With Great Power Comes Great Responsibility

There's a lot going on this week. And I'm not even talking about the First Years' anatomy exam. So please, bear with me, and at least skim through to the end.

First: Residencies. More medical schools + expanding medical school classes + proposed decrease in funding for graduate medical education = Not good for any of us. Do your future MD-self a favor, and go to this website to urge your congressperson to protect GME funding. All you have to do is type your name, address (it's a secured AAMC site) and click submit. If you're feeling more intrepid, check out the unofficial MSSNY-MSS website "The.Hidden.Curriculum," which is featuring a post on misconceptions about residency. It's worth a read.

Second: This part is going to get a little angry. (Feel free to skim, but it might be fun to experience my ire.) If you've read the more commentary-ful blogs on here before, or if you've met me, or if you decide to stereotype my values by my community health background and health care worker designation (correctly so, by the way), you'd know that I really, really hate anti-vaccine propaganda. I understand that that one MMR-autism article was rescinded by the author -- but how much of the general population does? Once information is out there -- especially information that broadcasts child illness -- it cannot and does not go away. I was just peering through Facebook, as I am wont to do, and saw an AMA-MSS update ("Like" their page here) that Delta Airlines is running anti-vaccine commercials during their in-flight entertainment. It's sponsored by the National Vaccine Information Center, whose website at publication discusses Vaccine Awareness Week. KevinMD's blog posted a great reaction to this and other anti-flu shot slander -- recognizing that everything has the potential for adverse effects, but the benefits far, far outweigh the risks. Especially when the risks are so infrequent.

Which brings me back to UB. This week, UB is running free flu clinics for all affiliated students and staff. That means that YOU should get your flu shot tomorrow in the BEB atrium between 9 am and 3 pm (your anatomy exam does not extend that entire time). Unless you have medical reasons to abstain from the vaccine, I can't imagine a good reason you can have. As a medical student (target demo here), you have a responsibility to your patients to NOT GET THEM SICK and to yourself to NOT GET SICK. Imagine getting the flu three days before the NEXT anatomy exam. Or going into preceptor in January feeling a little under the weather, and taking a history from an older patient undergoing chemotherapy. The MMWRs for the last forever have shown that flu season peaks around Valentine's Day. Not December, and not January. Lots of opportunities to get sick. Get your shot now.

Also, if you've made it this far, really go to the AAMC site to urge your congressperson to protect GME funding. Otherwise, your future MD-self may be unemployed. And that guilt is far more powerful than mine convincing you to get a flu shot.

Support Your Local, State, and National MSS!

A few important announcements from your VP of Leg/Policy:

1. Fundraiser SATURDAY NIGHT from 9-11 pm at Indulge (49 W Chippewa). For $10, get unlimited drinks for the first hour and discounted drinks the second hour. All proceeds to support our Annual Halloween Party for Kids with Juvenile Diabetes next Thursday, 10/27.

2. TOMORROW AFTERNOON is MSSNY's Legislative Committee meeting, where the grown-ups are going to discuss important health care and policy issues. From 1-4 pm, MSS legislative guru Rob Viviano will be LIVE BLOGGING HERE (<-- click). Check in to hear from Rob about what's going on, post questions, and stay informed!

3. Contact Congress to protect medical residency spots! TAKE ACTION HERE (<-- click). MSS is especially concerned given that the deficit reduction plan eliminates subsidized loans for grad students (like us!), so encourage your congressperson to ensure that we can complete our eduction.

A Public Health Kind of Tuesday

1. Vitamin supplements offer no help – but maybe harm: In the fallout of research indicating Vitamin E as a risk factor for prostate cancer, doctors are telling patients to stop taking multivitamins. Toren Finkel, head of NIH’s Center for Molecular Medicine, said that it’s completely intuitive to take vitamin supplements, although clinical data “pretty consistently show[s] no benefit.” That’s not to say all vitamins are bad – there are some whose actions and purposes we understand a bit better, like Vitamin D and calcium and prenatal supplements. But, the take home message remains: Don’t worry if you’ve missed your daily dose of multivitamins.


2. Vaccines for Substances Abuse: Two scientists were recently awarded “visionary” grants from the National Institute on Drug Abuse (NIDA) to develop vaccines against nicotine and methamphetamine.  Both drugs – which are expected to go into clinical trials within five years – stimulate the production of antibodies that would bind the target drug, forming compounds too large to cross the blood brain barrier. These vaccines could be life-changing for the estimated 22 mil drug abusers in the US, as well as for the $84 bil annual cost of addiction between health care, lost earnings, crime, and accidents.


3. California Medical Association Calls for Legalization of Marijuana: At their recent annual meeting, the state medical organization adopted the position of marijuana legalization. This marks the first major medical association in the US to adopt this position. The group acknowledges the touchy subject, but argues from both scientific and political perspectives: 1) If we’re worried about uses of cannabis, we need to legalize it to test it; and 2) We need to legalize it to regulate it.


4. Nasty Bugs Lurk on Cell Phones: A study out of the UK found that 92% of cell phones have bacteria (including E. coli) on them. Next step, maybe: Do people text on the toilet? My advice is to break out those Clorox wipes, friends. 

A Much Needed Update

1. As of this coming January, the federal SGR (sustained growth rate) for Medicare payments will go into effect. This means an almost 30% cut to Medicare reimbursements, a freeze in payments for 10 years (aka reimbursement will be static), and other changes that will create access issues for Medicare beneficiaries, as well as hurt physicians. The AMA has created radio and TV spots to encourage constituents to call their representatives on behalf of SGR repeal. Contact your elected officials through the AMA Grassroots Network.



