birminghammail--2019-10-08--The decline of NHS dentistry in Birmingham - one in four have never had an appointment

More than four in 10 people in Birmingham and Solihull haven’t tried to make an NHS dentistry appointment for at least two years.  And some 24 per cent say they have NEVER tried.  Dentists said NHS charges were “designed to discourage attendance” and warned the current system was “broken”.  The figures are taken from the latest edition of the GP Patients Survey - an independent study run by Ipsos MORI on behalf of NHS England and sent to more than two million people across the UK.  It found that while 21 per cent of people in Birmingham and Solihull had tried to make an NHS dentistry appointment within the last three months, 17 per cent hadn’t tried for at least two years. A further 24 per cent had never tried.  When those two groups were asked why, six per cent said it was too expensive.  Some 28 per cent said they hadn’t “needed” a dentist and 10 per cent said they didn’t think they’d be able to get an NHS dentist.  Twenty per cent said they preferred to use a private dentist, while 11 per cent said they had stayed with their surgery when it moved from NHS to private-treatment-only.  Across England as a whole, the proportion of people who haven’t tried to make an NHS dental appointment for at least two years has inched up from 41.2 per cent in 2018 to 41.7 per cent in 2019.  The NHS claims “everyone should be able to access good-quality NHS dental services”, and around 70 per cent of dentists’ work remains committed to NHS work.  Surgeries, however, are not obliged to take on new NHS patients and many have closed their lists.  The latest NHS Digital figures show 21,960,000 adults were seen by an NHS dentist in the two years to June 2019.  That was down from 22,061,000 in the two years to June 2018 and 22,159,000 in the two years to June 2017 - despite the population rising over that time.  Mick Armstrong, chair of the British Dental Association, said: “Prevention isn’t just better than cure, it’s cheaper too - but patients who need treatment face real barriers.  “The result is many bottle up problems, and our NHS pays the price.  “NHS charges are designed to discourage attendance. There’s no help for practices that are struggling to fill vacancies, and no investment so more patients can be seen.  “We have a broken system that funds care for little over half the population. The guiding principle of NHS dentistry should be improving oral health, not keeping costs down and patients away.”  Dr Tony O'Sullivan, a retired consultant paediatrician and co-chair of Keep Our NHS Public, said: “Disadvantaged people are more likely to be unable to access an NHS dentist.  “They then are vulnerable to untreated dental disease, pain, infection and loss of teeth. That affects their health, nutrition and self-esteem.  “The NHS offered free dental care in 1948. It should do so again and end the post code and wealth lottery that makes the current dental system so unfair and unacceptable."

newsdesk@birminghamlive.co.uk (David Ottewell, James Rodger)


drudgereport--2019-04-19--REVEALED The Trouble With Dentistry

REVEALED: The Trouble With Dentistry...

