Allegheny County Medical Society
BULLETIN
BULLETIN
Opinion
Editorial
• Fall Nourishment
Deval (Reshma) Paranjpe, MD, MBA, FACS
Editorial
• Buckner at the Bag
Anthony L. Kovatch, MD
Editorial
• The Changing Pharmaceutical Landscape for Alzheimer's
Robert H. Howland, MD
Editorial
• The "D" Words
Richard H. Daffner, MD, FACR
Society News
ACMS News
• ACMS Distinguished Awards November 2024
ACMS News
• MJ's Q&A: HOD Chair Dr. Hoffmaster, MD
MJ Lerma — MPH Candidate Policy & Administrative Intern at ACMS
ACMS News
• 2024-25 ACMS Foundation Grant Awardees
ACMS News
• Specialty Group Updates
ACMS Staff: Nadine Popovich, Melanie Mayer and Haley Thon
Articles
Medical News
• Reportable Diseases 2023: Q1-Q3 Allegheny County Health Department Selected Reportable Diseases/Conditions
Kristen Mertz, MD Allegheny County Health Department
Article
• Resting, Reflecting, & Refining the Year End
Lillian Liang Emlet, MD, MS, CPC, ELI-MP
Cover Photo by Malcom Berger, MD Malcolm Berger, MD is a Retired Neurologist Reflecting Bird
2024
Executive Committee and Board of Directors
President
Raymond E. Pontzer, MD
President-elect
Keith T. Kanel, MD
Secretary
Kirsten D. Lin, MD
Treasurer
William F. Coppula, MD
Board Chair
Matthew B. Straka, MD
Directors
Term Expires 2024
Douglas F. Clough, MD
David J. Deitrick, DO
Jan W. Madison, MD
Raymond J. Pan, MD
G. Alan Yeasted, MD, FACP
Term Expires 2025
Anuradha Anand, MD
Amber Elway, DO
Mark A. Goodman, MD
Elizabeth Ungerman, MD, MS
Alexander Yu, MD
Term Expires 2026
Michael M. Aziz, MD, MPH, FACOG
Michael W. Best, MD
Richard B. Hoffmaster, MD
Micah A. Jacobs, MD, FIDSA
Jody Leonardo, MD
PAMED District Trustee
G. Alan Yeasted, MD, FACP
2024 Board Committees
Bylaws
Kirsten D. Lin, MD
Finance
William Coppula, MD Nominating
Keith T. Kanel, MD
Women’s Committee
Prerna Mewawalla, MD & Meilin Young, MD
Bulletin
Managing Editor
Sara C. Hussey, MBA, CAE ACMS Executive Director shussey@acms.org
Medical Editor
Deval (Reshma) Paranjpe, MD reshma_paranjpe@hotmail.com
Bulletin Designer
Victoria Gricks victoria@thecorcorancollective.com
Term Ending 2024
Richard Daffner, MD; Anthony Kovatch, MD; Andrea Witlin, DO, PhD
Term Ending 2025
Robert Howland, MD; John Williams, MD; Alexandra Johnston, DO; Charles Mount, MD
Administrative Staff
Executive Director
Sara Hussey shussey@acms.org
Vice President - Member and Association Services
Nadine M. Popovich npopovich@acms.org
Manager - Member and Association Services
Haley Thon hthon@acms.org
Operations CoordinatorACMS & ACMS Foundation Melanie Mayer mmayer@acms.org
Part-Time Controller Elizabeth Yurkovich eyurkovich@acms.org
Bulletin Designer Victoria Gricks victoria@thecorcorancollective.com
EDITORIAL/ADVERTISING
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Fall Nourishment
By: Deval (Reshma) Paranjpe, MD, MBA, FACS
Election season is finally over (we hope), and as the cold weather finally settles in, it’s time to look for comfort food. Here are the latest offerings in the Pittsburgh area:
Chillin’ Drive Thru Babcock Boulevard, McCandless Daily 6am - 8pm
If you’ve driven down Babcock Boulevard and passed the landmark North Park Lounge recently, you can't miss the signs advertising this new drive thu service attached to NPL. Pick up shakes, smoothies, coffee, tea, breakfast favorites, sandwiches, salads, wraps and ye olde avocado toast. With something for everyone, there’s a kids’ menu-- as well as pup cups for your best friend. If you ever frequented the Harris Grill in its Bacon Night heyday, you’ll smile at the cups of crispy snacking bacon on offer as well—except they’re not free. Great for a quick stop as you head to work or head to North Park.
Bridge City Brinery
914 Main Street, Sharpsburg
Three words: Upscale Greasy Spoon. Get ready for over-the-top indulgent housemade sandwiches from the brick and mortar home of the Bridge City food trucks (which usually park outside various breweries around town). You’ll find smashburgers and Reubens alongside treats like Duck Duck Goat— duck confit with goat cheese, duck egg and agrodolce, Chicken and Waffles, and Lamb ramen. Bulgogi steak, shaved ribeye, pickle brined fried chicken and marinated pork round out the menu
with fries and housemade pickles to boot. You may need to roll yourself home from Sharpsburg. (Their motto is “Truck Around and Find Aht”)
Three Brothers Bagels
1718 Mount Royal Boulevard, Glenshaw Tu-Fri 7am - 2pm; Sat 9am-2pm
Get your New York style sourdough bagels here! Culinary Institute of America graduate Colin Whiddon and wife Sofia offer nine flavors of New York style bagels by the dozen or half-dozen. Part of your purchase will support the Inspired Hearts and Hands Charity.
Third Space Bakery, Co-op and Teaching Kitchen
5349 Penn Avenue, Wilkinsburg Thu-Sat 8am - 2pm; Sat 9am - 2pm
Organic, scratch-made baked goods are the order of the day at this new bakery founded by friends which also offers classes, workshops and events. Look for delicate (lemon chiffon, anyone?) as well as decadent cakes including the aptly named Bete Noire. Also seek out their holiday breads and pies like bourbon pecan, maple pumpkin, pear-cranberry and deep dish apple pie. This month, you can take classes on sourdough and making the perfect piecrust, as well as joining in for the monthly Cookbook Club. Next month, learn how to make authentic pierogi and come to a 12/6 holiday party ($30/ticket) which features cocktails, cocktail classes and appetizers.
Space Bar Market Square
The owner’s grandfather was a NASA engineer, and he himself will take you to the outer limits of your imagination with this space-themed bar with stellar cocktails and an all vegetarian menu. Molecular mixology meets gastronomy meets astronomy in a very cool setting, if you need to escape this world and its worries for a while.
