Health

June Physician Focus: Infectious Diseases

Posted in Health, Physician Focus, Public Health, Uncategorized on May 30th, 2014 by MMS Communications – Comments Off on June Physician Focus: Infectious Diseases

Measles has hit a 20-year high in the U.S., and mumps and whooping cough are likewise reappearing with disturbing frequency.  Warm weather approaches, raising the threat of mosquito- and tick borne illnesses, and new, emerging diseases such MERS and dengue are now reaching the U.S.

A stubborn resistance to immunization, global travel, and the seasonal return of mosquitoes and ticks are contributing to an increased threat of infectious disease this year.

The June episode of Physician Focus highlights several common and emerging infectious diseases, discussing their origins, symptoms, effects on health, and the steps patients can take to safeguard themselves from infection.  The conversation also covers the critical role vaccines play in preventing infectious diseases and what people should do prior to international travel to minimize the risk of disease.

The guest for this program is infectious disease specialist George Abraham, M.D., M.P.H., F.A.C.P. (seated, photo), who joins program host B. Dale Magee, M.D., past president of the MMS for the discussion.  Dr. Abraham is Associate Chief of Medicine at Saint Vincent Hospital in Worcester, Professor of Medicine at the University of Massachusetts Medical School, and Massachusetts Governor for the American College of Physicians.

Dr. Abraham earned a master’s degree in public health in infectious disease epidemiology from the Johns Hopkins School of Public Health and has served as a World Health Organization fellow in HIV disease in Uganda and as an infectious disease fellow at the Communicable Disease Center in Singapore.

Physician Focus is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.massmed.org/physicianfocus, www.physicianfocus.org, and on YouTube.

May Physician Focus: Oral Health

Posted in Health, Physician Focus, Public Health, Uncategorized on April 30th, 2014 by MMS Communications – Comments Off on May Physician Focus: Oral Health

Research has shown that oral health and physical health are linked,  and that problems with oral health are associated with such conditions as heart disease, diabetes, and pneumonia.

This connection between the health of the mouth and the rest of the body has led to a growing relationship between physicians and dentists to improve the overall health of their patients. The establishment of the Committee on Oral Health by the Massachusetts Medical Society and the Massachusetts Dental Society’s Connect the Dots program are two examples of collaborative efforts between the professions.

The May episode of Physician Focus, Oral Health, takes a closer look at this cooperative effort between physicians and dentists and how it can improve patient care.

Guests Hugh Silk, M.D. (photo, center), family physician and Chair of the MMS Committee on Oral Health, and Michael Wasserman, D.D.S. (right), President of the Massachusetts Dental Society, join host and primary care physician Bruce Karlin (left) to discuss the many aspects of oral health.

Among the topics of conversation are how oral health affects overall physical health, obstacles that prevent good oral health, populations most vulnerable to poor oral health, the importance of dental insurance, oral cancer, the benefits of fluoridation., and how the professions are working together to promote oral health.

Physician Focus is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.massmed.org/physicianfocus, www.physicianfocus.org, and on YouTube.

April Physician Focus: Health Care Disparities

Posted in Health, Health Policy, Medicine, Physician Focus, Primary Care on March 31st, 2014 by MMS Communications – Comments Off on April Physician Focus: Health Care Disparities

A dozen years ago, the Institute of Medicine released its groundbreaking report on health care disparities, Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. That report concluded that wide differences exist between racial and ethnic minorities and whites in access to health, availability of insurance, and the quality of care they received.

The IOM report made public a topic that today still commands the attention of the medical community, and it’s the subject of the April episode of Physician Focus.

Guests for the show are Ronald Dunlap, M.D. (photo, center), President of the Massachusetts Medical Society, and Milagros Abreu, M.D., M.P.H. (right), Vice Chair of the MMS Committee on Diversity in Medicine and Founder and President of the Latino Health Insurance Program in Framingham. Alice Coombs, M.D., (left) past president of MMS and a member of the American Medical Association’s Commission to End Health Care Disparities, serves as host.