Lund extracted the wisdom tooth with no complications, and Mitchell began seeing him regularly. He never had any pain or new complaints, but Lund encouraged many additional treatments nonetheless. A typical person might get one or two root canals in a lifetime. In the space of seven years, Lund gave Mitchell nine root canals and just as many crowns. Mitchell’s insurance covered only a small portion of each procedure, so he paid a total of about $50,000 out of pocket. The number and cost of the treatments did not trouble him. He had no idea that it was unusual to undergo so many root canals—he thought they were just as common as fillings. The payments were spread out over a relatively long period of time. And he trusted Lund completely. He figured that if he needed the treatments, then he might as well get them before things grew worse. Meanwhile, another of Lund’s patients was going through a similar experience. Joyce Cordi, a businesswoman in her 50s, had learned of Lund through 1-800-DENTIST. She remembers the service giving him an excellent rating. When she visited Lund for the first time, in 1999, she had never had so much as a cavity. To the best of her knowledge her teeth were perfectly healthy, although she’d had a small dental bridge installed to fix a rare congenital anomaly (she was born with one tooth trapped inside another and had had them extracted). Within a year, Lund was questioning the resilience of her bridge and telling her she needed root canals and crowns.  Cordi was somewhat perplexed. Why the sudden need for so many procedures after decades of good dental health? When she expressed uncertainty, she says, Lund always had an answer ready. The cavity on this tooth was in the wrong position to treat with a typical filling, he told her on one occasion. Her gums were receding, which had resulted in tooth decay, he explained during another visit. Clearly she had been grinding her teeth. And, after all, she was getting older. As a doctor’s daughter, Cordi had been raised with an especially respectful view of medical professionals. Lund was insistent, so she agreed to the procedures. Over the course of a decade, Lund gave Cordi 10 root canals and 10 crowns. He also chiseled out her bridge, replacing it with two new ones that left a conspicuous gap in her front teeth. Altogether, the work cost her about $70,000. A masked figure looms over your recumbent body, wielding power tools and sharp metal instruments, doing things to your mouth you cannot see. In early 2012, Lund retired. Brendon Zeidler, a young dentist looking to expand his business, bought Lund’s practice and assumed responsibility for his patients. Within a few months, Zeidler began to suspect that something was amiss. Financial records indicated that Lund had been spectacularly successful, but Zeidler was making only 10 to 25 percent of Lund’s reported earnings each month. As Zeidler met more of Lund’s former patients, he noticed a disquieting trend: Many of them had undergone extensive dental work—a much larger proportion than he would have expected. When Zeidler told them, after routine exams or cleanings, that they didn’t need any additional procedures at that time, they tended to react with surprise and concern: Was he sure? Nothing at all? Had he checked thoroughly? In the summer, Zeidler decided to take a closer look at Lund’s career. He gathered years’ worth of dental records and bills for Lund’s patients and began to scrutinize them, one by one. The process took him months to complete. What he uncovered was appalling.  We have a fraught relationship with dentists as authority figures. In casual conversation we often dismiss them as “not real doctors,” regarding them more as mechanics for the mouth. But that disdain is tempered by fear. For more than a century, dentistry has been half-jokingly compared to torture. Surveys suggest that up to 61 percent of people are apprehensive about seeing the dentist, perhaps 15 percent are so anxious that they avoid the dentist almost entirely, and a smaller percentage have a genuine phobia requiring psychiatric intervention. When you’re in the dentist’s chair, the power imbalance between practitioner and patient becomes palpable. A masked figure looms over your recumbent body, wielding power tools and sharp metal instruments, doing things to your mouth you cannot see, asking you questions you cannot properly answer, and judging you all the while. The experience simultaneously invokes physical danger, emotional vulnerability, and mental limpness. A cavity or receding gum line can suddenly feel like a personal failure. When a dentist declares that there is a problem, that something must be done before it’s too late, who has the courage or expertise to disagree? When he points at spectral smudges on an X-ray, how are we to know what’s true? In other medical contexts, such as a visit to a general practitioner or a cardiologist, we are fairly accustomed to seeking a second opinion before agreeing to surgery or an expensive regimen of pills with harsh side effects. But in the dentist’s office—perhaps because we both dread dental procedures and belittle their medical significance—the impulse is to comply without much consideration, to get the whole thing over with as quickly as possible.  The uneasy relationship between dentist and patient is further complicated by an unfortunate reality: Common dental procedures are not always as safe, effective, or durable as we are meant to believe. As a profession, dentistry has not yet applied the same level of self-scrutiny as medicine, or embraced as sweeping an emphasis on scientific evidence. “We are isolated from the larger health-care system. So when evidence-based policies are being made, dentistry is often left out of the equation,” says Jane Gillette, a dentist in Bozeman, Montana, who works closely with the American Dental Association’s Center for Evidence-Based Dentistry, which was established in 2007. “We’re kind of behind the times, but increasingly we are trying to move the needle forward.” Consider the maxim that everyone should visit the dentist twice a year for cleanings. We hear it so often, and from such a young age, that we’ve internalized it as truth. But this supposed commandment of oral health has no scientific grounding. Scholars have traced its origins to a few potential sources, including a toothpaste advertisement from the 1930s and an illustrated pamphlet from 1849 that follows the travails of a man with a severe toothache. Today, an increasing number of dentists acknowledge that adults with good oral hygiene need to see a dentist only once every 12 to 16 months. Many standard dental treatments—to say nothing of all the recent innovations and cosmetic extravagances—are likewise not well substantiated by research. Many have never been tested in meticulous clinical trials. And the data that are available are not always reassuring.  The Cochrane organization, a highly respected arbiter of evidence-based medicine, has conducted systematic reviews of oral-health studies since 1999. In these reviews, researchers analyze the scientific literature on a particular dental intervention, focusing on the most rigorous and well-designed studies. In some cases, the findings clearly justify a given procedure. For example, dental sealants—liquid plastics painted onto the pits and grooves of teeth like nail polish—reduce tooth decay in children and have no known risks. (Despite this, they are not widely used, possibly because they are too simple and inexpensive to earn dentists much money.) But most of the Cochrane reviews reach one of two disheartening conclusions: Either the available evidence fails to confirm the purported benefits of a given dental intervention, or there is simply not enough research to say anything substantive one way or another. Fluoridation of drinking water seems to help reduce tooth decay in children, but there is insufficient evidence that it does the same for adults. Some data suggest that regular flossing, in addition to brushing, mitigates gum disease, but there is only “weak, very unreliable” evidence that it combats plaque. As for common but invasive dental procedures, an increasing number of dentists question the tradition of prophylactic wisdom-teeth removal; often, the safer choice is to monitor unproblematic teeth for any worrying developments. Little medical evidence justifies the substitution of tooth-colored resins for typical metal amalgams to fill cavities. And what limited data we have don’t clearly indicate whether it’s better to repair a root-canaled tooth with a crown or a filling. When Cochrane researchers tried to determine whether faulty metal fillings should be repaired or replaced, they could not find a single study that met their standards.  “The body of evidence for dentistry is disappointing,” says Derek Richards, the director of the Centre for Evidence-Based Dentistry at the University of Dundee, in Scotland. “Dentists tend to want to treat or intervene. They are more akin to surgeons than they are to physicians. We suffer a little from that. Everybody keeps fiddling with stuff, trying out the newest thing, but they don’t test them properly in a good-quality trial.” The general dearth of rigorous research on dental interventions gives dentists even more leverage over their patients. Should a patient somehow muster the gumption to question an initial diagnosis and consult the scientific literature, she would probably not find much to help her. When we submit to a dentist’s examination, we are putting a great deal of trust in that dentist’s experience and intuition—and, of course, integrity. When Zeidler purchased Lund’s practice, in February 2012, he inherited a massive collection of patients’ dental histories and bills, a mix of electronic documents, handwritten charts, and X‑rays. By August, Zeidler had decided that if anything could explain the alarmingly abundant dental work in the mouths of Lund’s patients, he would find it in those records. He spent every weekend for the next nine months examining the charts of hundreds of patients treated in the preceding five years. In a giant Excel spreadsheet, he logged every single procedure Lund had performed, so he could carry out some basic statistical analyses.  The numbers spoke for themselves. Year after year, Lund had performed certain procedures at extraordinarily high rates. Whereas a typical dentist might perform root canals on previously crowned teeth in only 3 to 7 percent of cases, Lund was performing them in 90 percent of cases. As Zeidler later alleged in court documents, Lund had performed invasive, costly, and seemingly unnecessary procedures on dozens and dozens of patients, some of whom he had been seeing for decades. Terry Mitchell and Joyce Cordi were far from alone. In fact, they had not even endured the worst of it. Whereas medicine has reckoned with some of its own tendencies toward excessive and misguided treatment, dentistry has lagged behind. Dental crowns were one of Lund’s most frequent treatments. A crown is a metal or ceramic cap that completely encases an injured or decayed tooth, which is first shaved to a peg so its new shell will fit. Crowns typically last 10 to 15 years. Lund not only gave his patients superfluous crowns; he also tended to replace them every five years—the minimum interval of time before insurance companies will cover the procedure again. More than 50 of Lund’s patients also had ludicrously high numbers of root canals: 15, 20, 24. (A typical adult mouth has 32 teeth.) According to one lawsuit that has since been settled, a woman in her late 50s came to Lund with only 10 natural teeth; from 2003 to 2010, he gave her nine root canals and 12 crowns. The American Association of Endodontists claims that a root canal is a “quick, comfortable procedure” that is “very similar to a routine filling.” In truth, a root canal is a much more radical operation than a filling. It takes longer, can cause significant discomfort, and may require multiple trips to a dentist or specialist. It’s also much more costly.  Read: Americans are going to Juarez for cheap dental care Root canals are typically used to treat infections of the pulp—the soft living core of a tooth. A dentist drills a hole through a tooth in order to access the root canals: long, narrow channels containing nerves, blood vessels, and connective tissue. The dentist then repeatedly twists skinny metal files in and out of the canals to scrape away all the living tissue, irrigates the canals with disinfectant, and packs them with a rubberlike material. The whole process usually takes one to two hours. Afterward, sometimes at a second visit, the dentist will strengthen the tooth with a filling or crown. In the rare case that infection returns, the patient must go through the whole ordeal again or consider more advanced surgery. Zeidler noticed that nearly every time Lund gave someone a root canal, he also charged for an incision and drainage, known as an I&D. During an I&D, a dentist lances an abscess in the mouth and drains the exudate, all while the patient is awake. In some cases the dentist slips a small rubber tube into the wound, which continues to drain fluids and remains in place for a few days. I&Ds are not routine adjuncts to root canals. They should be used only to treat severe infections, which occur in a minority of cases. Yet they were extremely common in Lund’s practice. In 2009, for example, Lund billed his patients for 109 I&Ds. Zeidler asked many of those patients about the treatments, but none of them recalled what would almost certainly have been a memorable experience.  In addition to performing scores of seemingly unnecessary procedures that could result in chronic pain, medical complications, and further operations, Lund had apparently billed patients for treatments he had never administered. Zeidler was alarmed and distressed. “We go into this profession to care for patients,” he told me. “That is why we become doctors. To find, I felt, someone was doing the exact opposite of that—it was very hard, very hard to accept that someone was willing to do that.” Zeidler knew what he had to do next. As a dental professional, he had certain ethical obligations. He needed to confront Lund directly and give him the chance to account for all the anomalies. Even more daunting, in the absence of a credible explanation, he would have to divulge his discoveries to the patients Lund had bequeathed to him. He would have to tell them that the man to whom they had entrusted their care—some of them for two decades—had apparently deceived them for his own profit. The idea of the dentist as potential charlatan has a long and rich history. In medieval Europe, barbers didn’t just trim hair and shave beards; they were also surgeons, performing a range of minor operations including bloodletting, the administration of enemas, and tooth extraction. Barber surgeons, and the more specialized “tooth drawers,” would wrench, smash, and knock teeth out of people’s mouths with an intimidating metal instrument called a dental key: Imagine a chimera of a hook, a hammer, and forceps. Sometimes the results were disastrous. In the 1700s, Thomas Berdmore, King George III’s “Operator for the Teeth,” described one woman who lost “a piece of jawbone as big as a walnut and three neighbouring molars” at the hands of a local barber.  Whatever happened, from that point on, “the professions of dentistry and medicine would develop along separate paths,” writes Mary Otto, a health journalist, in her recent book, Teeth. Becoming a practicing physician requires four years of medical school followed by a three-to-seven-year residency program, depending on the specialty. Dentists earn a degree in four years and, in most states, can immediately take the national board exams, get a license, and begin treating patients. (Some choose to continue training in a specialty, such as orthodontics or oral and maxillofacial surgery.) When physicians complete their residency, they typically work for a hospital, university, or large health-care organization with substantial oversight, strict ethical codes, and standardized treatment regimens. By contrast, about 80 percent of the nation’s 200,000 active dentists have individual practices, and although they are bound by a code of ethics, they typically don’t have the same level of oversight. Read: Why dentistry is separate from medicine Throughout history, many physicians have lamented the segregation of dentistry and medicine. Acting as though oral health is somehow divorced from one’s overall well-being is absurd; the two are inextricably linked. Oral bacteria and the toxins they produce can migrate through the bloodstream and airways, potentially damaging the heart and lungs. Poor oral health is associated with narrowing arteries, cardiovascular disease, stroke, and respiratory disease, possibly due to a complex interplay of oral microbes and the immune system. And some research suggests that gum disease can be an early sign of diabetes, indicating a relationship between sugar, oral bacteria, and chronic inflammation.  Dentistry’s academic and professional isolation has been especially detrimental to its own scientific inquiry. Most major medical associations around the world have long endorsed evidence-based medicine. The idea is to shift focus away from intuition, anecdote, and received wisdom, and toward the conclusions of rigorous clinical research. Although the phrase evidence-based medicine was coined in 1991, the concept began taking shape in the 1960s, if not earlier (some scholars trace its origins all the way back to the 17th century). In contrast, the dental community did not begin having similar conversations until the mid-1990s. There are dozens of journals and organizations devoted to evidence-based medicine, but only a handful devoted to evidence-based dentistry. In the past decade, a small cohort of dentists has worked diligently to promote evidence-based dentistry, hosting workshops, publishing clinical-practice guidelines based on systematic reviews of research, and creating websites that curate useful resources. But its adoption “has been a relatively slow process,” as a 2016 commentary in the Contemporary Clinical Dentistry journal put it. Part of the problem is funding: Because dentistry is often sidelined from medicine at large, it simply does not receive as much money from the government and industry to tackle these issues. “At a recent conference, very few practitioners were even aware of the existence of evidence-based clinical guidelines,” says Elliot Abt, a professor of oral medicine at the University of Illinois. “You can publish a guideline in a journal, but passive dissemination of information is clearly not adequate for real change.”  Among other problems, dentistry’s struggle to embrace scientific inquiry has left dentists with considerable latitude to advise unnecessary procedures—whether intentionally or not. The standard euphemism for this proclivity is overtreatment. Favored procedures, many of which are elaborate and steeply priced, include root canals, the application of crowns and veneers, teeth whitening and filing, deep cleaning, gum grafts, fillings for “microcavities”—incipient lesions that do not require immediate treatment—and superfluous restorations and replacements, such as swapping old metal fillings for modern resin ones. Whereas medicine has made progress in reckoning with at least some of its own tendencies toward excessive and misguided treatment, dentistry is lagging behind. It remains “largely focused upon surgical procedures to treat the symptoms of disease,” Mary Otto writes. “America’s dental care system continues to reward those surgical procedures far more than it does prevention.” “Excessive diagnosis and treatment are endemic,” says Jeffrey H. Camm, a dentist of more than 35 years who wryly described his peers’ penchant for “creative diagnosis” in a 2013 commentary published by the American Dental Association. “I don’t want to be damning. I think the majority of dentists are pretty good.” But many have “this attitude of ‘Oh, here’s a spot, I’ve got to do something.’ I’ve been contacted by all kinds of practitioners who are upset because patients come in and they already have three crowns, or 12 fillings, or another dentist told them that their 2-year-old child has several cavities and needs to be sedated for the procedure.”  Trish Walraven, who worked as a dental hygienist for 25 years and now manages a dental-software company with her husband in Texas, recalls many troubling cases: “We would see patients seeking a second opinion, and they had treatment plans telling them they need eight fillings in virgin teeth. We would look at X-rays and say, ‘You’ve got to be kidding me.’ It was blatantly overtreatment—drilling into teeth that did not need it whatsoever.” Joyce Cordi’s new dentist says her X-rays resemble those of someone who had reconstructive facial surgery following a car crash. Studies that explicitly focus on overtreatment in dentistry are rare, but a recent field experiment provides some clues about its pervasiveness. A team of researchers at ETH Zurich, a Swiss university, asked a volunteer patient with three tiny, shallow cavities to visit 180 randomly selected dentists in Zurich. The Swiss Dental Guidelines state that such minor cavities do not require fillings; rather, the dentist should monitor the decay and encourage the patient to brush regularly, which can reverse the damage. Despite this, 50 of the 180 dentists suggested unnecessary treatment. Their recommendations were incongruous: Collectively, the overzealous dentists singled out 13 different teeth for drilling; each advised one to six fillings. Similarly, in an investigation for Reader’s Digest, the writer William Ecenbarger visited 50 dentists in 28 states in the U.S. and received prescriptions ranging from a single crown to a full-mouth reconstruction, with the price tag starting at about $500 and going up to nearly $30,000. A multitude of factors has conspired to create both the opportunity and the motive for widespread overtreatment in dentistry. In addition to dentistry’s seclusion from the greater medical community, its traditional emphasis on procedure rather than prevention, and its lack of rigorous self-evaluation, there are economic explanations. The financial burden of entering the profession is high and rising. In the U.S., the average debt of a dental-school graduate is more than $200,000. And then there’s the expense of finding an office, buying new equipment, and hiring staff to set up a private practice. A dentist’s income is entirely dependent on the number and type of procedures he or she performs; a routine cleaning and examination earns only a baseline fee of about $200.  In parallel with the rising cost of dental school, the amount of tooth decay in many countries’ populations has declined dramatically over the past four decades, mostly thanks to the introduction of mass-produced fluoridated toothpaste in the 1950s and ’60s. In the 1980s, with fewer genuine problems to treat, some practitioners turned to the newly flourishing industry of cosmetic dentistry, promoting elective procedures such as bleaching, teeth filing and straightening, gum lifts, and veneers. It’s easy to see how dentists, hoping to buoy their income, would be tempted to recommend frequent exams and proactive treatments—a small filling here, a new crown there—even when waiting and watching would be better. It’s equally easy to imagine how that behavior might escalate. “If I were to sum it up, I really think the majority of dentists are great. But for some reason we seem to drift toward this attitude of ‘I’ve got tools so I’ve got to fix something’ much too often,” says Jeffrey Camm. “Maybe it’s greed, or paying off debt, or maybe it’s someone’s training. It’s easy to lose sight of the fact that even something that seems minor, like a filling, involves removal of a human body part. It just adds to the whole idea that you go to a physician feeling bad and you walk out feeling better, but you go to a dentist feeling good and you walk out feeling bad.” In the summer of 2013, Zeidler asked several other dentists to review Lund’s records. They all agreed with his conclusions. The likelihood that Lund’s patients genuinely needed that many treatments was extremely low. And there was no medical evidence to justify many of Lund’s decisions or to explain the phantom procedures. Zeidler confronted Lund about his discoveries in several face-to-face meetings. When I asked Zeidler how those meetings went, he offered a single sentence—“I decided shortly thereafter to take legal action”—and declined to comment further. (Repeated attempts were made to contact Lund and his lawyer for this story, but neither responded.)  Lund was arrested in May 2016 and released on $250,000 bail. The Santa Clara County district attorney’s office is prosecuting a criminal case against him based on 26 counts of insurance fraud. At the time of his arraignment, he said he was innocent of all charges. The Dental Board of California is seeking to revoke or suspend Lund’s license, which is currently inactive. The World's Oldest Dental Filling Was Made of Beeswax Many of Lund’s former patients worry about their future health. A root canal is not a permanent fix. It requires maintenance and, in the long run, may need to be replaced with a dental implant. One of Mitchell’s root canals has already failed: The tooth fractured, and an infection developed. He said that in order to treat the infection, the tooth was extracted and he underwent a multistage procedure involving a bone graft and months of healing before an implant and a crown were fixed in place. “I don’t know how much these root canals are going to cost me down the line,” Mitchell says. “Six thousand dollars a pop for an implant—it adds up pretty quick.” Joyce Cordi’s new dentist says her X‑rays resemble those of someone who had reconstructive facial surgery following a car crash. Because Lund installed her new dental bridges improperly, one of her teeth is continually damaged by everyday chewing. “It hurts like hell,” she says. She has to wear a mouth guard every night. What some of Lund’s former patients regret most are the psychological repercussions of his alleged duplicity: the erosion of the covenant between practitioner and patient, the germ of doubt that infects the mind. “You lose your trust,” Mitchell says. “You become cynical. I have become more that way, and I don’t like it.” “He damaged the trust I need to have in the people who take care of me,” Cordi says. “He damaged my trust in mankind. That’s an unforgivable crime.” This article appears in the May 2019 print edition with the headline “The Trouble With Dentistry.”


