Looking Out for Our Patients

I drove to my CPM preceptor this week thinking, as I often do, "There is so much to learn, to appreciate from this experience -- if only there were four more hours in the day." It's easy to get bogged down by studying for our GI test or our endocrine test and forget that we're all in medical school to, one day, care for patients. Shouldn't CPM be the good part? (No offense to CPM.)

There was a recent article in NEJM that said we shouldn't limit ourselves to caring for our patients, but we should also recognize the need to care about them. It's great to know how to treat a heart attack, but it's also important to know that patients can get a lot of those meds at Wal-Mart -- or WEGMANS! -- for $4/month. The same goes for diabetes, but we have to realize that if you're homeless or you don't have a refrigerator, you can't store your insulin. That is honestly something I had never thought of before reading this article. Perhaps most impressive about the article is the author: Nick Rohrhoff, a senior medical student at the University of Miami. Some of you might recognize his name from a webinar about health care reform he gave to UB last year as the AMA GRAF (Gov't. Relations Advocacy Fellow). Check out the full article here (probably through UB's network, if you're not otherwise subscribed to NEJM).

In a more policy-oriented take on caring about patients, there's been a lot of discussion about transparency to improve patient care vs. hindering physicians' autonomy, and even impairing their professional reputations. Check out this article about peer review as a patient safety initiative, and whether the results of review should be released on the internet or in malpractice suits. Currently, everything is kept "privileged" as per a 2005 federal act, but that hasn't stopped some courts from allowing "facts" to be admissible or, in legal terms I don't exactly understand, discoverable. Check out this article about disclosing physicians' financial relationships with drug and device manufacturers that include anything over $10, including a CME course or a lunch. A lot of physician groups are worried about incorrect information ending up on-line, especially since docs can't correct data on a rolling basis. Then there's always the issue of internet reviews of physicians and hospital score cards -- for that, check out this YouTube video from Hofstra University which, while a few years old now, has some interesting points. Watch out for MSSNY's own Dr. Charles Rothberg (our MSS advisor).

For more MSSNY fun, be sure to stop by Butler Aud. this Monday, 3/19 at 5:30 for the annual Physician Advocacy Day webcast. Not only will it be a great opportunity to learn more about NYS goings-on regarding health care, but it will also be a great networking event, as local docs and professors will be there with us.

If these issues -- or anything else regarding health care or patient care -- speak to you, keep your calendars open on Sunday, 3/25 at 6 for a resolution writing webinar (from home) and on Wednesday, 4/11 at noon in Butler for a more convenient resolution writing workshop hosted by your current AMA E-board. We'll also talk about the AMA national meeting itself, which will be June 14-16 in Chicago. Registration opens on April 2, and the tentative meeting agenda can be found here.

In the Face of Failure

Alas, the congressional supercommittee failed to reach a concensus regarding deficit reduction -- so Medicare payments, GME funding, and many other medical and public health programs will be automatically cut as of 2013. Advocates are worried that the cuts will affect biomedical research (especially NIH funding), CDC funding (including emergency responses and subsidized vaccines), andHIV/AIDS therapy for low-income patients, to name a few.

The AMA is especially concerned about the new Medicare cuts, given that there is already a 27% payment cut scheduled for Jan 1 of next year. AMA Pres Peter Carmel said, “Congress has ignored the reality that short-term patches have grown the problem immensely. The cost of repealing the formula has grown 525 percent in the past five years and will double again in the next five years.”

In other federal government news, CMS Director Donald Berwicke is out, Deputy Administrator Marilyn Tavenner is in. Berwicke was appointed to the position in 2010 without congressional confirmation, with Republicans wary of his "pro-health care rationing" stance. Tavenner is similarly unlikely to be confirmed -- apparently no CMS director has been since 2009 -- and instability within the agency is likely to remain unchanged. The AMA supports Tavenner, though, if that helps things.

With so much going on in the world of health care this week, you can't help but get riled up. If you want to use this passion to get more involved with the AMA, the national Standing Committees are again accepting applications through Thurs 12/1! A bunch of us from your UB AMA hold positions on various committees, so feel free to e-mail us at sunybuffaloama@gmail.com with any questions.

The News from New Orleans

Right now, your delegation from SUNY Buffalo is sitting in the main ballroom at the New Orleans Sheraton for the Interim AMA meeting. Dr. Peter Carmel, the current president of the AMA, is encouraging -- nay, URGING -- all medical students to call the following number:

1 (800) 833-6354

It's a telephone service that links you to leave a voice message for your congress person to tell him/her that IT IS ESSENTIAL TO INCREASE THE GRADUATE MEDICAL EDUCATION CAP NOW. (That's literally all you have to say. Say this, maybe your name, and hang up. Easier than Med & Society.)

Otherwise we won't have jobs when we graduate. Well, some second years will. But the first years won't.

So take two minutes out of your studying, or during a commercial of whatever your sporting event of choice is, and call that number. Because, in the words of someone much wiser than I, it is essential to increase the graduate medical education cap now.

Hi welcome to Walmart, the Doctor/NP/PA will be seeing you shortly!

I will admit I am an NPR slave. I listen to it every morning on the days I decide to come into class-today is not one of those the days. So every time I read or hear a story about medicine or healthcare reform I am especially attentive. Today I read this article:

http://www.npr.org/blogs/health/2011/11/09/142156478/wal-mart-plans-ambitious-expansion-into-medical-care?sc=fb&cc=fp

What this article discusses is retail behemoth Wal-Mart's potential foray into providing primary care clinics in its stores. When I first saw this I immediately laughed. Of course Wal-Mart is trying to take over the world, this is just one more step in their global domination plan. They already have pharmacies, grocery stores (in their super Wal-Marts) as well as auto shops all under the same giant roof. In fact the optometrist I go to see is a Wal-Mart optometrist. So this is a logical next step. I guess I can't be too skeptical because Wal-Mart as a business rarely makes bad business decisions (I say business decisions because cutting the insurance policies of part time workers isn't the most ethical of decisions)

The portion of this story that may be especially relevant to medical students is the current plan has these future clinics being staffed primarily with nurse practitioners and physicians assistants. Lately there has been a great deal of controversy over the title of doctor and the roles of NPs and PAs. Could Wal-Mart clinics be a game changer that effects the way medicine is provided? The author of the article doesn't seem to think so, but then again this is Wal-Mart were talking about.

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.