Health care Reform and 3rd Party Payer System

A third party payer system is when the consumer is actually not the person directly paying for what they are consuming. The system works like this: You the consumer give your money monthly to someone else (like an insurance company) then you go shopping for something (like health care). You and the vendor come to an agreement on what you are going to get and the third party - the insurance company - actually pays the expense.

Imagine that you walk into a hardware store to buy a hammer. First thing you do is go see your home maintenance manager. He asks you why you are there. You explain to him that you need a hammer to drive some nails into a board, showing him pictures of the board to prove you are in need. He says fine and gives you a referral to see the hammer specialist.

You walk over to the hammer specialist with your referral slip. He shows you a selection of two hammers with wooden handles. You have a problem with that because wooden handles destroy trees which harms the environment and you want a hammer with a handle made from a new environmentally friendly material. The hammer specialist explains to you that your hardware insurance only covers the wooden hammer because there is a state law that requires all insurance companies to cover wooden handled hammers but not others.

In the end since the insurance company will cover the hammer with the wooden handle you take it and leave the store happy. You don't have to pay anything. It wasn't exactly what you wanted but the insurance covered it and you had no out of pocket expense. You also feel a small sense of satisfaction that the hardware insurance you have been required to carry by law finally got used.

You will never know actually how much was charged to the insurance for that hammer unless you put some effort into finding out. As a matter of fact you aren't even really sure how much you pay for hardware insurance monthly because it is a combination of payroll deduction subsidized by money you pay out in income tax and a series of other taxes you don't realize you are paying.

Through some inspection you discover that the hardware vendor charged $200 for the hammer and the insurance paid $75 for a hammer that normally would cost $10. The real cost to you was about $150 but because the costs are hidden from you through taxes you don't see this.

Another thing you are unaware of is that because there are a few centralized third party payers in the hardware world it is easier to regulate the market through legislation. Large companies in the market are able to lobby legislatures and other influential politicians to get them to make it law that their products have to be covered by the insurance companies. This is a great way for them to control the consumer who is being forced to pay into the insurance system.

The above ridiculous example is how health care works under the current third party payer system with the exception that, at least for now, we are not required to carry health insurance by law. But state governments and the federal government do use their authority as law makers to require insurance cover certain health care products and services. The consumer routinely does not pay directly for service or even know really how much it costs.

I guess it could be a solution to have the government further regulate health care. However what we really want is a system that gives the best health care possible in the most fair and efficient system. A suggestion is actually to create more of a free market system with the elimination of the third party paying system. I am proposing some regulation which would be to outlaw third party paying systems due to their lack of transparency to the consumer and great propensity for limiting competition. Instead one takes out fixed amounts of insurance to secure themselves in the case of illness. You can insure yourself for $20K worth of benefits if you contract cancer. If you get cancer the insurance company pays you $20k and it is up to you to spend it as you see fit. Now hospitals and care givers and others in the health care industry have to compete for your business.

One thing that is not given enough attention in the health care debate is why are costs so high. In any other industry competition results in better products, better service and lower costs. This is not happening with health care because the health care market is not a free market where suppliers and vendors need to respond to consumers. President Obama made an excellent point that the incentives inherent in our current system are mixed up. The solution is to put the consumer back into control by removing the practice of third party paying.

Healthcare Reform

Health care is an interesting debate. The question is that in this country is government regulated healthcare a good idea.

First thing is that it has to be stated that we currently DO have government regulated health care. For instance state governments have passed laws telling insurance companies what care they have to cover. As it turns out this actually makes the situation worse:

In some states, regulations make it impossible for individuals to purchase a low-cost plan that would provide only catastrophic coverage. In other cases, the benefit mandates and insurance rules might raise premiums to the point that insurance is prohibitively expensive for many people.

from an article The Effect of State Regulations on Health Insurance Premiums: A Revised Analysis. Interesting to note of course is that insurance companies are mandated to cover expensive medical treatments and drugs but none of the less expensive preventative measures. I am not saying it is the case in this country that powerful pharmaceutical and medical lobbies find it convenient and extremely profitable to be able to get state legislatures to force insurance companies to cover their drugs and treatments. I am not saying that...

So it should be clear that the current unworkable system is not a free market system - it is a government regulated system and that regulation can certainly be used by vested interests.

