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Roman RuleThe Eternal Empire
By Melvin Pugh
AuthorHouseCopyright © 2011 Melvin Pugh
All right reserved.
Chapter OneDrugstore 9000
The current health-care reform initiatives and attendant controversies of the United States speak to the complex moral questions related to the underlying motives of those who have money and those that do not. The exorbitant medical carousel is indeed driven by phenomenal profit for—but not limited to—medical equipment manufacturers, pharmaceutical companies, insurance companies, and the Hippocratic Oath attendants-also known as doctors. In the most powerful country extant on this planet, we find things are not as they seem; perhaps this is intended in the quest to live a reasonable life, as free from illness as possible, with a good death, and somewhere on the high side of the average U.S. life-span. Vanity or perhaps feigned indifference may bring a brief moment of comfort, but make no mistake; the escape is temporary at best, as we are all destined to face the reality of money, politics, conflict, worry, sickness, and ultimately the final call.
There are those in government who blame the high cost of health-care on waste, duplication, fraud, and of course, greed. Most of these same individuals are very good at identifying the problems in the system but become eerily reticent in offering effective solutions to the various problems that plague the American medical-monopoly. The "medical arts" are intended to be as arcane and dogmatically complex as humanly possible, with the answer to the mystery being locked in a word known simply as mortality. For many, this encompasses the totality of life existence in our fragile, electro-chemical, carbon-based vessel that we sometimes abuse but always rely on as the only true home for our most cherished possession. Here lies the essence of being; the government and the medical industry know that regardless of individual station, no other issue fully encompasses the life cycle. By virtue of biogenic and geopolitical intricacy, the powers-that-be control a significant aspect of all humanity and untold wealth.
Medicine, by virtue of its nature, is not an exact science; this is perhaps the most compelling component of the curiosity that motivates the physician in the healing art. This premise is directly attributed to the father of medicine, Hippocrates (460-377 B.C.). After nearly 2500 years, the "Hippocrati" and their subsequent descendents are credited with handing down many of the best practices or "dogma" related to the healing arts. Also known as "dogmatici" (dogmatics), these early physicians, of Greek origin, included Thessalus and Polybus; through their practice and teaching, they were instrumental in influencing their Roman conquerors in the adoption of structured medical practice, during the period of 400 B.C. From this era, and for at least seven centuries, the best practicing physicians were of the Roman Empire. The incessant wars perpetuated by the Romans contributed to advancements in surgery that were practiced in the first "MASH" units developed under Marius, one of Rome's fiercest warriors and most revered generals.
By the 2nd century A.D., Rome had produced not only noteworthy physicians but also major medical-arts practices still utilized in modern medicine; these include the sterilization of surgical tools in boiling water and using fresh utensils for each patient. Aulus Cornelius Celsus is considered to be one of the principal medical adherents to detailed records in procedure and practice of the healing arts. Historians call his record, The Eight Books of Medicine, the most comprehensive detailed description of surgical procedures ever produced by a Roman writer. In these writings Celsus formulated and promoted the principle that "accurate diagnosis must precede treatment." The prolific writings of Celsus could also be considered the forerunner of the "charting" prevalent in medicine today. It was during the reign of Emperor Augustus that the first Roman medical organization was formed, and history suggests that Celsus was the catalyst in its creation.
Galen holds the distinction as the most renowned doctor of antiquity and, although technically from Greece, he is considered the principal doctor of Rome. Galen also promoted the discipline of record-keeping and distinguished his medical practice by the use of drugs, such as opium, during surgery. It was Rome, and its avant-garde (for the times) approach, that developed the first hospitals for observation and dedicated rest and recuperation. By 164 A.D., Greco-Roman medicine had advanced to include specialization among physicians, including interns, urologists, ophthalmologists and thoracic surgeons. One of the most compelling aspects of medicine in antiquity is the fact that there were some good doctors and some very bad. Only the rich members of the aristocracy obtained the services of the best doctors; obviously the doctors that were near or equal to Galen were reserved, and the plebeians (low members) of society received mediocre doctors and treatment—which tends to mirror, to some degree, modern times.
There is any number of speculative reasons why medicine and the healing-arts in general drifted into abeyance during the Middle Ages. After the fall of Rome, the early Middle Ages, also called the Dark Ages, were a time of rampant paganism and necromancy. This environment bred medical indifference among vast numbers of warring factions, tribes, subcultures and even the detached pockets of Christians. With "black magic" as comfort and superstition as a guiding principle, who needs a doctor? Centuries passed before the Age of Enlightenment heralded the serious establishment of medicine as a science and a business.
In England, it was Henry VIII in 1518 that formalized and founded the Royal College of Physicians. This group of doctors went on to establish the first rules governing all aspects of the medical-arts at that time, including a defined charter by 1540 and a special "Quacks" charter in 1542. In 1617, the Society of Apothecaries was also formed in England.
