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Caduceus
Newsletter: Summer 2010.01 --
June
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“Hey, I’m premed, why should I
take organic chemistry?
To see one physician’s reply, please see Marginalia. |
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Table of
Contents: 1. The College
Information Book (CIB) of the American Association of Colleges of Osteopathic
Medicine (AACOM) contains information pertaining to the osteopathic medical
profession and to the admissions requirements, tuition, fees, deposits,
deadlines and special programs of the 26 osteopathic medical colleges. |
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1. The
College Information Book (CIB) of the American Association of Colleges of
Osteopathic Medicine (AACOM) contains information pertaining to the
osteopathic medical profession and to the admissions requirements, tuition,
fees, deposits, deadlines and special programs of the 26 osteopathic medical
colleges. |
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2. ===AAMC
STAT===, e-newsletter from the Association of American Medical Colleges,
May 3, 2010 edition. |
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3. The
University of Arkansas College of Arts and Sciences (Fayetteville)
announces its INBRE Research Conference for Biological Sciences, Physics, and
Chemistry and Biochemistry, October 16-16,2010. |
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4. ===AAMC
STAT===, e-newsletter from the Association of American Medical Colleges,
May 10, 2010 edition. |
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News from the Association of American Medical Colleges
May 10, 2010
• AAMC Workforce Conference highlights reform’s effect on
physician supply The Deloitte Center for Health Solutions “2010 Survey of Health Care Consumers” found that consumers’ views of health care
generally remained the same from 2009 to 2010. Most reported having
mixed and sometimes inconsistent feelings about the government’s role in
health care with 42 percent for and 38 percent against government-sponsored
health insurance. Consumers gave the health care system a C grading
again in 2010. The survey was conducted between December 28, 2009 and
January 5, 2010. |
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5.
Environmental Cancer Risk ‘Grossly
Underestimated’?, from WebMD Health News, May 7, 2010 edition. |
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From WebMD Health NewsEnvironmental Cancer Risk 'Grossly Underestimated'?
May 7, 2010 — "Grievous harm" from carcinogens in the environment has been "grossly underestimated" by the U.S. National Cancer Program, a presidential panel charges. But the American Cancer Society says the panel's report goes too far in trashing established efforts to prevent cancer and that its conclusions go well beyond established facts. The two-member President's Cancer Panel, appointed to three-year terms by President Bush, focused its efforts on environmental cancer risk. The panel held four hearings in which it consulted experts from environmental groups, industry, academic researchers, and cancer advocacy groups. The panel's report includes an open letter to President Obama signed by panel chair LaSalle D. Leffall Jr., MD, of Howard University; and panelist Margaret L. Kripke, PhD, of the University of Texas M.D. Anderson Cancer Center. "The grievous harm from this group of carcinogens has not been addressed adequately by the National Cancer Program," Leffall and Kripke write. "The Panel urges you most strongly to use the power of your office to remove the carcinogens and other toxins from our food, water, and air that needlessly increase health care costs, cripple our nation's productivity, and devastate American lives." One of the panel's central claims is pollutants cause far more cancer than previously appreciated. In an October 2009 review, the Cancer and the Environment committee of the American Cancer Society's suggested that pollutants cause no more than 5% of all cancers. The presidential panel says this greatly underestimates the problem because it does not fully account for synergistic interactions between environmental contaminants, an increasing number and amount of pollutants, and the fact that all avoidable causes of cancer are not known. Experts differ on this assessment. Michael Thun, MD, of the American Cancer Society, writes that this opinion "does not reflect scientific consensus" but "reflects one side of a scientific debate that has continued for almost 30 years." Richard Clapp, DSc, MPH, professor of environmental health at Boston University, praises the report for challenging "flawed and grossly outdated methodology." Clapp was among the experts who testified before the hearing. "This is an attempt to update the science," Clapp said at a news conference sponsored by the Breast Cancer Fund. "This report ... calls for action on things where we don't yet know all the details. We shouldn't wait until the bodies are counted to say, 'Well, maybe people shouldn't be exposed so much to that chemical.'" In its 240-page report, the panel calls on the National Cancer Program to emphasize environmental research, particularly so-called "green chemistry" that evaluates safety at the earliest stages of product development. It also calls for legislative and regulatory action to force industry to prove chemicals are safe before, not after, they are introduced into the environment. Although he differs with the panel's rejection of current cancer prevention efforts, Thun says the American Cancer Society agrees with the panel's concern over:
Presidential Panel's Advice for You In addition to recommending sweeping changes in federal legislation and regulation, the panel also made a number of recommendations for how individuals can reduce their risk of cancer from environmental exposures in several areas. As noted above, there is scientific disagreement over many of the panel's findings. These recommendations therefore do not necessarily represent scientific consensus. Children:
Reducing chemical exposures:
Avoid Radiation: Cut exposure to electromagnetic energy by wearing a headset when using a cell phone, texting instead of calling, and keeping calls brief.