Novo Asian Food Hall
Strip District Terminal
Smallman Street, Strip District
This is one of the hidden jewels of Pittsburgh. Tucked away inside the new destination-worthy Strip District Terminal Building is an intimate food hall with mood lighting. Mola, the excellent sushi establishment in East Liberty, has an outpost here. You can also get excellent Vietnamese cuisine including multiple varieties of pho, and also sample the fantastically named Kung Fu Chicken. To cap it off, there’s a central bar offering interesting libations, and an Asian bakery offering desserts to sweeten the experience.
The Strip District Terminal
Smallman Street, Strip District
If you haven’t been, you need to go. Don’t be intimidated by the parking situation—there are parking lots all around and behind the terminal now. The sheer variety and interest of the shops here are worth checking out. In addition to the Asian food hall above, you can treat yourself to a spa experience at Nail Spa and Clean Your Dirty Face at the eponymously named store. Explore health and wellness at
Hieber’s Compounding Pharmacy. You can check out Posman Books, pick up some pretty blooms at City Grows, and then some ice cream at Oddfellows Ice Cream Co. Play golf at PuttShack and chow down at Shake Shack. Find some beautiful wines at the Fine Wine and Spirits State Store. Have a delicious and romantic dinner at Balvanera or at City Winery, where you can enjoy live music and concerts while you dine. If you’re feeling a bit more casual, check out Aslin Beer Company, and then head to Chipotle or Primo Hoagies. Or work on your body at Stretchlab, where physical therapists will put you through passive stretching to improve your flexibility and range of motion head to toe without causing you pain. (Yes, it sounds silly. Yes, I’ve tried it. Yes, it works. You do
Buckner at the Bag
The Irony of Sports
By: Anthony L. Kovatch, MD
As I look back on my days as a lonely kid growing up in the New York Metropolitan area, only now in retirement do I perceive the irony of a bookwormish boy who “stank” at sports developing a lifetime love affair with baseball. In my debut as an 8-yearold trying to impress the “big kids” on the sandlot, I blindly backhanded a grounder hit back to me on the mound and, as my teammate were screaming “Throw it to first base, dummy,” I hurled the ball into the bushes way beyond the bag. This miscue prompted belly laughter from all watching, followed by the declaration “YOU STINK!!” For the rest of my playing career, I cursed myself with the inner dialogue “You ARE Mr. Stink!”
It took the bookworm years to reverse his negative thought processes enough to realize the truth in the adage: We all make mistakes; it’s only how we come back from the mistakes that matters in the long run. Amen.
Indeed, my fondest memories of childhood still reside in some bleacher seat at the hallowed Yankee Stadium, celebrating the birthday of a member of my nuclear family---especially my mother, who, in spite of being in the early throes of Huntington’s Disease, had, like many housewives in the greater metropolitan area, a vicarious, platonic love affair with “The Mick” (legendary, but physically and psychologically handicapped, center fielder Mickey Mantle). With no car in the family and the prospects of a oneway two-hour commute on buses and potentially dangerous subway lines to get to the “House that Ruth Built” in the Bronx unscathed, we took advantage
of those double-headers to engorge ourselves on that beloved piece of Americana referred to in those days of yore as “America’s pastime.” I regularly recited to myself the infamous poem by Ernest Thayer “Casey at the Bat.”
Being a 9-year-old zealot has its downsides. The greatest insult to any diehard Yankee fan---the “home run of infamy”—would occur on October 13, 1960, as this goo-goo-eyed fan blasted into his living room after running home at break-neck speed from the bus stop after a distracted day at school hoping to catch the anticipated Yankee victory on the radio. I listened with the greatest of indignation as Bill Mazeroski’s shocking walk-off home run in the bottom of the ninth inning off reliever Ralph Terry sealed the first World Series championship since 1925 for the underdog Pittsburgh Pirates. Ironically, the lowly Bucs were outscored 55-27 in the lopsided 7-game series against the New York juggernaut.
I was 9 years old and pathologically sensitive and neurotic. I cried until my dad (intolerant of babyish behavior) came home from work that evening. My baseball psyche would only be freed by parole from this personal and civic imbroglio 21 years later when I pulled up stakes and moved to Pittsburgh for a pediatric fellowship in infectious diseases at Children’s Hospital. I met my beautiful future wife---a native of the Steel City, of course---and had no real choice but to turn my loyalty around 180 degrees and become a diehard fan of the Bucs.
Much redemption would transpire in the aftermath of the Yankees’ heartbreaking loss. Goat Ralph Terry
would rapidly recover and emerge over the next 5 seasons as the all-star and “mister clutch” of New York’s starting rotation, winning the CY Young Award in 1962. Iconic Yankee skipper and raconteur Casey Stangel, who had been fired after the 1960 season under the pretense that he was too old to coach, would eventually also recover and display the greatest of intestinal fortitude in babysitting the hapless New York Metropolitans—fondly touted by Stengel as the “Amazin Mets” ---during the dismal, formative years of the infant franchise.
This Mets team pulled themselves up by the bootstraps and shocked the baseball world by unfathomably winning the 1969 World Series against the power-house Baltimore Orioles.
Although I was lucky enough to watch one of the Mets victories from the distant outfield bleachers, this privilege would pale in comparison to an almost miraculous event that would occur when I was well-settled in Pittsburgh in 1986 and rattle for one night the stability of my happy family life. Mr. Stink would be taught another paramount life lesion: “One man’s trash is another man’s treasure.”
It was in the evening---8:25 PM EST exactly---of October 25, 1986, that the redemptive event for me occurred. My sports-phobic wife Mary (who harbored no platonic love affairs with sports heroes like my mother) had already joined my 3 and 1 ½ year old children in twilight sleep, so I decided to deny what appeared to be an inevitable Mets downfall and watch the game’s ending with a measure of sacred devotion and cling to the “hope that springs eternal”
within the breasts of diehard New York fans. After all, the “Amazin’ Mets” had already been enrolled in the archives of the greatest of baseball’s miracles in 1969, which had ignited a frenzy that the “city that never sleeps” had still not forgotten. In 1986, however, the time for miracles appeared to be shifting to the long-suffering Boston Red Sox, who had not earned the coveted World Series ring since 1918 and were hellbent on extricating the franchise from the mythical, but powerful, “curse of the Bambino.” The Sox appeared to be on the threshold of breaking “the curse” with a series-clinching victory in game 6, having the upstart Mets pinned down to their final out behind by 2 runs in the bottom of the 10th inning.
