Wednesday, September 16, 2009


Having read the Open Letter to Dr. J Douglas Bremner of Emory University published on September 12, 2009 by Dr. David Gorski in Science-Based Medicine Blog in defense of Dr. Peter Lipson’s criticism of Dr Bremner I was immediately brought back to three articles all published in the 1999 medical literature.

One was by Dr Elliot Fisher from Dartmouth who was among the very first to dare to ask the basic question about “more possibly being worse” in US bio-medicine in JAMA. The second and third articles were from Dr Larry Dossey who then edited the journal Alternative Therapies in Health and Medicine who wrote eloquently about intolerance among bio-medical scientists toward even considering Alternative Medicine.(Dossey, Larry‘You people’: intolerance and alternative medicine. 1999;5(2):12-17,109-112)

I would ask Drs Gorski and Lipson if an iconoclast like Dr Bremner might be serving a valuable role as gadfly to an entrenched failing status quo in bio-medicine who have made the mistake of deifying science? I would posit that the very essence of science is always and incessantly asking the question- “is it possible that I may be wrong?”. And I strongly support the return of narrative- the patient’s individual story- to the practice of medicine. The incomparable Sir William Osler, one of my heroes in medicine, knew that well.

I believe that of all the determinants of successful US bio-medicine medicine going forward that a strong dose of humility is in very tall order.

To make progress our egos must die first- a basic psychiatric principle. It is much better and much more important to be tolerant and kind than to be right.

I support Dr Doug Bremner’s role as a colorful and passionate iconoclast. We need more just like him.

Dr.Rick Lippin

Tuesday, April 14, 2009

THE US NEEDS AN IMPROVED CDC-What Went Wrong and What Can Be Done?

The US Centers for Disease Control(CDC), almost synonymous with US public health, is clearly one of the most important health agencies in our federal government. Comprised of 7coordinating Centers with approx 8,800 total employees and a budget of approx $8.8 billion dollars the CDC is also one of our largest federal health agencies. While both its vision statement and mission statement are commendable, in recent years its seems to have gone “off track” and like, most of our federal agencies, and requires at the very least significant improvements- at best and, what this writer recommends, a major overhaul

This brief essay will explore my personal opinion as to where the CDC went wrong and suggest some solutions.


First and foremost is the CDC attempting to fulfill its good mission in an almost 30 year period of emphasis on deregulation and excessive emphasis on partnering with the for profit sector. While this pressure has been felt by all of our health agencies it seems to me that since public health efforts do not generally generate profits perhaps this trend may have differentially impacted the CDC? However personally I do not know to what extent the CDC’s programs have been directly affected by this trend other than by anecdote. The US GAO (Government Accountability Office) has published a limited number of reports on the CDC. Then there is The CDC Foundation which describes and applauds the CDC's public/private partnerships in some detail.(note Board of Directors). Now I believe that public/private partnerships are both necessary and desirable as long as strict conflict of interest and disclosure rules with teeth in them are enforced which I suspect has not been the case in recent decades. Also, bio-medical science, generally, in our federal agencies has also been regrettably influenced by unscientific religious agendas especially in President George W Bush’s 8 year administration (2000-2008)


Because the CDC history if filled with a remarkable historical legacy of major infectious disease success stories the agency is still very much populated by professionals who are thoroughly wedded to a reductionistic infectious disease paradigm. So we have CDC virologists and bacteriologists who are very “pathogenic organism” oriented by training, experience and temperament. This paradigm has resulted in a series of failures in managing and communicating such risks as West Nile, Lyme Disease, Mad Cow Disease (BSE), SARSs, the Seasonal flu and the Pandemic flu to name a few. More recently we have witnesses the mismanagement of pathogenic organism contaminated foods such as tomatoes, peanut butter products and pistachio nuts. Dr. Marc Siegel in his remarkable and prescient book entitled FALSE ALARM-The Truth About The Epidemic of Fear describes in some detail these failures. Referring to an epidemic of fear he cites the concept of “the bug de jour” which grabs what he calls the media megaphone only to turn out to be a “false or exaggerated alarm” which then dies off to be replaced by yet another needless scare. Also he provides numbers of US cases of these diseases compared to very real and present disease to back up his thesis. One example of this is the methods the CDC reports even seasonal flu deaths (25-30,00 annual deaths) or in the recent Salmonella peanut butter products deaths (less than 10 deaths) failing to advise the public that in both cases these deaths are most often in the frail and elderly who were likely to die from something else shortly. A CDC spokesman, Mr. Curtis Allen told Insight Magazine in 2004, "There are a couple problems with determining the number of deaths related to the flu because most people don't die from influenza - they die from complications of influenza - so the numbers [of deaths] are based on mathematical formulas. We don't know exactly how many people get the flu each year because it's not a reportable disease and most physicians don't do the test [nasal swab] to indicate whether [the symptoms are caused by] influenza." Also the most serious danger of predicting "epidemics that never happen" is what some have called “the boy who cried wolf phenomenon” meaning that if you scare the public enough on issues that never become reality then the public finally becomes desensitized and complacent which in the event of a every real event leaves us very dangerously vulnerable.