Health care is further complicated by the quantity of inaccuracies and unknowns in the field. A stunning fact is that 20% or more of sick people can be cured by a placebo. As a matter of fact an article in the Washington Post, re-published here, showed that a sugar pill is more effective than anti-depressants in managing depression! Here is another interesting fact:

America's healthcare-system-induced deaths are the third leading cause of death in the U.S., after heart disease and cancer.

The full article on that can be found here.

Given that we spend 15% of our GDP on health care vs. 8% to 10% in other countries considered healthier than ours it certainly doesn't appear that under the current system the money is being well spent.

So something is definitely crooked in the American health care system. I think one way a difference could be made would be to ensure that there is no mis-representation going on with our health care providers. We spend 1.5 to 2 times the amount of our GDP on healthcare than other countries that have lower mortality rates than we do?!?! Do you think there is some fraud in the system that when gotten rid of could lower our costs? Perhaps expensive less effective treatments are being marketed/lobbied for like crazy over less expensive more effective treatments. To wit - recently a court ordered a mother to have her son undergo chemo-therapy. Expensive and extremely doubtful in efficacy.

So the next thing we look for is who benefits from a wealthy country in poor health that spends 15% of its GDP on health care? Don't strain yourself too much on that one. The U.S. is home to more than half of the top 12 pharmaceutical companies and easily has the most pharmaceutical companies of any country. Make no mistake that they make a lot of money off of the current system.

It is also interesting that currently the debate is not about the cost vs. benefits of the treatments we are spending so much money on - it is about lowering the cost to the consumer for insurance coverage. What?!?! Anyone else thinking cart before the horse? Lowering the soaring cost of health care is not about lowering the insurance costs - those will go lower if the cost of the underlying care they have to cover goes down. That would happen freely competing market for health care - one we do not have. Some treatments have the advantage of the government making it the law that they have to be covered.

So trying to address the problem with a national healthcare program in a country with such a powerful pharmaceutical and medical lobby is folly. In the end we will end up paying as much or more of our production toward healthcare forcibly via taxes. This is in fact a dream for wealthy companies with powerful lobbies.

Another aspect is making the consumer accountable for their health care. Currently most consumers don't even know how much their healthcare costs them. "The insurance takes care of it." This is a terrible system - the doctor responsible for making you healthy doesn't even work for you. They work for the insurance company - after all it is the insurance that will in the end pay them. In turn the insurance company is told who and what to cover by state legislatures.

A better solution is a free market system where you can purchase dollar amount coverage for protection against getting certain illnesses. For instance you could purchase $20K in coverage in case you get cancer. If you get cancer your insurance company gives you $20K. It is now yours to spend on whatever treatment you choose to pay for.

Obama made a very intelligent statement - we have to change the incentive in health care. Now the incentive factually is that a person gets an illness that doesn't kill them but requires continuous treatment. With the above system which is more consumer based, treatments with higher success rates for curing what ails you will win out. After all you have $20K to deal with your cancer. You will seek out and spend it on the most effective treatment.

Read more on this type of solution...

Taxation with Unfair Representation

Our forefathers rebelled against the British Empire - put their lives and wealth on the line - because they were being taxed yet unfairly represented in the government that determined the rules under which they lived. Is the modern day progressive tax system any different?

Imagine a system where your tax bracket determines the weight of your vote: If you don't pay taxes you can't vote. If you are in the first tax bracket (lowest) you get one vote, the second two votes etc.

'Crazy!!' you say? Ok - think about this: Under our current system politicians have a vested interest in down-trodden people who are dependent on the government for money be it welfare or unemployemnent. People who are dependent on the government for sustenance or security are easy votes to get. We have set up circumstances where politicians benefit from a lack of success.

What would happen if we reversed this? Politicians benefit from promoting success. Every person who is so bad off they can't pay taxes is a lost vote. There is no benefit to having poorly educated people around who don't get paid well or have to depend on the government for money. Hmm...

The Recession is Over!

Thank goodness the 'worst recession since the Great Depression' is over! The Wall Street Journal has declared that the recession will end in September, CNN changed their slogan from 'America in Crisis' to 'Road to Rescue' about a month or so ago. Obama has changed his tone to one of optimism.

It all started after we let the Government borrow another $800 billion dollars because 'disaster was imminent' and we had to bailout what is apparently the American Aristocracy. Shortly thereafter the Fed Chairman stated that the recession would end this year. A message he repeated and then other media outlets started to fall in line.

