March 2015 Round-up Magazine

IN EVERY ISSUE:

To learn more visit www.mcmsonline.com

From the Exec. Director

Page 4

New Members

Page 9

In Memoriam

Page 10

Celebrating 60 Years

- 015 1955 2

round-up Marketplace

Volume 61

•

Number 3

•

Page 42

March 2015

Providing news and information for the medical community since 1955.

MEMBER PROFILE: Meet Diana Petitti, MD, MPH and learn about the path she has walked as an epidemiology researcher and public health advocate. Page 30

PRESIDENT’S PAGE: Dr. Stratford believes that all physicians can find a way to participate in public health through committees, by guiding businesses to affiliate with public health issues, and through example by living healthy lives. Page 12 PUBLIC HEALTH: The resurgence of measles transmission in the US after being almost eradicated several years ago provides a teachable moment to re-examine public health strategies and personal and community responsibilities. Page 16

FEATURE ARTICLE: Senator Bill Frist, MD reflects on a trip to Cuba and compares its public health system to the United States. Page 20 A PARENT’S PERSPECTIVE: Dr. Tim Jacks takes off his Pediatrician hat and puts on his “Papa Bear” hat with an open letter to a parent of an unvaccinated child. Page 24 A MEDICAL STUDENT’S PERSPECTIVE: An A.T. Still University and a University of Arizona College of Medicine – Phoenix student share their thoughts on Public Health. Pages 26 & 28

MCMS OPEN HOUSE: On March 12, 2015 MCMS hosted an open house celebrating the Society’s building facelift. As you will see by the photos a great time was had by all!

Page 36 VIEWPOINT: Happy Anniversary to the SS, M&M, ADA & ACA! Page 41

Save the date for “Philanthropy in Medicine” Details on page 13

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from the executive director What’s Inside?

Earlier this month, a MCMS member was honored for her contributions to the field of medicine. The Arizona Women’s Hall of Fame inducted Lucy Sikorsky, MD into their respected ranks on March 12th, and asked the Medical Society to accept the award on her behalf. I had no knowledge of Dr. Sikorsky, so I had to look through old copies of Round-up to learn about this amazing woman.

Jay Conyers, PhD MCMS, Executive Director Contact Information: E: jconyers@mcmsonline.com P: 602-251-2361

Lung disease brought Dr. Sikorsky to Arizona in 1950, after she had enjoyed a successful medical career in Massachusetts for nearly two decades. After a three-year stint with the San Carlos Indian Reservation, she moved to Phoenix and became the Director of the then Maricopa County Health Unit. In her four years at the helm, she led a number of public health initiatives, such as mandating TB testing in the schools, cleaning up mosquito infected areas across the valley, and establishing numerous maternal health and children’s clinics to help reduce the county’s abnormally high infant mortality rate. Her leadership did not go unnoticed, as her budget was increased from $156,000 to $627,800 by the end of her tenure.

To say the least, she convinced Arizona lawmakers of the public health’s role in the community, and today’s Maricopa County Department of Public Health wouldn’t be the same had it not been for her heroic efforts. When I asked the current Director, Dr. Bob England, he paid tribute to her in saying, “I never knew Dr. Sikorsky, but we all build upon the past, and I am grateful to have had a predecessor who understood the meaning and importance of public health."

To understand the evolution of public health, we have to go back even farther. We owe much to the collaborative efforts of Dr. John Snow and Reverend Henry Whitehead in defining this underappreciated field of medicine. Had the two of them not worked together, it is unlikely that Snow would have been able to understand what was plaguing Victorian London in mid 1950s. As a young physician and one of the first to properly utilize anesthesia, Snow built on Whitehead’s knowledge of the local community to map out the cholera cases throughout the city, and not only pinpointed the exact location of the cholera source — a water pump on Broad Street — but also patient zero.

I first learned of the pioneering efforts of Snow and Whitehead when I picked up Steven Johnson’s Ghost Map at an airport bookstore in early 2007. If you haven’t read it, I highly recommend it.

I’m sure that this month’s profile physician, Diana Petitti, MD, MPH, has long known about Snow’s discovery that led to his being known as the ‘father of public health.’ Dr. Petitti is a world-renowned epidemiologist who enjoyed a distinguished career studying evidence-based medicine and the delivery and quality of care. Petitti realized early on that her interests lay more in taking care of populations of patients rather than individuals. Read about her on page 30.

4 • Round-up • March 2015 • A monthly publication of the MCMS

from the executive director

MCMS Executive Director, Jay Conyers, PhD and Lee Ann Kelley, MD at the MCMS Open House on March 12th.

Jay is holding a photo of MCMS Member and Public Health champion Lucy N. Sikorsky, MD (1892-1972), and Dr. Kelley a vase.

Both were awarded earlier in the day by the Arizona Women’s Hall of Fame.

Dr. Sikorsky was one of seven inducted into the Hall of Fame’s Class of 2015.

In this issue we also look at the recent measles scare that captured the attention of the local community. MCMS Public Health Committee Chair, John Middaugh, MD, MPH pens an eloquent article that looks to the root of the recent measles crisis, and offers an alternative approach to mandatory vaccinations.

We have another great article from Senator Bill Frist, MD, who writes about his recent visit to Cuba and what he observed about the health of their community. His perspective on this impoverished nation is definitely some good food for thought.

We also have an article from a physician on the front lines of primary care, who unfortunately saw the crisis hit a little too close to home. MCMS member Tim Jacks, DO writes about his three-year old

daughter Maggie, who suffers from leukemia, and how she was exposed to measles during a recent stay at Phoenix Children’s Hospital.

Two of our educational members — A.T. Still University’s Catheryn Salibay, MPH, and University of Arizona College of Medicine – Phoenix student, Ralphy Mohty — share their thoughts on Public Health.

Lastly, we have a Viewpoint from Leonard Kirschner, MD, MPH who shares his thoughts on the anniversaries of the SS, M&M, ADA and ACA. But the Society isn’t just writing about public health, it’s also organizing member events that spotlight some heroic public efforts, both locally and abroad. On May 7th, we will be hosting a Medical Philan-

thropy Forum that will bring together Drs. Candace Lew, David Beyda, and Randy Christensen to discuss how they’re caring for those in need all around the world.

Stay tuned for more details, but go ahead and block out your calendar for 6-8 pm that evening. We hope to see you there.

So what about next month?

Our focus in April will be on patient empowerment, and we will be profiling Christine Harter, MD, a primary care physician in the West Valley who’s dedicated her career to working in community health centers. She goes above and beyond to help her patients take on a more active role in the care of their health. We look forward to sharing her story with you next month, but until then, we hope you enjoy this issue! ru

A monthly publication of the MCMS • March 2015 • Round-up • 5

round-up

march 2015

Providing news and information for physicians and the healthcare community since 1955.

Published by the Maricopa County Medical Society.

4 what’s inside page 12 president’s Contributing to Public Health: 16 20 24

Involvement, Partnership and Promoting Good Health

public health Exemption from Vaccination But Not from Education. Duties in a Free Society public health international medicine The Value of My Stethoscope: Lessons Learned From a Trip to Cuba

public health a parent’s perspective Let’s Talk Measles: An Open Letter to the Parent of an Unvaccinated Child

health 26 public a medical student’s perspective

Maintaining the Delicate Balance Between Science, Opinions and Beliefs: A Medical Student’s Perspective on Vaccinations

health 28 public a medical student’s perspective profile 30 member Meet MCMS Member:

Heat Related Illness and Public Health

36 41

Diana B. Petitti, MD, MPH

mcms open house Photos from the March 12, 2015 Event

viewpoint Happy Anniversary to the SS, M&M, ADA & ACA

In every issue New Members ..................................................................................................................................................................9 In Memoriam ..................................................................................................................................................................10 Marketplace ....................................................................................................................................................................42

Cover photo: Denny Collins Photography • www.dennycollins.com • 602-448-2437 6 • Round-up • March 2015 • A monthly publication of the MCMS

Round-up Staff

Editor-in-Chief Ryan R. Stratford, MD, MBA Editor Jay Conyers, PhD

Advertising, Design and Production Candice Scheibel Contributing Writer Dominique Perkins Advertising

To obtain information on advertising in Round-up, contact MCMS.

phone: 602-252-2015 advertising@mcmsonline.com Postmaster

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linkedin/MaricopaCountyMedical Society Periodicals postage paid at Phoenix, Arizona.

Volume 61, No. 3, March 2015.