Recognizing the enormous toll that individual health behaviors like smoking, overeating and a sedentary life style has on the health of American’s in 1992 the CDC to its credit changed its name to the Center for Disease Control and Prevention. However for a variety of reasons that emphasis on health promotion, while still recognized as on of its 7 coordinating centers – The Coordinating Center for Health Promotion- has gotten short shrift over the years with limited progress to show for all its efforts. Also the budget for Health Promotion is approx ½ of the budget for infectious diseases within the agency. Even though the name change occurred in 1992 but, by law, the well known three letter acronym CDC was retained. (sort of tells you something about the agencies priorities?)


Without question bioterrorism needed to be taken seriously by our nation as we became increasing aware of terrorism but most especially after the 9/11 attack and a month later (Oct 2001) the mailing of letter laced with anthrax spores which resulted in the death of 5 US citizens with 17 others sickened but scared most (over 300 million) Americans. The fact is, however, with the exception of a salad bar and coffee creamer contamination with Salmonella by a small disgruntled religious sect in The Dalles, Oregon in 1984 (751 ill – 0 deaths) our nation has never been attacked by a biological weapon from an external enemy in recent times. The 2001 anthrax letters, conversely, were sent by a mentally ill US ARMY scientist. Furthermore the two most important vaccine programs under Operation BioShield signed into law by President Bush in 2004 ($5.6 billion over 10 years) in our war against Bioterrorism –namely Anthrax and Smallpox Vaccines- were grossly mismanaged resulting in failures of both vaccine programs at great cost to the nation. While the CDC should not be solely blamed for these vaccine program failures since the FDA and DoD were involved the CDC was complicit in and contributed to their failures. The fact that the last case of Smallpox in the US occurred in 1949 and the World Health Organization declared Smallpox eradicated in 1976 begs the question of what the Government knows that we citizens don’t.


1)Like all US federal health agencies the CDC rules pertaining to collaborations with the for profit sector must be modified to allow for science driven policies and programs removed from the excesses of the profit motive. Also no CDC programs should be influenced by extreme religious views.

2)A new breed of infectious disease experts who understand a systems (holistic) approach to organism –host –environment interaction must be hired lest the reductionist model continue to fail

3)Much more of CDCs budget must be allocated to its Center for Health Promotion where the most significant public health benefits could accrue. A concerted effort and funding should be allocated to the worthy goals of the CDC’s Healthy People 2010

4)Or perhaps the entire Health Promotion program should be carved out of the CDC to free the CDC it to do what it does best?

5)While bioterrorism is important we must accurately perceive their risks, avoid profiteering off of unwarranted fear,and do much better with successful vaccination or other preparations as is necessary


This nation needs a strong, well funded and vibrant CDC. Perhaps the greatest tragedy of the recent CDC, again like other US Health agencies, is that the US public has lost confidence and trust in it. The rebuilding of trust may take years but it must begin in earnest as soon as feasible

Whoever CDC’s new leaders are must recognize the gravity of lost trust and must be committed to addressing that immediately

I am personally confident that our new administration is committed to most of the issues I address in the essay. But I’m not sure they fully understand yet either the reductionism verses systems (holistic) approach to infectious disease management or the gravity of the failed bioterrorism risk perception and risk management programs.

One can only hope that we have enlightened leaders who are leading our nation’s health agencies that are ready for change to meet the very real and pressing public health challenges of the 21st century

Richard A. Lippin MD
April 14, 2009

Saturday, March 07, 2009

Your Wallet Versus Your Nation?

