June 2024

JUNE 2024

Official Publication of SDCMS

Champions for Health Annual Report

2022–2023

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The CMA Insurance Program is administered by Lockton Affinity, LLC d/b/a Lockton Affinity Insurance Brokers LLC in California #0795478. Coverage is subject to actual policy terms and conditions. Policy benefits are the sole responsibility of the issuing insurance company. The California Medical Association will receive a royalty fee for the licensing of its name and trademarks as part of the insurance program offered to the extent permitted by applicable law. Not available in all states.

Contents JUNE

Editor: James Santiago Grisolia, MD Editorial Board: James Santiago Grisolia, MD; David E.J. Bazzo, MD; William T-C Tseng, MD; Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM Marketing & Production Manager: Jennifer Rohr Art Director: Lisa Williams Copy Editor: Adam Elder

VOLUME 111, NUMBER 6

OFFICERS President: Steve H. Koh, MD President–Elect: Preeti S. Mehta, MD Immediate Past President: Nicholas (dr. Nick) J. Yphantides, MD, MPH Secretary: Maria T. Carriedo-Ceniceros, MD Treasurer: Karrar H. Ali, DO, MPH GEOGRAPHIC DIRECTORS East County #1: Catherine A. Uchino, MD East County #2: Rachel Van Hollebeke, MD Hillcrest #1: Kyle P. Edmonds, MD Hillcrest #2: Stephen R. Hayden, MD (Delegation Chair) Kearny Mesa #1: Anthony E. Magit, MD, MPH Kearny Mesa #2: Dustin H. Wailes, MD La Jolla #1: Toluwalase (Lase) A. Ajayi, MD La Jolla #2: David E.J. Bazzo, MD, FAAFP North County #1: Arlene J. Morales, MD North County #2: Christopher M. Bergeron, MD, FACS North County #3: Nina Chaya, MD South Bay #1: Paul J. Manos, DO South Bay #2: Latisa S. Carson, MD AT–LARGE DIRECTORS #1: Rakesh R. Patel, MD, FAAFP, MBA (Board Representative to the Executive Committee) #2: Kelly C. Motadel, MD, MPH #3: Irineo (Reno) D. Tiangco, MD #4: Miranda R. Sonneborn, MD #5: Daniel D. Klaristenfeld, MD #6: Alexander K. Quick, MD #7: Karl E. Steinberg, MD, FAAFP #8: Alejandra Postlethwaite, MD ADDITIONAL VOTING DIRECTORS Young Physician: Emily A. Nagler, MD Retired Physician: Mitsuo Tomita, MD Medical Student: Kenya Ochoa

FEATURE

CMA OFFICERS AND TRUSTEES Trustee: William T–C Tseng, MD, MPH Trustee: Sergio R. Flores, MD Trustee: Timothy A. Murphy, MD

Champions for Health Annual Report 2022–2023

By Adama Dyoniziak

AMA DELEGATES AND ALTERNATE DELEGATES District I: Mihir Y. Parikh, MD District I Alternate: William T–C Tseng, MD, MPH At–Large: Albert Ray, MD At–Large: Robert E. Hertzka, MD At–Large: Theodore M. Mazer, MD At–Large: Kyle P. Edmonds, MD At–Large: Holly B. Yang, MD, MSHPEd, HMDC, FACP, FAAHPM At–Large: David E.J. Bazzo, MD, FAAFP At–Large Alternate: Sergio R. Flores, MD At–Large Alternate: Bing Pao, MD CMA DELEGATES District I: Steven L.W. Chen, MD, FACS, MBA District I: Vikant Gulati, MD District I: Eric L. Rafla-Yuan, MD District I: Ran Regev, MD District I: Quinn Lippmann, MD District I: Kosala Samarasinghe, MD District I: Thomas J. Savides, MD District I: Mark W. Sornson, MD District I: Wynnshang (Wayne) C. Sun, MD District I: Patrick A. Tellez, MD, MHSA, MPH District I: Randy J. Young, MD

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DEPARTMENTS

What’s Keeping the U.S. From Allowing Better Sunscreens?

By Michael Scaturro

Briefly Noted: Advocacy • Physician Development

20

Pediatricians Have Important Role in Talking About Substance Use, Experts Say

By Jennifer Henderson

21

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14

When Even a Hug Hurts

By Adama Dyoniziak

Classifieds

16 Opinions expressed by authors are their own and not necessarily those of San Diego Physician or SDCMS. San Diego Physician reserves the right to edit all contributions for clarity and length as well as to reject any material submitted. Not responsible for unsolicited manuscripts. Advertising rates and information sent upon request. Acceptance of advertising in San Diego Physician in no way constitutes approval or endorsement

by SDCMS of products or services advertised. San Diego Physician and SDCMS reserve the right to reject any advertising. Address all editorial communications to Editor@SDCMS.org. All advertising inquiries can be sent to DPebdani@SDCMS.org. San Diego Physician is published monthly on the first of the month. Subscription rates are $35.00 per year. For subscriptions, email Editor@SDCMS.org. [San Diego County Medical Society (SDCMS) Printed in the U.S.A.]

Newsom Boosted California’s Public Health Budget During COVID. Now He Wants to Cut It.

By Angela Hart

18 SANDIEGOPHYSICIAN.ORG

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ADVOCACY

CMA Marks Mental Health Awareness Month With Call to Pass AB 2164 DURING MENTAL HEALTH

Awareness Month, the California Medical Association (CMA) is urging legislators to pass Assembly Bill 2164 to improve mental health support for physicians.

The Medical Board of California licensure application for physicians and surgeons, including postgraduate training licensees, may inadvertently discourage physicians from seeking mental health services. The process perpetuates stigma around mental health and can exacerbate issues of burnout and depression within the medical community.

CMA is sponsoring AB 2164, introduced by Assemblymember Marc Berman, which seeks to eliminate the obligation for physicians to unnecessarily disclose their mental health conditions. Removing this barrier would make it more likely for physicians to seek the mental health support they need, benefiting both themselves and their patients.

Resident physicians can face high levels of stress due to moving to new cities without social or family support, high levels of debt, and long hours of work. All of these factors underscore the need to ensure they get the mental health support they need, without fear of jeopardizing their future career.

“CMA is calling on legislators to pass AB 2164 to ensure that physicians can access mental healthcare without fear of jeopardizing their careers,” said CMA President Tanya W. Spirtos, MD. “Physicians, like everyone else, can experience stress, burnout, and mental health challenges. Seeking mental health services can be crucial for maintaining balance, resilience, and overall wellbeing, benefiting both physicians and their patients.”

“For this Mental Health Awareness Month, I also want to stress how important it is for healthcare providers to prioritize wellness and seek mental healthcare when they need it,” Dr. Spirtos said.

Physicians for a Healthy California (PHC), the charitable arm of CMA, recently published a study that presents crucial insights into the factors contributing to burnout and attrition among women physicians of color. The study — “A Prescription for Change: Addressing Retention Among Women Physicians of Color in California” — evaluated the experiences of more than 1,150 women physicians, from various healthcare settings throughout California and found that, “Of those surveyed, 45.8% of women physicians reported high levels of overall burnout.”

“Physicians face unique challenges in supporting and nurturing their mental health,” noted Dr. Spirtos. “The study by Physicians for a Healthy California underscores the critical need for policies like AB 2164, which can alleviate some of these burdens and ensure that all physicians aren’t penalized for getting the mental health support they need to thrive in their careers and provide the best care for their patients.”

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JUNE 2024

PHYSICIAN DEVELOPMENT

Consider Physician Coaching With SurgeonMasters THE SAN DIEGO COUNTY MEDICAL

Society is committed to offering resources that enhance your overall wellbeing, and one of those resources is physician coaching with SurgeonMasters.

Professional coaching is widely embraced across various industries and can help foster career satisfaction, professional development, and personal growth. Specifically tailored for physicians, coaching provides a confidential, innovative partnership to create success throughout your life and career.

Physicians seek coaching to maintain peak performance, professional advancements, and a fluid work-life rhythm. They also work with coaches to manage challenges (both expected and unexpected) such as career or job transitions, new regulations or clinical practices, burnout, moral injuries, and personal/professional adversity. Drawing on proven executive coaching techniques, physician coaches specialize in facilitating conversations and reflection that address all career challenges and empower positive change and the pursuit of your goals.

In healthcare, coaching and mentoring share overlapping purposes and are at times used interchangeably, but the support models have significant differences. Mentoring, whether formal or informal, involves an arbitrary effort to match the background or aspirations of

the individual. A mentor shares their knowledge, expertise, and experience with a less–experienced mentee to help them develop personally and professionally. Mentoring offers advice, support, and guidance based on the mentor’s experiences. Most mentoring relationships are voluntary, based upon goodwill, and require the mentee to communicate with the mentor.