2. Last month, Sens. Nelson (D-FL), Schumer (D-NY), and Reid (D-NV) introduced a bill to increase the number of CMS-funded residency spots by 15,000 over five years. If passed, this would be the first expansion of residency positions since a cap was established in 1997. This is especially important as the number of students applying for residency (MD, DO, and international grads) exceed the number of residency slots. A recent NEJM article estimates that the number of domestic applicants will exceed the number of residency slots by 2015.

3. The AMA has organized a series of three webinars regarding physician and medical student suicide awareness and prevention. We’ve missed the first two (they’re archived here), but the final lecture is Wed. Nov. 16 at 1 pm. Studies show that physicians are more likely than the general public to commit suicide, and they are less likely to seek treatment for depression and suicidal thoughts than non-physicians. This is excellent information to use in future practice, to recognize warning signs in friends and colleagues, and to empower you to get help if you experience depression or thoughts of self-harm.

4. The official word from the USPSTF this week is that the prostate specific antigen (PSA) test “does not save lives, but results in needless medical procedures that have left tens of thousands of men impotent, incontinent or both.” This is the result of a panel that convened to determine whether PSA testing saves enough lives to justify the tests adverse outcomes, not to determine whether the test works. Nevertheless, the recommendation has unsurprisingly caused heated debate within the medical community. For example, the American Urological Association believes that the USPSTF recommendations will do more harm than good. Additionally, this has posed a problem for insurers and whether they will continue to pay for the test at all.

5. For those of you looking for a good study snack, a recent study published in the American Journal of Cardiology observed that women who ate more darkchocolate were less likely to have strokes. Granted, it was an observational study – no causal relationship here – but that doesn’t stop speculation. This is one of several studies that point to benefits of chocolate consumption, perhaps because of flavonoids that can decrease blood pressure and improve other blood factors linked to heart health.

In other junk food related news, the Interagency Work Group (comprised of the FTC, FDA, USDA, and CDC) is working on new guidelines to limit the advertising of unhealthful foods tochildren. One big change is broadening the definition of this market from 2-11 years old to 2-17 years old. The guidelines also expand the scope of advertising to include Internet pop-up ads, online sweepstakes, advertising through cellphones, celebrity endorsements, and in-school marketing. In astatement before the House Energy and Commerce Committee to be deliveredtomorrow, the FTC writes, “Children’s health is the ultimate goal, and marketing of more nutritious foods is one effective tool to help achieve that goal.”

Back in Business

Congratulations on finishing the first full week of school, UB students! I want to focus this much awaited update on medical education and what different schools and organizations are doing to make med school and residency better.

First, let's talk about UB! This year, we can get credit for volunteering as medical students in the community through Service Learning. Write up a short response to your experience and spend an hour talking with your peers, and get an automatic "H" in your transcript! If you missed the lunch lecture on Wednesday, e-mail Debbie Stamm for more information, at dstamm@buffalo.edu.

At other schools… Long Island's brand new Hoftstra SOM is certifying its entering student body as EMTs. Throughout their preclinical years, they get to/have to take ambulance shifts to gain clinical and team-building skills. Virginia Tech Carilion, another new med school, is spicing up the interview process with multiple mini-interviews: Instead of 30-45 minutes with one interviewer, applicants will spend about ten minutes per interviewer with several interviewers. This system is not new -- Stanford, UCLA, and others do it -- but it shows a trend at looking "past the numbers." University of Michigan Med is also changing the application trail: It has a smart phone app for applicants to track their admission progress. "M.D.Stat+" lets you check the status of application receipt, interview invite, and acceptance -- if you apply to U Mich.

On the GME front, the AMA is encouraging the NRMP to better standardize residency applications. Read the AMA's letter to figure out what we're concerned about. Also, CMS is planning to redistribute residency slots to weigh more heavily in underserved areas with low resident-to-population ratios.

Finally, check out The.Hidden.Curriculum, a "semi-anonymous" blog written by NYS med students to offer a cache of advice from med school social mores to wrapping your head around policy-speak.

I Blog, You Blog, We All Blog

For those of you who survived the epic update last week (or so), here's a much shorter one. Scroll down for some breaking news, health policy style, but first...

• Meet the new MSS GRAF, Abby Daniel! As the Government Relations Advocacy Fellow down in DC, she assists with the AMA's legislative agenda and policies on behalf of physicians, students, and patients. Want to stay in the know about health issues in the capital? E-mail her at Abby.Daniel@ama-assn.org to receive her weekly updates.

• Interested in global and public health? Follow the MSS Committee on Global and Public Health at their blog!

1. Salt is still bad for you: Contrary to a recent article by Taylor et al (American Journal of HTN), experts still say salt does lead to worse cardiovascular events. The study's been criticized since its publication, but the press has still been, shall we say, overzealous -- see UK's Daily Express: 'Now salt is safe to eat--Health fascists proved wrong after lecturing us all for years.'

2. Contraception for all: Following-up from a blurb I posted last time, the HHS mandates all insurance plans to cover certain women's preventive services, including contraception, starting in August 2012. (But, religious institutions with employer-based insurance won't have to cover this.)

3. Genes can be patented: A federal patent court determined that isolated DNA is "markedly different" in its chemical structure from natural DNA and is therefore not a product of nature. This is in keeping with national policy since the 80s but overturns a recent lower court ruling and rejects the anti-patent platform of the Obama administration.

4. Acetaminophen can be dangerous -- just ask any first-year medical student. The Acetaminophen Awareness Coalition put together a shiny new website, KnowYourDose.org, aimed to help consumer-patients figure out where the drug is hiding and what can go wrong if you take too much.

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.

Sarfoh Wins AMA Foundation’s Minority Scholar Award

Published July 1, 2011 on the UB SMBS Website

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.

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?

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 MedPageToday.com, 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 lgluck01@gmail.com!