The recent withdrawal of Dr. Sanjay Gupta from the nomination of US Surgeon General raises once more the financial sacrifice that less than independently wealthy individuals may have to make to enter the world of public service.

While Dr.Gupta denied that the huge drop in income was "not at all an issue" in his decision to withdraw his name as Surgeon General I for one suspect it was. We will never know?

Also I don't know what level of income Dr. Gupta generates as a sexy health media reporter for CNN, and it is really none of my business what a person's income is, sufficed to say that I suspect that it may be excessive given the value his "cheerleading style" of health reporting services brings to our nation. I liken it to the inflated value a superstar professional athlete or top movie star brings to the common national good. But as the old cliche goes if the market will bear it -it is we the consumers who "pay for these exorbitant salaries" who are to blame.

This Gupta withdrawal(good for the nation by the way) incident reminded me of a telephone conversation I had in the summer of 2004 with then my own Congressman Jim Greenwood from Bucks County,Pa (PA-8th District) after The Philadelphia Inquirer published a letter I wrote about Greenwood accepting a job with BIO- the trade association for the biotech industry at a base salary of $650,000 dollars per year before up to $250,000 supplemental bonus. What I objected to was Greenwood taking the job with BIO at a time that hearings were being held on possible unsavory practices by the pharmaceutical industry which Greenwood himself was chairing.Greenwood was offered the job of president of the Biotechnology Industry Organization on July 16,just four days before he was to hold a high-profile congressional hearing into antidepressants and child suicide.

Mr. Greenwood,a decent man,told me on the telephone call that he placed to me that he believed his position with BIO was "a continuation of his public service." That characterization seemed disingenuous to me- not because I don’t believe in free enterprise or biotechnology- but I do not believe it is "public service" when generating a profit is the fundamental goal of BIO's member companies. I conveyed this disagreement to Mr. Greenwood. He then complained about his personal financial needs of himself and his family on the "meager salary" of a Congressman.

Now I know that Ivy League University educations don't come cheap these days. Nor do grocery bills for that matter. But please Mr Greenwood or anyone else don't insult my intelligence by confusing a high salaried executive job with a position in public service to the nation.

Most Americans know the difference between serving your wallet and serving your nation.

Presumably people like Sanjay Gupta and "should have been President" Al Gore do know the difference between national public service and other means of generating income but my former Congressman Jim Greenwood and his more sleazy and venal former colleague in Congress Billy Tauzin, who now heads up Big PhRMA after pushing through a Medicare bill highly favorable to Big PhRMA, don't seem to undertand the concept.

Also, as Common Cause and other organizations have tried to propose over many years, do we really want to tolerate the capacity for politicians to accept private sector executive positions in companies or trade associations for which they had political oversight with just a 1 year waiting period before lobbying is permitted? Is this really good for a nation which has been witness to the number and gravity of corporate scandals that we have experienced in recent years? Haven’t we had enough? I think so.

I believe our new President is asking us all to consider more service to our nation and less to our individual wallets which is not really a bad idea for our troubled times

What do you think?

Dr. Rick Lippin

Sunday, March 01, 2009



Senator Mikulski,

My heartfelt congratulations to you for holding the HELP Senate Hearings this week on the value of Integrative Medicine as we embark on the long overdue process of transforming American Medicine.

If you peruse my website you will note that I have been involved in this effort for over 30 years and am pleased to inform you that I personally know several individuals who provided testimony at your historic hearings this past week.

As for me, I believe that the false dichotomy between Mainstream vs. Integrative Medicine is now over. Going forward we will only have "good" medicine which meets much more rigorous standards of efficacy (does it work?), safety (does it harm?), and affordability.(can we pay for it?)

Most importantly, all medical research and medical practice in the US must be removed from the pathology of the excesses of the influence of powerful vested financial interests which in past decades has placed valuable Integrative Therapies at a distinct and grossly unfair disadvantage

Those days are now over in part to you and other courageous politicians who are helping Americans give voice to a new American Medicine.

Again my personal thanks for the hearings and your leadership.

Be Well,

Dr. Rick Lippin


Here is my open letter to Senator Arlen Specter Re "Curing Cancer"

Senator Specter,

Since I heard you make a similar comment I want to express my objection to your and President Obama’s use of the phrase “we need to cure cancer in our lifetime”

This phrase is not consistent with what experts know about the biology of cancer- over 200 different types I might add.