sottnet--2019-05-07--Three failures of dentistry

Three failures of dentistry

Each of these studies determined that removing dental plaque by brushing and flossing was not critical to improve oral health as long as diet was corrected. Specifically, the researchers demonstrated that changing from a diet  in high-processed-carbohydrate and inflammatory foods to a diet  high-processed-carbohydrate and inflammatory foods will decrease signs of gum disease.  Dentists help repair or remove broken, damaged, and diseased teeth. Dentists also help replace missing teeth, correct bite and airway problems, and create beautiful smiles. And dentists help treat the results of many acute and chronic infections in the mouth. Unfortunately, dentistry fails the public in several other critical areas.Here is my take on 3 Failures in Dentistry:I know I will get quite a bit of blowback from my comments in this blog. My intention is to bring to the forefront the weaknesses of my profession so that dental professionals and dental educators can improve the delivery of oral healthcare, which ultimately affects overall health. Also, my intention is to help the public understand the failures I've stated and ask intelligent questions to their healthcare professionals.If dentists were successfully treating and preventing dental diseases, then the prevalence of periodontal disease and tooth decay should be very low. However, dental diseases are at epidemic levels..[1]In 2012, the Centers for Disease Control and Prevention (CDC) published their results in the Journal of Dental Research. The report was recently updated in 2015 in the Journal of Periodontology.[2] It showedThe CDC's National Center for Health Statistics reported from its most recent data approximately[3][4]The World Health Organization has stated that dental decay is one of the most infectious, non-communicable diseases globally.[5]Many dental materials, medicaments, and procedures are used routinely in the dental office. And many of them have been shown to be potentially toxic to human cells. Of course, toxicity usually depends on the dose and the frequency of exposure. But if a toxic element is in the mouth 24/7, then its presence could be potentially harmful.As you may know, I am treating my aggressive form of multiple myeloma through various unconventional protocols.I've listed a few of the substances and procedures that are frequently used in the dental office that might be toxic for some patients and the dental team. I also have provided links to peer-reviewed articles that go into detail about their toxicities:Three human studies clearly show that nutrition is the critical element to a healthy mouth - Baumgartner (2009)[16], Woelber (2016)[17], Woelber (2019)[18]. I have described these results many times.In a paper published in the Journal of Dental Research in 2015, Aubrey Sheiham summarized many peer-reviewed research articles, which clearly showed that.[19]Detrimental lifestyle, toxic elements in the environment, toxic substances accumulating in the body, and inflammatory foods are major factors that can damage the gut and create unhealthy gut bacteria (gut dysbiosis). Leakage from a damaged gut into the bloodstream and into the lymph fluid can cause systemic chronic inflammation and a compromised immune system. Both systemic chronic inflammation and a compromised immune system can cause havoc in other body tissues including the mouth.In the mouth, these may cause an overgrowth of pathological bacteria. Unhealthy food choices will continue to feed the pathological bacteria. As you know, unhealthy bacteria will cause periodontal disease and tooth decay. Dental diseases potentially could affect all other areas in the body causing a vicious back-and-forth cycle between the mouth, the gut, and other tissues of the body.The 3 failures in dentistry should be addressed and corrected. Dentists need to (1) inform patients about potential toxicity from dental procedures and only use the most biocompatible materials, (2) learn about the obscure causes of dental diseases, and (3) become knowledgeable about causal relationships within the body.[1] https://www.ncbi.nlm.nih.gov/pubmed/?term=20437720 [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4460825/ [3] http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/DentalCariesAdults20to64.htm [4] http://www.nidcr.nih.gov/DataStatistics/FindDataByTopic/DentalCaries/DentalCariesSeniors65older.htm [5] http://apps.who.int/iris/bitstream/10665/149782/1/9789241549028_eng.pdf [6] https://www.ncbi.nlm.nih.gov/pubmed/30099197 [7] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6466133/ [8] https://www.ncbi.nlm.nih.gov/pubmed/25813067 [9] http://www.ncbi.nlm.nih.gov/pubmed/27199224 [10] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216395/ [11] https://www.ncbi.nlm.nih.gov/pubmed/29859645 [12] https://www.ncbi.nlm.nih.gov/pubmed/28510277 [13] https://link.springer.com/article/10.1007%2Fs11906-017-0725-2 [14] https://www.ncbi.nlm.nih.gov/pubmed/27091347 [15] https://fb.cuni.cz/file/5700/FB2013A0027.pdf [16] https://www.ncbi.nlm.nih.gov/pubmed/19405829 [17] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4962497/pdf/12903_2016_Article_257.pdf [18] https://www.ncbi.nlm.nih.gov/pubmed/?term=10.1111%2Fjcpe.13094 [19] https://www.ncbi.nlm.nih.gov/pubmed/?term=Diet+and+Dental+Caries%3A+The+Pivotal+Role+of+Free+Sugars+Reemphasized


