Public Health

Public Health Forum: The Social Determinants of Health

Posted in Health, Health Policy, Public Health, Public Health Leadership Forum on March 9th, 2017 by MMS Communications – Comments Off on Public Health Forum: The Social Determinants of Health

MMS President Dr. James S. Gessner

Good health includes much more than access to care. Research has demonstrated that a range of factors – such as environmental conditions, education, employment, and social and economic status – play key roles in a person’s health.

These factors – the “social determinants of health care” – will be the focus of the Medical Society’s 13th annual Public Health Leadership Forum taking place on Tuesday, April 4, 2017 from 1 – 5 p.m.

“Access to care and our health care system are certainly essential to good health,” says James S. Gessner, M.D., President of the Massachusetts Medical Society, “but a host of other factors come into play that contribute to healthy behaviors and prevent premature death. It’s important for the medical community to recognize all those elements and how they affect a patient’s health, and to be prepared to counsel their patients in a way that reflects social factors.”

The forum, entitled Social Determinants of Health: Improving Population Health Through Prevention- Based Care, will examine what policy makers and the medical community can do to acknowledge the impact of these factors on health.

Hosted by Dr. Gessner and Steven Ringer, M.D., chair of the MMS Committee on Public Health, the forum will be moderated by Harold Cox, Associate Dean for Public Health Practice at the Boston University School of Public Health.

Featured Speakers are Thea James, M.D., Vice President of Mission and Associated Chief Medical Officer at Boston Medical Center, who will deliver the keynote address, and Monica Bharel, M.D., M.P.H., Commissioner of the Massachusetts Department of Public Health, who will speak during the second half of the program.  The program also includes panel discussions with local experts on the topic.

For the complete agenda and to register for the event, click here.

 

 

The President’s Podium: Physicians and Gun Violence II

Posted in Public Health, violence on February 13th, 2017 by MMS Communications – Comments Off on The President’s Podium: Physicians and Gun Violence II

by James S. Gessner, M.D., President, Massachusetts Medical Society

Last June, I devoted a President’s Podium to the subject of physicians and gun violence, noting our long-standing policy on firearm violence and the more recent efforts MMS has made to address this growing public health crisis.

Our latest activities include the creation of continuing medical education courses, based on content from our 2016 Public Health Leadership Forum, and a dedicated website at www.massmed.org/firearms, offering a variety of resources on firearm violence and gun safety.

Today I had the privilege of standing with Massachusetts Attorney General Maura Healey and Massachusetts law enforcement officials to announce new initiatives in enhancing provider-patient relationships regarding firearms. I take this space to share my remarks from the press conference with you.

Madam Attorney General, on behalf of the physicians of Massachusetts, I thank you for the invitation to co-sponsor and participate in today’s event.  It is an honor to stand here with you, other health care leaders, and law enforcement officials to remind everyone what has been evident for some time:  that gun violence is a major public health threat.

That physicians are collaborating in this event and are taking a stand against gun violence alongside law enforcement should not be considered unusual. For more than 20 years, our state medical society has been engaged in efforts to reduce violence in many forms. 

The physicians of our Committee on Violence Intervention and Prevention since 1995 have provided resources for both physicians, health care providers, and patients in such areas as intimate partner violence, bullying, child abuse, and human trafficking.  Gun violence has been prominent among those topics.


Physician efforts at gun violence have been directed at reducing deaths and injuries, making gun ownership safer, promoting education among health providers, and encouraging research to understand the risk factors related to gun violence.

The numbers alone make it abundantly clear that firearm violence is indeed a public health issue: more than 130 mass shootings have occurred in 39 states since 2009; more than 36,000 persons die from firearm injuries in the United States every year with 64 percent being suicides and 33 percent homicides; on an average day, more than 90 Americans are killed with guns, including seven children and teenagers; and for every person killed by a gun, two more are injured.  The number of deaths from firearms are rivaling those from motor vehicle accidents and in many states have surpassed vehicle fatalities.