Senator -There is no “cure for cancer”. Just like there is no “cure” for aging. We can cure individual patients with certain types of cancer, thank goodness, but indisputably, the greatest risk factor for most cancers is cellular and bodily aging.

Declaring we “need to cure cancer” is well intentioned but naïve – harkening back to President Richard Nixon’s failed war on cancer from the 1970’s.

We must continue to chip away at the many factors that contribute to cancers but to suggest we will “cure” all is completely unrealistic and is actually irresponsible.

I share your interest in these diseases and applaud your own personal triumphs and political leadership.


Richard A. Lippin MD
February 25, 2009

Monday, February 23, 2009



On January 6, 2009 TV news giant CNN announced that Dr. Sanjay Gupta, CNN’s Chief Medical Reporter, had been offered and accepted the offer by then President Elect Barack Obama to become our nation’s next US Surgeon General

Respectfully, the signers of this petition, as both health care professionals and many thinking US citizens from all walks of life believe that the appointment of Dr. Gupta would be both a mistake and a very serious lost opportunity for this historic administration and for our nation. Conversely, we strongly recommend that Dr. George Lundberg would be an ideal appointment to this office in these times of unparalleled challenge.

Perhaps for the first time in recent history we believe that our Surgeon General’s first task is to use the “bully pulpit” of that position to help remoralize American Medicine in the following three areas. These three issues transcend any particular important scientific public-health topic per se like smoking, obesity, mental health, HIV/AIDS and many other worthy topics. But these core issues must be addressed first and foremost before any worthy scientific pubic health issue can be addressed effectively. So we urge our new Surgeon General to address the following upon entering the position.

1) Affordable health Insurance for all American Citizens. Not having health insurance is a major determinant of poor health. It is immoral for the wealthiest nation in the world to have 47 million American (greater than 15%) without some level of basic health services coverage. All the scientific breakthroughs that bio-medicine has to offer will not remove this current moral stain upon our national identity and psyche and reputation in the international community of nations. If we do not act soon this immorality will continue.

2) Rebuilding Trust in our Federal Agencies that are Responsible for our Public Heath. Because of an emphasis on deregulation in recent decades there has been a very serious erosion of public trust in our federal agencies that are legally charged by mandate to protect our public health. Examples of agencies that have failed recently are the FDA (especially protecting us from unsafe medications and unsafe food), the CDC who has presided over a series of failures relating to accurate risk management and communication in infectious diseases, to the EPA who has dangerously weakened standards to ensure clean and healthy air and water, and OSHA who has virtually abandoned its mandate to provide safe and healthy workplace for hardworking American workers. American consumers literally don’t know who or what to believe. This loss of trust in our federal agencies may take years to rebuild but our next Surgeon General must participate in this rebuilding process.

3) Wanton Overuse of Potentially Dangerous Medicines and Medical Technology – While the uninsured don’t receive basic medical care the insured (most of us) receive too many potentially dangerous medical interventions. The most glaring examples of this are excessive use of medication (polypharmacy) among the elderly especially in nursing homes, the out of control use of diagnostic imaging services like MRI and CAT scans, and the continued problem of unnecessary medical procedures and surgeries. All of these are examples of miracle technologies when taken to excess becoming dangerous. The reason we have this phenomenon in American medicine is excessive emphasis on the free market where sellers of these services convince American consumers through doctors and hospitals that they actually need them. Our next US Surgeon General needs to help put the brakes on these dangerous and costly excesses driven by a for profit model that is clearly out of control.

Dr. George Lundberg not only is a consummate public health scientist who knows public health issues, he strongly embraces the above three priorities in words and deeds.

As Editor- in-Chief of the Journal of the American Medical Association’s journal, commonly known as JAMA, between 1982-1999, the most widely read medical journal in the world, Dr. Lundberg earned the respect of a worldwide readership of JAMA. In 1999 he then went onto become(until January 30, 2009) Editor-in-Chief of MEDSCAPE, the leading source of online health information and education for physicians thus establishing himself as genuine pioneer in e-medicine work a trend he recognized very early and began at the AMA. He was dubbed “Online HealthCare’s Medicine Man” by The Industry Standard. He excels in both professional and patient medical education.