While physicians often seek a coach with knowledge of the shared challenges and experiences of medical training and the healthcare system, this information is only used to facilitate more efficient coaching sessions with rapid understanding and rapport. Coaches are trained to consider the client’s values, beliefs, and what might work or not work for the client and their specific situation. Using best practices in coaching, the coach works with an individual or a group to help them identify and achieve specific goals, improve performance, or develop knowledge and skills beyond their current level. Coaching relationships can have a formal agreement.

To learn more, schedule a complimentary 25–minute intro coaching call with a SurgeonMasters Physician Coach. Visit www.surgeonmasters. com for more general information and www.surgeonmasters.com/coaches to connect with a coach.

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A DV E R T I S E M E N T

Safe and Effective Treatment for Major Depression at Sharp Mesa Vista to receive ECT. Team members will also explain ECT to patients and their loved ones and answer any questions.

A patient who receives ECT is asleep during the entire procedure. Electrodes are placed on the patient’s head to deliver a low amount of electrical current and induce a seizure that lasts a few seconds. The medical team monitors the seizure using an electroencephalogram (EEG) to measure electrical activity in the brain. The complete treatment process takes a few minutes.

The team monitors the patient’s vital signs as they wake up.

Most patients take about 30 minutes to rest after waking up and can go home the same day, but they will need someone to drive them.

Each year, more than 21 million adults in the U.S. experience major depression, one of the most common mental health

At Sharp Mesa Vista, patients may receive ECT three times

conditions. The symptoms — persistently low mood, loss of

a week, for about 10 to 12 total treatments. The number of

pleasure and suicidal thoughts — can be debilitating.

treatments depends on their symptoms. Results vary, but most patients need three or more ECT treatments before

To help care for patients who have severe symptoms or

they start feeling better. Usually, loved ones are the first to

are in danger of suicide, Sharp Mesa Vista Hospital offers

notice an improvement in the patient.

electroconvulsive therapy (ECT). This treatment uses electrodes to induce a short, painless seizure in the brain.

The most common side effects of ECT are headaches,

The seizure causes brain chemistry changes that can help

nausea and muscle aches, all of which can be treated with

relieve symptoms of severe depression. ECT may also be

medication. Some patients may experience temporary

used for severe cases of bipolar disorder and schizophrenia.

short-term memory loss that usually goes away within two weeks after the treatment ends. Long-term memory loss

Some may perceive ECT as scary and inhumane due to inaccurate depictions in movies or TV shows. However, modern ECT is administered safely under general anesthesia with the supervision of anesthesiologists, nurses and psychiatrists. It is highly effective, relieving symptoms in approximately 80% of patients. ECT is known to be effective for treating severe depression; it is less effective for cases of mild depression.

Only a few hospitals in San Diego offer ECT treatment. At

may also occur but is rare.

“By offering treatments like ECT, we are able to help patients relieve their symptoms and fully enjoy life,” says Dr. Fadi Nicolas, chief medical officer of Sharp Behavioral Health.

The care team at Sharp Mesa Vista regularly assesses ECT patients to check for side effects and any memory impairments, and to evaluate the treatment’s effectiveness. If a patient has a relapse, the team

Sharp Mesa Vista, the ECT process begins with a referral from a patient’s psychiatrist. The medical staff will perform

will determine whether maintenance ECT, medication or

an evaluation, discussing symptoms with the patient, who

psychotherapy can help. The frequency of maintenance ECT

will have a medical exam to ensure they are healthy enough

treatments can range from every other week to monthly.

If you or a colleague know of a patient who may benefit from ECT treatment or other services offered by Sharp Mesa Vista, 4

you can refer a patient by calling 858-836-8390 or visiting sharp.com/mesavista.

MAY 2024

Annual Report 2022–2023

Champions for Health is dedicated to providing access to critically needed healthcare for uninsured, low-income residents of San Diego County who would otherwise face insurmountable barriers to care. We recruit, mobilize, and support hundreds of volunteer physicians and other professionals to provide free preventive and specialty healthcare.

Dear Friends, Kindness — this word comes to mind when thinking about the past year at Champions for Health. Kindness shows up in our staff, volunteers, board members, partners, and participants. People are compassionate for the greater good. We have a sense of belonging to a greater purpose. We feel connected to each other, and our relationships grow stronger because of it.

We are at our best when we serve others, even if we may never know how our everyday actions impact someone’s life. Margaret Mead once said that a healed femur was the first sign of civilization. A healed leg is evidence that someone had taken time to stay with the one who fell, had bound up the wound, had carried the person to safety, and had tended the person throug h recovery. Helping someone else throug h difficulty is where civilization starts, especially here in San Diego. Thank you for helping us make San Diego healthy!

With much appreciation, Adama Dyoniziak

Executive Director with Champions for Health Board of Directors and Staff

SANDIEGOPHYSICIAN.ORG

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Volunteers The Greek philosopher Aristotle once said that the essence of life is “to serve others and do good.” Champions for Health’s diverse physician and healthcare volunteers are united in wellness with their compassion and energy to transform health and wellbeing in our communities. They are essential in helping our worthwhile cause of Health for All by administering vaccines, providing health screenings, educating about health topics, and providing primary and specialty care services. Their volunteer services are free … but to the clients, the volunteers and their time are priceless!

Project Access physicians: 152 Project Access specialty areas: 34 Physician volunteers recruited: 10 Hospitals and outpatient surgery centers: 13 Referring clinics: 8 Specialty and medical partners: 60 Medical interpreters: 126 Speaker’s Bureau presenters: 178 Immunizations: 707 6

JUNE 2024

Speaker’s Bureau presentations: 178 San Diegans educated: 2,746 Blood pressure screenings: 12,000 Immunization doses: 28,305 COVID-19 vax doses: 17,654 Immunization field clinics: 1,456 Flu vax doses: 7,839 Participants educated about LTBI: 150

Community Wellness We addressed the preventive health needs of low-income, uninsured, and underimmunized populations within San Diego County using Healthy Places Index mapping. Barriers to prevention services can include language, needing to make appointments, lack of technology, and transportation. Our amazing health equity partners and our community health workers conduct outreach in local neighborhoods to community members to promote opportunities for immunizations, health screenings, and education sessions. These efforts make access to preventive care more engaging and culturally accessible.

The Immunization team administered vaccinations to priority locations such as skilled nursing facilities, senior and lowincome housing, K–18 schools, businesses, farms, faith-based organizations, CBOs, free clinics, shelters, hotels, parks, small medical practices, parks, and community centers.

Speaker’s Bureau volunteers conducted presentations in multiple languages: English, Spanish, Arabic, Korean, Tagalog, Chamorro, and Vietnamese at immunization clinics, congregate care sites, businesses, schools, and shelters. Heart health, fall prevention, the newest in influenza and COVID-19 information, and appropriate social behavior were the most sought-after health topics.

Additional areas of interest were prevention of heat stroke, skin cancer, and diabetes.

Homebound COVID-19 vax clients: 776 TDAP, MPox, and HepA doses: 2,812

SANDIEGOPHYSICIAN.ORG

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San Diego TB Prevention Education & Community Engagement Summit An estimated 175,000 people living in San Diego County have latent TB infection (LTBI), which can progress to active TB if left untreated. This TB Summit was aimed at providers and community health advocates working with populations at risk for tuberculosis (TB). Attendees engaged in presentations, expert panels, and community planning. The focus included LTBI education, strategies for risk assessment, testing, and treatment, as well as integrating LTBI outreach and linkage to care in high-risk communities. This event fostered knowledge sharing among stakeholders and created an integrated community action plan to enhance TB efforts within San Diego County. Attendee feedback reported the Summit had a welcoming ambiance, and that they enjoyed the panel discussions, breakout groups, and connecting with community partners specifically networking with people in the field of public health.

One hundred and fifty participants attended this event and provided input to enhance approaches, treatment, and awareness surrounding TB. The feedback demonstrated that TB prevention and overall awareness must encompass understanding the various aspects of education, risk assessment, diagnostic advances, treatment options, community trust, and respectful patient engagement.

Four areas arose from the dynamic closing session action planning for community outreach to focus on media messaging, community gatherings, education to core staff, and trusted messengers. All of these areas will have a thread of building and fostering partnerships across San Diego.

“The case study sessions and panel discussions were engaging and helpful. Thank you for this amazing day of learning and connection.”

