Profits Before People


I recently had an interesting experience regarding insurance and providers (among hundreds over the years). It triggered some thoughts regarding our system of health care. Perhaps, I should call it by its proper name, Sickness/Disease Care.

My credentials for such observations include being a patient, spouse, parent and grandparent of patients, having sold insurance and being a health care provider. I hope this rather unique perspective helps readers understand what has been going wrong with our so called Health Delivery System.

In this particular incidence, our insurance policy refused to cover two different blood tests. Even though they were necessary prior to performing surgery on my wife, they were not covered. They involved, among other things, determining if there was a genetic possibility of either blood clotting or hemorrhaging. One would think this would be appropriate prior to major abdominal surgery.

I called Sonora Quest about the charges and suggested that perhaps instead of $374.22, I could pay the amount they would normally accept as reimbursement from an insurance provider (usually half of less). I was told this could not be done because the contract between the insurance company and the provider did not allow this.

That reminded me about my years of treating patients (40+). The insurance companies had the right (without warrant) to review all patient billings and records to, among other things, make sure those without insurance were being charged the same price as those who had coverage. If a provider was charging uninsured patients less, the company would then consider the lower price the provider’s actual price and force them to pay back the difference going back to “forever” PLUS interest. In other words, the insurance industry has been discriminating against those who could not afford insurance and punishing those providers who were trying to “do the right thing.”

Speaking as a former provider, I can affirm that for the past many years, the insurance industry has made sure their investors receive a significant return by regularly decreasing reimbursements. At the same time, they increase copay amounts making it more difficult for the patient to afford basic care.

As with all businesses, it costs health care providers a certain amount to provide their services. These include rent/mortgage, insurances, utilities, equipment leases/purchases, staff salaries, billing, workers compensation, Social Security contributions, computers, printers, programs, printer paper and toner. Oh, yes, toilet paper, soap, paper towels, patient gowns and many other little necessities, depending upon the services provided. Fees are set so a reasonable profit can exist for those who provide the actual care.

I have observed that fewer doctors are willing to take Medicare patients or limit the number they accept in a given period of time. The reason for this is they actually LOSE money with each such patient they accept and treat. Remarkably, insurance companies claim you can make up the deficiencies by spending less time with patients and seeing more of them. The logic escapes me.
Sadly, it is getting the same way with insurance providers besides Medicare. Many health care professionals have begun to practice “Concierge Medicine” where you pay a flat fee to the doctor and he/she will take care of you as much as you need. They do no insurance billing and know that they will at least make a reasonable return on their own investment in education and business.

Did you know that Medicare has their own “police force?” Without warning, they can enter any facility and review all billing to make sure EVERY bill is completely accurate. On the surface, that sounds great. In fact, it has been so successful that they have now sub-contracted outside companies to do their “no search warrant required” review of provider records. You probably also don’t know that this has been so successful that the money collected has significantly, beneficially affected Medicare’s bottom line.

A very large medical specialty group locally had such an audit. After careful evaluation, they found that in some cases there was over billing and also under billing. The audit showed that Medicare actually owed that facility money. Instead of paying what was owed, that facility was fined $1,000,000 because errors were made in the billing process. All were found to have been simple coding errors and not an attempt to cheat the system.

It appears that they require perfection while never practicing it themselves.

Many years ago, I attended a professional meeting at which the director of Blue Cross/Blue Shield spoke. At the time, they were the Medicare providers for the State of Massachusetts. When asked about errors made by his company, he replied, “We correct computer entry errors once each year.” He acknowledged that if they missed any corrections at that time, the patient and provider would have to wait another year. He didn’t appear to be the least bit embarrassed about what he said or the process his company used.

I had become a pioneer in the field of using Low Intensity Lasers/LEDs for treating pain and wounds. The only appropriate billing code is for Infrared Therapy (the light wavelengths include infrared). A patient asked me to bill his insurance company (Blue Cross/Blue Shield) for the hour long treatment. Since Blue Cross/Blue Shield of Arkansas, Tennessee and California covered the treatment and paid fairly well for it, I agreed. I received a letter in return stating that BC/BS does not cover that treatment because it considers it to be experimental. I sent a response which included the FDA approval certification and reminded them about BC/BS covering it in other states. Their response was, “We do not cover this treatment because we consider it to be experimental.”

As the insurance laws are written, if an insurance company states that they consider something to be experimental, they do not have to cover the costs. It doesn’t matter if it is FDA approved and used at the Mayo Clinic. As long as they SAY they consider a procedure to be experimental, they can and do refuse payment.

Have you noticed the number of expensive advertisements in print, television and other media that are promoting medical insurance plans? It always gets more intense around the time for Medicare renewal. The very same companies that complain about costs, are vying for your business. Does it make sense for companies who complain about losing money to spend so much to get your business so they can lose more money?

Speaking of health care insurance plans losing money, I have some numbers for you. These are available to anyone who looks for them. The dollar amounts are NET income for the 2016 business year. United Health Care Group, SIX BILLION, EIGHTY MILLION dollar profit. Aetna, TWO BILLION, EIGHT HUNDRED MILLION dollar profit. Humana, SIX HUNDRED FOURTEEN MILLION dollar profit. Blue Cross/Blue Shield parent company, TWENTY-SEVEN BILLION SEVEN HUNDRED MILLION dollar profit. Interestingly, even with that amount of profit, BC/BS was granted a 20% fee increase by the State of Texas. United Health Group claimed they lost $720,000,000 compared to 2015. They STILL had a net profit of $6,080,000,000.

I found it interesting that the highest dollar amount spent for lobbying in the United States involved the health industry. In 2016 it reached $509,580,000. Theoretically your premiums could be lower and their profits could be higher with less money spent on lobbying. Then again, BC/BS probably wouldn’t have gotten that 20% premium increase in Texas.

As I said previously, I once sold insurance. I worked for Horace Mann Insurance Company which was eventually taken over by the CNA Insurance Group. My job was to sell as much Permanent Life Insurance policies as possible. However, when I met with young couples I realized that the chances were far greater that he/she would become disabled rather than die. I had already benefited from disability income after my first operation to remove a benign tumor from my spine.

I suggested they purchase enough Term Life Insurance to be able to sustain their spouse/family for about five years and also get a disability policy. It made sense then and makes sense now.
My sales manager was not as happy as the couples and I were. It seems that there is far greater profit in Permanent Life Insurance than there is in Term and Disability Insurance.

Clearly, I am a believer in the profit model. I have no problem with any business, including the insurance industry and stock holders making a profit. Sometimes, I do wonder if the concept of caring for people ever enters the equation for insurance companies. I also wonder if there will ever be a ceiling to the amount of profits compared to the needs of the public.

The American system should be more like those in other countries who focus on Health Care rather than just Disease Care. Doctors are rewarded for getting patients to stop smoking, lose weight and exercising. Preventive care is paid for. Doctors can actually earn a living that covers their investments in education and their business.

Sadly, family practice/primary care doctors are earning less than workers in fields that require no education beyond high school or GED. Many are retiring early and rarely encourage their children to follow in their footsteps. I base this on my experience with such doctors locally and a national shortage of those in that specialty.

As evidenced by the rate increase for BC/BS in Texas as well as similar increases for all insurance companies throughout the United States, the tail seems to be wagging the dog. They are controlling how a doctor can practice health care, what tests can be run, what medications can be prescribed (that will be paid for on behalf of the patients), how many patients have to be seen per hour and preventing providers from helping patients who can’t afford to pay insurance premiums. They regularly have decreased provider reimbursements with impunity and force patients to pay higher and higher co-pays. In some cases, co-pays are higher than the actual fees.

Our so called health care system is, itself, very sick. In fact, it has almost reached the classification of critical. NO ONE is really addressing what is really wrong with our system. It should be relatively easy to remedy. Instead, we just have political battles. Sadly, the system appears to have a terminal condition called, “Profits Before People.” Until a BALANCE can be reached, the majority of Americans will continue to suffer while a small percentage will see their stock values increase.

So far, no state or national leaders have demonstrated the balls or ovaries to make the necessary changes. I wrote a proposal for a privatized national health care plan in a previous blog. I try not to just complain. I try to present some solutions. I am willing to read any suggestions that others may have.

As always, I encourage you to NOT BELIEVE what I have written. Please do your own research.

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The Flag and National Anthem


Thomas Jefferson at age 16 attended the College of William and Mary. At age 19 he studied law for five years starting under George Wythe. At age 23 was elected to the Virginia House of Burgess. Age 31 he wrote and distributed, “Summary View of the Rights of British America.” He became a delegate to the Second Continental Congress at age 32. At age 33 he wrote the Declaration of Independence. He was elected second Governor of Virginia at age 36, succeeding Patrick Henry. He served in Congress for two years starting at age 40. He became the first Secretary of State under George Washington. At age 53 he was Vice President then President of the American Philosophical Society. At 57 he was elected third President of the United States. At 61 he was elected for a second term. When he was 80 he helped President Monroe shape the Monroe Doctrine. At age 81 he created the University of Virginia and served as its first President. He died at age 83 on the 50th anniversary of the signing of the Declaration of Independence. He has been credited with many great accomplishments and comments. I quote just one here.

“To compel a man to subsidize with his taxes the propagation of ideas which he disbelieves and abhors is sinful and tyrannical.”

THIS is another reason I support those who kneel during the National Anthem. I stand to honor my uncle, Lenny Rubin, who was killed on June 6, 1944 during the Normandy invasion. It is not only their First Amendment right to kneel, but also their obligation as Americans. Of course, I’m sure there are many people who are smarter and more accomplished than Thomas Jefferson who will disagree. I support their right to believe and say as they wish. Doing so absolutely doesn’t make them better Americans.

There is actually another aspect of the National Anthem which is or should be, in my opinion, considered even more disrespectful than kneeling.

Singers glorify their voices rather than the lyrics and meaning of the song. It should be a showcase for this nation, not how great their voice range can be.
There are also those who stand, hand over heart and begin cheering loudly LONG BEFORE the National Anthem has ended. This has also become the accepted custom. Again, it disrespects the lyrics and meaning of the National Anthem and cheapens its meaning.

Both are very disrespectful. However, such disrespect is acceptable, but kneeling, as a response to the “sinful and tyrannical” behavior of our government and a large percentage of its citizens is singled out as being disrespectful.

Choosing which parts of the Constitution, amendments, Bill of Rights, meaning of the Statue of Liberty and various laws that one likes and ignoring others certainly does not make them better Americans.

The Pledge of Allegiance says as follows: I pledge allegiance to the flag of the United States of America and to the republic for which it stands, one nation under God, indivisible with liberty and justice for all.”

Indivisible? This nation is more divided than any time since the unCivil War (if for no other reason than there are so many more people, but lots of other reasons as well).

Liberty and justice for all? If it weren’t so sad, it would be a great punch line for a political joke. Whites get off for raping a girl, but people of color get essentially a life term for the same crime. Blatant racial profiling being pardoned by the President of the United States. People waving the American flag AND a Nazi flag are just exercising their constitutional rights, but those demonstrating against them are responsible for any physical altercation.

Eligible people are prevented from voting. Presidents and Congresses steal money from Social Security to pay for unnecessary, unwinnable wars and cover related budget deficits.
The United States being the ONLY industrialized nation to not have a single payer universal health care plan for all its citizens.

The very meanings of the Flag and our National Anthem have been severely diluted.The Statue of Liberty is virtually meaningless. As mentioned above, we have accepted the general disrespect shown our National Anthem, but choose to condemn those who kneel. However, according to one of our greatest founding fathers, they are not only exercising their constitutional rights, they are obligated to do so.