Massachusetts, however, stands out, with the lowest gun death rate in the country for 2015, the last year for which statistics are available.  We may pride ourselves on having the lowest death rate, but let us remember that 213 people in Massachusetts still lost their lives to firearms in that year.    

Strong firearm laws have contributed to the state’s low death rate.  But awareness and education must also play important roles, and the Massachusetts Medical Society is pleased to continue its educational efforts in collaboration with Attorney General Healey’s office and law enforcement leaders across the state in educating individuals about safe storage and disposal of firearms, and in encouraging health care providers to talk to their patients about gun safety.  These efforts complement our Society’s continuing medical education courses on firearm violence.

Increasingly, physicians are making their voices heard about gun violence.

Two years ago, more than one dozen physician organizations, along with the American Public Health Association and the American Bar Association, issued a call to action, declaring that deaths and injuries from firearms are a major public health problem in the United States.  Last year, the American Medical Association adopted a policy calling gun violence in the United States a “public health crisis.”

Also last year, our medical society sponsored a public health forum on firearm violence, featuring community leaders and public health and law enforcement officials, and Attorney General Healey was kind enough to accept our invitation to be the keynote speaker for that event.

In her remarks, she highlighted the importance of physician participation in curbing gun violence, and said it will require a “partnership” with physicians.  Physicians agree, Ms. Healey, and I will conclude my remarks by saying “You can count on that.”  

The President’s Podium appears periodically on the MMS blog, offering Dr. Gessner’s commentary on a range of issues in health and medicine.

Pictured: Covers of brochures for patients and physicians/health care providers provided by the Massachusetts Office of the Attorney General and the Massachusetts Medical Society and endorsed by the Massachusetts Chiefs of Police Association and the Massachusetts Major City Chiefs of Police. Available free via download from www.massmed.org/firearms

 

IM-16 Annual Oration: Zika – Responding to the Challenges of an Emerging Infection

Posted in Health, MMS Oration, Public Health on December 5th, 2016 by MMS Communications – 1 Comment
Dr. Alfred DeMaria Jr.

Dr. Alfred DeMaria Jr.

In delivering the Annual Oration at the Interim Meeting, Alfred DeMaria, Jr., M.D., Medical Director for the Bureau of Infectious Disease of the Massachusetts Department of Public Health, urged physicians to understand the origins of the Zika virus and to grasp its symptoms and dangers   to become better prepared to treat patients should they become infected. He also encouraged physicians to stay abreast of ongoing research into the virus’ symptoms. While there is currently no known vaccine or medicine for Zika, medical researchers are striving to develop better preventive and treatment methods.

Dr. DeMaria said that Zika was first discovered over 70 years ago by medical researchers in Uganda. It was limited in its scope of infection to a few cases, most in that region. Since 2007, however, due in large part to global travel, Zika has become an emerging infection that has spread and infected millions worldwide.

Spread mostly by the infected Aedes aegypti mosquito that bites humans during the day and night, Zika can be passed from a pregnant woman to her fetus. Infection that occurs during pregnancy can cause certain birth defects, including microcephaly. Dr. DeMaria noted that 40 percent of all calls to the state’s epidemiology information telephone line are Zika related. The state has also set up an informational website. Because Massachusetts already tracks mosquitos for West Nile virus and Eastern equine encephalitis, the state is prepared to respond to the emerging virus and very few cases have been reported in the state.

Dr. DeMaria’s presentation may be viewed here.

 

Statement from MMS President on Passage of Question 4

Posted in Drug Abuse, Health Policy, Public Health on November 9th, 2016 by MMS Communications – 1 Comment

“It is disappointing that the commercial interests of marijuana have won out over the health and safety of citizens in the Commonwealth.  Physicians will continue their advocacy to warn citizens about the dangers of recreational marijuana and pledge to work with state officials to ensure that public health oversight, protections for teens and adolescents, and provisions for education, treatment and recovery are included as the law is implemented.”