However, the potential victory celebration in Boston started to unravel. Three consecutive singles by the Mets and a wild pitch tied the score and I silently rejoiced in my lonely family room. When the next batter, the speedster and fan-favorite Mookie Wilson, hit a lazy ground ball down the first base line that trickled under the glove and through the legs of the usually sure-handed Bill Buckner into right field allowing the winning run to score, the momentum and fate of the cursed Red Sox “turned south.” The Mets won the deciding game 7; the bad kismet would not expire until 2004 when the Bostonians finally triumphed in the Series, ending an 86-year drought!
As the “error to forgive all errors” was taking place, I joined the crazed Mets fans along the first base line in spirit by jumping up and down in front of the TV, repeatedly howling “holy cow!” or “unbelievable!” My outburst did not die down until I heard my little children crying upstairs because of the rude awakening. What followed stung much worse than their crying: “What is wrong with you, Tony?! What can you be screaming about at this time of night? You woke everybody up! Shut up and come to bed immediately!” I apologized vehemently to my wife and turned down the TV volume to a negligible level. Fortunately, after a good night’s sleep,
my deranged behavior was forgotten! Although Buckner’s muffed play was only one small piece of the Red Sox collapse (he did get 2 hits in the competition, but losing, game 7), the frustrated fans and press of the city of Boston needed a scapegoat. A requirement of satisfying the whims of human nature! There were indeed several extenuating circumstances: the distraction posed by speedy Mookie Wilson’s race to the bag, the thunderclap eruption of the boisterous Mets fans in the stands surrounding first base, Buckner’s history of chronic ankle pain and instability following an old serious injury in 1975.
Unfortunately, the crestfallen Red Sox fans did not have it within their collective hearts to forgive and forget. Buckner’s error rekindled memories of “the curse,” and the previously cherished player incurred the wrath of the fans of Beantown and all New England. He began receiving death threats and was heckled and booed vociferously by his own fan base. Even worse, he became the focal point of derision from the Boston press and opposing fans throughout the country. There was even conjecture in the years to come that Buckner’s fall from grace and potential depression could put him at risk for self-harm, as had befallen Donny Moore (Angels’ relief pitcher who was the goat of the division championship series) at the age of 35.
To be sure, Bill Buckner was a competitor of Hall of Fame caliber. He finished his major league career spanning 4 decades with 2,715 hits---in 66th position all time, just behind Lou Gehrig with 2,721 and ahead of pinstripe greats Mickey Mantle (sorry Mommy!) and Joe DiMaggio. He won the National League batting title in 1980. Despite gimpy ankles, he was a stellar fielder, leading the league in assists 4 times.
Of far more importance and relevance, Buckner was regarded as a player of great humility and resilience, which was attributed to his taking on the burden of supporting his family after his father died when he was
merely a teenager.
The baseball landscape rapidly and dramatically changed for the Red Sox and for Buckner after Boston won the World Series in 2004. The then-retired Buckner was invited by the Sox to throw out the first pitch at the opening game in 2008 as the team unfurled the championship banner after winning the series again in 2007. Buckner received a 2-minute standing ovation as if he had personally extricated the team from the “curse.” When asked whether he had any misgivings about attending the ceremony, the ever gracious and professional Buckner responded with a “grand slam” (reminiscent of the immortal speech of the dying Lou Gehrig):
“I really had to forgive, not the fans of Boston per se, but I would have to say, in my heart, I had to forgive the media for what they put me and my family through. So I’ve done that. I’m over that. And I’m just happy that I just try to think of the positive. The happy things. I chose to look at it that life is great. You can make those choices.”
I think the legend of Bill Buckner exemplifies the challenges facing the medical profession today, especially in this era of burnout. Conversely and ironically, we more and more are bearing the burden of, not only diagnosing, but also ameliorating and striving to cure the mental health issues inherent in our society in this 21st century.
The Pirates were pounded by the visiting team at PNC Park in the game sponsored by the ACMS this past August, but the fireworks in its aftermath were awe-inspiring! I reiterate: You win a few, you lose a few--but ironically the game of life---like the game of baseball----is never over until the grand finale of the fireworks display! Thank you, Mr. Buckner! RIP
ACMS Distinguished Awards Nov. 13, 2024 - PNC Champions Club, Acrisure Stadium
The Allegheny County Medical Society (ACMS) proudly celebrated its 2024 Distinguished Awards Program, honoring leaders who have made exceptional contributions to healthcare. Honorees included Dr. Jodie Bryk, Dr. Thuy Bui and Dr. Julie Childers, Familylinks., Dr. Robert W. Mendicino, Dr. Darrell Triulzi, and Dr. Bruce MacLeod.
7.
Check out the full album of photos on our website.
1. Sara Hussey, MBA, CAE - ACMS Executive Director
2. Darrell Triulzi, MD - Awardee
3. Noor Khan, MD and Vicki March, MD (Nominee)
4. Matthew B. Straka, MD - ACMS 2024 Board Chair
5. Raymond E. Pontzer, MD 2024 ACMS Board President and Keith T. Kanel, 2025 Incoming Board President
6. Raymond E. Pontzer, MD and Jodie Bryk, MD (Awardee)
ACMS Team Members Nadine Popovich and Melanie Mayer
8. Veena Venkat, MD and Rep. Arvind Venkat, MD
The Pennsylvania Medical Society House of Delegates took place in late October of this year in Hershey, PA. Resolutions passed, or not passed, can have significant impacts on physicians, medical students, and fellows in Pennsylvania.
Dr. Richard B. Hoffmaster is a family physician, geriatrician, and palliative care specialist. An active member of both ACMS and PAMED, he served as the Chair of the Delegation at this year’s House of Delegates. In this interview, Dr. Hoffmaster shares his experiences from the House of Delegates and his hopes for next year.
Questions and responses have been edited for clarity.
What do you think went well?
I thought what went well was that we had a really big group this year. Everyone was really engaged, and we tackled some challenging issues both within the organization and in terms of public health policy. Over the years, I feel like we've been doing a better job of tackling some more controversial social issues and taking positions on them in ways that we haven't in the past, so I thought that was great.
Can you talk a little about what you thought could have gone better?