Round-up (USPS 020-150) is published 12 times per year by the Maricopa County Medical Society, 326 E. Coronado, Phoenix, AZ 85004.

To subscribe to Round-up Magazine please send a check for one-year subscription of $36 to Round-up Magazine, 326 E. Coronado Rd., Phoenix, AZ 85004.

Connect with your Society.

MCMS 2015 Officers President

Ryan R. Stratford, MD, MBA President-Elect

Adam M. Brodsky, MD Vice President

John L. Couvaras, MD Secretary

Kelly Hsu, MD Treasurer

Mark R. Wallace, MD

Immediate Past-President Miriam K. Anand, MD Board of Directors 2013-2015

R. Jay Standerfer, MD

Steven R. Kassman, MD Shane Daley, MD

Anthony Lee, MD 2014-2016

Lee Ann Kelley, MD May Mohty, MD

Richard Manch, MD Anita Murcko, MD 2015-2017

Ross Goldberg, MD

Jennifer Hartmark-Hill, MD Tanja L. Gunsberger, DO Marc M. Lato, MD

Letters and electronic correspondence will become the property of Round-up, which assumess permission to publish and edit as necessary. Please refer to our usage statement for more information.

Celebrating

60 Years - 015 1955 2

Round-up is a publication of the Maricopa County Medical Society (MCMS). Submissions, including advertisements, are welcome for review and approval by our editorial staff at roundup@mcmsonline.com.

All solicited and unsolicited written materials and photos submitted to Round-up will be treated as unconditionally and irrevocably assigned to and the property of MCMS and may be used at MCMS’ sole discretion for publication and copyright purposes and use in any publication, website or brochure. MCMS accepts no responsibility for the loss of or damage to material submitted, including photographs or artwork. Submissions will not be returned.

The opinions expressed in Round-up are those of the individual authors and not necessarily of MCMS. Round-up reserves the right to refuse certain submissions and advertising and is not liable for the authors’ or advertisers’ claims and/or errors. Roundup considers its sources reliable and verifies as much data as possible, but is not responsible for inaccuracies or content.

Readers rely on this information at their own risk and are advised to seek independent legal, financial or other independent advice regarding the content of any submission.

No part of this magazine may be reproduced or transmitted in any form or by any means without written permission by the publisher. All rights are reserved.

Editor: Ryan R. Stratford, MD, MBA rstratford@mcmsonline.com

Managing Editor: Jay Conyers, PhD jconyers@mcmsonline.com

A monthly publication of the MCMS • March 2015 • Round-up • 7

Seeing the Big Picture and Defining Success

By Mike McCann, CFP®, AIF® I’ve always believed successful financial management was more than crunching numbers, researching the analytics, and applying market principles and applicable tax laws. While there are certainly prerequisites to financial success, the real key to successfully managing your finances is knowing and managing yourself.

Poor financial decisions are often the result of not being able to see the big picture, looking at the short field rather than the long horizon, of not having proper perspective. This is certainly true with our personal lives, as well.

Recently, I gained a new perspective on my world when I served with a medical mission team in rural Guatemala. Excited for a new adventure, I agreed to participate without knowing much detail (and without having any medical training or speaking any Spanish). At a pre-trip meeting a few weeks out, we were told not to bring anything that would be upsetting to lose, to pack light, dress down, don’t walk alone or at night, and “try not to look like money.”

Upon arriving, a four-hour drive immersed us into a new reality — heavy air pollution, dilapidated

worn by most women and girls. housing, chaotic traffic, loose Boys wore ragged jeans and t-shirts. livestock and an endless stream of Most shoes were quite worn, people walking on the side of the typically with holes. Despite my road all carrying various supplies on best efforts, wearing plain gray ttheir backs, heads and arms. shirts and brown hiking shoes, I still We set up temporary medical looked like money. clinics each day in small villages.

The typical venue was a rectangular hall in which we strung up rope and tarps to make a couple private exam rooms.

We had two doctors, some local translators (Spanish and K’iche’, one of the Mayan languages), and a suitcase pharmacy stocked with basic needs. Guatemalans trust American doctors far more than their own, and for the most part this was their only doctor visit for the year.

One of our Our success in life, and how we define it, team members, can often be found by stepping back a Guatemalan once in a while and taking in the big picture. native who Lots of children hung around immigrated to the United States in unsupervised during and after the 1970s, helped collect 14 suitcases full of clothing, shoes, hats school. My job on the team soon became keeping the kids out of the and toys to distribute. Additionally, we had our 16-year-old “eye doctor” way and entertained. Many of them got to throw a Frisbee and who had collected glasses over the (American) football for the first last year and was prepared to test time. We also joined them for vision and provide a best-effort fit. soccer, and clearly gave up any Both were very popular. Many of competitive advantage. the people in these villages do not Our success in life, and how we have running water and electricity, define it, can often be found by much less these basic daily stepping back once in a while and necessities. taking in the big picture.

Traditional (Mayan) garb was

Mike McCann is an investment advisor and founder of Perspective Financial Services, LLC. He develops long-term relationships with physicians and other professionals to create and manage personalized financial plans and investment portfolios.

To learn more, visit his website at www.MoneyAZ.com.

You may call or email him at 602-281-4357 or Mike@MoneyAZ.com anytime.

new members There’s no place like the Maricopa County Medical Society.

Welcome Home!

MCMS would like to recognize our new members for helping us become a stronger, more unified, voice for our community’s physicians. Please reach out to one or more of our new members and welcome them aboard, and share with them your insight into how the Society can be of service.

KEVIN HENRY Anesthesiology and Pain Management Medical School: Wayne State University, Detroit, MI Internship: St. Joseph Mercy Hospital, Ann Arbor, MI Residency & Fellowship: John Hopkins, Baltimore, MD Practice: The Regional Pain Institute, LLC, 21321 E. Ocotillo Rd., Suite M131, Queen Creek, AZ 85142 Phone: 480-636-1225 Website: www.regionalpain.com

ANGELA HERRO, MD Ophthalmology/ Neuro Ophthalmology Medical School: Boston University, Boston, MA Internship: Banner Good Samaritan Medical Center, Phoenix, AZ Residency: University of Texas-San Antonio, San Antonio, TX Fellowship: Bascom Palmer Eye Institute, Miami, FL Practice: Horizon Eye Specialists & Lasik Center, 18325 N Allied Way Suite 100, Phoenix, AZ 85054 Website: www.horizonlaservision.com Phone: 602-467-4966 MICHELLE MCGEE, ANP Adult-Geronrology Acute Care Nurse Practitioner School: Grand Canyon University

MARK MCPHERSON Medical School: Arizona College of Osteopathic Medicine of Midwestern University Graduation Year: 2015

DEBRA ROSE Pediatrics Medical School: University of Oklahoma College of Medicine, Oklahoma City, OK Residency: Phoenix Hospital Affiliated Pediatric Program Retired from active practice.

GERMAINE RIVAL Medical School: A.T. Still University School of Osteopathic Medicine in Arizona Graduation Year: 2018

JOIN today.

outreach • advocacy • collegiality www.mcmsonline.com

A monthly publication of the MCMS • March 2015 • Round-up • 9

in memoriam

Honoring those we lost...

Ben J. Wilson, MD

Dr. Ben Wilson, 94, passed away February 14, 2015. He was born in Kokomo, IN on September 13, 1920, the second of three sons born to Charles Ben and Margorie Gayle Wilson. Dr. Wilson was raised in Indiana and graduated from Bloomington High School in Bloomington, Indiana, and attended Indiana University where he studied medicine, eventually graduating medical school in 1944.

In 1943 Dr. Wilson married his first wife, Elizabeth. After completing an internship and residency at Eloise Hospital in Wayne, Michigan, he served two years in the Army as a medical officer in Sendai, Japan and was honorably discharged in 1947. The Wilson family then moved to Dallas, Texas where he finished his residency at Parkland Hospital. His medical career blossomed further as he became Parkland’s Chief of Surgery and UT Southwestern Medical School’s Chairman of the Department of Surgery from 1952 to 1960.

In 1960, he moved the family of now four children to Grand Junction, Colorado to establish a private practice and begin a secondary career as farmer/rancher.

The lure of perfect winters with no snow brought Dr. Wilson to Arizona where he married his wife, Nancy, and purchased a home in the Ahwatukee community of Phoenix. He immersed himself in golf at first, but discovered a much more rewarding avocation in sculpting.

