Princess Health and DO HCG DIET EXPERTS REALLY KNOW WHAT THEY ARE TALKING ABOUT?. Princessiccia

Princess Health and DO HCG DIET EXPERTS REALLY KNOW WHAT THEY ARE TALKING ABOUT?. Princessiccia

Gusty 11:51 Add Comment

There are many "experts", practitioners and businesses prescribing hCG for Dr. Simeons' protocol. But how many of them actually understand why it works and how hCG could prevent starvation? Most have no clue. They know it works, but they don't understand why, so they repeat what they read in Simeons' manuscript, Pounds & Inches.

Here are 5 questions that reveal if an hCG diet business knows why the hCG protocol works:

1) Does the hCG business discuss 3 types of fat? This is a hypothesis Simeons' created, however it has never been laboratory tested or explained. As of today, there are two different types of fat (brown or white fat). We know that larger fat cells function the same as smaller fat cells, but with a more magnified response. Meaning they do the same things small fat cells do, but in a bigger way.  Larger fat cells produce more hormones, and provide more fuel than the smaller fat cells. As for three types of fat: science hasen't discovered a third type.

2) Does the hCG diet business profess that hCG burns fat. This could not be further from the truth. HCG DOES NOT BURN FAT. However, hCG does stimulate the hormone that regulates fat metabolism; Leptin. If you are not up to date with the new science of energy homeostasis you need to start studying recent research that has summarized what we know about the hormone leptin and its regulation of the thyroid, adrenals, testicles, ovaries, etc.  Leptin is a primary regulatory hormone of the body's fueling systems. It also regulates the body's hormonal response that causes symptoms of starvation. Low dose hCG stimulates leptin, which would reduce one's hunger but also increases the fueling response from fat cells. This is the same thing food does hormonally, but with hCG- you don�t need as much food! This is described thoroughly in the newly published book, Weight-Loss Apocalypse.  (www.weightlossapocalypse.com)

3) Does the hCG diet business monitor success, only by weight?  Weight is a superficial and insufficient measure of success, and by obsessing over weight for motivation you are creating a short term diet out of an incredible hormonal therapy. For example, is the hCG diet business telling customers/patients to weigh every day and to do an �apple-day� if they plateau? Are they suggesting that you can flush out fat with apples??? Obsessive weighing creates adverse emotional consequences that could encourage emotional eating disorders. Weight is too superficial when compared to the profound hormonal healing that the hCG protocol provides when its followed.

Weight cannot compare to the rewards of better sleep, improved adrenal function, diminished heart burn, improved breathing, reduced inflammation, improved sex drive, etc. Measures that include body fat composition and an assessment of hormonal symptoms are much more telling and more valuable than a number on a scale. Weight should be the least of your concerns when considering the long term change of lifestyle it will take for you to maintain whatever weight you lose. And weight should not be responsible for the motivation it takes to eat less among gluttons.

4) Does the hCG diet business monitor calories? The measure of calories in food is old and outdated information. In fact, how the protocol works completely conflicts with the idea that we are fueled from the food we eat that day. The caloric value in food is irrelevant as it concerns the body�s hormonal response to food.  For example, we now know that artificial sweetener (zero calories) stimulates leptin and this response stimulates fat's fueling mechanism.  The reason the hCG works to prevent starvation is because it stimulates the same hormone that food stimulates (leptin). For this reason, your body doesn't respond to starvation like it would without the hCG. Calories have nothing to do with starvation because starvation is defined scientifically by a measure of hormones.  Look it up: leptin and its relationship to starvation.

5) Does the hCG diet business profess you�ll lose a pound a day or 30 pounds in 40 days? This is a sign the business is run by people who have no clue how metabolism works, they have no interest in long term results, and they are more interested in one thing: money. This same business probably sells appetite suppressants (another sign they have no idea how the protocol works and that they want more money), fat dissolving injections, meal replacements, and other means to make money. Most of these are sold to take advantage of and to prostitute the desperation of people who need to lose fat and are willing to pay anyone who promises quick results.

Unfortunately most of the hCG diet industry is run by businesses that have no clue what they are doing. These businesses know the hCG protocol works and with that, they know they can make money. But where�s the integrity? Where�s the responsibility?  Without understanding how the protocol works, it has been marketed as another quick fix diet. Without giving the patient personal responsibility � it�s a scam!

But if you�ve done the protocol properly, you know- IT�S NOT A SCAM.  Then why market it in a way that has very little integrity? Why portray it in a way that looks just as fake as the rest? The only way the hCG protocol will make a significant impact on America�s overwhelming obesity epidemic, is if the hCG diet industry rethinks how the hCG protocol is portrayed, taught, presented, and advertised.

�     If you own an hCG diet business, do you want to look credible? Then know how it works hormonally.

�     Do you want to stand apart from the hCG diet businesses that market it like another fad diet? Than market it as a hormonal therapy.

�     Do you want your patients to have long lasting results that heal both the body and the mind? Than hold your patients accountable to change the way they eat emotionally.

I believe the hCG protocol has the potential to change our culture both physically and emotionally. If we as �experts� continue to mirror the same approach as the diet industry, we will fail. It will be another diet, another fad, and another attempt at losing weight, just to gain it all back.

For more information...BUY THE BOOK TODAY:  Weight-Loss Apocalypse: Emotional Eating Rehab Through the HCG Protocol.

Available at www.barnesandnoble.com or www.amazon.com

Princess Health and WHY WEIGHING YOURSELF SUCKS (and results in fat gain). Princessiccia

Princess Health and WHY WEIGHING YOURSELF SUCKS (and results in fat gain). Princessiccia

Gusty 09:16 Add Comment

If you think that by losing weight, your self-esteem will improve so much that your motivation to eat less will have everlasting motivation-you�re fooling yourself.

Monitoring weight is the biggest flaw in the foundation of a diet. Why: because desires to eat food have nothing to do with body fat. For example, how many of us sabotage our temporary diet in order to eat for emotional celebration?

How often have you eaten food at a party, then felt guilty about breaking your diet�s rules, as a result decided your desire to eat was bigger than your desire to lose weight at that moment, and instead of feeling guilty, you�d rather let go of that desire to lose weight, so that you could eat all that you�d like- without guilt. And because you can just �start over� the next day, you end up eating more than you actually want, which compensates for the impending diet restrictions that you don�t want in the first place. Sound familiar?