Dr. Sanjay Gupta , conversely , trained in neurosurgery,-named in 2003 as one of the sexiest men in America-,shows little to no evidence of embacing the three fundamental priorities outlined above in this petition. Quite to the contrary Dr. Gupta has been a voice for the status quo in our very broken, profiteering based, bloated, bio-medical complex. One medical journalist described Gupta’s reporting as an “unquestioning –almost cheerleading approach to health news” most often reporting on the “the issue, or worse, the breakthrough of the day”. Gupta’s ties to the pharmacutical industry and medical testing industry need to be further investigated in his vetting process. We the signers of this petition demand this. And Gupta’s on–air attack of Michael Moore’s data contained in Moore’s movie Sicko requiring formal retraction by CNN and duly noted by Nobel Laureate Paul Krugman of The New York Times was a disgrace.

At this critical time in nation’s history we need a physician with the gravitas, the in depth experience, the credibility with both the professional and public communities, and most importantly, the moral credentials and authority to effectively utilize the bully pulpit of the US Surgeon General position to speak, not only for good public health science removed from the excesses of financial interests, but also to speak from a platform of core lifelong values. Dr. George Lundberg fits that job description..

Quite frankly, in short, we need a man or woman of gravitas, moral fiber and substance – not a sexy media star, flitting from one opportunistic subject to another, apparently tied to vested interests- for this venerable office of US Surgeon General


Click here to sign the petition


Dr. Rick Lippin

NOTE UPDATE March 2009- We are now asking you to sign by clicking on this slightly revised petition- Thanks for your continued support!-Rick Lippin

Thursday, November 27, 2008

“If I were President Obama’s Health Care Czar- Here is what I would tell him”

Health care is complex Mr. President- No country on the planet has completely figured it out. But clearly there is something terribly wrong with the Unites States- the wealthiest nation on the planet- having 47 million of its citizens uninsured (>15%), with many millions more underinsured, not having the peace of mind that when they are sick they can access some level of health care. This is not only wrong, Mr. President –it is immoral- an immorality, Mr. President, that betrays the nobility of both the great profession of Medicine and the greatness of our nation.

Yet conversely, Mr. President in my opinion we in organized medicine and those industries that profiteer from it (most notably multinational pharmaceutical companies, diagnostic equipment companies and medical instrumentation companies) are in part to blame for promoting the premise that high technology medicine solves all human problems. We have medicalized all sorts of America’s social problems like joblessness and poverty for which there really is no justifiable medical intervention.

We must, as a profession, convince ourselves and our patients that in medicine “more is not always better”. We must focus, Mr. President, on diagnostic and therapeutic medical interventions that rigorously stand up to the necessary tests of proven efficacy (does it work?) and, more importantly, proven safety (does it harm?). Also, we in the medical profession- recognizing the truly miraculous technologies we have achieved- need a strong dose of humility now to recognize that we cannot cure everything. Certainly “aging and death are not curable medical conditions” Caring must achieve parity along with curing. We are not in fierce battle with disease. We are instead, first and foremost, in a caring profession- a profession that recognizes that just simply “being there” for the patient and their family is perhaps our most fundamental obligation. Mr. President- that is actually the historical root of the phrase “attending physician” which is still a term in common use today.

Many have said, including Dr Elias Zerhouni – immediate past head of our prestigious US National Institute of Health (NIH)- that a high-tech-high-cost treatment driven “disease care system” is just not economically sustainable.

Now I fully realize Mr. President that transforming a $2 trillion dollar plus disease care industry in this nation will be painful for many including possible economic dislocations for many employed in this industry. But we must transform our disease care industry into one that emphasizes and economically incentivizes and rewards both individual (health behaviors) and more importantly institutional (public health) prevention. We must retrain our disease care workers into genuine health care and prevention workers. We must transform high-tech-high-cost, often dangerous, hospitals into great institutions of healing again. The money save by engaging through this necessary transformation will free up necessary funds for those who really do need the best technology that contemporary bio-medicine can offer. Mr. President – we must engage in this necessary transformation incrementally and with great compassion since it is a change of monumental proportions.

Mr. President. I realize that my proposal to you is bold. But our times call for boldness perhaps like never before in our young nation’s history. Mr. President-Tinkering at the edges of a conceptually and fundamentally broken US health care system is not enough.

As your trusted advisor I believe that ultimately we need the kind of dramatic and bold change in health care as we envision and propose to address in dealing with our global environmental crises. Nothing less, Mr. President, will carry the day.