As I have said in the past, I am a disciple of George Carlin (without all the bad words). He was and still is, in my opinion, America’s greatest philosopher and social conscience. He said, “Question everything you read (see, hear).” I try my best to not get caught up in the emotional aspects of social/political issues. I try to intellectually analyze what is going on. What I have written above is an example of such an approach.

I believe the extremes in this country, both far Left and far Right are more dangerous to our constitutional way of life than any foreign terrorists. We need more moderates who are more willing to work together to solve important issues. In my opinion, number one on that list should be term limits for members of Congress. But that’s a topic for another blog.

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We Pay For The Sins Of Our Youth


The information presented here came from research by Marie Suszynski (reviewed by Farrokh Sohrabi, MD) and my 40+ years of treating patients including professional and college athletes.
When you were younger, kid and young adult, did you sprain and ankle, knee, have back, wrist shoulder, foot pain after an activity? If so, like most of us, yes, including me, it was ignored without treatment or shortly after recovery with treatment.

According to Joshua Baker, MD, assistant professor of medicine at the Hospital of the University of Pennsylvania and the Veteran’s Administration Medical Center in Philadelphia, you could end up with arthritis in the involved joint(s) several years later. From my professional experience, change the word COULD to PROBABLY.
As many as 15% of people who have been diagnosed with osteoarthritis may have developed joint problems as a result of injury. Damaging a joint raises your chances of developing arthritis seven fold according to the Academy of Orthopedic Surgeons. Again, from my experience, that percentage is more like 75. The surgeons see only those who seek a surgical opinion/solution.

According to Louis Kwong, MD, chairman and program director of the department of orthopedic surgery at Harbor-UCLA Medical Center in Torrance, California, having a bone fracture, tendon or ligament injury makes you more likely to develop arthritis in that joint in the years to come. A classic example of someone with post-traumatic arthritis is the high school athlete who tears a ligament (partial is a sprain) or cartilage in his or her knee and ends up with arthritis, sometimes decades later, according to Kwong.

He further stated that an injury sustained in a car accident is another type that could cause post traumatic arthritis. Your knees or ankles could be crushed, your wrists sprained, a hand broken or your back/neck would become strained as a result of a sudden jolt. Even a relatively minor event could eventually lead to arthritis— like an ankle sprained while hiking or a slip on ice that leads to a sprain or fracture.

Kwong also states that people can slow the progression of arthritis by keeping their body weight within a healthy range and exercising. He also encourages people to be conscious of the stress they put on their joints every day. If two men have high school football injuries and one goes on to have a desk job while the other is a construction worker, the construction worker is more likely to get early onset arthritis.

The arthritis could be osteoarthritis or an inflammatory arthritis such as gout, according to Anjali Casey, MD, Rheumatologist with North Shore University Health System in Skokie, Illinois.
Even when doctors treat the injury immediately after it happens, treatment can’t make it as through the injury never happened.

Any sport can cause a fracture or injure a ligament or tendon. Quickly changing direction on a soccer field, stopping suddenly while playing tennis/hockey, landing the wrong way on a basketball court, crashing into another player, hyper-extending the spine or a joint in gymnastics resulting in pain can, and quite possibly will, lead to arthritis later on.

A 2010 study of nearly 2,500 people in Iceland, showed that men with strenuous occupations such as farming and fishing were more likely to need total knee replacement or total hip replacement surgery because of osteoarthritis, compared to managers and professionals in non-strenuous occupations.

An example in my practice was a woman in her late 20s who had bad neck pain, with some numbness and tingling in her hands. Her x-rays showed a reversal of her normal lordosis (forward curve) in her neck and significant osteoarthritis. The latter was far greater than one would expect in someone her age. When asked if she had a car accident or played varsity football in high school, she replied no to both. I was perplexed. The third time she came in for treatment, she said she remembered that age 16, she flew out of the windshield of a car, landing on the side of the road. I was no longer perplexed.

The same has been evident in teenagers and early twenties for those who were in gymnastics and cheer leading at an early age.

There are many good treatments. Medicines, as you will see on television ads, have many negative side effects. If you are suffering, you need to decide if the benefits are worth the risks. Chiropractic, Light therapy, diathermy, GENTLE physical therapy are good choices with virtually no negative side effects.

The title of this Blog is, “We Pay for the Sins of Our Youth.” In truth, we didn’t know or wouldn’t have believed that our activities could cause long term damage. I always cringe when I see young children carrying their younger siblings. The pressure on their incompletely developed joints and spine are far more than they should possibly bear. Even that common day occurrence is the precursor to early onset arthritis.

Teaching youngsters how to throw a curve ball when pitching puts extraordinary stress on the elbow and wrist joints. This is a set-up for future arthritic problems.

Now you know. What you do with this knowledge is up to you.

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Privatized National Health Care—A Plan

About 30 years ago, a friend and I sat at lunch and talked about an idea he had about a national health plan that would cost taxpayers virtually nothing. We bounced ideas back and forth and then left. I continued thinking about it and made several modifications. However the basic premise remained the same.

Using simple numbers, assume the U.S. population to be 300,000,000. Congress will grant the six largest health insurance companies limited anti-trust immunity, similar to that enjoyed by professional baseball. This would apply to other insurance companies with whom the original six companies may choose to sub-contract.

Congress would also set up regional oversight committees, consisting of representatives from ALL professions, but with a voting majority belonging to lay persons. Those committees, in turn, would appoint representatives on a rotating basis to meet nationally to review possible abuses in the system.

The only other thing Congress has to do is pass legislation establishing the severest possible penalties for any and all individuals involved in cheating, bringing profit for themselves and/or the company they work for. I suggest 20 years in prison for the first offence without possibility for parole for all people involved AND supervisors who knew or should have known about their activities, including CEO’s. It is called accountability and necessary with dealing with billions of dollars.

The main companies, without tax dollars, will divide the population as evenly as possible. This would mean about 50,000,000 people per company. There would be mechanisms to “tweak” the number of individuals from all socioeconomic groups, health risk categories and age groups.

Why would this work? Even at only $10.00 per person per month, each company would bring in $500,000,000.00 per month or 6 billion dollars per year. That number could be higher if necessary, but this is a lot of money (why penalties have to be so harsh for cheating). With this amount of income, the six companies have tremendous purchasing power and can actually dictate process to the drug companies and other suppliers to health care facilities, etc.

There would be plenty of money for more doctors, to cover ALL conditions and actually provide preventative health care (good for their bottom line).

What about those who just can’t afford $10.00 per month per family member? This is where religious, civic and charitable organizations come in. Again, there would be NO TAX DOLLARS.

There will be profit for all of the insurance companies. They will pay regular taxes just a those paid by any other business. There will also be a Congress generated stipulation that at least 50% of the corporate profits (after taxes) have to be re-invested in the U.S. economy.

Every man, woman and child would be covered. Every form of treatment would be covered on an equal basis.

Of course, the amount could be higher than the $10.00 mentioned. Then again, it wouldn’t be but a small fraction of what is currently proposed. In truth, most people do not use their health care policy during a 12 month period. The possibility for profit is staggering, in spite of an aging population. The average citizen will be healthier and doctors, not HMO’s will once again practice medicine. They can prescribe tests and medicines that are necessary. People will not have to choose between food, rent, gasoline and medications. Doctors will once again be able to be reimbursed a reasonable fee for their services.

This is a template. It can work. The weakest link appears to be Congress. This plan was submitted to Congressmen Kolbe and Giffords. It was also sent to Senators Di Concini and McCain. A patient of mine is an attorney really tried to tear the plan apart. He finally said, “This could actually work”. He called his son, a lobbyist in Washington, D.C. (actually living in Phoenix) and asked him to check into this. A few days later, the son called to say that the plan had been floating around Congress for about 20 years.

It is reasonable that members of Congress could be concerned. After all, for the most part after passing a few regulatory laws, the government is out of the picture. They would certainly resent the thought that they would have to be part of the same insurance coverage that every other American has.

It is reasonable that the insurance industry would neither like the accountability aspects nor the requirement about re-investment of profits into the American economy.

For certain the pharmaceutical companies and other suppliers wouldn’t like it because they could no longer have total control over what they can charge for their products.

No doubt there will be many of our citizens won’t like this plan mainly because they are human and Americans. They resist anything just because they able to.

A patient of mine was a member of the American Arbitration Association. He said the measure of whether arbitration was successful was the reaction of the participants. If all parties walked away a bit dissatisfied, then the arbitration process was very successful. Based upon these criteria, this national health insurance plan is an excellent option.

Perhaps a more united voice could get Congress to actually pay attention to what their constituents suggest. Perhaps those who read this, lending their voices, are what it will take.

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Health Insurance, a matter of life and death.

An Interesting Dilemma

We frequently read, see, hear that the Insurance Industry is suffering and there is a need to keep raising premiums. The policies seem to cost more but cover less. The driving force for this is, of course, the need to provide “decent profits” for stock holders.

As a result of this insatiable need for more net income, the Insurance Industry has taken over our health care system. My primary care doctor eloquently stated, “At first I was a doctor. Then I became a provider. Now I am a f***ing data entry clerk.” A doctor’s choice for tests, procedures and prescriptions are largely controlled by the insurance provider.
In order to maximize profits, premiums have gone up as have co-pays. At the same time, reimbursements to doctors and other health care facilities have steadily gone down.
Most recently, United Health Care has DEMANDED that doctors accept a reduction in reimbursement by an ADDITIONAL 25%. Most offices, having to deal with previous reductions in reimbursement, have been operating on a very narrow margin of profit.

Being a retired doctor, I understand the business aspects of operating a health care facility. It costs “X” number of dollars to process each patient through such an office. That “X” number depends of the number of employees, their salaries, benefits, taxes, worker’s compensation premiums, building and malpractice insurance costs, rent/mortgage costs, utilities, repair and update costs as well as the costs of equipment (those lovely tables are very expensive) and disposable items such as tongue depressors, gauze, tape, gowns, toilet paper, paper towels and other items like computers, programs (which are also very expensive), paper, printer ink, postage AND MANY MORE NORMAL BUSINESS EXPENSES.
The Insurance industry, theoretically run by intelligent people, doesn’t care what it costs a doctor to process a patient. They believe having more patients go through your office results in the doctor making more money. In theory, that makes sense. In reality, it is remarkably stupid.

First of all, more patients mean LESS TIME with ALL patients resulting in decreased quality of care. Second, and for financial survival, if the reimbursement and copay are LESS than it costs to process a patient through the office, the doctor actually LOSES money with EACH PATIENT. More patients results in more loss.

As stated above, health care facilities have already significantly reduced their overhead/operating costs. They simply cannot absorb an additional decrease of 25% in income. But this is not the concern of the Insurance Industry. Their MAIN CONCERN is increasing return on investment for their stockholders and salaries of their top executives.

By the way, according to Laura Ungar, USA Today on January 19, 2016, United Health Care had a NET profit of 6.8 BILLION DOLLARS in 2015. It was $228 Million less than 2014, but hardly as bad as a stick in the eye. I was not able to find net profit report for United Health Care for 2016. However, United Health Care had estimated that in 2016 they would lose $25 million more than the year before, possibly as high as $500 million. If their estimate was correct, that would mean that in 2016 they would have a NET PROFIT of ONLY $6.3 Billion Dollars.
Speaking of Insurance, the most recent financial report from State Farm Mutual Automobile Insurance Company shows a NET PROFIT for 2016, (after taxes) of TWO BILLION, FIVE HUNDRED FIFTY-FOUR MILLION DOLLARS. This is FOUR HUNDRED AND SEVENTEEN MILLION DOLLARS MORE THAN 2015.