One thing I found challenging was dealing with some of the more hotbutton issues. For example, there were resolutions addressing divestment from countries convicted of genocide by the International Court of Justice, which clearly referenced the IsraeliPalestinian conflict. During testimony, there were some really unprofessional outbursts and shouts. Fortunately, our Speaker of the House immediately
MJ's Q&A: HOD Chair Dr. Hoffmaster, MD
By: MJ Lerma – MPH Candidate Policy & Administrative Intern at ACMS
stepped in, restored order, and reinforced the rules of decorum. After that, it was no longer an issue. However, it was clear that people were having very strong emotional reactions to even discussing these topics.
Another experience I had was as part of a task force that spent the last year negotiating compromises on how members are represented in the House of Delegates. Unfortunately, when we got to the House, it became apparent that some representatives were not negotiating in good faith and undermined the process. I think that was a real detriment—not just to the issue we were addressing but also to the integrity of the process itself. In an organization built on volunteerism, it felt to many of us that the effort and hard work invested in good-faith negotiations were wasted.
What resolutions that were or were not adopted do you feel impact or concern physicians the most?
There were a few things I think were really important. For instance, some resolutions focused on ensuring the integrity and independence of medical schools to provide education on diversity and inclusion—essentially, keeping the government out of how we teach medical students.
PAMED also resolved to support the decriminalization of marijuana, which was obviously a big topic of public health discussion. On the other hand, PAMED decided not to take a position on single-payer health care. That’s an issue that comes up year after year, but we still haven’t reached a consensus. For now, we’re continuing to take a neutral stance—or no stance—which
essentially amounts to the same thing.
Another important resolution was that PAMED supports reproductive decisions being made between doctors and patients, with minimal government involvement. However, we didn’t take a formal position on abortion rights as a whole. The idea was to emphasize that the less government interferes with those discussions and decisions, the better.
A recurring theme throughout was the importance of keeping the government out of personal health care decisions and health care education. Those were the big issues that I think were most relevant to public health.
You have mentioned PAMED taking the stance of keeping the government out of healthcare education and out of the physician-patient relationship, are there any other themes you noticed?
Like I said, minimizing government intervention in the education of doctors was a recurring theme. It wasn’t necessarily tied to any specific resolution, but as resolutions were drafted and the language was tweaked and amended, that theme kept coming up. The focus was really on narrowing how healthcare is provided in Pennsylvania to emphasize physicianled healthcare teams.
PAMED continues to oppose efforts to allow non-physicians to practice medicine independently without physician oversight. That’s been an ongoing position for PAMED. The conversations around how resolutions were framed and the language used in drafting them reflected that commitment to maintaining physicianled healthcare teams.
Society News
Can you talk about any resolutions that you feel were personal to you?
The one I mentioned that was sort of torpedoed was a resolution on the internal workings of PAMED— specifically how its members, including physician members, students, resident trainees, and fellow trainees, are represented in policymaking. This resolution was drafted by a task force I chaired and aimed to find a compromise that reinforced the critical importance of student and trainee members having a voice in PAMED, while also addressing and trying to rectify the imbalance in representation this can create across the organization as a whole. It also sought to prevent future disenfranchisement of those groups in
particular. Unfortunately, again, despite having representation from students on the task force, they ultimately did not support the resolution or the compromise. From my perspective, this outcome is concerning because it leaves these vulnerable members without any protections for their voices within PAMED. I believe this is to the detriment of the organization.
Can you tell me some of your hopes for next year?
I hope we can build on the momentum we've created to continue tackling some of these harder issues and take a stand as an organization. We're not always going to see eye to eye, and not every member is going to agree with every position PAMED takes, but we have—or
hope to have—a significant influence on public health policy, both across the state and nationally. Pennsylvania is a state that’s heavily involved politically and also has one of the largest and most active medical societies in the country. What we say and the positions we take matter.
I hope we can use this momentum to keep addressing issues that are relevant to public health—things like vaccinations, reproductive rights, and more. There’s a lot we accomplished this year that I think will continue to be challenged, and our positions will be important as we move into a new administration and navigate everything that comes with it.
The 2024 ACMS Delegation attended the PAMED House of Delegates October 25-27 in Hershey, PA.
Holly Appleberry, DO; Stacie McKnight, DO; Amber Elway, DO; Devon Ramaeker, MD
2024 Vice-Chair Michael Aziz, MD and 2024 Chair Richard Hoffmaster, MD
The Changing Pharmaceutical Landscape for Alzheimer’s
By: Robert H. Howland, MD
November is Alzheimer’s Disease Awareness Month, which was initially established by President Ronald Reagan in November 1983. Eight decades earlier, in 1901, Aloys Alzheimer, a German psychiatrist and neuropathologist, treated a 51-yearold patient who at first exhibited some hallucinations and delusions, then displayed serious disorientation, confusion and perception disorders, and finally suffered a complete loss of memory and understanding. After the patient died, Dr. Alzheimer conducted a post-mortem examination, including the brain.
At a 1906 German convention of psychiatrists, Dr. Alzheimer presented the clinical history and brain neuropathological findings of this patient. He described brain atrophy characterized by "fibrils arranged parallel…forming dense bundles", a "chemical transformation of the fibril substance" in "about one-quarter to one-third of all the neurons" and by "miliary foci…which represented the sites of deposition of a peculiar substance in the cerebral cortex", but no "infiltration of the vessels".
Emil Kraepelin, a colleague of Aloys, published the 8th edition of his textbook on psychiatry in 1909. In his chapter on senile and presenile psychiatric disorders, Kraepelin mentions Alzheimer at least three times and then defines an "Alzheimer's disease" characterized by a severe dementia, beginning at about the age of 50 with typical neuropathological alterations, especially tangles of fibrils, but without signs of cerebral arteriosclerosis.
The “discovery” of Alzheimer’s disease, traced back to the clinical and neuropathological description by Aloys Alzheimer and the nosological entity conceptualized by Emil Kraepelin, marked the beginning of understanding this debilitating and ultimately fatal condition as a medical disorder of the brain warranting treatment.
Among the most successful drug therapy efforts to treat Alzheimer’s disease were first based on later neuropathologic findings of a reduction in activity of cholinergic neurons. Hence, the development of acetylcholinesterase inhibitor drugs (Rivastigmine, Galantamine, and Donepezil) was predicated on reducing the rate at which acetylcholine is broken down. Tacrine was the first acetylcholinesterase inhibitor introduced, but it’s manufacture was discontinued in 2013 due to adverse effects. In July 2024, the FDA approved Benzgalantamine, which is a novel prodrug of Galantamine. As a prodrug, Benzgalantamine is absorbed in the small intestine and metabolized in the liver into the active drug Galantamine. This prodrug formulation therefore is associated with fewer adverse gastrointestinal effects.