I guess I am still a bit curious as to how 3 percent of the U.S. mortgage market caused the 'worst recession since The Great Depression'. It's not even that all those subprime loans were defaulting. I have read about the credit default swaps too and in the end it seems that all that was blown out of proportion too. Certainly there were companies that did some stupid things and brought themselves to the brink of disaster. Unfortunately it was also an election year and there was one party that knew the worse the economic picture was the more they would benefit. So bad economic news was inflated and since economic predictions are mostly self fulfilling next thing we know we really do have a problem because confidence dried up. Since the amount of cash in an economy is really a reflection of confidence that dried up and we enter a dwindling spiral.

So our elected representatives in both the Bush and Obama administrations answered this problem by scaring us into saving what must be some very well connected corporations. They gave those corporations hundreds of billions of our money which in the end appears to have been a thorough waste aside from preserving the fortunes of companies and their principles that really should have simply suffered the consquences of making bad decisions. We were nicely distracted by quibbling loudly about a couple hundred million in bonuses while hundreds of BILLIONS went unaccounted for.

I rant but it is good news that at last what is happening is what is really necessary to save this economy. For all that can be said about President Obama it is undeniable that he and his team are very good at public relations. Saving an economy is about changing a bad and insecure sentiment into one of hope and confidence. With hope and confidence then money flows back into the economy naturally and growth resumes.

Obama and his administration are also correct that to save the economy requires stimulating it with energy (a.k.a money). I think the main question here is whether or not it is the government that should decide where the money gets "flowed" or you and I. Under the current administration they have taken our money by taking out loans that we will have to repay via taxes and will spend it as they see fit. A small centralized group of people deciding how trillions of dollars are to be spent. A great set of circumstances for those that are currently well connected. Hence real change will not really be brought about.

There is also alot of talk now about inflation. Inflation will come about certainly if all the money that is dumped into the economy does not result in goods and services equivalent to or greater than that amount of money. History has shown that this is usually what happens when government does the stimulus spending. This is largely because the government only has as it's goal spending the money. They don't really ensure that the money results in added goods and services of at least equal value to what was spent. A certain portion usually lines the pockets of corrupt individuals, some goes towards projects that were not really needed or wanted and some may go towards things of actual value. There is nothing to say that the government couldn't do this correctly - it just seems that it has never happened that way.

In any case what does one do to participate in the recovery and not get screwed by inflation? This is actually simple - make sure you are producing goods and services that are of value. If there is inflation then your recompense for those goods and services will simply increase along with everything else. If a time comes when we are paying $10 for a dozen eggs it won't matter because people earning $40K a year will now be earning $400K a year. Another part of this is don't sit back apathetically letting the government waste this stimulus money. Those deals are done but Obama has promised transparency and we can hold his and the Congresses feet to the fire. Pay attention, monitor the websites that make public where this money is going. If it is used to add value to our country and its economy we really can come out of this in a much better situation.

Everybody is an Economic Expert

On a morning radio the announcer exclaimed that it seems like everyone is an economic expert these days. I guess as compared to how our finance and banking system has been run and our governments current answer to economic distress most people are economic experts.

It's very scary to hear President Obama exclaiming that "trickle down economics" and tax cuts are "the failed economic policies that got us here." I actually don't think that Obama is that stupid but like any other politician is simply pushing some partisan rhetoric to help him implement his agenda and strengthen his party's influence. It is unfortunate because as Obama and his PR machine are trying to lead us away from the hard won personal liberty that this country is about with misleading statements about what caused the economic crisis he is also not bringing about any meaningful change in this country.

Let's be clear about what caused the economic meltdown: financial institutions sold risky debt as though it wasn't risky. What some bankers and mortgage brokers and other financial firms committed was flat out fraud. We don't need new regulations or bank bailouts or other nonsense. We need those organizations that mis-represented risky loans as not being risky to be sued for the damage they caused and their executives to be imprisoned for fraud and their ill begotten assets seized. That is the government's responsibility in this situation. If a bank was bamboozled into making bad loans based on fraud then they should sue whoever ripped them off and if they can't and go broke as a result then tough.

The new administration could bring about real change by for once not bowing to the political clout of Wall Street and Bankers and just start investigating for fraud and legal violations in this sub-prime mortgage meltdown. We don't need new laws - just enforce the ones already in existence.

