Friday, July 22, 2011

And Today's Word of the Day Is: Advocacy

Lots to catch up on, so I'll keep it to just the facts.

1.Efforts Continue in Opposition to Proposed GME Cuts: This week, more than 60 members of the US House of Representative expressed their opposition to a 60% cut in GME spending as part of the deficit reduction plan. Read the letter they sent to Congressional leadership here. Additionally, the AAMC ran a radio ad, which you can listen to here.

2.Panel recommends coverage for contraception: The Obama administration is “inclined to accept” a proposal for all insurers to cover contraception as a preventive service.

3.Should parents of morbidly obese children lose custody?: JAMA recently published a commentary piece titled, “State Intervention in Life-Threatening Childhood Obesity” (2011), which has been taken by the media to mean that all fat kids will be removed from their homes. A Medscape article brings the message back with “Childhood Obesity is Not Child Abuse.”

4.Florida "gag law" on gun questions: There is a recent Florida law that prohibits physicians from asking patients about gun ownership/guns in the home. Several Miami physicians have filed litigation against this law, and the AMA is on board. The NRA is on the other side of the debate, arguing that any inquiry into gun ownership can be seen as harassment. (This article is about whether the NRA should be allowed into the lawsuit. I haven’t been able to found out if there’s been a decision yet.)

5.Student-Run Clinics Help Patients in the Face of Challenges: Here’s an AAMC article about student-run clinics, touting the benefits to providing students with experience but also recognizing that the lack of physician supervision may lend itself to less than stellar care.

6.IAS: ‘Cure’ comes out of the closet: AIDS doctors from around the world are hopeful for a cure for HIV/AIDS after the first patient was cured earlier this year. Research will focus on natural ways to develop the delta-32 deletion on the CCR5 receptor that is believed to be the mechanism of the patient’s cure.

7. More discussion on whether cell phone use causes cancer. A more exciting argument can be found here.

8.Sex abuse by doctors a "profound betrayal": The American Academy of Pediatricians set forth its first policy admonishing child sexual abuse by doctors, in light of a recent Delaware case in which a former DE pediatrician was convicted on multiple counts of rape, assault and exploitation of children.

9.AMA adopts policy discouraging airbrushed images, especially in teen magazines.

10.ACOG recommends annual mammograms begin at age 40: 40- to 49-year-olds have the shortest “sojourn time” with breast cancer, meaning that the time from detection by mammogram to symptomatic disease is less than that for other age groups already getting mammograms. The only group to disagree with the recommendation is the US Preventive Service Task Force, which stick to previous guidelines.

11.Watch Low-Sodium Products in Vulnerable Groups: Patients with renal dysfunction should be advised against low-sodium foods, since such products often have higher potassium that can be dangerous. One case report that is cited mentions a patient who became hyperkalemic during his hospital stay due to ingestion of Solo, a low-sodium salt replacement.

Tuesday, July 19, 2011

Sarfoh Wins AMA Foundation’s Minority Scholar Award

University at Buffalo medical student Vanessa Sarfoh is one of 13 students nationwide to receive a $10,000 Minority Scholar Award from the American Medical Association (AMA) Foundation.

The award recognizes academically outstanding medical students who are committed to promoting diversity in medicine and eliminating health care disparities.

Inspires Minorities to Pursue Medical Careers

Sarfoh, a member of UB's class of 2013, has co-hosted Doctors Back to School, an AMA program that brings physicians and medical students into high school classrooms to encourage minority students to consider medical careers.

She received funding from the AMA Foundation to start a health initiative at UB’s Lighthouse Free Medical Clinic that addresses obesity in the minority population.

Sarfoh also serves on the AMA-Medical Student Section Minority Issues Committee.

In 2010 she was one of 14 students who received the American Society of Hematology's Minority Medical Student Award to pursue hematology research.

Saturday, July 9, 2011

Much Ado About Stem Cells (and Medicaid!)

Important things happened this week! Read on!

1. Lots going on in stem cell research. A patient in Sweden just received a trachea transplant -- made out of a synthetic Y-shaped polymer framework coated in his own stem cells! Two days later, the patient even had a cough reflex after accepting the transplant. This is a step-up for Dr. Paolo Macchiarini, professor of regenerative medicine at Karolinska University Hospital in Stockholm. Macchiarini previously performed a transplant of an artificial trachea created from donor tissue and combined with recipient stem cells in 2008.

In other news, a Phase II study out of Northwestern found that cardiac injections of hematopoietic stem cells (CD34 positive) can help relieve refractory angina. Angina occurred less often, and patients were better able to exercise, for about a year. Everyone involves cautions that these are preliminary results, and the invasive method of injection makes it impractical for routine use. There were adverse effects, to be sure: patients experienced bone pain and angina from the GCSF, and several patients showed cardiac enzyme levels consistent with non-STEMI.