Allstate Insurance Company had a NET PROFIT (after taxes) in 2016 of ONE BILLION SEVEN HUNDRED AND SIXTY MILLION DOLLARS.
GEICO, admitting it had a bad year in 2016, had a NET PROFIT (after taxes) in 2016 of ONLY FOUR HUNDRED AND SIXTY MILLION DOLLARS.

On February 19, 2016 the U.S. Government announced it was giving a big increase to private insurance companies that participate in the Medicare advantage program (Medicare alternative). Based on that news, investors rushed to buy as much of the health insurance companies’ shares as they could get their hands on. By the time the market closed on Friday, February 26, 2016, just seven days later, Cigna’s stock was up 5.5% and Human’s was up a whopping 8.1%. By comparison, the Dow Jones industrial average was up just 1.5% (Wendell Potter, This would mean that United Health Care estimate of loss was probably too high.

Once again, the driving force behind automobile and home insurance is to make greater and greater income dollars for their investors. In our society, there is nothing wrong with this model.
However, when it comes to health care, THERE IS EVERYTHING WRONG WITH THIS MODEL.

Kaiser Permanente has been a non-profit health care system since 1945. It has been tremendously successful. There will always be complaints, warranted or not, about particular doctors or policies, but overall, doctors and patients are very satisfied. They have NO stockholders, NO department dedicated to stockholder issues and, by the nature of being non-profit, are required to reinvest surplus income into facilities, equipment, services, doctors and support staff.

There is no doubt that Health Care would be significantly superior to what it is if ALL health insurers were non-profit. Unfortunately, national and state leaders do not have the balls or ovaries to pass legislation concerning improving health care for ALL Americans. That, too, is understandable because the Insurance Industry supplies, through direct donations and PAC’s, enormous amounts of money to elect and reelect members of Congress and Legislatures.

It is time to make the necessary changes. It certainly will be a steep, uphill battle. American citizens cannot match the irrational amount of money given to our state and national leaders. There are some legislators who agree with the concept of quality health care for everyone and getting the Insurance Industry out of the money making business which, therefore, would take health care back to where it belongs, the doctors.

So, remember when you hear the Insurance Industry cry about not being able to cover all citizens for health care, it is NOT that they would lose money. It IS that the number of NET BILLIONS or NET HUNDRED MILLIONS of dollars they earn could possibly be reduced. DO NOT EVER BELIEVE THAT YOUR INSURANCE COMPANY IS YOUR BEST FRIEND. They have only two best friends, dollars and investors. They are neither your good neighbor nor your good hands. They may provide good service for homeowners, renters and automobile damages. But, as with health care insurers, their most significant concern is profit.

My goal is to have more people think about our entire health care system, from insurance companies to doctors. At very least, I hope to provide a different perspective of the system. And, after intelligent consideration, realize and demand that we, as Americans, deserve a high quality health care system. Currently, we are ranked last compared to all other industrialized nations when it comes to health care. We are also the only country in that group that has FOR PROFIT management of our health care system.

Perhaps we can’t outspend the Insurance Industry, but we can make legislators believe, regardless of the money they spend on campaign advertising, that WE won’t elect them if they don’t get us high quality health care on a non-profit basis. And by non-profit, I do not mean the doctors. They are pretty much already at the non-profit status.

I hope you agree and want to help promote a grass roots movement to recapture our health care system and remove profit from determining our health status and whether/when we live or die. If so, please pass this blog on to others. It is time to stop being passive about accepting an inferior health care system. I have always believed that I/WE are either part of the solution or I/WE are part of the problem. Especially now, there can be no middle ground. Without your health, regardless of your wealth, YOU HAVE NOTHING.

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Fifteen or so years ago, as a member of the Rotary Club of Tucson Sunset, I along with others, was asked to make a presentation about the ethics of my profession. What follows is the information I presented to that group.

A 27 year old male presented at my office with severe neck and upper extremity pain. He was, at that time, a sophomore at the University of Arizona.
His x-rays showed perhaps the worst looking neck I had ever seen. He had a perfect cervical curve. Unfortunately, instead of going in the forward (lordosis) direction, it was going absolutely in the opposite, backward direction (kyphosis). (I love using technical terms so you think I am really smart).
As I recall, his treatments began in September. In November, he asked me if I would write a letter on his behalf so he could drop a class for medical reasons, rather than withdraw with a failing grade. Considering the extent of his issues, I wrote that letter on his behalf.
As time passed, he improved, but the structural issue was not, as yet, resolved. However, the frequency of his treatments decreased.
During homecoming at the U of A, his parents visited Tucson and came to my office during his scheduled appointment. While he was receiving therapy, they asked if they could speak with me. I share what they told me.

Their son was a “Wunderkind” in music, in particular, piano. His parents were convinced to send him to Europe for special training. He left home at age 10. When he left, he was an outgoing, gregarious, fun kid who loved sports. At age 16, this young man returned home, totally withdrawn, depressed, non-communicative and would not go anywhere near a piano.
His parents sent him for counseling but he would not communicate what had happened to him causing the drastic changes. While they, and I, had our suspicions, they were never discussed or confirmed. His total withdrawal was the reason he was so much older than other sophomores in his class.

Once again, in November, he came to me asking for another medical excuse letter to avoid failing another class. THIS CREATED A MAJOR ETHICAL DILEMA FOR ME. As a patient, he had significant symptomatic improvement. His follow-up care was scheduled for every three to four weeks. I realized the structural issue had not completely resolved, but he was functioning, for the most part, without symptoms. I truly struggled with this decision. I had asked him to return in one week, at which time we would discuss his request.
When the patient returned to my office, I informed him that I had written the letter and gave it to him. My reason, which I did not tell him, for this “breach of ethics” was that, an adult or adults had seriously failed him in the past. I couldn’t, in good conscience, be another adult to fail him.

As Paul Harvey used to say, “Now for the rest of the story.” That young man graduated from the University of Arizona. He took and passed (an unusual occurrence) the CPA exam on his first attempt. He got a job in Phoenix working for Arthur Anderson Company.

When that company decided to leave Arizona, he returned to Tucson. His first job here was with Thomas Davis Clinic, Tucson’s first HMO, owned by a group of doctors. During his first month, he found a $100,000 correctable mistake. He was a hero.

While here, he decided to explore a possible law degree. He took the LSAT and not only did well, he had a PERFECT SCORE. Since he loved being here, he chose to attend the University Of Arizona School Of Law. He made the Law Review during his first year, and decided to also seek his MBA degree at the same time.

The young man and his family invited my wife and me to his graduation from the MBA program. After he attended the Law School graduation, we all got together for a subdued celebration. His gift from us, because he was really tall, was a wood book stand that could be folded flat or opened and placed on a desk. That way his head/neck would not be as stressed while he was reading.
He got a job with a well-known law firm in Tucson, best known for taking newly graduated lawyers and putting them through internship that, as in medicine, works them beyond belief. They also gain an amazing amount of experience.

In all honesty, I don’t remember his name. I NEVER tried to track him down, although I would love to know how he is doing. In my mind, it would cheapen what I had done and what he had accomplished.

Back to the opening title of this epistle. Obviously, I have given this a great deal of thought and still do. While I realize this type of experience is atypical, nevertheless they do arise. All societies must have laws/rules. Without them any society cannot exist or survive. Then again, some laws and rules are, at best, ill conceived. At worst, they are downright stupid. I refer you to the recent episode having to do with a passenger on United Airlines and far too many Home Owner Associations.

So what happens when ethics is in conflict with humanity? I am very comfortable when I say that ETHICS MUST ALWAYS LOSE. In my opinion, if we become a nation or world where rules and laws are more important than humanity, we have really lost the reasons to live as a society and human race. And, if I am correct, God will be proud of me for putting a person before ethics.

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Bigger, Stronger, Faster


This is in response to a newspaper article I read about how much bigger, faster and stronger athletes are becoming thanks to newer and better training methods and equipment.
I begin with an analogy. You purchase a standard vehicle, new or used, from a dealership. You decide to modify it from its original configuration by installing a 500 HP engine. Then you add a racing transmission, differential and drive shaft. However, you keep the original universal joints that connect the transmission to the drive shaft and the drive shaft to the rear end.
The first time you stomp down on the accelerator, the Universal or “U” joint snaps. It does so because it is the weak link in the now super powerful vehicle you have created.

Making athletes, high school, college and professional bigger, stronger and faster is good for the games and in many ways may help protect the participants. However, as in taking medicine that can save your life, there are side effects (just watch some drug company commercials on television).There are certain parts of the body, like the original “U” joint, that cannot be made stronger. Cartilage, ligaments, tendon attachments and, for the most part, bones are examples.

For many years I have been observing athletic injuries at all levels that occur without contact. At the University of Arizona, the nation’s top football linebacker, Scooby Wright, injured his knee and foot without any physical contact. In basketball, Kaleb Tarczewski injured his ankle and had a “stress reaction” in a bone of his foot. Once again, there was no contact causing those injuries. Don’t forget Tiger Woods. He built himself to the size of a professional football linebacker. His knee and low back (multiple times) have failed him. They should not have happened at his age, in a non-contact sport.

A player was recruited to be a linebacker for the University of Arizona. He was changed to nose tackle, and pushed to gain weight. He got up to 295 pounds. He had spontaneous fractures of the cuboid bone in both feet. They occurred one at a time. The first happened in pre-season camp and the second working out after the season ended. His position was then changed for the following year and his weight dropped to 265, a more rational weight for his height (about 6’1”). He had no issues since dropping the weight.

Teddy Bridgewater, quarterback for the Minnesota Vikings NFL team, tore up his knee and missed an entire season. The injury happened without contact. There are many more examples at all levels of organized sports.

The process is to make muscles bigger and stronger with faster “twitch”. This means that the muscles contract faster and with more force. This is like adding the bigger, more powerful engine. The padding that provides a cushion between bones (cartilage) now bears more weight and faster, more frequent compression. Add a little twisting to that and that weaker area is subject to tearing. The same is true with bones of the feet. They can’t be made stronger. They are taking heavier, faster and more frequent pounding. A little twist or jump and a break can occur.

Ligaments are the parts of the body attaching bone to bone. They can’t get stronger. Have you notice how many knees, over several seasons, end up with torn ACL’s (anterior cruciate ligament)and MCL’s (medial collateral ligament)? Every season more of those injuries happen without contact? Ligaments can stretch only 4% of their length before fibers tear. Anything more than that and you have a sprain. A sprain, as compared to a strain, means that ligament fibers have torn. A lot more stretching and the ligament tears completely.

Discs of the spine are also vulnerable weak spots. They can tolerate an unpredictable amount of compression, twisting and stretching. Unfortunately, there is no way of knowing or predicting which part of a player is subject to being his or her weak link. However, will there ever be a point that an athlete is big enough, strong enough and fast enough? If one has watched the NFL Combine, it appears the answer is, no.

At this time it seems that, as with medicines, the bigger, stronger, faster philosophy will continue until or unless it is “scientifically” proven that the negative side effects are no longer worth the benefits. Unfortunately, I have yet to see any research that studied the “Weak link theory.” I don’t expect to see such research any time soon.

In summation, most people are aware of the benefits of bigger, stronger and faster. I just want to point out the possible negative side effects that have been observed during athletic competition at all levels for many years. I am not suggesting suspending strength and conditioning programs for athletes. I am suggesting consideration of the concept of when enough is enough.