Among the topics of conversation by the physicians are the causes of health care disparities, their consequences on the health outcomes of patients, and the steps both physicians and patients can take to reduce these differences and improve care.

April’s Physician Focus is part of a renewed attention to the issue of health care disparities by the Medical Society, as outlined by Dr. Dunlap in his blog post of March 28 (below).

Physician Focus is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.massmed.org/physicianfocus , www.physicianfocus.org, and www.massmed.org/itunes.

The President’s Podium: It’s Time for Equal Treatment

Posted in Health, Medicine, Physician Focus, Primary Care on March 28th, 2014 by MMS Communications – 1 Comment

By Ronald Dunlap, M.D., President, Massachusetts Medical Society

When the Institute of Medicine published its groundbreaking report on DSC_0003 Dunlap 4x6 color 300 ppi_editedhealth care disparities in March of 2002, the topic touched a raw nerve in the medical community. Almost overnight, health care disparities became a top priority for medical professionals and policymakers alike.

Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care disclosed what all of us consider to be a distressing and unacceptable aspect of health care in America: that racial and ethnic minorities receive poorer quality medical care than whites, even when such factors as insurance coverage, ability to pay, and access to care were equal among the groups.  It is also quite clear that socioeconomic status and poverty contribute to health care disparities.

More than a decade after the IOM’s report, health care disparities still commands our attention, a topic increasing in importance, as our population continues to undergo demographic changes.

For years, the Massachusetts Medical Society has been one of the leading voices in the effort to reduce health care disparities in the Commonwealth. Our members have worked to educate our colleagues about the issue. We have testified before the state legislature in support of bills to reduce disparities in care. We have examined the ethical aspects of disparities, and our patient education efforts have focused on the subject.

I am proud to say we are continuing our efforts.

Our 2014 Public Health Leadership Forum, The Impact of Health Care Reform on Health Care Disparities (occurring Friday, April 4 from 9 a.m. to 1 p.m.) brings together some of the nation’s best health care experts to discuss how reform efforts may affect disparities in care. This forum, moderated by Lenny Lopez, M.D., Chair of the MMS Committee on Diversity in Medicine, adds a new dimension to our efforts on health care disparities, as it is being conducted in collaboration with the Commission to End Health Care Disparities.

The Commission was formed in 2004 by the American Medical Association and the National Medical Association, with the National Hispanic Medical Association joining soon thereafter, to respond to the IOM’s report. It has become the nation’s leading advocate to reduce disparities in care.  The MMS has had and continues to have a seat at the table: Alice Coombs, M.D., MMS past president and past chair of the Committee on Diversity in Medicine, has represented MMS on this committee for several years.

Among the scheduled participants in our Leadership Forum are Commission Co-Chairs Jeremy Lazarus, M.D., immediate past president of the American Medical Association, and Lawrence Sanders, M.D., president-elect of the National Medical Association. Besides looking at the effect of reform on disparities in care, participants will also address how changes in policy and practice and such areas as pay for performance and technology can reduce disparities in care.

Our continuing efforts also include a new dedicated web page on health care disparities that provides research and reports on the topic, resources and activities to identify and reduce disparities, strategies and tools to help eliminate them in the physician’s office, and information on the role of a diverse physician workforce in addressing differences in care.

And to bring the message beyond the medical profession, our April episode of Physician Focus, the MMS’s monthly patient education television program, discusses the issue in depth, describing the causes and consequences of health care disparities and what physicians and patients can do to reduce these differences and improve care. Hosting this show is Dr. Coombs, with Milagros Abreu, M.D., Vice Chair of the Committee on Diversity in Medicine, joining me as a guest. An accompanying print article is also being distributed to media across the state.

Twelve years after the Institute of Medicine’s report, we are making progress in reducing disparities, certainly more slowly than we would like, but making progress nonetheless. It is clear that reducing disparities will involve the efforts of everyone in health care – all physicians, providers, payers, and policymakers, and, yes, even patients.

