Archive for the 'Opinion' Category

Rep. Kolkhorst Needs Help to Keep TMB Reform Alive

18 May – As Chairwoman of the House Public Health Committee, Rep. Lois W. Kolkhorst has demonstrated her commitment to ensuring that physicians are afforded legal due process whenever they have dealings with the Texas Medical Board (TMB). She has done a yeoman’s job in writing the provision to HB 3816 during the 2009 Legislative Session and in HB 1013 Continue reading ‘Rep. Kolkhorst Needs Help to Keep TMB Reform Alive’

Medical Peer Review Used to Silence MD

4 Jan – In the Superior Court of California, County of Alameda, a peer review drama is unfolding. Petitioner R.V. Rao has taken on Washington Township Health Care District, Respondent, re its judicial review committee. Continue reading ‘Medical Peer Review Used to Silence MD’

MEDICAL PEER REVIEW DOES NOT PROTECT THE PUBLIC

15 Sep - “Reduce the medical errors”, was the public outcry in the 1970’s and 1980’s.  Big malpractice awards were sounding alarm for public and politicians alike.  The medical establishment took the stand that there existed a few “bad apples”, who were causing most of the problem.

“Leave it to us”, the establishment said, ”We are going to establish a fine system of ‘peer-review’.  We shall review our colleagues with utmost ‘candor’ and throw out the bad apples”.  “But”, they argued, ”We can only do our work with honesty and candor, if our decisions can not be challenged in a court of law and the reviews are not open to the public.  Otherwise these “bad apples” will sue us.”

With a strong leap of faith in the medical establishment (i.e. hospitals and doctors entrenched in it), all states enacted stringent laws protecting peer reviews from public disclosure and scrutiny.  The Congress enacted the Health Care Quality Improvement Act (HCQIA) of 1986, giving doctors and hospitals immunity from damages for their peer-review actions.  Sen. Ron Wyden (D- Oregon) authored the 1986 law that created the National Practitioner Data Bank (NPDB), which was established to blacklist the “bad doctors” so that after committing malpractice, they could simply not cross state lines and set up a new practice.

But the medical errors have not gone down!  Seventeen years have passed since then!  Institute of Medicine (IOM) reported in November 1999 that 98,000 patients die each year because of medical errors.  St. Paul Insurance Company reports that the rate of malpractice claims has remained steady over between 1990 and 1999.  In case you did not notice, we are in the middle of malpractice crisis once again, right now.  St. Paul Insurance Company has completely closed its medical malpractice insurance business.  Malpractice rates are soaring.  Where did things go wrong?  Does this peer-review driven system of catching errors, educating and disciplining doctors and throwing out the “bad apples” really work as promised by the establishment?  Or is it merely a smoke screen for some doctors to maintain lucrative (but short on quality of care) practices at the expense of their more conscientious colleagues who actually practice good medicine?

Let’s see how the system is supposed to work.  After any patient is discharged from the hospital, the quality assurance (QA) nurses check the chart to see if aberrations have occurred.  If not, the chart is filed away.  Otherwise the chart is flagged and goes to the “peer-review” committee of physicians.  This committee checks to see if the physician attending the patient met the standard of care.  If not, the attending physician is questioned, counseled, disciplined, suspended, terminated depending on the seriousness of medical error.  Largely, peer-review is meant to be a learning process so that the medical errors are caught and all doctors are educated in order for patients in future to get better care.  But this is also where doctors can play out their personal politics of favoritism, prejudices and turf-wars!

First, who are these doctors that are reviewing their colleagues?  Are they somehow tested and proven to be better qualified than those they are reviewing?  Do they have the necessary integrity to judge others?  Are they dispassionate?  Not really, in most cases, they are simply the “favorites” of the administrators.  Chances are that they are “stale, pale, male”, who bring in a lot of patients, surgery, and money to the hospital.  They and the hospital lie in the same economic bed, sharing strong motive of profiting from keeping control of the medical practice in a given community.  They form the “inner sanctum” and closely guard against “outsiders” using whatever means necessary.  They oftentimes have a substantial conflict of interest in doing a proper peer review. 

Second, are these reviewers honest in reviewing their colleagues?  Can they objectively critique their friend who is simply a part of their everyday professional and social life?  Who often refers to them?  Who they play golf and dine with?  On the other hand, can they be fair to one who just came into town and who may be taking some of their patients away?  An inadvertent competitor?  How about one who has this funny accent about him?  Or different shade of skin?  Can these doctors rise above their personal and professional ties, prejudices and insecurities to uphold the standards of medical profession, as they assure the public?

Third, why should they expend time and effort on this thankless job?  The reviewers can simply gloss over the charts, do a perfunctory review.  In fact, the department of ob-gyn, of which I was a member at that time, at Presbyterian Hospital, Charlotte, circulated a memo in April 1995, admitting euphemistically:

Overall, our (peer-review) process has been very relaxed these past few years. 
 
Finally, the fact is that managed care has shrunk the size of the monetary pie to be had, so it is a doc-eat-doc world out there!  If I can review you and eliminate you before you even get a chance to review me, I can be way ahead in the game.

Many, if not most hospitals, place “politically correct” physicians on peer review committees, not those who are better doctors.  For these reviewers to criticize other politically powerful physicians who are making medical errors would be to commit professional hara-kiri.  Of course, the reviewers have to make a showing that they are doing something, because their job is to protect the public.

Given all these factors, it is very easy to see that the reviewers set up a double standard of covering up the real mistakes of their friends and exposing their politically vulnerable, but medically superior, colleagues for non-substantial, flimsy, clinically insignificant, bogus and fabricated reasons.

If they accept you or if you are part of the “inner circle”, meaning politically powerful, they simply look the other way if you make mistakes.  Chances are that your charts may never be peer-reviewed because the administration, through the “understanding” quality assurance nurses, can simply let these charts slide by.  However, if you are a competitor but/or do not belong to a powerful group, gender or race, full fury of the peer-review system may be unleashed upon you.  That is what happened in my case 6 years ago.

