course except for the insurance company employees, the bill collectors, the lawyers and the innumerable people employed by caregivers to chase down their payments. Just imagine what we could accomplish by putting those folks to work doing something constructive, something that actually contributed to our quality of life rather than detracted from it, ‘cuz that’s about all I can see that we’re paying them for now.

    I’ve been to numerous “board certified” thieves and frauds who maintain a practice that is dependent on unnecessary testing and billing schemes to make a profit. Boutique group practices sell themselves to prospective physicians just like they’re selling time shares. I actually stood at the reception desk while one such criminal described to his billing clerk how to code my treatment so that they would be paid twice over for treatment that I didn’t even receive. I left and reported him.

    When my wife delivered our son he was a face presentation, and she was is labor for over 70 hours. The hospital was not a teaching hospital, but due to the uniqueness of the delivery everybody in obstetrics and pediatrics stopped in at one time or other. The crazy part didn’t reveal itself to me until the second day when the chief of pediatrics came by.

    Just like everyone before him he said nothing to us, picked up my wife’s chart and signed it and then began to leave. When I asked him why he signed her chart, even though this wasn’t his department and he wasn’t her doc, he smuggly replied that he was the chief of peds, etc. and who did I think I was…

    A few minutes later, security was called as I pushed him out of the room and blacked out the visitors’ initialings. He had very pompously admitted that that was how they got paid, and when I objected he asked if I had health insurance. When I replied that I did, and that I paid dearly for a good plan, he responded “then what do you care, the insurance company pays for it?” When I threatened to call the radio and T.V. stations they finally left us alone, but low and behold, no less than 12 different doctors, other than her OB, showe up on the final bill.

    Now we all know that Dr. Houk could make a lot more money if he would succumb and allow himself to be absorbed by the Borg. Fortunately for his patients we still have him because he is motivated by more than just making money. Adopting England’s socialized system here would probably provide him with a decent raise. My god, can you imagine…a system where instead of financial rewards for insurance companies denying treatment we rewarded care givers for helping their patients get and stay healthy?

    Guess there’s just no profit in it!

  23. AppealToAuthority says:

    Worknfool: thank you for an excellent exposition of your experience of the US situation.

    Moore’s films are clearly intended as propaganda. I’m more interested in judging their outcomes than their methods; and I think the primary outcome of Sicko is useful: public scepticism about healthcare judgements made by business interests. I await his polemic about the same scenario in quackery.

    Unlike Wallace, i have seen Sicko. It did not strike be as being anti-science, or anti-medicine — while it is of course not ‘scientific’. If anything, it was supportive of scientists and doctors doing good medicine, and critical of the business and social systems that prevent that.

    And that brings me to the bigger issue revealed here: most people do not distinguish between the science that informs medicine, the technological application of that science, the business practices within which it operates, and the social setting where health care is delivered.

    This lack of separation occurs among ‘sceptics’ as well — if we judge Sicko (especially without having seen it!) as anti-science, we are just disrespecting the entirely rational conclusions many have reached that the _business_ of medicine is mostly unscientific and not health-promoting — as you would expect.

    Allowing the institutions of medical science to be forced into collusion with those of medical business (and quack business) is a major failing. Treating them as synonymous, when they are separable, just makes us look silly.

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