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JUNE 2024

131 PASD patients 80 Procedures/surgeries 717 Specialty appointments 85% Reduction in missed workdays $1,074,130 In donated specialty care 172 Interpretation services 312 Transportation services

Project Access San Diego

Our Project Access Partners Alcon Cares Alliance Retina Consultants Arch Health Partners Arthritis Consultants of North County Anesthesia Service Medical Group Balboa Nephrology California Eye Prosthesis cCare California Cancer Associates Center for Hormonal Health & Well Being Coast Surgical Group Coastal Gastroenterology – Genesis Healthcare Partner Coastal Pain & Spinal Diagnostics Medical Group, Inc. Coastal Skin & Eye Institute Core Orthopaedic Medical Group Davies Eye Center Eye & Retina Institute of San Diego Eye Care of La Jolla Eye Care of San Diego Eye Institute of California Fallbrook Family Health Center Family Allergy, Asthma, Immunology and Sinus Center Family Health Center of San Diego Gastroenterology & Liver Institute Genentech Foundation Genesis Healthcare Partners Greider Eye Associates Grossmont Dermatology Gordon Schanzlin New Vision Institute Hearwell Aid Center IGO Medical Group Imaging Healthcare Specialists Kaiser Permanente Kaska Orthopedics La Jolla Endoscopy Center

La Jolla Neurosurgical Associates La Jolla Vein and Vascular La Mesa Cardiac Center Neighborhood HealthCare North Coast Surgery Center North County ENT, H&N Surgery Northern Litho Otay Lakes Surgery Center Pacific Surgery Center Pacific ENT Medical Group Palomar Health Medical Center Parkway Endoscopy Center Physio 2 Go Point Loma Nazarene University Health Promotion Center Premier Surgery Center Regents Pharmacy Retina Consultants of San Diego San Diego Cardiac Center San Diego Cardiovascular Associates San Diego ENT San Diego Endoscopy Center San Diego Hand Specialists San Diego Podiatry Group Scripps Health Hospitals Scripps Mercy Surgery Pavilion Skin Surgery Medical Group Spine and Sport Physical Therapy Stryker Corporation UCSD Student Run Free Clinic Tri City Medical Center True Care Vision Care & Correction of San Diego Vista Community Clinic Volunteers in Medicine Whole Person Care Clinic

Project Access provides a referral pathway to specialty care services for uninsured people ages 18–50 years old between 139% and 322% of federal poverty level, who are not eligible for Medi-Cal or Medicare, and cannot afford Covered California insurance premiums. We arrange elective, medically necessary specialty care consultations and outpatient procedures by leveraging donated care. Community health clinics are the home to the patients who are referred for specialty care. Clinic referral staff coordinate all the forms and diagnostic tests from the primary care provider (PCP) to Project Access. PCPs provide ongoing care during the process. Project Access staff screen clients for eligibility, match patients with specialists, navigate patients through all appointments and surgeries, coordinate all communication between the PCP and specialist offices, provide interpreters, transportation, medicines, and diagnostic tests. The physician specialists donate their time and expertise, hospitals and surgery centers donate their facilities, medical groups donate anesthesiologists, imaging, and other ancillary services, medical equipment suppliers donate and discount devices, and pharmacies discount medicines. All of this is free to our Project Access patients!

52% Reported improved health status 89% Reduction in emergency department visits SANDIEGOPHYSICIAN.ORG

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Physician Support The Alzheimer’s Project Clinical Roundtable has made significant progress in system adoption, provider education, and outreach to providers serving communities of color who are at increased risk of dementia. New primary care providers were recruited for the Roundtable from all major health systems and the VA, as well as FQHCs, PACE programs, and small-practice providers. The Clinical Guidelines Edition Four is set to publish by mid-2024. The latest information on the disease modifying medications, caregiver resources, and a catalog of professional education opportunities outside of the ones created by the Roundtable were<1% added to the 1.3% $23,871.16 CFH website. In August 2022, the Roundtable was funded to $55,516.28 Other income Individual conduct a research study on the effectiveness of, and clini<1% contributions $20,100 cian behavioral changes through the use of the Guidelines.

3% SDCMS in kind $128,193 A significant part of this study has been the changes made <0.1% Grants to the EMR. The research3.8% study will conclude by $1,495 the end of Event in kind $166,705 has been involved with the 2024. The Clinical Roundtable Event income federal Geriatric Workforce Enhancement Program, and with $440,442 the statewide Dementia Care Aware efforts, as well as being Project Access kind supported by funding in from the10% County of San Diego HHSA and the Sanford Institute for Empathy and Compassion.

FY 2022–23 revenue sources including in kind

3.3%

1.4%

$128,193 Grants

$55,516.28 Individual contributions

4.3%

1%

$166,705 Event income

$23,871.16 Other income

FY 2022–23 Revenue sources without in kind

3,875,884.34

$4,337,921.34

90%

715 physicians educated on 81% screening, evaluation, and management of dementia $3,501,598.90 Contract income

90 providers took on-demand, online dementia webinars

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JUNE 2024

$3,501,598.90 Contract income

1.3%

$23,871.16 Other income

$55,516.28 Individual contributions

<1%

$20,100 SDCMS in kind

3%

$128,193 Grants

<0.1%

3.8%

$1,495 Event in kind

$166,705 Event income $440,442 Project Access in kind

Thank you! Donors, Sponsors, and Foundations

<1%

10% FY 2022–23 revenue sources including in kind

$4,337,921.34

81%

3.3%

$3,501,598.90 Contract income

1.4%

$128,193 Grants

$55,516.28 Individual contributions

4.3%

1%

$166,705 Event income

$23,871.16 Other income

FY 2022–23 Revenue sources without in kind

3,875,884.34

90% $3,501,598.90 Contract income

$359,122.13 Fundraising

$174,762.51 Administrative

11.1% 5.4%

2022–23 Expenses

$3,244,928.84

83.5% 2,711,044.20 Program

Financial Highlights

Daniel Michaels, MD Aldrich Advisors 3.3% Eimaneh Mostofian, MD Alliance Healthcare Foundation $128,193 1.4% Grants Kelly Motadel, MD Amazon Smile Foundation $55,516.28 Individual contributions Tim Murphy, MD America’s Charities My Point Credit Union American Medical Response 1% 4.3% $166,705 Emily Nagler, MD Anesthesia Services Medical$23,871.16 Group Event income Other income Neighborhood Healthcare Toluwalase Ajayi, MD Jennipher Ohmstede Karrar Ali, MD $174,762.51 Cheryl Olsen, MD Daniel Stonewall Anderson, MD Administrative OM&E Partners Brett Atkinson 5.4 Jorge Otanez, MD Patricia Bainter, MD Pacific Foundation for Medical Care David Balfour Palomar Health Sunil Bhoyrul, MD Rakesh Patel, MD Susan Boiko, MD FY 2022–23 Revenue sources Lorena Perez California Colorectal Cancer Coalition without in kind Raymond Peterson, MD Maria Carriedo Ceniceros, MD 3,875,884.34 Pacific ENT Medical Group Nina Chaya, MD Physicians Radiology Medical Group Community Health Group 90% Pinnacle Private Advisors Alan Conrad, MD Carlos Pino, MD Conrad Prebys Foundation $3,501,598.90 Point Loma Frank Coufal, MD Contract incomeNazarene University Alejandra Postlethwaite, MD Monica Crellin Preferred Employers Insurance Del Mar Surgical Christian Ramers, MD Joseph Diaz, MD Albert Ray, MD Steven Dilauro, MD Rheumatology Center of San Diego Paul Durr Gregory Rianhard Emergency Care Dynamics Richard Heath & Associates Emily Flores Camila Romero, MD Sergio Flores, MD Jeff Sachs Mark Franke, MD $359,122.13 Kosala Samarasinghe, MD Kathleen Gallagher Fundraising San Diego County Medical Society Monica Garcia San Diego Wellness Collaborative Tom Gehring $174,762.51 San Ysidro Health Robert Goldklang, MD 11.1% Administrative David Savage, MD Laurie Greenberg, MD Thomas Savides, MD Ali Hamzei, MD 5.4% James Schultz, MD Charles Hardison, MD SDSU Research Foundation Guy Hart Sharp Community Medical Group James T. Hay, MD 2022–23 Expenses Ayham Skaf, MD Stephen Hayden, MD $3,244,928.84 Miranda Sonneborn, MD Paul Hegyi Karl Steinberg, MD Angelica Hernandez Stewardship Wealth Management Robert Hertzka, MD Solutions Linda Hill, MD 83.5%Gabriela Stichler IGO Medical Group Maria Sturchler, MD Lydia Ikeda 2,711,044.20 Program Sung, MD Wynnshang Imaging Healthcare Specialists Sycuan Casino Rina Jain, MD Mark Jeffrey Tamsen, MD Sunil Jeswani, MD Carol & Patrick Tellez, MD Kaiser Permanente The Country Friends Susan Kaweski, MD The Doctors Company Daniel Klaristenfeld, MD Karin & Tony Toranto Monique Knight True Care Michael Krelstein, MD Anne Truitt, MD Connie La Fuente Tuberculosis Elimination Alliance (TEA) Albert Lai, MD Unio Health Partners Las Patronas Lindsay Urband, MD James Lepanto UC San Diego Health Quinn Lippmann, MD UCSD Preventive Medicine Residency Liver Coalition of San Diego Reneé Wailes Daniel Loch Robert Wailes, MD Mike Logan Whitespace Vanessa & Nik London, MD Whole Person Care Clinic Juan Lopez Jeffrey Willmann Marc Marconi Jessica Wilson Med Data Quest Holly Yang, MD Preeti Mehta, MD Theophilos Ypantides, MD Ritvik Mehta, MD Boulos Michael Champions for Health Is Proud to Be a Live Well San Diego Partner

SANDIEGOPHYSICIAN.ORG

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Thank you to our 200+ Health Equity Partners!