thetelegraph--2019-08-13--10 best UK universities for dentistry

10 best UK universities for dentistry

Dentistry, while it may not be everyone's first career option, is a pretty exciting field to enter. After all, every aspect of the medical profession and its contributing fields changes and develops each year.  On top of that, dentistry graduates have a uniquely clear career path to forge once they've left university. And the numbers prove it. For the top ten best dentistry courses in the UK, almost all students are guaranteed work within the first six months after graduating.  To help you make the right choice for you, we've rounded up the top ten universities to study dentistry for 2020, according to the Complete University Guide.  The course: The University of Leeds has hovered in and around the top ten for a number of years, but a strong performance in both Research Intensity and Quality have secured its place for 2020. At the School of Dentistry students benefit from gold-standard teaching and exceptional learning facilities. As its courses are varied, it is also easy to specialise in dental surgery (MChD/BChD), oral science (BSc), dental hygiene and dental therapy (BSc Hons), dental technology (BTEC), or take on an advanced apprenticeship in dental nursing or national diploma in dental nursing.


theguardianuk--2019-11-18--Veterinary college apologises after vegan outcry over use of sheep in naked calendar

The principal of the Royal Veterinary College (RVC) has apologised after vegan activists complained about a naked calendar featuring an image of several students posing with sheep.  The college said the calendar would still be published but the “ethically challenged” image would be removed.  The photo featured seven male final-year students standing holding live sheep in front of them. According to the British Cattle Veterinary Association (BCVA), the technique they used to handle the animals is called tipping, “a standard handling mechanism in animal husbandry”.  The technique allows vets to examine areas of sheep, such as their feet, that are not accessible while the animals are standing. The BCVA says sheep tipping is “widely recognised as being safe and pain-free for the animals”.  The Veterinary Vegan Network (VVN) said in a Facebook post, since deleted, that the photo was “deeply disturbing”.  The RVC said some students received comments that were “obscene, threatening and … illegal” following the post. It said the threats would be reported to the authorities.  The college’s principal, Stuart Reid, apologised to those who had been offended by the image but said there was “no place for harassment or threats” directed at students.  “It is with a rather heavy heart that I pen this note to a rather wider readership than I might have anticipated,” he said. “For a number of years, the RVC student body in final year have produced a calendar, a proportion of whose proceeds go to nominated charities.  “There can be no denying that in more recent times these activities have started to divide opinion, both within the RVC community and in wider society.”  Reid said the college had learned lessons about “the need to understand a changing world”.  “No student is being blamed, individually or collectively, and we will work together to ensure these events do not happen again,” he said.  “To those who have taken offence at the calendar, I apologise. It may have fallen short of the standards some expect in terms of animal welfare, but that responsibility is mine. The complaints and attacks should be directed to me and me alone.”  A spokeswoman said students affected by the backlash would receive support and the calendar would be published on a date yet to be confirmed.


theirishtimes--2019-01-22--Hundreds of veterinary inspector positions for Brexit being filled at a trickle

Hundreds of veterinary inspector positions for Brexit being filled at ‘a trickle’

Hundreds of new veterinary inspector positions promised as part of Brexit preparations are being filled at “a trickle” just weeks away from the UK’s expected departure, the organisation representing the profession has claimed.  The Veterinary Officers Association (VOA) said it has become “increasingly alarmed with the [Department of Agriculture’s] response to the impending crisis”.  Patrick Holmes, association president, told The Irish Times:”They are not happening...the clock is running down.”  Last July the Cabinet agreed to hire 700 additional customs officials and 300 extra staff to carry out checks on agricultural produce and animals travelling between Ireland and the UK.  The VOA represents full-time veterinarians responsible for ensuring EU rules on food standards and animal safety and welfare are met. It has raised its concerns around the Brexit-related jobs alongside a separate internal dispute with the department over staff recruitment and mobility practices.  A number of veterinary management posts, one of which has remained unfilled for seven years, are due to be filled. However, in managing the process the department has been accused by the association of scrapping a 20-year-old mechanism through which the appointment process had previously worked.  According to Mr Holmes, the previous arrangement would have allowed senior veterinary staff to transfer into the new roles. The department has indicated its intention to appoint less experienced staff from a panel instead. The VOA called it an “unwarranted and hostile management action”.  Mobility amongst senior superintendent level staff between laboratory work and the area of food safety and animal welfare inspections is now said to be under threat.  The VOA said its members had agreed last year to enter a process of arbitration with department officials to address the issue but it had now been “escalated” by the department’s actions, the association said.  Its executive will meet in the coming days to consider its response, which could prompt anything up to and including industrial action.  Mr Holmes said the organisation would be guided by its membership.  In response, the department said the issues raised by the VOA referred to transfer arrangements whereby posts were filled on the basis of seniority.  However, it said the decision to fill six specific vacancies at the centre of the dispute was “unrelated to any decision on the number of additional veterinary staff that will be required in the event of a disorderly exit from the EU by the UK”.  In a statement, the department said it and the VOA had been unable to reach agreement on proposals to designate a small number of “critical senior management positions”.  “Given the uncertainties that have arisen in relation to Brexit, and the risks to Irish agriculture that Brexit poses, the department deemed it necessary to accelerate these appointments by designating the posts in question and filling them from existing promotion panels.  “The department remains committed to the resolution of the substantive issue in dispute going forward through the agreed dispute resolution mechanisms.”


thedailyrecord--2019-08-02--Orthopaedic surgery shake-up in Perth

Orthopaedic surgery shake-up in Perth

More planned orthopaedic surgery could be carried out in Perth, as part of new proposals for the region.  NHS Tayside is planning a redesign of its orthopaedic services as part of a transformation programme.  Its ‘Shaping orthopaedic services’ proposal aims to improve patient outcomes and the quality and safety of the care they receive, and will involve making changes to where surgeons, doctors and nurses work in the region.  The plan is to have all unplanned orthopaedic trauma operations carried out at Ninewells Hospital in Dundee, with patients who require further care being transferred thereafter to their closest hospital within 48 to 72 hours after their surgery.  Meanwhile, centres of excellence for planned surgery will be established at both Perth Royal Infirmary and Stracathro Hospital, where expert health professionals will work to provide specialist care and treatment.  This will mean more planned orthopaedic operations will be carried out in Perth.  It is hoped this will create 400 more operations in the region each year, and reduce waiting times.  Sankar Sripada, consultant trauma and orthopaedic surgeon at NHS Tayside, launched a consultation into the proposals and said: “It is vital that services are designed to manage both unplanned trauma care and planned care as effectively as possible to benefit patients and to ensure we use NHS resources in the best way.  “Patient safety and high quality care are our top priorities.  “The proposed redesign of orthopaedic services will ensure the long-term sustainability of orthopaedic services in NHS Tayside and will improve the quality of care and enhance patient safety.  “Feedback from our communities is vital and we would encourage members of the public to take part in the consultation and share their views on the proposed future plans for orthopaedic services in Tayside.”  Surgeons, doctors, nurses and other members of the clinical team have been leading the consultation and looking into the different options available for the service.  The clinically preferred option was presented to the board of NHS Tayside who supported the option to move all emergency orthopaedic surgery to Dundee.  NHS Tayside says because more people are living longer, demand on orthopaedic services is set to rise over the next 20 years, and the health board cannot continue operating the way it does just now.  Currently, emergency orthopaedic trauma operations are carried out in both Perth and Dundee, but the health board says there is evidence to show separating planned and emergency surgery is best practice to make sure patients receive the right care in the right place.  NHS Tayside hopes the redesign of orthopaedic services will allow it to deliver high quality care, respond to the growing numbers of patients, reduce patient waiting times and make best use of its three acute hospitals.  The ‘Shaping orthopaedic services’ consultation will run until Thursday, October 31.


sottnet--2019-03-11--Eye injuries epidemic at Yellow Vest protests French ophthalmologists demand Macron ban rubber bull

Eye injuries epidemic at Yellow Vest protests: French ophthalmologists demand Macron ban rubber bullets

Once a government is committed to the principle of silencing the voice of opposition, it has only one way to go, and that is down the path of increasingly repressive measures, until it becomes a source of terror to all its citizens and creates a country where everyone lives in fear.


dailyheraldchicago--2019-06-17--How Good Samaritan Hospitals new operating room opens surgical possibilities