This is typical of most when attempting a weight-motivated diet. Consider the failure of the entire diet industry. Consider how much fat our country gains each year compared to how much fat we lose. How�s weight as motivation working? Not well. With all of the differences between one diet to the next, the one consistency between them all is their hyper-focus on weight. The long term result: more fat gain.

If you observe the obsession over weight-loss during the protocol (or any other diet) you�ll find that as soon as weight-loss stops, or slows down, complaints go up. Why? Because there�s emotional hardship when choosing to eat less-which is why there�s a desperate need for weight-loss as reward. We falsely believe weight is the problem and temporarily submit to a reduction in food intake-but only if weight is lost. Without holding accountable our desires to eat excessively and emotionally, fat is falsely accused as the problem.

Have you ever considered that the normal way you eat is the real challenge? Without weight loss, would you voluntarily eat less? If you continue to have desires to eat at every party, every social event, every moment you feel bored, and whenever you feel emotionally tested - your body will always be forced to accumulate fat.

Go ahead -obsess over your weight while dieting. Find out if your weight will motivate you to eat less the rest of your life. Or, decide you�re disgusted by our cultural gluttony. Recognize that you�ve stopped using your creativity, which is why you�re bored and use food for entertainment. Acknowledge that eating has become your best friend, your hobby, your crutch, and without eating at all social functions, you feel punished.  You might hate the amount of money you�ve spent to lose and gain weight over and over again-but eventually, you�ll recognize that weight isn�t the problem and that using it as motivation, will always fall short.

Without changing your desires to eat, anything less will feel punishing, and each time you restrict, that desire to eat will magnify even more. Stop kidding yourself. If you have emotional desires to eat and want to continue this dysfunctional relationship with food, you might as well accept the outcome.

If you want permanent change, consider transforming the normal way you eat

to a realistic �new normal�, that doesn�t require you eating emotionally

-whether you lose weight or not.

Motivation to eat less is profound, especially when you live in a culture that eats excessively as the norm. Especially, when the diet industry has plagued us with constant guilt about what we eat, and the food industry is continuously shoving food down our throats.

You have to understand that obesity isn�t the problem-it�s the inevitable outcome of gluttony. So if you continue to assume that losing weight will change your desires to eat, you�re fooling yourself-again.

Princess Health and THE HCG PROTOCOL IS NOT FOR SISSIES. Princessiccia

Princess Health and THE HCG PROTOCOL IS NOT FOR SISSIES. Princessiccia

Gusty 07:12 Add Comment

Have you ever considered what it would emotionally feel like to be limited to less than 500 calories of food, while living amongst gluttons? For most, when considering the benefits versus the risks of the hCG protocol, emotional hardship isn�t well thought-out. Instead, the biggest influence when deciding to do the protocol, is potential weight-loss.

They�re tired of battling with weight, and frustrated with the diet industry�s failure to make a difference. They think, �If what thousands of people proclaim on the Internet is true-- eating such a small amount of food must be worth it.� There�s no hunger, the food is simple, and if the weight is lost as fast as everyone says, how could the protocol be difficult?

This mentality is naive. The hCG protocol requires the participant eat 500 calories in food for about a month, and when done correctly, hunger may limit eating to even less. Take a step back and observe this amount of food. Compare it against the backdrop of our normal cultural eating behavior. Notice the difference? Our culture is the most gluttonous and dysfunctional culture with food --in the Universe. 

We spend hundreds of billions of dollars on food,

and what�s ironic is that we spend billions, trying not to eat it.

The hCG protocol is the extreme opposite.The naivety is in thinking that weight-loss will perpetually motivate us to eat less, even amongst friends, family, and coworkers who eat significantly more.  And to believe that without hunger you�ll be emotionally resilient-- is crazy!

How many of you eat without hunger? When you�re bored, when you�re celebrating, when you�re drunk, have the munchies, when you�ve had a difficult day at work, to suppress negative feelings about someone, or to avoid having to talk to strangers in social settings? Anybody who thinks that hunger is why American�s eat too much, needs a reality check.

If you ask anybody who is obese how often they�re hungry (I�m talking true physical hunger), they will tell you they�re not hungry that often. However, for reasons I�m not going to explain in this blog, their hunger occurs more rapidly than others who have less fat. In general, they�re not hungry for breakfast; they could wait hours and hours before feeling that physical irritation and urgency to eat, and they don�t need as much food to reduce hunger.

This makes sense, considering the science that has proven the more fat a person has, the higher (exponentially) their blood leptin levels are. Leptin, in the brain, reduces hunger. So it makes sense that if you have more leptin, you�re going to experience hunger less often. But does lack of hunger and weight loss keep you from continually eating with the rest of our gluttonous culture? Probably not. Otherwise the first diet you ever attempted would have worked long term.

The hCG protocol is not as easy as you think. It requires you eat less than what small children eat, and for over a month. If you live in America, that means you�re going to be constantly surrounded by food commercials, surrounded by restaurants and fast food joints on every corner, and will have invitations to eat all the time-- for any reason.  Our culture is defined by eating and food, so to think any amount of fat loss would completely overhaul your desires to eat is na�ve.

Before considering the hCG protocol, take into account the desire and emotional strength you�re going to have to develop to let go of excessive emotional eating. And to keep from gaining fat back, you'll have to let go of emotional eating forever. Are you ready to divorce this gluttonous way of life? Do you really want to let go of food emotionally?  Are you seeking an intrinsic desire to eat less, whether you lose weight or not? If so, the hCG protocol will change your life. Your body will heal and your relationship with food will too. With freedom from emotional eating as your goal, consider yourself anything but a sissy, and ready to take on the hCG protocol challenge.

Princess Health and WHY SKINNY B*TCHES EAT MORE(and don't get fat). Princessiccia

Princess Health and WHY SKINNY B*TCHES EAT MORE(and don't get fat). Princessiccia

Gusty 08:14 Add Comment

By the time I first meet with a client, they�ve already decided they want to do the hCG protocol. Not because they want to completely overhaul the way they eat, but because they�ve convinced themselves losing weight will improve their life.

On some level, they are absolutely correct. Fat cells are organ cells that create and stimulate all sorts of hormones, and because these clients have too many fat cells, weak stimulus results in a strong hormonal response.

Do you understand the hormonal difference between a leaner body compared to a more obese body? The more fat you have the weaker hormonal stimulus you need. On the other hand, the less fat you have the stronger hormonal stimulus you need.

