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Doctors Without Borders/Médecins Sans Frontières (MSF) Releases 12th Annual ListRepublished with permission - New York, December 21, 2009 - Civilians attacked, bombed, and cut off from aid in Pakistan, Somalia, Yemen, Sri Lanka, Afghanistan, and the Democratic Republic of Congo (DRC), along with stagnant funding for treating HIV/AIDS and ongoing neglect of other diseases, were among the worst emergencies in 2009, the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) reported today in its annual list of the “Top Ten” humanitarian crises.Sudan, along with the failure of the international community to finally combat childhood malnutrition were also included on this year’s list.  The list is drawn from MSF’s operational activities in close to 70 countries, where the organization’s medical teams witnessed some of the worst humanitarian conditions.Sri Lanka, tens of thousands of civilians were trapped with no aid and limited medical care as government forces battled Tamil Tiger rebels in the spring.  Aid groups, including MSF, were banned from entering the conflict zone. In Somalia, civilians continued to bear the brunt of a vicious civil war.  More than 200,000 people fled the capital, Mogadishu, in just the first few months of 2009 and aid workers were increasingly targeted – at least 42 relief workers have been killed since 2008, including three MSF staff.Yemen, civilians and hospitals were heavily affected by fighting in the Saada region in the north of the country as government forces fought rebels.  The fighting forced tens of thousands of people from their homes and compelled MSF to close the only hospital serving an entire district after it was shelled. And in a glaring case of abuse of humanitarian action for military gain, civilians gathered with their children at MSF vaccination sites in North Kivu, DRC in October, came under attack by government forces.  The attack threatened to severely undermine the trust necessary to carry out independent medical humanitarian work in conflict settings.Pakistan, where tens of thousands fled fighting, hospitals were struck by mortar fire and two MSF workers were killed in Swat Valley, where the organization ultimately suspended its operations due to the violence there.US President’s Emergency Plan for AIDS Relief (PEPFAR) announced plans to reduce or limit funding.Rome in 2009 failed to commit to combating the disease, which groups like MSF have shown can be prevented and treated by providing growing children with proper foods that meet their nutritional requirements.

Continuing crises in north and south

Three distinct patterns dominated in 2009: governments blocked lifesaving assistance to trapped populations, including in Sri Lanka, Pakistan, and Sudan, where aid groups—including some MSF teams—were expelled from Darfur; respect for civilian safety and neutral humanitarian action further eroded, such as in Yemen, Afghanistan, Pakistan, DRC, and Somalia, where people—and in some cases aid workers—were either indiscriminately or directly attacked; people suffering from a host of largely ignored diseases were again neglected by the international community, and those living with HIV/AIDS saw their chances of receiving life extending therapy further diminished.

“There is no question that civilians are increasingly victimized in conflicts and further cut off from lifesaving assistance, often deliberately,” said MSF International Council President Dr. Christophe Fournier.  “In places like Sri Lanka and Yemen, where armed conflicts raged in 2009, aid groups were either blocked from accessing those in need or forced out because they too came under fire.  This unacceptable dynamic is becoming the norm.  Our teams on the ground are witnessing the very tangible human consequences of these crises directly, either in war zones or in the AIDS and nutrition clinics in which they work,” he said.  We’re therefore compelled and obligated to speak out.” (continue reading…)

As the human tragedy unfolds in the aftermath of the earthquake in Haiti, MD Preferred Services, the Internet based physician resource center, is calling on their entire network of physicians and professionals to assist Doctors Without Borders in their relief efforts.�
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“The work that Doctors Without Borders does around the world is truly amazing and their assistance in Haiti is needed now more than ever,” said Michael O’Malley, CEO of MD Preferred Services.  “We are hopeful that the thousands of professionals within the MD Preferred Service network and the thousands of medical professionals using the network will make it a priority to support, in any way that they can, Doctors Without Borders and the people affected in Haiti.”
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MD Preferred Services, which maintains online physician service directories in Legal Services, Financial Advisory Services, Relocation & Real Estate Services, Insurance Services, Physician Job Services and Travel Services, is asking their service partners to forward their request for aid to their staff and clients and that Residency & Fellowship Directors that read their monthly E-Newsletter, The Advisor, forward a special edition detailing the relief effort being mounted by Doctors Without Borders to their physicians.  All forms of assistance both medical and financial are going to be needed in the coming days, weeks and months.   All travel and allied travel services booked through the MD Preferred Travel Site will generate an immediate donation to Doctors Without Borders.
 

Please read the release from Doctors Without Borders below.
A special site has been set up to handle offers of assistance and financial contributions.
You will find links at the end of the article.

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MSF Teams Set up Clinics to Treat Injured After Facilities Are Damaged

The first reports are now emerging from Doctors Without Borders/Médecins Sans Frontières (MSF) teams who were already working on medical projects Haiti. They are treating hundreds of people injured in the quake and have been setting up clinics in tents to replace their own damaged medical facilities.