How Good Samaritan Hospital's new operating room opens surgical possibilities

When doctors choose which way to perform common heart surgeries, they're typically stuck with that route -- largely because of location.  Operating rooms where doctors perform minimally invasive procedures, maybe using a catheter inserted in the leg or groin to travel through the blood vessels and access the heart, often don't have the X-ray and ultrasound imaging technology or the anesthesia required to change course and perform a full open-heart surgery if the need arises.  But that's no longer an issue at Advocate Good Samaritan Hospital in Downers Grove.  The hospital on Monday plans to perform its first surgery inside a new Hybrid Cardiovascular Operating Room designed to provide the technology and space for doctors to use the best type of surgery for each patient.  "We can actually have the surgeons and the cardiologists working together in the same room," said Dr. Peter Kerwin, a cardiologist and medical director of the cardiac catheterization lab. "And we have all options open to us, up to and including open-heart surgery."  The new space, double the size of a typical operating room, allows all surgical options because it incorporates an X-ray machine and an ultrasound with images displayed on a large screen.  "That's important because we need to be able to see everything," Kerwin said.  Doctors can use real-time images to guide precision procedures, such as mitral valve repair or aortic valve replacement. Surgeons also can use the assistance of an anesthesiologist, equipped with all of the medications needed for moderate "twilight" or full sedation.  "It allows us to move into this new area in cardiology," Kerwin said.  Four doctors and up to six nurses or other medical experts will work as a team to conduct each surgery in the new space, into which the hospital invested several years of planning, several rounds of simulations and millions of dollars, President Nancy Tinsley said.  Dr. Mahesh Raju, a cardiologist and medical director of endovascular services, said the new operating room will decrease the time it takes to perform procedures and make the experience safer for patients.  Using a hybrid approach between open-heart surgery and catheter insertion in the leg or groin, doctors can make an incision much closer to the heart -- in the neck, for example -- to decrease potential complications.  "When you have a shortcut, your risk goes down," Raju said. And so does time in the hospital and recovery time at home.  The new hybrid operating room is part of the Advocate Heart Institute at Good Samaritan Hospital, which includes an outpatient clinic, diagnostics, inpatient and surgical units, and an advanced heart failure treatment area -- nearly all in one place near the hospital's main entrance.  The new facility adds to the hospital's "extremely comprehensive" list of cardiovascular services, Tinsley said. "We consider ourselves the complex care provider in the community," she said. "No matter what your cardiac symptom is, we're your one-stop shop."  And it follows the hospital's history of advances in cardiac care, Kerwin said.  In 1987, Good Samaritan became the first recorded community hospital to treat heart attacks with clot-dissolving medications, he said. Previously, only research hospitals had tried this method.  And in 2002, Kerwin said, Good Samaritan became one of the first in the nation to address heart attacks by following a now-standard "cardiac alert process" that involves coordinating with paramedics to bring patients directly to a catheterization lab where they can get immediate help.


tass--2019-11-10--Russian surgical robots to appear in hospitals within two years - RDIF

MOSCOW, November 10. /TASS/. Hospitals will receive domestically produced robotic surgical systems as early as in the span of a year or two, chief executive of the Russian Direct Investment Fund (RDIF) Kirill Dmitriev said in an interview with Rossiya-1 TV Channel.  "The surgical robot will appear in ordinary hospitals as early as in a year or two," Dmitriev said. It has advantages over the Da Vinci robot [a robotic surgery system produced in the US - TASS]. Our [robot] will be cheaper, it will be more accurate. Application of artificial intelligence technologies will make possible for it to perform a wider range of operations," he added.  The Fund completed the first round of investments into Assisted Surgical Technologies (AST), the domestic developer and producer of innovative surgical robots, RDIF said earlier. According to the Fund, AST expects to capture up to 50% of the domestic robotic market in such kinds of medical services as abdominal, gynecological and urological surgery.


thedailyrecord--2019-07-06--Top Glasgow cosmetics doc shares incredible before and after pics of non-surgical procedures

Forget going under the knife...cosmetic surgery is changing and the surgeon’s scalpel could soon become a thing of the past.  New techniques, from non-surgical liposuction to nose contouring, pain-free facelifts and even an alternative to traditional high-risk gastric band surgery, mean less plastic surgery procedures are being carried out.  Glasgow Botox and filler practitioner Dr Darren McKeown said traditional operations are being superseded by less invasive options.  He added: “There has been a perception that non-surgical treatments must mean inferior results. We’re now reaching the point where non-surgical can reach some of the results of surgical procedures and, in some cases, be better. They do that without any of the risks or side-effects.”  New procedures are becoming so popular so fast because none of them require an anaesthetic or a stay in hospital. And they have none of the risks and complications associated with traditional plastic surgery.  Darren’s clinic is offering CoolSculpting as an alternative to liposuction. The results, he said, speak for themselves.  He added: “I can say that, having had liposuction myself, complications don’t happen that often, but the recovery process is pretty traumatic.  “It’s painful, you are in compression garments for six weeks. No matter how expert the surgeon, there’s always a wee bump there, a wee dent there.  “This costs about the same, so it’s not cheap but do it properly and by god does it work.  “We technically still offer liposuction but we are thinking about stopping. Why offer an invasive procedure when there is a non-invasive alternative?  “Liposuction is still considered the gold standard in spot fat reduction treatment but in the next 10-15 years, no one will be doing it.”  CoolSculpting works by freezing the fat cells in problem areas under the skin. Once they have been destroyed, they are gradually broken down and processed by the liver.  Darren is hosting a CoolSculpting event at Glasgow’s Princes Square from July 10-24 to show people how it works.  The British Association of Aesthetic Plastic Surgeons report that liposuction has fallen by 46 per cent in the last four years.  Surgical facelifts have gone down 67 per cent and nose jobs by 44 per cent.  Darren is also at the forefront of facelifts using fillers and nose and chin contouring.  He said: “Fillers get a really bad name. People think of fillers as big, fat, puffy faces. That’s just not the way it should look.  “As the face ages, it does lose fat and needs to plump up. But the more profound changes are at the level of the bone. The skeleton is shrinking, the jaw and cheekbones are getting smaller, the eye sockets are getting bigger, there’s less bone around them.  “These fillers will need to be topped up every two years or so. But over 10 years – the life span of a facelift – the cost is about the same.”  Darren also uses fillers to reshape the nose. And there is a new injectable chin implant that has replaced a major operation on the jaw or a silicone chin implant.  Sam Robson, another aesthetic doctor, is pioneering a weightloss treatment that is getting as good results as gastric band and bariatric surgery.  The five-step programme is led by a team of professional therapists, nutritionists, psychologists and personal trainers at her Temple Clinic in Aberdeen.  The former GP said: “For some people, surgery will always be an option. But for a lot of others, we are getting just as good results.  “This is something I am incredibly passionate about. Many of the patients I used to see in my practice had health conditions related to their weight. Often, they asked me about surgery to control their eating.  “Gastric band or stomach sleeve surgery is not always the right option. Like all surgical procedures, there are risks and with these operations, it means that the way you eat and what you can eat is changed forever.”