Similar to hormones, food (all food) stimulates your fat cells to release hormones. As a result, in order to maintain hormonal balance, those who have more fat need significantly less food. If you continue to eat similar to others who have less fat, you�ll inevitably have hormonal problems. This is why those who are leaner (skinny b*tches) can eat more without gaining fat or having hormonal problems. And a person who has more fat, eats less, gains fat, and has hormonal problems. (This is thoroughly explained in Weight-Loss Apocalypse)

Because of this magnified hormonal response after eating, the larger you are, the more you end up feeling like crap if you eat �normal� amounts of food. You're tired, fatigued, have suppressed adrenal function which makes you less motivated to do anything, have hot flashes, daily symptoms of heart burn, erratic sex drive, inflamed joints, breathing issues, night sweats, sleep disruptions, etc. These symptoms don�t occur with people who have less fat-- unless they binge eat or have a hormonal cause, such as thyroid, ovary, or other organ problem.

As soon as clients begin the very low calorie protocol and their food intake is regimented and minimal, they notice how much better they feel. Energy for most improves. Hot flashes and heart burn disappear. The more fat they lose, the more their sleep improves, etc. However, many people look past how incredibly better they feel to instead, base all of their motivation on their weight. If they lose more weight, they want to continue. If they don�t lose enough weight, they feel burdened by the reduced food intake.

Weight on the scale is a very superficial reason to eat less. When you consider the disease and hormonal problems associated to obesity and eating�s hormonal magnification, don�t you think there are more profound motivations to eat functionally?

Unfortunately, the diet industry has plagued us with the idea that weight is the only measure of success. Why? Because you pay for it. The more you obsess over your weight, the less focus you put towards ending the reasons you eat that have nothing to do with true physical hunger, and have everything to do with why you have excess fat. Weight motivated diets don�t realistically prepare you to live in our culture of normalized gluttony.

This time, instead of enlisting for another shallow diet that judges food, causes guilt every time you eat, and encourages you to weigh obsessively-- do something very different. Choose to eat less to feel better, and to reduce your hormonal problems. If you�re never going to lose the damn weight anyways, wouldn�t you at least want to lose all the sh*tty hormonal symptoms?

For the next couple of months try this: stop judging food. Eat anything you want. HOWEVER, the boundary is that you must have true physical hunger to eat, and you must avoid fullness at all cost. Throw away your scale, and choose to eat functionally no matter what the result. You�ll notice you physically feel much better. Binging because of diet guilt will immediately stop, food isn�t such a big deal anymore, and neither is your weight.

Because you aren�t allowed to eat without hunger, you�ll have to find other things to do with your spare time. Projects you�ve started will finally get finished; you�ll try new hobbies, and have more creative drive. Emotionally, you�ll be held accountable. This is similar to a baby and a pacifier. If food is your pacifier, you�re going to have to learn to handle change and life without superstitiously thinking food will make things better. Truthfully, letting go of food emotionally will get you back to the way you used to eat as a child.

Children spend their time playing, thinking, and creating. Eating is only necessary when they get the physical irritation of hunger, which eventually can�t be ignored. They eat, but only enough for the pang to go away. Then they bolt out the door, back to the fun and creativity they only left, because of hunger. No fullness, no emotional high, no emotional guilt, no fear of gaining fat, and no caring about weight.

This is a challenge of your ability to understand what physical hunger feels like, and to understand the difference between true physical need to eat, from emotional desire. Ultimately, as you no longer need food as a pacifier, your emotional confidence will grow. Eating less won�t need motivation or feel like punishment. With hormonal balance, you�ll immediately feel better, and the obvious result will be fat loss. This immediately solves hormonal problems that created fat gain, and were caused by eating without hunger in the first place.

This is one of those win/win situations: Eat what you want, but only when there�s true physical hunger, and avoid fullness at all cost. I challenge you to try this, and let me know how it goes!

Princess Health and INTRODUCTION TO WEIGHT-LOSS APOCALYPSE. Princessiccia

Princess Health and INTRODUCTION TO WEIGHT-LOSS APOCALYPSE. Princessiccia

Gusty 06:09 Add Comment

I first heard about the hCG protocol from my sister, a registered dietitian. She�d already finished her first week on it before she called to tell me about her experience. I�m sure she waited because she expected me to criticize what she was doing.

You could say I was skeptical, considering I�m a personal trainer, and my college degree is in exercise physiology. Obviously eating less than 500 calories in food causes weight loss, but what about muscle loss, too? Destroying your metabolism? And preparing you for what? You can�t eat 500 calories the rest of your life! Yes, I was critical.

At the time, I thought I was thoroughly informed as to how the body uses fuel, and how the body responds to starvation. Before I read Dr. Simeons� 1967 manuscript, Pounds & Inches, I assumed it was written by a con man taking advantage of our desperation due to the obesity crises. But to my surprise, the manuscript made some sense. I could relate to his theories because his observations of fat gain and loss paralleled my own during three pregnancies, and what I�d witnessed with many clients over my ten-year career.

I�d observed, measured, and assessed body fat compositions for thousands of people. Some of those clients meticulously exercised and reduced their food intake�without results. I watched as female clients gained abdominal fat during menopause, even though they were eating less and exercising more. I observed clients before, during, and after pregnancy, and witnessed the shape of their bodies change, adding fat in some areas, and losing it in others. I knew through experience that fat gain and loss were linked to hormones.

I was excited when Simeons� observations validated mine.

Dr. Simeons assessed scale weight for decades to deduce the strict guidelines of his protocol. He had theorized, based on his observations, that the pregnancy hormone, human Chorionic Gonadotropin (hCG), somehow prevented symptoms of starvation during a 500-calorie protocol. In 1967, he privately published his findings and hypothesis in a manuscript called Pounds & Inches: A New Approach to Obesity. Dr. Simeons� believed the brain determines where and when fat is used for fuel. He observed that hCG redirected the brain to use abnormal fat (fat that�s difficult to lose) for energy. He observed that 1) participants felt minimal hunger, 2) their weight loss was rapid, and 3) their losses were specific to areas that regular diet and exercise didn�t influence.

Dr. Simeons was convinced that by tricking the brain with hCG, and manipulating fuel demand with the 500-calorie protocol, the brain would �re-set� its fat-burning capacity. Ultimately, this would allow the participant to eat normally without having the same susceptibility for fat gain when the protocol was over.

After understanding his protocol, and finding a doctor willing to prescribe it, I decided to present the information, as well as the opportunity to do the protocol, to appropriate clients.  They had to allow me to follow, measure, and record their progress, and in particular, compare their metabolic rate before they started, and after they finished.

