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Mistreated – book by Dr. Robert Pearl - May 2017

Dr. Robert Pearl is the top doctor of Permanente

Note: Kaiser is a non-profit
Permanente group, which provides the medical care, is a for-profit
Permanente profits go to the doctors

pageNotes by Henry Lahore of VitaminDWiki
Vitamin D notes are in BLUE
xiiiThe US not anywhere near the top of health care in the world
Pay 50% more for healthcare, get the 17th best
XvCouncil of Accountable Physician Practices how to get optimal health care at no additional expense– Dr. Pearl is the chairman
2Dr. Pearl’s father had sepsis (which can be treated by Vitamin D )
8His spleen had been removed, but no one had told his father of the big increased risk of sepsis as a result
8Father’s heel became infected while recovering from sepsis (Vitamin D not only treats sepsis but also heals skin ulcers)
9Surgical procedure for his heel needed weekly long drives for visits to hospital - which could have been done by video instead
Vitamin D could have interrupted the avalanche at any stage: Prevented the sepsis, Treated the sepsis, Treated the sore heel
23US medical system financially rewards doctors for providing more care (not better care)
33Sepsis kills more than AIDS, prostate cancer, and breast cancer combined
and killed 2 US presidents, a pope, and even Superman
*Dr. Pearl references a Sepsis study published in 2001 which indicated better outcomes if treated faster. In 2017 a paper was published showing a 15% reduction in mortality by faster treatment (vs a 30% reduction in mortality by use of vitamin D described at bottom of page
34Sepsis is an orphan disease – no specialty focuses on it First International Sepsis conference occurred in 2016
48A new proven medical technique takes an average of 17 years to make its way into routine medical care
VitaminDWiki thinks that proven techniques (many RCT) should be given a chance to be tried in medical facilities, without waiting for medical committees and hospitals to decide it is OK. They are VERY reluctant if they perceive that the new technique will lower their income
50Hospitals get 350% more profit from complications than the original surgery (for private paying patients)
782/3 of people think Chemotherapy as a cure, rather than a short life extension
Wikipedia),   RCT found it to be no better than without chemo – lung cancer,  Chart of 5 year survival rate – from 7% pancreas to 99% prostrate
8830% of all US govt spending goes to health care (Medicare, Medicaid, VA, marketplace subsidies, medical research)
89Commonwealth Fund promotes high performance in healthcare
$780 million endowment, since 1918
VitaminDWiki wonders if they would be interested in investing in vitamin D – and getting a share of the profits to be made
93Hospital CEOs are often paid in proportion to hospital beds filled and profits generated
Those CEOs would probably have little interest in reducing the number of beds filled
99Dr. Pearl lists only 3 options to deal with increasing medical costs 1) charge more, 2) cut benefits, 3) ration care for those who cannot afford it
Dr. Pearl fails to mention prevention to reduce the need for medical care (such as by Vitamin D)
101Insurance company executives are rewarded when the Medical Loss Ratio (MLR) is LOW =$ spent on patient care and quality improvement / $ spent on administrative overhead and profit. Before Obamacare MLR = 70-75%, now it is forced to be > 85%
102 Insurance company executive take-home salaries exceed $15 million
102US politicians received $152 million in campaign contributions during the last election cycle (1 year, 4 year?) from the insurance industry (all insurance or just medical insurance?)
103Hospital-acquired infections in US: 700,000 annually in ICUs (what about regular facilities?) CDC agrees
107400,000 annual meniscus surgeries in US each year, but RCT using sham surgeries found the surgery to be no better than just physical therapy. Orthoepic surgeons in the US earn 2 to 3X more than family-practice medicine doctors (The surgeries generate far too much income to be eliminated)
111More surgeons ==> more surgeries. The mumber of surgeons in a region is the best predictor of number of surgeries (not the amount of disease)
112Nexium drug in US costs $305, Canada $30, UK $42, Spain $58
119Opiate use is now the most common cause of death from injury in the US. This costs employers $53 billion annually in missed work and additional health care expenses
137 “When we (patients) develop a medical problem, we overrate the impact of intervention. When we’re not yet sick, we fail to take the steps necessary to prevent the problem from happening in the first place” (very true for Vitamin D)
139 30 minutes of exercise 5X per week would save average (obese) American $2500 in medical expenses (The 130 hours per year would be worth $19/hour – but requires a lot of willpower)
139. . “knowing something and doing something about it are two very different things.” (immediate financial incentives would probably help)
143Job-related stress costs US industry $300 billion a year in absenteeism, turnover, diminished productivity, and on-the-job accidents. Also, workers reporting high levels of stress have 50% higher health care expenditures. (Note Many studies have found that people with higher levels of vitamin D are less stressed and increased stress decreases Vitamin D)
143Depression 2X increases the risk of cardiovascular disease and of going to the hospital. Depression also costs employers $44 billion a year = more than the cost of diabetes + heart disease (Vitamin D was found in a meta-analysis to decrease depression as well as drugs. Here are 138 studies of depression and vitamin D
234It’s better and Cheaper to Not Get Sick in the First Place - 2 pages, but not much content
239Kaiser expects to have more virtual (electronic) visits than physical visits by 2018
Insurers in 30 states won’t pay for video care

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Mistreated – book by Dr. Robert Pearl - May 2017        

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