MY PERSONAL EXPERIENCE

When I received my M.D. from New Jersey Medical School, Newark in 1985, I decided to take up the happy specialty of delivering babies.  In 1989, I finished my ob-gyn residency from Temple University Hospital, Philadelphia.  I graduated in the top 20% of my senior class.  I moved down to Charlotte and started ob-gyn practice, first with a group then solo.  I became board certified in ob-gyn.

On December 1, 1994, I scheduled a laser-laparoscopy on a patient to alleviate pelvic pain.  At the time of surgery, I inadvertently punctured an artery in her abdomen.  I recognized the injury immediately and performed open surgery with the help of a general and a vascular surgeon.  The patient went home after a few days stay in the hospital.  Many experts later reviewed my case and found that I met the standard of care.

But the Presbyterian hospital used this incident to target me in the worst possible manner.  They initiated a completely secretive peer-review of all my cases.  On September 1, 1995, the CEO of Presbyterian Hospital, Charlotte and chief of the ob-gyn department summoned me to the imposing boardroom of the hospital.  They told me that the hospital had peer-reviewed my 102 charts and found 24 of them to be ‘problematic”.  They would not identify these 24 charts or what the “problems” were with each of them.  They told me that I was summarily suspended from the hospital from that very day!

I was the first physician to be suspended from the hospital in 20 years!  The reviewers were either my competitors or employees of the hospital or both!

This was truly a stab in the back, because I was never given a chance to defend any of those 24 cases.  According to the hospital’s own by-laws, I should have been given written query for each of those charts.  If that were done, they would simply not have been able to suspend me, since there was nothing wrong with the charts.  They simply wanted to hush up the matter.  In fact, the secretary in the medical staff office offered me the “friendly” advice that I should resign.  Had I done that, there would have been no legal recourse.  My lawyer correctly advised me to choose to be suspended!

I went through the “fair hearing” process in the hospital, which was a laughable exercise in corporate rubber-stamping.  There was nothing “fair” about it.  The hospital handpicked the members of the “hearing panel”.  None of the members of the panel was even an ob-gyn physician.  Even though two eminent ob-gyn experts testified in my favor, doctors on the panel voted me down.  They were not going to destroy their long-standing relationship with the hospital!  Yet, they had enough conscience to write in their opinion:

“The sequence of events as presented leaves the distinct impression that this physician was intimidated.  That impression damages the entire community.”

I took the hospital to the state court in Mecklenburg county in January 1996.  The court determined that the hospital had violated its by-laws and ordered the hospital to perform a new peer-review of my charts.  Meanwhile North Carolina Medical Board reviewed my “24 problematic charts” and found them to be satisfactory.  Sadly, the Board decided to stay on the sidelines while the hospital continued to decimate my career and drag me though the vagaries of the judicial system.

The hospital initiated a new review of my charts using two external reviewers but they knew that I would be vindicated.  Therefore, they simultaneously appealed to the Court of Appeals in Raleigh, North Carolina against having to do the review.  They also went to the State Supreme Court asking for a stay of the ongoing review in February 1997.  Beyond all reason and logic, the Supreme Court stayed my almost finished external review.  The Court of Appeals ordered in August 1997 that the hospital should indeed give me a new review in accordance with its by-laws.

American Medical Association and North Carolina Medical Society, in fact all medical people and entities in this country support an “external” review of a physician.  The by-laws of the hospital allow for an external review of a physician.  But the hospital chose to abandon the external review that had been going on.  For the second time, the hospital selected internal physicians, employed and otherwise controlled by the hospital, to review my cases.  The marching orders were intuitively clear for the reviewers; they were to find my charts full of “mistakes”.  They did just that and justified the revocation of my privileges.

Dr. E. Albert Reece, chairman and professor at Temple University hospital’s ob-gyn department in Philadelphia, reviewed these cases at my request.  He and another board certified ob-gyn physician personally testified at a hearing in the hospital in January 1999 that I met the standard of care in all those charts that the hospital had pointed out as problematic.  Still the hospital would not listen!

I was the first ob-gyn physician of Asian-Indian heritage in the city of Charlotte.  I felt that discrimination was the real reason for my exclusion from the hospital.  I filed a civil rights suit against the hospital in January 1999.  In June 2000, the federal judge ordered the hospital to produce to me all the records of ob-gyn physicians to compare with mine.  Not wanting to have the jury see how the performance of other ob-gyn physicians stacked up against mine, the hospital appealed this order to the 4th circuit Court of Appeals in Richmond, VA.  In August 2001, the Court rendered its forceful and unanimous decision in my favor, holding that the interest in obtaining probative evidence in an action for discrimination outweighs the interest that would be furthered by recognition of a privilege for medical peer review materials.  In September, 2001, the Court denied the petition by the hospital for a hearing by the full bench of the court.  The hospital decided that they would not appeal to the U.S. Supreme Court.  The case is in litigation now and trial is expected in 2005.

I still hold full and unrestricted licenses in North Carolina, New Jersey and Pennsylvania.  I have attending privileges at Carolinas Medical Center, Charlotte.  But because of my suspension from the hospital and entry of this information in the NPDB, I have been unable to do ob-gyn work for several years.  I had to close my practice in May 1997.  My skills have doubtlessly gone down.  My career and social life have been ruined.

While the hospital has used several million dollars of public money to keep me from serving the public, blatantly violated its own by-laws, the Joint Commission for Accreditation of Healthcare Organizations (JCAHO) has not questioned the hospital to my knowledge.  Many doctors, who have committed much bigger “errors”, have continued to practice there without being subjected to absurdly harsh peer review and/or discipline of any kind.

