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Philadelphia County Medical Society 2100 Spring Garden Street, Philadelphia, PA 19130

(215) 563-5343 www.philamedsoc.org EXECUTIVE COMMITTEE Michael DellaVecchia, MD, PhD, FACS PRESIDENT

Daniel Dempsey, MD PRESIDENT ELECT

Features

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The Zika Virus: Is the Mysterious World Health Menace a Threat to our Area?

10 Dr. C. Everett Koop and His Historic Surgeon General’s Report on Aids: A Remembrance

Anthony M. Padula, MD, FACS IMMEDIATE PAST PRESIDENT

Careers in Medicine

Max E. Mercado, MD SECRETARY

21 Einstein Medical Center First in Philadelphia to Offer New Technology for Breast Cancer Patients

J. Q. Michael Yu, MD, FRCPC TREASURER

BOARD OF DIRECTORS Angel S. Angelov, MD Martin Brown Richard J. Cohen, PhD, FCPP Donald M. Gleklen Enrique Hernandez, MD Cadence Kim, MD Harvey B. Lefton, MD Henry Lin, MD Curtis T. Miyamoto, MD Ricardo Morgenstern, MD Natalia Ortiz, MD, FAPA, FAPM Stephen R. Permut, MD, JD Dane Scantling, DO John Vasudevan, MD

22 Drexel University College of Medicine 26 When a 911 Call is Not a 911 Call

18 A Bridge to Nowhere The Deadly Prescription Drug Epidemic in Philadelphia

38 Exciting Advances in Gastroenterology By Rising Stars in the Field

27 Dr. Daniel Schidlow The Dean of Drexel University College of Medicine is a Man Who Whistles While he Works 28 Einstein Healthcare Network Celebrates 150 Years of Compassionate Care

FIRST DISTRICT TRUSTEE Lynn Lucas-Fehm, MD, JD EXECUTIVE DIRECTOR Mark C. Austerberry EDITOR Alan J. Miceli The opinions expressed in this publication are for general information only and are not intended to provide specific legal, medical or other advice or recommendations for any individuals. The placement of editorial opinions and paid advertising does not imply endorsement by the Philadelphia County Medical Society. All rights reserved. No portion of this publication may be reproduced electronically or in print without the expressed written consent of the publisher or editor.

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Spring 2016

Contents


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Letter from the president

T

his spring issue of Philadelphia Medicine is PCMS at its core. For 167 years our society has helped our members get a deeper understanding of their calling as physicians and patient advocates. Through education and organization we lead in fighting for the rights and needs of our members and patients in our communities, and before city, state and national legislative venues.

Michael DellaVecchia, MD, PhD, FACS President

We Welcome Your Comments! They should be sent to our email address at editor@philamedsoc.org. If you would like your comments considered for publication, they must include your name, town, and phone number.

In this issue we take an in-depth look at the emerging Zika virus concerns, which have arisen from the epidemics in South and Central America and the Caribbean. Philadelphia Medicine initiated two exclusive interviews with Dr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases, and Dr. Marcos Espinal, one of the leaders of the Pan American Health Organization’s effort in Latin America. Their insights will help determine approaches to the upcoming response in the USA. PCMS is also at the frontline of another deadly epidemic—the overuse of prescription narcotics. The special agent in charge of the Philadelphia division of the Drug Enforcement Administration, Gary Tuggle, describes the crisis in frightening detail and how doctors can help battle the problem. Drug overdoses in Philadelphia take more lives than gun violence. This issue also takes a historic look back at the greatest health crisis of the 20th century— the AIDs epidemic—on the 30th anniversary of the 120 million household mailing of the surgeon general’s report on the disease. Dr. Peter Hartsock who helped write the original report describes the courageous effort of Dr. C. Everett Koop, to help the nation come to grips with the crisis, by dispelling prejudices, and by dealing with the problems of the disease in a practical, scientific way. Our many medical students continue to contribute to our efforts. An article on the plight of the homeless, written by Aleesha Shaik, second year medical student, Drexel University College of Medicine, brings great insight to this social problem. PCMS continues its presence before legislators and government officials, to protect the public health and to keep physicians informed. Our quarterly updates are once again enclosed in this spring issue. Doctors need to stay organized with a united voice, to ensure excellence in our profession and to accomplish our primary duty—good patient care. If you are not a PCMS member, please join us. Call us at: 215-563-5343 x 101, for details. Philadelphia Medicine is informative and worthwhile—spread the word.

EDITORIAL BOARD • Michael DellaVecchia, MD • William S. Frankl, MD

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• Corina Graziani, MD • Alan Miceli, MA

• Stephen L. Schwartz, MD • Paul D. Siegel, MD


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feature

The Zika Virus: Is the Mysterious World Health Menace a Threat to our Area?

which scientists are scrambling to find answers. Bruce Aylward of the World Health Organization, who spearheaded the WHO’s battle against the West African Ebola epidemic, and now leads the organization’s fight against Zika, recently said that the unanswered questions surrounding Zika make it “much more insidious, cunning and evil” than Ebola. The disease is spreading so quickly that some experts estimate it could infect as many as three million people within the next 12 months. Almost all Zika infections have been caused by the Aedes aegypti mosquito. Most people infected end up with minor symptoms, but there is growing evidence that that is not the case for many unborn children.

au ci

Alan Miceli

A team of U.S. researchers announced on March 4, that they believe they have discovered a mechanism for how the Zika virus yF n o can cause microcephaly, a rare nth Dr. A birth defect in which babies are born with abnormally small heads and underdeveloped brains.

here’s a pretty obvious reason for the World Health Organization’s decision to tag the Zika virus as a global public health emergency—it is the disease’s apparent threat to a pregnant woman’s unborn child. But an almost equally unnerving reality is that we simply don’t know what potential the virus has to do harm. When it was first detected in monkeys in Africa about 65 years ago, it didn’t appear 6

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to be much of a problem. The virus remained under the radar until last May when it became clear it was infecting human beings in Brazil, and could be causing birth defects. Unlike Ebola, which became a global public health emergency because of what we knew about it, Zika is a health crisis in large part because it’s a mystery about

Working with lab-grown human stem cells, researchers found that the virus infected cells forming the brain’s cortex, making them more likely to die and less likely to divide normally and make new brain cells. The researchers say their findings are


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Zika virus

the strongest evidence yet of how Zika is harming fetuses. Even before this research was announced, Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, told Philadelphia Medicine, that there’s associational evidence linking the virus to the brains of stillborn babies and the miscarriages of women who were infected with Zika. Dr. Marcos Espinal, director of Communicable Diseases and Health Analysis for the Americas, for the World Health Organization, agrees. “The evidence suggests very strongly that Zika could be the cause of microcephaly.” Dr. Fauci said he’s satisfied that what Brazil has documented in several hundred infants infected with the Zika virus, points to a very serious health threat. “The CDC has people down there (in Brazil). They’re monitoring this in real time, and they’re convinced that it is as bad as people are saying.” A Yale study of a stillborn baby delivered by a Brazilian woman with Zika, provides evidence that, in addition to microcephaly, congenital Zika infection may also be linked to hydrops fetalis (abnormal accumulation of fluid in fetal compartments), hydranencephaly (almost complete loss of brain tissue), and fetal demise (stillbirth).

More than one hundred people in the United States have contracted the disease while visiting one of about 30 countries in South and Central America and the Caribbean. Among them is a Philadelphia woman over 60 and two Pennsylvania women.

issued decrees, they have involved the military in mosquito spraying campaigns. They have social workers going door-to-door in affected areas, educating residents about ways they can help prevent mosquitoes from breeding.”

