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Mon Jul 2 14:46:47 BST 2007

Ken,

I am in awe!  What you have written is (as usual) well said - balanced,
fair, and without bias. 

I expect that this will show up in the New York Times, Washington Post
and the Chicago Sun Times - NOT!  As with Mr. Moore, all of these
political - OOPS - publications would probably not print something this
analytical and balanced.  Just the same, I think that your piece should
be submitted to as many publications as possible as an Op ED.

Congratulations...and thanks for continuing to say what needs to be
said - and, at the very least, for functioning as a moral compass!

Ron

>>> <KMATTOX at aol.com> 7/2/2007 12:03 AM >>>

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
f
ree 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 pro
blems 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

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