Dr. Wilson is survived by his wife, Nancy; sons John (Carol), James, and Bill (Rose); daughters Susan, Julie, Jeanne (Donnie) and Kathy; grandchildren Ryan, Renee, Jon, Allison, Jeff, Lindy, Brian, Ashley, and Sarah; great grandchildren Rory, Gabby, Tiffany, Mykala, Sterling, Brennus and Brekin; and great-great grandchildren Mila and Charlotte. ru

Ross Yellen, MD

Dr. Ross Yellen, 73, of Phoenix passed away on January 10, 2015. He was a devoted husband of nearly 40 years, a loving father of four, and a grandfather of eight. Dr. Yellen was a practicing physician for over 20 years and valley resident for a greater part of his life. He was a cigar aficionado, a lover of classical music, held an affinity for beagles and had an infectious laugh that was impossible to resist. He received his bachelors degree from Brooklyn College, and studied Medicine at the University of Louvaine in Belgium. He performed his residency in Halifax, Nova Scotia, and settled in Phoenix in the early 80’s.

He was preceded in death by his wife, Bernadette, and survived by his children, Valerie Heller (Marc), Eric Yellen (Jeri), Mark Yellen (Julia) and Sandra Englehardt (Joshua). ru

Robert A. Oster, MD

Dr. Robert (Bob) Oster, 85, passed away March 10, 2015. He was born and raised in Centralia, IL and attended the University of Illinois and then worked as a chemical engineer in Texas. Bob married his wife Jean in 1954 in Sulphur, Louisiana and went on to attend medical school at UTMB in Galveston, graduating in 1960. Dr. Oster worked as a general practice physician in Boulder City, Nevada from 1962 to 1970 and as an OB/GYN physician in Phoenix, AZ from 1973 to 1990.

Dr. and Mrs. Oster lived in Kentucky, Texas, Louisiana, Nevada, Arizona and Oregon. He is survived by his wife Jean, four children, grandchildren, and great grandchildren. ru

10 • Round-up • March 2015 • A monthly publication of the MCMS

Re sp ser ac ve e y to ou da r y!

Don’t miss your chance

to advertise in Round-up Magazine’s Special Issues!

IN EVERY ISSUE: From the Exec. Director Announcements Marketplace Board of Directors Meeting Minutes To learn more visit www.mcmsonline.com

Volume 61

•

Number 2

Page 4 Page 10 Page 34 Page 36

MCMS Members: Join us for cocktails and hors d’oeuvres as we celebrate the Society’s building facelift with an Open House on March 12. Details on page 3.

•

February 2015

Providing news and information for the medical community since 1955.

May 2015 The Business of Medicine September 2015 Affordable Care Act Call for May issue space and materials deadline.

Dr. Paul Berggreen is keeping pace with technology.

Page 16

PRESIDENT’S PAGE: Technology has transformed a physician‘s ability to discover, diagnose and treat their patients.

However, with great advancements come great responsibility.

Page 8

PUBLIC HEALTH: The causes of childhood obesity are many, and as such, more than one approach to treating it is important.

Page 12

FEATURE ARTICLE: Senator Bill Frist, MD shares his thoughts with Round-up readers on how our nation’s health IT framework needs to adapt.

Page 26

MEMBER PROFILE: Meet Dr. Ryan Stratford, MBA, MCMS 2015 President. Learn more about what he believes are the challenges MCMS and organized medicine face, the opportunities that exist, and the commitment it will take from our members to truly make a difference. Page 8.

To learn more visit www.mcmsonline.com

TECHNOLOGY: The legal pitfalls of documentation shortcuts when using EHRs and steps to take to ensure that your practice is properly securing electronic records.

Pages 28 & 32

Celebrating 60 Years

-2015 1955

round-up Volume 61

•

Number 1

•

January 2015

Providing news and information for the medical community since 1955.

The Society received a much needed facelift to the building and courtyard, page 20.

PRESIDENT’S PAGE:

September space reservation deadline: 8/3/15 Materials deadline: 8/10/15

A CLOSER LOOK: We bring you a summary of a recent initiative led by the AMA to help improve the cumbersome EHR certification process for physicians.

Page 25

editorial of the new year he formally takes the reins from Dr. Miriam Anand and describes his vision to keep MCMS moving in a forward, positive direction.

Page 14.

MCMS 2015 BOARD OF DIRECTORS: Meet the physicians that lead your Society.

Page 16.

A CLOSER LOOK: Round-up sat down with Dr. Jeff Mueller, a MCMS member and ArMA’s President, and asked him about the role of physicians in the legislative process and what to expect during this year’s Legislature.

Page 26

FEATURE ARTICLES: We asked Rep. Heather Carter and Sen. Kelly Ward to share their thoughts on the importance of physician involvement in the health policy-making process and how the physician community can get involved.

Pages 28 & 30.

Circulation: 9,000 Distribution: 2,500 copies to MCMS Members and paid subscribers. 6,500 mailed to actively practicing physicians (MD/DO) in Maricopa County, Phoenix, AZ

For more information and rates, contact Candice Scheibel, Advertising Director cscheibel@mcmsonline.com • 602-251-2363

To learn more visit www.mcmsonline.com

TREATMENT OF EBOLA THROUGH TELEMEDICINE:

EBOLA, MEDICAL SYSTEMS, & PUBLIC HEALTH POLICY:

Telemedicine can be an effective tool to prevent Ebola disease transmission, control spread of the disease, and facilitate access to timely and appropriate clinical care. Page 14

Working together, the medical and public health systems in Arizona can protect the public from Ebola. Clear communication and decisive actions based on CDC guidelines and scientific evidence must be the foundation for success. Page 22

round-up Volume 60 • Number 12 • December 2014

Providing news and information for the medical community since 1955.

Congratulations to Dr. James Pehoushek the winner of our photo cover contest, page 4.

PRESIDENT’S PAGE:

FEATURE ARTICLE:

PRACTICING MEDICINE:

Dr. Miriam Anand reflects on her 2014 Round-up editorials and her term as MCMS President as she looks forward to 2015 under the leadership of Ryan Stratford, MD, 2015 President. Page 8

According to a report published online by the journal Health Affairs and produced by the Centers for Medicare and Medicaid Services, the growth in U.S. health spending for 2013 is the lowest since 1960.

Mary Agnes Carey with Kaiser Health News breaks the report down and shares details of the money trail. Page 24

Being proactive about the process of prescribing controlled substances will help limit your practice’s susceptibility to prescription theft and/or forgery. In this month’s article, Jeremy Wale, JD, Risk Resource Advisor with ProAssurance, shares his thoughts on prescription theft and forgery with Round-up readers. Page 28

president’s page

Contributing to Public Health: Involvement, Partnership and Promoting Good Health

By Ryan R. Stratford, MD, MBA

T

his month in Round-up we are focusing on public health. Unlike healthcare, which deals with the individualized treatment of patients with disease or injury, public health is rooted in prevention and attempts to impact the population as a whole.

MCMS President 2015 Ryan R. Stratford, MD, MBA Dr. Stratford specializes in Urogynecology/Pelvic Reconstructive Surgery.

He joined MCMS in 2005.

Contact Information: The Woman's Center for Advanced Pelvic Surgery 4344 E. Presidio Street www.TheWomansCenter.com P: 480-834-5111 E: rstratford@mcmsonline.com

While I am not an authority on public health, I believe that nearly all of us as physicians have been inspired by the idea of population-based health promotion. So long as the years of training and subsequent efforts to eek out a living have not beat those initial altruistic desires from us, we still all hope to improve the health of all those around us.

It is our basic passion and what drives us.

Like many of you, I have always been intrigued with the premise of preventing disease and promoting good health. As a medical student, I chose to attend Business School at the University of Chicago with the hope of finding a way to align business incentives to promote physician involvement in public health. My hope was to find a way to finance physician-staffed medical missions to promote good health in under-developed countries. This interest was bred during the two years that I served as a missionary in Chile and observed firsthand the impact of poverty on public health.

During my fellowship training I met and befriended physicians who spent the lion share of their careers managing childbirth-related fistulas in Africa, which further fueled my aspirations. The epidemic of pelvic floor fistulas is widespread in Africa, largely due to preteen and teenage pregnancies in women with underdeveloped pelvises. Due to limited medical resources, this often results in prolonged obstructed labor, neonatal death, and necrosis and subsequent vesicovaginal and rectovaginal fistulas in the mother.