365 Connect 7452 Medical Operations Readiness A.G.A. Investments Inc. Albert Einstein Academy Alpha Project Shelters Alpine Special Treatment Center Antonio’s Board and Care Arbor Hills Arc of San Diego BAE Systems Borrego Springs Library Butterfly Gardens Cal State San Marcos California Conservation Corps Camp Lockett Middle School Cape Cod Senior Villas Casa De Misericordia Castle Manor Champagne Village Property Owners Association Child Development Associates Children’s Paradise Church of Christ Church Of Resurrection Clark Middle School Community Missionary Baptist Church Compass Station, Shoreline Community County of San Diego HHSA Cozy Cove CRASH INC. Crawford High School Creative Performing Media Arts Middle School Cross Border Xpress Cuyamaca College Dojo Café Dr. Tulagan’s Clinic Dramm Etcher Farms Dreams of Change East County Transitional Living Center EF San Diego International School EJE Academies Charter El Cajon Valley High School El Dorado Community Service Emerson Elementary School Employee Rights Center Empowering Latino Futures Encanto Village Apartments Ericson Elementary School Escondido Care Homes Fallbrook Regional Health District Fallbrook Union Elementary School District Family Health Centers of San Diego Father Joe’s Village First Presbyterian Church of El Cajon Fleet Science Center Fletcher Elementary School Fo Guang Shan Hsi Fang Temple Fourth District Senior Resource Center Fresh Origins Gary & Mary West Senior Center George Stevens Retirement Center Golden Hall Grossmont College Grossmont Health Occupations Center Guadalupe Plaza Senior Apartments Guajome Park Academy Harris Family Senior Residence Hawthorne Cat Heartbeat Music Performing Arts Academy

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JUNE 2024

Heartland House Hog Wild Homeless Response Center Hope through Housing House of Metamorphosis Howard Gardner Community School Imperial Beach Sports Park and Recreation Center Innovation Middle School Interim Family Shelter Island Village Apartments Japanese Friendship Garden Jewish Family Services Julian Town Hall Kearny Mesa Convalescent & Nursing Home Kent’s Bromeliad Nursery Knox Middle School La Fuente Post-Acute Care La Mesa-Spring Valley School District La Mirada Academy La Paloma Old Town Lakeside Union School District Lemon Crest Elementary School Lemon Grove Community Garden Mobile Farmers’ Market Lemon Grove Library License to Freedom Lions Club Live Well San Diego Living Water Church of the Nazarene Logan Memorial Educational Campus Loma Verde Elementary Love Linda Vista Farmer’s Market Magnolia Post-Acute Care Manchester Grand Hyatt Marshall Elementary McAlister Institute Meadows Senior Property Medical Operational Readiness Unit Mellano Flower Fields Mental Wellness for Artists Mexican Consulate of San Diego Mira Costa College Mira Mesa Senior Center Mission Cove Property MJ Housing Montgomery High School Mountain High PTA Mountain View Elementary School Mount Hope Garden Mundo Garden New Life Baptist Church Nicoloff Elementary Niel Good Day Center North County Family Justice Center North Inland Mental Health Systems Northgate Market O’Farrell Charter School Olive Pierce Middle School Olivewood Elementary Our Lady of Guadalupe Church Pacific Housing Inc. Palomar Community College Paul Mirabile Center People Assisting the Homeless PIMA Medical Institute San Marcos Pine Valley Middle School PNASD Mental Health Committee Potiker Family Senior Residence

Potter Junior High Rachel’s Promise Rainbow Pride Youth Alliance Ramona Library Ramona Unified School District Rancho Monsarte Country Club Redwood Apartments Reliable Care Medical Group Rio Vista Health Care Center Riviera De Ville Apartments Roosevelt Middle School Saint Brigid Parish Salk Institute San Diego City College San Diego County Library San Diego Freedom Ranch, Inc. San Diego LBGT Center San Diego Miramar College San Diego Post-Acute Care San Diego Pride San Diego Seventh Day Adventist Church San Diego Sheriff’s Department San Marcos Elementary San Ysidro Senior Village Second Chance Youth Garden Serving Seniors Shady Lane Family Apartments Sherman Heights Community Center Silvercrest Independent Residences Somali Family Service of San Diego Sons & Daughters of Guam Club Inc. Sorrento Tower Seniors Housing South Bay Community Services South Region Public Health Center Southwestern College Sports for Exceptional Athletes Spring Valley Community Room St John’s Episcopal Church St. Leo’s Clinic St. James Senior Apartments Stand Down/Veteran’s Village Summerfield of Encinitas SYHC Community Center Talmadge Senior Village Temple Emanu The Grove Family Apartments The Meadows Three Treasures Cultural Arts Society Thrive Lemon Grove Tierra Del Sol Middle School Treganza Heritage Park Twelfth Step House of San Diego Universidad Popular Urban Corps Charter School USS Midway Museum Vista Del Sol Apartments Vista Terraza Apartments Vituity Cares Foundation Wakeland Housing & Development Corporation Warner Springs Community Resource Center We Need To Talk Men’s Health Wesley Terrace Senior Apartments Westlake Village Family Apartments Wings Recovery YMCA – Copley Price Family, Jackie Robinson, El Cajon Zest Dental Solutions

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13

SUBSTANCE ABUSE

Pediatricians Have Important Role in Talking About Substance Use, Experts Say ‘You Can’t Just assume That Somebody’s Going to Get Care Elsewhere’ By Jennifer Henderson ALARMING DATA ON FENTANYL, INCLUDING THE synthetic opioid’s staggering presence in counterfeit pills and contribution to overdoses among young people, continue to emerge, as do questions about the role of physicians in addressing the crisis.

Notably, pediatricians and other physicians who regularly provide care to children and teens are in a unique position when it comes to having conversations about the dangers of fentanyl and other drugs.

“If we look at the big picture, we are seeing, unfortunately, a rapid increase in the number of overdose deaths in adolescents,” Kao-Ping Chua, MD, PhD, a pediatrician and health policy researcher at the University of Michigan, told MedPage Today. “Almost all of those overdose deaths involved fentanyl.”

From July–December 2019 to the same period in 2021,

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median monthly overdose deaths among kids and adolescents ages 10 to 19 increased 109%, CDC researchers reported, while deaths involving illicitly manufactured fentanyls (IMFs) increased 182%. Approximately 90% of deaths involved opioids, 84% involved IMFs, and counterfeit pills were present in nearly a quarter of deaths.

“It is becoming increasingly important for

primary care pediatricians to provide anticipatory guidance to adolescents at well-child visits, or really any visit, regarding the increasing dangers of using substances now,” Dr. Chua said, pointing out that people don’t know what they’re getting.

As a result, “screening is hugely important,” noted Aaron Quiggle, MD, a psychiatrist and medical director of Addiction Recovery Management Services at Massachusetts General Hospital and an instructor at Harvard Medical School.

This includes asking young people about whether they use substances and with what frequency, and whether they have friends or know people who do, he said, as well as offering “guidance around the fact that counterfeit pills are containing fentanyl,” discussing the signs and symptoms of overdose, and what should be done in the event that an overdose occurs.

There’s a gap in understanding “what the dangers of contamination are,” he added.

Previously, there has been a perception that people who are dying of opioid overdoses have an opioid use disorder, “which is a tragedy itself,” Dr. Quiggle said. The reality is that many young people who are dying of these overdoses don’t have such a disorder.

A Growing Problem The National Institute on Drug Abuse reported that the number of individual pills containing fentanyl

seized by law enforcement was 2,300 times greater in 2023 compared with 2017, with more than 115 million pills seized in 2023 and fewer than 50,000 in 2017.

“Drugs mixed with fentanyl are extremely dangerous, and many people may be unaware that their drugs contain it,” according to the CDC. Powdered fentanyl, for instance, “looks just like many other drugs,” and “is commonly mixed with drugs like heroin, cocaine, and methamphetamine and made into pills that are made to resemble other prescription opioids.”