James S. Gessner, M.D.
President, Massachusetts Medical Society
November 8, 2016

MMS Restates the Risks of Marijuana

Posted in Health, Health Policy, Public Health on November 4th, 2016 by MMS Communications – Comments Off on MMS Restates the Risks of Marijuana

The following statement from MMS President James S. Gessner, M.D. was issued November 4 in response to a press conference held by proponents of Question 4 and featuring physicians who advocate for the legalization of recreational marijuana.  Coverage of the event may be read here.

“Presenting recreational marijuana as something most physicians believe is beneficial to health is deceiving and dishonest.  Massachusetts already has a program for medical marijuana, strictly regulated by the Department of Public Health.  Question 4 provides no public health oversight and directs no revenue to health or substance abuse education or treatment.

The facts are that marijuana presents a real risk of addiction. Its use damages the developing brains of young people, risks pregnancy, and increases the risk of accidents.

We urge voters to read the ballot question carefully.  Question 4 is bad policy and bad for public health.  Those are the reasons why the Massachusetts Medical Society, 11 physician specialty organizations, hospital and nursing associations, and other health care groups in the state are strongly opposed to Question 4.”

The public health dangers of recreational marijuana are further outlined in this commentary by Dr. Gessner and in this essay by five health care professionals from McLean Hospital.  More information on marijuana and the risks it presents is available on the MMS website and at the National Institute of Drug Abuse.

 

 

MMS Responds to Column on Question 4

Posted in Drug Abuse, Health, Health Policy, Public Health on November 3rd, 2016 by MMS Communications – Comments Off on MMS Responds to Column on Question 4

In a column entitled Countering the anti-pot hysterics with a ‘yes’ on Question 4 published October 28 online in The Boston Globe, WGBH’s Margery Eagan took the opponents of recreational marijuana to task, labeling them as “hysterics” who are engaged in “reefer madness.”

In the column, she accuses the MMS of “shameful” behavior in its opposition to marijuana (both medical in 2012 and recreational in 2016).recreationalmarijuana_ballotquestion_image_990x450

MMS responded to the column October 31 in a letter to the editor from MMS President James S. Gessner, M.D. As of this posting, the letter has not appeared, so we publish it here for our members to read.

Marjorie Eagan may believe that opposing marijuana is “shameful” behavior by physicians, but her willingness to ignore the public health effects of legalization and discount the threat to children in favor of having a “really fun time” is simply irresponsible. (Countering the anti-pot hysterics with a ‘yes’ on Question 4, Oct. 28). Marijuana is not the harmless substance she and the proponents of Question 4 claim it to be. 

Today’s marijuana has four times the amount of the mind-altering THC substance it had in years past, and its use can lead to addiction, impair cognition, risk pregnancy, and damage the developing brains of adolescents.  Those are the facts, not reefer madness hysteria. Question 4 also offers no public health oversight and provides no resources for prevention, education, or treatment.  It represents bad policy, and physicians take pride in advocating for public health over the ready access to a substance that can cause harm.

MMS and 11 physician specialty societies in Massachusetts have stated their strong opposition to Question 4 for a host of reasons. We urge voters to visit the National Institute on Drug Abuse and MMS websites for information on recreational marijuana and watch the October 30th CBS 60 Minutes report on the effects of recreational marijuana in Colorado. All three indicate that marijuana is not the harmless substance many people think it is.

 

Senator Markey Headlines MMS Opioid Summit

Posted in Health, Health Policy, opioids, Public Health, Uncategorized on November 1st, 2016 by MMS Communications – Comments Off on Senator Markey Headlines MMS Opioid Summit

On October 31, MMS sponsored a leadership summit on opioid addiction, Medication Assisted Treatment: Improving Access to Evidence-Based Care, an event intended to raise awareness of the need for medication assisted treatment for substance use disorder. The summit was attended by nearly 200 health care professionals at MMS headquarters in Waltham.

U.S. Senator Edward J. Markey, in his keynote address, said, “If we are going to reduce the supply for heroin, fentanyl, and illicit prescription opioids, we have to reduce the demand through treatment.”

“I will not stop fighting for legislative support on this issue,” Sen. Markey added, noting that despite his efforts and those of his colleagues, Congress has repeatedly rejected bills that would financially support addiction recovery programs.