Six clients agreed to participate.  Before starting the protocol, I did a battery of tests. These included a record of: metabolic testing to find out how many calories they burned in a day, a cardiovascular endurance test done on a treadmill, blood pressure, resting heart rate, flexibility testing, push-up and sit-up tests for muscular endurance, bench press to measure their estimated strength, two different body-fat composition assessments, as well as circumference measurements.

I continued to measure everything weekly during and after the 500-calorie protocol, except for the fitness testing and metabolic rates, which I measured again at the end. I wasn�t surprised by their significant fat and size loss but I was not prepared for the drastic amount of fat lost in the stomach area. Quickly I added three additional circumference measurements to that stomach area to ensure I was accurately assessing their size change.

All participants agreed they had minimal hunger, and most said their energy level was good. Completely shocking were the fitness and metabolic testing results after the protocol was completely over. Not only did the fitness tests improve, but the amount of calories their body burned in a day significantly increased.  Considering each participant ate less than 500 calories for over a month, these results were astonishing.

I knew there had to be a logical explanation. I worked with new clients on the protocol, and continued to perform all of the tests before, during, and after the protocol. After collecting data for over 40 people, a local university statistically analyzed my metabolic testing results. When the results came back they were the same as my own observations. The metabolic rates significantly increased after the protocol. At this point, I was determined to find legitimate reasons for the increase.

After all, my findings completely conflicted with everything I was taught regarding calories, fat loss, muscles, metabolism, and what�s supposed to weaken during chronic starvation.

I compiled the data, and searched for local doctors of endocrinology that specialized in organs and hormones of the body, hoping they would be interested in my findings. I assumed they�d be able to explain how the hCG could influence the body in a way that prevented typical symptoms of starvation during such drastic caloric restrictions. I wanted to know why all my participants had overall improvements, after the fact. Only one doctor was willing to meet with me. After 45 minutes of discussing what I�d been doing, and my hope for some answers, he suggested I create a hypothesis that might make sense of what I observed.  I was taken aback that he didn�t have any answers, and that I would have to do my own research to understand what I�d been witnessing.

If this endocrinologist, who had a Ph.D., and also owned his own diabetes center, couldn�t help, then I was definitely on my own. That evening I started from square one, searching for scientific explanations for the physiology of hunger, energy, fueling, and how the body regulates fat metabolism, starvation, etc. This was a huge undertaking that required the ability to read scientific journals and reports to understand the cellular physiology.

Fortunately, my degree focusing on physiology came in handy. However, I was not prepared for what I found�thousands of medical journals written since I graduated in 2000� describing new hormones, new mechanisms, and new explanations for how the body regulates metabolism, hunger, and its complex fueling systems.

For two weeks I spent 12 hours a day, cross-referencing, reading and re-reading material over and over. I created charts and my own dictionary of organs, hormones, and functions, basically teaching myself the new physiology of energy homeostasis/equilibrium. The difficulty was not in finding the answers, but in understanding the new terminology and mechanisms I was not taught in school, or with any of my certifications.

Once I understood the most influential hormones involved in hunger and metabolism during both starvation and feeding, I formed a hypothesis that made the most obvious sense to me. Based on the modern science I studied, hCG must stimulate sufficient leptin in order to prevent all symptoms of starvation.

I felt like I was about to answer a million-dollar question, because I was so confident that the link between hCG and leptin had to be the answer.  Within seconds of entering those two key hormones into a search engine, all of my hard work and focus became worth the effort. Immediately I found studies that connected hCG to leptin.  Some specifically indicated the most powerful relationship between the two hormones occurred at almost the exact amount Dr. Simeons prescribed for the hCG protocol.  My heart was racing, and I literally jumped up and down with excitement.

Not only did scientific evidence exist that could easily explain how hCG, through the stimulus of leptin, could prevent symptoms of starvation during a very low-calorie diet, but a huge body of science also explained the reason for significant metabolic increases. Any scientist involved in the new studies of the hormone leptin, as it concerns starvation, fat gain, and fat loss, would find the answer obvious. The only reason a person would have minimal hunger, increased energy, and wouldn�t experience lean tissue loss during a 500-calorie protocol, is if hCG adequately stimulated blood leptin levels.

I wrote a hypothesis, but unfortunately the doctor who suggested I find the answers never responded. I continued to collect data and be amazed at the protocol�s physical results. Today, I�ve closely monitored over 500 people through protocols, and continue to follow Simeons� method. However, I use only modern science to explain how it works.

 I�ve met with doctor after doctor, but so far all of them have been unaware of the new science, and most haven�t a clue as to the function of leptin. The protocol �experts� on TV, or who�ve written books on �new and improved� protocols, have yet to even mention new science, and continue to reference Dr. Simeons� outdated and insufficient theories. It�s not surprising, considering the amount of time, effort, and extensive research it took for me to educate myself to formulate an answer.

Each person I met with to discuss the protocol, continued to reference what he found on the Internet, which is based on misinformation that inaccurately explains the protocol.

But, with the lack of relevant scientific explanation, and the majority of hCG sold on the Internet by people who aren�t necessarily educated in weight loss or human physiology, it makes sense to repeat the theories found in Simeons� manuscript. No other explanation is out there. Unfortunately, there are many people attempting the protocol don�t follow it the way Dr. Simeons intended.

Most participants are completely unaware that eating and hCG directly influence the hormonal response from all of the organs in the body, and without strict compliance to the protocol, there could be harmful consequences. It�s approached like a diet, and businesses have started to manipulate and change the protocol to increase their profits and to make it more appealing to the masses. It�s unfortunate, considering the decades of observation and work it took Dr. Simeons to deduce the specificity of protocol.   But Dr. Simeons didn�t really know how the protocol worked either, and even he admitted laboratory explanation and proof was needed.

 If he had known what was going to happen with our culture, as it concerns over-eating and obesity, and the lack of integrity in the hCG diet industry, he would have written and presented the protocol differently Dr. Simeons didn�t foresee his protocol would be used, prostituted, and misdirected as a short-term fix by the consumer. He had no idea we were going to have a massive, cultural, emotional eating disorder, and that we�d continue to blame the consequences of fat gain on everything but ourselves. Just because you have minimal hunger, doesn�t mean you won�t eat. Just because you have significant fat loss, doesn�t mean you will be motivated to change the way you eat forever.

My goal in writing this book is to start a new conversation about Dr. Simeons� protocol that has relevance, not only as a hormonal therapy, but as a means to end our national eating disorder. Instead of continuing to apply the protocol as a short-term diet, I�d rather it be discussed as a real solution, a tool to end irrational eating for emotional fulfillment. We are dealing with a crisis that is an addiction to emotional eating, and the obvious result is the overwhelming increase in obesity.