Tax cuts and de-regulation are so far the only proven policy to ever bring about rapid economic recovery. Socialism has never resulted in anything but pushing a society to a base mediocrity at best and in the extreme impoverishes all citizens except politicians and the politically connected. Socialist countries like France hope for 7.6% unemployement in GOOD times.

Economics and banking are not complicated subjects. Economics is about people supplying each others needs. Banking is the service of using the excess produced by a society to fund new enterprises and raise the standard of living. The system can expand continuously with an ever improving standard of living for all participants. There doesn't have to be booms and busts and ups and downs. Governments role is to ensure that the participants act honestly and do not misrepresent their products or services. This should extend to honesty in the press and laws against the press being used to spin situations which is simply another form of fraud.

Generally when governments get into the business of "managing" the economic system they simply wind up reducing the economy's effectiveness to raise the standard of living and maintain a continuous expansion. That's why socialism and it's extreme communism when implemented on a large scale leads always to lower standards of living for everyone. This is because the government has to try and guess the needs and desires of its constituents which it cannot do effectively. That's why the government trying to save an economy with bailouts or government spending is a very inefficient way to save an economy.

So what is this "economic expert's" solution: I offer a 3 pronged attack -
1. Start vigorously enforcing current laws and removing fraud from the system. Loudly start arresting the bankers, corrupt regulators, politicians who committed the fraud that lead up to this mess.
2. Agressive corporate and personal income tax cuts that will immediately energize the economy and make the U.S. the best place to make investments.
3. Instead of hundreds of billions in bailouts use that money to put out some positive press about the economy. Press manipulation is a fact in this country (if you don't believe this then WAKE UP). So be that as it may lets use it to bring about a more positive economic attitude because you can pump all the money you want to into the economy if people don't feel upbeat and confident that will kill any economy even in the best of times.

I'm no community organizer but I think that will work. Unfortunately it also means less opportunity for political power - after all when you are a politician doling out billions of dollars it is pretty easy to get "favors". That doesn't happen with tax cuts.

Why I didn't vote for Obama but I'm glad he won...

When Barak Obama and John McCain both supported the $700 billion bank bailout/junk stock purchasing waste-of-tax-payer money program they both lost my support.  But that's for another post...

I think Barak is a very intelligent and charismatic person.  He ran the better campaign which says something - but not that much given how badly McCain ran his.  In the end I am certain he was the better candidate but it's scary that he won on what was an unabashed socialist platform.

Yes, yes - I know...how dare I use the "s" word.  One of the funniest things I saw during the campaign was a fact check segment on CNN where they were analyzing this claim of whether or not Barak Obama's policy of increasing progressive taxation both for individuals and corporations is socialistic.  In the end the conclusion by the "expert" was that the claim was false on the condition that we already have progressive taxation so unless you thought the current tax system was socialistic then Barak Obama's tax policy is not socialistic.

Hmmm...that doesn't make sense.  The correct analysis is actually that progressive taxation IS socialistic and making taxation MORE progressive is thereby more socialistic.  Karl Marx's defining slogan was From Each According to his Ability, To Each According to his Needs.  Progressive taxation is about greater taxes for people who are able to earn more because "they can afford it" and give that wealth to people who earn very little via welfare and other subsidies because they are in need.  Sorry but to quote Obama - "You can put lipstick on a pig..."  Actually that saying is even more appropriate given the Animal Farm referrence.

Anyway I couldn't vote for him since I disagree with the policies he espoused while campaigning and I felt that casting a vote for him would show support for his campaign platform.  I wanted him to win but not by a large margin so that he would see that we Americans do not support socialism.  In the end he won by only 4% and the "record voter turnout" turned out to not be true.  It seems that he may have won largely because Republicans are disgusted with their own party, and rightly so, and didn't vote.

I was also a bit disparaged because so many people did vote for him despite his platform but as it turns out the more I listen to people who voted for Obama it seems they just voted for him because they liked him better and didn't really understand his platform at all.

In the end I don't believe that his win represents that we as Americans are turning away from personal responsibility and small government toward a culture of dependence and big government.  He did not get a mandate and most people who voted for him didn't do so because of his platform.  I do think Barak is very intelligent and has enough personal integrity to see that socialism is not the solution to our ills and that the campaign platform will fade into memory...