My hope is that our upcoming efforts will signify a renewed commitment to equal treatment. It is a goal worth pursuing and achieving, and it’s time is long overdue.

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

  

 

February Physician Focus: Crohn’s and Colitis

Posted in Health, Medicine, Physician Focus on January 31st, 2014 by MMS Communications – Comments Off on February Physician Focus: Crohn’s and Colitis

Medicine in the 21st century constantly seeks answers, yet precise explanations can still be elusive. Such is the case with Crohn’s disease and ulcerative colitis, part of a group of chronic digestive disorders known as inflammatory bowel diseases.

For patients, Crohn’s and colitis can be frustrating. Their causes are unknown, they have no known risk factors (although they tend to occur in families), no preventive measures can be taken to avoid them, and because their symptoms are non-specific to the diseases, most cases are diagnosed months or years after symptoms first appear. Their effects on daily living, social and professional activities, can also be discouraging.

The February episode of Physician Focus provides a basic introduction to these digestive diseases. Both conditions afflict a total of nearly 1.4 million Americans, with men and women in equal numbers.

The special guest for this program is Andrew Warner, M.D., Chief of Gastroenterology at Lahey Health in Burlington and co-author of 100 Questions & Answers About Crohn’s Disease and Ulcerative Colitis. Hosting this edition is Lynda Young, M.D., Clinical Professor of Pediatrics at Children’s Medical Center at UMass Memorial Healthcare in Worcester and a past president of the Massachusetts Medical Society.

The conversation between the physicians covers details about the symptoms of the diseases; their similarities and differences; how they affect a patient’s health and quality of life; how the conditions are diagnosed; and how the diseases are treated, including dietary plans, medicines like steroids and biologics, and surgery.

Physician Focus is available for viewing on public access television stations throughout Massachusetts. It is also available online at www.massmed.org/physicianfocus, www.physicianfocus.org, and www.massmed.org/itunes.

President’s Podium: 50 Years and Still Counting

Posted in Health, Public Health on January 14th, 2014 by MMS Communications – Comments Off on President’s Podium: 50 Years and Still Counting

By Ronald Dunlap, M.D., President, Massachusetts Medical Society

Fifty years ago this month, Luther Terry, M.D. issued the U.S. DSC_0003 Dunlap 4x6 color 300 ppi_editedSurgeon General’s first report on smoking and health, marking the start of the nation’s campaign against tobacco.  It is arguably the most important public health document ever published: it called attention to the destructive nature of a product that nearly half of the U.S. population at the time used routinely and without fear.

Since 1964, 36 additional reports on the subject have followed, many establishing clear and convincing connections between tobacco, diseases such as cancer and heart disease, and nicotine addiction.

On Friday of this week, the Surgeon General will issue a 37th report: 50 Years of Progress; it will  highlight the successes of anti-tobacco efforts over five decades, present new data on tobacco’s health impact, and suggest ways to end the tobacco epidemic in the U.S.

The anniversary of the first report has attracted great attention, as it should. Newspapers large and small, from The Washington Post to the Cape Cod Times, have published editorials on its meaning, and the Associated Press has even returned to its archives, distributing its first account of the event from 1964.

The anniversary reminds us that we have much to celebrate. We have cut the adult smoking rate from 43 percent in 1964 to 18 percent today. Per capita consumption of cigarettes has dropped by 70 percent.  The incidence of lung cancer has declined, as have deaths from heart disease and stroke.

Many elements have led to this stunning reduction in tobacco use. Prevention and treatment strategies, such as approved medications for tobacco addiction and toll-free quit lines, have proved fruitful. So, too, have warnings on cigarette packages, limits on advertising, higher tobacco taxes, and laws restricting tobacco use in public venues. And new efforts are occurring: communities are raising the age to buy tobacco and prohibiting health facilities like pharmacies from selling tobacco products.

This latest Surgeon General’s report, however, also serves as a warning.