SOURCES: "Reducing Environmental Cancer Risk:
What We Can Do Now," President's Cancer Panel, 2008-2009 Annual
Report." WebMD Health
News © 2010 |
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6. The Medical University of South Carolina (Charleston)
is offering two Summer 2010 Information Sessions on Friday, June11th and
Thursday, July 15. |
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7. St.
George’s University (Grenada) Schools of Medicine and of Veterinary
Medicine are sponsoring a series of Open Houses in June and July. |
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8. Medical
Societies Have Mixed Reactions to Medicare Payment Bill. From Medscape Medical News, May 20, 2010
edition. |
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From Medscape Medical NewsMedical Societies Have Mixed Reactions to Medicare Payment Bill
May 20, 2010 — Several major medical societies have mixed feelings about the latest Congressional solution to the Medicare reimbursement crisis, but they are not exactly fighting the new legislation. After all, who is going to turn down a pay raise? Earlier today, Congressional Democrats released a summary of legislation that would delay a 21% cut in Medicare reimbursement to physicians from June 1 of this year to 2014. In between, Medicare rates would increase by an unspecified amount through the remainder of 2010 as well as 2011, with the possibility of additional increases in 2012 and 2013. Pay hikes would be higher for physicians delivering primary and preventive care. The prospect of a raise looks better than the idea that floated around Congress earlier this month — a 5-year freeze of Medicare rates. Both the American Academy of Family Physicians (AAFP) and the American College of Physicians (ACP) issued statements today giving qualified thanks for the new bill and the raises envisioned for primary care, which both organizations consider undervalued in terms of third-party reimbursement. They have contended for many years that higher pay will attract more physicians to this field. "If we're going to grow healthcare coverage by 32 million people [as a result of healthcare reform], we need those doctors onboard," Ted Epperly, MD, chairman of the AAFP board, told Medscape Medical News. "This is the Best Option We Face" Both the AAFP and the ACP also agree that instead of continually postponing scheduled pay cuts, Congress needs to repeal the sustainable growth rate (SGR) formula that Medicare uses to determine physician reimbursement. The SGR formula sets an annual target for Medicare spending on physician services based in part on growth in the gross domestic product. If actual spending exceeds the target — which it regularly does — Medicare is supposed to recoup the difference the following year by cutting reimbursement rates. Congress has postponed such cuts each year going back to 2003, but every postponement only makes the next cut even deeper. Organized medicine contends that the SGR formula is flawed because physician practice expenses have grown at a faster clip than the gross domestic product. It warns that if a gigantic reduction ever goes into effect, many physicians will stop seeing not only Medicare patients but also military families, whose TRICARE coverage is based on the Medicare fee schedule. As it stands under the new bill, the SGR formula would go back into force in 2014, triggering a likely pay cut of more than 30%. Students of the Medicare reimbursement crisis call this day of reckoning "the cliff." "It's not just a cliff, but a nightmare," said Dr. Epperly. "The cut just keeps getting bigger and bigger." Similar to the ACP and the AAFP, the American Medical Association also wants the SGR formula repealed. In a statement issued today, American Medical Association President J. James Rohack, MD, said that his group was "deeply disappointed" by the failure of Congress to permanently correct the Medicare payment formula, although he conceded that the new bill will provide "temporary stability for seniors and their physicians." The solution preferred by organized medicine, though, comes with a price tag that makes Congress squeamish. The cost of merely freezing Medicare rates through 2020, as opposed to imposing SGR-mandated cuts, would come to $276 billion, according to the Congressional Budget Office. Last year, the House approved a bill scrapping the SGR formula that would have cost $210 billion. However, a similarly priced bill in the Senate was squelched by budget hawks on both sides of the political aisle. With Congress tightly clutching the federal wallet, organized medicine is glad for what it can get. "Congress isn't at this point ready to permanently fix the Medicare pay problem," said Dr. Epperly. "It doesn't have the will or spirit to do it. "So [the new bill] is the best option we face." Congressional Democrats were planning to release a full-text version of
their bill by day's end, which might contain more particulars about proposed
increases in reimbursement. They are aiming for a vote in the House later
this week, with the Senate following suit next week. Medscape Medical
News © 2010 Medscape, LLC
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9. ===AAMC
STAT===, e-newsletter from the Association of American Medical Colleges,
May 24, 2010 edition. |
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News from the Association of American Medical Colleges
May 24, 2010
• AAMC comments on proposed conflicts of
interest rules In a statement
issued last week, the AAMC commented on proposed
conflicts of interest rules released by the U.S. Department of
Health and Human Services. The proposed rules would implement a new set
of guidelines for how institutions that receive research funding from the
National Institutes of Health (NIH) and other public health service agencies
