Letters to the Editor - May 16, 2011

As public health issue, AMA "must engage the climate deniers head on"

Regarding "Confronting health issues of climate change" (Editorial, April 4): Bravo, AMA. Thank you for taking on the issue of climate change. This is the most serious issue that our civilization has ever faced next to global nuclear war.

The science is settled but for the details of how bad, how soon and how to cope with a transformed planet. Physicians, who base their practice on sound scientific evidence, must get involved in the debate over the inevitable transition to a post-carbon energy future. Everything is at stake, including our ability to maintain human health.

The resistance to moving to Industrial Revolution version 2.0 is purely political. Powerful forces who stand to lose business are spending hundreds of millions of dollars spreading misinformation, attacking scientists and sowing doubt in the public's mind, just as they did in the tobacco "debate."

The AMA is a political organization that must engage the climate deniers head on, as a matter of public health. Earth's climate will not wait for us to work out the politics over decades. Irreversible tipping points have arrived 100 years ahead of schedule, and we are out of time. We physicians have a duty to warn -- and act.

--Peter G. Joseph, MD, San Anselmo, Calif.

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Do not link Maine Lyme disease increase with climate change

Regarding "Confronting health issues of climate change" (Editorial, April 4): Your editorial is without factual basis.

Any change in Lyme disease incidence in Maine is likely the result of changes in deer density, better awareness by physicians, and better reporting to the Dept. of Public Health. The impact of local weather on deer tick populations can indeed be great: Hot and dry weather accelerates nymphal tick mortality and leads to fewer Lyme disease cases. Lack of snow (which insulates) exposes adult ticks to cold-related mortality. Thus, any "warming" would probably lead to less Lyme disease overall.

--Sam R. Telford III, ScD, North Grafton, Mass.

Editor's note: Telford is a professor of infectious diseases at Tufts University.

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AMA should educate Congress on the dangers of climate change

Regarding "Confronting health issues of climate change" (Editorial, April 4): It was heartening to read an editorial that discussed the health effects of climate change that physicians already are confronting.

Prolonged and intensified allergy and asthma seasons, heat-stress-related effects on patients with chronic cardio-respiratory illnesses, a recrudescence of subtropical diseases and more extensive distribution of domestic infectious diseases have occurred. As the editorial points out, these are the first of many climate change-related health effects that physicians will be confronted with.

The opinion piece then went on to describe the laudable education and outreach actions our AMA is taking to prepare physicians for the health effects of global climate change.

While encouraging to read in the article about AMA's action on climate change, it was ironic that during the same week the editorial was published, 50 U.S. senators voted to strip the Environmental Protection Agency of its authority to take incremental steps to address climate change, and the House of Representatives passed legislation stripping the EPA of such authority.

Perhaps the AMA's efforts would be better directed at educating Congress about the evidence-based science documenting climate change with its adverse health effects on humans that physicians are currently encountering. The physician community can treat patients with climate-related illnesses, but only Congress has the power to actually address climate change.

--Joseph Sokolowski Jr., MD, Medford Lakes, N.J.

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Meaningful use is a concept that could be applied to patients

During a family vacation in Orlando, I am thinking about the Medicare requirements for electronic medical records. As a physician, I will need to prove that I am a "meaningful user." Although the government is dangling financial incentives to use an EMR, penalties begin in 2015 for failing to demonstrate meaningful use.

Now let's contrast these requirements with what I'm seeing today at the theme park. I see multitudes of morbidly obese people and morbidly obese children eating ice cream, cheeseburgers and other junk food. I see sunburned smokers huddling like drug addicts next to the attractions. I see fellow citizens daring fate to strike them down with diabetes, hypertension, strokes and cancer.

And then the absurdity of it all is apparent. Why am I being threatened with penalties from Medicare when some of the main drivers of health care costs are not being addressed? Obesity, smoking and risky behaviors are dangerous, irresponsible, expensive, unpatriotic and damaging to the financial well-being of the U.S.

Why not penalize patients who refuse to lose weight, stop smoking and stop irradiating their skin on the beach? Maybe patients should be required to prove that they're meaningful users of health care. If they cannot, their health care premiums should be higher. Why not?

Unless Americans stop poisoning themselves, health costs will keep rising. If the government thinks ratcheting down payments to providers is the solution, we're doomed. Eventually, just like Medicaid in many offices, Medicare will not be accepted for payment, because the cost of providing the care will exceed reimbursements. Medicare will cease to be a safety net for the elderly and disabled.

Now I'm going to return to watching my kids enjoy their carrots.

--Peter A. Klein, MD, Stony Brook, N.Y.

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Oncologist pay illustrates flaw in posting Medicare billing data

Regarding "Bill would post every physician's Medicare billing data on Internet" (Article, April 4): Sen. Charles Grassley has proposed that Medicare publicly release data on Medicare reimbursement for individual physicians. This would be terribly unfair to doctors, and especially oncologists, in private practice. We have a center with nine medical oncologists and two radiation oncologists, and we have onsite imaging, laboratory and chemotherapy, which is appreciated by our patients.

Unlike for hospital-based physicians, Medicare sends payments for all of these services in the name of the physician in the practice, thus increasing private physicians' "reimbursement" greatly. I explained to a patient yesterday that I wish I received all of that, and he laughed. Our actual pay has decreased 25% over the last few years.

The AMA must stand firm against this distortion of the data. If I were cynical, I would think that this is just another nail in the coffin that Medicare is trying to build for all physicians in private practice.

--Joseph J. Muscato, MD, president, Missouri Oncology Society, Columbia, Mo.

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