Excitotoxicity from excessive glutamate contributes to neurodegeneration seen in Alzheimer’s disease. Based on this phenomenon, the N-methyl-D-Aspartate (NMDA) receptor antagonist memantine was developed and subsequently approved in 2003 by the FDA for Alzheimer’s disease. The drug therapies most used for Alzheimer’s disease continue to be acetylcholinesterase inhibitors and
Memantine, although the magnitude of their clinical benefit is modest, and they are not curative or disease modifying.
One of the most important recent developments for the treatment of Alzheimer’s disease are immunotherapies targeting the underlying neuropathological amyloid plaques and neurofibrillary tangles described by Aloys Alzheimer more than a century ago. The first class of these therapies are amyloid-β-targeting monoclonal antibodies. Aducanumab was the first monoclonal antibody to show robust reductions in amyloid-β plaques and was approved by the FDA in 2021. Since then, two additional monoclonal antibody therapies have been approved by the FDA: Lecanemab (2023) and Donanemab (July 2024). The FDA approval of these immunotherapies was controversial, partly because of the accelerated approval process as well as their significant safety concerns and modest clinical efficacy. Insurance coverage for Aducanumab was significantly restricted and it was rarely used. As a result, the manufacturer elected to discontinue manufacturing and marketing in January 2024.
Given the direct and indirect costs of developing, manufacturing, administering and monitoring these immunotherapy treatments, and their unfavorable risk-benefit ratio, the number of patients likely eligible for such therapies is quite small (on the order of less than 10%). Nonetheless, the principle of developing therapeutics that can target and modify neuropathological features of Alzheimer’s disease carries the promise of greater preventive benefits if
administered much earlier in the course of disease or during a preclinical phase before neurodegeneration sets in and progresses.
Identifying and targeting other risk factors for Alzheimer’s disease has opened other potential treatment pathways. Type 2 diabetes mellitus and obesity are two significant and interrelated modifiable risk factors for Alzheimer’s disease.
Within the past two decades, three newer classes of drugs have been marketed for treating type 2 diabetes and in some cases obesity: Dipeptidyl peptidase 4 inhibitors (DPP-4i); Glucagon-like peptide-1 receptor agonists (GLP-1RA); and Sodium/ glucose cotransporter 2 inhibitors (SGLT2i).
The GLP-1RA drugs include Exenatide, Liraglutide, Albiglutide, Dulaglutide, Lixisenatide, Semaglutide, and Tirzepatide. A 2022 analysis of pooled data from three randomized double-blind placebo-controlled cardiovascular outcome trials of patients with type 2 diabetes and a nationwide Danish registry-based cohort study found that the incidence of dementia was lower in patients taking GLP-1RA drugs. Another metaanalysis of five observational studies published in 2023 found that users versus non-users of GLP-1RA drugs were associated with a significant reduction in the risk of all-cause dementia.
Among GLP-1RA drugs, Semaglutide might be unique. In 2024, an analysis of a huge nationwide database of electronic health records found that Semaglutide was associated with significantly reduced risk for firsttime diagnosis of Alzheimer’s disease compared to various other antidiabetes medications, including insulin, SGLT2i drugs, DPP-4i drugs, and other GLP-1RA drugs. Preclinical animal studies have found that Semaglutide is associated with reduced amyloid-β-mediated neurotoxicity, amyloid-β plaques, and tau tangles. Currently, three studies are listed on clinicaltrials.gov investigating
the neuroprotective and immune system effects of Semaglutide in patients with Alzheimer’s disease.
The SGLT2i drugs include Bexagliflozin, Canagliflozin, Dapagliflozin, Empagliflozin, Ertugliflozin, and Sotagliflozin. A metaanalysis of 12 longitudinal studies of patients with diabetes, published in 2024, found that the use of SGLT2i drugs significantly lowered the risk of dementia compared to non-users. Another 2024 pooled data analysis from seven observational studies found that SGLT2i drug was associated with a lower risk of dementia in people with diabetes.
The DPP-4 inhibitor drugs include Sitagliptin, Saxagliptin, Linagliptin, and Alogliptin. Although one meta-analysis of seven observational studies found that users versus non-users of DPP4 inhibitor drugs were significantly associated with a decreased risk of all-cause dementia and vascular dementia, there was no observable effect on risk of Alzheimer’s disease. Moreover, several observational studies found that dementia risk reduction was greater for SGLT2i drugs than for DPP-4 inhibitors.
That some types of antidiabetes drugs may prevent or treat Alzheimer’s disease is plausible. Receptors for GLP-1 and SGLT are found throughout the central nervous system. GLP1RA and SGLT2i drugs influence oxidative stress, mitochondrial dysfunction, inflammation, and other neurophysiological pathways associated with progression of Alzheimer’s disease. Whether these drugs prevent or treat Alzheimer’s disease, however, cannot be established only by observational studies in patients with diabetes. Additional clinical studies are needed in primary populations of individuals at risk for Alzheimer’s or in the earliest stage of disease. Also, it is quite likely that any truly successful drug or disease modifying treatment should be used well before neurodegeneration progresses measurably.
Alzheimer's disease and other forms of dementia are associated with immense medical, social, emotional, and economic burdens for individuals, families, and society. These burdens will increase with the expected rise in the prevalence of dementias with an aging population. It is no cliché to state that new treatments are urgently needed.
The “D” Words
By: Richard H. Daffner, MD, FACR
The late Groucho Marx was known for his sharp wit and his ability to respond quickly, particularly to foolish comments. My aunt Molly, my mother’s older sister, was a fan of Groucho and shared his disdain for fools and foolish thinking. Aunt Molly and Groucho favored people saying what they meant and not using euphemisms. I remember a conversation she told me about the day my grandmother (her mother) died.
The new intern was nervous. “Mrs. Benziger, I’m sorry to tell you that your mother expired about an hour ago.”
“What was she, a magazine subscription?” she replied.
“No,” the flustered intern said, “She passed.”
“I didn’t know she was taking an
exam.”
The intern was at a loss for words. Molly, who knew her 97-year-old mother had been slowly failing with “the dwindles” said, “Sonny, do you mean to tell me that my mother died?”
