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Mon Jul 2 13:05:56 BST 2007

This was INCREDIBLE, Doc!!!!!!!!!!!!!!!!!!!!!!!!!!!!

Well-written and although long, this should be an editorial in every major
medical journal.

May we use this on other listserves?!

Maximum respect--

Charlene Morris, PA-C
Stonewall, NC

On 7/2/07, KMATTOX at aol.com <KMATTOX at aol.com> wrote:
>
>
> I have now seen the movie, SiCKO, in its entirety, twice  - once on the
> small
> computer screen and then, today, in a theater.  I went to the theater to
> see
> the people,  listen to their reactions, and also see and hear the movie in
> a
> big screen  setting.  And, indeed, some of the  material is better
> appreciated
> in the theater, rather than on the small  screen.
> First, someone has changed the image of the producer,  Michael
> Moore.  Both
> in the movie  and on the publicity talk shows, he is less angry, less
> hostile,
> and has  "cleaned up" in speech and appearance since his previous movies
> and
> books.  He is a producer and was very, very  specific in what he wished to
> create, and he created it.  He knew just what he needed to show,  what he
> needed
> NOT to show, and in what order he needed to show the  material.
> Unfortunately, the movie approaches an extremely complex and many-faceted
> issue in a totally superficial manner, the goal being to elicit emotions
> and
> reactions with regard to the dismal state of health care in
> the  United  States.
> Many of the essential elements for the success of our health care network
> were totally omitted.  Just a few of  these omitted issues include:
> 1.                    Biomedical research,
> 2.                    the long list of medical educational issues
> (nursing,
> allied health, pre med, medical school, graduate medical education,
> continuing
> education, etc.),
> 3.                    Critical Care and all of its  ramifications
> a.       Sepsis
> b.      Futility
> c.       End of life expenses
> d.      Demands of families regarding doing "everything" in  critical care
> 4.                    Complex operations done (and expected) almost
> exclusively in the United  States, such as thoracoabdominal
> aneurysms,  etc.
> 5.                    Regulatory Industrial Complex and its
> contributions  to
> the cost of health care in the United States
> 6.                    Medical legal issues, although MM has talked about
> medical legal issues in the talk shows
> 7.                    Costs of new pharmaceuticals (the majority of which
> are developed at great research and safety costs in the United  States)
> 8.                    and many many others
> I was sympathetic and in agreement with a number of  points that the
> producer
> made repeatedly.  These include:
> 1.         Condemnation of the greed, cold-bloodedness, profit motive of
> the
> insurance industry
> 2.         Condemnation of the same thing in HMOs
> 3.         Condemnation of managed health care in general
> 4.         Criticism of big money that the pharmaceutical industry throws
> at
> politicians (and the politicians who take it)
> 5.         The hundreds of millions of dollars spent by insurance, HMOs,
> and
> industry for LOBBYING
> 7.         Condemnation of Sen HR Clinton for her greed in receiving the
> second  highest amount of lobbyist money AND in her ineffectiveness in
> addressing
> health  care reform in the 1990s.
> 8.         Hassle factor in the sea of paperwork
> 9.         Condemnation of insurance and HMO medical directors and doctor
> reviewers  who are rewarded for DENIALS
> The producer's main point throughout the movie and in his final scene
> was  a
> plea/demand for UNIVERSAL FREE HEALTH CARE FOR ALL (and he tossed in free
> day
> care, free college, and free nanny visits to new Mom's).  This is where I
> totally part ways with  his views and motivations.  No  service is
> FREE.  He
> visited 5  countries to prove his point about "free" care – UK, Canada,
> France,
> and Cuba and the US.  Both access and quality of care in the  UK, Canada,
> France and Cuba, according  to what was presented in this movie, are
> superb.
> Furthermore, patients and physicians in  these countries could not be
> happier with
> their respective systems.  Based on this movie, the paperwork  hassle
> factor
> that both docs and patients deal with in the US is  nonexistent in these
> countries.  Also, based on this movie, the cost of all these government
> provided
> services is not a hardship on anyone or any group.  Not a single person
> interviewed in any  of these countries had a remotely negative thing to
> say about
> care, quality or  even taxes to support the system. Contrarily, ALL
> interviews in
> the US were  totally negative – not ONE success story was
> presented.  Hence,
> my greatest criticism of this  movie – bias to the point of deception.
> There appeared to be a good bit of manipulation of timing  of events to
> support the producer's position.  For instance, when attempting to
> present  the AMA
> as an organization opposing "healthcare for all," he showed a portion
> of  a
> speech from Dr. Annis, President Elect in the AMA in the EARLY
> 1960s.  This
> was more than 40 years ago.  Such mixing of past and present was  common
> throughout the movie.
> I listened to and watched the views of the people who accompanied
> Mr.  Moore
> to Cuba.  I have tried to read in the newspapers  about just what was done
> for
> them in Cuba which they did not get in the United  States.  One was
> apparently given a diagnosis of sarcoidosis, which he did not  have prior
> to going
> (although sarcoidosis is often a dx of exclusion).  One was taken off a
> couple of
> her  medications, something we all do when we see a referred
> patient.  Others
> were given outlines of treatment  plans for them to try when they go home.
> What else is new?  When any  patient presents with continuing symptoms, we
> manipulate their treatment plans  and their medications if there is not an
> operation or directed acute  interventional treatment which is
> indicated.  Quite
> frankly, I saw nothing in the  Cuba trip that gave anything new to  any of