ABUSE OF PEER-REVIEW IS WIDESPREAD

Mine is not an isolated case.  In numerous cases, as the article in Medical Economics (Feb 7, 2000) points out, peer-review has been abused by hospitals and their “favorite” doctors to meet their own personal and economic agenda.  The victims of peer review are often less well connected.  Hospitals and doctors use peer review as a potent weapon to attack competition, achieve racial profiling and simply getting rid of those they do not like.  Once a physician gets a bad peer review, there is “domino effect” in that, other hospitals would not give you privileges, HMO’s would not put you on their panels and potential employers will turn you down.  The physician’s career is finished. You get branded as a social and professional outcast across the entire United States.  Everybody believes that hospital must have done the right thing.  Even if they think the hospital made a mistake, it is entirely too much baggage for anybody to deal with.  They simply leave you on the sidelines to wither.

On December 2, 2001, reference committee G of American Medical Association held a hearing on the issue of peer-review.  I personally testified about my case. Dr. Gil Mielekowsky (a physician from California), who became a victim of peer review, also presented his case in very effective and thoughtful way.  Dr. Demsch, Pennsylvania delegate, stated that in his state, abuse of peer review was rampant.  AMA is to study the issue of bad-faith peer reviews and bring out a report in June 2002.

However arbitrary and capricious the peer review, you can not question the process or the reviewers in the state courts.  In most states, peer review enjoys near-absolute privilege and immunity; therefore not much redress is available.  The courts are loathe to second-guess the hospitals’ “internal” matters.  As Dr. Jane Orient, executive director of American Association of Physicians and Surgeons (AAPS), points out, even the most egregious of peer-reviews prevails.  There is something wrong here, peer-reviewers can get away with murder, and nobody can question them!  They can professionally hang a physician in pubic, but the public is not allowed to see what evidence they have!  The public should merely take them on their word!  While the government has no difficulty getting their hands on internal documents of Firestone or Enron for public to view, the medical establishment simply hides its skeletons under the guise of “public good”!  How long is the public going to swallow that?

Robert Meals, Esq. has compiled a long list of physicians victimized by peer-review.  Dr. Verner Waite and Robert Walker, Esq. have termed the process “kangaroo court”.  Dr. Waite founded Semmelweis Society International.  Dr. Paul Ebert, the President of American College of Surgeons, questioned whether the peer reviews could remain unbiased with the ‘corporatization’ of medicine.  David W. Townsend, JD, wrote in Medical Economics(Feb 7, 2000) that solo practitioners lacking political support are frequent victims of peer review actions.

On the other hand, the establishment uses the peer review process to hide the mistakes of their own.  When you belong to the “inner circle” at a hospital, you do not get reviewed or get reviewed/disciplined less harshly.  The same goes for reporting to NPDB.  Even if your outcome is bad, it is brushed aside as “these things happen”.  Sometimes, you can make a sweet deal with the administrators, so as to avoid any reporting to NPDB.  But, as mentioned before, the establishment conducts a zealous witch-hunt to scapegoat those who do not have the clout to be part of the power structure – less well connected, solo and minority physicians.

Behind the smoke screen of every one physician targeted by sham peer-review, there are a dozen physicians whose medical errors are quietly shoved under the rug!  Therein lies the real source of threat to public health as well as injustice to those individual physicians, who become sacrificial lambs.  The system goes to great lengths to create an illusion of public protection, while it is really protecting the establishment, by hiding medical errors of the politically powerful physicians.  The concept that an elite group of physicians and the system, who are in a cozy symbiotic relationship, will demonstrate enough courage to criticize and discipline other members of their elite group, is plain ludicrous.  If they did, they would threaten their own survival because their own medical errors would come to surface.  (I use the word “elite” here because of their social power not because of their superior medical skills and judgment).

NATIONAL PRACTITIONER DATA BANK

This data bank was created with much fanfare by the Congress in 1986.  Public perception was created and persists to date that somehow all the bad doctors would end up in the data bank and all the good doctors outside.  U.S. congress Rep. Tom Bliley (R) has now introduced a bill to open up NPDB to the public.

But as elucidated above, one’s entry into the data bank simply depends on his or her political connections.  As with everything else in life, there is an extreme double standard here.  If you belong to the larger subset of physicians who constitute the “country club”, you will be protected by your colleagues from being disciplined.  Or that your penalty will be so chosen that it does not get reported to data bank.

However, if you belong to the other subset of physicians, who are bright, conscientious, good defender of public health but lack social connections, you may be thrown into the bank as a scapegoat for minor and non-substantial infarctions.  Medical establishment has the power to make you look like a monster lurking in the dark.  They kill two birds with a stone, they eliminate you for reasons of their whim as well as they get a “notch” in their belt, show the public they are being guardians of public trust.  Nothing is more hypocritical than that.

I believe that the information entered into the data bank is so incomplete and biased regarding physicians in general as to be of any help in stating with much confidence whether a physician is competent or not.  The federal General Accounting Office reported in November 2000 that NPDB contained information that is incomplete, inaccurate or both.  It is well-accepted that there is a low rate of reporting of “real” problem physicians to the data bank.  A report by the Inspector General of the Department of Health and Human Services said that in the last decade, 84% of HMO’S and 60% of hospitals never reported a single “adverse action” to the government.  It should therefore be obvious that, the bill introduced by Rep. Bliley is not going to give the public any meaningful insight into a physician’s competence, rather a false sense of security when they do not find a doctor’s name in the bank.

The consumer groups continue to want more entries in the data bank.  Sen. Ron Wyden has said that the low level of reporting was unacceptable.  While they are rightfully concerned with the low number of the overall entries, they should also be concerned with the fact that many of these entries are “forced” upon good doctors!  They should also be concerned with the political, unjust and high-handed process by which these entries are generated to appease the public demand.  And with the fact that peer-review process is controlled by the power elite in largely a mob fashion!

If five doctors assert that a woman should have a hysterectomy for no medical reason but for their obvious financial reward and one doctor disagrees, the lone doctor can be branded incompetent and cast away into the data bank.  From then on, he is falsely perceived by the public as a bad doctor.  He is headed for oblivion!  There is no process of check or balance against such a sham peer review.