12 • Round-up • March 2015 • A monthly publication of the MCMS

president’s page The women who suffer from this disorder, and the continuous urinary and/or fecal incontinence it cause, are frequently rejected from their families and tribes, resulting in social isolation and helplessness. Even if they are able to seek care and surgical treatment at one of the few fistula hospitals in Africa they can rarely return to their families and must face the challenge of learning a trade and integrating into society on their own.

I highly admire urogynecologists who devote so much time to the treatment and care of patients with such debilitating fistulas, and I aspire to join them in their efforts.

Fortunately, involvement in public health does not always require that we travel to another country. There are major public health issues right here at home, in our local communities. I can think of three additional ways physicians can help address these issues.

First, our Society has an excellent Public Health Committee who are addressing many of these issues and aims to involve us as members to participate however we feel most interested and comfortable.

The Public Health and Philanthropy committees have organized an event on May 7th where three champions of international and local public health are coming to Arizona to share their experiences with us. This is a unique opportunity to learn and broaden our perspectives, and may be a great way to begin your efforts to participate in public health. I hope you will join us at the event.

If joining the Public Health Committee does not interest you, there is another way we can participate in public health promotion as physicians: through guiding businesses to affiliate with public health issues. Businesses outside of medicine want to support public health; it makes them profitable.

To explain, let’s take a look at the car industry. With the development of the Model-T Ford, Ford Motor Company did not market the vehicle with different colors, interiors or engines but rather focused solely on promoting their product.

Ford figured that people would buy cars because they were a wonderful new mode of transportation. There was no need for individualizing the car — just mass produce them and people would buy them. However, as competition grew,

save the date! for the Maricopa County Medical Society’s

Philanthropy in Medicine

Thursday, May 7, 2015 6-8 pm Featured speakers: David Beyda, MD Randal Christensen, MD Candace Lew, MD More information to follow in April 2015.

Event sponsor and MCMS Preferred Business Partner:

A monthly publication of the MCMS • March 2015 • Round-up • 13

president’s page

“I believe that each of us can find a way to participate in public health.

We can participate in committees like the Public Health Committee for our Society, we can guide businesses to affiliate with public health issues we find important, we can promote public health issues with our patients, and, finally, we can take care of ourselves to promote public health through our examples of living healthy lives.”

– Ryan R. Stratford, MD, MBA

other car makers started offering individual variations of their cars such as different colors, different shapes and different options. The market shifted from product-focused to consumer-focused, and the market grew rapidly. Seeking an edge over their competitors, car makers started offering more and more options. The consumer-focused market continued for decades but, with time, gaining a competitive edge in the market became more and more difficult. Car makers started looking for other ways to differentiate their products. The market started to shift once they found a new edge: affiliation with public health issues and promoting healthy living. Now, car makers use “green” materials and donate large sums of money to charitable organizations that improve public health to motivate us to purchase their products.

Consumers have responded favorably, and now make purchase decisions based on company’s affiliations with charitable or public health issues. I find this fascinating. It suggests that people, as a whole, are motivated by and willing to place high value on public health and will show that willingness by purchasing products simply because of their affiliation with public health promotion. Just ask the owners of Tom’s shoes who made their business by giving a pair of

shoes to someone in an under-developed country for every pair of shoes you buy. Although I have over-simplified the marketing evolution in the car industry, I believe the concept is powerful and suggests that there is a very clear opportunity to align incentives to fund advancements in public health.

As physicians, we can help businesses find ways to align their incentives with public health.

The final way we can address public health issues in the delivery of healthcare is by starting with one individual at a time. While helping individual patients live healthier lifestyles and overcome issues that affect public health as a whole does not directly affect the whole population, it promotes what I think is at the heart of public health — prevention. We all can be contributors in promoting prevention as physicians.

In my own field of urogynecology, recent data suggests that directly reducing obesity and smoking, two of our society’s greatest public health issues, has a very significant impact on the outcomes in treatment of pelvic floor disorders.

For instance, a 10% decrease in BMI results in a 50% decrease in stress urinary incontinence. In the past seven years, I have held firm in my resolve to help my patients overcome the issues that ultimately cause the problems that have caused them to come to me for treatment, and I have been overwhelmed with the success I have seen in patients’ lives.

Because I require all of my patients to stop smoking and to reduce their BMI below 35 prior to repairing prolapse (pelvic floor hernias), residents who work with me often ask whether such a strategy can be successful. I have been amazed! Although it probably has a lot to do with the daily reminder and motivation to eliminate socially embarrassing urinary leakage or fecal incontinence, not a single patient I have treated has not quit smoking or reduced her BMI in order to repair her pelvic floor disorders. I find that remarkable!

I believe that each of us can find a way to participate in public health. We can participate in committees like the Public Health Committee for our Society, we can guide businesses to affiliate with public health issues we find important, we can promote public health issues with our patients, and, finally, we can take care of ourselves to promote public health through our examples of living healthy lives.

I hope you will consider and find some way you can participate in promoting public health. ru

14 • Round-up • March 2015 • A monthly publication of the MCMS

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public health

Exemption from Vaccination But Not from Education Duties in a Free Society John Middaugh, MD

John Middaugh, MD Dr. Middaugh is a Public Health Consultant and retired Epidemiologist.

His previous positions include Director, Division of Community Health and Chief Health Officer for the Southern Nevada Health District.

He joined MCMS upon re-location to Arizona in 2014.

Through February 13, 2015, the two outbreaks of measles in the United States have resulted in 141 people developing the disease in 17 states and Washington, DC. Of these, 113 people with measles have been linked to the outbreak at Disneyland in California. The majority of people who developed measles were unvaccinated, and 17 people have been hospitalized.

The resurgence of measles transmission in the United States after being almost eradicated several years ago provides a teachable moment to re-examine public health strategies and personal and community responsibilities.

He can be reached at jpmidd@cox.net.

16 • Round-up • March 2015 • A monthly publication of the MCMS

public health

Well documented in recent media coverage are many important facts. Measles is one of the most infectious diseases and causes serious illness among those who become infected. Measles and measles vaccines have been extensively studied, and the measles vaccine is very safe and very effective. Unethical researchers and others caused serious damage to individuals and communities by lying about side effects from measles (and other) vaccines. For example, the measles vaccine does not cause autism, yet sensationalistic media

coverage and reprehensible conduct by unethical physicians resulted in many parents believing otherwise and refusing to vaccinate their children. In the United States, enforcement of school and day care vaccinated requirements was essential in reducing, if not eradicating, many childhood, vaccine-preventable diseases. The success of vaccines has been called one of the greatest successes of science, research, medicine, and public health in the 21st century.

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public health Yet, mandatory vaccination has always been at the center of the inherent tension between individual autonomy and community rights. Some individuals believe they have an absolute right not to vaccinate themselves and their children.

Yet, by not vaccinating their children, they create inherent risks to the community. No vaccine is perfect and does notprovide protection to every person who is vaccinated. Some vaccinated persons simply do not develop protective antibodies; others have underlying diseases that preclude vaccination. These persons garner protection from herd immunity.

If a high proportion of persons in the community are vaccinated, then if the disease is introduced into the community, the likelihood of spread of the disease is greatly reduced.

If many members of a community do not get vaccinated, then herd immunity can fail, and the introduced disease can spread widely to others. Epidemiologists have identified an important additional concern. In the United States, people who have refused to vaccinate their children have tended to share other common characteristics, and so they have tended to cluster together geographically and socially. As a result, although as a whole a community may be highly vaccinated, in a local neighborhood, or a school or day care or church, a much higher proportion of children may be unvaccinated. If measles is introduced, transmission can readily spread.

There are many possible strategies to try to control childhood vaccine-preventable diseases. Two states have made mandatory vaccination a requirement for all persons attending school or day care except those who have medical diseases that preclude vaccination. These two states do not permit religious or personal exemptions from vaccine re-

quirements. Nineteen states allow personal exemptions. All 50 states allow medical exemptions. Many of the states that allow medical, personal, or religious exemptions also have provisions for excluding the unvaccinated child from school or day care if a vaccine-preventable disease occurs in that jurisdiction. Some states have made provisions for parents who refuse to vaccinate their children to home school, but they do not allow the unvaccinated children to participate in school or day care organized activities such as clubs or sports.

In response to the current measles outbreak, new strategies are being considered by many states. Among strategies that have proven effective is the adoption of requirements that parents (or guardians) who do not wish to have their children vaccinated take an educational course administered by the local or state public health agency. This course provides scientifically accurate information about the childhood diseases, the available vaccines, the potential adverse outcomes from catching the disease, the risks of vaccine side effects, and the procedures that are implemented to exclude unvaccinated children if an outbreak of disease occurs in the area. Parents must sign an affirmative statement that acknowledges the risks they are accepting. States that have these requirements in place have far fewer parents who end up refusing vaccination after receiving unbiased information about the risks and benefits of vaccination.