In his own practice, Dr. Chua often asks his patients whether they know what drug is killing more people their age than any other. Less than half answer correctly.

Sarah Nosal, MD, a family medicine physician in New York City and director of the American Academy of Family Physicians, has seen her conversations with patients shift over her 15-year career in the South Bronx.

In the mid-2000s, she remembers talking to her patients about fentanyl. However, at that time, the conversations were mostly about instances in which there may have been a grandparent in the home or someone near end of life, and how to safely store these medications.

Now, “the discussion has changed,” she said, noting that all kids and adolescents will “pass by fentanyl in their lives,” and that it has vastly “contaminated illicit substances on the street.”

“You should expect that any substance is contaminated,” Dr. Nosal said. “We need to have those conversations with young people.”

Conversation Starters Ultimately, there are two types of conversations that physicians have when it comes to substance use, Dr. Nosal noted.

There are those with parents or guardians, explaining to them why this is an appropriate discussion. And there are those with children, which can be initiated with questions about what other kids they know are doing, and whether any kids they know have taken a pill.

As a family physician, “we see young people by themselves, as well,” Dr. Nosal said, and it’s important to give them the opportunity to talk about topics ranging from sex to substance use with their family doctor. In New York, this is confidential, unless patients are a risk to themselves or others.

Direct conversations with patients about substance use are usually appropriate around middle-school age, she noted.

“We need to be talking to families about where our kids are going,” she said. Just like asking about whether there is a firearm in the home, physicians should be asking whether families have a naloxone (Narcan) kit to reverse the effects of an opioid overdose.

Dr. Nosal herself has used a naloxone kit, which she regularly carries. “Do I think ‘one pill can kill?’ — yes,” she said.

Dr. Chua said he also has used the concept of “one pill can kill” with patients, though not that exact language. The message he tries to convey is that avoiding substance use

altogether is the “safest path.”

However, for people who are already experimenting with substances, “it really becomes a conversation about how you mitigate risks,” he noted. This can include discussions about having access to naloxone, as well as avoiding mixing drugs.

It’s important to emphasize that “you just don’t know what you’re getting these days,” Dr. Chua said, without engaging “in too much fear-based messaging.”

“It’s more effective, sometimes, to say, ‘You’re a healthy person. I want to keep you healthy. And I know you want to stay healthy to achieve all the things you want to do in life,’” he explained.

Persisting Challenges Regardless of precise messaging, experts agreed that having conversations with young patients about substance use can be difficult for a number of reasons.

Findings from a survey of U.S. pediatricians revealed that, of 474 respondents, most agreed or strongly agreed that it is their responsibility to identify substance use disorders (93.9%) and refer patients to treatment (97.4%).

However, fewer respondents felt prepared or very prepared to counsel adolescents on opioid use (48.3%) compared with alcohol (87.1%), cannabis (81.7%), and e-cigarette use (80.1%). They were also less likely to provide counseling and more likely to refer patients to off-site care for opioid use than for alcohol, cannabis, and e-cigarette use.

“I’m sure there are a lot of pediatricians who are not necessarily aware of the fentanyl issue,” Dr. Chua said. “Maybe there’s another group who is aware of it, but may not view it as their responsibility.”

It’s also possible that some physicians don’t think it’s a common enough issue to warrant discussions during office visits that are already stretched for time, he added. Moreover, patients may have other issues of concern and “can only retain so much.”

“There are times when this type of counseling about drugs doesn’t come to the forefront for various reasons, even if pediatricians believe it’s important to provide that counseling,” Dr. Chua acknowledged. But these conversations are essential in the context of a “general lack of pediatric specialists,” especially in pediatric addiction medicine.

“You can’t just assume that somebody’s going to get care elsewhere,” he said.

Dr. Quiggle noted that pediatricians and family medicine physicians really are at the front line for “treating mental health and substance use in this country.”

Dr. Nosal pointed out that, ultimately, the things physicians want to address are “unlimited,” but talking about the risks of substance use is critical.

“It’s worth it,” she said. “You can take a moment.”

Jennifer Henderson is an enterprise and investigative writer for MedPage Today, where this article first appeared.

SANDIEGOPHYSICIAN.ORG

15

PUBLIC HEALTH

Newsom Boosted California’s Public Health Budget During COVID. Now He Wants to Cut It.

By Angela Hart

WHEN A DOCTOR IN PASADENA,

Calif., reported in October that a hospital patient was exhibiting classic symptoms of dengue fever, such as vomiting, a rash, and bone and joint pain, local disease investigators snapped into action.

The mosquito-borne virus is common in places like Southeast Asia, East Africa, and Latin America, and when Americans contract the disease it is usually while traveling. But in this case, the patient hadn’t left California.

Epidemiologists and public health nurses visited 175 households to conduct blood draws and local pest control workers began fumigating the patient’s neighborhood. In the process, they discovered a second infected person who hadn’t traveled.

Both patients recovered, and in that neighborhood nearly 65% of the carrier mosquitoes, part of a genus called Aedes, were eradicated within seven days, said Matthew Feaster, an epidemiologist with the Pasadena Public Health Department.

The swift and intensive response was funded largely by a new bucket of money in the state budget for public health and preparedness across California, said Manuel Carmona, Pasadena’s deputy director of public health.

In the midst of the COVID-19 pandemic, and facing pleas from public health officials who said they didn’t have enough resources to track and contain the disease, California Gov. Gavin Newsom had agreed to allocate $300 million each year for the state’s chronically underfunded public health system.

Two years after the money started to flow, and facing a $45 billion deficit, the second-term Democratic governor

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proposes to slash the funding entirely.

“This is a huge step backward,” said Kat DeBurgh, executive director of the Health Officers Association of California. “We can’t go back to where we were before the pandemic. That future looks very scary.”

Michelle Gibbons, executive director of the County Health Executives Association of California, said about 900 public health workers have already been hired with the new funding — including some of Pasadena’s disease investigators — positions that are at risk should Newsom prevail.

The governor unveiled his updated budget plan for the 2024–25 fiscal year on May 10, saying it pained him to push such deep cuts to health and human services but that the state needed to make “difficult decisions” to balance its budget. Unlike the federal government, it cannot operate on a deficit.

Tense budget negotiations are underway between Newsom and the leaders of the state Senate and Assembly, who must reach an agreement on the state’s estimated $288 billion budget by June 15.

“We have a shortfall. We have to be sober about the reality, what our priorities are,” Newsom said after unveiling his suggested cuts. “This is a program that we wish we could continue to absorb and afford.”

Public health officials lobbied Newsom hard in 2020 and 2021 to get more resources, and secured additional annual funding of $100 million for the state Department of Public Health and $200 million for the 61 local health departments that form the backbone of California’s public health system.

Now they are fighting to preserve their funding — just as cities and

counties had begun using it to bolster California’s public health defenses.

Some of the workers hired with the money are battling homelessness, fighting climate change, or surveying farmworkers to identify their health and social needs, but most are communicable disease specialists such as epidemiologists and public health nurses charged with investigating threats and outbreaks.

Measles infections are breaking out in Davis, San Diego, Humboldt County, and elsewhere. Long Beach declared a public health emergency early this month over an outbreak of tuberculosis, which spreads through the air when an infected person coughs, speaks, or sneezes. Los Angeles public health authorities are investigating a spate of hepatitis A infections among homeless people.

And around the United States, the spread of bird flu from animals to humans is causing widespread concern.

“The more time this virus is out there transferring between cows and birds, the more chance it has to evolve and spread human to human,” DeBurgh said. She argues that public health agencies must have enough funding to hire workers who can halt threats as they emerge — like they did in Pasadena.

“That dengue outbreak was stopped because we had more ability to hire, and that was a huge public health success,” she said.

Pasadena public health authorities teamed up with the local mosquito control agency to spray pesticides and deployed 29 staffers to test residents for dengue.

“We put our best people on that case,” Carmona said, adding that four of the disease investigators were fund-

ADVOCACY ed with about $1 million in new state money the department receives each year. “Without it, we wouldn’t have a timely response and we probably would have identified dengue as West Nile or some other type of viral virus.”

Rob Oldham, the interim public health officer and director of Health and Human Services for Placer County, said he’s weighing the “devastating” cuts he’d have to make if Newsom’s proposal passes. The county has hired 11 full-time and six part-time workers using about $1.8 million in new annual state funding, he said.

“This money was just starting to take hold,” he said. “Honestly, we’re scrambling, just as we’re responding to another measles case.”

Legislative leaders were reluctant to say whether they would try to safeguard the funding, as they face deep cuts in nearly every sector of state government, including early childhood education, public safety, energy, and transportation.

“We’re knee-deep in budget negotiations but we’re working like hell to protect the progress we’ve made,” said state Senate leader Mike McGuire, a Northern California Democrat.