He decried the rising numbers of deaths in Massachusetts due to overdoses  — doubling in number in the Bay State in one year — and warned that due to the potent influx of fentanyl from China and Mexico, “we are poised to lose even more lives.”

Gathered for the Opioid Summit: Dr. Dennis Dimitri, Dr. Monica Bharel, Sheriff Peter Koutoujian, Senator Edward Markey, MMS President Dr. James Gessner, MMS President-Elect Dr. Henry Dorkin, MMS Vice President Dr. Alain Chaoui

Gathered for the Opioid Summit: Dr. Dennis Dimitri, Dr. Monica Bharel, Sheriff Peter Koutoujian, Senator Edward Markey, MMS President Dr. James Gessner, MMS President-Elect Dr. Henry Dorkin, MMS Vice President Dr. Alain Chaoui

“Fentanyl is like a Class 5 hurricane making landfall,” Sen. Markey said. “It is the Godzilla of opioids. It is trending too quickly. It is so dangerous that first responders insist on wearing HazMat suits when they arrive at a scene of an overdose for fear they will become contaminated if exposed to it. We just don’t know how dangerous it is, and it’s coming to every street in America.”

Combatting the opioid epidemic requires vigilance coupled with “aggressive data collection, surveillance, increased prescriber and patient education, and the passage of aggressive new laws,” he said, that are aimed at controlling the influx and consumption of opioid drugs.

Markey alerted attendees to a report by U.S. Surgeon General Dr. Vivek Murthy on opioids due to be released early in 2017.

“The Surgeon General’s report on opioids will have a great societal impact,” Sen. Markey said, “similar to when the former Surgeon General years ago released the report about the health hazards of cigarette smoking. History will judge us, because now is our opportunity to respond to the greatest public health crisis in the 21st century.”

Several speakers, including Massachusetts Public Health Commissioner Monica Bharel, M.D., Middlesex County Sheriff Peter J. Koutoujian, and others called for a unified effort to destigmatize those who struggle with substance abuse.

“Treatment works, recovery is possible,” Koutoujian said. He described treatment programs sponsored by the Bay State’s criminal justice system that are helping inmates to return to society after incarceration better able to control their drug habits.

Dr. Bharel reminded the capacity audience to commit to viewing substance abuse addiction through the lens of the #StateWithoutStigMA campaign, launched last year by Governor Charlie Baker’s Opioid Working Group. The statewide campaign aims to eradicate the negative stereotype of drug misuse by declaring it to be a treatable illness.

MMS gathered more than a dozen national and local experts on the topic for this summit to speak to such topics as the treatment of addiction as a disease, the importance of psychological treatment and behavioral support, models of care, and supporting physicians and providers in treating opioid use disorders. It was hosted by MMS President James S. Gessner, M.D. and moderated by Dennis M. Dimitri, M.D., immediate past president and Chair of the MMS Task Force on Opioid Therapy and Physician Communication.

Presentations by the participants may be viewed here.  For highlights and photos from the event visit the MMS Twitter page.

Healthcare Leaders Urge a NO Vote on Question 4

Posted in Public Health on October 31st, 2016 by MMS Communications – Comments Off on Healthcare Leaders Urge a NO Vote on Question 4

recreationalmarijuana_ballotquestion_image_990x450The leaders of the Massachusetts Medical Society, the Massachusetts Health & Hospital Association, the Organization Nurse Leaders of Massachusetts, Rhode Island, New Hampshire, and Connecticut, and the American Nurses Association of Massachusetts today issued a joint statement urging voters to cast a “no” vote on Question 4 that would permit the legalization of recreational marijuana.

The statement was signed by MMS President James S. Gessner, M.D., MHA President and CEO Lynn Nicholas, ONL CEO Amanda Stefancyk-Oberlies, and ANAMass. President Cathleen Colleran Santos, D.N.P., R.N.

The statement called attention to a “misleading video advertisement and direct mail piece” directed to voters, implying that the ballot question is related to medical marijuana and that Question 4 has broad support from the healthcare community.  Neither is accurate.

