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!

Is the AMA Still Relevant?

It's been a week since the AMA-MSS Annual Meeting ended, and we're finally bringing you an update. The big big big news is that the MSS and the HOD proper (the physicians' voting body) reaffirmed policy to support an individual mandate in regard to health care (read more here). This is a major step forward for the historically conservative organization, and many have been blaming the AMA's stance on the individual mandate for the membership decline this past year. Others cite the platform as a reason for new members to have joined. But the AMA does only represent 20-30% of US doctors, which has brought up the question: Is the AMA still relevant?

We think so. Despite its poor-looking numbers, the AMA is one of the most powerful lobbying groups in Washington. It is the most powerful health care lobby. It advocates hard for physicians, and its support for universal (ish) health care does show that the group adheres to its motto, "Helping doctors help patients." A recent article at KevinMD.com said it best: "The AMA may not be every doctor’s cup of tea, but it’s the best voice we have. And that is better than no voice at all."

Whether or not you like the politics of medicine, it will affect you. Get involved. As students, we have more influence than one might think. Did you know that smoking bans on airplanes started at the AMA-MSS and moved its way through the HOD and onto federal legislation? If you think our AMA is not moving in the right direction, fix it. E-mail VP of Legislation Lauren Gluck at lgluck01@gmail.com to get more involved with policy and advocacy here at UB. We owe it to ourselves, our profession, and our patients to make health care better.

Congratulations, Buffalo AMA!

Your SUNY Buffalo AMA officers just came back from the Annual AMA-MSS meeting in Chicago -- with great news! Our chapter has been named the NATIONAL Chapter of the Year! We are all proud of the past and current leadership, but mostly we are so thankful for our wonderful, active membership -- that means YOU!

But the excitement doesn't end there. SUNY Buffalo continued to make a splash in regional elections. We belong to Region 7, which is composed of seven states New York and northward, a great group of students that have, for example, brought us Miles for Healthier Lifestyles. Here is a list of leadership positions now held by Buffalo students:

• Community Service Chair: Julie Garchow, MS 2
• Community Service Committee Seat, Upstate NY: Jennifer Daily, MS 2
• Membership Chair: CJ Cancino, MS 2**
• Membership Committee Seat, Upstate NY: Angela Sandell, MS 3

**Extra special congrats to CJ, who now heads up membership and recruitment for SUNY Buffalo, MSSNY-MSS, and Region 7!

How Would You Like Some Health Policy News with Your Flash Thunderstorms?

Hello again, and welcome to Arthritis Awareness Month! (Terribly fitting, wouldn't you say, for all the UB First-Years finishing up their musculoskeletal unit next week.) I'm sorry it's been so long without any updates, but this should tide you over for a few days.

1. Here are a few things you need to know, or maybe you just forgot: Health care reform is affecting future doctors by emphasizing primary care and by paying them differently (but goodness knows how, at the moment); Kids who watch a lot of TV may grow up to get CVD; Old people who exercise may get fewer age-related complications; Hospitals are being forced to deal with too many patients, drug shortages, and reimbursement problems; Uninsured patients rack up a whole lot of money for everyone involved ($49 mil annually in unpaid medical bills).

2. A few weeks ago, the AMA testified to Congress regarding the planned 29.5% physician pay cut for 2012 due to the proposed SGR (sustained growth rate) to deal with Medicare funding/reimbursement. AMA Pres Cecil B. Wilson said to 1) repeal the SGR (no one, in medicine at least, likes it), 2) setup a 5-year period of positive Medicare payments (aka increased, not decreased, reimbursement), and 3) figure out a better way to deal with the "Medicare problem" without resorting to a "one-size-fits-all formula." Essentially, Wilson campaigned for a transition to multiple payment models.