No Significant Statistical Correlation Between Smoking and Lung Cancer

I don't smoke (currently - I have in the past) and I am not posting this to encourage smoking. I am posting it because I have often on conversation brought up this fact generally to point out that we often accept datums that are presented to us via the news and commercials and "experts" that don't hold up under examination. They wind up as data "everybody knows..." - sometimes harmlessly - but some datums that wind up like this are products of calculated propaganda machines to fool us and push public policy initiatives which in the end errode our liberty and enrich or empower special interests.

Journal of Theoretics Vol.1-4 Oct/Nov 1999 Editorial Smoking Does Not Cause Lung Cancer (According to WHO/CDC Data)* By: James P. Siepmann, MD Yes, it is true, smoking does not cause lung cancer. It is only one of many risk factors for lung cancer. I initially was going to write an article on how the professional literature and publications misuse the language by saying "smoking causes lung cancer"1,2, but the more that I looked into how biased the literature, professional organizations, and the media are, I modified this article to one on trying to put the relationship between smoking and cancer into perspective. (No, I did not get paid off by the tobacco companies, or anything else like that.) When the tobacco executives testified to Congress that they did not believe that smoking caused cancer, their answers were probably truthful and I agree with that statement. Now, if they were asked if smoking increases the risk of getting lung cancer, then their answer based upon current evidence should have be "yes." But even so, the risk of a smoker getting lung cancer is much less than anyone would suspect. Based upon what the media and anti-tobacco organizations say, one would think that if you smoke, you get lung cancer (a 100% correlation) or at least expect a 50+% occurrence before someone uses the word "cause." Would you believe that the real number is <>Yes, a US white male (USWM) cigarette smoker has an 8% lifetime chance of dying from lung cancer but the USWM nonsmoker also has a 1% chance of dying from lung cancer (see Appendix A). In fact, the data used is biased in the way that it was collected and the actual risk for a smoker is probably less. I personally would not smoke cigarettes and take that risk, nor recommend cigarette smoking to others, but the numbers were less than I had been led to believe. I only did the data on white males because they account for the largest number of lung cancers in the US, but a similar analysis can be done for other groups using the CDC data. You don't see this type of information being reported, and we hear things like, "if you smoke you will die", but when we actually look at the data, lung cancer accounts for only 2% of the annual deaths worldwide and only 3% in the US.** When we look at the data over a longer period, such as 50 years as we did here, the lifetime relative risk is only 8 (see Appendix A). That means that even using the biased data that is out there, a USWM smoker has only an 8x more risk of dying from lung cancer than a nonsmoker. It surprised me too because I had always heard numbers like 20-40 times more risk. Statistics that are understandable and make sense to the general public, what a concept! The process of developing cancer is complex and multifactorial. It involves genetics, the immune system, cellular irritation, DNA alteration, dose and duration of exposure, and much more. Some of the known risk factors include genetics4,5,6, asbestos exposure7, sex8, HIV status9, vitamin deficiency10, diet11,12,13, pollution14 , shipbuilding15and even just plain old being lazy.16 When some of these factors are combined they can have a synergistic effect17, but none of these risk factors are directly and independently responsible for "causing" lung cancer! Look in any dictionary and you will find something like, "anything producing an effect or result."18 At what level of occurrence would you feel comfortable saying that X "causes" Y? For myself and most scientists, we would require Y to occur at least 50% of the time. Yet the media would have you believe that X causes Y when it actually occurs less than 10% of the time. As ludicrous as that is, the medical and lay press is littered with such pabulum and gobbledygook. Even as web literate physician, it took me over 50 hours of internet time to find enough raw data to write this article. I went through thousands of abstracts and numerous articles, only to find two articles that even questioned the degree of correlation between smoking and lung cancer (British lung cancer rates do not correlating to smoking rates)19,20and another two articles which questioned the link between second hand