Public health officials warned the state would be vulnerable to health and economic disasters should they lose the hard-won funding.

“It’s tempting to go back to what we had before, because when we do our jobs, we are invisible. Crises are averted,” Gibbons said. “But it’s devastating to think of going back to this boomand-bust cycle of public health funding that goes neglect, panic, repeat.”

Angela Hart is an award-winning journalist and senior correspondent for KFF Health News, where this article first appeared, and she covers healthcare politics and policy in California and the West, with a focus on California Gov. Gavin Newsom, government accountability, and political influence.

Governor’s Healthcare Funding Cuts Highlight Urgency of Protect Access to Healthcare Ballot Initiative

By California Medical Association Staff LATE LAST WEEK GOVERNOR GAVIN NEWSOM RELEASED his proposed May Revision to the 2024–25 state budget, revealing disappointing news about the state’s financial outlook. Despite efforts to reduce the projected shortfall earlier this year, the current deficit for the 2024–25 budget year is $27.6 billion, with a projected deficit of $28.4 billion for 2025–26.

Last year, the Governor and the Legislature made a historic investment in the Medi-Cal system and healthcare workforce, including provider rate increases that began on Jan. 1, 2024. These increases were slated to be significantly expanded in 2025, benefiting primary care, specialty care, emergency department care, increasing residency slots, and more.

In his May Revision to the budget, the Governor proposes to maintain the provider rates that became effective on Jan. 1, 2024, but have not yet been paid to providers. However, he calls for redirecting funds from the Managed Care Organization (MCO) Tax, intended to fund much broader provider rate increases scheduled for implementation in the 2024–25 state budget, to the general fund to address the state’s budget deficit. CMA and our coalition partners will be pushing back on the Governor’s proposal to “sweep” this revenue intended to increase access to healthcare and will keep you informed about how to get involved.

The proposed revisions to the budget underscore the importance of passing our ballot measure in November, the Protect Access to Healthcare Act, to ensure continued investment in Medi-Cal and the healthcare workforce.

The Coalition to Protect Access to Care, chaired by the California Medical Association (CMA), has gathered more than 800,000 signatures to qualify the Protect Access to Healthcare Act for the November 2024 ballot. Once passed by the voters, this ballot measure will make the MCO tax permanent and ensure that the majority of the revenue goes toward investments in the Medi-Cal system and the healthcare workforce, including physician loan repayment and Graduate Medical Education (GME).

In response to the May revision of the state budget, CMA President Tanya W. Spirtos, MD, said, “CMA expresses deep disappointment in the Governor’s proposal to reverse course when it comes to investment in the Medi-Cal system that provides coverage to one in every three Californians and half our state’s children and in building the healthcare workforce.

During challenging fiscal times, meaningful access to healthcare becomes even more critical in sustaining healthy and productive communities and driving our economy forward.”

Passage of the November ballot measure is essential to safeguarding the budget deal negotiated last year and ensuring the continuation of increased Medi-Cal provider rates starting Jan. 1, 2025. Over the next month, CMA will continue actively engaging with legislators and the Governor to advocate for maintaining these critical investments in healthcare in this year’s budget.

As the budget process unfolds, CMA encourages its members to stay informed and engaged in advocating for these vital healthcare investments.

More information and updates on the ballot measure can be found here: https://www.cmadocs.org/access/initiative.

SANDIEGOPHYSICIAN.ORG

17

CANCER PREVENTION

What’s Keeping the U.S. From Allowing Better Sunscreens?

By Michael Scaturro WHEN DERMATOLOGIST ADEWOLE “ADE” Adamson, MD, MPP sees people spritzing sunscreen as if it’s cologne at the pool where he lives in Austin, Texas, he wants to intervene. “My wife says I shouldn’t,” he said, “even though most people rarely use enough sunscreen.”

At issue is not just whether people are using enough sunscreen, but what ingredients are in it.

The Food and Drug Administration’s ability to approve the chemical filters in sunscreens that are sold in countries such as Japan, South Korea, and France is hamstrung by a 1938 U.S. law that has required sunscreens to be tested on animals and classified as drugs, rather than as cosmetics

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as they are in much of the world. So Americans are not likely to get those better sunscreens — which block the ultraviolet rays that can cause skin cancer and lead to wrinkles — in time for this summer, or even the next.

Sunscreen makers say that requirement is unfair because companies includ-

ing BASF Corp. and L’Oréal, which make the newer sunscreen chemicals, submitted safety data on sunscreen chemicals to the European Union authorities some 20 years ago.

Steven Goldberg, a retired vice president of BASF, said companies are wary of the FDA process because of the cost and their fear that additional animal testing could ignite a consumer backlash in the European Union, which bans animal testing of cosmetics, including sunscreen. The companies are asking Congress to change the testing requirements before they take steps to enter the U.S. marketplace.

In a rare example of bipartisanship last summer, Sen. Mike Lee (R-Utah) thanked Rep. Alexandria Ocasio-Cortez (D-N.Y.) for urging the FDA to speed up approvals of new, more effective sunscreen ingredients. Now a bipartisan bill is pending in the House that would require the FDA to allow non-animal testing.

“It goes back to sunscreens being classified as over-the-counter drugs,” said Carl D’Ruiz, a senior manager at DSMFirmenich, a Switzerlandbased maker of sunscreen chemicals. “It’s really about giving the U.S. consumer something that the rest of the world has. People aren’t dying from using sunscreen. They’re dying from melanoma.”

Every hour, at least two people die of skin cancer in the United States. Skin

cancer is the most common cancer in America, and 6.1 million adults are treated each year for basal cell and squamous cell carcinomas, according to the Centers for Disease Control and Prevention. The nation’s second-most-common cancer, breast cancer, is diagnosed about 300,000 times annually, though it is far more deadly.

You can order overseas versions of sunscreens from online pharmacies such as Cocooncenter in France. Keep in mind that the same brands may have different ingredients if sold in U.S. stores. But importing your sunscreen may not be affordable or practical. “The best sunscreen is the one that you will use over and over again,” said Jane Yoo, MD, a New York City dermatologist.

Though skin cancer treatment success rates are excellent, 1 in 5 Americans will develop skin cancer by age 70. The disease costs the healthcare system $8.9 billion a year, according to CDC researchers. One study found that the annual cost of treating skin cancer in the United States more than doubled from 2002 to 2011, while the average annual cost for all other cancers increased by just 25%. And unlike many other cancers, most forms of skin cancer can largely be prevented — by using sunscreens and taking other precautions.

But a heavy dose of misinformation has permeated the sunscreen debate, and some people question the safety of sunscreens sold in the United States, which they deride as “chemical” sunscreens. These sunscreen opponents prefer “physical” or “mineral” sunscreens, such as zinc oxide, even though all sunscreen ingredients are chemicals.

“It’s an artificial categorization,” said E. Dennis Bashaw, a retired FDA official who ran the agency’s clinical pharmacology division that studies sunscreens.

Still, such concerns were partly fed by the FDA itself after it published a study that said some sunscreen ingredients had been found in trace amounts in human bloodstreams.

When the FDA said in 2019, and then again two years later, that older sunscreen ingredients needed to be studied more to see if they were safe, sunscreen opponents saw an opening, said Nadim Shaath, president of Alpha Research & Development, which imports chemicals used in cosmetics.

“That’s why we have extreme groups and people who aren’t well informed thinking that something penetrating the skin is the end of the world,” Shaath said. “Anything you put on your skin or eat is absorbed.”

Adamson, the Austin dermatologist, said some sunscreen ingredients have been used for 30 years without any population-level evidence that they have harmed anyone.

“The issue for me isn’t the safety of the sunscreens we have,” he said. “It’s that some of the chemical sunscreens aren’t as broad spectrum as they could be, meaning they do not block UVA as well. This could be alleviated by the FDA allowing new ingredients.”

Ultraviolet radiation falls between X-rays and visible light on the electromagnetic spectrum. Most of the UV rays that

people come in contact with are UVA rays that can penetrate the middle layer of the skin and that cause up to 90% of skin aging, along with a smaller amount of UVB rays that are responsible for sunburns.

The sun protection factor, or SPF, rating on American sunscreen bottles denotes only a sunscreen’s ability to block UVB rays. Although American sunscreens labeled “broad spectrum” should, in theory, block UVA light, some studies have shown they fail to meet the European Union’s higher UVA-blocking standards.

“It looks like a number of these newer chemicals have a better safety profile in addition to better UVA protection,” said David Andrews, deputy director of Environmental Working Group, a nonprofit that researches the ingredients in consumer products. “We have asked the FDA to consider allowing market access.”