At the time of this publication, the Centers Brazil, alone, has 200,000 soldiers spraying for Disease Control and Prevention reported mosquito-infested areas, and 40,000 people that at least two pregnant women in the draining puddles of water and teaching United States infected with the Zika virus residents to do the same. Dr. Espinal says have had abortions. Two others have suffered education is a key to fighting the virus. miscarriages. One woman gave birth to a “People in these countries have to be taught baby with serious birth defects. Two other that they must get rid of standing water on Zika-infected pregnant women decided to their property. A big factor is old car and go full term, and delivered healthy infants. truck tires. They fill with water after a rain and are prime breeding areas.” Nine countries where the virus is active have also reported a significant increase in Latin America has been through this cases of Guillain-Barre syndrome, a disease before. From 1947 to 1962, 18 of those that can cause paralysis and even death. countries carried out a military-style program of vector control against the mosquito that Along with the direct infection from mos- was spreading the dengue fever, the same quito bites, there are at least 14 women who mosquito now carrying Zika. Aggressive, contracted the virus through sexual contact widespread spraying and the relentless with infected men. Some of those women effort to clear standing water, virtually are pregnant. The specter of these cases in wiped out the mosquito back then. But the U.S. adds yet another layer of complexity when governments stopped spraying, the to the medical mystery surrounding Zika. mosquitoes returned and another dengue epidemic broke out in Cuba in 1981. Dr. Espinal told Philadelphia Medicine that the affected countries are responding quickly Dr. Espinal said new tools will most to the outbreak. He is very encouraged by likely be added in this fight—genetically a recent video conference he had with the modified, bacteria infected and sterilized presidents of those countries. “They have mosquitoes—all designed to prevent the Continued on page 8

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ZIKA virus

Dr. Espinal said the U.S. is well positioned to keep Zika from breaking out. He believes that most cases here will continue to be brought in from other countries. “The United States is doing the right thing. Florida, for example, has declared an emergency and has stepped up vector control.” The Zika-carrying mosquito is common in the United States, only in Florida, along the Gulf Coast and in Hawaii, although it has been found as far north as two cities that sandwich Philadelphia—Washington, DC, and New York City. It has also been detected in Chicago. But a new study in Brazil is raising concerns that a mosquito that is far more common in the United States might also be able to carry the Zika virus. Preliminary laboratory tests have shown that the Culex mosquito may not only be infected with Zika but could also reproduce the virus. If further tests confirm this research, it would force every country involved in the Zika fight, including the United States, to radically rethink their mosquito control campaigns.

pest from reproducing. There are estimates that these new additions could reduce the mosquito population by more than 90%.

Dr. Fauci is urging pregnant women here and throughout the United States to avoid traveling to countries where there is Zika transmission. Each year, about a half million pregnant women travel between the United States and South and Central America and the Caribbean.

So far, no one has contracted the Zika virus from a mosquito in the United States. Of course, mosquitoes aren’t flying around most of the continental U.S. during the winter and early spring. But Dr. Fauci does not think that when the summer arrives, women in the Philadelphia area will have to worry about a Zika-carrying mosquito biting them. “The only time they should be concerned is if we have a widespread outbreak in the United States, which we don’t anticipate.” Dr. Fauci said experience dealing with the dengue virus in the past has given him confidence that the U.S. will be able to control the mosquito population.

Women who contract the disease do not appear to have it in their system for a prolonged period of time. People who recover from the infection are then immune. “There’s no evidence that it lingers in a woman,” Dr. Fauci said. “We don’t know definitively, but from a considerable amount of observation, it looks like the virus lasts in your blood anywhere from five to seven days after you get acutely infected. So, by all experience it should be gone within a period of a month.” But Dr. Fauci added, “there are still a number of unknowns, so it’s premature to say what’s safe and not safe.”

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There is evidence, however, that the virus lingers in a man’s semen. There is a report that one man had the virus in his semen a full 65 days. There are also two cases of contamination of blood transfusions. The CDC recommends that if you return from a Zika area, you wait at least 28 days before donating blood. Dr. Fauci said that “if a man goes to an infected region of the world and comes back home and his wife is pregnant, he should practice safe sex with correct and consistent use of a condom.” There are tests available to detect the virus. The NIH is working on improving them so they do a better job of differentiating between Zika and two related viruses, dengue and yellow fever. The tests only work in the first week or so of the infection. The NIH is also developing a vaccine that could reach the trial stage by this summer, and be ready for a larger-scale trial by early next year. Both Dr. Fauci and Dr. Espinal hope that Congress approves President Obama’s request for $1.8 billion to fund mosquito eradication programs and research for a vaccine. They say the money would go a long way toward effectively combatting the spread of the virus. Mosquitoes kill about 750,000 people a year, mostly from malaria. No other animal is a deadlier threat to human beings. The Aedes aegypti mosquito, the confirmed Zika carrier, is a notoriously effective disease spreader. It bites only human beings and attacks during the day, and most times people don’t even know they’ve been bitten. It is quite the blood-sucking glutton, snacking on four to five people during each meal. It thrives in densely populated areas and can breed in a drop of water in a bottle cap. Dr. Fauci doesn’t think it’s likely that we can wipe out the Aedes aegypti, but he believes we should try. “They have no ecovalue. They’re food for some birds, but those birds can eat a lot of other things. I don’t think the birds need them to survive.”


CONSIDER MEMBERSHIP in The Philadelphia County Medical Society

Membership in the Pennsylvania Medical Society and the Philadelphia County Medical Society go hand-in-hand, addressing the many issues facing the medical profession today and preserving the patient-physician relationship. PCMS Membership is available to all opathic (MD) and osteopathic (DO) physicians residing or practicing in Philadelphia County, who are in good moral and professional standing. Membership is also available to residents, fellows, medical students, and practice managers. The PCMS physician leadership and staff are committed to addressing the issues confronting medicine today, and we are pleased to have you as part of that effort. By making the choice to be a part of organized medicine, you are choosing to have a voice in the way you practice medicine every day.

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Apply Today Join the Philadelphia County Medical Society, and become more engaged in the decisions that impact your livelihood and the future of healthcare. Member Application:

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Feature

Dr. C. Everett Koop and His Historic

SURGEON GENERAL’S REPORT ON AIDS:

Peter Hartsock, PhD

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eptember of this year marks the 30th anniversary of the release of the Surgeon General’s (SG) Report on AIDS. October of this year would have been the 100th birthday of the prime mover of the report, the late Dr. C. Everett Koop, SG at the time. I have been asked to write a personal remembrance of both the report and of a man who appeared almost out of nowhere to answer his country’s call for help at a particularly harrowing time in history. It was a time when radical change in public health thinking and practice was required to confront an unprecedented form of disease which mocked traditional medicine’s attempts to control it. When AIDS first appeared it reminded me of Michael Crichton’s novel, Andromeda Strain. AIDS still does, with its uncanny ability to morph rapidly, leaving unfulfilled, attempts to develop vaccines and treatments in its wake. The story concerning Dr. Koop’s heroic and much-needed public confrontation of this scourge is a deep one and, for various reasons, including my having been too close to the story and the man, I cannot do them justice. Nonetheless, I will try to say something. I first met Dr. Koop in the early 1980s, shortly after he had been appointed SG and 10 Philadelphia Medicine : Spring 2016

head of the U.S. Public Health Service. What was to become an HIV/AIDS pandemic was in its early stages, and people living in most parts of the nation thought that the disease wouldn’t wind up on their doorstep. Here and in many other countries the feeling was that AIDS was an African disease that would stay on that continent. I was a commissioned officer in the U.S. Public Health Service and Dr. K was the commander of the USPHS’s commissioned officer corps, as well as SG. He also had major responsibilities for international health. At that time, I was working to develop the National Institute on Drug Abuse’s AIDS research program and, so, I came to the attention of Dr. K and was asked to assist him in writing the first-ever SG’s report on the new disease. The Office of the SG (OSG) back then consisted of very few people—the SG, a secretary and a Deputy Surgeon General, Dr. Faye Abdellah, a wonderful lady who was known as the “Clara Barton of the Twentieth Century.” The only other help the OSG received was from volunteers. I was one of them. I couldn’t say no to someone who had the guts to try to bring AIDS out of the shadows and make it, and in turn public health, everybody’s business. AIDS had to be pushed into the open then,

during what was a time of denial. Those few who worked to try to combat AIDS had their hands full just trying to initiate critical research and intervention efforts, let alone dealing with obstructions thrown in their way from every source imaginable. Certain words, such as condoms, or the “C word,” were banned from official usage. The oppressiveness on necessary free speech and thought was more than tangible. Discussing human sexuality and interventions like harm reduction (e.g., outreach, counseling, and syringe exchange for injection drug users) was extremely difficult because doing so challenged current convictions about morality. That period was a frightening time and not just because of the insidious nature of AIDS but also the moral and political football it became which cowed people into silence and inaction. The slow national response was already having a serious impact. Even before the SG’s AIDS Report, Dr. K said that we had already lost an entire generation of hemophiliacs—people who were not, for the most part, members of certain stigmatized groups such as gays and drug users, whom the public perceived as responsible for the epidemic.