> those
> accompanying Mr. Moore.  I was impressed that while in Cuba, I saw none of
> them
> appear to be  dyspnec, or lacking energy.  I was  impressed with their
> HIKE
> down the hillside to the Navy Base.  Interestingly, neither of the
> two  "patients
> " with lung problems (and obese) exhibited shortness of breath.  I also
> know
> that the Cubans would also  go out of their way to maximize the propaganda
> opportunities of this visit.  Many on this list have been to medical  or
> surgical
> meetings in Cuba, as have I.  The Cuban doctors are very dedicated and
> hungry for new knowledge.  Many of  their facilities are often not as well
> equipped
> as ours, and I have seen  hospitals far different from the examination
> rooms
> shown in the Havana Hospital in this movie.  If all I had to base my
> reactions
> of  medicine in Cuba was this movie, I would "know"  that there is a state
> of the art hospital and virtually free pharmacy on every  corner and
> available
> to any and all who need services.
> There are members of this list server who reside in  Canada, Cuba, United
> States, France, and England, and we  all respect each other.  Each of
> us  knows
> the many differences in our "systems," both good and bad.  We know the
> many
> frustrations with our  own "system".  We know of two,  three, or even four
> tiers of care in EACH of the cited countries.  We know of rationing by
> various
> means  and limitations.  None of the  negative issues in any country
> except the
> US were even  mentioned, much less openly discussed.  I have been told by
> Canadian physicians  and patients of various problems with that system. I
> have
> just been in London for a week and  heard about the frustrations and
> regulatory
> difficulties of the NHS from the  physicians' points of view.  AND I  have
> gotten an "ear full" of the frustrations from French surgeons I know,
> all  of
> whom have second offices to see "private patients" who pay cash.  Mr.
> Moore
> cited none of this other  side.
> This is not the time and place to criticize other  country's health care
> delivery system, for we all have our share of horror  stories and
> difficulties, as
> well as great successes.  I have cited many of the problems in the  United
> States, and Mr. Moore re-stated many of the  problems many on this list
> have
> expressed in the past.  However, he only gave one side of the  story – his
> side
> - to push his vision of FREE CARE (up to and including the  government
> doing
> his laundry) for ALL.
> Most of the members of this list server have at one time or another
> been  on
> a debating team.  One overstates  a point to make a point and picks the
> most
> extreme examples of good and bad that  can be found to accentuate the
> point to
> be made.  Mr. Moore has done that in SiCKO.  I would have found this an
> exceptional  piece of film and, indeed an historical event, had he had the
> insight,
> intellect  and integrity to just as aggressively present the opposite side
> of
> the debate.  In that way, the American people  and the world could have
> seen
> and possibly comprehended the many complicated  aspects of health care and
> come
> closer to a solution.
> I was interested to see who attended the movie.  This is the second day
> that
> SiCKO is  showing in Houston and is in three movie theaters.  I went at a
> "
> popular movie going  time."  Several of the 15 movies  showing were sold
> out
> 15-30 minutes before the show started.  SiCKO was shown in one of the
> smaller
> rooms and was only about 25%-33% full.  About 15% of the attendees were
> Medicare
> age, and 2 people were receiving  supplemental oxygen.  I was a
> bit  amused to
> see a lady come in on a "Hover-Around."  I wonder how many people in the
> UK, Canada, Cuba and France have those paid for by their  governments?  I
> saw NO
> other doctors  in the room that I recognized, and I do know many of the
> Houston doctors.  I estimate that about 30 nurses were  present, as they
> were
> carrying the flyers sent to nurses across the country by  the California
> Nursing
> Union.  Every  time a statement was made about giving FREE anything, such
> as
> child care,  laundry, cooking, extra vacation time for a honeymoon,
> (anything to
> be paid by  the government), there were murmurs of approval, sometime
> clapping, in the  theater.  Based on the Houston attendance, I  would not
> think this
> show will have a very long running at the box office.  Because it presents
> a "
> you can and  should have it all at no real cost to YOU," I have no doubt
> that
> many  individuals and groups will "latch" onto this film and champion
> it.  I
> cannot envision it having any long  term real societal impact on health
> care,
> simply because it does not present  anything new or offer solutions on HOW
> we
> reach this nirvana state that is  enjoyed in France,  UK, Cuba and Canada.
> At one point, Mr. Moore emphasized that the US is a country where people
> are "
> afraid of  government," afraid to speak out and demonstrate – implying
> this
> was quite  different in France,  Cuba, Canada and the UK.  I'm still
> puzzled
> by that premise. When  in recent history have Americans had ANY reticence
> about
> speaking out and  demonstrating???
> I will admit again that some of the central core  complaints are common
> among
> patients, nurses, doctors, organized medicine, and  medical professional
> groups.  Those  core issues about which there is agreement were cited in
> the first
> paragraphs of  this review, and I will not repeat them.  It would be
> wonderful if we could unite in addressing THOSE core issues  with a
> massive
> communication effort to policy makers (inside and outside
> the  government).  I am afraid
> that the  solutions are going to be very complex and multifactoral and not
> as
> simple as  getting the "government to give you free drugs, free doctors,
> free
> hospitalization, and free laundry services."
> Kenneth L. Mattox, MD
>
>
>
> ************************************** See what's free at
> http://www.aol.com.
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