3. iScrub App: Anyone who's taken a microbiology class knows that the biggest infection problem in hospitals comes from staff slacking in the hand-washing department. Dr. Atul Gawande dedicates a chapter to this in his book "Better" (2007; check it out): He writes about Ignaz Semmelweis, the doctor who virtually eradicated so-called puerperal/childbed fever by getting other doctors to wash their hands. No easy feat, Semmelweis supposedly stood guard near the ward's one sink and hounded all passersby. Too bad there's no one to do that in today's hospitals -- but wait! The ingenuity of a new iPhone application, the iScrub, records and analyzes hand hygiene observations in hospitals and provides real-time feedback without the need for transcribing anything. Best of all, research shows that it does increase hand hygiene compliance!

4. This week marks the first Medicare EMR incentive payments! This applies to all doctors/hospitals/etc. that have met the CMS's meaningful use stipulations and other program requirements once they surpass a $24,000 threshold. Where these early bird EMR users will receive benefits, those who do not have systems in place by 2015 will be penalized by lower Medicare and Medicaid payments. But, there are still lingering concerns over remaining security gaps, including unencrypted wireless connections, easy passwords, and "a taped-over door lock on a room used for data storage" at one of seven large hospitals investigated. Fixing the problems is the responsibility of the Office of the National Coordinator in HHS (which sets the standards) and the Office for Civil Rights (which guards the privacy and safety of medical records).

5. How to best coordinate health care? Accountable Care Organizations (ACO) seem to be the wave of the future. They're essentially medical home systems, just applied to Medicare and therefore federally organized. The goal is, obviously, to coordinate care for patients with multiple providers in multiple settings, and the Medicare population is overall in great need of such organization. Additionally, ACOs are designed to achieve cost savings for Medicare, employers, and patients (payment models are currently being "tested"). Despite the promise of ACOs, physicians don't seem to be too gung-ho about similar federal models: No states have opted into a Medicaid health home program after five months of recruitment. Maybe it's that states have their own systems in place (some do), but a big problem is poor physician reimbursement.

Just for my own amusement:
Botox regulations for minors pass NJ committee: Apparently, this is a thing found outside of that one Bones episode about the 10-or-whatever-year-old beauty pageant contestant. The article doesn't say whether the Botox is used for minors outside of beauty pageants, but the stats are >12,000 injections in minors as of 2009, almost double the number from 2008. And as a South Shore Long Island native, I get to say this: Obviously this is in New Jersey.

San Fran to vote on male circumcision ban: The group advocating for the bill looks to "protect ALL infants and children in San Francisco from the pain and harm caused by force genital cutting," citing autonomy over one's body -- and the US ban on female genital mutilation -- as the need for such a law. Needless to say, Jews are upset, anyone concerned about spreading STDs and HIV is upset, and the chief of pediatric urology at UCSF calls it "a bunch of nonsense."

Policy Things I Think Are Interesting, Part II

1. Recently, I was talking to a fellow student about the new MSSNY policy to remove the exemption for off-shore students to get NYC clerkships. At one point, she said, That's all well and good, but what can MSSNY actually do about it? As I've mentioned before, AMA and MSSNY are advocacy groups that represent physicians' and medical students' interests. They have political action committees -- AMPAC and MSSNYPAC, respectively -- and those PACs have lobbyists to voice our concerns to state and federal government officials. The groups care about expanding health coverage for the uninsured, reforming medical liability, and graduate medical education. Is there something you care about? Join the Physicians Grassroots Network! As a member of "the leading voice for America's physicians in Washington DC," you have a hand in shaping the nation's health and health policy for the better. Get involved today!

2. Public Smoking Ban May Be Nationwide by 2020: It's a misleading title, actually. The CDC collected data on the trend of banning public smoking (in bars, restaurants, etc.) over 25 states in the last 10 years and extrapolated it -- if the trend continues, "the entire nation could have similar bans by 2020." This would be a great advancement, since second-hand smoking has dire health consequences, causing about 46,000 heart disease deaths and 3,400 lung cancer deaths in non-smokers each year. An issue, though, is southern states, of which none have public smoking bans in 2011. However, hope lies in the fact that individual communities have bans, and their sentiments might spread state-wide. There is especially an onus on state legislators in this region -- another reason to get involved with the AMA!