By 1832, The British Medical Association (BMA) had been formed; this would later be the model for creating a similar association in America—which could be considered the beginning of the medical-monopoly that exists today. In the period from 1700 to the early days of the BMA, the notable inventions of nitrous-oxide (laughing gas) by chemist Sir Humphrey Davy gave doctors a new more versatile anesthetic. His apprentice, the brilliant scientist Michael Faraday, continued his work and ultimately Faraday became famous in his own right. With the refinement of morphine from opium in 1804, the physician now had two highly effective anesthetics, (besides the opium) which contributed to advancements in surgery.
Morphine was extensively used during the American Civil War and was administered with a newly developed device we know as the hypodermic syringe. Not until 1853 was there a fine-needle, capable of easily piercing the skin, developed and mass-produced. This medical turning point, the ability to administer a broad spectrum of medicines without the problems associated with the digestive system, allowed doctors to use less medicine with quick-acting results but also purportedly led to "soldier's disease" and a high incidence of morphine addiction.
The American Medical Association was officially founded in 1847, and although there were some successful physicians at the time, it would be 30 years before medical licensing and the purging of "irregular practitioners" (quacks) made the agency respectable. From the outset, the leadership aggressively set out to consolidate its dominance in medicine. In identifying the influence of the medical schools over the hospitals and the medical examination boards over the medical schools, the AMA sought and eventually gained control over the various state medical examination boards. The AMA began rewriting licensing laws, as well as the medical school curricula. The number of schools began to decline, along with the number of doctors; this was the start of the AMA imperative, and the remaining doctors' salaries and prestige began to rise dramatically.
With the American Medical Association in firm control of health-care at the start of the twentieth century, a new paradigm for medicine, doctors, hospitals, insurance coverage and a quasi-control of government began to emerge. The first order of business, more money in the doctor's pocket, had effectively been established with control of the licensing and review boards. The head of the AMA, Dr. George H. Simmons, created the culture of the AMA being the absolute arbiter of all things pertaining to medicine. Dr. Simmons came up with the idea of publishing the Journal of the American Medical Association, with the expressed intent of gaining advertising revenue and giving the "seal of approval" to select drug companies. This was a brilliant business initiative and by 1909, JAMA was generating revenues of $150,000 per year. In addition, its subscriber ranks grew from 8,000 in 1900 to more than 70,000 in 1910. Having your product endorsed by the AMA proved to be very lucrative for all concerned; and although there were controversies pertaining to extortion and unethical business practices, Dr. Simmons relentlessly pursued and established AMA preeminence in the world of medicine.
Dr. Simmons was pro-active in finding a suitable second-in-command, and ultimate successor, in Dr. Morris Fishbein. By 1924, the multiple scandals associated with Dr. Simmons forced his resignation and heralded the ascendancy of Dr, Fishbein. What his predecessor might have lacked, Dr. Fishbein more than compensated for with an aggressive business model that made Dr. Simmons look like a Boy Scout. Dr. Fishbein wrote derisive books and attacked all forms of competition with assiduous conviction. The competing health doctrine, known as homeopathy, was excoriated and given the moniker of "cult." Fishbein attacked "health fraud" in multiple media, including syndicated newspapers and his own weekly radio show heard by millions of Americans; this was during a time when radio had profound cultural influence. There were occasions where Dr. Fishbein attempted to buy promising health-care treatments and apparatus; if the perspective owner refused to sell the rights, the individual was attacked, derided, and ultimately destroyed. If the individual was a doctor, he was labeled a "quack" and punished through AMA channels; if the person was a layman, Dr. Fishbein would have the individual arrested for practicing without a license or have the product confiscated by the Food and Drug Administration (FDA) or the Federal Trade Commission (FTC). The first evidence of medical tyranny reared its ugly head, and you did not want Dr. Morris Fishbein as an enemy.
These abuses caught up with Dr. Fishbein in 1937, as he and the AMA were tried and convicted of anti-trust violations for conspiracy and restraint of trade. But a huge bank account does wonders, as Dr. Fishbein—and the AMA—rebounded and, with the help of a new ally, grew exponentially more powerful. That new partner in commerce was the tobacco companies—Camel and L&M in particular. By 1950, JAMA was making in excess of $10 million dollars in advertising revenue annually from the tobacco companies alone. Like his predecessor, Dr. Fishbein was eventually forced out in 1949; but unlike his mentor, he picked up a high-paying consulting job with one of the tobacco companies that he had helped to grow market share and profit.