Dr. Leonard Rudnick, (Retired)

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AMONG THE MANY HUMAN FRAILTIES-drugs you don’t need for conditions you don’t have!

Dear Reader,

As I have mentioned many times, I am a disciple of George Carlin. Among his greatest concerns was that we, as Americans, had to learn and teach our children to, “Question everything we read/hear/see.” Even though this article deals specifically with pharmaceutical marketing and products, the application of the need to question everything applies to political campaigns, tabloids, the internet, product sales and, as I always suggest, everything I publish on my blog.

In this article, you will notice that all other countries besides the U.S. and New Zealand, prohibit the use of public advertising for marketing of drugs. The reason is that human gullibility transcends geographical borders. As an American who has lived through the Second World War, I have always questioned how the people in Germany were swayed to follow a leader like Hitler. I also wondered if we, as Americans, could fall into the same trap. I now understand how all of us (humans) can be led in a specific direction even if we don’t recognize this is happening.

In America, the Supreme Court ruled that reporters, especially in tabloids, are immune from being sued for liable and slander because people in the public eye set themselves up to be vulnerable to the attention of the press. As a result, the amazing headlines seen at check out counters in your favorite super markets and drug stores have absolutely no need to be remotely true. Nevertheless, the articles will be read and believed. This is not unlike political campaigns. There is absolutely no penalty for stating things that have no basis in fact.

This article was published by Huffington Post. It is brilliantly researched and reported. Of course, you should feel free to do your own research and come to your own conclusions. Having been part of and a believer in business and profits, I as a consumer, needed and still need to be aware of the extent some businesses will go to earn a profit. The point of it is that we are constantly brain washed for profit. Honestly, how many different cars and trucks can be number one in a given year? “Initial Quality” scores, in most cases, are determined by the number of issues associated with the entertainment/information systems, not the true overall quality of the vehicles. Is it possible for all national chain stores to have the absolute lowest prices? If hospitals are suffering financially, how come they keep building newer and bigger facilities on more and more land that they purchase? They replaced RN’s with CNA’s (Certified Nursing Assistants). As compared to a bachelor’s degree for the former, the latter can be certified after 6 weeks of training. Newer facilities will be staffed primarily with the latter. Auto insurance companies keep telling us how tough business is, but look at the profit, year to year, sent to all State Farm policy holders (hint, it’s in the Billions). Health insurers are constantly complaining about costs, but spend hundreds of millions on television ads to try to get your business. If I were actually losing money like they claim, it would have been necessary for me to lock my office and go out of business. Most of the time, it is smart to just quit losing money. Apparently, there’s really a lot of money to be made in the health insurance business.

How did I get all this from the Huffington Post article? It just reminded me that I continually need to question everything. Having been married 54+ years I learned that everything in my life can’t be logical. Outside of that, I really try to decide if what I read/hear/see is logical. I try to do this without being emotional, but rather look at things intelligently. If something doesn’t seem logical, I look beyond the hype. I believe this is what George Carlin was trying to accomplish. I hope that what I have written in the past and the following article help you look at things from a different perspective. By the way, I am not surprised that the information in the following article was not broadcast on network or local television outlets. The pharmaceutical industry represents a majority of advertising income for them. It would be financially dangerous to present the findings and conclusions in this article.

Big Pharma, Drugs You Don’t Need For Disorders You Don’t Have
Inside the pharmaceutical industry’s campaign to put us all to sleep.

Story by Jonathan Cohn

Illustrations by Sam Rowe

One evening in the late summer of 2015, Lisa Schwartz was watching television at her Vermont home when an ad for a sleeping pill called Belsomra appeared on the screen. Schwartz, a longtime professor at Dartmouth Medical College, usually muted commercials, but she watched this one closely: a 90-second spot featuring a young woman and two slightly cute, slightly creepy fuzzy animals in the shape of the words “sleep” and “wake.”

Schwartz had a reason to be curious about this particular ad. Two years earlier, she had been a member of the advisory panel that reviewed Belsomra for the U.S. Food and Drug Administration—and the process had not gone well for the manufacturer, Merck. The company saw its new drug as a major innovation, emphasizing that the medication acted on an entirely different mechanism within the brain than the previous generation of insomnia medicines like Ambien and Lunesta. During the drug’s development, Merck had suggested that it could treat insomnia more effectively and produce fewer side effects than existing medications. In 2012, one Merck scientist described the science underlying Belsomra as a “sea change.”

But when Schwartz and her colleagues scrutinized data from the company’s own large-scale clinical trials, what they found was a lot less impressive. People taking Belsomra fell asleep, on average, only six minutes sooner than people taking a placebo and stayed asleep for a mere 16 minutes longer. Some test subjects experienced worrying side effects, like next-day drowsiness and temporary paralysis upon waking. For a number of people, these effects were so severe that the researchers halted their driving tests, fearing someone would get into an accident. Because of these safety concerns, the FDA ended up approving the drug at a lower starting dosage than the company had requested—a dosage so low that a Merck scientist admitted it was “ineffective.”

So when Schwartz saw the Belsomra ad, she was struck by how smoothly it sidestepped the drug’s limitations. A soothing voice-over hypes the science, giving a sophisticated explanation of how Belsomra targets a neurotransmitter called orexin to turn down the brain’s “wake messages.” “Only Belsomra works this way,” the voice continues. The ad ends with the young woman curling up with the “sleep” animal and falling into a peaceful slumber. “You have no idea watching that ad that we’re talking about falling asleep 6 minutes faster and staying that way an extra 16 minutes—and that’s at higher doses,” Schwartz said. “We really don’t have a great idea of how well it works at the lower dose FDA actually recommends for people starting the medication.”

In the United States, commercials like these are simply part of the cultural wallpaper. But just because drug ads are ubiquitous here doesn’t mean they’re a normal way of informing consumers about their medical options. In fact, the U.S. is one of only two developed countries in the world that allow drug companies to advertise their products on television. (The other is New Zealand, which has a population of some 4.5 million people.) One study, from the Journal of General Internal Medicine, found that 57 percent of claims in drug ads were potentially misleading and another 10 percent were outright false.

For a variety of reasons, drug companies are now increasingly relying on direct marketing to American consumers. Last year, the pharmaceutical industry spent $5.2 billion on ads promoting specific drugs—an increase of 16 percent over the previous year. At a time when most other industries are spending less on television advertising, drug companies are spending more. They are also devising new forms of so-called direct-to-consumer outreach, like smartphone apps that consumers may not even realize are a form of marketing and that the FDA is still figuring out how to regulate. (The FDA recently asked Kim Kardashian to delete Twitter and Instagram posts touting a morning sickness pill she was taking, because she hadn’t explained its side effects.)

Concerns about direct advertisements of pharmaceutical products have become so acute that last November the American Medical Association called for an outright ban, saying that the practice was “fueling escalating drug prices.” Spending on prescription drugs already accounts for about one in every six dollars that go into medical care. Between 2013 and 2018, the government anticipates that the average annual increase in this spending will be about 7.3 percent—higher than the overall rate of health care inflation. One of the reasons for the increase is the massive sum that manufacturers pour into advertising.

Last year, for instance, Merck spent $96 million promoting Belsomra. The investment proved to be worth it. Analysts expect the drug to generate more than $300 million in sales this year and to overtake both Ambien and Lunesta as the top-selling insomnia medication sometime within the next decade.

Up until the early 20th century, newspapers were full of ads making outlandish claims about potions and elixirs that were sometimes toxic and nearly always useless, such as Doctor Quenaudon’s Spring Cure, an “extract of green herbs for purifying the blood and the cure of all diseases arising from its impurity, also of all other chronic diseases.”

Over time, a series of federal laws, starting with the Pure Food and Drug Act of 1906, took these concoctions off the shelves and put their producers out of business, giving rise to the pharmaceutical industry as we know it. In 1938, the Federal Food, Drug and Cosmetic Act mandated that the most powerful drugs could only be purchased with a doctor’s prescription. After that, manufacturers focused their promotional efforts exclusively on physicians, running ads in professional journals, dispatching representatives to doctors’ offices, and wooing them with fancy dinners and junkets.

But the FDA, which eventually gained authority over both the manufacturing and marketing of drugs, had never actually prohibited mass advertising. In 1981, Merck broke new ground by running a text-heavy, black-and-white advertisement for a pneumococcal vaccine in Reader’s Digest. The following year, Arthur Hull Hayes Jr., the head of the agency, hinted in a speech that the FDA would be OK with such ads. Seizing the moment, Boots Pharmaceuticals created the first-ever television commercial to promote its version of prescription ibuprofen. That’s when the FDA got jittery. It asked the industry to observe a moratorium while the agency came up with some ground rules.

Under guidelines released in 1985, the FDA allowed drug companies to run ads that simply raise awareness of a disease without much restriction. But if a company wanted to describe what a drug was supposed to do, it was required to explain the risks. The ads that followed fell heavily into the first category, because companies saw no way to cram sufficient information about side effects into 30-second spots. The companies began pushing for fewer restrictions, and in 1995, they gained a powerful ally in new House Speaker Newt Gingrich, who started beating up on the FDA as a “job killer.” Under pressure from lobbyists and Capitol Hill, the FDA in 1997 produced new guidelines declaring that companies’ ads just had to devote roughly equal time to the risks and benefits of a drug.

One year later, spending on television drug ads had more than doubled, from $310 million to $664 million. A major early beneficiary was a new generation of antihistamines that did not make people drowsy. Thanks to the advertising push, first Claritin, then Zyrtec and Allegra became some of the most frequently prescribed medications in America.

These antihistamines represented a meaningful improvement for allergy suffers. The same could not be said for other drugs that manufacturers began promoting with multi million-dollar campaigns. Take the case of Nexium, which is now infamous in the world of health care policy. Until the 1980’s, doctors had treated acid reflux with over-the-counter pills, like Tums, that counteracted the effects of stomach acid. Then, in 1990, a drug went on the market that reduced the production of acid itself.

Prilosec would become a moneymaking monster, with sales reaching $6 billion a year. But AstraZeneca, the company that ended up marketing it, knew these profits would last only as long as the drug’s patent, which was set to expire in 2001. So it launched a desperate bid to find a replacement—an effort named “Project Shark Fin” because the graph of Prilosec’s expected revenues rose and fell like an inverted V. Eventually, researchers produced Nexium, which AstraZeneca promoted as a new, improved acid inhibitor.

Chemically speaking, however, Nexium was extremely similar to Prilosec. There was little evidence that it was better than Prilosec or new generic alternatives. In fact, public health experts argued that many people taking acid inhibitors didn’t need medications at all—they needed to change their diets. But the advertising blitz worked: Within two years of its release, Nexium had surpassed Prilosec in sales; by 2010, it had surpassed Lipitor, the anti-cholesterol drug, as the highest selling drug of all.

The best thing I heard experts say about Belsomra was that it was no worse than any of the other drugs out there.

There’s a well-established body of research showing that advertising plays a critical role in a drug’s popularity. In one of the most famous studies of direct-to-consumer advertising, a team of researchers from Canada and the U.S. studied consumer behavior in two demographically similar cities: Sacramento and Vancouver. The U.S. consumers, deluged with ads for prescription drugs, were more than twice as likely to ask for a drug they’d heard about as the consumers in Canada, which doesn’t allow such ads. In another study, researchers trained actors to seek medical help for symptoms that resembled depression at different levels of severity. The good news was that most people with symptoms warranting medication received drugs. The bad news was that most people without symptoms warranting medication also received drugs. Just over half of that latter group came away from their physician’s office with a prescription for a drug they’d asked about after seeing an ad on TV.