Tobacco in 2014 is still the leading cause of preventable disease and premature death in the U.S.  The Centers for Disease Control estimates that nearly 44 million American adults still smoke, and each year, tobacco use accounts for some 443,000 deaths. It also claims a huge part of our nation’s annual health care expense – at $96 billion in direct medical costs. Globally, according to the World Health Organization, tobacco accounts for some five million deaths a year, and kills more people than tuberculosis, HIV/AIDS, and malaria combined.

Today’s concern is greatest with youth, as nearly all tobacco use begins in childhood and adolescence. Every day, more than 1,000 youth under 18 become daily cigarette smokers.  Adolescents and young adults are susceptible to social influences to use tobacco, and the targeted marketing techniques by tobacco companies appeal to them.  The young are also more likely to use multiple tobacco products, and smokeless tobacco and new products such as flavored cigars and electronic present additional challenges. Indeed, the Surgeon General’s 2012 report – the first to explore tobacco data on young adults as a discrete population – has described tobacco use as a “pediatric epidemic, around the world as well as in the United States.”

Other vulnerable populations with high rates of tobacco addiction demand our attention as well: recent immigrants, the LBGT community, and individuals with mental illness, the last of whom, remarkably, consume about 44 percent of all cigarettes in the U.S.

To help draw attention to the topic locally, MMS has produced Smoking, Tobacco, and Health, the January episode of our patient education television program, Physician Focus.

Featuring Alan Woodward, M.D., MMS past president and current chair of Tobacco Free Mass, and Douglas Ziedonis, M.D., M.P.H., professor and chair of the Psychiatry Department at UMass Memorial Health Care and UMass Medical School, and hosted by James Kenealy, M.D., the program has been widely distributed across the Commonwealth and is available online. It examines the impact of tobacco on personal and public health, looks at what can be done to further reduce the use of tobacco, discusses new challenges such as e-cigarettes, and offers ways for people to quit smoking.

The program also includes a one-minute public service announcement on youth and tobacco recorded especially for MMS by Howard Koh, M.D., Assistant Secretary for Health in the U.S. Department of Health and Human Services and former Massachusetts Commissioner of Public Health.

I thank these physicians for their efforts and invite you to view their presentations at www.physicianfocus.org/tobacco, not so much as a reminder of the success we’ve achieved, but more as a notice of the work we have yet to do.

The President’s Podium appears regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.

Editor’s note:  The U.S. Surgeon General’s latest report, The Health Consequences of Smoking: 50 Years of Progress, was issued Friday, January 17, and the full report is available here. An Executive Summary is located here. The Surgeon General has also produced a Consumer Booklet, available here.

 

 

December Physician Focus: Violence and Mental Illness

Posted in behavioral health, Health, mental health, Physician Focus, Public Health, violence on December 2nd, 2013 by MMS Communications – Comments Off on December Physician Focus: Violence and Mental Illness

Mass killings such as those at the Washington Navy Yard earlier this year and in Aurora, Colorado and Newtown, Connecticut last year continue to raise alarms about the link between violence and mental illness. A recent Gallup poll found that nearly half of Americans – 48 percent – blame the mental health system “a great deal” for mass shootings and for failing to identify individuals who are a danger to others.

The December episode of Physician Focus offers a perspective on the topics of violence and mental illness and explores the link between them.

Guests are John Bradley, M.D. (center, photo), Chief of Psychiatry and Deputy Director of Mental Health for the Veterans Administration Boston Healthcare System and former Chief of Psychiatry at Walter Reed National Military Medical Center, and Michael Tang, D.O., M.P.H. (right), psychiatry resident at Harvard South Shore Psychiatry, a program of Harvard Medical School. Hosting this program is John Fromson, M.D. (left), Vice Chairman for Clinical Affairs of the Department of Psychiatry at Brigham and Women’s Hospital and Chief of Psychiatry at Brigham and Women’s Faulkner Hospital.

Among the topics of conversation are the definitions of violence and mental illness, predictors and risk factors for violent behavior, the pervasiveness of violence in daily life, the role and impact of the media in covering violent acts, the relationship of violence to firearm access, and whether, as public opinion polls suggest, the mental health system has failed in identifying individuals who may commit violent acts.