smoke (passive smoking) and lung cancer.21,22 Everywhere I looked, the information was hidden in terms like "odds ratio," "relative risk," or "annualized mortality rate." Most doctors probably could not accurately define and interpret them all these terms accurately, let alone someone outside the medical profession. The public relies on the media to interpret this morass of data, but instead they are given politically correct and biased views. If they would say that smoking increases the incidence of lung cancer or that smoking is a risk factor in the development of lung cancer, then I would agree. The purpose of this article is to emphasize the need to use language appropriately in both the medical and scientific literature (the media, as a whole, may be a lost cause). Everything in life has risk; just going to work each day has risk. Are we supposed to live our lives in bed, hiding under the blanket in case a tornado should come into our bedroom? We in science, have a duty to give the public accurate information and then let them decide for themselves what risk is appropriate. To do otherwise is a subtle imposition of our biases on the populace. We must embrace Theoretics as a discipline that strives to bring objectivity and logic back into science. Every article/study has some bias in it, the goal is to minimize such biases and present the facts in a comprehensible and logical manner. Unfortunately, most scientists have never taken a course in logic, and I'm sure that English class was not their favorite. Theoretics is a field of science which focuses on the use of logic and appropriate language in order to develop and communicate scientifically credible theories and ideas which will then have experimental implications. As someone whom I respect says, "Words mean things." Let us use language and logic appropriately in our research and in the way that we communicate information. * * * * * Yes, smoking is bad for you, but so is fast-food hamburgers, driving, and so on. We must weigh the risk and benefits of the behavior both as a society and as an individual based on unbiased information. Be warned though, that a society that attempts to remove all risk terminates individual liberty and will ultimately perish. Let us be logical in our endeavors and true in our pursuit of knowledge. Instead of fearful waiting for lung cancer to get me (because the media and much of the medical literature has falsely told me that smoking causes lung cancer), I can enjoy my occasional cigar even more now...now that I know the whole story. * * * * * The Untold Facts of Smoking (Yes, there is bias in science) or "I feel like the Fox Network" (a bastion of truth in a sea of liberalism) USWM smokers have a lifetime relative risk of dying from lung cancer of only 8 (not the 20 or more that is based on an annual death rate and therefore virtually useless). No study has ever shown that casual cigar smoker (<5> Lung cancer is not in even in the top 5 causes of death, it is only #9.** All cancers combined account for only 13% of all annual deaths and lung cancer only 2%.** Occasional cigarette use (<1> Certain types of pollution are more dangerous than second hand smoke.3 Second hand smoke has never been shown to be a causative factor in lung cancer. A WHO study did not show that passive (second hand) smoke statistically increased the risk of getting lung cancer. No study has shown that second hand smoke exposure during childhood increases their risk of getting lung cancer. In one study they couldn't even cause lung cancer in mice after exposing them to cigarette smoke for a long time.23 If everyone in the world stopped smoking 50 years ago, the premature death rate would still be well over 80% of what it is today.1 (But I thought that smoking was the major cause of preventable death...hmmm.) *This article was revised after errors in the data and calculations were noticed by Charles Rotter, Curtis Cameron and Jesse V. Silverman. This is the corrected version. A special thanks to both. **WHO data of member countries Keywords: lung cancer, mortality, tobacco, smoking, Theoretics, language, WHO, cigarette, cigar, logic. References (I back up my statements with facts, will those who respond do the same?) 1. Articles: Pisani P, Parkin DM, Bray F, Ferlay J, Estimates of the worldwide mortality from 25 cancers in 1990,Int J Cancer 1999 Sep 24;83(1):18-29; "Tobacco smoking and chewing are almost certainly the major preventable causes of cancer today." American Thoracic Society, Cigarette smoking and health.. , Am J Respir Crit Care Med; 153(2):861-5 1996; "Cigarette smoking remains the primary cause of preventable death and morbidity in the United States." Nordlund LA, Trends in smoking habits and lung cancer in Sweden, Eur J Cancer Prev 1998 Apr;7(2):109-16; "Tobacco smoking is the most