As the debates about mandatory childhood vaccination continue, Arizona should seriously consider adopting new requirements to make sure parents are as informed as possible and to make the exemption process more difficult. Parents should have the best information and assistance as they make decisions about giving or denying protection from serious diseases to their children. Parents also must accept their responsibility to their community for their decision, because their unvaccinated children can be the source of transmission of disease to others. ru

18 • Round-up • March 2015 • A monthly publication of the MCMS

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public health — international medicine

The Value of My Stethoscope Lessons Learned From a Trip to Cuba

By Senator Bill Frist, MD

I have always found a romanticized Cuba ironic. In one of the world’s poorest countries, the streets are filled with automobiles from the 1950s, internet access is almost non-existent, and 20% of the population lives below the poverty level. But what is idealized is the nostalgia: the culture, a bygone time. Interestingly this is true of their medical system as well.

Sen. Bill Frist, MD Dr. Frist, senator from Tennessee from 1995 to 2007, is a nationally acclaimed heart and lung transplant surgeon, former U.S. Senate Majority Leader, and chairman of the Executive Board of the health service private equity firm Cressey & Company.

Connect with him through http://billfrist.com/

The last several years have seen reports on Cuba’s medical system and astounding outcomes: life expectancies that rival the U.S. and infant mortality rates that put ours to shame. I could not help but wonder if this is really true. And if so, how?

I have also recently shifted my focus to public health indicators and the relevant social determinants. Specifically in meeting Dan Buettner and hearing about his Blue Zones project, the question arose – is Cuba next?

With these questions in mind, I traveled to Cuba in October 2014 with a delegation organized by Kraft Healthcare Consulting. While there, I had the opportunity to talk to healthcare practitioners, visit hospitals and medical schools, and talk to Cuban citizens.

20 • Round-up • March 2015 • A monthly publication of the MCMS

public health — international medicine What I witnessed was poverty and lack of resources compensated for by subsistence rationing and broad healthcare access and continuity. Indeed Cuban medical care warrants the nostalgia. Their system harkens back to the days of family physicians making house calls armed only with their deep personal patient knowledge and their stethoscope.

In Cuba, routine care visits are mandatory. Everybody has a primary care physician, and each doctor is responsible for a roster of about 1000 patients. Patients are seen at least once a year, often in their home. The entire population is riskstratified as well based on characteristics such as smoking or existing disease, and higher risk categories are seen more frequently. Physicians are available 24/7 and dispense with 70% or more of all medical issues. All of this is provided at no charge to the Cuban national.

These physicians are paid practically nothing, may not have a nurse, an x-ray machine or access to the internet, but they know their patients intimately and respond to that knowledge. Emergencies are addressed immediately.

Chronic conditions are identified and managed early.

The system works well, and it’s easy to see why. An over-

weight or genetically-vulnerable 33-year-old may have early signs of hypertension and a creeping blood glucose level. In the U.S.—with lack of access to or emphasis on preventative primary care—this patient may not even begin seeing a physician regularly until he starts to feel overly fatigued at 42 or has his first heart attack at 49. At that point, the damage is well underway. He will start multiple blood pressure medications, a medication for diabetes, and may need procedures as well. But catching a pre-hypertensive blood pressure in the patient’s early 30’s, initially trying weight loss followed by a single blood pressure agent and titration over the next decade will likely prevent that first heart attack. The patient may still go on to die from heart failure, but it might be at 85 instead of 65 and he may largely avoid many of the medical complications of his disease by catching and intervening early.

This early intervention is possible because patients trust their doctors and are more likely to comply with treatment recommendations. I spoke with several primary care doctors and patients, and I was very impressed with their rapport. I found the doctors to be empathetic and compassionate. The pay for these neighborhood physicians is paltry, but they are

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A monthly publication of the MCMS • March 2015 • Round-up • 21

public health — international medicine

“ While the primary care system may be idealized, the tertiary care system is definitely not. You do not want to be seriously ill in Cuba. The reason is simply a lack of resources. There are shortages of medicine, imaging equipment, operating rooms, and essential cancer treatments. Tertiary care is certainly underfunded, and the U.S. trade embargo has probably hurt that as well.” — Sen. Bill Frist, MD dedicated and accessible. They are not encumbered by paperwork or bureaucracy. They truly love their work. As a result, their patients deeply respect and appreciate them. Over and over patients told me that their doctors really listen to them, and they are grateful.

While the primary care system may be idealized, the tertiary care system is definitely not. You do not want to be seriously ill in Cuba. The reason is simply a lack of resources.

There are shortages of medicine, imaging equipment, operating rooms, and essential cancer treatments. Tertiary care is certainly underfunded, and the U.S. trade embargo has probably hurt that as well.

However, throughout Cuba healthcare is always mentioned in the same breath with education and social justice— socialism—as a major cultural priority, and the human capital investment in primary care is evident. It is remarkable to me that as one of the poorest countries in the world, no one was without access to food or provision of at least basic medical care.

Some of the statistics are largely supportive. The Cuban life expectancy is 78 years because they are not dying of infectious diseases or prematurely of chronic diseases. Instead they are facing the illness of wealthy countries: cancer.

On the other hand, I am very skeptical of the government’s reported infant mortality rate. There is tremendous pressure to report good results, and my anecdotal impression is that data are manipulated at all levels. However, national

efforts at education on family planning and pre-natal care are exemplary and should be applauded.

Two other points that struck me as simple but potentially very impactful: healthcare literacy is highly-valued, and education on healthcare issues is a required part of public curriculum. Despite offering completely free care, the government posts costs of healthcare services at all hospitals and doctor’s offices. Though they do not pay for their own health services, Cubans are literate about healthcare and aware of what it is costing their government.

I would hardly advocate for the exaltation or emulation of the Cuban medical system, but there are certainly some lessons to be learned.

• Access to primary care and an emphasis on prevention are effective if they are made a priority of the system.

In the U.S. this cannot happen until we change our current payment structure.

• Continuity of care is a valuable resource. We are moving away from family doctors and into the world of urgent care clinics and hosptialists, but we have to find a way to preserve some continuity to decrease costs.

The solution is a heavy investment in healthcare IT. • Physicians must be freed to be physicians. Increasing rules, regulations, and changes are driving many from the field and this is a threat to the future of our nation.

• Healthcare literacy is imperative. The best asset any patient has for their health is their own investment in and knowledge of their care. Patients have to be an active participant in their care.

• Transparency in cost can be a powerful tool in guiding decisions even in a situation where moral hazard applies.

If I were able to tell my father about my trip, he may have responded, “Well, of course!” This focus on personal primary care was certainly how he practiced medicine. Our challenge is to apply the principles that work while retaining our resources and advanced knowledge. A little nostalgia is not a bad thing. We must remember that more money, more drugs, and more procedures do not always mean better care; and a physician’s ears—in and out of her stethoscope—are his/her most important tools. ru

Reprinted with permission. First posted: October 24, 2014. To view original post, visit: www.themorningconsult.com/2014/10/columns-cubas-medical-system-stethoscope/

22 • Round-up • March 2015 • A monthly publication of the MCMS

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public health — a parent’s perspective

Let’s Talk Measles An Open Letter to the Parent of an Unvaccinated Child Tim Jacks, DO

To the parent of the unvaccinated child who exposed my family to measles: I have a number of strong feelings surging through my body right now. Towards my family, I am feeling extra protective like a papa bear. Towards you, unvaccinating parent, I feel anger and frustration at your choices.

Tim Jacks, DO Dr. Tim Jacks, DO, FAAP is board-certified by the American Board of Pediatrics and a fellow of the American Academy of Pediatrics. Originally from Elmhurst, Illinois, Dr. Jacks has lived in the greater Phoenix area for the past 25 years. When not working as a pediatrician, Dr. Jacks enjoys spending time with his wife and two children, running, playing with computers, exploring the great outdoors, and being involved at his church.

Reprinted with permission. Originally posted on January 26, 2015 – www.caringbridge.com.

By now we’ve all heard of the measles outbreak that originated in Disneyland. Or, more accurately, originated from an unvaccinated person that infected other similarly minded vacationers.