Medical marijuana is already permitted in the Commonwealth, under strict regulations issued by the Department of Public Health, and Question 4 is unrelated to medical marijuana and pertains only to recreational marijuana.  Major health care organizations in the Commonwealth, including the MMS, have explicitly stated their opposition to Question 4, outlining the dangers to public and individual health and pointing out serious failings in the ballot question itself.

The complete statement issued this morning by the four organizations:

“As four of the state’s leading healthcare provider organizations, representing hospitals, health systems, doctors, nurses, and other healthcare providers, we stand firmly against Question 4 on the November 2016 ballot. Question 4 seeks to legalize the commercial sale of marijuana in Massachusetts, and poses a direct threat to the public health and safety of our patients and communities. We are proud to be part of an even larger coalition of healthcare, business, and community leaders – joined by a bipartisan group of state and local leaders – all aligned with the Campaign for a Safe & Healthy Massachusetts to oppose Question 4.

The corporate interests promoting Question 4 recently issued a misleading video advertisement and direct mail piece sent to voters across the Commonwealth. Both pieces incorrectly imply that this ballot question is about medical marijuana, which is already legal in Massachusetts, and also inappropriately indicate the question has broad healthcare community support.  Considering the comprehensive alignment of the state’s major healthcare organizations in opposition to Question 4, these advertisements are deceptive and inaccurate.  As healthcare leaders, we believe it is important for voters to know that healthcare professionals and organizations throughout the Commonwealth have a clear and unified message –Vote NO on Question 4.

Other healthcare organizations urging your opposition to Question 4 include: the Conference of Boston Teaching Hospitals, the Association of Behavioral Healthcare, Massachusetts Chapter of the American Academy of Pediatrics,  Massachusetts Chapter of the American College of Physicians, Massachusetts Academy of Family Physicians, Massachusetts Psychiatric Society, Massachusetts College of Emergency Physicians, Massachusetts Society of Anesthesiologists, Massachusetts Section of the American Congress of Obstetricians and Gynecologists, Massachusetts Gastroenterology Association, Massachusetts Society of Neurosurgeons, Massachusetts Association of Practicing Urologists, Massachusetts Orthopaedic Association, the Massachusetts School Nurse Organization, and the Health Foundation of Central Massachusetts.”

 

 

The President’s Podium: The Real Issue of Question 4

Posted in Health, Health Policy, Public Health on October 12th, 2016 by MMS Communications – Comments Off on The President’s Podium: The Real Issue of Question 4

by James S. Gessner, M.D., President, Massachusetts Medical Society

Citizens thinking about how to vote on Ballot Question 4 – whether or not to legalize recreational marijuana – should ask some important questions before casting their ballot.

How would our health and safety, and especially that of our children, be affected should recreational Dr. James S. Gessner, MMS President '16-'17_editedmarijuana become legal?  What affect will it have on our highway and occupational safety?  Should Massachusetts allow ready access to a substance with a potential for addiction when we are fighting an epidemic of opioid abuse that is already disrupting and destroying too many lives?

These are critical questions, because this referendum, more than anything else, is really about public health and safety.

Marijuana is not harmless. Its main ingredient – tetrahydro-cannabinol (THC) – is a mind-altering substance, and the amount of THC has been increasing steadily over the years. The THC content in marijuana today is four times stronger than it was in the 1980s.

We know that a risk of addiction exists with marijuana. According to the National Institute of Drug Abuse (NIDA), approximately 9 percent of those who use marijuana will become addicted. The rate jumps to 17 percent, or about 1 in 6, for those starting to use it in their teens and rises to 25–50 percent among daily users.

We also know its use contributes to cognitive impairment, presents a risk during pregnancy, poses a threat to highway and occupational safety, and can damage the developing brains of adolescents – the last being one of marijuana’s most troubling effects.

A 2014 article in the New England Journal of Medicine by NIDA Director Dr. Nora D. Volkow and her colleagues reviewed the current state of the science on the adverse health effects of recreational marijuana. Here is part of what they concluded:

Marijuana use has been associated with substantial adverse effects, some of which have been             determined with a high level of confidence…. As policy shifts toward legalization of marijuana, it is   reasonable and probably prudent to hypothesize that its use will increase and that, by extension, so will the number of persons for whom there will be negative health consequences.