Be Well Mr.President

Dr. Richard Lippin
Southampton, Pa

*Reprinted with permission of Assad Meymandi MD.PhD., Founding Editor-in-Chief of the Wake County Physicians Magazine .Vol. 14, No. 1, January 2009

Wednesday, March 26, 2008

AMERICAN MEDICINE’S HANDWASHING OBSESSION- Yet another good concept taken to irrational excess.

Recently US Medical leaders from the hospital sector and the public health community have been imploring hospital employees and the public to spend much more time washing their hands.

I knew we were in trouble however with this concept – essentially a good one when applied rationally – when the Commissioner of Health for my home state of Pennsylvania said at a public meeting that I attended last year that he was considering giving up the practice of shaking hands with people especially during the winter months. Whoaaaa???

And where money can be made an entire "handwashing industry" has sprung up including training modules,educational materials and a variety of handwashing products.

Now in hospitals we have the very real and very tragic problem of increasing number of hospital acquired infections(HAIs)which undoubtedly could be partially mitigated by more handwashing especially by staff so a to avoid cross transmission of pathogenic organisms between patients. But even in this situation hospitals would do well to focus on other underlying reasons for increased hospital based infections such as the overuse of antibiotics and other medications and a variety of patient host resistance factors such as aging, nutritional status, the presence of underlying diseases and immuno-suppressed states.

My basic reasons for positing that we are perhaps overly obsessed with handwashing are twofold-

-Firstly I have believed for decades that infectious disease specialists who tend to populate our public health agencies including our own CDC focus far too much on organisms and their pathogenicity exclusive of considering host resistance or general environmental factors in disease causation. I have always been surprised by this bias toward organism vs. host because I thought that the interaction between the two was a well established principle. As truly remarkable the contributions of Louis Pasteur were in establishing the Germ Theory of Medicine it would not hurt to re- look at two of Pasteur’s contemporaries Claude Bernard and Antoine Bechamp who held a more holistic scientific view of disease causation. Yet because of the miracles of the infectious disease model and the incredible effectiveness of vaccines and antibiotics we ran successfully with this model in my opinion to excess. Now the excess is “biting us back”.

On a personal note in 1991 I wrote a letter about the common cold that was published in a local medical society journal which posited that the adenovirus theory of the common cold wasn’t getting us very far and that we just might want to look at other possible factors. I was in part validated by the work of Dr.Sheldon Cohen of the University of Pittsburg who published rigorous scientific studies on the relationship of stress to the common cold.(and other diseases)

-Secondly I have become intrigued with what has become known as "The Hygiene Hypothesis" first proposed in 1989 by David P Strachan in an article in the British Medical Journal(BMJ)which fundamentally posits that possibly a large number of immunologic disorders such as allergies and asthma might actually be caused by or contributed to by the excesses of a clean environment especially during infancy and childhood. Much more work needs to be done and I am not suggesting that we all "consume a daily portion of dirt" but expert epidemiologists, allergists and immunologists are taking the theory seriously. Perhaps the infectious disease specialty community would benefit from considering this theory in their deliberations about the frequency and intensity of handwashing?

Now I give full credit to Viennese physician Ignaz Semmelweis who in 1857 introduced the simple principle that students and physicians in the Vienna General Hospital must clean their hands with a chlorine solution between patients in the obstetrics clinic and after visiting the hospital morgue thus reducing the deadly disease known as puerperal fever. But ironically Semmelwies’ handwashing recommendation was stimulated by noting that Viennese mothers who gave birth at home attended to by midwives had a much lower rate of this disease.

Anyway we have come a long way since the days of the “Father of Handwashing” Semmelweis and much good information can be gleaned by the CDCs current recommendations for both handwashing in health care settings and
handwashing for the general populations

I can’t help but think however that washing of ones hands is only a small part of a comprehensive approach to reducing hospital based infections and reducing the spread of common diseases like the flu or the common cold.

Using some poetic license- not very popular at all with bio-medical scientists- I cannot help but wonder that on some unconscious level whether we handwashers are like Shakespeare's Lady Macbeth trying to cleanse way our collective guilt about where we have taken contemporary modern medicine- in part because we take good scientific principles to excess. Handwashing is only one example of this phenomenon of excess.

And the next time I hear a health care leader announcing publically that he/she is giving up on the shaking of hands as a warm greeting to others remind me once more to question authority.

Dr. Rick Lippin
Southampton, Pa