Physician Focus is available for viewing on public access television stations throughout Massachusetts and online at www.massmed.org/physicianfocus and www.physicianfocus.org.

Physician Focus for November: Hepatitis

Posted in Health, Physician Focus, Public Health on November 1st, 2013 by MMS Communications – 1 Comment

The November episode of Physician Focus provides an introduction to hepatitis, a condition perhaps most well known to patients as a viral infection, but one with multiple causes, several variations, and potentially serious consequences.

This disease of the liver affects a total of more than four million Americans – many of whom are unaware they have the condition – and is a major cause of cirrhosis and liver cancer and death by infection, claiming some 15,000 lives every year.

Guests for the program are two gastroenterologists from Milford Regional Medical Center in Milford, Massachusetts, Albert Crimaldi, M.D., Ph.D. (right, photo) and Maggie Ham, M.D., (center). They join host and primary care physician Bruce Karlin, M.D. (left) to discuss the causes, types, prevention, and treatments of the condition.

The conversation includes a focus on two of the more prevalent forms of the disease: hepatitis C, a viral infection that reaches more than three million people and one that has been targeted by public health officials, and NASH, nonalcoholic steatohepatitis, or fatty liver disease, a condition becoming more prevalent as obesity rates remain high.

Physician Focus is available for viewing on public access television stations throughout Massachusetts and also available online at www.massmed.org/physicianfocus and www.physicianfocus.org.

The President’s Podium: A Tough Start, but Worth Pursuing

Posted in Health, Health Policy, Health Reform on October 23rd, 2013 by MMS Communications – 2 Comments

By Ronald Dunlap, M.D., President, Massachusetts Medical Society

We’re only a few weeks into the rollout of the Affordable Care Act, and DSC_0003 Dunlap 4x6 color 300 ppi_editedby most accounts, it’s been a rocky start at best.  Technology failings, consumer frustration, changing deadlines and other problems are all painting a gloomy picture of what might lie ahead. Even some physicians are expressing reservations, unsure that they’re going to participate in the exchanges.

Figuring out where we might be six or twelve months or more from now is almost impossible.  A massive overhaul of the nation’s health care system affecting such a big part of the nation’s economy will take time to settle. Even one of the program’s most ardent advocates admits the law is not perfect and “virtually any section or provision of this law could have been better.”

So we shouldn’t be swayed by daily reports in the media, whose members always seek instant results and immediate judgments on success or failure. Pundits pro and con are jumping on the best and worst aspects of what’s happening right now, quick to justify their viewpoints.

Since the ACA was passed three years ago, the nation has sought answers from Massachusetts as the first state to enact universal coverage. Reporters from around the country have been asking any number of questions: How did it happen? How has it affected patients? Do physicians like it? Are insurers behind it? How did it affect  costs?

Massachusetts will thus be forever linked to national health reform, and we can take some pride in that.  A broad coalition of different interests came together in 2006 to make it happen in Massachusetts. Physicians, notably, overwhelmingly supported the Massachusetts effort, with 70% in favor and only 13% opposed, according to a Harvard poll in 2009. And when asked about the law’s future, even more – 75% – wanted the law to remain in place.

When the ACA was first proposed, the Massachusetts Medical Society stated its support, saying “we believe this legislation should go forward, to fulfill the promise of providing all Americans with health insurance coverage and to enact long overdue insurance reforms. This legislation builds upon the groundbreaking Massachusetts universal coverage law. [It] is a first step to meaningful health care reform and achieving universal coverage for all Americans.”

At the same time we said it was important “that Congress enact legislation that ensured that patients will have access to physicians as well as correcting other problems with this bill,” specifically noting that it was crucial that Congress pass a permanent change to the Medicare physician payment formula and that certain provisions in the ACA, such as the Independent Payment Advisory Board, should be corrected,  as they could “undermine the quality of health care.”