Continued on page 12


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A negative and convenient rationale had been used to inhibit doing anything to combat a plague which was “ridding the country of undesirables.” At the same time, the mortality rates of hemophiliacs and people who needed blood transfusions shot up as they contracted AIDS. The sad fact was we had to use the blood transfusion tragedy to help turn around public perceptions, and break loose resources for necessary research and interventions. AIDS was not just something associated with “rogue” elements in society but could and did strike everywhere, including people who were thought to be totally out of the path of the disease.

the Surgeon General, who could hopefully give the country realistic, appropriate and understandable advice. The decision was not popular. Only a small group of us were involved in the enterprise. Getting the report on AIDS written was daunting. To base our observations and recommendations on sound science, we had to go after the best research available in those early days. That was not a simple matter because of vigorous opposition from political and social sources who pushed for silence. Those forces did not want research or intervention—labeling them a waste of taxpayers’ money.

I wrote about that in a Washington Post letter when Dr. K passed away in February 2013:

We wrestled over the ethical basis for that report, and Dr. Koop even asked me to write a paper on the Bible and AIDS to assist with our thinking. What we finally arrived at was informed by the Bible as well as many other sources, and it basically said regardless of whom the person is or what they do, you love them. As surgeon general, Dr. Koop was above politics. He was a born-again Christian and conservative Republican who said to me, “I have my own biases, but we don’t base public health policy on our biases; we base it on science. We don’t play politics with people’s lives.”

That lesson was not lost on some good people and, in 1989 when Dr. K was leaving office, The New York Times reflected in an editorial, that “throughout, he has put medical integrity above personal value judgments and has been, indeed, the nation’s First Doctor.”

The pressure mounted to produce a coherent public health statement from the federal government concerning AIDS and how to confront it. That finally led to a decision to try to write an official report from 12 Philadelphia Medicine : Spring 2016

Interestingly, and at first seemingly in contradiction to our emphasis on science, Dr. K asked me, as part of what I was doing for him, to see what the Bible might imply about AIDS and how to confront the disease.

During his service as SG, it was this peculiar strength in Dr. K, evidenced by his balancing deep religious convictions with a strong commitment to science and the greater good, that produced as unbiased public health policies as were humanly possible. It also infused what we did in the AIDS Report with a strong sense of conscience and a refusal to play politics. The report and the honest way in which Dr. K presented it to the nation was what rocketed this SG to real public attention. It amazed those in Congress who had opposed his confirmation as SG, some of whom had called him “Dr. Kook” and a right wing demagogue.


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Dr. C. everett Koop

The AIDS Report (which was extremely difficult to get approved, a large story that I don’t have the space to discuss here), along with other brave actions that Dr. K took, led to his becoming one of the most trusted persons in the country. Some tried to take advantage of that trust by trying to push Dr. K into mixing politics with public health decisions. That torment was played out in both open and hidden ways, and it dismayed but did not stop Dr. K. He took his position as the “nation’s family doctor” seriously and never once thought about his own welfare. It was that same commitment to humanity which had made him a pioneering pediatric surgeon at Children’s Hospital of Philadelphia. He had saved, both directly and through the pediatric surgical techniques he developed which became widely used, the lives of thousands of babies. He was made surgeon in chief there at an uncommonly young age, where his work earned him international respect and fame. When we were working on the AIDS Report, he told me that “the greatest natural high is taking a baby who would be dead tomorrow and giving it a life expectancy of at least 75 years.” Dr. K was committed to public service and provided much pro bono help to poor families. He helped put some of his former patients through college. He kept in contact with many of them. Every one of them was special to him. I look back on when we developed the AIDS Report and marvel at how productive Dr. K’s office turned out to be, getting along on a shoestring with myriad obstacles thrown in its way. In its singular AIDS work, the OSG became recognized, perhaps for the first time in its history, as a major power for good. Dr. K became the embodiment of public health’s bully pulpit. Through him the OSG was put to productive use, confronting other public health problems in addition to AIDS. These included tobacco, which had been recognized as a serious public health threat in SG Luther Terry’s report of 1964. But it was still an issue thanks to Big Tobacco’s campaign to persuade the

public that neither smoking nor secondary smoke was a public health menace. As Dr. K confronted tobacco and other issues, the efforts to muzzle him increased. I have seen plenty of machinations in government but the ones that were used to try to intimidate Dr. K into silence were petty and byzantine. Just a couple of examples—much of his staff was pulled out from under him, without his say, and he was banned from executive bathrooms and cafeterias. There was an incredible dynamic in Dr. K which spread through his office and positively touched many good and even some bad people inside and outside of government. It was the same dynamic which had manifested itself during Dr. K’s decades as a visionary pediatric surgeon. The dynamic was infectious. Seeing that big man who had saved the lives of the tiniest, ignite passion and commitment in others across the land to join him in facing some of the largest public health issues in the world, was nothing less than alchemical. To many people, Dr. K looked dour, very serious. He was serious. He was devoted to the common good. But he also had a fine sense of humor and could dish out one-liners when the opportunity came his way. And he could take a joke. He got a good laugh out of “The Capitol Steps,” the comedy troupe that poked fun at the dour look, by using a stylized mask of Dr. K’s face. The mask comically featured his stiff upper lip, white hair and white beard, and looked the same whether it was right-side up, or upside down. While he took his mission seriously, he did not take himself that way. One thing did bother Dr. K deeply. It was that, “most people never asked me what I really thought” about the AIDS crisis. He had been pegged and stereotyped in so many ways—both positive and negative—which never fit him and he knew it. He had a large

“most people never asked me what I really thought” intellect and a heart to match. Dr. K’s heart encompassed joy but it also held real sadness, coming from grievous personal losses and his abiding concern for the health of the nation. At times, he would weep, but never publicly as I recall. When the AIDS Report finally came out in September 1986, Dr. K caught hell from his critics. They found the Report’s humane and plain spoken nature to be downright immoral. There were soon calls for Dr. K’s dismissal. At the same time, others in government assumed the mantle of “national AIDS spokesman” and tried to undermine Dr. K’s credibility. But their statements did not have the compelling scientific and pragmatic public health emphasis which emanated from SG Koop. Despite his critics, he became a household name, gaining a reputation as possibly the most trusted and admired person in America. Many of those who had despised him during his tortuous Congressional confirmation became some of Dr. K’s staunchest supporters. If he had been twenty years younger, he might have had a decent shot at the White House. Nonetheless, the attacks wore him down, and he finally left the office which had become indelibly associated with him. He had become the very embodiment of the OSG, and the OSG gained a stature during his tenure that it never had before Continued on page 14 Spring 2016 : Philadelphia Medicine 13


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and has never had since. There was talk in government after he left office, of never wanting “another Koop” as SG. After he left office, a number of moves were made to limit the power of the Surgeon General. Which begs the question: why do we not want brilliant, hard-working, and self-sacrificing public servants? Do we prefer those who would sell their souls to the lowest, not just the highest, bidder and conveniently forget that theirs is a sacred public trust? Dr. K was a member of the College of Physicians of Philadelphia (CPP), the oldest such institution in the U.S. and the birthplace of American medicine. The CPP was founded at a time when the thencapital of the young nation, Philadelphia, was hit with an AIDS-like public health crisis—a cholera epidemic. Major efforts were undertaken to combat the outbreak

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by two Philadelphians who were signers of the Declaration of Independence, Dr. Benjamin Rush, former Surgeon General of the Continental Army, and Dr. Benjamin Franklin. They pioneered the first major public health effort in America. That effort led eventually to the establishment of the U.S. Public Health Service (USPHS). Dr. Koop was a proud member of the CPP before becoming Surgeon General and head of the USPHS. His embodiment of the vision and commitment of Drs. Rush and Franklin was absolutely critical in the battle against the strange and terrible scourge of AIDS. After his tenure as SG, Dr. K. spent several years in Washington assisting in various public health efforts. Eventually, he was pulled to his alma mater, Dartmouth College,


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Dr. C. everett Koop

where he established the Koop Institute, whose primary mission was to help instill a social conscience in health professionals. “Conscience” was something with which he was obsessed, and his obsession grew more and more over time. It reminded me of George Washington’s similar obsession, where “the man who would not be king” urged humanity to “strive to attain some spark of that celestial fire called ‘conscience.’” I know that Dr. K’s exposure to lack of conscience in so many people who could otherwise have set the world right troubled him endlessly and was a driving force in establishing the Koop Institute. Dr. K continued to be involved in national and international health issues and he also continued research on his hemoglobin-based oxygen carrier, or artificial blood. As well as his M.D., Dr. K had also earned a Sc.D. in hematology. He volunteered, but was turned down for service, in World War II and the Persian Gulf War. Despite his service to his country as Surgeon General, he was not permitted to be buried in Arlington National Cemetery because he had not served in the military. I ended my Washington Post letter at the time of Dr. K’s death with this thought: “When we sailed a 17th-century ship on his 72nd birthday in 1988, Dr. Koop told me that he had then already outlived all previous males in his line. Live he did, much longer and wonderfully so, for all humanity.” I close this tribute to the great man by asking how we can truly describe what happened when Providence gave us a person so singular that he turned out to be the only clear and comprehensible voice of sanity essential for mobilizing the nation at a singularly dark time in its history. Most other exhortations to work together in confronting AIDS fell upon deaf ears or were drowned out by the same conspiracy of silence which did not ever silence the only U.S. Surgeon General who is remembered by name.