identify, report, and manage conflicts of interest. In the statement,
AAMC Chief Science Officer Ann C. Bonham, Ph.D., said the rules “clarify the
processes and requirements to help institutions make informed decisions about
potential financial conflicts of interest in research, provide the NIH with
the information it needs to meet its obligations to the public, and ensure
greater public disclosure and transparency.” The new regulations
would require researchers to disclose all significant financial interests
related to their institutional responsibilities, lower the threshold for
disclosing significant financial interests from $10,000 to $5,000, and
require that institutions post on a Web site those interests that constitute
a conflict of interest, among others. “As we prepare formal comments,
the association will work closely with our members to assess their concerns
and determine what challenges they will face in implementing these standards
when they become final,” said Bonham. The AAMC released
the 2009 “Medicaid
Direct and Indirect Graduate Medical Education Payments: A 50-State Survey” this
week. The report contains comprehensive information about Medicaid
direct graduate medical education (DGME) and indirect medical education (IME)
payments and methodologies, reflecting both fee-for-service and managed care
programs. The survey found
that 41 states and the District of Columbia provided payments for DGME and/or
IME costs under their Medicaid programs in 2009. Eight states did not
make either payment. Of that group, Illinois, Massachusetts, and Texas,
are among the states with the largest number of graduate medical education
programs. The increase in the number of states which do not make
these payments has almost tripled since 2005. While Medicare DGME and
IME payments are difficult to obtain and must be estimated in a number of
states, the survey responses suggest that total DGME and IME payments
increased from an estimated $3.2 billion in 2005 to $3.78 billion in 2009,
despite the decline in state support for graduate medical education. The health care
reform implementation timeline has been updated as well as information on key
commissions and initiatives under the law: www.aamc.org/reform. |
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10. The Saint Louis University School of Medicine
offers M.D., M.D.-Ph.D., M.D.-M.P.H., and M.D.-M.B.A. programs. |
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11. Indoor
Tanning Poses Melanoma Risk; There Are No Safe Devices – from Medscape
Medical News, by Nick Mulcahy, May 28, 2010.
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Nick Mulcahy The study provides "strong evidence" that indoor tanning is a risk factor for melanoma, said lead author DeAnn Lazovich, PhD, associate professor of epidemiology and community health in the School of Public Health and Masonic Cancer Center at the University of Minnesota in Minneapolis. In a variety of other work on the subject to date, including a 2006 report from the World Health Organization's International Agency for Research on Cancer (IARC), a history of indoor tanning has been found to be only "weakly associated" with melanoma, Dr. Lazovich and colleagues report in their study published online May 26 in Cancer Epidemiology, Biomarkers & Prevention. However, the IARC recently declared tanning devices to be carcinogenic. In the new study, more than 90% of the participants were white and more than three quarters were very fair or fair skinned. A majority (62.9%) of the 1167 people who had melanoma and about half (51.1%) of the 1101 control subjects who did not have melanoma had tanned indoors at some point in their lives. Just how much the risk for melanoma is increased by tanning depends on the device used and the amount of tanning undergone, said Dr. Lazovich, who spoke at a press teleconference held by the American Association for Cancer Research. The melanoma risk was especially pronounced among users of ultraviolet (UV)B-enhanced devices, who had a 2-fold increase (adjusted odds ratio [OR], 2.86; 95% CI, 2.03 - 4.03), and users of primarily UVA-emitting devices, who had a 4-fold increase (adjusted OR, 4.44; 95% CI, 2.45 - 8.02). No device is safe. "No device is safe," said Dr. Lazovich, dispelling the belief that UVB devices are not carcinogenic. In general, melanoma risk increased with use, whether it was measured in hours, sessions, or years. For instance, 1 to 9 hours of lifetime tanning resulted in a 46% increased risk (adjusted OR, 1.46; 95% CI, 1.15 - 1.85). But 50 or more hours resulted in a 3-fold increased risk (adjusted OR, 3.18; 95% CI, 2.28 - 4.43). This study is the largest of its kind to date and "advances what we already knew on this subject," said Dr. Lazovich. Among the things the study revealed for the first time is the fact that there is a "dose-response relationship" between the amount of time spent indoor tanning and melanoma risk, and the fact that certain devices are riskier than others, she noted. Changes Needed "It's a very timely study," said Allan Halpern, MD, chief of the dermatology service at Memorial Sloan-Kettering Cancer Center in New York City. "There are more than 120,000 melanoma cases in the United States every year, and over 8,500 deaths," said Dr. Halpern, who also spoke at the press conference. Dr. Halpern called for the US Food and Drug Administration (FDA) to upgrade the regulatory designation of indoor tanning devices from category 1, which is "equivalent to a tongue depressor." Dr. Halpern said that the agency is aware of the dangers of indoor tanning and has just issued a video on the subject. The FDA says that "any UV-emitting device should be avoided." The study should be used to educate teens and their parents, said Electra Paskett, PhD, associate director for