activistpost--2019-09-05--Psychiatry in Charge of Gun Control Utter Disaster

Psychiatry in Charge of Gun Control: Utter Disaster

During the reign of Barack Obama, mass shootings prompted a White House declaration that community mental health centers would be created across America, in order to spot and treat persons before they committed violent acts. Now, under Trump, we are seeing a similar reaction, with a twist.  The Daily Caller, Aug 22, 2019: “Trump Admin Is Considering Using Amazon Echo And Apple Watch To Determine If Citizens Should Own A Gun”  “The Trump administration is considering a proposal that would use Google, Amazon and Apple to collect data on users who exhibit characteristics of mental illness that could lead to violent behavior, The Washington Post reported Thursday.”  “The proposal is part of an initiative to create a Health Advanced Research Projects Agency (HARPA), which would be located inside the Health and Human Services Department, the report notes, citing sources inside the administration. The new agency would have a separate budget and the president would be responsible for appointing its director.”  “HARPA would develop ‘breakthrough technologies with high specificity and sensitivity for early diagnosis of neuropsychiatric violence,’ according to a copy of the proposal. ‘A multi-modality solution, along with real-time data analytics, is needed to achieve such an accurate diagnosis’.”  “The document lists several technologies that could be employed to help collect information, including Apple Watches, Amazon Echo and Google Home. Geoffrey Ling, the lead scientific adviser on HARPA, told reporters Thursday the plan would require enormous amounts of data and ‘scientific rigor.’”  Translation: Use all available resources to spy on Americans; and by deploying psychiatric definitions of mental disorders, somehow intercede before potentially violent individuals can legally obtain a weapon. Whether or not you favor gun control, creating this new federal agency would be on the order of injecting poisons in people to prevent poisoning.  Why? Because some of the most popular psychiatric drugs, given for “mental disorders,” cause people to go over the edge and commit violent acts, including murder. Once diagnosed, an uninformed person is at the mercy of psychiatrists who refuse to admit what their drugs are creating.  NOTE: Withdrawing from the drugs without expert supervision can result in effects which are even worse than those resulting from taking the drugs.  Here is an excerpt from my 1999 white paper, “Why Do They Do It? School shootings Across America.”:  The massacre at Columbine High School took place on April 20, 1999. Astonishingly, for eight days after the tragedy, during thousands of hours of prime-time television coverage, virtually no one mentioned the word “drugs.” Then the issue was opened. Eric Harris, one of the shooters at Columbine, was on at least one drug.  The NY Times of April 29, 1999, and other papers reported that Harris was rejected from enlisting in the Marines for medical reasons. A friend of the family told the Times that Harris was being treated by a psychiatrist. And then several sources told the Washington Post that the drug prescribed as treatment was Luvox, manufactured by Solvay.  In two more days, the “drug-issue” was gone.  Luvox is of the same class as Prozac and Zoloft and Paxil. They are labeled SSRIs (selective serotonin reuptake inhibitors). They attempt to alleviate depression by changing brain-levels of the natural substance serotonin. Luvox has a slightly different chemical configuration from Prozac, Paxil, and Zoloft, and it was approved by the FDA for obsessive-compulsive disorder, although many doctors apparently prescribe it for depression.  Prozac is the wildly popular Eli Lilly antidepressant which has been linked to suicidal and homicidal actions. It is now given to young children. Again, its chemical composition is very close to Luvox, the drug that Harris took.  Dr. Peter Breggin, the eminent psychiatrist and author (Toxic Psychiatry, Talking Back to Prozac, Talking Back to Ritalin), told me, “With Luvox there is some evidence of a four-percent rate for mania in adolescents. Mania, for certain individuals, could be a component in grandiose plans to destroy large numbers of other people. Mania can go over the hill to psychosis.”  Dr. Joseph Tarantolo is a psychiatrist in private practice in Washington DC. He is the president of the Washington chapter of the American Society of Psychoanalytic Physicians. Tarantolo states that “all the SSRIs [including Prozac and Luvox] relieve the patient of feeling. He becomes less empathic, as in `I don’t care as much,’ which means `It’s easier for me to harm you.’ If a doctor treats someone who needs a great deal of strength just to think straight, and gives him one of these drugs, that could push him over the edge into violent behavior.”  In Arianna Huffington’s syndicated newspaper column of July 9, 1998, Dr. Breggin states, “I have no doubt that Prozac can cause or contribute to violence and suicide. I’ve seen many cases. In a recent clinical trial, 6 percent of the children became psychotic on Prozac. And manic psychosis can lead to violence.”  A study from the September 1989 Journal of Clinical Psychiatry, by Joseph Lipiniski, Jr., indicates that in five examined cases people on Prozac developed what is called akathesia. Symptoms include intense anxiety, inability to sleep, the “jerking of extremities,” and “bicycling in bed or just turning around and around.” Dr. Breggin comments that akathesia “may also contribute to the drug’s tendency to cause self-destructive or violent tendencies … Akathesia can become the equivalent of biochemical torture and could possibly tip someone over the edge into self-destructive or violent behavior … The June 1990 Health Newsletter, produced by the Public Citizen Research Group, reports, ‘Akathesia, or symptoms of restlessness, constant pacing, and purposeless movements of the feet and legs, may occur in 10-25 percent of patients on Prozac.’”  “Emergence of self-destructive phenomena in children and adolescents during fluoxetine [Prozac] treatment,” published in the Journal of the American Academy of Child and Adolescent Psychiatry (1991, vol.30), written by RA King, RA Riddle, et al. It reports self-destructive phenomena in 14% (6/42) of children and adolescents (10-17 years old) who had treatment with fluoxetine (Prozac) for obsessive-compulsive disorder.  July, 1991. Journal of Child and Adolescent Psychiatry. Hisako Koizumi, MD, describes a thirteen-year-old boy who was on Prozac: “full of energy,” “hyperactive,” “clown-like.” All this devolved into sudden violent actions which were “totally unlike him.”  September, 1991. The Journal of the American Academy of Child and Adolescent Psychiatry. Author Laurence Jerome reports the case of a ten-year old who moves with his family to a new location. Becoming depressed, the boy is put on Prozac by a doctor. The boy is then “hyperactive, agitated … irritable.” He makes a “somewhat grandiose assessment of his own abilities.” Then he calls a stranger on the phone and says he is going to kill him. The Prozac is stopped, and the symptoms disappear.  The well-known Goodman and Gilman’s The Pharmacological Basis of Therapeutics reveals a strange fact. It states that Ritalin [given for ADHD] is “structurally related to amphetamines … Its pharmacological properties are essentially the same as those of the amphetamines.” In other words, the only clear difference is legality. And the effects, in layman’s terms, are obvious. You take speed and, sooner or later, you start crashing. You become agitated, irritable, paranoid, delusional, aggressive.  In his book, Toxic Psychiatry, Dr. Breggin discusses the subject of drug combinations: “Combining antidepressants [e.g., Prozac, Luvox, Paxil] and psychostimulants [e.g., Ritalin] increases the risk of cardiovascular catastrophe, seizures, sedation, euphoria, and psychosis. Withdrawal from the combination can cause a severe reaction that includes confusion, emotional instability, agitation, and aggression.” Children are frequently medicated with this combination, and when we highlight such effects as aggression, psychosis, and emotional instability, it is obvious that the result is pointing toward the very real possibility of violence.  In 1986, The International Journal of the Addictions published a most important literature review by Richard Scarnati. It was titled, “An Outline of Hazardous Side Effects of Ritalin (Methylphenidate)” [v.21(7), pp. 837-841].  Scarnati listed over a hundred adverse affects of Ritalin and indexed published journal articles for each of these symptoms.  For every one of the following (selected and quoted verbatim) Ritalin effects then, there is at least one confirming source in the medical literature:  • Paranoid delusions   • Paranoid psychosis   • Hypomanic and manic symptoms, amphetamine-like psychosis   • Activation of psychotic symptoms   • Toxic psychosis   • Visual hallucinations   • Auditory hallucinations   • Can surpass LSD in producing bizarre experiences   • Effects pathological thought processes   • Extreme withdrawal   • Terrified affect   • Started screaming   • Aggressiveness   • Insomnia   • Since Ritalin is considered an amphetamine-type drug, expect amphatamine-like effects   • psychic dependence   • High-abuse potential DEA Schedule II Drug   • Decreased REM sleep   • When used with antidepressants one may see dangerous reactions including hypertension, seizures and hypothermia   • Convulsions   • Brain damage may be seen with amphetamine abuse.  Other ADHD medications, which also have a chemical profile similar to amphetamines, would be expected to produce some of the same effects listed above.  The ICSPP (International Center for the Study of Psychiatry and Psychology) News publishes the following warning in bold letters: “Do Not Try to Abruptly Stop Taking Psychiatric Drugs. When trying to withdraw from many psychiatric drugs, patients can develop serious and even life-threatening emotional and physical reactions…Therefore, withdrawal from psychiatric drugs should be done under clinical supervision…”  —end of excerpts from my 1999 white paper on school shootings and psychiatric drugs—  There is a problem. It is chilling. Pharmaceutical companies, which manufacture drug after drug for “mental disorders,” are doing everything they can to cover up the drugs’ connection to violence.  They use their lawyers and PR people—and their influence over the press—to scrub the connection.  And now, one typical, disturbing, official reaction to every new mass shooting is: build more community mental health facilities. Obama was prominent in this regard, after Sandy Hook in 2012. The implication? More drug prescriptions for more people; thus, more violent consequences.  I’ll close with another excerpt from my 1999 report. It is the tragic account of Julie Marie Meade (one account of many you can find at ssristories.org (also here)):  Dr. Joseph Tarantolo has written about Julie Marie Meade. In a column for the ICSPP (International Center for the Study of Psychiatry and Psychology) News, “Children and Prozac: First Do No Harm,” Tarantolo describes how Julie Meade, in November of 1996, called 911, “begging the cops to come and shoot her. And if they didn’t do it quickly, she would do it to herself. There was also the threat that she would shoot them as well.”  The police came within a few minutes, “5 of them to be exact, pumping at least 10 bullets into her head and torso,” as she waved a gun around.  Tarantolo remarks that a friend of Julie said Julie “had plans to make the honor roll and go to college. He [the friend] had also observed her taking all those pills.” What pills? Tarantolo called the Baltimore medical examiner, and spoke with Dr. Martin Bullock, who was on a fellowship at that office. Bullock said, “She had been taking Prozac for four years.”  Tarantolo asked Bullock, “Did you know that Prozac has been implicated in impulsive de novo violence and suicidalness?” Bullock said he was not aware of this.  Tarantolo is careful to point out, “Violent and suicidal behavior have been observed both early (a few weeks) and late (many months) in treatment with Prozac.”  The November 23rd, 1996, Washington Post reported the Julie Meade death by police shooting. The paper mentioned nothing about Prozac.  Therefore, readers were left in the dark. What could explain this girl’s bizarre and horrendous behavior?  The answer was there in plain sight. But the Post refused to make it known.  Mainstream psychiatrists would certainly be in charge of any new Trump program to “predict violent individuals” before they obtain a gun or commit heinous acts. The program wouldn’t just fail. It would increase violence. Two questions always pop up when I write a critique of psychiatry. The first one is: psychiatric researchers are doing a massive amount of work studying brain function. They do have tests. Yes, experimental tests. But NONE of those tests are contained in the DSM, the psychiatric bible, as the basis of the definition of ANY mental disorder. If the tests were conclusive, they would be heralded in the DSM. They aren’t. The second question is: if all these mental disorders are fiction, why are so many people saddled with problems? Why are some people off the rails? Why are they crazy? The list of potential answers is very long. A real practitioner would focus on one patient at a time and try to discover what has affected him to such a marked degree. For example: Severe nutritional deficiency. Toxic dyes and colors in processed food. Ingestion of pesticides and herbicides. Profound sensitivities to certain foods. The ingestion of toxic pharmaceuticals. Life-altering damage as a result of vaccines. Exposure to environmental chemicals. Heavy physical and emotional abuse in the home or at school. Battlefield stress and trauma (also present in certain neighborhoods). Prior head injury. Chronic infection. Alcohol and street drugs. Debilitating poverty. Other items could be added. Psychiatry is: fake, fraud, pseudoscience from top to bottom. It’s complete fiction dressed up as fact. But the obsessed devotees of science back away from this. They close their eyes. If a “branch of knowledge” as extensive as psychiatry is nothing more than an organized delusion, what other aspect of science might likewise be parading as truth, when it is actually mere paper blowing in the wind? And yet, the Trump administration, following the same general game plan as the Obama administration, is seriously considering the creation of a whole new federal agency that will somehow use “psychiatric knowledge” (an oxymoron), as a guide, to carry out new forms of surveillance on the whole population and intercede, when individuals with “mental disorders” try to buy a gun in order to commit a violent crime. Not only will this strategy utterly fail, it will, through the prescription of violence-inducing drugs, make the tragedies expand and multiply. The author of three explosive collections, THE MATRIX REVEALED, EXIT FROM THE MATRIX, and POWER OUTSIDE THE MATRIX, Jon was a candidate for a US Congressional seat in the 29th District of California. He maintains a consulting practice for private clients, the purpose of which is the expansion of personal creative power. Nominated for a Pulitzer Prize, he has worked as an investigative reporter for 30 years, writing articles on politics, medicine, and health for CBS Healthwatch, LA Weekly, Spin Magazine, Stern, and other newspapers and magazines in the US and Europe. Jon has delivered lectures and seminars on global politics, health, logic, and creative power to audiences around the world. You can sign up for his free NoMoreFakeNews emails here or his free OutsideTheRealityMachine emails here. Subscribe to Activist Post for truth, peace, and freedom news. Follow us on Minds, Twitter, Steemit, and SoMee. Become an Activist Post Patron for as little as $1 per month. Provide, Protect and Profit from what’s coming! Get a free issue of Counter Markets today.