Peter I. Hartsock

For the past 32 years Captain Hartsock has been U.S. Public Health Service/Scientist Director, for the National Institutes of Health. He has worked on AIDS research since the epidemic broke out. He initiated the National Institute on Drug Abuse’s AIDS research program, and served with Surgeon General C. Everett Koop in developing and writing the SG’s Report on AIDS. He also worked with Dr. Koop on related issues such as development of safer syringe technology, and needle/syringe exchange. Hartsock was awarded the Surgeon General’s Exemplary Service Medal. He developed the first federally-supported evaluation of needle/ syringe exchange, and supported research that produced a reversal in two decades of U.S. HIV testing policy that did not run tests on the disease. At the request of IOM, he hosted the first Soviet AIDS research team to visit the U.S. Hartsock has worked with the former Soviet Union and now Russia on AIDS and related/syndemic problems (drug abuse, MDR TB, HCV) for three decades. Russia and Ukraine have the fastest-growing AIDS epidemics on earth and they constitute an international security threat. He has worked with countries on every continent except Antarctica. His current research efforts focus on syndemics, and development of integrated interventions which are necessary for addressing the negative synergies of combined diseases that can overwhelm the health systems of both the developed and developing worlds. Hartsock is also developing federal/state/local partnership cooperation/training for mass casualty/disaster preparedness.

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Young Physicians Insights

Aleesha Shaik, Second Year Medical Student, Drexel University College of Medicine

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   man sits, leaning against the side of a parking garage in the    middle of a bustling city. His tired eyes and unkempt hair make him look much older than he actually is, though the wrinkles around his eyes indicate that once upon a time, this man had a life full of smiles. All his possessions lie in a bag next to him. His jacket is draped over his body as a barrier against the harsh wind. A sign propped on the wall beside him reads, “Homeless. Anything helps. Thank you. God bless.” A tin can rests at his feet and a few quarters glisten from within in the afternoon sun. He stares idly as passerbys hurry past, each engrossed in their own lives and troubles. Occasionally, someone stops to drop some money in the little tin can. But no one stays long enough to say hi. No one knows that his name is Kevin. No one knows that he once used to be the smartest kid in his class or that he is a talented artist or that his favorite color is blue, like the color of his deceased son’s eyes.

deserves food and shelter. Many of these people were forced into such circumstances after a single life-changing event that could happen to anyone. There are many other aspects of homelessness that would make any human rights activist cringe, but one particular issue that I feel strongly about as a future physician is the healthcare of this population, or more specifically the health inequity that this population faces. According to the Office of National Drug Control Policy, nearly 30% of chronically homeless people have a serious mental illness, compared to 6% of the general US population. Very few of these people receive adequate care for their illnesses. The National Health Care for the Homeless Council says that beyond mental illness, this population also has greater rates of hypertension, asthma, heart disease, and other conditions than the general population. Solving the problem of homelessness would reduce the rate of mortality and morbidity significantly.

I met Kevin in Chicago, but this man could have been anywhere in the United States because, unfortunately, the story is the same everywhere. Homelessness is an enormous problem in America. According to the National Alliance to End Homelessness, more than half a million people were homeless on a given January night in the U.S. last year. Thirty-one percent of them were found in unsheltered locations (such as streets and abandoned buildings), though I’m sure that number would have been much higher if the count had been done in the summer. In August 2015, nearly one thousand homeless people were found to be living on the streets of Philadelphia. It’s hard to gauge how accurate that number even is, considering the difficulty in accounting for every obscure area.

The AMA Medical Students Section has a resolution in place asking the AMA to “support improving the health outcomes and decreasing the health care costs of treating the chronically homeless through housing-first approaches; and support the appropriate organizations in developing an effective national plan to eradicate homelessness.” The sooner we enact such national policies and make it a priority to end homelessness, the sooner we can not only improve health outcomes, but also ensure that everyone has the opportunity to reach their full potential. Who knows, maybe one of these people could find the cure for cancer or the secret to world peace.

But the exact number isn’t really that important. Any number over zero is too many. From the perspective of humanity, everyone

After seeing so many homeless people in Philadelphia and around the country, I decided that I wanted to learn more about the health

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PHILADELPHIA MEDICAL SCHOOL STUDENTS

care needs of this population and I thought that the best way to do this would be to speak with homeless people themselves. I definitely learned a lot about health care for the homeless through my conversations, but what I learned more than that is, as clichéd as this sounds, we are all human. We all have an innate desire to be loved and to be heard, to have someone to talk to, to not feel invisible. For me, one of the most rewarding parts of talking to these “outdoor residents,” as one Phoenician called them, is seeing their eyes light up when I tell them I want to hear their story. Since I first met Kevin in Chicago when I was there for an AMA conference, I’ve made it a point to speak to as many homeless people as I can, especially those in other cities, so that I can better understand the system each city has in place for this population. I don’t always have the time for a long conversation, but I do always have the time to say hi.

Launch Debate Program

M. Tucker Brown, Sidney Kimmel Medical College, Class of 2018

Just after the publication date of this issue of Philadelphia Medicine, two medical schools—Jefferson University and Temple University—were scheduled to launch an audacious new student activity—debates on some of the most controversial issues of our day. The first debate topic made it clear that the students were not pulling their punches—physician assisted suicide. While the subject matter and even the nature of the debates may make us uncomfortable, we believe that they will accomplish many goals that will translate to better patient care. These goals include deepening our understanding of both sides of current issues, increasing student engagement in organized medicine, and, perhaps most importantly, promoting fraternity among the future physicians of our Philadelphia medical schools. The debates will also allow for student representatives to better represent their school and their city by collecting audience responses throughout the event. One of the many exciting things about this first debate is how it came to be. The initial idea came not from faculty members or club presidents but from a first year student. And it came at a time when we students in Philadelphia and in the state were looking to increase “inter-Hershey trip” discussion and action, bridge the gaps between our schools, and give greater voice to the everyday medical student. Spontaneous brainstorming ensued and before long our very own Jefferson AMA president and PAMED Vice Chair Ludwig Koeneke drafted the initial manual of the Medical College Debate League. Perhaps the best part of all, is the collaboration that next took place. Using an online platform, Koeneke enabled us to tap into the talents of students from all five Philadelphia schools (PCOM, Drexel, Penn, Temple, Jefferson) in order to create something none of us could have on our own. We plan to report on the first debate in the next issue of Philadelphia Medicine.

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Feature

The Deadly Prescription Drug Epidemic in Philadelphia Alan Miceli

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t only takes a couple of numbers to describe in gruesome detail the illegal prescription drug epidemic in Philadelphia. In 2014, 248 people in the city were murdered, mostly by gun violence. But in that same year more than twice as many of the city’s residents—655, to be exact—died from accidental drug overdoses. And many of the 248 homicides, by the way, were drug-related.

Gary Tuggle, special agent in charge of the Philadelphia Division of the Drug Enforcement Administration (DEA), says more people in our area die from accidental drug overdoses than traffic accidents. “This is the worst drug crisis in the history of this country,” Tuggle told Philadelphia Medicince. The vast majority of people who get hooked don’t have police records before their 18 Philadelphia Medicine : Spring 2016

addictions. They often became dependent while taking legally-prescribed pain medication after, for example, a surgery. When they can no longer get the prescriptions from their doctor, they start buying the drugs on the street, a very expensive process. People then often turn to heroin, because it’s cheaper. “Illegal prescription drugs are now a feeder system to our current heroin epidemic,” Tuggle said. “Eight out of 10 new heroin users report first using and abusing prescription opioids before transitioning to heroin.” The Centers for Disease Control and Prevention reports that people addicted to pain killers are 40 times more likely to become heroin addicts. Tuggle has seen three drug epidemics in his lifetime. The first one was the Vietnam War-era heroin epidemic. The second—the crack epidemic in the 1980s—he witnessed while working as a young police officer in Baltimore—“highly addictive, a lot of violence, extremely destructive.” But he says the current heroin epidemic dwarfs the others because of the feeder system. “The prescription drugs are a bridge to heroin.” Before prescription drugs, Tuggle said, Philadelphia’s heroin problem