Companies like Merck point out that their ads always instruct patients to consult a physician. And it’s true that doctors aren’t supposed to prescribe medication unless they think it makes sense clinically. But as multiple studies have shown, doctors often give patients the particular brand-name drugs they ask for, even when a cheaper generic version is available.

Pharmaceutical companies are eager to exploit this fact, because promoting drugs to doctors has become harder than it used to be. In 2002, the federal government prohibited pharmaceutical companies from providing financial incentives or other “tangible benefits” to physicians who prescribe their drugs. In the last few years, it has begun prosecuting apparent violations through anti-kickback statutes. “In the old days, pharmaceutical representatives were always taking docs out to dinners, bringing them Cuban cigars, taking them to Yankee games in the box seats,” said Stephen Hoelper, a veteran drug marketing executive and vice president for sales and marketing at MediSolutions. The Centers for Medicare & Medicaid Services “doesn’t like that and says that if you induce a physician to prescribe a product, then you are potentially making health care more expensive.”

Meanwhile, the employers and insurers who pay most of America’s medical bills have been looking for ways to discourage excessive prescribing in an attempt to rein in costs. Most private insurance plans have formularies, or lists of approved drugs, managed by special companies called “pharmaceutical benefit managers.” These firms negotiate with drug makers over prices and divide medications into tiers, forcing patients to pay more out of their own pockets for certain expensive drugs. Brand-name sleeping pills frequently end up in the tiers requiring higher co-pays, which means the pharmaceutical companies must work even harder to convince consumers that the drugs are worthwhile.

Finally, during the past decade, drug companies have simply had fewer genuine game-changing drugs coming onto the market. With the exception of occasional breakthroughs for diseases like hepatitis C, it is becoming harder and harder to find drugs that offer clear-cut clinical advantages over existing treatments. Between 2003 and 2011, the success rate for clinical trials fell, the time from trial to approval rose, and the ratio of approved drugs to trial drugs declined. These are all signs that the drug pipeline is drying up. Innovation could pick up again, but in the meantime, drug companies have been spending much of their time pushing drugs of questionable clinical advantage, or persuading viewers to seek medication for “a disease that may be hard to distinguish from normal behavior in most cases,” according to Aaron Kesselheim, an associate professor at Harvard Medical School who focuses on the drug industry. In his field, the tactic is known as “disease mongering.” And to critics of consumer drug advertising, Belsomra is a perfect example of these practices at work.

The first marketing efforts for Belsomra appeared not long after the FDA had approved the medication, in the summer of 2015. Anyone who saw them might not have realized what was being sold, since many didn’t mention Belsomra—or any sleep drug—at all. There was a website,, which focused on sleep science, and a related Twitter feed, which now has more than 60,000 followers. Merck also worked with the nonprofit National Sleep Foundation to develop, a site where people with insomnia talk about their experiences. And there was an iPhone app called SleepGuru, which allowed users to monitor their sleep activity. For pharmaceutical companies, the great advantage of such “unbranded” advertising is that, since the ads don’t make claims about specific drugs, they aren’t legally required to talk about side effects, either.

Like the fuzzy animal commercial, the unbranded campaign for Belsomra told a compelling story about new developments in the field of sleep research. Older insomnia drugs try to induce sleep by making the brain more receptive to chemical signals that make people drowsy. Over the last two decades, scientists have developed an understanding of a separate set of chemical signals that make people alert. The WhySoAwake site gives a cartoonish version of this story, and a link on one page takes visitors to the Belsomra site, which explains that it is the only drug that acts to quiet the wake signals.

In Merck’s last quarterly earnings call for 2015, Adam Schechter, the president for global human health, linked the drug’s sales success directly to these marketing efforts. “With regard to Belsomra, I think we started off with a really good launch and we had nice growth,” he said. “It then flattened a little bit. We ran direct-to-consumer advertising and we saw an increase again in … volume.”

Merck’s Belsomra commercial.

The insights about separate sleep and wake mechanisms represent real scientific advances, as Ian Parker documented in a 2013 account of Belsomra’s development for The New Yorker. Someday, the discovery might even lead to major advances in treatment. But those advances have not yet been made. All of the sleep medicine experts I interviewed emphasized that therapy and behavioral changes remain the best treatments for insomnia. Like most other sleep drugs, Belsomra provides only mild relief. “Clinically meaningless” is the way one sleep expert, Gregg Jacobs from the University of Massachusetts Medical School, described Belsomra’s effects. “Almost none of the patients I see are taking Belsomra because it does not work,” Jacobs said. The best thing I heard experts say about Belsomra was that it was no worse than any of the other drugs out there.

In response, a Merck spokesperson pointed out that in one of its trials, Belsomra patients slept half an hour longer than people taking the placebo. However, the sample for that trial was just 62 people. Larger, more predictive trials found that Belsomra had much weaker effects.

In a January 2016 report, the nonprofit Institute for Safe Medication Practices analyzed more than 1,000 consumer complaints that the FDA had received about Belsomra between February and July 2015—a number the institute described as “substantial.” A large number came from patients who complained that the drug was ineffective. Others reported that they had experienced side effects including sleep paralysis and next-day drowsiness. There were also reports of suicidal thoughts and attempts, two of which were successful. Merck correctly points out that the side effects correspond to the ones the company included on the warning label. There is also no way to definitively prove a link between these particular complaints and the drug, particularly when it comes to the suicides. Still, in its report the institute noted that the trials of Belsomra had not tested the drug’s effect on people taking anti-psychotics or antidepressants, even though insomnia is a “key symptom” of depression and anxiety. It concluded, “The preapproval trials of [Belsomra] had so many limitations that it was challenging to draw any valid conclusions about what might happen when a new kind of hypnotic is marketed to a patient population measured in tens of millions.”

When drug companies defend their use of advertising, they often argue that it performs a valuable public service. A much-aired commercial might prompt patients to discuss conditions they never knew they had, the logic goes, or reduce the stigma around certain diseases. If you see ads for depression or irritable bowel syndrome every night while eating dinner, you might feel less embarrassed asking your doctor about it. Critics of direct-to-consumer advertising acknowledge these benefits.

But when the people raising awareness about a condition are the same people selling a drug to treat it, some rather obvious problems arise. Ads rarely provide the kind of context consumers need to make good decisions about their health—about how often a drug actually works or whether an alternative treatment might be better. I asked Dominick Frosch, a senior scientist at the Palo Alto Medical Foundation Research Institute who has published widely on how patients make decisions, to review the Belsomra television spot with the fuzzy animals. “The ad promotes a very clear story as to what causes insomnia … that somehow insomnia is a problem of your neurotransmitters,” Frosch said. “They are giving you a very one-sided explanation of what causes insomnia, and of course into that cause fits this particular drug.”

Policymakers in Europe and Australia have decisively rejected proposals that allow American-style drug advertising.

“We all want consumers … to be highly engaged in their health care, and certain advertisements can do that. But it can also lead to a lot of over-treatment,” said David Grande, an assistant professor of medicine at the University of Pennsylvania who has written extensively on drug advertising, “It’s not as if we live in an imaginary world where messages in advertising are being driven by what’s important, rather than what makes more money.”

On multiple occasions, policymakers in Europe and Australia have considered and decisively rejected proposals to allow companies to advertise specific drugs there. In 2002, the European Parliament voted down legislation that would have allowed the direct advertising of medications to treat HIV/AIDS, asthma and diabetes. “If we open the door to direct advertising it is a slippery slope down the American road where pink pills on television advertisements offer a miracle solution to everything from baldness to chronic fatigue,” Catherine Stihler, a Labour Party representative from Scotland, said at the time. “Medicines are like no other product. The aim must not be to maximize sales but to ensure that the product is used appropriately.”

In the U.S., a similar ban on ads for specific drugs would face a slew of First Amendment challenges in the courts. But there are plenty of other remedies available. Democrats in Congress have proposed prohibiting advertising until a drug has been on the market for a few years, giving health care professionals more time to see how the drug worked in the wider population. Another possibility, which Hillary Clinton has endorsed, would be to make advertising less attractive to drug makers by barring them from writing off the associated costs on their tax returns. The FDA could seek to review all ads before they air and reject those that make false or misleading claims. It could also require ads to include more information about how often a drug is effective or whom it actually helps.

Lisa Schwartz has been working with the FDA and consumer advocates to develop a better model for presenting this kind of information. Along with her husband and fellow researcher, Steven Woloshin, she started a company that is creating “drug facts boxes” for different medications. The idea is to translate the gobbledygook that appears in prescription package inserts or those fine-print full-page magazine ads into language that average consumers can understand.

After Belsomra hit the market, Consumer Reports asked Schwartz to create a label for it. Her version presents the data on the drug in an even-handed way, noting that its ability to aid sleep is “modest” at the highest approved doses. “Short track record means that new, unexpected side effects are possible,” it explains. “Since this drug has a different way of acting than other insomnia drugs, the experience with it is particularly limited.” The label gives brief details on alternative remedies for insomnia, like cutting down on caffeine. Finally, it lists Belsomra’s known side effects. Not included on the list but probably warranted: skepticism.


StoryJonathan Cohn

Jonathan is a senior national correspondent for The Huffington Post.

IllustrationsSam Rowe

Sam is a UK-based illustrator.

Video EditingOliver Noble

Oliver is a senior video producer at The Huffington Post

Development & DesignGladeye

Gladeye is a New Zealand-based digital design agency.

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Dear Readers,

I have rewritten this article several times. The problem is that the information is a “tweener.” It is in between too easy for health care professionals and scientific types and a bit of a stretch for those without such backgrounds.

My advice is, when you find some material that is too technical for you, skim over it and get to the stuff you can understand. I do the same thing when reading an adventure novel. I skim over the flowery descriptions and get back to the plot.

The plot here is about using light to treat myriad conditions. In my previous blog, I mentioned using light in conjunction with a photo reactive drug to INSTANTLY KILL CANCEROUS TUMORS. This article is about the various conditions successfully treated using just light and the mechanisms behind the success.

Do not be disheartened if you don’t understand the scientific mechanisms. In the Physician’s Desk Reference, a publication listing and describing everything about all medications made in the world, there are the following entries. For the drugs Amitriptyline, Naproxen, and Robaxin (antidepressant, anti-inflammatory and muscle relaxant, respectively), under the heading, Mechanisms of Action, you will find, “The exact mechanism in man is unknown.”

So, if you don’t understand the exact mechanism of action when using light (more is known about how it works than is known about how the above mentioned drugs work), don’t fret. Just skip over it and get back to the plot. It is worth the wait.



Leonard W. Rudnick, BA, BSc, DC (ret.), DABDA

Among the more notable facts of life that appear too good to be true is PHOTOSYNTHESIS.  Can anyone honestly believe that sunlight (or any other form of light) combines with some “green stuff” in plants (CHLOROPHYLL), to form glucose and oxygen?  The plant then uses the glucose to grow and gives off oxygen into the atmosphere. Really?

Although studies prove these photo-chemical actions and reactions, you can’t see it happen.  You can’t smell the oxygen being released.  Holding a match near the leaves will not result in an increased flame.  If you tasted the plants, they are likely bitter, not sweet like glucose. Obviously, we can’t prove photosynthesis exists.  Therefore, it is not true.  EXCEPT it actually happens and our planet and its inhabitants survive solely because of this process. This is a critical reason that we should not cut down all our trees and “black top” our planet.