The Martissant health center in a poor area of Port-au-Prince had to be evacuated after the earthquake because it was damaged and unstable. The patients are now in tents in the grounds and the medical staff have been dealing with a flow of casualties from the town. They have already treated between 300 and 350 people, mainly for trauma injuries and fractures. Among them are 50 people suffering from burns-some of them severe-many of them caused by domestic gas containers exploding in collapsing buidings. At the Pachot rehabilitation center another 300 to 400 people have been treated. In one of MSF’s adminstrative offices in Petionville, another part of Port-au-Prince, a tent clinic there has seen at least 200 injured people. More are getting assistance at what was the Solidarite maternity hospital, which was seriously damaged.

One of MSF’s  coordinator’s there, Hans van Dillen, confirmed that Port-au-Prince was quite unable to cope with the scale of the disaster. “There are hunderds of thousands of people who are sleeping in the streets because they are homeless,” said van Dillen. “We see open fractures, head injuries. The problem is that we can not forward people to proper surgery at this stage.”

So many of the city’s medical facilities have been damaged, healthcare is severely disrupted at precisely the moment when medical needs are high.

Please help support MSF’s relief efforts in Haiti.�
You can donate here
and keep updated on their efforts at
www.doctorswithoutborders.org.

Ted Kennedy resided in one of Massachuset’s two Senate seats for nearly forty seven years until his recent death. It was a solid, ultra liberal Democratic seat that would have required large quantities of C-4 explosives to dislodge. Last night, a Republican won that seat and as political earthquakes go this one was a doozy.

Scott Brown’s stunning victory breaks the Democrat’s Super Majority in the Senate and throws into question President Obama’s far left road map for America. And at the very top of that list of broken china is Healthcare Reform. The Democrat’s carefully crafted healthcare legislation, sugar coated just enough to bring dissident party conservatives into line, appeared to be safely stuffed down Republican throats.

It would now appear that they neglected to notice that they might also be sticking it to the American public. And last night they got a harsh dose of medicine that is going to be very difficult for the Socialist wing of the Democratic party to swallow. A vast and growing majority of the Americans are sticking their heads out of their windows and yelling, “I’m as mad as hell and I’m not going to take it anymore.” They are have come to realize that the incompetent Republicans that they turned out a year ago have been replaced with arrogant Bolsheviks who plan to “take from each according to their ability and give to each according to their needs.” Even life long Democrats are beginning to understand that those who fail to learn history and doomed to repeat it.

And at the risk of using a sports metaphor, a habit that probably helped to secure Martha Coakley’s defeat, the bat that Massachusetts voters presented the Democrats with is now sticking safely where the sun never shines. And moderate Dems from both the Senate and the House who are facing reelection in November are finding their seats in the hallowed halls of Congress a very uncomfortable place indeed.

So, setting aside other effects of the debacle, what might this mean for healthcare reform? What are the Democrat’s options?
• First, the House could simply swallow hard and pass the Senate bill unchanged. They still hold more than enough seats to pass anything they wish. This would keep the bill from going back to the Senate where they no longer have a rubber stamp in hand. But this option might well self destruct because a growing list of liberal Democrats are coming to believe that no reform is better than the watered down reform that the Senate compromised its way to.
• Second, they can use a tactic called Reconciliation to pass portions of the legislation with a simple majority in both houses. This is problematic on a number of levels. The process can only be applied to those portions of the bill related to spending or the budget. Major policy issues would probably be out of bounds. But on a more fundamental level, resorting to arcane legislative smoke and mirrors would only enrage the public and send a message that the Democrats didn’t get the message.
• Third, the conference committee could gut the bill and only report out a scaled back version with provisions that are likely to garner bipartisan support…things like a limit on pre-existing conditions and a prohibition on dumping coverage when a person becomes ill. But this would be a defeat for healthcare reform in all but name only.
• Finally, the Democrats, starting with the President himself, might come to realize that their mandate for change did not mean re-crafting American capitalism into a European style Socialist state. The lion might sit down with the lamb and Republicans and Democrats alike might search for a sensible way to make healthcare accessible and affordable to a vast majority of Americans who are willing to work and pay for it. They might come to agree that the government should guide, encourage, reward and inspire rather than punish, restrict, demoralize and destroy the private sector. The chances of this happening was elegantly summed up by liberal Democratic Representative Rep. Anthony Weiner, D-New York, in a frustrated interview with reporters on the steps of Congress, “Yeah, when pigs fly out my ass.”

And there you have it. On the anniversary of Obama’s sweep into power, the American people have spoken. And to take a phrase from another famous Democrat, “No matter how long it may take us to overcome this premeditated invasion, the American people, in their righteous might, will win through to absolute victory.”