A Bridge to nowhere

centered most of its destructiveness on the inner city. “Heroin use and distribution was typically generational before we hit this whole new epidemic. Before opioids, heroin was largely driven by what is called ‘modeling.’ People modeled their drug behavior on family members. I recall arresting the father, the son, the grandson, literally multi-generations of heroin users and distributors in the same household.” Heroin has broken out of the dysfunctional family setting and out of the inner city, thanks to the prescription painkiller bridge. That bridge has made the drug epidemic an equal opportunity killer. The worst drug problems are no longer limited to a handful of city neighborhoods. Sparsely populated Elk County in Northcentral Pennsylvania has a drug death rate that rivals Philadelphia. “The United States has an insatiable appetite for drugs,” Tuggle emphasized. “We consume about 99% of the hydrocodone produced in the world. Roughly 85% of the narcotic prescriptions in the world are written for folks in this country. I can’t tell you why, but the appetite in this country is just enormous compared to the rest of the free world.” Young people make up a significant percentage of painkiller addicts. They start by stealing drugs from the medicine cabinets of family members and friends. The biggest sources of illegal prescription drugs, however, are doctors, pharmacists, other health professionals and members of office medical staffs. “I refer to them as white coat drug dealers,” Tuggle said. “Some of them are the very small percentage of doctors who hide behind their education, the white coat and stethoscope, pretending to be upstanding members of society, when in fact they’re no better than the guy or girl standing on the corner, selling heroin.” Philadelphia DEA agents have arrested more than 120 doctors in the past two years in connection with illegally prescribing painkillers. Investigators say these doctors often run pill mills, cash-only clinics where they write a large number of prescriptions

for narcotics. Tuggle said pill mills end up putting hundreds of thousands of opioid dosages on the streets of Philadelphia each year. Drug pushers go “doctor shopping” to find physicians willing to write phony prescriptions. But they also use smurfing rings to take aim at honest doctors. Smurfing rings consist of fake patients who visit unsuspecting doctors, in order to get prescriptions for painkillers. Pennsylvania lawmakers have approved a prescription monitoring program to help law enforcement detect smurfing operations, by catching people who go from one doctor to another for opioids. Tuggle pointed out that “what we find is, particularly in smurfing operations, suspects go from state to state to state. So you find someone who lives in Ohio, coming to Northeast Philadelphia to have a prescription filled. But we don’t know that unless the states can talk to one another.” The new state law is designed to solve that problem. But the law has a glaring issue—it’s not funded. Drug traffic operations make it pretty easy for local addicts to become pawns in the Philadelphia area’s multi-million dollar drug business—a business that makes sure its two inner rings of hell—painkillers and heroin—are available on demand. The top drug in Philadelphia is heroin. As we’ve mentioned, it’s the go-to drug for people who get addicted to painkillers, then can’t afford to buy those drugs on the street. Thirty milligrams of oxycodone can cost about $30 on the street, while an addict can buy a gram of heroin for only about $95. Addicts are also attracted to the powerful synthetic opiate, fentanyl, which is often sold on the street as heroin. It’s both more potent and more dangerous than heroin. Drug traffickers have sophisticated, welloiled distribution operations, that use virtually every means of transportation available to get the drugs here from Mexico, Continued on page 20

Pa. Dept. of Health Urges FDA to Issue Overdose Warning

In February, the Pennsylvania Department of Health joined 13 cities and 17 other state health departments to call on the U.S. Food and Drug Administration to mandate “black box warning” labels on certain drugs that when used in combination can cause death. The department wants the FDA to require the labels on opioids and benzodiazepines. The health department says combining dangerous drugs is helping to drive the prescription drug overdose epidemic. The department said seven people in the state die each day from overdoses. Secretary of Health Dr. Karen Murphy said it is “a tragic number that highlights the overdose epidemic we are currently battling.”


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Feature

“We have to get the community engaged in treating people and getting them off drugs, and preventing folks from using them in the first place. It’s going to take time. It’s going to take a lot of energy and a big commitment.”

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A Bridge to nowhere

Puerto Rico, the Dominican Republic and South America. The drugs are often in specially-made hidden compartments in tractor trailers that are bringing fruits and vegetables, furniture and toys to our area. Drugs are also in passenger cars, airplane luggage, and onboard small boats and cargo vessels. So what can we do about this seemingly intractable problem? Tuggle said only a multi-pronged approach will work that involves everything from better coordination among government agencies, to doctors closely monitoring patients who are prescribed powerful opioids. Drug companies have to do a better job of educating doctors and the public about the challenges involving opioid use. And families, clergy, schools and the rest of the community must pay better attention to the warning signs of addiction among their family, friends and neighbors,

and encourage programs that help steer people away from drugs. State laws have to be not only passed, but given the money they need to carry out their mission. Tuggle said he has enough DEA agents, but Pennsylvania has an enormous drug treatment shortfall. Right now about 52,000 people receive addiction counseling, but that’s only one out of every eight addicted individuals in the state who are seeking treatment. A staggering 760,000 residents want and need treatment and are not getting it. “We’re not going to arrest our way out of this,” Tuggle warned. “We have to get the community engaged in treating people and getting them off drugs, and preventing folks from using them in the first place. It’s going to take time. It’s going to take a lot of energy and a big commitment.”


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Einstein Medical Center First in Philadelphia to Offer New Technology for Breast Cancer Patients

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instein Medical Center Philadelphia is the first hospital in Philadelphia to offer brand new technology to help breast surgeons achieve clear margins during lumpectomy. When surgeons perform a lumpectomy for breast cancer, a rim of normal tissue is removed around the tumor called the margin. When margins around the tumor show no cancer, the margins are described as clear or negative. Having a clear margin is an indication that the cancer has been completely removed.

Designed in Israel and known as the MarginProbe® System, the new technology is FDA-approved and is being used at Einstein Medical Center Philadelphia as a pilot program. The device uses electromagnetic waves and includes a console and a probe that examines the surface of the removed breast tissue to help determine if it is free of cancer cells. “This technology helps surgeons learn the status of the margins before the lumpectomy is completed. In this way, we can remove tissue in one surgical procedure, hopefully avoiding the need for a second surgery,” says

Lisa Jablon, MD, FACS, Director of the Breast Program at Einstein Medical Center Philadelphia. “After we remove breast tissue during a lumpectomy, it typically takes about a week to get the results from pathology.” Dr. Jablon said that if the pathologist finds cancer cells at the margin, the patient may need to have another surgical procedure. A large percentage of women have had to undergo these second surgeries. But studies have indicated that the MarginProbe can cut the rate of re-operation by more than half. “Our hope is that this cutting-edge technology will help us reduce the need for additional surgery,” Dr. Jablon added. “Having breast cancer can be very frightening, and reducing the need for additional procedures is just one of our goals in helping women move on to their next steps of treatment.” It takes just five minutes to use MarginProbe in the operating room on the removed breast tissue while the woman is still under anesthesia. The device uses a sterile, single-use sensor attached to a handheld probe which does not come into contact with the patient, and detects subtle electromagnetic

differences between breast cancer cells and normal breast tissue. Information from the probe is sent to the console for analysis, and using an algorithm, comparisons are made to signals from thousands of other tissue specimens. Based on this information, the surgeon decides if additional tissue needs to be removed in order to get all the cancer cells and complete the lumpectomy. The device is used as an adjunct to other standard methods to help ensure that all the cancer cells have been removed, such as visual inspection, imaging and palpation of the tumor (using one’s hands to examine the tissue). It can be used during lumpectomy for both DCIS ductal carcinoma in situ and invasive breast cancer. “When it comes to breast cancer,” Dr. Jablon concluded, “we want to offer our patients as many options as possible to beat the disease, and I’m glad we have MarginProbe in our arsenal.”