The FDA defends its review process and its call for tests of the sunscreens sold in American stores as a way to ensure the safety of products that many people use daily, rather than just a few times a year at the beach.

“Many Americans today rely on sunscreens as a key part of their skin cancer prevention strategy, which makes satisfactory evidence of both safety and effectiveness of these products critical for public health,” Cherie Duvall-Jones, an FDA spokesperson, wrote in an email.

D’Ruiz’s company, DSM-Firmenich, is the only one currently seeking to have a new over-the-counter sunscreen ingredient approved in the United States. The company has spent the past 20 years trying to gain approval for bemotrizinol, a process D’Ruiz said has cost $18 million and has advanced fitfully, despite attempts by Congress in 2014 and 2020 to speed along applications for new UV filters.

Bemotrizinol is the bedrock ingredient in nearly all European and Asian sunscreens, including those by the South Korean brand Beauty of Joseon and Bioré, a Japanese brand.

D’Ruiz said bemotrizinol could secure FDA approval by the end of 2025. If it does, he said, bemotrizinol would be the most vetted and safest sunscreen ingredient on the market, outperforming even the safety profiles of zinc oxide and titanium dioxide.

As Congress and the FDA debate, many Americans have taken to importing their own sunscreens from Asia or Europe, despite the risk of fake products.

“The sunscreen issue has gotten people to see that you can be unsafe if you’re too slow,” said Alex Tabarrok, a professor of economics at George Mason University. “The FDA is just incredibly slow. They’ve been looking at this now literally for 40 years. Congress has ordered them to do it, and they still haven’t done it.”

Michael Scaturro is a journalist for KFF Health News, where this article first appeared.

SANDIEGOPHYSICIAN.ORG

19

CHAMPIONS FOR HEALTH

When Even a Hug Hurts

By Adama Dyoniziak AS THE MOTHER OF A SON IN REMISSION FROM leukemia, Karla was a fierce advocate for her son, and was present when he rang the bell to celebrate the completion of treatment. However, advocating for herself was a different story. Karla was feeling pain and swelling in her hands and legs since 2019, but she always thought that in comparison to her son, her pain was nothing.

It was not until 2021, when treatment for her son was over, that she realized that the emotional relief she felt did not lead to physical relief. “I thought everything bad that I felt was because of stress,” she says. “I had a lot of swelling and redness moving up my legs.” Karla says her legs looked like she had red boots on, with continuous leg pain and easy bruising. “If I hit myself on something that would cause a bit the pain, for me it was exaggerated. Even a hug would hurt ... a hug from my daughter at one time felt like someone hitting me with a hammer.”

One physician recommended ibuprofen, which did not help. Karla was feeling more and more desperate and saw another physician, with whom she shared that her mother was diagnosed with rheumatoid arthritis. Additional tests confirmed inflammation and arthritis. She was so happy to have a doctor who listened and respected her.

Since Karla was uninsured, she was referred to Project Access at Champions for Health for her specialty care appointment with a volunteer rheumatologist. Karla recalls Evelyn from Project Access securing transportation assistance and medical interpreting for her appointments. “With Ms. Evelyn, she makes me feel like part of the family, very comfortable.”

Karla says she was blessed to meet not only Rashad Ansari, MD, the Project Access volunteer rheumatologist, but also the amazing team at his office. Karla was nervous about her treatment, but “when I met with Dr. Ansari, he is so kind, he is so busy, but he is always so kind.” Dr. Ansari, who has volunteered his services for 20 years with Vista Community Clinic, and now with Champions for Health, adds, “The best thing about being a physician is helping people on a daily basis lead lives with less pain. You learn more from listening to people than talking to them. I ask questions and just listen as long as it takes to make sure that I help them.”

Karla had tears in her eyes as she described the compassion and commitment of Dr. Ansari and his team who stayed after hours for her consultation when the freeway between her home and the office was so flooded that it collapsed,

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Above: Karla M., Project Access patient. Right: Dr. Rashad Ansari, rheumatologist, Project Access volunteer.

making driving impossible.

“My deepest respect is for the doctor,” she says. “It is like he feels what I feel.

I appreciate it so much.

Getting to his office was the best thing that has happened to me.”

Since 2008, Project Access has facilitated $27 million in care for 9,600plus uninsured patients just like Karla by providing free consultations and sur-

geries — all thanks to the dedication of our volunteer specialty physicians.

Open doors for a Project Access patient: Contact us at adama.dyoniziak@ championsfh.org or call (858) 300-2780.

Adama Dyoniziak is the executive director of Champions for Health.

CLASSIFIEDS PRACTICE ANNOUNCEMENTS

PHYSICIAN POSITIONS WANTED

VIRTUAL SPEECH THERAPY AVAILABLE: Accepting new pediatrics and adult patients. We accept FSA/HSA, private pay, Medicare, Medi-Cal, and several commercial insurance plans pending credentialing. Visit virtualspeechtherapyllc.org or call 888-855-1309.

PART-TIME CARDIOLOGIST AVAILABLE AFTER 7/4/23: Dr. Durgadas Narla, MD, FACC is a noninvasive cardiologist looking to work 1-2 days/week or cover an office during vacation coverage in the metro San Diego area. He retired from private practice in Michigan in 2016 and has worked in a San Marcos cardiologist office for the last 5 years, through March 2023. Board certified in cardiology and internal medicine. Active CA license with DEA, ACLS, and BCLS certification. If interested, please call (586) 206-0988 or email dasnarla@gmail.com

PSYCHIATRIST AVAILABLE! Accepting new patients for medication management, crisis visits, ADHD, cognitive testing, and psychotherapy. Out of network physician servicing La Jolla & San Diego. Visit hylermed.com or call 619-707-1554.

VOLUNTEER OPPORTUNITIES PHYSICIANS: HELP US HELP IMPROVE THE HEALTH LITERACY OF OUR SAN DIEGO COUNTY COMMUNITIES by giving a brief presentation (30–45 minutes) to area children, adults, seniors, or employees on a topic that impassions you. Be a part of Champions for Health’s Live Well San Diego Speakers Bureau and help improve the health literacy of those with limited access to care. For further details on how you can get involved, please email Andrew.Gonzalez@ChampionsFH.org.

CHAMPIONS FOR HEALTH PROJECT ACCESS SAN DIEGO: Volunteer physicians are needed in the following specialties: endocrinology, rheumatology, vascular surgery, ENT or head and neck, general surgery, GI, and gynecology. These specialists are needed in all regions of San Diego County to provide short term pro bono specialty care to adults ages 26-49 who are uninsured and not eligible for Medi-Cal. Volunteering is customized to fit your regular schedule in your office. Champions for Health is the foundation of the San Diego County Medical Society. Join hundreds of colleagues in this endeavor: Contact Evelyn.penaloza@championsfh.org or at 858-300-2779.

PHYSICIAN OPPORTUNITIES COUNTY OF SAN DIEGO PROBATION DEPT. MEDICAL DIRECTOR: The Probation Medical Director plays a pivotal role in the medical management team, spearheading the Justice-Involved California Advancing and Innovating Medi-Cal (CalAIM) program. This initiative targets individuals with a history of incarceration, who face elevated risks of harm. California’s groundbreaking approval on January 26, 2023, allows Medicaid services to be extended to aid in their transition back into society.

The Medical Director’s responsibilities encompass CalAIM’s implementation, oversight of clinical programs, and seamless integration of services for justice-involved youth. This leadership role involves collaboration with various stakeholders, ensuring quality healthcare, behavioral support, and a successful return to the community. https://www.governmentjobs.com/careers/ sdcounty/jobs/4193564/medical-director-probation23034008u?keywords=medical%20director&pagetype=j obOpportunitiesJobs PART-TIME CARDIOLOGIST POSITION AVAILABLE: Cardiology office in San Marcos seeking part-time cardiologist. Please send resume to Dr. Keith Brady at uabresearchdoc@yahoo.com INTERNAL MEDICINE PHYSICIAN: Federally Qualified Health Center located in San Diego County has an opening for an Internal Medicine Physician. This position reports to the chief medical officer and provides the full scope of primary care services, including diagnosis, treatment, and coordination of care to its patients. The candidate should be board eligible and working toward certification in Internal Medicine. · Competitive base salary · CME education · Four weeks paid vacation, year one · 401K plan · No evenings and weekends. · Monday through Friday, 8:00 am to 5:00 p.m.

For more information or to apply, please contact Dr. Keith Brady at: uabresearchdoc@yahoo.com.

FAMILY MEDICINE/INTERNAL MEDICINE PHYSICIAN: San Diego Family Care is seeking a Family Medicine/ Internal Medicine Physician (MD/DO) at its Linda Vista location to provide outpatient care for acute and chronic conditions to a diverse adult population. San Diego Family Care is a federally qualified, culturally competent and affordable health center in San Diego, CA. Job duties include providing complete, high quality primary care and participation in supporting quality assurance programs.