dailyheraldchicago--2019-07-30--Constable Telepsychiatry uses video conferencing to help mental health patients

Constable: 'Telepsychiatry' uses video conferencing to help mental health patients

With physical health, most people embrace the philosophy that preventive care provided by a vaccine is cheaper, easier and safer than a hospital stay to treat a case of potentially fatal measles.  That same concept is true with mental health, says state House Rep. Michelle Mussman, a Democrat from Schaumburg who serves on legislative committees that deal with mental health, human services and elementary education. Paying for the proper psychological help today could save taxpayer money that might otherwise be needed for expensive emergency room visits, hospital stays or prison.  "If I had just gotten you help in the community, could you stay out of that situation?" Mussman asked Monday after watching a presentation of "telepsychiatry," which allows someone with a mental health issue to talk with a psychiatrist by way of an online video conference.  Mussman, whose 56th House District covers all or parts of Hanover Park, Keeneyville, Roselle, Elk Grove Village, Hoffman Estates, Palatine, Schaumburg and Rolling Meadows, joined fellow state Reps. Robyn Gabel, an Evanston Democrat, and Justin Slaughter, a Democrat who represents the South Side of Chicago, for a presentation by Regroup, a Chicago company that is a leader in the telepsychiatry field.  Many studies have found that telepsychiatry is just as effective as meeting with a psychiatrist face to face in an office, said Dr. Hossam Mahmoud, medical direct for Regroup.  And Dr. Omar Elhaj, a psychologist who talked to the Chicago group by way of a camera in his Ohio home, said "sometimes it's even better than face to face."  Elhaj recently treated a prison inmate serving a term for murder who was upset after not being granted permission to attend the funeral of his wife of 25 years. During the session, the doctor, who has worked exclusively as a telepsychiatrist the past two years, pointed his camera out his window so the inmate "could see the grass where his wife would be buried."  "That camera gave me something nothing else could have," Elhaj said.  Prisons save money by using telepsychiatry instead of transporting a patient to a facility, said David Cohn, founder and CEO of Regroup. Schools can use telepsychiatry in emergencies the same way the school nurse can treat a skinned knee.  The cost of a two-day hospital stay could pay for 50 telepsychiatry sessions, Mahmoud said.  Mussman said mental health issues have no boundaries.  "We talk about mental health in a number of committees," she said. "There's a whole lot of pieces that overlap."  She notes that one in four Illinois residents has a mental health need at least once a year. "What are we doing to see those needs get met?" Mussman said. "It's something we've got to figure out."  A second group of Illinois legislators, including Rep. Deborah Conroy, a Democrat from Elmhurst, will see the Regroup presentation on Friday.  Regroup provides 10,000 telepsychiatry sessions a month across 20 states, but 70 percent of those cases are in Illinois. More than 4.8 million people in Illinois reside in areas without the necessary behavioral health care, according to research from the Leonard D. Schaeffer Center for Health Policy & Economics at the University of Southern California.  Many of the mental health issues involve people who receive Medicaid benefits, and Illinois has the eighth-lowest reimbursement rate among the 50 states, which can be a disincentive for physicians to accept patients, the research showed. Some private insurance providers won't cover telepsychiatry.  Mussman said Illinois must find ways to pay for mental health and treat small issues before they become expensive problems.  "Preventive services can save you money in the long run. It's government money well-spent," Mussman says. "But we've got a lot of work to do."


npr--2019-09-09--Telepsychiatry Helps Recruitment And Patient Care In Rural Areas

Dr. Sarfraz Khan, chief medical officer at Meridian Health Services in Indiana, connects with patients over the internet. **Yuki Noguchi/NPR** ****hide caption****  ****toggle caption****  Yuki Noguchi/NPR  Dr. Sarfraz Khan, chief medical officer at Meridian Health Services in Indiana, connects with patients over the internet.  Yuki Noguchi/NPR  It used to take at least nine months for a patient to schedule an initial appointment with a psychiatrist at Meridian Health Services in Indiana. Now, it takes days, thanks to a program that allows doctors to connect over the Internet with patients, reaching those even in remotest corners of the state.  That has also helped with recruitment. Over the last several years, Meridian's staff of psychiatric specialists, including nurse practitioners, tripled from four to 12.  "In my opinion, it's lifesaving," says Dr. Sarfraz Khan, Meridian's chief medical officer. Meridian increased its investment in telepsychiatry in the last six months, in part because of what Khan says is a burgeoning addiction crisis. "There are drugs and then more drugs and then more and more drugs."  Growing problems with addiction and depression have made the country's shortage of mental health professionals much more acute for rural areas. Geographic isolation exacerbates a vicious cycle. A shortage of doctors means patients can't get timely care. The health system atrophies, and doctor recruitment gets even tougher.  As a potential workaround, telemedicine is one of the most promising and lucrative opportunities in healthcare. The way it has transformed both psychiatric care and recruitment for Meridian is a case study of its appeal.  "There was a time when we were seriously considering: Would it be viable for us to provide psychiatric services because nobody would like to come to small towns?" Khan says.  Now, such care is readily available. And it makes more money for Meridian, a provider of mental health and primary care, **** because Medicare and Medicaid pay more for care provided to underserved areas.  Meridian set up what it calls a "hive" in Indianapolis, where it's easier to recruit talent. Patients drive to a local Meridian office, where a nurse measures their vitals and observes their demeanor, and sits them in front of a computer. On a split screen, the physician appears at the other end of a secure connection.  Patients seem to embrace it.  At Meridian's offices in Muncie, Mariah, a visually arresting 20-year-old woman emerges from her first telepsychiatry appointment. She wears a metallic kitty-ear headband over a florescent green wig that matches her dramatic eye shadow.  "Yesterday, I had heart-shaped freckles that were like colored glitter, and it also looked like I was crying glitter," she explains.  Elaborate costumes help her mask a years-long struggle with depression and anxiety, says Mariah, who declined to use her last time to protect her medical privacy.  She says she prefers talking over a computer to an in-person appointment, because it feels less confrontational. "It's easier because they're not there, so I feel like I can tell more, and speak more and truly just be fully real," she says. "If they're sitting right there, I might not want to say everything or say as much."  For all its benefits, telemedicine hasn't solved all of Meridian's recruitment needs.  "In my offices, I've got probably close to 50 positions that are vacant," says Gerard Cyranowski, one of the company's vice presidents covering the eastern part of Indiana. "It's a tight labor market, there's a limited number of practitioners. They can name their price."  So Cyranowski says the company is interested in expanding its use of telemedicine to address staffing challenges in other areas, including primary care and psychotherapy. In the past few months, Meridian has been using it to treat patients in emergency rooms, addiction treatment centers and even schools.


prisonplanet--2019-05-14--U of Toronto Psychiatry Prof Suspended By Twitter For Saying Transgenderism Is A Mental Disorder

U. of Toronto Psychiatry Prof Suspended By Twitter For Saying Transgenderism Is A ‘Mental Disorder’

University of Toronto Professor of Psychiatry Ray Blanchard, PhD, was temporarily suspended from Twitter on Sunday after sharing his professional position on transgenderism after a lifetime of research in the field.  Here’s the full statement Blanchard made which got him suspended:  Earlier today I wrote this thread in response to a follower who asked me, “What is your actual position on transgender people?” It looks like my reply has not been delivered to a single person besides the original inquirer, so I am reposting it here. My beliefs include the following 6 elements: (1) Transsexualism and milder forms of gender dysphoria are types of mental disorder, which may leave the individual with average or even above-average functioning in unrelated areas of life. (2) Sex change surgery is still the best treatment for carefully screened, adult patients, whose gender dysphoria has proven resistant to other forms of treatment. (3) Sex change surgery should not be considered for any patient until that patient has reached the age of 21 years and has lived for at least two years in the desired gender role. (4) Gender dysphoria is not a sexual orientation, but it is virtually always preceded or accompanied by an atypical sexual orientation – in males, either homosexuality (sexual arousal by members of one’s own biological sex) . . . or autogynephilia (sexual arousal at the thought or image of oneself as a female). (5) There are two main types of gender dysphoria in males, one associated with homosexuality and one associated with autogynephilia. Traditionally, the great bulk of female-to-male transsexuals has been homosexual in erotic object choice. (6) The sex of a postoperative transsexual should be analogous to a legal fiction. This legal fiction would apply to some things (e.g., sex designation on a driver’s license) but not to others (entering a sports competition as one’s adopted sex).  Blanchard’s suspension was later lifted after widespread outrage.  As Tim Pool pointed out in a recent interview with Jack Dorsey and Vijaya Gadde on Joe Rogan’s show, Twitter’s rules on “misgendering” and “deadnaming” demand that users submit to their radical, far-left gender ideology or risk being banned:  Twitter’s “hateful conduct” policy mandates that users not “deadname” transgender people by referring them to using their birth name or “misgender” transgender people, which in this case means referring to them as their actual biological gender rather than the gender they’ve chosen to identify with.  Facebook came up with a similar speech mandate earlier this month after banning Paul Joseph Watson and others where they declared that users are no longer allowed to share links to Infowars unless they’re “explicitly condemning the content.”  Perhaps Big Tech could hold a conference in the future and bring all their “trust and safety” teams together to create a list of all the prog-globalist political beliefs we’re all mandated to espouse in order to keep our accounts on social media?  This article was posted: Tuesday, May 14, 2019 at 6:05 am


renegadetribune--2019-05-27--Psychiatry in the Military The Hidden Enemy

Psychiatry in the Military: The Hidden Enemy

This documentary shows how the army is exploited as Psychiatry’s testing ground for drugs and other inhumane “treatment” which have resulted in exponential growth of military suicides. Currently, more US soldiers die from suicide than from combat.