About the Marion-Louise Saltzman Women’s Center at Einstein Medical Center Philadelphia Recognized as a Breast Imaging Center of Excellence by the American College of Radiology and accredited by the National Accreditation Program for Breast Centers (NAPBC), the Marion-Louise Saltzman Women’s Center offers advanced diagnostic imaging and testing. The Center was one of the first in the Philadelphia region to use Digital Breast Tomosynthesis (DBT), also known as three-dimensional mammography, which allows radiologists to see through breast tissue and detect abnormalities that may not be found in traditional two-dimensional mammography. The Center offers individualized treatment plans, access to the newest and most advanced therapies and clinical trials, one-on-one counseling, support groups and educational seminars and nutrition counseling. Spring 2016 : Philadelphia Medicine 21


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Drexel University

College of Medicine

rexel University College of Medicine represents the legacies of two historic medical schools: Hahnemann Medical College and the Woman’s Medical College of Pennsylvania. As their proud successor, the College of Medicine upholds enduring values: commitment to educational opportunity; excellence in basic science and clinical preparation; dedicated mentorship; and the innovative spirit of revolutionary institutions. 22 Philadelphia Medicine : Spring 2016

Hahnemann was established as the Homeopathic Medical College of Pennsylvania in 1848, to provide standardized training in the emerging system of medicine called homeopathy, linked to a foundation in orthodox medical science. It was renamed Hahnemann Medical College in honor of Samuel Hahnemann, the founder of homeopathic medicine. The school welcomed students of all backgrounds. By the late

1920s, the homeopathic focus was gone, and Hahnemann became a nationally known academic medical center and a leading provider of subspecialty care, particularly for cardiovascular disease. The Woman’s Medical College, the first medical school in the world for women, was founded in 1850 as the Female Medical College of Pennsylvania. Woman’s Med


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Drexel University college of medicine

trained physicians who practiced all over the world, creating a corps of impressive female clinicians and scientists to serve as faculty and leaders in medicine. In 1970, the school became co-educational under the name Medical College of Pennsylvania, or MCP. MCP won renown for educational innovation and research, including in women’s health, and continued to advance the standing of women scientists and physicians. Our legacy schools were combined in 1993 as MCP-HU. When Tenet Healthcare Corporation acquired the MCP and Hahnemann hospitals in 1998, a nonprofit —MCP Hahnemann University—was created to take over the merged medical schools. Drexel University, a historic institution in its own right, assumed management of this new academic entity. The medical school became Drexel University College of Medicine in 2002. Like MCP and Hahnemann, Drexel University had its roots in the provision of opportunity. Financier Anthony J. Drexel founded the Drexel Institute of Art, Science and Industry in 1891 to offer practical education to men and women without regard to socioeconomic status, race or religion. The institute evolved into a university known for excellence in engineering and technology and for its cooperative education program—one of the first of its kind and among the most highly regarded in the nation. With the addition of schools of medicine, nursing and public health, Drexel entered the ranks of the top 100 research universities in the country.

United States.) The College is the academic partner in the education of some 560 interns, residents and fellows in 39 accredited specialty programs. Exponential growth in the doctoral, master’s and professional programs led to the creation in 2013 of the Graduate School of Biomedical Sciences and Professional Studies within the College of Medicine. The school offers research-intensive master’s and doctoral programs; career-oriented and interdisciplinary programs; and pre-med and pre-health programs—together enrolling more than 850 students. Many of its collaborative programs involve faculty across the university, in engineering, law, computing and informatics, and arts and sciences. The high value Drexel places on interdisciplinary work is embodied in the Clinical & Translational Research Institute, a university-wide initiative housed in the College of Medicine, to promote and support research opportunities. Drexel engineers have long collaborated with both clinical and basic science faculty in the medical

school, with notable discoveries in, for example, HIV prevention, wound healing and breast cancer detection. Pharmacology faculty have recently won patents for novel compounds targeting metastatic cancer and Parkinson’s disease. The college has one of the largest centers for spinal cord research in the mid-Atlantic region, and one of the leading centers for malaria study in the nation. Other prominent research programs focus on Alzheimer’s disease and related dementias; hepatitis C; liver, breast and prostate cancers; and all aspects of HIV. Research and education activities take place at the College of Medicine’s main campus, Queen Lane, in the East Falls section of Philadelphia, and at the Center City Campus, adjacent to Hahnemann University Hospital. The Department of Pediatrics is based at St. Christopher's Hospital for Children, and Psychiatry is based at Friends Hospital. The medical students receive clinical education at 25 affiliated hospitals and ambulatory sites, Continued on page 24

Today, with more than 1,070 medical students, Drexel University College of Medicine is educating one in every 76 medical students in the nation. (In 2014 and 2015, Drexel received more medical school applications than any other MD-granting school in the Spring 2016 : Philadelphia Medicine 23


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Careers in Medicine

working with faculty in metropolitan centers, working-class neighborhoods, suburbs, inner city areas and rural communities. In 2014, Kaiser Permanente Sacramento, in California, became a regional medical campus, joining Abington Memorial Hospital, Allegheny General Hospital, Monmouth Medical Center and WellSpan York Hospital as away campuses where students can elect to spend all of their third- and fourth-year rotations.

qualities essential to clinical excellence, while also possessing the essential emerging competencies, including an understanding of population health, health informatics, quality and patient safety, and health care systems and financing. The curriculum will prepare students to provide humanistic care to a diverse population as an integral member of a health care team in an evolving health care environment.

formation, and the opportunity to develop an area of expertise; perform research or a scholarly project; or attain further distinction in programs such as informatics, population health or humanities. Drexel was among the first medical schools to formalize the teaching of doctor-patient communication, and the college has won national recognition for its digital communication-skills training and assessment program. CommSimTM, as the program is now known, was acquired in 2015 by DecisionSim, Inc., whose decision-making simulation program is used by the U.S. Department of Veterans Affairs. Drexel also pioneered the inclusion of professionalism as an explicit element of medical education. Our physicians’ involvement in the education and research programs enhances our patient-focused practice, Drexel Medicine®, a network of more than 275 faculty physicians. Specialized groups include the Drexel Center for Women’s Health, the Drexel Sleep Center and, most recently, the Drexel Neurosciences Institute, bringing together neurologists, neurosurgeons and researchers. A longstanding practice with similar synergies, the Partnership Comprehensive Care Practice is the largest HIV/AIDS practice in the Greater Philadelphia region. The Partnership’s providers offer primary and specialty care, as well as ancillary services for patients, while its investigators pursue long-term treatment options for those who are HIV positive and potential vaccines.

In August 2017, Drexel will implement a new medical education curriculum called “Foundations and Frontiers,” the result of a two-year development process with the participation of current students, faculty, alumni and national medical education experts. Foundations and Frontiers is designed to create physicians for the 21st century, who possess all of the enduring 24 Philadelphia Medicine : Spring 2016

Foundations and Frontiers builds on what is “uniquely Drexel” and forges collaborations with the University’s outstanding programs in technology, informatics, public health and business, among others. Basic science and clinical education will be integrated from the start. Other hallmarks of the curriculum include team learning, cultural competence, humanism and professional

Research, education and patient care are the core missions of every medical school. Our fourth mission, which is both separate and entwined with the other three, is service to the community. Our goal is to provide Philadelphia residents with access to quality health education and care despite the social inequalities that exist in the urban environment. This


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commitment is articulated in our administration, which includes an associate dean for Urban Health Equity, Education & Research, and an associate dean for Primary Care & Community Health; our first year curriculum, which requires a service component; the Office of Community Experience, which arranges service opportunities through relationships with more than 50 local social service agencies and public schools; and the Office of Global Health Education, which helps students participate in service learning abroad.

Every year, Drexel medical students perform thousands of hours of community service. The majority of our students continue in service after completing their service requirement. First- and second-year students run several clinics through the college’s Health Outreach Project. Among the sites is the Salvation Army Eliza Shirley House, an emergency shelter for women and their children, where students organize a clinic for the parents and a reading program for the children. The newest clinic is located at the Arc of Philadelphia, part of a national

organization that protects the rights of people with intellectual and developmental disabilities. It is the first student-run free clinic dedicated to serving intellectually disabled adults in the country. As a leading college in a vibrant urban university, our medical school benefits from and enhances Drexel’s place on the national and international stage with a heritage of innovation, inclusiveness and opportunity that goes back more than 165 years.


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WHEN A

911 CALL

is not a 911 Call

Alan Miceli

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t happens all too often in Philadelphia. Dispatchers get a 911 call while virtually all of the city’s 50 EMS units are on other calls. Sometimes the closest available unit is clear across the city. The dispatcher has no choice but to send it, even though it will take at least twice as long as usual for the unit to get to the emergency.

Responding to such calls taxes the limits of an EMS fleet that services a city of 1.6 million people and nearly 40 million visitors a year. Fire department statistics bear out the problem. While most of the city’s 911 calls in 2015 were clearly legitimate, a crucial percentage of them were not. Of the nearly 270,000 calls made last year, about 27,000 of them were rejected by insurance companies, because they were not considered emergencies.