“Yes,” he stammered.
“Then, why not say so in plain English?” (I know from which side of the family I inherited my curmudgeon genes).
Years later, while reading a chest radiograph, I discovered a tension pneumothorax in a patient who had complained of being short of breath. I immediately paged the attending physician who had ordered the study to report the findings. When I told him about the pneumothorax he replied,
“Thanks for the call. But Mr. X is “CTB”.
“What’s that?” I asked.
“Ceased to breathe.”
“You mean he died?”
“Yes.”
Instead of asking, “Why not say he died?”, I held my tongue and thanked him for the update.
Most people have trouble using the “D” words – death, dead, dying. Unfortunately, so do most physicians, nurses, and other health care providers. Instead, they use many euphemisms such as passed on, expired, departed, or deceased. Roget’s Thesaurus lists over one hundred synonyms for dying, some of which are humorous (Table 1).
For those of us in the healing arts death is a constant companion whom
we strive to keep from doing his/her duty (Fig. 1). The death of a patient is often perceived by physicians as a personal failure, regardless of the circumstances. Before we began medical school, for most of us, death was an abstract event, happening only to old people. I had an older sister whom I had never known. She suffered severe brain damage because of a prolapsed umbilical cord during birth and died when I was five years old. Two grandparents, in their eighties died when I was in high school. During my sophomore year in college a classmate, who sat next to me every day died in a motor vehicle crash. That death of someone my age got my attention and made me realize how fragile life was. The first death that I witnessed as a third-year medical student was a 19-year-old man who had collapsed while waiting for a bus. He died in our emergency room from what a subsequent autopsy found was a bleeding arteriovenous malformation in his brain. Again, how fragile life was. Most of us, like soldiers in combat, learn how to deal with death in a way that allows us to do our duties. Unfortunately, some cannot cope.
Despite humans’ eternal quests for immortality, we are all subject to the most important rule of nature: All living things eventually die. Fatalists believe that one’s destiny has been determined at the moment of one’s birth. Death does not play favorites. In death, everyone is equal, no matter if they were young or old, rich or poor, powerful or weak, good or evil. All the major religions, perhaps to ease the pain of losing loved ones, speak of an afterlife, where the good are rewarded in Heaven and the sinners are punished in Hell. Cynics say the concept of Heaven and Hell was invented to account for the inequalities found in everyday life, where good people are oppressed (or worse) and evildoers prosper.
We use euphemisms to describe the deaths of loved ones, friends, and acquaintances because it is hard for us to accept that they are gone forever. But we will always have memories of the departed. We honor our dead with memorial stones in cemeteries or on plaques in houses of worship.
Rabbi Naomi Levy, in her book “Talking to God”1 has a passage entitled “What Death Cannot Destroy”:
“Death cannot sever our connection to those we have lost. The soul is eternal and can never be extinguished. But not only the soul survives the grave. The bonds of love are stronger than death. The lessons that our loved ones taught us, their goodness, their deeds, their wisdom will remain with us always. They have left a permanent imprint upon our souls that can never be erased. They continue to guide us wherever we go.
“Some people think heaven is a far-off place. But perhaps heaven is closer than we think, perhaps our loved ones are still with us. Perhaps they are silently watching over us and sheltering us and guiding our steps. We believe that we are surrounded by the loving presence of those we have loved and lost. May they continue to be with us; may they bless us and inspire us to goodness, in death as they did in life.1”
Reference:
1. Levy N: Talking to God: Personal Prayers for Times of Joy, Sadness, Struggle, and Celebration. New York, Knopf Doubleday, 2002
Dr. Daffner is a retired radiologist.
Fig. 1. Ivo Soliger (1894 – 1987)
“Doctor, Death and a Girl” (1918)
Reportable Diseases 2024: Q1-Q3
Allegheny County Health Department Selected Reportable Diseases/Conditions
* Case classifications reflect definitions utilized by CDC’s Morbidity and Mortality Weekly Report. ** These counts do not reflect official case counts, as current year numbers are not yet finalized. Inaccuracies in working case counts may be due to reporting/investigation lag.
NOTE: Disease reports may be filed electronically via PA-NEDSS. To register for PA-NEDSS, go to https://www.nedss. state.pa.us/NEDSS. To report outbreaks or diseases reportable within 24 hours, please call the Health Department’s 24-hour telephone line at 412-687-2243. For more complete surveillance information, see ACHD’s 10-year summary of reportable diseases: https://www.alleghenycounty.us/Health-Department/Resources/Data-and-Reporting/Infectious-DiseaseEpidemiology/Epidemiology-Reports-and-Resources.aspx.
Society News
Allegheny County Medical Society board members Dr. Alan Yeasted, Dr. Raymond Pontzer, and Dr. Keith Kanel joined Dean Dr. John Kauffman of Duquesne University College of Osteopathic Medicine White Coat Ceremony, celebrating the next generation of healthcare professionals. Students and guests enjoyed remarks from a host of distinguished speakers, received their white coats and recited the Osteopathic Oath.
Haley Thon has joined the Allegheny County Medical Society as the new Manager of Membership & Association Services. With a Bachelor’s in Public Health from Mercyhurst University and over seven years of experience in healthcare and managed care, Haley brings a strong blend of expertise in membership services, marketing, and event coordination. At ACMS, she’ll focus on enhancing member engagement and building community partnerships to support Allegheny County’s healthcare professionals. Haley will also serve as the new Administrator for the Pennsylvania Geriatric Society Western Division. Haley can be reached at hthon@acms.org
Foundation News
Congratulations to the 2024 - 2025 ACMS Foundation Grant Award recipients! This year, we are honored to support 29 remarkable organizations with a total of $260,000 in grants, furthering our commitment to advancing health, wellness, and access to medical care across Allegheny County. Through the ACMS Foundation—the charitable arm of the Allegheny County Medical Society—we strive to improve the lives of residents by supporting innovative programs, health services, and community-driven initiatives. Thank you to all recipients for your impactful work in our community.
Keep an eye out for the 2024 ACMS Foundation Annual Report and an opportunity to complete your year-end giving with a contribution to the ACMS Foundation.
To learn more about the ACMS Foundation visit: www.acms.org/foundation.
Abiding Missions
Anchorpoint Counseling Ministry
Angels' Place, Inc.
Beverly's PGH
Blind & Vision Rehabilitation Services of Pittsburgh (BVRS)
Community Human Services Corporation
Familylinks
Garden Home Ministries
Healthy Start, Inc.