Let me give you another example.  A surgeon is operating on a patient while the anesthesiologist is keeping the patient asleep.  The surgery takes an unexpected turn and blood transfusion is needed.  The anesthesiologist does not give patient blood in time.  The patient suffers some damage.  Now if the surgeon is not a good old boy but the anesthesiologist is employed by the hospital.  Who do you think the hospital is going to hold responsible for the damage?  And who do you think is going to end up in the data bank?  This is exactly what happened in my case.

The chance of finding good or bad doctors is about equal either inside or outside the data bank!  While I consider myself a well-trained, competent and humanitarian physician, my paper trail in the data bank would convince any potential patient to run away at the sight of me!
 
There are many other significant flaws in the system of reporting errors.  For example, you will find multiple entries regarding the same factual issue concerning a physician.  While the factual issue may be minor, substantial amount of public money is spent to generate these entries in the name of public good.  Also, a frenzy of activity is created to give an impression that the system is doing its best trying to find the “bad apples”.  With this adequate “distraction” created, the system merrily goes on with “business as usual”.

I have been called to task by my senior colleagues for doing the equivalent of an extra Pap smear while I know full well that these gentlemen themselves have filled their coffers with hundreds of unnecessary surgeries!  Suddenly they pretend to be paragon of virtues and upholding every pillar of medical ethics!  They exhibit “holier than thou” attitude for the simple reason that they are the establishment, I am the Johnny come lately.

It is difficult to go into all the details due to space considerations here.  The medical profession has managed to put itself on a pedestal in public eye but the doctors are also human beings with instincts of survival and greed.  They, along with the hospitals that control their behavior to control the bottom line, should be answerable to the society in general.  There truly needs to be an independent study of the whole process of catching errors, disciplining the guilty and seeing that the process and data bank are more than a dog and pony show.

Analysis

Although medical peer review is (or rather can be) A protector of public health, its current form, without balances, invites abuse.  There is much reason to believe that peer review is practiced more in its corrupt form rather than for its original established purpose.

The Congress had devised peer review and NPDB as the way to reduce medical errors and keep the medicine safe from the public.  However, they entrusted the establishment, the hospitals and the established doctors, with the process.  They thought that the system would catch its own errors and reform itself.  Well, as it turns out, the system is not such a saint!  The situation with medicine today is reminiscent of the days when scientists of cigarette companies did their own research and declared that cigarettes did not cause cancer.

By and large, the people sitting in the review-committees themselves are interested in the bottom line – more surgery and more hospitalization.  But to make a showing that they are doing something in the direction of “reducing errors”, they hang their more conscientious colleagues and the ones who may be better guardians of public health.  The “bad apples” are thus throwing out the “good apples”. Dr. Charles Silver of Dallas, TX, has therefore said that the “noble act” (HCQIA of 1986) originally intended to monitor problem physicians, has gone totally in the opposite direction and, in many cases, decimated fine careers.  Such is the power of establishment, that wants to maintain the “status quo” and pays cursory lip service to quality in order to quiet the critics.

Dr. Gerald Moss wrote in The American journal of Surgery” in 1994:

Our better (usually younger) surgeons increasingly are placed in jeopardy by the unchecked ignorance and/or malice of their established colleagues.

The establishment has thus thwarted the intent of Congress.  As columnist James J. Kilpatrick points out in his column, their “candor” in review may be a camouflage for “cover up”.  Once the hospital has thrown out the conscientious and the competent physician/s under the false label of “bad apple”, the rest of the doctors can “play while the cat is away”.  They can do unnecessary surgery with impunity, hide each other’s mistakes, and generally forget about the public good.

The problem of bad faith peer reviews has come to the attention of the American Medical Association. However, the report (December 2001) of Board of Trustees fails to recognize and address many of the important issues as pointed out in this treatise.  They need to dig deeper and more diligently in greater public interest and come up with a better report.

 It is also unfortunate that the new report of Institute of Medicine (IOM) does not recognize or address the need to correct the severely flawed peer review process.  The IOM report, however, abandons the “good apple, bad apple” theory and correctly blames the “system” for majority of errors.  The AMA, however, completely ignores the “system’ contribution to medical errors.  Thus, AMA and IOM both miss the mark in recognition of the problem and offering solutions for better health care.

If patient care is to reign supreme, this problem must be tackled and solved.  AMA, state medical boards and societies, JCAHO and other concerned entities need to look into this matter seriously.  However, it may ultimately rest with the Congress to do something about it.

In February 2000, President Clinton announced an initiative to improve patient safety and reduce the number of medical errors by 50% over the next 5 years.  I believe that the following needs to happen to meet that goal:

  1. The hospitals need to stop playing favorites with some doctors at the expense of others and public health.  ALL members of the department should review the medical charts on a round-robin basis.  That would be more democratic, would it not?  No administration appointed group of physicians should tower above the rest and abuse its power.  The same should go for all hospital committees that control various functions.  The way some people have all the power all the time, is the root of all corrupt practices.
  2. Secondly, laws need to be put in place for independent and unbiased “external review”.  The external reviewers, when employed, should have no vested interested in the outcome of the review.  This option should be available to the reviewed physician. But, some of the so-called independent “external” organizations are simply “guns for hire”, we need to watch out for them.
  3. American Medical Association envisions an “oversight committee” in each state to prevent abuse of peer-review process.  This will serve as a check for sham peer reviews, avoiding local politics and conflict of interests.  Some states, such as New York, have an oversight mechanism needed for the check.  However, there is no mention of the “oversight committee” in the recent report of AMA.
  4. JCAHO and the medical boards should not just sit around in the face of calamity of justice.  Conspiracies like the one in my case are far too common.  They are not exceptions.  Vital public health interests are at stake.  If the hospitals can force physicians to review others with complete dishonesty, they can also force them to do more cesarean sections and hysterectomies.  The economic interests are so powerful, mere power of suggestion from the administration will do.
  5. The hospitals should be required to show that they have reviewed everybody in a similar fashion and nobody is being doled out a disparate treatment.
  6. Some measure of judicial scrutiny is necessary for the peer review process to be honest, fair and beyond reproach.  It is ludicrous to trust the administrators of hospitals with the altruism of defending the public.  The job of the administrators is to make money.  The strange concept of the need of a process to be completely hidden from public eye in order to achieve public good needs to be reexamined.  Secretiveness invites abuse.  The courts need to abandon their “hands-off” approach of today, public health is not just the realm of medical conglomerates, and the little man should be heard.
  7. Finally, there is nothing in today’s regulations that forces the hospital to do effective (non-perfunctory) peer reviews.  The hospital can merely make a showing that they are doing something and get away with it.  This situation needs to be remedied.
  8. Finally, the “system effect” on medical errors should be addressed.  These last two points are topics for a whole new book on the subject. 