Think about the number of people in our culture who eat without hunger. How many people eat to gratify emotions? How many eat because they�re bored? When you observe our nation�s behavior with food, it�s very clear that fat isn�t what we should be obsessed about, and weight shouldn�t be the target of the problem. We need a genuine desire to eat less, one that isn�t dependent on weight loss as a reward. This requires each of us to be accountable for our own emotions, and find happiness in life not centrally stimulated by food. 

�         Can you find a different hobby when you�re bored, instead of eating?

�         Can you deal with stress without using food as a pacifier or distraction?

�         Can you create happiness without having to eat?

If you can, then eating less would not be such a big deal, and you wouldn�t have to pay for a diet to help.  For most people, eating is almost entirely an emotional decision and behavior. If we forced the majority of our society to eat functionally, it would be torture for them, especially if you didn�t allow them to monitor their weight.

Even if someone has little hunger, and no symptoms of starvation, his or her emotional distress is far worse than the physical when it comes to eating less on the protocol.

We�ve created a society that is so emotionally connected to eating that any form of restriction feels like punishment. Shouldn�t there be some personal accountability?  Look at the overall implications that emotional eating has on medical costs, health care, and the occurrence of disease directly linked to obesity. However, the decision to find emotional strength without eating must come from an individual�s internal desire. It can�t be forced; otherwise we�ll end up with even more psychological problems.

As more and more people choose to free themselves from emotional eating, we would see a social movement with a new cultural distaste for excessive eating. Eating minimally would be sanctioned and encouraged by peer pressure, and emotional accountability and strength would be the next �big� thing.

I believe the protocol provides the ideal atmosphere for participants to rethink the role that eating and food plays in their lives, and to develop emotional strength without needing a crutch. By letting go of food, and eating a minimum amount during the protocol, your emotional strength can be tested, and you can experience a life of eating less. However, for there to be a drastic impact on a participant�s overall relationship with food, he or she has to approach the protocol with that as the ultimate goal, eliminating the need to monitor weight for motivation.

Many people falsely assume that when they lose the weight, they�ll change their relationship with food.

This makes absolutely no sense, considering the role food plays has very little to do with body fat, and everything to do with their lack of emotional security. How many people have lost a substantial amount of fat, just to gain all of the weight back when they return to their �normal� relationship with food? Most.

It�s time to set a new standard for ourselves, fulfilling ourselves emotionally without needing to eat for emotional support. We have to want to limit ourselves, eating less even though we don�t have to.  Then losing weight wouldn�t matter because you�d want to continue to eat less even without a weight problem. This would require a new approach to reducing our food consumption, an intrinsic desire that no diet could enforce or create. Eating less must be a personal decision� a life-lasting change.

One of my favorite quotes is by Albert Einstein.

�No problem can be solved from the same consciousness that created it.�

In the case of our culture, solving the cause of obesity would require us to allow ourselves to feel vulnerable when emotionally tested; the ultimate goal being an awakening to our own emotional strength without needing to eat. This confidence would remove the need to eat as a pacifier, and eventually the physical result would be fat loss or prevented fat gain.

The protocol provides the perfect environment to rehabilitate our emotional strength.   If the hCG protocol provides a hormonal environment that indeed prevents starvation while drastically reducing the need for food, then each participant has the opportunity to re-establish his or her emotional well-being independent of food.

With the right frame of mind, participants can observe their desires to eat often have nothing to do with hunger. They can redevelop a sense of true physical hunger that would help them control their functional need for food.

The hCG protocol would revolutionize our culture. Not only because of the mass reduction in obesity, but because when people are able to develop emotional strength and well-being without needing to eat, society would be healthier, happier and more productive.

Eating less�not because we have to, but because we want to.

Princess Health and ONC: "The Benefits Of Health Information Technology: A Review Of The Recent Literature Shows Predominantly Positive Results" .Princessiccia

Princess Health and ONC: "The Benefits Of Health Information Technology: A Review Of The Recent Literature Shows Predominantly Positive Results" .Princessiccia

Healthcare IT ONC

Gusty 18:43 Add Comment

The Office of the National Coordinator for Health IT in the US (ONC) has just published an article in "Health Affairs" entitled "The Benefits Of Health Information Technology: A Review Of The Recent Literature Shows Predominantly Positive Results", Buntin, Burke, Hoaglin and Blumenthal, Health Affairs, 30, no.3 (2011):464-471, doi: 10.1377/hlthaff.2011.0178.

It is available at the hyperlink above, but may not be publicly accessible.

The authors all are, or were, ONC officials:

Melinda Beeuwkes Buntin (Melinda.buntin@hhs.gov) is director of the Office of Economic Analysis, Evaluation, and Modeling, Office of the National Coordinator for Health Information Technology (ONC), Department of Health and Human Services, in Washington, D.C. Matthew F. Burke is a policy analyst at the ONC. Michael C. Hoaglin is a former policy analyst at the ONC. David Blumenthal is the national coordinator for health information technology.

The abstract is as follows:

ABSTRACT
An unprecedented [indeed- ed.] federal effort is under way to boost [coerce? - ed.] the adoption of electronic health records and spur innovation in health care delivery.We reviewed the recent literature on health information technology to determine its effect on outcomes, including quality, efficiency, and provider satisfaction.We found that 92 percent of the recent articles on health information technology reached conclusions that were positive overall. We also found that the benefits of the technology are beginning to emerge in smaller practices and organizations, as well as in large organizations that were early adopters. However, dissatisfaction with electronic health records among some providers remains a problem and a barrier to achieving the potential of health information technology. [Some? That sounds like an understatement - ed.] These realities highlight the need for studies that document the challenging aspects of implementing health information technology more specifically and how these challenges might be addressed.

I have long stated, at least since 1999, that:

Healthcare information technology (HIT) holds great promise towards improving healthcare quality, safety and costs.

The new ONC review article is certainly pointing in this direction. Perhaps Health Affairs will release it to general circulation.

However, I also wrote:

As we enter the second decade of the 21st century, however, this potential has been largely unrealized. Significant factors impeding HIT achievement have been false assumptions concerning the challenges presented by this still-experimental technology, and underestimations of the expertise essential to achieve the potential benefits of HIT. This often results in clinician-unfriendly HIT design, and HIT leaders and stakeholders operating outside (often far outside) the boundaries of their professional competencies. Until these issues are acknowledged and corrected, HIT efforts will unnecessarily over-utilize precious healthcare resources, will be unlikely to achieve claimed benefits for many years to come, and may actually cause harm.