Benefits include flexible schedules, no call requirements, a robust benefits package, and competitive salary. If interested, please email CV to sdfcinfo@sdfamilycare.org or call us at (858) 810-8700.

PSYCHIATRIST AVAILABLE! Accepting new patients for medication management, crisis visits, ADHD, cognitive testing, and psychotherapy. Out of network physician servicing La Jolla & San Diego. Visit hylermed.com or call 619-707-1554.

OFFICE SPACE / REAL ESTATE AVAILABLE OFFICE SPACE FOR SUBLEASE IN SOUTHEAST SAN DIEGO: 3 patient exam rooms, nurse’s station, large reception area and waiting room. Large parking lot with valet on-site, and nearby bus stop. 286 Euclid Ave - Suite 205, San Diego, CA 92104. Please contact Dr. Kofi D. SefaBoakye’s office manager: Agnes Loonie at (619) 435-0041 or ams66000@aol.com MEDICAL OFFICE FOR SALE OR SUBLEASE: A newly remodeled and fully built-out primary care clinic in a highly visible Medical Mall on Mira Mesa Blvd. at corner of Camino Ruiz. The office is approximately 1000 sq ft with 2 fully equipped exam rooms, 1 office, 1 nurse station, spacious and welcoming waiting room, spacious reception area, and ADA accessible restroom. All the furniture and equipment are new and modern design. Ample parking.

Perfect for primary care or any specialty clinic. Please contact Nox at 619-776-5295 or noxwins@hotmail.com.

Available immediately.

EL CAJON – RENOVATED MEDICAL OFFICE AVAILABLE: Recently renovated, turnkey medical office in freestanding single-story unit available in El Cajon. Seven exam rooms, spacious waiting area with floor-to-ceiling windows, staff break room, doctor’s private office, multiple admin areas, manager’s office all in lovely, droughtresistant garden setting. Ample free patient parking with close access to freeways and Sharp Grossmont and Alvarado Hospitals. Safe and secure with round-the-clock monitored property, patrol, and cameras. Available March 1st. Call 24/7 on-call property manager Michelle at the Avocado Professional Center (619) 916-8393 or email help@avocadoprofessionalcenter.com.

OPERATING ROOM FOR RENT: State of the Art AAAASF Certified Operating Rooms for Rent at Outpatient Surgery of Sorrento. 5445 Oberlin Drive, San Diego 92121. Ideally located and newly built 5 star facility located with easy freeway access in the heart of San Diego in Sorrento Mesa.

Facility includes two operating rooms and two recovery bays, waiting area, State of the Art UPC02 Laser, Endoscopic Equipment with easy parking. Ideal for cosmetic surgery. Competitive Rates. Call Cyndy for more information 858.658.0595 or email Cyndy@roydavidmd.com PRIME LOCATION MEDICAL BUILDING LEASE OR OWN OPPORTUNITY IN LA MESA: Extraordinary opportunity to lease or lease-to-own a highly visible, freewayoriented medical building in La Mesa, on Interstate 8 at the 70th Street on-ramp. Immaculate 2-story, 7.5k square foot property with elevator and ample free on-site parking (45 spaces). Already built out and equipped with MRI/CAT machine. Easy access to both Alvarado and Sharp Grossmont Hospitals, SDSU, restaurants, and walking distance to 70th St Trolley Station. Perfect for owner-user or investor. Please contact Tracy Giordano [Coldwell Banker West, DRE# 02052571] for more information, (619) 987-5498.

POWAY MEDICAL OFFICE SPACE FOR LEASE 2/1/2024: Fully built out, turnkey 1257 sq ft ADA-compliant suite for lease. Great location in Pomerado Medical/ Dental Building, next to Palomar Med Center Poway campus. Building restricted to medical/allied health/dental practices, currently houses ~26 suites. Ideal for small health practice as primary or satellite location. Lease includes front lobby, reception area, restrooms, large treatment area, private treatment/exam rooms. Located on second floor, elevator/stair access. Bright, natural lighting; unobstructed views of foothills. On-site parking; nearby bus service. Flexible lease terms available from 3-5 years at fair market rate. Contact Debbie Summers at debjsummers3@gmail.com (858) 382-8127.

KEARNY MESA OFFICE TO SUBLEASE/SHARE: 5643 Copley Dr., Suite 300, San Diego, CA 92111. Perfectly centrally situated within San Diego County. Equidistant to flagship hospitals of Sharp and Scripps healthcare systems. Ample free parking. Newly constructed Class

A+ medical office space/medical use building. 12 exam rooms per half day available for use at fair market value rates. Basic communal medical supplies available for use (including splint/cast materials). Injectable medications and durable medical equipment (DME) and all staff to be supplied by individual physicians’ practices. 1 large exam room doubles as a minor procedure room. Ample waiting room area. In office x-ray with additional waiting area outside of the x-ray room. Orthopedic surgery centric office space. Includes access to a kitchenette/indoor break room, exterior break room and private physician workspace. Open to other MSK physician specialties and subspecialties. Building occupancy includes specialty physicians, physical therapy/occupational therapy (2nd floor), urgent care, and 5 OR ambulatory surgery center (1st floor). For inquiries contact kdowning79@gmail.com and mgamboa@ortho1.com for more information. Available for occupancy projected as February 2024.

LA JOLLA/UTC OFFICE TO SUBLEASE OR SHARE: Modern upscale office near Scripps Memorial, UCSD hospital, and the UTC mall. One large exam/procedure room and one regular-sized exam room. Large physician office for consults as well. Ample waiting room area. Can accommodate any specialty or Internal Medicine. Multiple days per week and full use of the office is available. If interested please email drphilipw@gmail.com ENCINITAS MEDICAL SPACE AVAILABLE: Newly updated office space located in a medical office building.

Two large exam rooms are available M-F and suitable for all types of practice, including subspecialties needing equipment space. Building consists of primary and specialist physicians, great for networking and referrals. Includes access to the break room, bathroom and reception.

Large parking lot with free parking for patients. Possibility to share receptionist or bring your own. Please contact coastdocgroup@gmail.com for more information.

NORTH COUNTY MEDICAL SPACE AVAILABLE: 2023 W. Vista Way, Suite C, Vista CA 92082. Newly renovated, large office space located in an upscale medical office with ample free parking. Furnishings, decor, and atmosphere are upscale and inviting. It is a great place to build your practice, network and clientele. Just a few blocks from Tri-City Medical Center and across from the urgent care. Includes: multiple exam rooms, access to a kitchenette/break room, two bathrooms, and spacious reception area all located on the property. Wi-Fi is not included. For inquiries contact hosalkarofficeassist@gmail.com or call/ text (858)740-1928.

MEDICAL EQUIPMENT / FURNITURE FOR SALE UROLOGY OFFICE CLOSING 6/2023—EQUIPMENT AVAILABLE: Six fully furnished exam rooms including tables (2 bench, 3 power chair/table, 1 knee stirrup), rolling stools, lights, step stools, patient chairs. Waiting room chairs, tables, magazine rack. Specialty items—Shimadzu ultrasound, SciCan sterilizer, Dyonics camera with Sharp monitor, Medtronic Duet urodynamics with T-DOC catheters, Bard prostate biopsy gun with needles, Cooper Surgical urodynamics, Elmed ESU cautery, AO 4 lens microscope. RICOH MP-3054 printer with low print count.

For more information contact: r.pua@cox.net.

NON-PHYSICIAN POSITIONS AVAILABLE RESEARCH SCIENTISTS: (non-tenured, Assistant, Associate or Full level): The University of California, San Diego campus multidisciplinary Organized Research Units (ORUs) https://research.ucsd.edu/ORU/index.html are conducting an open search. Research Scientists are extramurally funded, academic researchers who develop and lead independent creative research programs similar to Ladder Rank Professors. They are expected to serve as Principal Investigators on extramural grants, generate high caliber publications and research products, engage in university and public service, continuously demonstrate independent, high quality, significant research activity and scholarly reputation. Appointments and duration vary depending on the length of the research project and availability of funding. https://apol-recruit. ucsd.edu/JPF03713 PROJECT SCIENTISTS: Project Scientists (non-tenured, Assistant, Associate or Full level): The University of California, San Diego, Office of Research Affairs https:// research.ucsd.edu/, in support of the campus multidisciplinary Organized Research Units (ORUs) https:// research.ucsd.edu/ORU/index.html is conducting an open search. Project Scientists are academic researchers who are expected to make significant and creative contributions to a research team, are not required to carry out independent research but will publish and carry out research or creative programs with supervision. Appointments and duration vary depending on the length of the research project and availability of funding. https://apolrecruit.ucsd.edu/JPF03605/

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