I won’t get into a debate about the whole antivaccine movement, the thimerosal controversy (no longer even used in childhood vaccines), or the myth that MMR causes autism (there are changes in autistic brain chemistry prior to birth).

Let’s talk measles for just a minute. It was once widespread in our country. It is now considered ‘eliminated’ in the U.S. (not continually circulating in the population—only contracted through travel out of country). Measles is highly contagious (>90% infectious) and can survive airborne in a room and infect someone two hours later. Another fun fact is that measles is transmittable before it can be diagnosed – four days before the characteristic rash appears. “Measles itself is unpleasant, but the complications are dangerous. Six to 20 percent of the people who get the disease will get an ear infection, diarrhea, or even pneumonia. One out of 1000 people with measles will develop inflammation of the brain, and about one out of 1000 will die.1” That sounds fun!

24 • Round-up • March 2015 • A monthly publication of the MCMS

public health — a parent’s perspective Ok. Calm down self.

I assume you love your child just like I love mine. I assume you are trying to make good choices regarding their care.

Please realize that your child does not live in a bubble. When your child gets sick, other children are exposed. My children. Why would you knowingly expose anyone to your sick unvaccinated child after recently visiting Disneyland?

That was a bone-headed move.

Why does this effect me and mine?

Why is my family at risk if we are vaccinating? I’m glad you asked.

Regarding measles, there are four groups of people. All are represented in my family.

First, the MMR vaccine results in immunity for most who receive it. Two doses provides protection that can be confirmed with blood titers. My wife is in this group.

Second, about 3% of fully vaccinated children do not develop a lasting immune response. They have low blood titers and are not protected against measles. If exposed, this group will likely get the illness. I am in this group.

I was thankfully not exposed.

Third, we have the unvaccinated. My son, Eli, is ten months old. He is too young to received the MMR vaccine and thus has no protection. Whether by refusal or because they are too young, exposed unvaccinated children have a 90% chance of getting measles.

Fourth, there are children like my Maggie. These are children who can’t be vaccinated. Children who have cancer.

Children who are immunocompromised.

Children who are truly allergic to a vaccine or part of a vaccine (i.e anaphylaxis to egg). These children remain at risk.

They cannot be protected... except by vaccinating people around them.

Back to my story.

It was Wednesday. Maggie had just been discharged from Phoenix Children’s Hospital after finishing her latest round of chemotherapy. That afternoon she went to the PCH East Valley Specialty Clinic for a lab draw. Everything went fine, and we were feeling good; until Sunday evening when we got the call. On Wednesday afternoon, Anna, Maggie, and Eli had been exposed to measles by another patient. Our two kids lacked the immunity to defend against measles. The only protection available was multiple shots of rubeola immune globulin (measles antibodies). There were three shots for Maggie and two shots for Eli. They screamed, but they now have some temporary protection against measles. We pray it is enough.

Unvaccinating parent, thanks for screwing up our three week “vacation” from chemotherapy. Instead of a break, we get to watch for measles symptoms and pray for no fevers (or back to the hospital we go). Thanks for making us cancel our trip to the snow this year.

Maggie really wanted to see snow, but we will not risk exposing anyone else.

On that note, thanks for exposing 195 children to an illness considered ‘eliminated’ from the U.S. Your poor choices don’t just effect your child. They affect my family and many more like us.

Eli Jacks before receiving his immunization.

Eli receiving the immunization.

Please forgive my sarcasm. I am upset and just a little bit scared.

Papa Bear (Tim Jacks, DO)

Reference: 1. http://www.cdc.gov/vaccines/ vpd-vac/measles/faqs-dis-vac-risks.htm

Maggie Jacks after her cancer diagnosis.

A monthly publication of the MCMS • March 2015 • Round-up • 25

public health — a student perspective

Maintaining the Delicate Balance Between Science, Opinions and Beliefs A medical student’s perspective on vaccinations Catheryn J. Salibay, MPH

In January 2013, I was reminded of how vaccines reduce morbidities and mortalities.

Catheryn Salibay, MPH Catheryn J. Salibay, MPH, is a first year osteopathic medical student at A.T. Still University, Mesa, Arizona.

Prior to attending school, she was an epidemiologist at the California Department of Public Health Immunization Branch. She aspires to become a family medicine physician with an emphasis in public health.

She can be reached at csalibay@atsu.edu

My 2-year-old niece was being admitted into the pediatric intensive care unit for what was later determined to be respiratory syncytial virus (RSV) infection. RSV is the most common cause of lower respiratory tract infections in children. Nearly all children are infected by their second winter and pass the disease without incident. My niece, however, developed complications, and stayed in the hospital for five unnerving days. Luckily, with proper care, she recovered well and is now a very active and sharp 4-year-old.

But after her hospital stay, I could not help but wonder how many young lives would be spared the illness if an RSV vaccine existed. How many complications, hospitalizations, and worried families would also be spared? According to the Centers for Disease Control and Prevention, each year, that would equate to 100,000-126,000 children younger than 1-year-old spared from hospitalizations and 2.1 million children younger than 5-years-old spared from outpatient visits.1 Needlessness to say, I support vaccines. However, as a future physician, I hope to work with each patient to understand their perspective and ensure the best healthcare for their family and the community.

26 • Round-up • March 2015 • A monthly publication of the MCMS

public health — a student perspective In the middle of my medical school interview, I was asked how I would talk to a long-term patient who was concerned that giving her daughter the human papillomavirus vaccine would encourage sexual behavior. The question was asked by the immunology professor—no pressure. Drawing from my experience as an epidemiologist for a State Immunization Branch, I remembered a discussion with a health educator who informed me that there are three groups of people: those for vaccines, those against vaccines, and the undecided. His focus was to discuss—not convince or lecture—those people who were undecided.

I explained to the professor that, first and foremost, I would not quickly disregard the years of trust established between the patient, her family, and myself based on this hot button issue. The patient-doctor relationship is built on a two-way road of trust and respect. Just as the patient trusts me to provide her with the best medical care, I should respect her pro-active attitude towards learning more about the vaccine and its effects on her child’s health. In fact, I do not

know her motivation for asking the question. It might be based on a one-line comment she read by chance or from a long discussion with someone who is against vaccines. Regardless, I must be open to discussion. And during those conversations, I would remind the mother to trust her instincts.

She knows her daughter best. One shot will not change her into an over-sexualized being. In fact, regardless of what her daughter’s sexual behavior is now (existing or not) or will be, this vaccine will assure one thing - greatly reduce her risk of cancer and potentially save her life.

Currently, I am pursuing family medicine so naturally, conversations about vaccines are inevitable. And for the betterment of personal and community health, I will administer vaccines. But I will balance that personal choice with maintaining my patients’ trust and respect. ru References: 1. http://www.cdc.gov/rsv/research/us-surveillance.html

A monthly publication of the MCMS • March 2015 • Round-up • 27

public health — a student perspective

Heat Related Illness and Public Health Ralph Mohty

Arizona has the fortune and misfortune of being a sunny state for a significant part of the year, and the hot season is just around the corner! While the relative warmth during the fall and winter makes many eastern states envious, the heat we receive from May to September is a non-trivial public health concern (Figure 1).2

Ralph Mohty Ralph Mohty is a dual degree MD/MPH student at the University of Arizona College of Medicine – Phoenix. He completed degrees in Mathematics and Physiology at the University of Arizona.

He joined MCMS in 2014.

Contact him by email to: rmohty@email.arizona.edu

Heat-related illnesses such as heat cramps, heat exhaustion, heat syncope, or heat-stroke are serious possibilities for patients this summer.

These illnesses result when the body becomes unable to effectively regulate temperature via balancing heat load with heat dissipation.4 In the United States between 1999 to 2003, extreme heat contributed either as a direct cause or contributing factor to 3,442 deaths.3 From 1979-2003, excessive heat exposure caused 8,015 deaths in nationwide—more deaths than from hurricanes, lightning, tornadoes, floods, and earthquakes combined. At the state-level, Arizona, between 2000 and 2012, reported an average of 118 heat-related deaths per year.2 Which patient demographics are at greatest risk and should be educated as such? Older adults (aged ≥65 years), individuals with chronic medical conditions (e.g. cardiovascular disease, respiratory conditions, diabetes, and obesity), individuals currently taking certain medications (diuretics especially), outdoor workers, homeless individuals, athletes, and infants/young children.4 Data from the Arizona Department of Public Health Services shows that between 2000 and 2012, the Hispanic/Latino population saw the most deaths (898), followed by White Non-Hispanic (444), American Indian/Alaskan Native (50), African American/Black (40), Asian/Pacific Islander (10), and Unknown (100). Geographically,

28 • Round-up • March 2015 • A monthly publication of the MCMS

public health — a student perspective ing, avoid strenuous activity, and stay indoors when possible during the hottest hours of the day. For heat cramps or exhaustion, the primary objectives are to get the person to a cooler location, have the person rest, and attempt to give cool water (without letting them drink too quickly).