2. The National Center for Health Statistics just released the findings of a survey on >4,000 private practice doctors regarding whether they would/do take on new patients with Medicare or Medicaid insurance. The survey is from 2005 to 2008 (it takes about two years to publish this info), and >90% would take new Medicare patients (most no's were for patients with fee-for-service plans here) but only about 2/3 of those surveyed would take new Medicaid patients. The article says that the Medicare numbers contrast with the popular idea that it's hard for older patients to get doctors -- but maybe it's an issue about certain regions?

3. Speaking of Medicaid, the first "valid" study was published proving that people with Medicaid are better off than people without any insurance. In 2008, Oregon had enough money to cover 10,000 people under Medicaid, but 90,000 applied. So the state sent up a lottery, and the National Bureau of Economic Research snatched up the opportunity for, essentially, a randomized trial comparing Medicaid vs. no insurance. The NBER found that those patients with Medicaid saw doctors more often, were more likely to be prescribed medication, were more likely to have preventive screening exams, had lower medical debt, had fewer bills sent to collection, and WERE MORE LIKELY TO SELF-REPORT BETTER PHYSICAL AND MENTAL HEALTH. Now please, stop cutting funding to this program.

4. I recently waited at the doctor's office 1.5 hours for a medical clearance visit (this consisted only of getting a TB test), which ended up costing me two hours in NYC traffic and being late to a meeting with a Dept. of Defense investigator (long story short, I needed to get up to Boston that day, and I was a personal reference for a friend). A few articles have been circulating lately about patients billing their doctors for wait times -- even I were so inclined, I have no idea how I'd do that for my aforementioned visit. But it is an interesting concept that doctors don't even seem that averse to. In fact, a few even preempt this by giving out giftcards for long waits or providing free wi-fi. How do you feel about this? Would free wi-fi make you more accepting of a long wait? What are your thoughts as future physicians?

Friday, July 1, 2011

Beat the Heat with Some Health News Updates

1. I was a community health major in college, so I spent a lot of time talking about "herd immunity." The idea here is that if everyone around you is immune to a disease (say, measles), then you should theoretically be protected against the disease even if you are not immune. This is an important if imperfect tool for individuals who are vulnerable because they cannot build an immunity or, by ignoring vaccine recommendations, choose not to. But then the CDC comes out with a statement that there have been more cases of measles in the US in the last six months than there have been in any full year since 1996, where most of the cases are in children who have traveled out of the country to measles-endemic areas. I admit, this makes me angry. I understand one's right to have personal beliefs about vaccines, but physicians and physicians groups (hey, AMA) need to do better about educating the public about vaccines' benefits and about countering attacks of misinformation against vaccines.

2. Okay, so I finally understand that SGR -- sustainable growth rate -- is the Affordable Care Act's attempt at controlling Medicare costs by reducing physician reimbursements -- ah, that's why docs are up in arms. There's a bill making its way through Congress now that would address SGR by maintaining physicians' reimbursement rates for three years. Sounds good. The problem is that benefits would start at 67 instead of 65, wealthier seniors would have to pay additional premiums, and everyone would pay more for Part B (the outpatient stuff). Depending on what "additional pay" constitutes, I still might be okay with this. It is obviously difficult to ask seniors on fixed incomes to pay more and wait longer for Medicare, especially as pensions seem to be up for grabs -- my retired state-employed lawyer grandfather is staying with my family this week, and we had a long talk about the Minnesota and Colorado rulings that reduce pension plans for those already receiving them and how this might expand to other states. The aforementioned Medicare bill is tricky, but it might be part of a larger step toward dealing with The Medicare Problem.

3. It's news to no one that a lot of ER visits could be avoided by better primary care and coordinated care therein. Massachusetts officials recently stated as much, but the problem is primary care doctors can't always afford to hire extra nurses for follow-up management or to implement electronic health records systems. But Dr. Michael Cantor of the New England Quality Care Alliance and Tufts Medical Center had a great idea: Insurers that collect money for "care management" programs should forward it back to doctors. Cantor contends that doctors' offices handle the management better than the insurers anyway. If this idea were to become policy, it will be a hard fight, but I think it could go a long way in improving primary care outcomes.

4. When I look for health-related news, I tend to stick to the e-newsletters that are sent to me daily (or more): The AMA is good for big health news articles; MSSNY does a lot to tell you what's going on in New York; Medscape's articles are easier to digest and there are some good blogs and articles targeted at doctors-in-training ; and I've recently been introduced to, which has a good balance of policy news, health issues, and blog discussions (I really like this and wish I'd found it sooner). What do you read? If you have any recommendations, comment here or e-mail me at!