3. Telehealth Rated Top Medical Innovation: A survey of over 100 health sector leaders from around the world found that "technologies that combine data exchange with people-to-people interactions help enable easy, efficient, professional practices." This means electronic medical records and similar technology. The main benefits of telehealth, the study showed, was from increasing efficiency of the healthcare workforce and improving equitable access to care.

4. A New MCAT in 2015?: The AAMC has recommended a series of updates to the trauma-inducing MCAT that would be enacted in 2015 (if all the recommendations are adopted). The new and questionably improved test would have a stronger focus on cell/molecular biology, biochemistry, and social/behavioral sciences. The changes reflect the boon of research in the former fields since the MCAT was last completely revamped (ca. 1990) as well as the importance of ethics and cultural competency in medicine. The updates would also extend the test by another 90 minutes - yikes. Additionally, this would indirectly change pre-med requirements and force students to front-load more upper-level science classes into their college education.

What Happens When We're in Class All Day

Lauren Gluck here, your friendly neighborhood VP of Policy & Legislation. It can be hard to stay updated on all the goings-on of health news and policy, so I'm going to try to bring it to you. I'll take five of the most relevant and interesting stories/articles/websites and break them down into need-to-know information. As always, if you have any questions or comments, e-mail me at lgluck01@gmail.com.

1. HealthCareandYou.org: The brainchild of the ACP, AMA, AAFP, AAP, and many others, this website is a fairly user-friendly guide to decoding what the Affordable Care Act means to you, broken down by state, age group, etc. Take a look at the "timeline" header for a year-to-year evaluation of how ACA will affect >65, <65, physicians, and small business owners.

2. AMA promotes Graduate Medical Education funding: Remember how the MSSNY-MSS called for advocacy to increase residency/GME spots and funding? The AMA is doing just that! This article says, "To ensure an adequate physician workforce and better access to care, proper GME funding is a must." Some of AMA's solutions include: expand GME programs geographically to areas in need; extend GME to include non-hospital training sites, like outpatient settings, nursing homes, and community health centers; and create an all-payer GME system that includes federal and/or state mandates.

3. New ACGME resident duty hour standards: As of July 1 2011, the Accreditation Council for Graduate Medical Education will enact new rules for how long residents can work. Some of the updates include: 16-hr (PGY1) and 24-hr (PGY2+) max within 80-hr workweek, one-day-off-in-seven standard, direct supervision for interns (they'll never be the only doctor on their service), and maximum 6 consecutive nights of night float. (Here's a link to all the rules, plus specific rules by specialty program.) How do you feel about this? Take a quick survey from the Eastern Virginia Medical School Dept. of Surgery to voice your opinion as a medical student!

4. How Can I Help Patients Change Unhealthy Behaviors?: Here's an issue I've encountered a lot in preceptor, and I'm sure I'm not alone. This article focuses on Collaboration, Autonomy, and Education to help patients adopt healthier habits. The author tells us to: 1) Resist the "righting reflex" -- you know, when you think explaining the medicine behind, say, smoking, will magically help your patient quit, but often makes the patient resist the change; 2) Understand the patient's motivations; 3) Listen to the patient; and 4) Empower the patient. Easy enough, right? Well… We'll get there.

5. The AMA-MSS Annual Meeting is coming up from June 15-18 in Chicago. It's a great opportunity to meet medical students from all over the country and to learn about issues important to us as medical students and future physicians. Scheduled events include: 3 days of educational programs on a wide range of topics; policy-making sessions; a medical specialty showcase; leadership elections; and an AMA National Service Project event. Interested in attending? Register (free!) here. A few of us from the UB AMA-MSS Executive Board will be going, so you won't be alone!

AMA's 5K Fun Run

To further promote healthy living, the UB AMA hosted a 5K Fun Run yesterday afternoon, April 14th. There were about 15 students who participated. Water and healthy snacks were provided to the participants.


To view their course taken click on this link: MAP
To view more pics CLICK HERE