In addition to photosynthesis, there exists PHOTOMORPHOGENESIS (photo=influenced by light, morph=form of an organism, genesis=development).  An example in plants is the action of red light (+/-633 nm) on an inactive molecule called PHYTOCHROME.  Upon absorption of this light, the phytochrome becomes active.  This induces a cascade of enzymatic reactions that lead to such responses as seed germination and flowering, among others (Karu, 1998).  This is analogous to actions that occur within human tissue.

It is arguable that light is the most critical sources of energy for our planet.  Societies living in areas deprived of sunlight have significantly higher suicide rate than those where the sun shines almost daily.  Please note that, in the first book of the Bible, Genesis, it does NOT say, “….Let there be cortisone, surgery or ultra-sound”.  IT says, “Let there be LIGHT”.  Without it, there is no replenishment of atmospheric oxygen, no food chain and no evaporation leading to rain.

For approximately 50 years, light, in the form of Low Intensity Laser Therapy (LILT) has been used to treat myriad conditions.  Significant advances with this technology have occurred since the mid-eighties.  Most recently, Michael Hamblin, PhD has been conducting research at the Wellman Photo Medicine Center at Massachusetts General Hospital.  This is in conjunction with Harvard Medical School and the MIT Division of Health Science and Technology.  He is a member of the affiliated faculty and principal investigator.  His research will be listed with the conditions that have been successfully treated using LILT.

It has been proven that visible light enhances cell proliferation through photo-chemical changes in the mitochondria (the chemical factories of the cell), which then set in motion a chain reaction of biological events that ultimately affect cellular membranes.  This, in turn, has an effect on messenger RNA synthesis, which ultimately leads to the observed enhancement of cell proliferation.

Pores in membranes open and close to let ions, such as calcium, sodium and potassium in and out of cells.  This results in physical changes in the membrane.  Calcium ions act as intracellular messengers in many signal transducing pathways.  The cellular calcium ion concentration can be abruptly raised for signaling purposes by transiently opening calcium channels in the plasma or intracellular membranes.

The catalytic activities of many enzymes are regulated by calcium concentration.  Since infrared radiation affects the physical state of molecules, it can affect the pore molecules directly.  Thus, a similar effect on cell proliferation can occur whether the cells are irradiated with visible light at +/-633 nm or infrared at +/-830 nm.

Specific types of molecules absorb specific wavelengths of light, both visible and infrared.  Absorbed radiation produces specific biological effects in tissue, depending upon which types of molecules absorb the light (Karu, 1998).  Red light (+/-633 nm) has a primary effect on the Cytochrome-C-Oxidase portion of the respiratory chain of the Mitochondria (also known as the vitamin C cycle).  In this process, Nitric Oxide (NO) is produced.  This is used along with infrared light to mechanically alter the permeability of the cell membrane.  Nitric oxide, combined with macrophages (one of the body’s white blood cells), vascular endothelial growth factor (VEGF) found in all tissue and red light produce new blood vessels in the form of arterioles (the smallest or arteries) (Karu, 1998).  This explains the remarkable healing effects of LILT on severe wounds.

According to Mester, (1985) and Muxeneder (1998), the effects of LILT on wound healing are dramatic.  They stated, “Many irradiated septic wounds heal as if by first intention” (like a paper cut).

Trelles, et al (1989) reviewed the use of local irradiation with LILT.  They found this approach elicited the following types of effects:  bio-stimulatory, analgesic, anti-exudative, anti-hemorrhagic, anti-inflammatory, anti-neuralgic, anti-edematous, anti-spasmodic and vasodilatory, among others.

Trelles, et al (1989) and Muxeneder, (1988) also reviewed the effects of LILT on vertebral pain, headaches and local immune responses.   They found the main clinical uses included wound healing, pain control, soft tissue injury, arthropathy (abnormal joint condition), osteopathy and treatment of existing scars.  They observed local irradiation stimulated extremely rapid healing, even of extensive indolent (not healing) superficial wounds.  It was considered effective and safe.  Scarring was minimal.

Numerous clinical studies, and this author’s experience as team physician for a nationally ranked college hockey program, all indicate that swelling/inflammation in superficial muscles, tendons, ligaments, bursa and sheaths can be alleviated by irradiation of the affected areas.  In arthropathy and osteopathy, mid-range lasers can alleviate pain and inflammation of accessible joints, especially if the primary sites are irradiated.  Initially, the effect was thought to be anti-inflammatory.  However, recent studies have shown that LILT enhances the inflammatory process and allows the body to reach the healing stage much faster.  It is also effective in pain control and resolution of osteitis and periostitis in superficial areas.  It was, and still is preferable to ultrasound in these conditions as the latter can heat bones, potentially causing damage.

Old scars (surgical or traumatic) can act as trigger points if there are tender areas, keloid formation and adhesions along the scar.  Such scars can be associated with chronic pain, reflex pain, lameness and autonomic effects.  LILT of such tissue can produce dramatic clinical improvement in most cases.

The earlier lasers were “powered” by gasses such as Helium and Neon (He, Ne).  It was not until the 1980’s that the semiconductor diode system became available.  The most popular of these for clinical use were gallium arsenide (GaAs) and gallium aluminum arsenide (GaAlAs).  These super luminous diodes are mounted into a “treatment head” for easy application.  The emitted light includes far and near ultra-violet, the visual spectrum and near, mid and far infrared.  Since then, studies have conclusively found that the use of Light Emitting Diodes (LED) have the same clinical effects as the more expensive GaAs and GaAlAs diodes (NASA, 2001).

In LILT, nothing happens unless the tissue absorbs the photons (bundles of light).  In the therapeutic near infrared range, absorption takes place in the tissue water (about 70%) and organic molecules (about 30%).  For this purpose, absorption may be defined as the conversion of light into some other form of energy.  Once absorbed, the photons have different effects on amino acids, nucleic acid and other groups called chromophores.  The former is the basis for DNA and proteins.  The latter involves porphyrins, which are bio-organic molecules (hemoglobin and melanin are examples).

Another factor in the photo-chemical action of LILT is attenuation, or how much light is lost as it travels through tissue.  This depends upon the ratio between absorption and scattering.  This ratio varies according to the type of tissue irradiated and the wavelength applied.  Where light absorption is low, (600 nm – 1200 nm), scattering predominates.  In human tissue, scattering tends to be in a forward direction.

Considerable cellular research concerning laser irradiation has been done since the 1970s.  At that time the focus was primarily on wound healing due to the great clinical success using LILT.  For obvious reasons, the studies related to this involved observing the actions of fibroblasts, lymphocytes, monocytes, macrophages as well as epithelial and endothelial cells.

All studies exhibited the positive effects on healing mechanisms involved with the cells being treated either by stimulation or inhibition.  As a result, one could explain why wounds heal faster with LILT.  However, the exact mechanism by which light causes these photochemical reactions is still unknown.  This should not be cause to discount the efficacy of Low Intensity Laser Therapy.  If one were to read the Physician’s Desk Reference for the drugs Amitriptyline, Robaxin and Naprosyn (to name a few), under the heading of Actions, it says, “The exact mechanism in man is unknown”.  The effect on a patient and how it affects healing is, however, known.

Of at least equal importance, especially for the practitioner, is the role of LILT in pain relief.  This, more than wound healing, results in the, “too good to be true” attitude within the American medical community.  After all, EVERYONE knows the only ways to relieve pain are by medication and surgery.  If those don’t work, patients are referred for psychotherapy.

However, since 1986 world respected researchers have recommended LILT for such use (Seitz & Kleinkort, 1986; Zhou Yo Cheng, 1988,; Woolley-Hart, 1988; Jert & Rose, 1989).  In addition, clinicians around the world, based upon their professional experiences, confirm the analgesic effects of LILT.

Unfortunately, from a strictly scientific point of view, these reports are hardly conclusive.  There has been little or no standardization in the application of LILT. The type of laser, the wavelength, contact or non-contact mode, length of treatment as well as skin color, age of the patient and body types are all variables that can affect outcomes.  As a result, the majority of reports concerning the efficacy of LILT have been considered anecdotal.  A great many of the older reports were in foreign languages, which resulted in obscuring information during translation.

The Arrant-Schultz Law (Baxter, 1997); Oshiro & Calderhead (1988) may help explain some of the inconsistent findings of researchers.  It is to photo biological activation that the law of diminishing returns is to economics.  Basically, it says there is a threshold amount of energy (light) that is required to affect a change in cellular activity.  This amount varies with individuals.  When the dosage is increased above threshold (relatively little), the degree of cellular biological activity also increases.  When the dosage increases further, above a certain level (variable), a plateau effect occurs.  There is simply no increase in cellular activity.  When dosage is increased above plateau level, there is an inhibitory effect upon the cells.

These issues were resolved with the research and testing of the BioFlex Professional Laser System by Meditech, International, Inc. in Toronto, Canada.  In more than 25 years of exacting collection of data and constant upgrading of the laser equipment, Fred Kahn, MD, FRCS(C) has produced a LILT unit that can eliminate the above listed variables.  His publications, “Low Intensity Laser Therapy-The Definitive Texts” (three volumes) have documented the standardizations for application of LILT that were previously missing.

Another major obstacle to pain relief using LILT involves the subjectivity of pain.  The very nature of pain is such that there is no truly scientific way to measure it.  Also, some people have higher or lower sensitivities.  They also react differently to having it (victim vs. survivor).  On almost a daily basis, pain sensitivity can vary depending upon physical, chemical and/or emotional factors.

In spite of these limitations, the number of clinicians and patients who report significant analgesia from LILT has grown dramatically.  Whether or not we know exactly why, LILT is proving to be a very valuable modality in the treatment of pain.  In fact, clinicians using LILT and other forms of electrotherapy consistently report the clear superiority of the former.  In a growing number of instances, it is now used as the first treatment of choice for pain.  Professional teams and players use it as a first choice for “itis” conditions (Miami Heat, Toronto Raptors and others).  Perhaps of greatest importance is that, in more than 50 years worldwide, there has never been a single report of a significant long term negative side effect attributed to this procedure.

The list of conditions treated by LILT is extremely impressive.  It transcends just pain.  In fact, it would be easier to list conditions on which LILT does not work.  Even then, failure is not outright.  It would be more appropriate to say that the percentage of success in some patients, with some conditions, is lower than usual.

It is essential to note that, because LILT returns cells to normal function, and that the normal function of cells is to HEAL and not to hurt, this procedure is curative rather than simply getting rid of symptoms.  The healing can be inhibited if a structural component exists.  A reasonable analogy is having a motor vehicle that pulls toward the right side of the road.  If the right front tire is not flat, there is a probability that a misalignment of the front end of that vehicle exists.  The driver might not want to spend the money to get it aligned (perhaps the lease is up shortly).  Instead, they lower the air pressure in the left front tire to the point that the car drives straight.  Problem solved!  The symptom goes away.  Unfortunately, they will have to purchase two new front tires every 3,000 miles (5,000 km) or so.  Thus, structural problems demand structural corrections.

If a patient has a misalignment in the hips, spine or extremities, there is constant irritation to the soft tissue components of those areas.  It can feel better with LILT, but permanent healing will be extremely difficult to achieve.  When this is the case, concomitant structural correction (manipulation by a Chiropractor or Osteopath) and LILT results in rapid, complete recovery.  Considering the 10,000 patients treated in my office with LILT, this author has found that 30 patients have ever returned for treatment of the same problem.  The common denominator was structural issues that were not corrected or has once again become an issue.

Following is a partial list of conditions which clinically and in more scientific research, have been successfully treated.  This list is not all-inclusive.