With these measures in place, the peer-review and NPDB will have the desired effect of reducing medical errors and protecting public health.  By bringing honesty into medical practice, they may well reduce unnecessary surgery, reduce medical costs and save lives.  The congress and states need to take urgent steps to clean up the peer review process.  And to say the least, the media needs to promptly bring this matter to public attention.

Ron A. Virmani MD, F.A.C.O.G is still in litigation.

Corruption Threatens DC Whistleblowers

May 21 Wash DC: Next week, the Government Accountability Project (GAP) will host the 2010 Whistleblower Assembly in Washington DC. According to their latest release, the event is co-sponsored by Semmelweis Society International (SSI) – this despite receiving proof that their alleged connection to SSI is a pharmaceutically-funded fraud. Continue reading ‘Corruption Threatens DC Whistleblowers’

Requiem for a Loving Mother

The autopsy, pathology, and the clinical data and observation… show clearly that Christine did not suffer from any AIDS indicator illness during the two years prior to her death or at the time of her death. The gross and microscopic examination of Christine lymphoid organs and bone marrow appeared normal. The growth of P. jiroveci observed in Christine’s lungs and other tissues resulted from her treatment with corticosteroids during the 9 days prior to her death

When HIV skeptic Christine Maggiore passed away in December 2008, the PharmaSluts could not contain their elation.

Citing this LA Times report, gay activists and corrupt doctors claimed that Maggiore got what she deserved. What kind of money motivates for-rent professors like John Moore to write something like this on Seth Kalichman’s unscientific blog about a dead mother?

“Maggiore had the blood of thousands of South African kids on her hands after helping persuade Mbeki not to allow the use of Nevirapine to prevent HIV transmission from pregnant women to their children. She is also responsible for the premature death of her own daughter from AIDS. Allowing herself to die of AIDS-related pneumonia was unnecessary, but her culpability in the death of others is what she will be remembered for. Perhaps some of her friends will finally learn a lesson from what happened to her and cease their efforts to harm other people. But I doubt it, considering how crazy her fellow AIDS denialists are.

Moore is the same heterophobe who wrote to another Maggiore friend, “This IS a war, there ARE no rules, and we WILL crush you.”

Although nothing contained in Moore’s stories were true, that didn’t stop fake reporters like Jonny Steinberg or Moore’s South African blogger-buddies from claiming that Maggiore died from AIDS:

Unfortunately, no autopsy was performed on Maggiore’s body, and she was cremated. Presumably, her family made these decisions. AIDS denialists often claim that they are victims of conspiracies and cover-ups. But they have been anything but transparent in the way they have handled the horrible and unnecessary death from HIV/AIDS of Christine Maggiore.

Unfortunately for these rent-a-PhD propagandists and fake journalists like Anna Gorman, Alexandra Zavis and Adam Feuerstein, an autopsy was done. But unlike the politically rushed job by Los Angeles County Deputy Coroner James Ribe, pathologists David M. Posey, MD and Mohammad Ali Al-Bayati, PhD, DABT, DABVT have completed their eleven-month investigation into Christine Maggiore’s death and found that, like most allegedly HIV+ patients and millions of other Americans, died from complications related to preventable adverse drug reactions (ADR).

I kept Maggiore’s autopsy confidential so that the pathologists would not be influenced or pressured by someone from within the LA County Department of Health like Walt Senterfitt. While I have nothing against gay atheist anti-capitalist social revolutionaries per se, I’d rather not have them dictating healthcare to LA County’s 11 million residents or risk having them pressure doctors into faking evidence that John Moore and Daniel Kuritzkes MD can use for propaganda the way Moore and Kuritzkes did in 2006:

Christine Maggiore is a person who’s proselytized against the use of antiretrovirals to prevent HIV/AIDS. She’s a classic AIDS denialist, and she gave birth to a child who died at age three late last year of an AIDS-related infection. The coroner’s report clearly reports that the child died of AIDS.

Had Dr. Ribe reported the obvious signs of anaphylactic shock in 2006, Moore and Kuritzkes could not have exploited the death as AIDS-related the way they exploited Christine’s death this past year. After Christine’s death, Dr. Ribe settled her family’s claims against him.

This is why doctors Posey and Al-Bayati quietly and methodologically took eleven months to collect the evidence and complete their report.

Other excerpts:

Christine was a well developed and well-nourished Caucasian woman who appeared younger than her age of 52 years. She measured 66 inches in length and weighed 145 pounds…

Christine did not have interstitial pneumonia and the edema observed in her lungs resulted from her heart and renal failure induced by medications.

The autopsy, pathology, and the clinical data and observation described in this report show clearly that Christine did not suffer from any AIDS indicator illness during the 2 years prior to her death or at the time of her death. It has been reported that Christine’s serum was tested positive for HIV with subsequent testing indeterminate in the 1990s. The clinical findings in Christine’s case clearly challenge the clinical and scientific validity of the HIV test, if it is intended as a certain marker of gradual immune demise, which she did not manifest. (full report here)

Celia Farber comments as well.

House of Numbers Upsets Corrupt Scientists

The lady doth protest too much, methinks.