Captain Crystal Yates, head of the Philadelphia Fire Department’s EMS Community Risk Reduction Office, says EMS units often Yates said many patients and doctors get into these binds because of 911 calls that need to be educated on when to call 911, should never have been made. “We get too and when to do something else. “We get many of what we describe as low acuity calls,” a lot of calls, for example, from diabetics,” she told Philadelphia Medicine. “They’re basic level calls for cold or flu symptoms, Captain Yates said, “when they have trouble maintaining their blood sugar level. Some are or abdominal pain.” suffering from hypoglycemia when we arrive. “They know they can call 911. We go there. We administer dextrose and make sure they’re okay, and we leave them home.” But Yates pointed out that many of these calls could have been avoided if the patient had a better understanding of the other options available. She said sometimes diabetics should call 911, but other times a call to their doctor would often take care of the problem. Yates added that even doctors sometimes make 911 calls from their offices for situations that are not true emergencies. “We receive 26

many calls from medical providers that could have been made to private ambulance services, for example, that are covered by insurance companies. There are times when a family member or friend could transport the person. “If it’s not life threatening and the patient is in the presence of a medical provider then I think alternatives should definitely be considered.” Captain Yates said the problem to a certain degree is the result of a concerted effort to get the word out that if there is a true medical emergency, people should call 911. “When you reach your doctor’s voice mail, usually the first thing you hear is, ‘if this is a true medical emergency hang up now and call 911.’ I think we have done a really good job of teaching people to make that call. But I think we need to do a better job of teaching them what a true medical emergency is, or what alternatives are available when the situation is not a medical emergency.” Yates encourages doctors to review with patients the parameters of a true medical emergency. “You should always call 911 if you are having chest pain. If you are having abdominal pain and you are vomiting blood, you should call 911. But if you are vomiting food, and you have the symptoms of a stomach virus you should not call 911. “You should consider if you have ever experienced similar symptoms before. Belly aches with nausea and vomiting can usually be handled on the phone with your doctor or someone at the doctor’s office. The stomach ache call is the number one call we get that does not require 911.”


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Dr. Daniel Schidlow The Dean of  Drexel University College of Medicine is a Man who Whistles While he Works Aleesha Shaik, Drexel College of Medicine, Class of 2018

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t’s easy to tell when Dean Schidlow is around because his carrying voice is often in the middle of singing a song or cracking a joke. And he often is around because he makes it a point to be involved in students’ lives by attending student group events and holding office hours. When running a school of more than 2,000 medical and graduate students, humor is definitely a good personality trait to have.

Fittingly, that’s how he started our interview. When I asked how he got into medicine, he replied “through a backdoor.” The slightly more serious answer is that Dan Schidlow’s interest in medicine began when he was a child giving shots to his stuffed animals. As he grew older, he realized that he loved understanding diseases as he spoke with his doctors about whatever was ailing him. In Chile, where Dr. Schidlow grew up, students are required to pick one of three tracks by their senior year of high school: math, humanities, or biology/medicine, and those deciding to pursue medicine continue into a seven-year program. A definitive decision on what to do with the rest of your life would be difficult for most 16-year-olds, but luckily for Dr. Schidlow, he knew that he wanted to go into medicine, and even more specifically, pediatrics. Upon enrolling at one of Chile’s three medical schools, Dr. Schidlow immediately found ways to become involved in medical

education, such as joining curriculum review committees. While in medical school, he realized that he wanted to be in academics and become a professor. He went on to do just that at Drexel. His time in medical education has profoundly shaped his views on how he believes medicine should be taught. The primary difference between the medical education we have today and that which Dr. Schidlow experienced as a medical student is the development of technology that allows us to access and internalize medicine in completely new ways. Though the content is similar, we now have more experience-based curriculums with earlier clinical experiences. These aspects are the foundation of Dr. Schidlow’s vision for the future of medicine and education. He believes that we are heading toward a more team-based and inter-disciplinary approach to patient care. With the advancement of technology and knowledge, we are also realizing the importance of genetics, which will allow us to personalize medicine. Medical education will reflect these changes by incorporating more independent learning, for instance, through online means with more hands-on clinical experiences from the very beginning that parallel the basic and clinical sciences being taught in school. Technology will allow better delivery of material and will simulate clinical settings for

students to practice their skills. Furthermore, medical education will expand to emphasize the role of social determinants of health and to give students the opportunity to have longitudinal interactions with patients. Lastly, Dr. Schidlow believes that research is an integral component of medical education. Being exposed to research and the methodology behind it will develop students’ critical thinking and help them to better understand the mechanisms of disease. Dr. Schidlow hopes to integrate all of these aspects into Drexel’s new curriculum in 2017. The class of 2021, however—all hand-picked for possessing what Dr. Schidlow calls the 5 C’s (compassion, competence, critical thinking, common sense, and character)—will notice that the essence of Drexel remains the same—the tradition of appreciating diversity, women’s role in medicine, inquisitiveness, and clinical excellence which has been passed down from its predecessor schools. The access to faculty, the supportive environment, the value of service and civic engagement, the opportunities to engage in humanism, and especially the “Drexel mojo” are what make DUCOM one of the country’s most vibrant medical schools. Check out Dr. Schidlow’s blog for insightful and comedic thoughts on DUCOM happenings and current events: https:// drexelmeddean.wordpress.com/ Spring 2016 : Philadelphia Medicine 27


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Careers in medicine

Einstein Healthcare Network

Celebrates 150 Years of Compassionate Care

instein Healthcare Network marks its 150th anniversary in 2016 with a year of events, including an anniversary bash with a performance by legendary singer Diana Ross and hosted by award-winning stage and screen actor Jason Alexander; a series of talks given by medical experts; a “Born at Einstein” social media campaign; a time capsule burial and more. From its start in 1866, the 22-bed Jewish Hospital has evolved into Einstein Healthcare Network, a comprehensive, regional health care system offering world-class care in a variety of specialties, including women’s health, physical medicine and rehabilitation, heart and vascular care, kidney transplant, liver disease and breast health. “It’s a remarkable accomplishment for an institution to have the resiliency and stamina required to adapt to a century and a half of changes in healthcare,” says Barry R. Freedman, President and Chief Executive Officer for Einstein Healthcare Network. “The ability to continually grow, anticipate change, and create new models of care, has made it possible for our organization to thrive. 28 Philadelphia Medicine : Spring 2016

I am proud of the countless contributions that our doctors, nurses, staff, board members and volunteers have made to health care in the Philadelphia region.”


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einstein health care network celebrates 150 years

Through 150 years of monumental growth and development, Einstein is embedded into the fabric of Philadelphia, with 8,500 employees, three acute care hospitals—Einstein Medical Center Philadelphia, Einstein Medical Center Elkins Park, Einstein Medical Center Montgomery—along with MossRehab, a world-renowned provider of physical medicine and rehabilitation, two physician companies and a series of outpatient care centers throughout Philadelphia and Montgomery County.

Today, Einstein stands at the forefront in: • The latest diagnostic technology in breast cancer detection, including digital breast tomosynthesis, also known as 3D mammography. Einstein played a pivotal role in the research of 3D mammography which has shown significant benefits in detecting breast cancer compared to traditional 2D mammography. • Advanced robotic technology—MossRehab offers more advanced robotics than any provider of rehabilitation care in the country. MossRehab was the exclusive U.S. site for clinical trials of ReWalk™, a revolutionary exoskeleton that enables people with spinal cord and other injuries to stand, walk and climb stairs, and played a key role in the regulatory process that led to ReWalk’s commercial approval. • Education—grounded in its mission of education, Einstein Medical Center Philadelphia is the largest independent academic medical center in the Philadelphia region, training over 3,500 health professional students each year with 400 residents in more than 30 accredited programs. Over its 150-year history, many generations of doctors and healthcare professionals have trained at Einstein, including doctors, nurses, pharmacists, physician assistants, psychologists, physical therapists, occupational therapists, and others.

Our History & Mission The mission and founding principle of the Jewish Hospital was to provide relief to the sick and wounded, without regard to creed, color or nationality, or ability to pay. This was a revolutionary concept in 1866. The hospital quickly became a refuge for soldiers returning from the Civil War, freed slaves and immigrants. Its original mission and core principle to care for all in need continues to guide Einstein Healthcare Network today.

150th Anniversary Website To journey through Einstein Healthcare Network’s history and learn about and register for upcoming events, visit our interactive timeline at www.Einstein150.com.

Born at Einstein Social Media Campaign As a way to connect people throughout the country and across the globe who were born at Einstein, a social media campaign called Born at Einstein is underway throughout 2016. People are invited to upload photos and stories if they were born at an Einstein hospital through BornAtEinstein.com and via social media by using the hashtag #BornAtEinstein on Facebook, Twitter, and Instagram. Through the campaign, members of the Einstein family are connecting with new friends and re-connecting with old ones. Everyone who

shares a photo is eligible to receive a free #BornAtEinstein t-shirt. (Einstein hospitals include: the Jewish Hospital, Jewish Maternity Hospital, Mount Sinai, Northern Liberties, Albert Einstein Medical Center/Einstein Medical Center, Rolling Hill Hospital, Montgomery Hospital Medical Center, Germantown Hospital, and Einstein Medical Center Montgomery.)