thedailycaller--2019-08-22--Yale Psychiatry Professor Sexually Assaulted Five Male Students Report

Yale Psychiatry Professor Sexually Assaulted Five Male Students: Report

Former Yale psychiatry professor Eugene Redmond sexually assaulted five male students, an independent report released by Yale reveals.  Redmond served as Yale faculty for 44 years, during which time he allegedly assaulted five students in an intern program that he ran, according to CNN.  Yale ordered an investigation into Redmond’s conduct after a student filed a complaint of sexual misconduct against the professor in March 2018. The investigation revealed that there had been other complaints against Redmond as many as 24 years ago.  The 54-page report found “five credible accounts of sexual assaults in a shared bedroom, three incidents where Redmond conducted inappropriate medical examinations, and multiple other forms of sexual harassment.” (RELATED: ‘Largest Pedophile Ring On Earth’: Abuse Lawyers Make First Case Against The Boy Scouts)  These sexual assaults involved male students and incidents which allegedly took place at a private residence on the Caribbean island of St. Kitts, at the psychiatry professor’s home, at a location on Yale’s campus and in other locations off campus.  Redmond reportedly sexually assaulted these male students in bed after drinking with them. Students said that Redmond accepted more students into his program than he had beds for, according to the report.  The Yale School of Medicine initially launched an investigation in 1994 after two of Redmond’s summer interns said that he had sexually molested them. Redmond signed a settlement that required him to end his program and stop recruiting or supervising students at St. Kitts as well as live in separate housing.  But Redmond violated the settlement beginning in 2001 and continuing until at least 2017, according to the report. He retired in July 2018 after he was disciplined by Yale and banned from campus, according to CNN.  “…if Yale had implemented a longstanding monitoring program after the 1994 investigation, Redmond’s ongoing misconduct might well have been detected and stopped,” the report said.  “In addition, at various points after 1994, several members of the Yale community had concerns about Redmond’s subsequent interactions with certain students, which, if they had pursued, might have prompted Yale to further scrutinize Redmond’s conduct and potentially uncover his misconduct.”  Content created by The Daily Caller News Foundation is available without charge to any eligible news publisher that can provide a large audience. For licensing opportunities of our original content, please contact licensing@dailycallernewsfoundation.org.


thetelegraph--2019-09-29--Psychiatry is at risk of imploding because junior doctors see the profession as soft Royal Coll

Psychiatry is at risk of 'imploding' because junior doctors see the profession as 'soft', Royal College warns

Trainee doctors are being put off becoming psychiatrists because medical school teachers tell them the field is “not prestigious”, health leaders have said.  The Royal College of Psychiatrists (RCP) is calling for the number of medical school places to be doubled to prevent the profession “imploding”, due in part to stigma among students.  The body says the move would create an extra  4,497 consultant psychiatrists within ten years.  Currently, just 5.6 per cent of junior doctors opt for a career in mental health, leaving the workforce understaffed and “over-reliant” on foreign medics.  RCP last night said the situation is exacerbated by a tendency among some medical school lecturers to talk down the speciality.  Dr Kate Lovett, Dean of the college, cited examples of students sniggering at the back of classes on depression because “they think it’s soft”.


birminghammail--2019-09-01--The best GP surgeries and doctors in Birmingham revealed for 2019

The top doctors surgeries in Birmingham can be revealed today - but where does yours rank?  Keynell Court surgery in Kings Norton has beaten scores of other practices in the city to claim the number one spot as the patients’ choice.  West Health Primary Care Centre was second and Selly Park Surgery in Selly Park was third.  The new league table is based on the latest findings from the GP Patient Survey - a huge ongoing poll involving more than a million people a year.  It covers everything from the trust patients have in their doctor, to the attitude of reception staff and how easy it is to get an appointment.  Our data team has crunched the numbers in seven key areas: how easy it is to get an appointment, whether opening times are convenient, whether people trust the GP, whether the GP listens to them, whether the GP treats them with care and concern, whether receptionists are helpful, and how patients rate their overall experience.  Nearly 95 per cent of patients at Keynell Court felt their doctor listened to them properly, while more than 97 per cent said they were treated with care and concern.  One hundred per cent said reception staff were helpful, and 98 per cent said their overall experience of the surgery was good.  You can find out how your local surgery performed by typing its name or postcode into our interactive gadget.  In order to rank all surgeries nationwide, the Reach Data Unit looked at weighted survey results in each of the seven key areas.  Each surgery was given a rank for its performance in each area. Those category rankings were then added up to give an overall ranking.  Surgeries which had fewer than 50 responses were excluded on the basis that the sample was too small to draw reliable conclusions.


cnn--2019-03-18--What Medicare for all means for doctors and hospitals

(CNN) Americans generally don't like the idea of giving up their private health insurance. Hospitals and doctors don't want them to, either.  Private insurers typically pay medical providers a whole lot more than Medicare and Medicaid. And that's one of the main reasons why many hospitals and doctors oppose Medicare for all proposals that would eliminate or minimize private insurance.  The renewed interest in Medicare for all has prompted the American Hospital Association, Federation of American Hospitals and American Medical Association to join a national coalition seeking to chill the growing fervor. Instead, they are pushing to strengthen employer-based policies, which currently cover roughly half of Americans.  It's not hard to see why.  Medicare payments only covered 87% of costs in 2016, the most recent data available from the American Hospital Association. But private insurers paid nearly 145% of their policyholders' hospital expenses.  "Hospitals are already paid far less than the cost of caring for Medicare patients, and more patients with Medicare would strain hospitals even more, and could threaten hospitals' survival," wrote Rick Pollack, chief executive of the association, in a blog post last month.  Private insurance payments provide the funding hospitals need to offer the care that Americans expect, said Chip Kahn, chief executive of the Federation of American Hospitals, which represents for-profit institutions.  "It would be great if we had this national health insurance, but the question is would you then have the system to provide the services," Kahn said.  The main Medicare for all legislation would let either the federal government or regional directors set reimbursement rates and create annual budgets based on the Medicare system.  Vermont Independent Sen. Bernie Sanders' Medicare for all bill, which he floated in 2017 and expects to reintroduce soon, calls for continuing Medicare's current payment formulas but doesn't establish the rates. The House version, unveiled in late February by Democratic Rep. Pramila Jayapal of Washington, would establish an annual lump-sum budget for hospitals and other institutions, but pay doctors based on the services they provide.  While the key industry group for doctors opposes single-payer proposals such as Medicare for all, some physicians are more open to it, particularly younger ones.  Under Medicare for all, there would likely be some redistribution, acknowledged a Sanders staffer. Hospitals and doctors that see a lot of privately insured patients could see their reimbursements drop, but those that take care of the uninsured and Americans on Medicaid, which covers the poor, could wind up making more money under Medicare for all than they do now.  "There are tradeoffs," said Sanders spokesman Josh Miller Lewis. "Our goal is to ensure every single person is guaranteed health care, and we do it in the most cost-effective way."  But Medicare pays hospitals about 40% less than private insurance for inpatient services and doctors about 30% less for their treatment, according to Charles Blahous, a senior research strategist at the conservative Mercatus Center at George Mason University and a former trustee for Social Security and Medicare. And the gap is expected to grow over time, he says, citing data from the Centers for Medicare and Medicaid Services' Medicare actuary.  Other studies of the Sanders plan assume that Medicare will increase its rates to keep up with or even slightly exceed costs -- though that would levy a heavier burden on taxpayers.  Plus, proponents say, medical providers will be able to shrink administrative costs, which will save them money, and they will benefit from everyone having coverage.  "The vast majority of doctors will not get paid less," Jayapal told reporters before unveiling her bill. "In fact, they'll be seeing many more clients and they won't have to spend sometimes up to 25% of their time on administrative stuff."  To contain health care costs, Jayapal wants to pay hospitals under a so-called global budget system, which other developed countries use.  So does Maryland, which has specified the amount of annual revenue hospitals can receive from Medicare, Medicaid and private insurers since 2014.  Yet some experts question whether Maryland's system can be replicated nationally, especially because Medicare pays higher rates in the state.  "It would cause health care spending to balloon beyond what would be affordable for the budget," said Eric Roberts, assistant professor of health policy at the University of Pittsburgh. That could then lead to rate cuts or service reductions, both of which are tough to implement. "You get yourself potentially into a fiscally unsustainable scenario."