Those important issues remain, along with the question of cost control (at both the federal and state levels). Physicians are continuing to work on them, both nationally and locally.

The judgment here is that the ACA is landmark legislation that, properly conducted, can result in enormous good for our country and our patients. Federal officials, however, must quickly fix the faults now plaguing the system before frustration breeds contempt that will erode a program that could benefit so many.

Despite its current failings, the negative public attitudes, and its future challenges, the Affordable Care Act still holds the promise of better care and better health outcomes for millions of our citizens. Those are goals certainly worth pursuing.

The President’s Podium appears regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.

The President’s Podium: Primary Care Competition

Posted in Accountable Care Organizations, Health, Health Policy, Health Reform, medical homes, Primary Care, Retail Clinics on October 15th, 2013 by MMS Communications – 1 Comment

by Ronald Dunlap, M.D., President, Massachusetts Medical Society DSC_0003 Dunlap 4x6 color 300 ppi_edited

The shortage of primary care physicians, besides creating longer wait times for both new and existing patients, is also changing how care is being delivered.

National pharmacy chains are seeking bigger roles in patient care, like managing chronic diseases, and they’re developing partnerships with medical groups large and small across the country.

Non-physician health professionals are also pressing for more opportunities. Nurse practitioners, for example, encouraged by a 2010 Institute of Medicine report, are engaged in advocacy and legislative efforts to establish independent practice, unburdened by physician supervision. Chapter 224 of Massachusetts General Laws, passed last year, included a new definition of primary care and expanded authority for NPs to sign documents once limited to physicians. This has given some NPs the impetus to set up independent practice.

What effects will these efforts have on primary care? Let’s take a closer look.

Retail clinics:  How often and for what purposes patients will visit retail clinics remain open questions, as these clinics are just now expanding their services from basic offerings to more complex endeavors such as lab services and managing chronic diseases. Unlike many other states, Massachusetts health officials have established a long list of regulations that these limited service clinics must follow.  However, Chapter 224 also requires the Department of Public Health to promote these clinics to the full extent of the scope of practice of NPs (who generally run these operations), but not to classify the clinics as primary care providers.

Research shows that patients like the convenience of retail clinics, particularly when they have difficulty getting to their primary care provider. Given the limited resources and no onsite physicians, most patients may not regard them, at least for now, as a place for primary care. As they add more sites, services, alliances, and advertising, however, they are likely to play a bigger role in health care – a prediction already being made by health care analysts.

Nurse practitioners: NPs play a vital role in health care. They always have, and they will play an even larger role as the team approach to care becomes more prevalent with medical homes and accountable care organizations.

The idea, however, that independent practice by NPs can fill the physician gap falls short. For one, a nursing shortage exists alongside the physician shortage, and nurses, like physicians, are an aging part of the healthcare workforce, with more than half of nurses approaching retirement.  The difficulty in recruiting nursing school faculty to teach a new generation adds to the problem.

Independent practice by NPs isn’t likely to increase the number of primary care providers; at best it might redistribute some to underserved areas. Most now work in urban areas, as physicians do, and most hospitals will not allow NPs on staff without physician supervision.

Further, with an emphasis on cost containment, replacing high-salaried providers (physicians) with lower ones (NPs) with less training will likely not result in savings. We have seen that less-experienced providers tend to order more tests and procedures, raising costs. Cost control will result best from the team approach of coordinating care and avoiding unnecessary referrals, testing, and procedures.

Finally, as independent or solo practice by physicians is becoming less and less viable with the growth of medical homes and accountable care organizations, the same is likely to happen with nurse practitioners.

While retail clinics and independent practices may have their place, continuity and coordination of care is much preferred over fragmented care from multiple providers. I believe the basis of good health care remains within the physician-patient relationship, supported by nurse practitioners, physician assistants, and other allied health professionals in a team approach. Patients will benefit most from this kind of an approach.

The President’s Podium appears regularly on the MMS Blog, offering Dr. Dunlap’s commentary on a range of issues in health and medicine.