Over time, investigators learn how to identify common characteristics of criminal behavior. Whether the suspect is a lawyer, longshoreman or pharmaceutical company, the cues are often the same. Though some are as subtle as a heartbeat, one does not need a phlebotomist to hear them.

Despite the preventable deaths and injuries to thousands of trusting patients each year, billion-dollar drug companies routinely pay off prosecutors with profits bled from their victims. In 2009 alone, Eli Lilly and Pfizer paid billions to settle criminal charges and, despite the death and injuries, not a single executive went to jail.

Like common crack and heroin dealers, drug companies are friendlier to customers than to those who ask tough questions. If drugs like Sustiva and Nevirapine offered something more than a addiction and death, drug makers wouldn’t have to pay the activists at TAG, TAC and AIDSTruth to attack those who question their schemes with tactics taught by Marxist radicals.

Conceived in 1981 by shady scientists (who faced unemployment) and gay men (who refused to accept blame for their self-destructive behavior), AIDS was marketed as an existential threat to humanity. This 1983 report alleged that the number of AIDS victims was doubling every six months which, if accurate, would have claimed the lives of 100 billion people a decade ago.

Though my original investigation presents a synopsis of what has always been a political disease, no one has captured the high priests of HIV in flagrante as well as the documentary House of Numbers. In some ways, filmmaker Brent Leung has exposed them much the same way that Hamlet identified his father’s murderer.

Hamlet’s Play

As Shakespeare explained, Hamlet was suspicious. Weeks after the king’s sudden death, his mother (Queen Gertrude) married Claudius, Hamlet’s uncle. Hamlet suspects that Claudius murdered the king to marry his mother and ascend to the throne.

While suspecting is one thing, proving it is quite another. To expose the crime, Hamlet commissions a play to reenact the king’s death in hopes of pressuring Claudius to admit his crime. If Claudius and Gertrude are innocent, the play will have no effect. But if they are guilty, their responses will corroborate it.

As expected, Claudius is furious and plots numerous schemes that, in the end, expose the crime and leads to the demise of Claudius and his morally-confused queen.

Like Hamlet’s invention, House of Numbers exposes HIV causation and policy as something akin to Queen Gertrude’s illicit marriage.

Like Claudius, lab rats like Robert Gallo and John Moore are “shrewd and conniving in contrast to the other characters”:

Whereas most of the other important men… are preoccupied with ideas of justice, revenge, and moral balance, Claudius is bent upon maintaining his own power… Claudius is a corrupt politician whose main weapon is his ability to manipulate others through his skillful use of language. Claudius’s speech is compared to poison being poured in the ear—the method he used to murder
Hamlet’s father

Like Queen Gertrude, gay activists like Richard Jefferys, Walt Senterfitt, RN, MPH, PhD, and Jeanne Bergman PhD are:

… defined by (their) desire for station and affection, as well as by (their) tendency to use men to fulfill (their) instinct for self-preservation — which, of course, makes (them) extremely dependent upon the men in (their) life…

After initial refusals, the soft-spoken film student convinced one of the lab rats to agree to an interview, which resulted in a procession of lab rats who couldn’t resist the opportunity of having their egos stroked on the big screen with other scientific frauds. Unfortunately for them, no one memorized their alibis and the interviews of the planet’s most incandescent AIDS scientists and researchers quickly devolved into a food fight of he-said-she-said conflicts that culminated in Jay Levy’s impassioned five minute argument with himself. If not for the part they continue to play in the preventable deaths of thousands of people like Joyce Hafford, the ensuing hijinks would have been comical.

Like Claudius, the lab rats were so enraged that they drafted and signed this letter weeks before the film was released. Their queens joined them and issued thousands of libelous emails and letters to pressure film festival managers to censor the film.

Despite the pressure, House of Numbers has won ten awards at festivals around the world despite a few predictably ghostwritten attacks in the lame-stream media. After rave reviews at London’s Raindance Film Festival, The Spectator (UK) published Neville Hodgkinson’s expose, while political editor Fraser Nelson asked about the legitimacy of questions related to the link between HIV and AIDS. The ensuing comments (171 now) not only captured the rational comments of skeptics, but also the rage of apoplectic lab rats and the queens who defend them.

In this comment, Cornell’s John Moore argues:

I’m one of the scientists (the legitimate ones) that Leung deceived into appearing in this shoddy film. He used Sasha Baron Cohen-style tactics to sit in our offices and disguise his true agenda…

Whether questions were asked by Cohen or Leung, what possible impact would their questions have on the truthfulness of Moore’s responses? Although Leung did not pose as Kazak or a hooker, he elicited Moore’s honest answers the same way that Hannah Giles exposed ACORN. While Moore might’ve been friendlier to a man in heels, he fails to explain how Leung’s straightforward questions deceived him. Moore continues:

- an “honest investigation”? Yeah, right….. Leung is an AIDS denialist, pure and unadulterated.

Using Rule 13 of Alinsky’s Rules for Radicals, Moore 1) Picks his target and attempts to 2) Freeze It, 3) Personalize It and 4) Polarize It.” Like Galileo, Leung is a heretic – a non-believer of Moore’s deadly theology. Moore continues:

And his multi-million dollar and its promotional budget was paid for by a few wealthy AIDS denialist backers that Leung consistently refuses to identify…

This from the militant bagman whose servile complicity with the makers of HIV drugs and tests has resulted in illness, death and millions of dollars in pharmaceutical grants to his employer. Moore wants them identified so that fellow lab rats like Daniel Kuritzkes MD, who coaches journalists in the fine art of character assassination, can apply Rule 13 to them as well. In one speech, Kuritzkes complained that denialists like Peter Duesberg “still work in universities” and urged that they be “denied access to students and reported to authorities whenever possible.” Said Kuritzkes, “If this happens in your neighborhood ask the university authorities why they allow this and then write about it.”

Moore continues:

The film itself is deliberately edited to make AIDS scientists look bad, and to create controversy where none lies.