CERVICAL PAIN                                                       FACIAL PAIN (INFLAMMATION)


HEADACHE/MIGRAINE                                       TENDONITIS

SCAR TISSUE                                                            CARPAL TUNNEL SYNDROME

ROTATOR CUFF INJURY                                      EPICONDYLAGIA


COSTOCHONDRITIS                                              NEURALGIA



ARTHRITIS/ARTHRALGIA                                   BURSITIS

CAPSULITIS                                                               FRACTURES

HEMATOMA                                                              HERPES ZOSTER

MYALGIA/FIBROMYALGIA                                  NERVE ROOT/TRUNK PAIN

DIABETIC LESIONS                                                 BED SORES

GANGRENE                                                                COPD

CYSTIC FIBROSIS                                                     STROKE

CLOSED HEAD INJURIES                                     DEPRESSION

PTSD                                                                            ADHD


BELL’S PALSEY                                                        TRIGEMINAL NEURALGIA


PARKINSON’S DISEASE                                        WOUNDS



Included in the above list are sports related injuries experienced by ‘weekend warriors”, college and professional athletes.

After a double blind clinical trial conducted by General Motors Corporation using LILT for treating Carpal Tunnel Syndrome on workers disabled at least two years (40% went back to work), the company had established laser treatment facilities in all of its manufacturing plants.

Low Intensity Laser Therapy has been clinically proven to be superior to other forms of pain therapy.  In comparative applications, it has worked better than medication (that just masks the pain), ultra-sound, electrotherapy, heat, ice, etc.  It also does not have the side effects as do other forms of treatment.

LILT is not a “magic wand”.  It uses a device which promotes rapid healing and pain relief.  This is a PROCESS, not an on/off switch.  However, millions of patients have been helped when no other form of treatment has worked.  Of +/-10,000 patients treated by this author and in the BioFlex Laser Therapy Clinics in Toronto and Etobicoke, Canada (+/-200,000 patients), about 98% have tried every other possible form of treatment and failed to get better.  In both facilities, the LILT success rate has been more than 90%.

Success is measured by how the patient feels, if they experience better sleep, if they take less medication, spend more time every day not being aware of the pain, participate in more of life’s daily activities without limit due to pain, and other considerations patients believe to be important.

Laser/Light therapy also dramatically reduces healing time when compared to other traditionally used modalities.  Hospitals in Great Britain have used LILT in post-surgical recovery rooms.  They have found patients have much less pain, take 50% less pain medication, heal in half the time and have significantly less scar tissue.  To those of us who have been privileged to use this technology, our patients’ permanent recoveries are not only believable, but are expected.

As a lecturer at international conferences dealing with LILT, I include a reminder to all of us who treat patients, regardless of profession.  Oliver Wendell Holmes, an American author, lawyer and Supreme Court Justice was also a medical doctor (unknown to most people).  He is quoted as saying, “The body does the healing but the doctor pockets the fee”.  Ultimately, the body, not the doctor, does the healing.  Those of us privileged to work with patients are mediators who hopefully provide something a body needs in order to recover.  This author believes LILT is the best and safest way to assist the body, human or otherwise.

Having been a principal investigator for two FDA Clinical Trials involving Low Intensity Laser Devices, and having used several other such devices, it is the author’s opinion that the most superior form of LILT is via the BioFlex computer driven laser instrument.  This device is produced by Meditech International, Inc. in Toronto, Canada.  Besides dozens of pre-set protocols, it can also accommodate customized protocols.  All parameters can be altered to truly individualize each treatment.  Even such things as age, skin color and body type can be considered when choosing the appropriate amount of light exposure.  Once chosen, the dosage is calculated automatically.

Another of the unit’s most unique features is the “Flex” part of the name BioFlex.  The treatment heads can wrap around joints (knee, elbow wrist, etc.), delivering light through as many as 240 LEDs. In addition, there are laser probes with single diodes using red (100 mw) and infrared (200 mw). The flexibility of the treatment heads in application and choices as well as almost unlimited settings create a treatment device second to none.

Dr. Fred Kahn is founder of Meditech International, Inc., Toronto, Canada.  He has tirelessly worked to create the most complete LILT device based on research at the Meditech Clinics in Etobicoke and Toronto. The most detailed, complete records have been kept on more than 200,000 patients for over 25 years. Based upon the findings of these patient treatments, the equipment and protocols have been constantly updated.

Now, available for the first time, are two Personal Therapy Systems. They are the BioFlex 120 and the BioFlex 180. The numbers represent the number of Red and Infrared LED diodes in the respective treatment heads. There are 12 body areas pictured on the control unit. There are also four stage settings which actually gives you forty-eight treatment options. They are remarkable advances in treatments available for home use. Information about these units can be found at If you have additional questions, you can reach me by writing a comment/question in response to this blog.

Dr. Kahn’s trilogy of books, “In Clinical Practice”, “The New Therapeutic Dimension” and “Clinical User’s Manual” (Meditech International, Inc. 2006), are the platinum standards for those who treat patients with LILT.

For those of you who are interested, I am not an employee of Meditech International, Inc. Toronto, Canada. I get no commission for selling any of their equipment. I have just entered my 22nd year of using LILT, having experience with many different manufacturers and their equipment. I have made it clear that, should I find a superior LILT device, I would tell doctors and patients about it. I have never found this to be the case. The BioFlex equipment has been and continues to be the most superior LILT equipment based on research, design, field testing and results.

Several years ago, I read in a medical journal that, on average, it takes twenty years for a new medical procedure to be generally accepted by the majority of medical professionals. Unfortunately, this has been the case with Low Intensity Laser Therapy or, as now called, Light Therapy or Photo Medicine. Sadly, the medical profession (AMA) has yet to assign LILT a reasonable CPT (Current Procedural Terminology) code used to bill outpatient and office procedures. Until this is corrected, there will either not be insurance reimbursement or the reimbursement will be so low that doctors cannot afford to provide this type of care. Of course, with the current trend toward very high deductibles and co-pays, paying out of pocket for LILT is cheaper than having to constantly return for follow-up office visits and paying for medication that will only, at best, temporarily hide the symptoms.

I want to make it clear that I would not want to live in a world where there were no medications or surgery. As with everything in life, with the good comes the potential for negative outcomes. The only exception appears to be LILT. It should be used first and fall back on the other two if necessary, not the other way around.




Basford J R, Daude J R, Hallman HO et al 1990.  Does low-intensity Helium-Neon laser irradiation alter sensory nerve action potentials or distal latencies?  Lasers in Surgery and Medicine 10:  35-39

Baxter G D, Bell A J, Allen J M et al 1991   Low Level Laser Therapy – Current clinical practice in Northern Ireland.  Physiotherapy 77:  171-178

Baxter G D, Diamantopoulos C, O’Kane S, Sheilds, 1997.  Therapeutic Lasers Theory and Practice, Churchill Livingston, New York, NY

Dyson M, Young S 1986, The effect of laser therapy on wound contraction and cellularity in mice.  Lasers in Medical Science 1:  125-130

Kahn, F 2006, Low Intensity Laser Therapy-the definitive texts (In Clinical Practice, The New Therapeutic Dimension and Clinical User’s Manual) Meditech International, Inc., 415 Horner Ave. Etobicoke, Ontario, Canada m8w 4w3

Kert J, Rose L 1989 Clinical laser therapy: low level laser therapy.  Scandinavian Medical Laser Technology, Copenhagen

Mester E, Mester A F, Mester A 1985 The biomedical effects of laser application.  Lasers in Surgery and Medicine 5:  31-39

Muxeneder R, 1988 The conservative treatment of chronic skin alterations of the horse via laser acupuncture.  Praktische Tierarzt Vol 69 Iss 1

Oshiro T, Calderhead R G 1988 Low level therapy: a practical introduction.  Wiley, Chichester

Seitz L, Kleinkort J A 1986 Low-power laser: its applications in physical therapy.  In: Michlovits S L, Wolf S L, Thermal agents in rehabilitation, F A Davis, Philadelphia

Smith K C Professor Emeritus, Radiation Oncology, Stanford University School of Medicine, Founder and First President of the American Society for Photobiology, Karu T In: The Science of Low-Power Laser Therapy, Gordon and Breach, Amsterdam, The Netherlands

Trelles M A, Mayayo E, Miro L et al 1989 The action of Low reactive Level Laser Therapy on mast cells: a possible relief mechanism examined.  Laser Therapy 1: 27-30

Wolley-Hart A 1988 A handbook for low-power lasers and their medical application.  East Asia, London

Ahou Yo Cheng, Ohshiro T, Calderhead R G  1988 Laser acupuncture anesthesia  In: Laser acupuncture anesthesia, Low-level laser therapy: a practical introduction  Wiley, Chichester







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The Best Treatment for Cancer That You Probably Never Heard Of




In January, 1996 the FDA approved a photo reactive drug and the use of red light to treat lung cancer. It is called Photo Dynamic Therapy or PDT.

The first report of this technique was in Newsweek magazine on January 26, 1998 (page 72). I will present the entire article, as written by Claudia Kalb, with Anne Underwood and Tara Weingarten.

When doctors discovered a speck of cancer on Phillip McCormick’s lung a couple of years ago, they gave him two options. The most traditional and conservative route, they advised, would be surgery-the complete removal of the lung (because his cancer was discovered early, he would be spared radiation and chemotherapy). Or, he could participate I a clinical trial of photodynamic therapy (PDT), an innovative treatment that relies on, of all things, light beams. For McCormick, 68, a farmer in Astoria, Illinois, PDT was the more appealing choice. “I was so scared of it” he says. “It sounded a lot better than using a knife.”

PDT works much the way photosynthesis does in plants, by using light to spark a chemical reaction. McCormick’s treatment began with an injection of porfimer sodium, brand name:  Photophrin, a special light-sensitive drug that travels through the bloodstream and settles in cancerous cells. The drug, which the FDA has just approved for this use, is inactive until triggered by light. Two days after the injection, doctors numbed McCormick’s throat, then snaked a bronchoscope into his lung where it emitted a red laser light. The laser caused the drug to produce an unstable form of oxygen, which made the cancerous tissue inflame and detach from the lung lining. The dead cancer cells “just slough off like a scab does,” according to Dr. Eric Edell, vice chair of pulmonary and critical care at the Mayo Clinic in Rochester, Minnesota.

The use of photodynamic therapy is currently restricted in the United States, approved only for late-stage esophageal cancer and for early –stage lung cancer in patients who have no treatment alternatives (ironically, McCormick, a PDT success story, wouldn’t be eligible for the procedure today). And long-term follow-up is limited. But researchers are heartened by preliminary success rates. In a study of 102 lung-cancer patients conducted in Canada, Germany and France over the last decade, doctors eradicated early-stage tumors on 79 percent of patients after just one round of PDT. “It kills cancer, no doubt,” says Edell.

The treatment is also swift – McCormick’s outpatient session lasted 15 minutes:  surgery would have required a hospital visit plus six weeks of recovery. PDT can save money, too:  in a 1996 Japanese study of lung-cancer treatments, researchers found that PDT cost about half as much as surgery, and it’s a whole lot less invasive. “I didn’t feel a thing,” says McCormick. Doctors are now testing the procedure on everything from skin and breast cancer to macular degeneration, a progressive eye disease. “A few years ago we said PDT was promising,” says Thomas Dougherty, a research scientist at Roswell Park Cancer Institute in Buffalo, N.Y. “Now we say it works.”