population sciences at the Ohio State University Comprehensive Cancer Center in Columbus. A large proportion of indoor tanning bed users are teens. "A large proportion of indoor tanning bed users are teens," she reported at the press conference. "We have to change the social norm," she said about the widespread use of tanning among young people, likening the public health challenge to that of decreasing smoking and obesity. "The study strengthens our hand with patients," said Dr. Halpern. But he also admitted that any education effort is up against the "aesthetics of a tan," which is coveted in youth culture. He especially praised one dimension of the study: the inclusion of data on participants' exposure to sunlight. "Industry always says that [tanning bed users] also go to the beach," said Dr. Halpern. However, in the study, lifetime sun exposure (high, medium, and low), including that from outdoor activities and jobs, was not associated with increased risk. Industry Group Criticizes Study The indoor tanning industry is a big business, note Dr. Lazovich and her coauthors. According to the authors, a reported 30 million Americans visit indoor tanning salons each year and, in data from 116 American cities, the average number of tanning salons exceeds the average number of Starbucks or McDonalds. An industry group criticized the study, calling it "reverse engineered," and criticized Dr. Lazovich, calling her an "advocate" because of her past involvement with public health projects related to possible melanoma risk and indoor tanning. "This study was designed and executed by an advocate, not a neutral party, and the advocate failed to properly disclose that she is not a neutral party," said Joseph Levy, vice president of the International Smart Tan Network on the organization's Web site blog. I am not an advocate, I am a cancer researcher. "I am not an advocate, I am a cancer researcher," said Dr. Lazovich during the press conference, adding that the study had grant support from the National Cancer Institute and the American Cancer Society. The industry group also criticized the choice to study Minnesotans, calling them a "homogenous" group. Dr. Lazovich defended the study sample, in which 98% of cases and 96% of controls were white, saying that it was "entirely appropriate to study those people most at risk." She also acknowledged that there "clearly was a genetic predisposition [for melanoma] among the participants." However, the study accounted for that by adjusting the odd ratios for the known risk factors for melanoma, she added. The factors include skin color, freckles, moles, family history of melanoma, routine sun exposure, outdoor activity sun exposure, outdoor job exposure, mean sunscreen use, and number of lifetime painful sunburns. The International Smart Tan Network also cited "statistical irregularities" in the study. The study says that 51% of the control group reported indoor tanning in the past. This seems very high, suggested the International Smart Tan Network. "Only an estimated 10% of the adult population in Minnesota utilizes indoor tanning facilities," according to the organization's blog, which calls the statistical variance between the 2 figures "so unlikely as to almost be impossible." The study authors report that control subjects were randomly selected from the Minnesota state driver's license list (which includes people with state identification cards) and frequency-matched to cases in a 1:1 ratio on age (between 25 and 59 years) and sex. The authors also address the high percentage of control group members who had formerly tanned or who currently tan. "Although the prevalence of indoor tanning among participating controls (51.1%) is high compared with most other reports, we do not think this is due to differential selection of indoor tanners into the study," they write. "In a 2002 Minnesota statewide survey of adults, we found that overall, 36.3% of respondents reported indoor tanning use; prevalence was higher (42%) in the sample with the same age range as the current study," they add. The authors have disclosed no relevant financial relationships. Cancer Epidemiol Biomarkers Prev. Published online May 26,
2010. Medscape Medical
News © 2010 Medscape, LLC |
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12. Marginalia: One physician’s answer to the age-old
question, “Hey, I’m premed, why must I
take organic chemistry? |
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From the HLTHPROF listserv, a
reply from a retired cardiothoracic surgeon: I would like to respond to your analysis of the usefulness of
organic chemistry as a milestone in the selection process for medical school.
I am a retired cardiothoracic surgeon with over twenty-five years of clinical
practice. Although, on a day to day basis I clearly did not use organic
chemistry per se, I did have to continue to teach and learn throughout my
career. What organic chemistry demonstrates, insofar as undergraduates [are
concerned], is the capacity to absorb huge amounts of information in the
context of a rigorous concomitant course load. When the student matriculates
at medical school, they take the equivalent of 30 to 35 credits per semester
and are expected to be able to conduct excellent time management and learn
all of this material. As a practicing physician, you may not use every piece
of data that you had to learn in medical school, but you do need to have the
capacity to apply knowledge, and continue to learn (and teach) throughout
your career. Medical schools recognize that organic chemistry helps to demonstrate
these abilities as prospective applicants.
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Dr. Stan Eisen,
650
E-mail: seisen@cbu.edu
http://www.cbu.edu/~seisen/
Caduceus Newsletter Archives: http://www.cbu.edu/~seisen/Caduceus.html