Homeless Children's Education Fund
Jeremiah's Place
Light of Life Ministries, Inc.
Mary & Alexander Laughlin Children's Center
MAYA Organization
New Sun Rising - Fiscal Sponsor for Camp Lucy
North Hills Affordable Housing dba HEARTH NurturePA
Our Giving Kitchen
Pittsburgh Action Against Rape (PAAR)
Pittsburgh Mercy
Reagan's Journey
Roots of Faith (ROF) - Faith United Methodist Church
Samaritan Counseling Center of Western Pennsylvania
DBA Samaritan Counseling, Guidance, Consulting
Sojourner House MOMS (Mentoring Opportunity Motivation Spirituality)
South Hills Interfaith Movement
Strong Women, Strong Girls
The Blessing Board
The Children's Home of Pittsburgh
Variety the Children's Charity
Looking to boost your year-end giving? The ACMS Foundation could use your support! Scan this QR Code to donate via Qgiv or visit acms.org/acms-foundation/donate/.
Resting, Reflecting, & Refining the Year End
By: Lillian Liang Emlet, MD, MS, CPC, ELI-MP
As we enter into the Fall and Winter seasons, we often forget to recognize the importance of resting and reflecting. Fall into Winter offers us opportunities to take pause, slow down, celebrate, and appreciate. It's a new time of temperature changes, trees in abundant colors, falling leaves, and comfort foods (think soups, pumpkin spiced lattes, and ciders, anyone?). As the time changes and it gets darker earlier, there's a desire for warm blankets and relaxation. There are lessons and guidance from this season if we look for them.
Trees grow from spring rain, gather strength in summer sun, and express their beauty in fall foliage. Similar to trees, life has a cycle and a rhythm, especially for those juggling career, partnership, and family. The energy by which we absorb, flourish, blossom, and bloom also has a season of peace, rest, and presence.
As Katherine May describes in "Wintering: The Power of Rest and Retreat in Difficult Times," winter is a necessary part of the cycle of life, and to winter well means appreciating and embracing it.
For healthcare professionals, the concept of rest might seem like a luxury we cannot afford. If I had a penny for the number of times I have heard a healthcare professional tell me about their lack of time, I would be a billionaire by now. Our work is demanding, often unpredictable, and the needs of our patients or life don't adhere to seasonal rhythms. Yet, it is precisely because of these challenges that we must learn to intentionally create and capitalize on periods of rest and reflection. As Brené
Brown points out,
"We cannot give what we don't have. We cannot bring people on journeys to places we've never been."
So what I suggest to many of my coaching clients is: slowing down to speed up. With intentional rest and deliberate actions to schedule soulreplenishing moments for yourself, you'll be better able to show up for the world. When the world begins to spin faster, you must pause and objectively look at the spinning from afar. Recentering allows us to celebrate and notice patterns, successes, wins, and challenges with greater clarity.
In the business world, particularly in project management, there's a practice known as conducting premortems and post-mortems. If we think of crafting our most ideal life-work integration to be the biggest, most important, most fulfilling project we could ever undertake, then it makes sense that we would want to prepare, analyze, and reflect often on our successes and challenges. And yet, that is often one thing that many early-career physicians neglect in the push and pull of life as a person and a physician. As we approach the end of the year, we can adapt these practices to our professional lives:
Reflection on the Past Year:
1. What were your three biggest accomplishments or moments of growth?
2. Which patient interactions or colleague collaborations are you most grateful for?
3. What new skills or knowledge have you gained that you're excited about?
Quarter 4/ Year End Focus:
1. What is the top one priority you want to accomplish before the year ends?
2. How will you leverage your strengths to achieve this goal?
3. What support or resources do you need to tap into in order to make these happen?
Setting Goals for the New Year:
1. What are three areas in your life where you'd like to grow?
2. How will you align your personal values with your professional goals?
3. What new habits or practices will help you achieve these goals?
Re-centering Amidst Holiday Commitments:
• Practice mindful moments: Take brief pauses throughout your day to breathe deeply and center yourself. Transition times are key: 5 minutes in the car, 1 minute while washing hands, 30 seconds before the next meeting.
• Prioritize self-care through small ritruals : Schedule non-negotiable time for activities that replenish you, even if it's just 15 minutes a day. Establish small, meaningful rituals that ground you, like a morning cup of tea or an evening gratitude practice.
• Connect with purpose: Remind yourself with intention that you choose to show up in all the various ways each and every day. It’s not a “have to,” it’s a “get to,” to paraphrase the well-known life coach Tony Robbins.
Adam Grant, in his book "Think Again," argues that the power of rethinking and reflection in improving our decisionmaking and performance is critical. When we allow ourselves moments to deliberately pause, we can gain new perspectives on our work and find new ideas or solutions to the challenges we face daily in jobs and life.
As we approach Thanksgiving, I just wanted to end with gratitude in our reflection practice. Gratitude isn't just a feel-good exercise; it's a tool used to help strengthen emotional resilience and capacity, especially in high-stress professions like healthcare. Benefits of gratitude practice for healthcare professionals include improved psychological and subjective well-being, reduction in stress and depressive symptoms, enhanced relational energy, and work satisfaction. (Komase 2021, Emmons 2003)
As we move through fall and into winter, let's challenge ourselves to
embrace this natural rhythm of rest and action. By allowing ourselves periods of reflection and recharge, we're not just benefiting ourselves—we're improving our capacity to care for others.
In the words of Marie Forleo, "The world needs that special gift that only youhave." By taking the time to rest, reflect, and recharge, we ensure that we can continue to offer our unique gifts to our patients and colleagues with renwed energy and clarity.
So, as the leaves fall and the days grow shorter, consider this your invitation to pause, reflect, and recharge. Your future self—and your patients—will thank you for it.
References:
1. Brown, B. (2018). Dare to Lead: Brave Work. Tough Conversations. Whole Hearts. Random House.
2. Robert A Emmons et al. "Counting blessings versus burdens: an experimental investigation of gratitude
and subjective well-being in daily life.." Journal of personality and social psychology, 84 2 (2003): 377-89. https:// doi.org/10.1037/0022-3514.84.2.377.
3. Y. Komase et al. "Effects of gratitude intervention on mental health and wellbeing among workers: A systematic review." Journal of Occupational Health, 63 (2021). https://doi.org/10.1002/13489585.12290.