Whether the new ONC article demonstrates that these issues are starting to approach resolution, or is just another opinion paper not fully supported by facts, is not certain.

Two charts are presented that summarize the findings (click to enlarge):

(Click to enlarge.) Evaluations Of Outcome Measures Of Health Information Technology, By Type And Rating

(Click to enlarge.) Health Information Technology: Study Design And Scope Factors Associated With Positive Overall Conclusions

There are several caveats. The first has to do with possible selection bias that can be present in any review article.

On article selection for the review:

... we decided that to be included in this review, an article had to address a relevant aspect of health IT, as listed in the Appendix [7]; examine the use of health information technology in clinical practice; and measure qualitative or quantitative outcomes. Analyses that forecast the effects of a health IT component were included only if they were based on effects experienced during actual use. ... Using this framework, the review team removed 2,692 articles based on their titles. An additional 1,270 articles were determined to be outside the study�s scope after the team examined the article abstracts. For example, 269 abstracts focused solely on health IT adoption.

[What, exactly, does that mean? Were the problems with HIT adoption potentially significant towards causation of lack of benefit, and/or presence of harm, for instance? - ed]

By the third review stage, the review team had 231 articles. An additional forty-three were excluded after further review because they did not meet the criteria, and thirty-four review articles were dropped from the analyses because they did not present new work.

[What does that mean? Did they drop highly comprehensive articles showing uncertainty in the literature about HIT, such as Greenhalgh's "Tensions and Paradoxes in Electronic Patient Record Research: A Systematic Literature Review Using the Meta-narrative Method" from University College London? That article appeared in the Dec. 2009 Milbank Quarterly. I wrote about it at this link.]

This left 154 studies that met our inclusion criteria, 100 of which were conducted in the United States. This is comparable to the 182 studies found over a slightly longer time period that were evaluated by Goldzweig and colleagues.

I should also note that no mention is made of independent reviewers of the article corpus and elimination process. It appears the entire effort was conducted within ONC itself, where a bias towards finding positive results is likely present (and understandable).

Another caveat is the the Health Affairs/ONC article appears to bypass a body of literature, both peer-reviewed and non-peer reviewed, that sheds doubt on health IT in its present form from a number of angles such as I recently aggregated at "An updated reading list on HIT" and at "2009 a pivotal year in healthcare IT." Bypassing literature such as this is a possible major weakness.

Further, in the current political environment, it is not hard to imagine that articles highly critical of health IT, or revealing major mishaps and possibly exposing organizations to litigation, are scarce.

I addressed that in a paper "Remediating an Unintended Consequence of Healthcare IT: A Dearth of Data on Unintended Consequences of Healthcare IT." The paper itself was initially found needing revisions, largely in format, by a small group of blinded reviewers in the Medical Informatics community (with the exception of one faux-newshound who commented that "material like this could be read in any major newspaper", a rather perplexing comment considering the topic). Rather than revise, and not being on the tenure treadmill, I chose instead to publish at the Scribd link above.

The ONC paper does acknowledge this:

A recent study found that for clinical trials, studies with positive results are roughly four times more likely to be published than those without positive findings. Because the articles were limited to health IT adopters, we anticipated that authors more often approached studies looking for benefits rather than adverse effects.

They do, however, then issue a value judgment:

It is important to note that although publication bias may lead to an underestimation of the trade-offs associated with health IT, the benefits found in the published articles are real.

I"m not sure a dear relative of mine would find that value judgment heartening. They suffered a crippling injury that would likely not have occurred if paper had been used in the ED rather than an EHR.

I note that if a pharmaceutical company were to issue such a value judgment about a drug as justification for national marketing, they'd likely be nailed to the cross...

The ONC paper also ignores accounts of "near misses" and actual patient injury from impeccable sources, such as in "Health informatics � Guidance on the management of clinical risk relating to the deployment and use of health software. UK National Health Service, DSCN18 (2009), formerly ISO/TR 29322:2008(E)":

Annex A

Examples of potential harm presented by health software

GP prescribing decision support
In 2004 the four most commonly used primary care systems were subjected to eighteen, potentially serious, realistic scenarios including an aspirin prescription for an eight year old, penicillin for a patient with penicillin allergy and a combined oral contraceptive for a patient with a history of deep vein thrombosis. Using dummy records, all eighteen scenarios failed to produce appropriate alerts by all of the systems, most of the time. The best score was a system that flagged up seven appropriate alerts. The health organization clearly has, in such a system deployment, a key responsibility to ensure that knowledge bases used within a design are correctly populated and aligned with clinical practice within their organization.

Inadvertent accidental prescribing of dangerous drugs (such as methotrexate)
This incident occurred when a user of a primary care system attempted to issue two repeat items. The items were highlighted and instead of the issue selected repeats button, the prescribe acute issues from the formulary button was pressed. This brought up the formulary dialogue which contained the high risk items. Either the issue button was then pressed or the particular items were double clicked. When the warning messages came up, they were all ignored and proceed and issue selected. The user chose the first item presented on the formulary list, which just so happened to be a methotrexate injection. In this particular case, it was determined that patient risk was minimal as the treatment was rarely used in primary care and would, in practice, be rejected by the pharmacist. To preclude any recurrence of the problem, access to the high risk formulary was removed from the formulary part of the acute drug issue dialogue. This example again demonstrates the need to align clinical practice and authority levels with the knowledge and rule bases within the system. Wherever possible, design and implementation of health software systems should be undertaken to improve control and accuracy, note introduce new exposures. Furthermore the hazard and risk assessment of this situation may well not apply in other settings, e.g. prescription issue by nursing staff on a ward versus a pharmacist in a retail store.

Incorrect patient details retrieved from radiology information system
This incident arose from the fact that medical reference numbers (MRNs) are usually prefixed by an alpha code. Some hospitals however do not use these prefixes and identical MRNs can be generated. This gave rise to the creation of shared MRNs and subsequent confusion of records in the central datastore when retrieval key is the Medical Record Number. Four specific instances were found where a patient number had been entered in the radiology information system and incorrect patient details had been retrieved. The manufacturer could have built in an appropriate format check during development. Alternatively, the problem could have been spotted by the health organization if a structured risk assessment had been undertaken.