important cause of lung cancer and accounts for about 80-90% of all cases of lung cancer among men and about 50-80% among women." JAMA 1997;278:1505-1508; "The chief cause of death included lung cancer, esophageal cancer and liver cancer. The death rate was higher for those who started smoking before age 25. If current smoking patterns persist, tobacco will eventually cause more than two million deaths each year in China." JAMA 1997;278:1500-1504; "We have demonstrated that smoking is a major cause of death in China...." Hecht SS hecht002@tc.umn.edu, Tobacco smoke carcinogens and lung cancer, J Natl Cancer Inst1999 Jul 21;91(14):1194-210; "The complexity of tobacco smoke leads to some confusion about the mechanisms by which it causes lung cancer." Sarna L, Prevention: Tobacco control and cancer nursing, Cancer Nurs 1999 Feb;22(1):21-8; "In the next century, tobacco will become the number-one cause of preventable death throughout the world, resulting in half a billion deaths." Liu BQ, Peto R, Chen ZM, Boreham J, Wu YP, Li JY, Campbell TC, Chen JS, Emerging tobacco hazards in China: 1. Retrospective proportional mortality study of one million deaths, BMJ 1998 Nov 21;317(7170):1411-22; "If current smoking uptake rates persist in China (where about two thirds of men but few women become smokers) tobacco will kill about 100 million...." Nordlund LA Trends in smoking habits and lung cancer in Sweden. Eur J Cancer Prev 1998 Apr;7(2):109-16; "Tobacco smoking is the most important cause of lung cancer and accounts for about 80-90% of all cases of lung cancer among men and about 50-80% among women." Skurnik Y, Shoenfeld Y Health effects of cigarette smoking, Clin Dermatol 1998 Sep-Oct;16(5):545-56 "Cigarette smoking, the chief preventable cause of illness and death in the industrialized nations." 2. Websites: JAMA Website: http://www.ama-assn.org/sci-pubs/sci-news/1996/snr0424.htm [link no longer active as of 2004]; "Yet huge obstacles remain in our path, and new roadblocks are being erected continuously," writes Ronald M. Davis, M.D., director of the Center for Health Promotion and Disease Prevention, Henry Ford Health System, Detroit, Mich., in urging a review of the effort against "the most important preventablecause of death in our society." JAMA Website: http://www.ama-assn.org/sci-pubs/sci-news/1997/snr1203.htm#joc6d99 [link no longer active as of 2004]; "According to the authors, tobacco use has been cited as the chief avoidable cause of death in the U.S., responsible for more than 420,000 deaths annually ...." JAMA Website: http://jama.ama-assn.org/issues/v281n2/ffull/jwm80010-2.html [link no longer active as of 2004]; "The researchers reported that deaths caused by tobacco...." 3. The World Health Report 1999, chapter 5 and Statistical Annex and CDC data (http://www.cdc.gov/scientific.htm). 4.Mutat Res 1998 Feb 26;398(1-2):43-54 Association of the NAT1*10 genotype with increased chromosome aberrations and higher lung cancer risk in cigarette smokers. Abdel-Rahman SZ, El-Zein RA, Z 5. Schwartz AG, Rothrock M, Yang P, Swanson GM, "Increased cancer risk among relatives of nonsmoking lung cancer cases," Genet Epidemiol 1999;17(1):1-15 6. Amos CI, Xu W, Spitz MR, Is there a genetic basis for lung cancer susceptibility?, Recent Results Cancer Res1999;151:3-12 7. Silica, asbestos, man-made mineral fibers, and cancer. Author Steenland K; Stayner L Cancer Causes Control, 8(3):491-503 1997 May 8. Lam S, leRiche JC, Zheng Y, Coldman A, MacAulay C, Hawk E, Kelloff G, Gazdar AF, Sex-related differences in bronchial epithelial changes associated with tobacco smoking, J Natl Cancer Inst 1999 Apr 21;91(8):691-6 9. Ignacio I. Wistuba, MD, Comparison of Molecular Changes in Lung Cancers in HIV-Positive and HIV-Indeterminate Subjects, JAMAVol. 279, pp. 1554-1559, May 20, 1998 10. Kumagai Y, Pi JB, Lee S, Sun GF, Yamanushi T, Sagai M, Shimojo N, Serum antioxidant vitamins and risk of lung and stomach cancers in Shenyang, Cancer Lett 1998 Jul 17;129(2):145-9 China. 11. 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Finch GL, Nikula KJ, Belinsky SA, Barr EB, Stoner GD, Lechner JF, Failure of cigarette smoke to induce or promote lung cancer in the A/J mouse, Cancer Lett; 99(2):161-7 1996 Appendix A: US white male data3 For those of you who actually read the whole article... As long as I'm being controversial by presenting both sides of the story, do I dare tell you that a woman is three times more likely to die from an abortion than from delivering a baby (WHO data). Journal Home Page email: archive@journaloftheoretics.com © Journal of Theoretics, Inc. 1999 (Note: all submissions become the property of the journal) Discount domain name registration and web hosting www.netgonian.com. Philadelphia Web Development, Philadelphia Database Development, Philadelphia Systems Design