By the decade of the 1960s, the AMA had established its organization among all the monolithic power brokers in the capitalistic realm, the operative word being capital-and more money. The AMA, starting in 1927, had stopped, modified, influenced, or outright controlled most of the legislation related to health-insurance adoption and had become adept at molding the rules of the game to suit its growing cupidity. The Medicare bill of 1965 is one of the most definitive examples of the AMA taking a government program intended to help the aged and, by using advanced undermining techniques, turning the program into a taxpayer-funded channel of largess to the members of the AMA. This was (is) done through creative billing practices and lobbying law makers for exemptions and special concessions intended to covertly fleece the Federal Government (the people) by stealth. Through high-powered lobbying and the blandishment of commission members, the AMA was able to alter pay schedules to the benefit of the doctors, make medical malpractice lawsuits (which encourage defensive medicine) harder to file, and completely protect doctors from anti-trust litigation. The fee-for-service aspect of Medicare billing monetarily encouraged doctors to perform more services; when Medicare froze fees; the doctors simply ordered more patient visits and medical tests.
The American Medical Political Action Committee (AMPAC) is perhaps the most powerful PAC in the United States. Its power stems from the relentless campaigns to get "their" men in positions of power and the philosophy of "socioeconomics." The AMA is further augmented by the joining of forces with the equally powerful Pharmaceutical Manufacturers Association (PMA). Through the combined wealth of the AMA and the PMA, the possibilities of monopolistic and anti-trust activity are beyond the imagination of the average layman. In 1974, Congress sought to pass comprehensive campaign reform in an attempt to attenuate the power of the AMA-PMA. It was a study in futility. In 1976 Congress added amendments to the 1974 campaign act, but again the AMA-PMA found loopholes in the laws and were able to get their candidates all the money they needed—nearly $1 million—to run in an election cycle.
There are hundreds of examples of abuse of power in the American Medical Association and their ubiquitous partner, the PMA (big pharmaceutical) companies. In the last 40 years, the symbiotic relationship between the AMA and the PMA has combined to form a medical oligarchy. During the early days, the AMA was the dominant partner in the ascendancy to the position of power now held by the medical-monopoly. With advances in technology and pharmacology, big pharmaceutical companies have now taken the lead, in an apparent "tail wagging the dog" reversal of fortune. This is not to say that doctors, or the AMA, have been relegated to second-class by any measure. The AMA still contributes to the success of the drug companies by assisting or conducting clinical trials and endorsing the use and proliferation of various drugs. (Note the eagerness of doctors to give out samples of drugs to their patients). This is not magnanimity, but shrewdly crafted advertisement and the quest to get patients hooked on the new drug; ultimately perpetuating sales and profits for the drug companies. (Note the prodigious spending and promotion of various drugs by the drug companies in television advertisements).
The advent of laws (patent limiting) pertaining to the original drug versus generic (cheaper) drugs being allowed to compete in the market place, may have weakened some of the larger drug companies to some degree. This has apparently contributed to the top drug companies merging and forming mega-drug-companies to maintain their supremacy. In 2009 alone, drug company Pfizer purchased Wyeth for $68 billion dollars, making the combined units the largest single drug maker on the planet. Just six weeks later, Merck purchased Schering-Plough to become the second-largest drug manufacturer. In both mergers the purchasing company cited the need to combat competition from generic drug makers and price.
Drug makers contribute to the challenges associated with health-care reform and are thus characterized as the greedy and demonic chemical peddlers. Some of this derision is justified. However, if the average person knew of the complexity, time, and billions of dollars associated with the development of certain drugs, not to mention intellectual property rights, they too would want to recoup their investment and enjoy some of the profit and spoils contributing to a "better life through chemistry." The drug makers have created a need for their products—in some cases—by making drugs that were later determined to have caused medical maladies, thus perpetrating a further need for a "miracle" cure and an additional, irrefutable purpose for the pharmaceutical industry.
One example of this relates to vaccines. Vaccination has been integral to medicine for over two centuries, dating from Edward Jenner and his smallpox vaccine (1796). The early success Jenner experienced contributed to the founding of immunological medical-science and an improvement in the human condition. But, like all scientific advancement, there are associated controversy and risks.
The era of the first polio vaccine (1954) and famed epidemiologist Jonas Salk speaks to a period when the Salk vaccine was the panacea for the scourge of the crippling poliomyelitis. Because of the tremendous fear of being paralyzed by polio, any successful preparation that gave hope was accepted without question. For the most part, Dr. Salk and others made a tremendous contribution to the eradication of polio in the twentieth century. Polio became a polarizing issue with respect to research credit, politics, money, and ultimately fame. John Enders received a Nobel Prize for his discovery of how to grow the constituent parts of the polio virus in a laboratory setting; it was Salk, however, that advanced the use of inactivated virus in the making of a usable vaccine. Dr. Salk took much of the credit for the vaccine and may have even disparaged a colleague-turned-enemy in one, Albert Sabin. The story is well chronicled and even includes Communist Russia as an aside. It would be interesting to find parallels in the career of Galen.
Excerpted from Roman Rule by Melvin Pugh Copyright © 2011 by Melvin Pugh. Excerpted by permission of AuthorHouse. All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Table of Contents
Buy Some Money....................20
Blood for Oil....................42
Peak oil versus Peak grain....................55
More Bread and Circuses....................71
The Philosophy of Truth....................86