Politics, where would us bloggers be without it?

As an educated, well read American citizen, I am well aware that nothing good can happen without the guidance and direction of the government.

• The government provides for my retirement through Social Security. The fact that Social Security is facing insolvency can be explained I am sure.
• The government provides for my healthcare when I grow old. The fact that Medicare is facing insolvency can be explained I am sure.
• The government insures my savings and regulates the banks where I keep my money. The fact that banks are failing and the insurance fund is facing insolvency can be explained I am sure.
• The government defends this country with the best trained and equipped military in the history of the world. $500 hammers, $800 toilet seat covers and state of the art fighter planes that cost $65 Billion dollars to develop, that cost $142.8 million dollars each and that have been judged unsuited for the military are the prices of freedom I guess.
And now the government is going to manage healthcare from cradle to grave. I am sure that the $1 trillion dollars that they plan to spend to do so will be as wisely invested as every other dollar that I and my fellow citizens send them each April.

But what if there were a hospital out there that could do a good job of delivering healthcare without the guidance and direction of the government.

• What if the hospital just went ahead and installed electronic medical records on their own and started saving millions of dollars?
• What if they introduced wellness plans, smoking cessation plans and weight control plans not just for their own employees but for every citizen in their entire service area…for free… and in doing so saved millions of dollars in future health costs?
• What if they put all of their doctors on a generous salary and then gave them bonuses for creating value and positive outcomes for their patients? What if that system saved millions of dollars and resulted in measurable gains in survival rates and cure rates? And what if they were honest enough to actually publish the results of their program?
• What if they envisioned a new way of delivering and costing healthcare? What if the model was patient-centered through the consolidation of clinical services into patient-centered institutes, improving efficiency by reducing redundant services and enhancing collaboration among specialties? And then what if the model called for a single bill for the event rather than for every procedure, supply and doctor charge? Wouldn’t that reduce duplication and encourage collaboration and result in better outcomes?

Pretty ‘pie in the sky’ stuff you say? Take a visit to Cleveland Clinic sometime…or Mayo Clinic…or Lahey Clinic…or Guthrie Clinic. It’s happening now. It’s working.

AND IT’S HAPPENING WITHOUT THE GUIDANCE AND DIRECTION OF THE GOVERNMENT!

One of the things that makes the job of Snake Charmer less attractive is the fact that the snakes you are charming have poison tipped fangs.  If you could find me a couple of nasty looking snakes that didn’t bite and weren’t poisonous and paid me a decent salary (with benefits of course) I might give it a try.  A compelling argument could be made that the job of ER physician has many of the drawbacks of Snake Charmer. 

Many primary care physicians who are otherwise qualified will not accept shifts in the ER.  Fewer medical students are selecting Emergency Medicine as a career track.  The reason most often cited…the fear of litigation…and by a wide margin. 

Making life and death decision in a pressure cooker environment can sometimes lead to poor outcomes.  I can’t think of another profession where the standard of performance upon which professionals are judged is perfection!  The doctors I talk to tell me that they refuse to put their lives, their careers and their financial future at risk by being second guessed by attorneys who, with the luxury of hind site, and with all the time in the world to review, evaluate and speculate, judge decisions made by those on the front line of medicine.

And that is a shame because one of the most challenging, exciting, rewarding and fulfilling medical positions out there is that of Emergency Room physician.  Each day ER doctors are faced with true life and death decisions.  They have access to the best technology that medicine has to offer.  They are performers on the most demanding stage imaginable. 

A good place to start healthcare reform might involve pulling some of the fangs from the legal profession…a charming if somewhat unrealistic expectation. 

By Robert Bartley, CPA, CFP, President Bartley Financial Advisors

The stock market is getting more and more overvalued by the day. The Economist in an article this week titled Bubble warning wrote (paraphrasing) –

The overvaluation of stocks is on par with two of the four greatest valuation peaks of the 20^th century 1901 and 1966. They also warn those who feel the market is depressed from its all time highs - the Japanese market trades at a quarter of the high it reached 20 years ago and the NASDAQ is at half the level it was during the dot.com stock market bubble.

The above is a constant theme in many of the well respected periodicals and analysts opinions. However The Economist and some others note that the current low interest rates and fiscal stimulus will continue to encourage investors to seek the higher returns of risky assets. This has played out since last March and may for a while longer. It is difficult to know what will reverse the momentum; a series of bad economic news, a terror attack, geopolitical events…We will continue to see good economic numbers but all the good news has been factored in (and some) into the price of most stocks.