Although Moore’s lab rats issued the same allegations weeks before the film debuted, none have offered a single example – terrified of the filmmaker’s repeated offer to post uncut interviews so that viewers can decide for themselves. Like their political complaints of Prof. Duesberg’s scientific report, the lab rats can only blog their contempt. After 20 years, Duesberg’s paper remains unanswered.

Moore’s whining continues:

And of course Leung’s friends are made to look wise and thoughtful, honest questioners of the truth, when the reality is very, very different.

Wiser and more thoughtful than Moore?

Like I say, it’s Sasha Baron Cohen in action…… But of course this film is no comedy intended to entertain; its effect will be to cause yet more people to become infected with HIV and die of AIDS.

Moore’s arguments fail. Despite the unsupported numbers produced by profiteers, HIV is hardly noticed in the US or Africa (chart). Compared to a century ago, infectious disease is statistically nonexistent. But if we consider that AIDS consumes three-quarters of all US medical research funding despite its statistical non-existence, we can understand why the lab rats and queens believe that the political disease that funds America’s gay movement is more important than fighting real diseases like diabetes and heart disease. (chart). Moore concludes:

There’s much material on the AIDS denialists, who they are and what they do, posted on the AIDS Truth website. Read it and weep that such crazy and evil people can still influence others to make poor choices with their lives. And pay particular attention to the pages on “The denialists who died of AIDS”.

If we consider why HIV is so important to corrupt African regimes we will understand why HIV is so important to the Marxist South African propagandists at AIDSTruth.

As a career criminal investigator with nearly 30 years of experience, House of Numbers may be the most important documentary of the 21st century. Although I’m not a virologist, criminal behavior is less mysterious.

While Claudius, assorted lab rats and queens like Moore assume that ordinary people are too stupid to figure it out, the documentary and a review of the The Spectator comments will allow readers to decide for themselves.

Another Nobel Laureate Exposes AIDS Clerics

As if Nobel Laureates Walter Gilbert, Kary Mullis, Linus Pauling and 2600 other nominees, investigators and scientists weren’t enough, 2008 Nobel Laureate Luc Montagnier MD has broken ranks to expose HIV and AIDS as little more than a pharmaceutical marketing scam. As one of two alleged co-discovers of HIV, how clerics like John Moore and others defend themselves from Montagnier’s charges will be interesting to see.

Montagnier: We can be exposed to HIV many times without being chronically infected… our immune system will get rid of the virus within a few weeks if you have a good immune system.

Brent Leung: If you have a good immune system then your body can naturally get rid of HIV?

Montagnier: Yes.

Brent Leung: If you take a poor African who’s been infected and you build up her immune system is it also possible for them to also naturally get rid of it?

Montagnier: I would think so… It’s important knowledge, which is completely neglected. People always think of drugs and vaccine.

Brent Leung: There’s no money in nutrition, right?

Montagnier: There’s no profit, yes.

While the documentary House of Numbers (HON) continues to shock audiences around the world, pharmaceutical marketers continue to incite the gay inquisition against the film and those who promote it. As described in previous reports, most of these crystal meth radicals are supported by the makers of HIV tests and drugs and predators like George Soros who exploit them.

In many ways, HIV has become the de facto religion of the radical gay movement that parades under the pretext of human rights – as if cross-dressing, gay sex and crystal meth somehow equate to the abolition of slavery.

The AIDS Church requires believers to evangelize Robert Gallo’s unproven assumptions about HIV (1, 2, 3, 4) and subject themselves to a baptism of HIV tests. Once confirmed, believers receive a sacramental cocktail of highly addictive psychotropic drugs and DNA inhibitors so that members can suffer and die for their church just like Jesus.

Thankfully, the vast majority of men and woman (gay and straight) know better than to subject themselves to the church’s social marketing schemes – which may be why the Academy of Education Development and pharmaceutical companies are now paying ex-celebrities like Blair Underwood and Magic Johnson to target their own vulnerable communities.

Montagnier and Gallo are only two of the highly paid clerics who make fools of themselves throughout the documentary. It would be comedic, except that these clerics are complicit in the deliberate and unnecessary sickness and death of millions around the world – drug-caused mortality that continues to be used to perpetuate a fake epidemic that the American Medical Association cannot substantiate.

Years from now, researchers and students will watch recordings of those clerics with the same fascination we now share for humanity’s other historical monsters. Our amazed progeny will ask themselves, “How could millions of people around the world fall for such a transparent lie?”

Coming to a film festival near you.

AAPS Reports 93% of Doctors Oppose ObamaCare

The headline says it all… Obama invited physicians to discuss reform and then used their presence to give credibility to his plan. (video)  More information is posted at AAPS.

House of Numbers: Stunning!

“A stunning piece of filmmaking!”

That’s what Canadian filmmaker and Raindance Film Festival founder Elliot Grove said this week about Brent Leung’s documentary House of Numbers. Having worked on 68 feature films and over 700 commercials, Grove knows what he’s talking about.

Objecting to the wasted resources and union bureaucracy that prevents aspiring filmmakers from getting their features off the ground, Grove moved to London in the late 1980s and launched the Raindance Film Festival in 1993 – a festival devoted to independent filmmaking and its emerging talent. He has written books about, and lectures on, screenwriting and filmmaking throughout the UK, Europe, North America and Japan. In 1992, he set up the training division of Raindance, which offers nearly two dozen evening and weekend master classes on writing, directing, producing and marketing films.

After the film’s screening, Grove said:

I’ve just come out of screening of House of Numbers Brent Leung’s film… I hadn’t seen it until now. I was a bit skeptical because of all the furor around the film that has swirled around Raindance, but I’ve gotta say that it was just a stunning piece of filmmaking…

In another coordinated attack on free expression, the pharmaceutical industry’s marketing goons tried to pressure Grove into spiking the film:

We were flooded with hate mail, emails, legal letters couriered from the States from all sorts of people threatening us and accusing us of being prissy and smug about showing this film obviously from people who obviously hadn’t seen it accusing this film of being an “AIDS denialist” film and I’ve just seen the film and it’s obviously not an “AIDS denialist” film at all. It’s just a brilliant piece of filmmaking – journalistic filmmaking which, anyone who takes the time and effort to see it should completely re-examine their view of the whole AIDS/HIV question… I think history is gonna be re-written or should be re-written and perhaps this… film is one of the first steps.