4. Grant, A. (2021). Think Again: The Power of Knowing What You Don't Know. Viking.
5. May, K. (2020). Wintering: The Power of Rest and Retreat in Difficult Times. Riverhead Books.
Lillian Liang Emlet, MD, MS, CHSE, CPC, ELI-MP is Founder of Transforming Healthcare Coaching, which provides energy leadership coaching for healthcare professionals of all professions, and a practicing academic adult intensivist and simulation educator in Pittsburgh, PA.
Tucker Arensberg Lawyers Have Experience in All Major Healthcare Law Issues Including:
• Compliance
• Reimbursement
• Mergers & Acquisitions
• Peer Review and Credentialing for Physicians
• Employment Contracts and Restrictive Covenants
• Tax & Employment Benefits
For additional information contact any of the following attorneys at (412) 566-1212
• Mike Cassidy - Compliance; Contracts, Peer Review, Stark/AKS
• Jeremy Farrell - Labor & Employment and Commercial Litigation
• Adam Appleberry - Mergers & Acquisitions and Physician Contracts
• Jerry Russo - Criminal Defense and Investigations
• Paul Welk - Mergers & Acquisitions
Visit our med law blog for the latest news and information for you and your medical practice: medlawblog.com
Society News
Specialty Group Updates
October/November 2024
By: Nadine Popovich, Melanie Mayer and Haley Thon
Allegheny County Immunization Coalition (ACIC) — 2024 Chair - Patrick Hussey, PharmD, MBA: Conference Recap: The Allegheny County Immunization Coalition’s 19th Annual Conference, held on November 6, 2024, focused on “Guardians of Public Health: Strengthening Vaccine Confidence.” Attendees gained insights into emerging infectious diseases like influenza and RSV and developed strategies to combat vaccine hesitancy through effective communication techniques such as motivational interviewing and empathybased messaging. The event also emphasized community engagement, partnering with local organizations, and involving trusted community voices to enhance vaccine advocacy, address misinformation, and ensure equitable access in underserved areas.
Upcoming Meeting: The next hybrid general membership meeting is December 5, 2024. Allegheny County Immunization Coalition membership is free and funded by our grants. All healthcare professionals with an interest in vaccination are welcome. See our website for full details www. immunizeallegheny.org.
American College of Surgeons
Southwestern Pennsylvania Chapter (ACS-SWPA) — 2024 President – Richard Fortunato, DO, FACS: On October 2nd, the College of Surgeons hosted a lively Surgical Jeopardy event with resident members at Eddie Merlot’s. In other updates, new billing changes will now combine national and chapter dues, which will be invoiced simultaneously for added convenience. Additionally, the redesigned ACS website is set to launch later this month and will feature an improved, user-friendly interface aimed at enhancing the member experience.
Pennsylvania Geriatric Society Western Division (PAGS-WD) — 2024 President - Heather Sakely, PharmD, BCPS, BCGP: The PAGS-WD Welcomes their new Chapter Administrator, and new ACMS staff member, Haley Thon to the organization. Haley can be reached at hthon@acms.org.
Fall Program Recap: On November 6, The PA Geriatric Society - Western Division gathered at the PNC Champions Club for their Annual Fall Program, celebrating an incredible evening of recognition and insightful discussions.
With four prestigious awards presented and a fantastic turnout, it was a night full of inspiration and connection. A huge thank you to our speakers and everyone who joined us!
Save the date for the 33rd Annual Virtual Clinical Update in Geriatric Medicine to be held on April 24-25, 2025. Visit the website for more information and to stay up to date on the conference - https://pagswd.org/ Clinical-Update-in-Geriatric-Medicine
Keynote speaker, Richard Zimmerman, MD
Dr. James Tew, Dr. Rollin Wright, Dr. Suzanne Collila and Dr. Allan Philp
Dr. Rollin Wright and Dr. Shuja Hassan present the Lifetime Achievement Award to Dr. Fred Rubin.
The Pittsburgh Ophthalmology Society (POS) — 2024 PresidentPamela P. Rath, MD: The Pittsburgh Ophthalmology Society Welcomes Christopher Glisson, DO, MS, FAAN.
The Pittsburgh Ophthalmology Society (POS) held its November meeting featuring guest faculty Christopher Glisson, DO, MS, FAAN, an adult neurologist and neuroophthalmologist for both adult and pediatric patients. Dr. Glisson, currently Medical Director of the Warren Neuroscience Institute at Saint Francis Health in Tulsa, Oklahoma, presented two exceptional lectures: I Can't See! Cases That Can Make (or Break) Your Clinic Day and Evaluation and Management of Diplopia. Both talks prompted lively Q&A sessions, reflecting strong engagement from attendees.
Additionally, Dr. Glisson led a discussion on a case study presented by Oliver Beale, MD, a secondyear ophthalmology resident at the University of Pittsburgh. The POS extends its thanks to Alexion Pharmaceuticals, Amgen, and Mallinckrodt Pharmaceuticals for generously supporting the November meeting.
The POS monthly series will continue
December 12 with guest speaker Lauren Blieden, MD, Associate Professor Departmental Glaucoma, Assistant Clinical Professor, Alkek Eye Center, at Baylor College of Medicine’s Cullen Eye Institute, presenting on glaucoma. The Society extends special thanks to Dr. Ian Conner for arranging Dr. Blieden’s visit and to Alcon, Nova Eye Care, and Viatris for their support.
ACMS Alliance: Join Us for the ACMS Alliance Winter Holiday Luncheon!
The Allegheny County Medical Society Alliance warmly invites you to our annual Winter Holiday Luncheon on Saturday, December 7, 2024, at 12:30 PM at the South Hills Country Club. Enjoy a festive afternoon with musical entertainment by vocalist Sean Moran.
Event Details:
• Date: Saturday, December 7, 2024
• Time: 12:30 PM
• Location: South Hills Country Club
• Cost: $45 per person (Guests Welcome)
• Menu: Choice of Chicken Mozzarella or Grilled Atlantic Salmon
Please bring gloves or hats for donation to Operation Safety Net to help those in need this winter.
RSVP by November 30, 2024
Make checks payable to "ACMSA" and mail to:
Patty Barnett
6659 Kinsman Road Pittsburgh, PA 15217
Celebrate the season with friends and community – we hope to see you there!
Pamela Rath, MD, President, POS; Christopher Glisson, DO, MS, Guest Faculty; Donald Morris, DO, Board Member, POS