Remember liquids that contain alcohol or caffeine can make conditions worse.

Heat stroke is a life-threatening situation! Immediately call emergency medical services (9-1-1) and then attempt to cool the patient by any means available (including cool water and ice; do not use rubbing alcohol because it closes the skin's pores and prevents heat loss).

Figure 1 Deaths From Exposure to Excessive Natural Heat Occurring in Arizona by Month, 2000-2012 750

Number of Deaths

589

500

318 285 250 141

2

6

9

Jan.

Feb.

Mar.

121

33

20

Apr. May

Jun.

Jul.

8

Aug. Sept. Oct. Nov.

3 Dec.

Month of Death

Maricopa and Pima counties have the highest absolute number of children under the age of 5, individuals ≥65 years of age, and individuals who live below the poverty line.1 These are all contributing factors to risk of heat-related illnesses, and as would be expected the number of deaths between 2000 and 2012 in Maricopa and Pima counties were 460 and 729, respectively (both the highest number of deaths of all counties in the state of Arizona).

What signs and symptoms indicate that an individual is suffering from extreme heat? First and foremost is thirst!

By the time an individual feels thirsty, they are already mildly dehydrated.

Second is heat cramps due to heavy water and salt loss; these are characterized by muscular pains/spasms usually involving the abdominal muscles or

legs. Thirdly, heat exhaustion—while less severe than heat stroke—results in paleness, heavy sweating, headache, nausea & vomiting, dizziness, and exhaustion. If heat exhaustion is left untreated, it may progress to the fourth and most serious and life-threatening heat-related illness: heat stroke. Heat stroke is characterized by red, hot, dry skin, confusion, rapid pulse, and a very high body temperature (above 103°F).3

What are the potential interventions and recommendations for both avoiding extreme heat and treating heat-related illnesses? The most pertinent instructions for patients are: drink water regularly (to compensate for losses of up to 4 liters of water hourly), avoid alcohol and caffeine (which dehydrate the body), avoid the use of salt tablets unless directed to do so by a physician, wear lightweight, light-colored cloth-

While this piece does not provide advanced information on heat-related illness, it is hoped that the information provided has begun to educate the reader on this important issue. For more information, one can visit the CDC website concerning extreme heat (www.bt.cdc.gov/disasters/extremeheat) or Arizona’s Dept. of Public Health website: www.azdhs.gov. ru References:

1. “Extreme Weather and Public Health: Heat Safety.”

AZ Dept. of Health Services website www.azdhs.gov/phs/oeh/extreme/heat/. Updated August 14, 2014. Accessed March 05, 2015.

2. “Trends in Morbidity and Mortality from Exposure to Excessive Natural Heat in Arizona, 2012 report.”

The Bureau of Epidemiology & Disease Control, The Bureau of Public Health Statistics, AZ Dept. of Health Services. http://www.azdhs.gov/plan/report/im/heat /trends-in-morbidity-and-mortality-from-exposure-toexcessive-natural-heat-in-az-2012.pdf. 2012. Accessed March 05, 2015.

3. “Emergency Preparedness and Response: Extreme Heat.” Office of Public Health Preparedness and Response (OPHPR), CDC website. www.bt.cdc.gov/ disasters/extremeheat/. Updated July 27, 2012. Accessed March 10, 2015.

4. “Surviving Arizona’s Extreme Heat.” Maricopa County Department of Public Health website http://www.maricopa.gov/publichealth/programs/ heat/default.aspx. Accessed March 05, 2015.

A monthly publication of the MCMS • March 2015 • Round-up • 29

member profile

Meet MCMS Member:

Diana B. Petitti, MD, MPH Article photos: Denny Collins Photography www.dennycollins.com 602-448-2437

I

n the face of ever-rising cases of obesity, diabetes, and the current vaccination arguments sweeping the nation, the public eye is certainly on public health. But how can we turn this conversation into one that produces results? And what can private physicians and organized medicine do alleviate the confusion this topic presents?

Round-up sat down with Dr. Diana B. Petitti, a widely regarded expert in epidemiology research and author of Meta-Analysis, Decision Analysis, and Cost-Effectiveness Analysis: Methods for Quantitative Synthesis in Medicine, to discuss her career in research and academics, and her views on public health.

30 • Round-up • March 2015 • A monthly publication of the MCMS

member profile

The Path to Medicine and Public Health

A Career in Academics and Research

Petitti was exposed to the medical practice very early on.

Her father was a physician, and when she was accepted to Cornell University she planned to become a chemist. However, as her studies progressed, she quickly found she preferred biology. So she switched tracks to become a neuroscientist. Before her final year of college, Petitti spent the summer in very rural Ethiopia, and it was there she was truly bitten by the medicine bug.

After leaving the CDC, Petitti moved to California to join the University of California at San Francisco as a full-time faculty member. She spent 10 years there, working in their Department of Family and Community Medicine.

Diana Petitti grew up in Pueblo Colorado, which she describes as being, “not really a small town, but certainly not a big one.”

After returning from Ethiopia, she graduated from Cornell University and was accepted to Harvard Medical School. From there she went on to complete an internship at the University of Colorado. It was one year into her internship when she found her passion for public health.

“Within the field of public health, I quickly found epidemiology,” she recalled.

She went on to obtain a Masters of Public Health from Berkley School of Public Health, and would eventually spend the bulk of her career in public health and epidemiology, beginning with the Center for Disease Control as an Intelligence Service Officer.

Petitti spent two years in the field with the Center for Disease Control, and then settled into her true passions: academics and research.

When asked what prompted her to choose a career in academics, Petitti said, “I loved science from an early age. My career in research and in academics is a reflection of my longstanding and continuing devotion to science.”

Her love and devotion to science led her to devote much of her life to research. After leaving the University of California, Petitti accepted a position with the Kaiser Permanente Medical Care program, where she began as a researcher. She would go on to serve as First Director of Research and Evaluation, and eventually as a Senior Policy Advisor with Kaiser.

In 2008, an opportunity would arrive that would take her away from California and lead her to settle in Arizona.

“There was an opportunity in Phoenix to return to teaching and I decided to take it,” she said. “As a long-time westerner, the transition from California to Arizona was logical.

I do wish it were a bit cooler in the summer!”

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A monthly publication of the MCMS • March 2015 • Round-up • 31

member profile On the Personal Side 1. Describe yourself in one word.

Hyperactive.

2. What is your favorite food, and favorite restaurant in the Valley?

I love Tuttu Santi by Nina on 16th Street. The veal is to die for.

3. What career would you be doing if you weren’t a physician?

An economist or a statistician. I love numbers and models. Both professions involve numbers and models even more than epidemiology!

4. What’s a hidden talent that you have that most wouldn’t know about you (play the guitar, sing, etc.)?

I took up enameling a little more than a decade ago. Enameling is an ancient craft that involves fusing glass to metal. I have taken many classes and worked hard to try to master the craft from the technical side. I have a kiln and a torch and a “studio” in my garage and none of my friends and relatives is without an enameled box.

5. Best movie you’ve seen in the last ten years?

I love movies and there are many good ones over the last 10 years. Choosing among Leviathan (2014), Slumdog Millionaire (2008), and Ratatouille (2007); I’m going with Slumdog Millionaire. It is a sad but happy and ultimately triumphant movie that also helped me understand India better.

6. Favorite Arizona sports team (college or pro)?

I live close to Chase Stadium and like to watch the D-Backs there.

An artist at work...

...and the fruits of her labor.

32 • Round-up • March 2015 • A monthly publication of the MCMS

member profile

“I took up enameling a little more than a decade ago. Enameling is an ancient craft that involves fusing glass to metal. I have taken many classes and worked hard to try to master the craft from the technical side.

I have a kiln and a torch and a “studio” in my garage and none of my friends and relatives is without an enameled box.”

Petitti served on the faculty in the department of Biomedical Informatics at ASU, and was involved with the Center for Health Information and Research. She continues to hold a part-time faculty position with the University of Arizona College of Medicine-Phoenix.

During her time as a researcher, Petitti published two books, both of which are now in their second edition, as well as authoring over 200 peer-reviewed publications.