This explains why the makers of deadly AIDS drugs and dangerously unreliable testing kits are so fearful of Leung’s film. Grove wasn’t deterred:

Regardless of the topic… as the way the film was put together, the journalistic approach and the skill of the filmmaking, the post-production, the music and everything reminded me of a British documentary… called Man on Wire… I’ve got to say that Brent’s film, House of Numbers was right up there – and Oscar season isn’t far away… It’s extreme, it’s honest… a really good piece of filmmaking.

Hollywood Gumshoe has posted more on the film here.

A View from the Exam Room

I learned a lot about the cost of health care when I had a hybrid general surgery practice in California ‘s rural San Joaquin Valley.  My practice consisted of uninsured women with breast cancer combined with a smaller percentage of cosmetic patients whose cash payments for “vanity care” subsidized the treatment of women unable to pay for needed medical treatment.
Although patients seeking cosmetic services tend to be healthy, I evaluated them like any other patient.  I asked about medical history, allergies, medications and genetic disorders.
Upon questioning Sherry S., a pretty 46-year-old seeking wrinkle relief, I learned that four of her immediate family members had been diagnosed with breast or colon cancer before the age of 50.  Alarmed, I asked why she had not had the recommended screening mammogram for more than four years.
She said that she knew already that her risk for developing breast cancer was likely higher than that of most women.
“But I don’t have insurance,” she replied.
A screening mammogram could be obtained for about $90 and was discounted or free at local facilities every October for “Breast Cancer Awareness Month.”
She smiled when I proposed a deal: if she were to get a screening mammogram within sixty days of her treatment, I would offer a discount on what she paid me for cosmetic services.
“I’ll think about it,” she said, then shelled out over $400 for BotoxTM injections that took me ten minutes to administer.
Five months later, when she returned for her next wrinkle treatment, she reported that she still had not obtained a mammogram.
I encountered patients who gladly paid upwards of $1000 in cash for laser hair removal treatments.  The paperwork filled out during their initial consultation asked them to indicate whether or not they had health insurance.
 
Several hair removal patients reported being covered by Medi-Cal, the government funded health coverage for California ‘s low-income population.
 
A friend of mine sells private health insurance plans.  He told me of the 39-year-old father of two whose family was quoted a monthly insurance premium of $250.
“Are you kidding?” he said, refusing the coverage. “That’s almost as much as my boat payment!”
When serving in the Rural Health Center in my community, my colleagues and I offered free or discounted care for a large number of patients.  Many were covered by Medi-Cal or one of dozens of state programs paid for by the taxpayers of California.
The following items were commonly seen on patients or carried by their dependent children, who were also covered by subsidized programs:
• Cell phones and “BlackBerry” PDAs, including just-released models with a price tag of $400, plus an ongoing monthly service fee of $65-$150
• iPods and portable DVD players
• GameBoys and handheld electronic games
• Artificial fingernails requiring maintenance every two weeks at a cost of $40-$60 per salon visit
• Elaborate braided hair weaves, $300 per session plus frequent maintenance
• Custom-designed body art, including tattoos covering the entire torso, neck and arms, as well as body jewelry piercing every skin surface imaginable-and a few unimaginable ones.  Custom tattoo work, particularly the “portrait-type” and “half sleeve” art popular in this area, runs from $100-$300 per hour and can require up to 20 hours of work, depending on the complexity of the design. 
[Author's note: in three years, I performed over a dozen operations as the result of complications related to infected or abnormally healed body piercings.  Breast abscesses were the most common pathology, followed by cauliflower-shaped keloid scars that interfered with function.  Blood-borne diseases can be contracted during amateur and prison tattoos and piercings, and patients self-reported Hepatitis B, Hepatitis C and HIV infections.  Treatment of the complications of body art among my patients was largely covered by Medi-Cal or left unpaid.]
 
From the office I shared with another doctor at the clinic, I had a clear view of the patient parking lot.  It was not unusual for me to see clinic patients drive away in late model SUVs or cars customized in the style popular in my area.   I was given an education about the after-market accessories I saw daily, including “mag” wheels, chrome trim, spinning hubcaps and fancy custom paint jobs.  Gasoline prices were particularly high in central California at that time.
I overheard patients and their children chatting as I wrote in their charts.  Many had an excellent command of the plotlines of cable television shows aired only on premium channels.  Basic cable in my area cost over $50 per month, with premium channels extra.
I also overheard the front desk clinic staff members explain politely to angry patients that they did, in fact, have to make $5 co-pays for an office visit or meet their $20 “Share of Cost” on a $600 bill as required by Medi-Cal.
Like many of my colleagues in rural communities with few resources, I did care for patients who actually lived in poverty.  For them, luxury meant keeping the utilities on and having clean clothes for a rare visit to the doctor.  In California ‘s Central Valley , “dirt poor” is not just a phrase.  But these patients, who rewarded me in ways that don’t fit in the lines on any tax return, were outnumbered by others who considered health care a lower budget priority than decorated skin and expensive toys.
Individuals in this country have a right to decide how — and how not — to spend their money.
But that right does not include accepting entitlements without sharing responsibility.  Doing so contributes to the high cost of care that burdens every unsubsidized patient.
If individuals prefer to buy luxury items rather than pay for their healthcare needs, that preference should not be rewarded while taxpayers struggle to foot their own bills.
Dr. Linda Halderman was a Breast Cancer Surgeon in rural central California until unsustainable Medicaid payment practices contributed to her practice’s closure. She now serves as the healthcare policy advisor for California’s Senator Sam Aanestad while continuing to provide trauma and emergency services in rural communitieswww.americanthinker.com