The problem is as Bill Gross of Pimco noted recently - when will “the juice” (stimulus and low interest rates) be squeezed again from the market? The markets will suffer “with no sugar daddy” The Fed and other global central banks have a difficult exit strategy. If they keep interest rates low then they risk building a larger bubble but if they cut off “the juice” too early in an anemic recovery then they risk a double dip recession (the highly respected economist Martin Feldstein of Harvard thinks we are still in one, we have often had positive GDP quarters in midst of a recession). The problem is that where our “sugar daddy” is still providing the low interest rate juice we may continue to see the markets rise short term. It could be a frustrating market for the average fundamental investor (non trader) in the near term to watch investment values continue to rise not based on values or opportunities, more of the same old same old that we have experienced for more than a decade.

We are in a holding pattern waiting for another shoe to drop or the economic information that will provide some guidance on where we go from here. Once the information becomes available the horizon will become clearer. You have to play the hand you have been dealt, which is not a good one. Across the deck of investment cards there are no obvious values:

• Stocks – overvalued
• Bonds – not overvalued but the low hanging fruit has been taken with the riskier bonds
• Real Estate – not yet
• Commodities – possibly overvalued
• Gold – possibly undervalued? (Where gold does not provide income it is not easily valued)

Time will only tell whether the market’s sugar daddy will stop providing the juice so the bubbles don’t burst again.

Robert Bartley, CPA, CFP is president of Bartley Financial Advisors, Andover, Massachusetts.  Robert can be contacted at Robertb@bartleyfinancial.com or at 877-474-8811

As the Super Bowl approaches here are some thoughts for our readers whose teams may have missed the big dance:

You’re trapped in a room with an angry grizzly bear, a hungry Lion, and a fan of the Oakland Raiders. You have a gun with two bullets. What should you do?

Shoot the Raiders fan… twice.

Why are the St. Louis Rams like a possum?

Because they play dead at home and get killed on the road.

Why did The Dolphins choose Orange for the team color?

So the fans could wear it on Saturday to the game, on Sunday to go hunting, and the rest of the week picking up garbage on the highways.

What’s the difference between a winning Redskins team and a UFO?

Some people claim to have actually seen a UFO.

What do you call a Cleveland Brown with a Super Bowl ring?

A thief

Why doesn’t Columbus, Ohio have a professional football team?

Because then Cleveland would want one.

Why did the Chicago Bears players miss their flight for the big game?

They were stuck on a broken escalator!

If you see a Detroit Lions fan on a bike, why should you not swerve to hit him?

It could be your bike.

What do you call the Chiefs on their opponents 10-yard line?

Lost

What do you say to a Bucs fan with a job?

“I’ll have a Big Mac, fries and a coke, please.”

What’s the difference between the Buffalo Bills and a dollar bill?

You can still get four quarters out of a dollar bill

Guest Contributor, David T. Mayes, MA, EA, CFP®

Starting in January 2010, practice owners who currently sponsor a retirement plan for themselves and their employees will have a new option to consider as an alternative to the ubiquitous 401(k). Commonly referred to as 414(x) or DB-K plans, this new option adds a defined benefit (pension) component to the more familiar 401(k). But, by combining the two, the administrative burden of operating separate plans is eliminated. These combined or hybrid plans were originally created under the Pension Protection Act of 2006, but were not slated to become effective until 2010.

If, as a practice owner, you would like to minimize your current taxes by setting aside as much as possible for retirement as well as attract and retain talented employees by offering valuable, significant retirement benefits, a DB-K plan may be a good alternative. Because of their defined benefit component, these plans allow for larger retirement plan contributions than 401(k) plans, helping to solve a couple of issues: 1) The practice owner’s need to maximize retirement plan contributions and 2) the employee’s desire for an additional source of guaranteed income to supplement social security.

In addition to simplifying administration by eliminating the need for separate 401(k) and pension plans, eligible combined plans are not subject to the administratively costly nondiscrimination or top-heavy testing imposed on the standard 401(k). This is because the 401(k) piece of the combined plan requires specific limits for employee salary deferrals and employer matching contributions. The DB-K plan requires automatic employee contributions equal to four percent of compensation, with the employer providing a 50% matching contribution. Employees may elect not to participate in the plan, or to have contributions made at a different rate.

The defined benefit portion of the plan provides for an annual retirement benefit equal to a percentage of the participant’s final average pay. The applicable percentage is determined by crediting each employee with 1 percent for each year of service, up to a maximum of 20%. Final average pay is defined as the period of consecutive years, up to a maximum of five, during which the participant had the greatest aggregate compensation. Because this formula requires larger contributions to the plan on behalf of older, higher-earning employees, the hybrid plan naturally generates substantial contributions for the benefit of the practice owners.

David T. Mayes, MA, EA, CFP® is a financial planner at Mackensen & Company, Inc., a fee-only financial planning firm in Hampton, NH. He is also a member of the National Association of Personal Financial Advisors (NAPFA) and the MD Preferred Financial Advisor Network. He can be reached at 603-926-1775 or david.mayes@mackensen.com.