Drug mapping error
Sodium valproate 200 mg slow release was incorrectly mapped to sodium valproate 200 mg in a formulary encoded into a health software system. These are anti-epilepsy drugs and thus the implications for patient safety could be significant. This particular incident is just one of many that have been reported in relation to drug mapping.

An initial investigation indicated that 35 prescriptions had been generated using the incorrect map. Corrective action included contacting the relevant primary care practices to check upon patient health and the supplier to correct the mapping process to ensure no further incorrect prescriptions were generated. As before, this was a design/coding error by the manufacturer but was compounded by the health organization not checking the mappings and failing either to build in appropriate prescribing controls, or map the controls to health organization individuals with the appropriate experience and authority.

Pre-natal screening
The ages of women who had undergone pre-natal screening were wrongly computed by a health software system. As a result 150 women were wrongly notified that they were at no risk. Of these, four gave birth to Down's syndrome babies and two others made belated decisions to have abortions.

Patient identification
A student died of meningitis because of a misspelling of her name and inadequacy in computer use. The student was admitted and a blood test proved negative for meningitis. The following day another blood test was taken and filed on a new computer entry but the letter ?p was missed in the spelling of the name. When a doctor looked up results they were presented with only the first negative tests result because of the misspelling. If the second result had been seen it would have triggered further investigations and probable diagnosis of meningitis. The investigating panel concluded that problems with the health software system had been greater than first thought and in this case there was a combination of a misspelled name and the doctor not being able to use the computer system property. The health software system could have been designed to use unique numbers either instead of the name or in addition to it.

They also missed consideration of serious IT defects reports as in the FDA's Maude database that I wrote about at my Jan. 2011 post "MAUDE and HIT Risks."

Another confounding factor is the issue of possible unreliability of the medical literature itself as expressed in a recent post on the IBM Watson supercomputer exuberance:

Consider the issue of the medical literature suffering from numerous conflict of interest and dishonesty-related phenomema making it increasingly untrustworthy, as pointed out by Roy Poses in a Dec. 2010 post "The Lancet Emphasizes the Threats to the Academic Medical Mission", at my Aug. 2009 post "Has Ghostwriting Infected The "Experts" With Tainted Knowledge, Creating Vectors for Further Spread and Mutation of the Scientific Knowledge Base?" and elsewhere on this blog.

They do state what I have been writing about for over a decade now:

... In fact, the stronger finding may be that the �human element� is critical to health IT implementation. The association between the assessment of provider satisfaction and negative findings is a strong one. This highlights the importance of strong leadership and staff �buy-in� [which will only occur if the systems are not miserable examples of poor engineering, not due to P.R. or the irrational exuberance of others - ed.] if systems are to successfully manage and see benefit from health information technology. The negative findings also highlight the need for studies that document the challenging aspects of implementing health IT more specifically and how these challenges might be addressed.

Dear ONC: see this site, and the many posts since 2004 on this blog.

I was surprised to see this:

... Taking a cue from the literature on continuous quality improvement, every negative finding can be a treasure if it yields information on how to improve implementation strategies and design better health information technologies.

As in my post at this link, does this mean that 'anecdotal' accounts of HIT problems will no longer be summarily dismissed? I wonder.

I have also written in the past that in order to truly understand a domain, one must look at both evidence of the upside, and evidence of the downside. My concern is that the latter was not well addressed in this paper. A beneficial technology with a significant downside, especially in medicine, is not ready for national rollout (cf. Vioxx).

In summary, the new ONC paper may present a glimmer of hope that health IT is starting to produce real results. On the other hand, its possible deficiencies and biases might also make it more a political statement than anything else. It will certainly be used as such from the high government perch of HHS regardless. This has already started:

... President Obama and Congress envisioned that the HITECH Act would provide benefits in the form of lower costs, better quality of care, and improved patient outcomes. This review of the recent literature on the effects of health information technology is reassuring: It indicates that the expansion of health IT in the health care system is worthwhile.

[Note the use of "is worthwhile" as opposed to "may be worthwhile", a continuation of the "it's proven, nothing else to say" style I noted at my July 2010 post "Science or Politics? The New England Journal and "The 'Meaningful Use' Regulation for Electronic Health Records." Such statements of absolute certainty are of concern; they remind me of the global warming debate - ed.]

...Thus, with HITECH, providers have an unparalleled opportunity to accelerate their adoption of health information technology and realize benefits for their practices, institutions, patients, and the broader system. [Ditto - ed.]

Does the article truly show a breakthrough, or is it a flawed review by a governmental agency that will be used for political purposes? I simply do not know which.

I am certain, however, that there will be active debate and dissection of this paper and its source articles in the months to come by those with more time, resources, and expertise than I have at my disposal.

-- SS

March 10, 2011 addendum:

Trisha Greenhalgh at Barts and The London School of Medicine and Dentistry and the author of the aforementioned comprehensive review article "Tensions and Paradoxes in Electronic Patient Record Research: A Systematic Literature Review Using the Meta-narrative Method" (link to my essay), had this observation about the following passage in the ONC paper:

�Our findings must be qualified by two important limitations: the question of publication bias, and the fact that we implicitly gave equal weight to all studies regardless of study design or sample size.�

Prof. Greenhalgh relates: "Given these very fundamental acknowledged biases, I�m very surprised anyone published this paper in its present form.�

-- SS

March 14, 2011 addendum:

Dr. Roy Poses had this to say:

Dr Silverstein commented on a new review of research of health care information technology whose results were mainly optimistic. The authors were from the US government agency that promotes health care IT, so its optimism is not surprising. However, its credibility was unclear, since it did not appear to be systematic. [In general, one at least assesses and takes into account the methodologic quality of studies used in a systematic review, and does not "give equal weight to all studies regardless of study design or sample size" - ed.]

Furthermore, the authors had no methodologic standards whatsoever for article inclusion. [They did, sort of, as in my paragraphs "On article selection for the review:", but one might term the standards "loose" - ed.] The review included qualitative studies that were probably not meant to be evaluative, and observational studies subject to severe methodologic bias.

The publication of this review demonstrated how the conventional wisdom is continually reinforced based on the strength of the influence of its proponents, rather than the strength of the supporting evidence. Adaptation of new drugs and devices should be based on evidence that their benefits outweigh their harms, rather than the enthusiasm and financial interests of their proponents.