Her most well-known work teaches how do a systematic review and meta-analysis to better serve the formulation of policy recommendations in medicine. The book was very well received, and this gave Petitti several opportunities to participate in both national and international committees and advisory boards.

Public Health and Preventative Medicine

These opportunities to serve with committees and advisory boards have allowed her to make her voice heard on the topic of Public and Preventative Health.

“I was a member and then Vice-Chair of the United States Preventive Services Task Force from 2003 through 2009 and was able to help shape policies about preventive services for individuals,” she recalls. “Since my retirement from full-time employment, I continue to be involved in work on methods for making good decisions and good policies about prevention.”

Petitti said there are some misconceptions about the exact nature of public health.

A monthly publication of the MCMS • March 2015 • Round-up • 33

member profile In the studio working on one of her many beautiful creations.

“Public health and the delivery of clinical preventive services get confused,” she explained. “It is a misconception that the delivery of clinical preventive services will obviate the need for strong, well-functioning state and local public health departments.”

When asked about the biggest public health challenges here in the valley, Petitti said it is definitely funding.

“Since I came to Arizona, I’ve witnessed a continuing erosion of the funding base for public health at the national, state and county level.”

Petitti said it is difficult to compare public health systems between cities, but she feels the public health infrastructure is significantly less developed in Maricopa County compared to other metro areas she has lived and worked in.

“Particularly lacking is the employment here of a large cadre of full-time public health physicians, who bring unique insights and skills to the public health enterprise,” she explains.

When it comes to battling both the lack of understanding, and the lack of funding, Petitti felt that physicians and physician organizations could help by promoting a better understanding of public health verses preventative medicine, as well as encouraging a changing perception of public health in general.

“There are tremendous opportunities of physicians to be involved in promoting health lifestyles among their patients and to the public at large,” she said.

Involvement and Advocacy

Petitti remained very active in organized medicine throughout her academic and research endeavors. She was very active in the Society for Epidemiological Research, serving on multiple committees and eventually as president of the organization.

She has also served as a Regent for the American College of Preventive Medicine, and has been a member of MCMS since 2010.

“I have enjoyed being able to participate in activities with the Maricopa County Medical Society, which is a much less forbidding organization that many of the professional societies in southern California,” she said.

When asked whether she had seen any concepts that our medical society should consider, Petitti highlighted the role of organized medicine as an advocate for the public as well as for physicians.

“The Society and physicians everywhere in Arizona need to continue to be at the forefront of discussions of access to healthcare for all citizens of Arizona,” she said.

“The medical society needs to work to be seen as an organization that serves the public through its advocacy for good policy.” ru

34 • Round-up • March 2015 • A monthly publication of the MCMS

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the mcms open house The last nail was hammered, the last tree was planted, and the wheelbarrows were put away.

What was next? Why an Open House of course!

On March 12, 2015 the MCMS hosted an open house celebrating the Society’s building facelift. As you will see by the photos on the following pages, a great time was had by all!

Be sure to mark your calendar for Thursday, May 7, 2015 for the Society’s next membership event – “Philanthropy in Medicine.”

Photos by Denny Collins Photography.

the mcms open house

Top left: The swag table with a beautiful floral bouquet compliments of MCMS Preferred Business Partner Healthcare Medical Waste Services.

Middle (left to right): Dr. Salvatore Gualtieri, Roberta Aidem, and Patt and Dr. Norman Thompson Bottom: Mardy and Dr. William Lawrence Above: Dr. Mark Kartub A monthly publication of the MCMS • March 2015 • Round-up • 37

the mcms open house Dr. Sam and Mary Colachis

(left to right): Drs. Leland Fairbanks, MPH and Michael R. Mills, MPH

Below: Dr. Sebastian Ruggeri

Below: Drs. Atef and May Mohty, and Midwestern University medical student Philip Standen (center) chatting with fellow members.

38 • Round-up • March 2015 • A monthly publication of the MCMS

Below: Dr. Paul Jarrett

the mcms open house

Top (left to right): Drs. Dean Gain and Adam Brodsky

Top: Drs. John Middaugh and Jonathan Weisbuch

Bottom: foreground – Drs. May and Atef Mohty and Patt Bottom: Drs. Deborah Mendelson and Diana Petitti Thompson; background – Drs. Paul Jarrett and Norman Thompson

Left to right: Drs. Leonard Kirschner and Nathan Laufer

A monthly publication of the MCMS • March 2015 • Round-up • 39

the mcms open house

Below left: Dr. Ryan Stratford. Right: Terese and Dr. Michael Cleary Bottom left: Dr. J. Ulises Urcuyo and Mardy Lawrence. Right: Emily and Dr. Ryan Stratford chatting with Dr. Michael Mills

40 • Round-up • March 2015 • A monthly publication of the MCMS

viewpoint

Happy Anniversary SS, M&M, ADA & ACA Leonard Kirschner, MD, MPH

Americans love anniversaries whether it is the birth of our nation on July 4th, our parents 50th, Pearl Harbor or 9/11. The year 2015 has a number of significant anniversaries of laws that have changed.

On August 14, 1935, in the height of the Great Depression, President Franklin Delano Roosevelt signed Social Security into law. Opponents fought long and hard to stop passage calling it “Socialism.” Ida May Fuller received the first Social Security check for the grand sum of $22.45.

Leonard Kirschner, MD, MPH Dr. Kirschner is a retired medical administrator and public health champion. During his career, he served on numerous committees and boards, and was frequently invited to speak at conferences across the country on the subjects of Medicaid, Medicare, managed care, behavioral health and healthcare reform. He was the second Director of the Arizona Health Care Cost Containment System (AHCCCS) from 1987 to 1993 He served on active duty in the United States Air Force for 22 years commanding five Air Force hospitals before retiring in 1985 as Commanding Officer of the USAF Hospital, Luke Air Force Base with the rank of Colonel.

In 2006, he was awarded the Healthcare Lifetime Achievement Award by the Phoenix Business Journal. He joined MCMS in 1983.

Contact him at dock1961@aol.com.

July 30, 2015, is the 50th Anniversary of the historic signing of Medicare and Medicaid into law by President Lyndon Johnson. The ceremony took place at the Truman Library in Independence, Missouri, and President Harry Truman got Medicare card #1. His premium for Part B was $3.00 per month. LBJ spoke only about Medicare and declared it a memorial to the slain JFK. Medicaid was an afterthought, added at the last moment before the law was passed by a divided Congress, and was intended to be a rather modest program with minimal financial impact. Congressional opposition was fierce calling it, once again, “Socialism.”

It was July 26, 1990, when President George H. W. Bush signed the Americans with Disabilities Act into law. The event took place on the South Lawn of the White House and the President considered it an extension of the Civil Rights Act of 1965. He said, “Let the shameful wall of exclusion finally come tumbling down.” The signing was the culmination of a quarter century of advocacy by and for the members of our society with disabilities. Some opponents called it “Socialism.”

Can you believe it has been five years since President Barack Obama signed the Affordable Care Act into law on March 23, 2010? I don’t believe I need to recount the battles leading up to the passage and subsequent battles to repeal and replace. Opponents, when not talking about “Death Panels,” even called it “Socialism.”

As we celebrate the 80th anniversary of Social Security, the 50th Anniversary of Medicare and Medicaid, the 25th Anniversary of the ADA and the 5th Anniversary of the ACA remember that these five laws took years of effort, advocacy and politics to achieve the end result of passage. And also don’t forget that once the laws were signed the political battles did not end. So stay tuned for 2015 and the 2016 Presidential election. The debate has not ended and will not in our lifetime.

Reprinted with permission by The Hertel Report. Originally posted on February 5, 2015.

A monthly publication of the MCMS • March 2015 • Round-up • 41

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42 • Round-up • March 2015 • A monthly publication of the MCMS

marketplace EDUCATION OPPORTUNITY

Dr. Satyendra Jain, General Medicine Practitioner with 30 plus years’ primary preventive medicine experience, invites actively practicing physicians, NPs and PAs to visit his clinic and observe his best practices in the different modalities of his practice.

The doctor is available two days a week and the office is closed on Wednesdays.

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Round-up Marketplace provides local classifieds for full-time or part-time jobs, office space for sale or lease, services, community events, and much more!

To advertise your product or service, contact Candice Scheibel at cscheibel@mcmsonline.com or call 602-251-2363.

44 • Round-up • March 2015 • A monthly publication of the MCMS

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