In summary: the legalization of marijuana will lead to more marijuana use and more use will lead to more people with poorer health.

Physicians are especially concerned about the impact of this law on children and adolescents, despite a proposed ban on sales to anyone under 21.  An age restriction doesn’t work with tobacco and alcohol; it won’t work with marijuana. In Colorado, where legalization occurred in 2012, the state has seen an increase in marijuana use by youth 12-17 that is now 56 percent higher than the national average.

Adding to the concern is that teen perception of the risks of marijuana has decreased over the past decade, largely due to efforts to legalize medical and recreational marijuana.  The American Academy of Pediatrics has warned that increasing the availability of marijuana for adults, regardless of restrictions, expands access for youth and persuades them that it’s not dangerous – and that’s a wrong message to send to our young people.

Legalization will also likely to lead to greater danger on our highways, because the skills needed for driving – alertness, concentration, coordination, reaction time – are impaired with marijuana use.  In Washington state, where voters approved recreational marijuana in 2012, the number of fatal crashes involving drivers who recently used marijuana doubled in one year, according to a study by the AAA Foundation for Traffic Safety. Colorado has likewise seen a jump – 48 percent – in marijuana-related traffic deaths.

Those are compelling reasons against legalization. But the ballot question itself gives us more reasons to vote no on Question 4.

First, the referendum permits the sale of marijuana edibles, such as cookies, candies, snack foods, and drinks, which are especially appealing to children.

Second, it lacks any provision for public health oversight or authority in the development of regulations that would guide implementation of the law. And third, it has no allowance for any revenue from the sale of the drug to be earmarked for health education, prevention, or treatment programs.  These are serious failings.

A careful read of this ballot question reveals that this was created by and for the marijuana industry, without regard for public health in the Commonwealth.

The Massachusetts Medical Society and 10 physician specialty groups, representing a wide variety of medical specialties, including pediatrics, primary care, emergency medicine, obstetrics, and psychiatry, have stated their opposition to Question 4 for the reasons listed above.

We think preventing possible addiction, guarding our public health and safety, and protecting children and adolescents are far more important and valuable than the commercialization of marijuana and the “recreational” use of a substance capable of causing harm. We hope our patients think so, too.

The President’s Podium appears periodically on the MMS blog, offering Dr. Gessner’s commentary on a range of issues in health and medicine.  Versions of the above have been distributed to newspapers across the Commonwealth for publication as commentary. 

 

 

 

September Physician Focus: The Misconceptions of Obesity

Posted in Physician Focus, Public Health on September 1st, 2016 by MMS Communications – 2 Comments

Despite enormous attention and multiple programs created to reduce the condition, obesity remains prevalent in the U.S. with more than a third of the population considered obese.  Conventional wisdom has thought of obesity as primarily a lifestyle issue, with people eating too much and not getting enough physical exercise.  New research, however, is discovering that obesity is much more complex than first thought.

From left: Dr. Dale Magee, Dr. Scott Butsch, Dr. Fatima Cody Stanford

From left: Dr. Dale Magee, Dr. Scott Butsch, Dr. Fatima Cody Stanford

The September edition of Physician Focus examines the many other factors contributing to obesity and overweight with two physicians from the Massachusetts General Hospital Weight Center, Scott W. Butsch, M.D. and Fatima Cody Stanford, M.D., both members of the Society’s Committee on Nutrition and Physical Activity.  Hosting this edition is MMS Past President Dale Magee, M.D.

Among the topics of conversation are the importance of changing one’s diet to healthier foods, the role of the body’s fat cells in obesity; how ‘gut bacteria’ affects weight; and how such factors as sleep, stress, and medications can contribute to obesity.

Physician Focus is distributed to public access television stations throughout Massachusetts, reaching residents in more than 275 cities and towns. It is also available online at www.physicianfocus.org, www.massmed.org/physicianfocus and on YouTube.