-- SS

Princess Health and "Cogs in the Corporate Machine" - More on the Plight of Corporate Physicians .Princessiccia

Princess Health and "Cogs in the Corporate Machine" - More on the Plight of Corporate Physicians .Princessiccia

contracts corporate physician mission-hostile management patient "leakage" Stark Law

Gusty 14:01 1 Comment

We discussed last week some of the perils of the latest trend towards the corporatization of medicine, practicing physicians becoming employees of hospital systems, including for-profit corporate systems.  A recent article in Medscape Business of Medicine included a striking anecdote about the life of a corporate physician.

Controlling Referrals by Contractual Provision
It started with the revelation that some employed physicians may sign contracts that obligate them to refer patients within the corporate system, even if that is not in their best interests:

Victoria Rentel, a family physician in Columbus, Ohio, joined a hospital-owned group several years ago. At first, nearly everything went fine. There were a few glitches: she'd occasionally order tests or consults at competing facilities, either for patient convenience or because of health plan coverage. When the hospital's administrators found out, they told her it was a violation of her contract; but that didn't stop her because she knew the hospital never enforced this provision.

A Non-Compete Clause, Even for a Laid-Off Physician

It also included the observation that corporate physicians may be abruptly laid off. Worse, being laid off means having to leave town, because apparently even laid-off physicians are still obligated by non-compete clauses in their contracts:

Then, out of the blue, she was informed that the hospital was going to close her practice within 45 days. She knew this wasn't her fault; the recession had hit the hospital hard, and it was laying off nearly half of the primary care doctors in her group. Still, it was a hard pill to swallow.

Making matters worse, her contract's noncompete clause prohibited her from going to work for any of the other healthcare systems in town. To avoid legal sanctions, she joined the student health service at Ohio State University.

Signing Contracts Without Understanding Them
The article's introduction emphasized the problem of physicians signing onerous contracts, perhaps without fully understanding them or without getting adequate legal advice:

Many other physicians -- especially those who, like Rentel, were previously in private practice -- complain about their jobs. In some cases, it's because physicians rushed into the arms of a hospital without looking carefully at their contracts or asking the right questions during their job interviews.

Cogs in the Corporate Machine

The introduction ended ominously:

Ultimately, the loss of control over their own professional lives is what irks employed doctors the most if they used to be in private practice. But some doctors also get the sinking feeling that they've become cogs in the corporate machine.

'The reality is that when you work for a hospital system, you're a service line,' says Rentel. 'And because primary care reimbursement is relatively low, you're a service line that feeds more lucrative service lines.'

Oddly enough, after that striking beginning, the article peters off into a discussion of some "gripes of employed physicians," which either soft-pedaled or failed to include the issues listed above.

The specific issues, and the general response of physicians to their role as corporate wage slaves deserve further consideration.

Signing Bad Contracts

First, the notion that physicians frequently sign contracts, particularly such important contracts as their own employment agreements, without reading them, without clearly understanding them, and without obtaining competent legal counsel is very disturbing.   A physician who signs a contract without reading it, understanding it, and getting competent legal advice about it is at best naive to the point of foolishness. 

My late father, an attorney, done told me to "never sign a contract you haven't read and understood."  Contracts are - surprise - enforceable legal documents that may involve surrendering important rights.  One should never sign a contract without being satisfied that its benefits outweigh its harms.

It could be that physicians who so blithely sign contracts are exhibiting learned helplessness.  Maybe they feel somehow pressured to apparently voluntarily agree to doing something that ultimately will harm them.  I am not sure that simply declaring on a blog that we will have to unlearn our helplessness if we are ever to save medicine and health care will do much to solve what may be a fairly deep problem.  But we must do so.

In addition, contracts are valid if entered into voluntarily.  It may be that some physicians truly sign contracts under duress.  Those contracts may not be valid, and could be challenged if they were so signed (again, if physicians are willing to unlearn their helplessness enough to get the counsel of a competent attorney.)

Stopping "Leakage" Possibly Unethically, Maybe Illegally?

The physician in the example above apparently had a contract provision which was violated simply by referring patients to competing facilities.  This appears to be an extreme way for a hospital to deal with the problem of "leakage," that is, the financial problem to the hospital caused when patients are referred outside the system.  Note that we discussed (here and here) the example of a for-profit hospital system with a large number of physician employees pushed to choke off "leakage" of patient referrals outside the system.

Although leakage may pose financial problems for hospitals, fighting leakage may lead to ethical problems.  Physicians are supposed to decide how to manage patients, and specifically to decide where to refer patients in the patients' interests, not just to keep money flowing to the health care system. "Leakage reduction" may possibly threaten physicians' first commandment, to make decisions to maximize benefits and minimize harms to individual patients, before all other considerations.

Worse, in the example cited in the Medscape paper, the leakage reduction was apparently implemented not by just trying to persuade doctors to keep patients within the system, but by a contract provision that somehow forbade referrals out of the system.  That may have not only been unethical, but it could have been illegal.  

The "Stark Law" (Title 42, Chapter 7, Subchapter XVIII, Part E, Section 1395 of the US Code) generally prohibits basing referral decisions on payments.  Full-time employed physicians are exempt from some of its provisions, but only if the physicians' "amount of remuneration under employment" "is not determined in a manner that takes into account (directly or indirectly) the volume or value of any referrals by the referring physician."  Therefore, were the contract referred to above to have forbidden outside referrals on pain of termination or reduction in remuneration, it could potentially violate this law. 

There have been rumors that physicians have been pushed to sign contracts that could so violate the Stark Law, but the published example above makes this a real possibility.

Physicians ought not to sign contracts that seem to limit referrals under penalty of pay reduction or termination, which may be both unethical and illegal.  Any physician presented with or who has signed such a contract ought to consult a competent attorney.

If hospitals and hospital systems are trying to force physicians to make referrals based on the hospitals' financial advantage instead of in the best interests of patients, that is reprehensible.  If these organizations are trying to do so via contractual provisions, this deserves investigation, including investigation by the relevant law enforcement agencies. 

Don't Be a Corporate Cog

This article underscores my previously expressed fears about how making physicians into corporate employees may remove the last barriers preventing patients from becoming corporate financial cannon fodder.  Physicians' most central professional value is to put patients' interests first.  Practicing physicians who practice as corporate employees are at risk of being pressured, or even threatened under the cover of contract enforcement to put their corporate employers' revenues ahead of patients' interests. 

Physicians should not let their patients, and their own values be so threatened.  Physicians who have inadvertently, foolishly, or under duress signed contracts that could threaten their professionalism and their patients' welfare need to do the right thing and challenge these contracts, or else there will soon be nothing left of the medical profession, and no one left to ethically care for patients.