Doctors warn that light therapy is by no means a replacement for standard treatments. Unlike chemotherapy, PDT cannot attack cancer cells that have spread throughout the body, since it works by targeting tumors. Nor is it useful for blood borne cancers like leukemia. And because light waves cannot penetrate more than several millimeters of tissue, deeply lodged tumors are inaccessible to PDT.  The therapy isn’t devoid of side effects either. Photophrin remains in the body for about six weeks after treatment, leaving patients extremely sensitive to sunlight and bright bulbs (even a dentist’s lamp can cause an uncomfortable burn).

But that’s a side effect many cancer patients would be willing to put up with. Phillip McCormick got a bad sunburn planting his corn, but he’s been cancer-free since his treatment for two years. To him, “it’s the greatest thing since bubble gum.” His four grandkids would likely agree.


On March 3, 1998 the AP (Associated Press) Health/Science Division, at 1:31 PM (ET) released a document titled:  DOCTORS USE LIGHT TO FIGHT CANCER. I provide the entire article for your perusal.

BALTIMORE (AP) – Dr. Marcia Canto threaded a thin fiber optic line deep into the throat of Jesus Jimenez. The fiber pulsed with bright red light for 12 and a half minutes, destroying deadly cancer cells without pain and without hurting healthy esophagus tissue trembling just behind.

Scientists once scoffed at harnessing light to fight cancer and other diseases, but now they say such “photodynamic therapy” has potential thanks to potent new drugs that make diseased cells vulnerable to light beams.

The Food and Drug Administration recently approved light therapy to fight advanced esophageal cancer and early lung cancer. It’s not a silver bullet, but it is showing promise against other cancers, too – with fewer risks than surgery or chemotherapy. It is even being tested against the leading cause of blindness and autoimmune diseases.

“It’s pretty exciting,” Canto said. She was treating Jimenez at Johns Hopkins University Hospital after his doctors in Puerto Rico said operating on his mid-stage tumor was too risky.

It’s too early to know Jimenez’s prognosis, but his main worry upon leaving the hospital hours later was to guard against sunburn from the light-sensitive drug left in his system.

“This treatment was so easy, I can’t tell you,” added 83 year old Walter Winkelmeyer, whose two treatments have left his esophagus cancer-free for six months. “My doctors had told me I had 18 months to live and look at me now.”

Winkelmeyer’s tumor was caught early, but serious heart and lung problems meant that he wouldn’t survive any strenuous surgery. Doctors in Sarasota, Florida said he would die, but relatives discovered Canto also was studying photodynamic therapy, or PDT in early esophageal cancer.

Doctors have known for nearly 100 years that light could kill. Many drugs are photosensitive – it’s why patients on the antibiotic tetracycline, for example, get sunburned.

The key to making light therapy work was injecting photosensitizers that concentrate in diseased cells but quickly clear out of normal cells – and then harnessing the right wavelength of light.

Blasting the disease site with a laser’s non-burning red light makes the photosensitizer produce a toxic oxygen molecule that kills targeted cells.

“It sounded kind of goofy…..that shining visual light on something would kill a cancer cell. There’s been some resistance,” said Dr. Stephen Hahn, who is testing the method against three intractable cancers – ovarian, advanced lung and mesothelioma – at the University of Pennsylvania.

But with recent advances in laser fiber optics and photosensitizers, “we’re seeing a resurgence in interest,” said George Washington University’s Dr. Michael Manyak, who has had success in bladder cancer and now is studying infertility-causing endometriosis.

The government has approved one photosensitizer, Photofrin, by Canada’s QLT Phototherapeutics. It doesn’t cure advanced esophageal cancer, but regulators determined it offered patients a longer reprieve before throats reclog. Even better, it eliminated early lung cancer in 79 percent of patients.

The drawbacks:  the drug takes two days to concentrate in tumors, leaves patients prone to sunburn for six weeks and penetrates only relatively shallow tumors.

Still, “anyplace that you can reach with a laser light-delivery system can theoretically be treated with this kind of approach,’ says FDA oncology chief, Dr. Robert DeLap.

So companies in the United States, Canada, Japan and England are hunting better photosensitizers – and other targets.

In the case of macular degeneration, which blinds the elderly, regular lasers can burn away vision-robbing abnormal blood vessels that grow into the eye, but they leave damaging scar tissue and the vessels grow back.

Preliminary experiments suggest therapy every three months with BPD, a next-generation Photofrin, can kill the abnormal blood vessels and block relapse. Now over 20 North American and European hospitals are searching for proof.

More radical are experiments to see if light therapy affects the immune system to alleviate autoimmune disorders.

QLT treated 20 psoriasis patients inside a body long light box. Beaming enough light to partially activate the photo-drug but not kill cells, doctors found psoriasis lesions improved enough that the company is pursuing a larger study.

After reading both of the above articles, and having worked with Low Intensity Laser Therapy (primarily using LEDs) for, at that time, about three years, I knew that the need to use only fiber optic red laser lights for treating cancer was no longer necessary. I came up with a plan for a study using Photophrin and Red LEDs to treat breast cancer.

I wrote a letter to Sydney Salmon, MD, the Director of Oncology at the University of Arizona Medical Center. Dr. Salmon, a man of class, quickly responded to my request to meet with him or a member of his staff. While prompt and very polite, he informed me that such a meeting was not possible at that time.

At the time that I wrote that letter, I was a regular co-host/health care consultant for a radio program in Pima County, AZ. It was called, “Talk of the Town”, hosted by Bert Lee on KTKT, 990AM. I told Bert about this and we discussed the PDT procedure and FDA approval on the air.

Without my asking him to do so, Bert contacted Elaine Richardson, at that time an Arizona State Senator. She, in turn, contacted someone at the Cancer Center, and I received a note telling me to contact the Director’s Office to arrange an appointment. I eventually saw Dr. Hugo Villar, chief of oncology surgery and Dr. Rich Fryer, chief resident in oncology surgery. The following is a very accurate summary of that meeting.

After introductions, Dr. Villar began asking me questions about myself and Fred Kahn, MD, FRCS, founder and developer of low intensity laser equipment and Meditech International, Inc. in Toronto, Canada. Actually, it was more like a medical verbal inquisition.

I explained to Dr. Villar that neither Dr. Kahn nor I needed credit for anything positive that may result from my proposed study. I told him that, if it worked as it should, he could name it the Hugo Villar breast cancer cure. My reward would be knowing that countless thousands of women would not have to be maimed, poisoned or unnecessarily die from breast cancer.

Dr. Villar insisted that all credentials had to be confirmed because a State Senator had arranged that this meeting take place. When he finished his questioning and looking for our names in various reference books, I was able to begin my presentation.

My idea was to establish a breast cancer study using PDT. The drawbacks listed in both articles were, the need to use fiber optic red lasers that only penetrated a few millimeters and that the previous studies treated only relatively shallow tumors. I explained that red LEDs could penetrate about four inches and breasts could be squeezed to the point that even with the largest breasts the light could reach every part of them. Those who ever observed or experienced a Mammogram being done know exactly what I refer to. In addition, I pointed out that, if necessary, the Photophrin could be targeted toward specific areas, even tumors deep in large breast tissue.

Dr. Villar’s immediate response was, “it would be illegal, immoral and unethical to do this. Such a study would have to be done on animals first.”

I suggested that many FDA approved drugs were used for off study purposes. I mentioned Terbutaline, a drug approved for upper respiratory conditions such as asthma and emphysema that was used for 25 years to help stop premature contractions during pregnancy. It had never been officially studied or approved for that use by the FDA.

Dr. Villar insisted that such a study had to be done on animals first. I suggested that the University of Arizona had an agricultural department and there were cows that had breasts (at that point I understood I was wasting my time). He responded that the research department had no money for such a study. When I asked about the National Institutes of Health, he said, “They had no money.” I got the same response when I asked about the American Cancer Society. He added, “I cannot speak for the research department, but I am inclined to believe they would not be interested.”

I realized it was time to tuck my tail between my legs and slink out of that building but was stopped when Dr. Fryer spoke up. He had been reading the articles while I spoke to Dr. Villar. He said “I read that PDT kills 79% of cancer cells. Chemo therapy kills 99.99 percent of cancer cells. If you have 1,000,000 cancer cells, and that’s not be very many, that still leaves 10,000 cells to proliferate and metastasize. THAT IS WHY CHEMO THERAPY DOES NOT WORK.”

I recovered quickly from the shock of hearing that statement while sitting in an office that was part of the University of Arizona Cancer Center. I did not bother to correct Dr. Fryar even though he mistakenly interpreted what he read as PDT killing only 79% of cancer cells instead of total kill of all cancer cells/tumors with one 15 minute treatment in 79% of the cases studied.

I thanked both of them for taking time from their busy schedules to speak with me. I left their office, but could not leave the building. It seems there was an old car left in front of the ER that had some visible suspicious looking packages. The police, fire department and Bomb Squad were called. About an hour and a half later it was determined the packages were harmless and the person who left the car was being treated on an emergency basis. I don’t remember the exact date, but if anyone is interested, that incident may be listed in hospital security, police and/or fire department archives.

On various occasions, spanning the past 19 years since that meeting, I have shared this information with patients individually and in small groups.  I even described it, just as I have written, on the radio program. People have been upset to hear this but, alas, nothing has changed. After multiple times of me renewing my effort to promote a breast cancer study using PDT, I had to back off for a while. I found the repeated experiences to be too frustrating and stressful.

As mentioned above, Dr. Eric Edell of the Mayo Clinic in Rochester Minnesota acknowledged that patient Phillip McCormick would now not qualify for PDT.

I have my own feeling as to why the FDA would make a cancer treatment they approved virtually impossible for patients to receive. That treatment has absolutely the best percentage of success of all other treatments, and the least bad side effects. It stipulated that one could not get PDT until they had gone through two of the normal three forms of cancer treatments (Chemo Therapy, Radiation and Surgery). However, I want this blog to educate people about a “new” cancer treatment that has been FDA approved for 21 years. I hope that you consider why YOU believe PDT was purposely restricted for use as only an end stage treatment option. Clearly, both early detection and early treatment with PDT could have the highest success rate of all existing cancer tumor treatments. It would also cost significantly less.

I am hoping you don’t come up with the only reason I can think of. In fact, if you are so inclined, please use the blog response capability and let me know what you think. I truly welcome your thoughts and pray they are different than mine.

The American Cancer Society web site has several pages describing Photo Dynamic Therapy. It is relatively positive. It describes the use of several newer drugs that have been developed in the past 21 years. It also lists the possible side effects of each. None are anything as serious as those from Chemo Therapy, Radiation or Surgery. Notably absent is the recommendation that PDT be allowed to be used as a first line of defense against cancer.

There is no such thing as a perfect answer for the treatment of cancer. People with specific genetic markers for breast, ovarian and other types of cancers definitely need a more aggressive approach. However, for women diagnosed with breast cancer who don’t have those genetic markers, alternative approaches would seem appropriate. PDT should certainly be one of those.

As always, I suggest that you don’t believe anything I write and do your own research. However, I am the only source for the experience described about my meeting at the University of Arizona Cancer Center. As such, I make the following offer:  I will gladly submit to a polygraph. In fact, should Drs. Villar and Fryar be willing to take one, I would pay for theirs. At this point, it is the best I can do to help confirm the validity of my personal experiences.

If you are so inclined, I ask that you share this blog with as many people as possible. The only way change can possibly take place is if there is massive public pressure to make it happen. I have already proven that I can’t make this change on my own. Any help you can give will be greatly appreciated. If successful, those countless thousands of women who are not poisoned, maimed or otherwise die from breast cancer, will be eternally grateful.






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