Events in 2016

Great Thinkers Series 2: Conversations Join us for a lively and informative panel discussion on women’s health and wellness issues. Enjoy a reception before the event and dessert afterward. Tickets: $80. per person; $150. per couple.

Harvest Ball Weekend Celebration

This four-day extravaganza includes entertainment and dining to reflect different eras in Einstein’s history; a reception honoring 150 employees, donors, or patients; an alumni event; a Sunday brunch for people “Born at Einstein,” and much more. Ticket information to be determined.

Einstein 150

Today, Einstein has 8,500 employees, three acute care hospitals—Einstein Medical Center Philadelphia, Einstein Medical Center Elkins Park and Einstein Medical Center Montgomery—MossRehab, a world-renowned provider of physical medicine and rehabilitation, outpatient care centers and a network of primary and specialty care physicians. Einstein Philadelphia is the largest independent academic medical center in the Philadelphia region, training over 3,500 health professional students each year with 400 residents in more than 30 accredited programs.

September 8

6:00pm–8:00pm National Museum of American Jewish History 101 S. Independence Mall East, Philadelphia, PA 19106

November 3–6 Hyatt at the Bellevue, 200 South Broad Street, Philadelphia, PA 19102

For more information, visit www.Einstein150.com or call (215) 456-7200

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PCMS & Community News

Health Awareness

MARCH 2016  National Colorectal Cancer Awareness Month  National Endometriosis Awareness Month

APR I L 2016  Alcohol Awareness Month  National Autism Awareness Month— Pennsylvania Autism Action Center

 National Kidney Month  Multiple Sclerosis Education Month

 National Donate Life Month

 National Nutrition Month

 American Stroke Awareness Month (promoted by the National Stroke Association)

 Arthritis Awareness Month  National Child Abuse Prevention Month

(promoted by the Multiple Sclerosis Foundation and others)

M AY 2 0 1 6

 National Asthma and Allergy Awareness Month  Better Hearing & Speech Month

 National Facial Protection Month  Irritable Bowel Syndrome (IBS) Month

 Save Your Vision Month

 National Celiac Disease Awareness Month  Healthy Vision Month

 Occupational Therapy Month  Trisomy Awareness Month

—Pediatric Therapy Center Interview

 National Sarcoidosis Awareness Month  Sexual Assault Awareness & Prevention Month

 Lupus Awareness Month (promoted by the Lupus Foundation of America)

 National Mediterranean Diet Month  Melanoma/Skin Cancer Detection & Prevention Month  Mental Health Month  National High Blood Pressure Education Month  National Osteoporosis Awareness & Prevention Month  Preecalmpsia Awareness Month  Ultraviolet Awareness Month  National Women’s Health Week (begins on Mother’s Day)

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PCMS & Community News

Welcomes

PCMS President New Philadelphia Health Commissioner

D

r. Michael DellaVecchia gave a warm welcome to the city’s new health commissioner, Thomas A. Farley, MD, MPH, during a get-together at the College of Physicians of Philadelphia.

Dr. Farley is an ideal choice for the city’s top doc job. The trained pediatrician is the former commissioner of New York City’s Department of Mental Hygiene . He made headlines in the Big Apple by advocating for such innovative policies as making the city’s parks and beaches smoke-free, banning price-discounting of cigarettes, and raising the legal age of tobacco to 21. He also spearheaded the effort to restrict the burning of air-polluting dirty fuels to heat buildings. When Mayor Kenney announced the appointment, he said, “Dr. Farely’s ‘outof-the-box’ approach to public health, along with his medical expertise and his experience running one of the largest health departments in the nation, will make him a valuable asset to Philadelphia. During Farley’s tenure with the NYC Health Department, the agency led the National Salt Reduction Initiative, which successfully worked with major food companies to reduce sodium levels in food nationwide. He is also known for his creative use of mass media to deliver messages to promote healthy behaviors, introducing the “Two Drinks Ago” campaign to reduce binge alcohol drinking, and developing a series of hard-hitting ads on the health consequences of smoking.

Dr. Farley, Philadelphia’s new Health Commissioner, with Dr. Michael DellaVecchia, President, Philadelphia County Medical Society. Photo taken at the College of Physicians of Philadelphia during the Philadelphia Public Grand Rounds on Wednesday, February 17.

Prior to accepting the position in Philadelphia, Farley served as chief executive officer of The Public Good Projects, a nonprofit organization that leverages the power of the mass media and the techniques of marketing to combat the nation’s biggest health problems. He has also served as chair of the Department of Community Health Sciences at the Tulane University School of Public Health and Tropical Medicine. Earlier

in his career, he served in the Centers for Disease Control’s Epidemic Intelligence Service, where he investigated outbreaks of disease and directed programs to control HIV/AIDS, tuberculosis and various other infectious diseases. Dr. Farely says ensuring the health of Philadelphia’s residents will be his administration’s priority. Spring 2016 : Philadelphia Medicine 31


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Pamed Updates

S U R I V A K I Z PAMED Holds Call-in to Provide a Pennsylvania Update he World Health Organization anticipates that the Zika virus will spread to all but two countries in South, Central, and North America. Two types of mosquito can carry the virus. One is only common in our country in parts of the South and Hawaii, but the other one, Aedes albopictus, is present throughout the U.S., but so far, has rarely been found to carry Zika. The Pennsylvania Medical Society (PAMED) held a media call-in in late January, to talk about the chances of the virus breaking out in our area. The panelists included several state and health care leaders: Loren Robinson, MD, deputy secretary for health promotion and disease prevention at the Pennsylvania Department of Health (DOH); Stephen Colodny, MD, and Ray Pontzer, MD, both infectious disease specialists; and Kurt Barnhart, 32 Philadelphia Medicine : Spring 2016

MD, chair of the Pennsylvania Section of the American Congress of Obstetricians and Gynecologists and a practicing OB/GYN in Philadelphia. PAMED President Scott Shapiro, MD, and Michael Fraser, PAMED’s executive vice president, also participated. Dr. Robinson talked about alerts DOH has recently issued, including one on January 28 that has information on the process for diagnostic testing in the state. She also discussed Pennsylvania’s status and DOH’s preparations.

are kept safe. She said that at this time, DOH fully supports the travel advisories issued about the affected countries, especially with regard to pregnant women. She also said that DOH will work with health care providers and facilities to ensure that patients with appropriate risk factors (primarily travel to the above-mentioned areas) be properly evaluated and screened for the Zika virus. Dr. Robinson confirmed that the state will monitor mosquito activity as the weather warms up.

She said that DOH is closely following the surveillance and advisory Drs. Colodny and Pontzer talked information from the Centers for Dis- about the virus and how it spreads. ease Control and Prevention (CDC), as The virus is not transmitted through well as guidance issued from national casual contact. Dr. Colodny said that physician organizations, to ensure symptoms include fever, rash, and that Pennsylvanians and their families body aches, but also noted that most


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Zika virus—PAmed provides PA update

people who get infected with Zika virus have no symptoms. Dr. Pontzer added that the symptoms of the virus, when present, are mild. As there’s an increased risk for pregnant women, Dr. Barnhart talked about what is known and unknown about the chance of transmitting the virus from mother to baby. If a pregnant woman is infected with the virus, ultrasound is recommended to assess the fetus.

“It’s reassuring to me to know that we have experts and state officials aware of the possibility of Zika arriving in Pennsylvania, and that we’re all working towards a common goal to be ready just in case,” said Dr. Shapiro. “And, for the Pennsylvania Medical Society, our role is primarily educational—keeping our members up-to-date through our communication channels but also working with our media partners to keep the public

informed. We are in regular touch with the Pennsylvania Department of Health and the Centers for Disease Control and Prevention. And we will continue to do so as part of the team working to keep Pennsylvania healthy and safe.” Stay up to date with the latest news, advisories, and guidance on PAMED’s Zika web page at www.pamedsoc. org/zika.

To find out what two of the leading doctors in the fight against Zika think the chances are of an outbreak in our area, go to “The Zika Virus: Is the Mysterious World Health Menace a Threat to our Area?” in this issue of Philadelphia Medicine.

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Pamed updates

Physician General Outlines Steps Physicians Can Take to Help

SOLVE OPIOID CRISIS P

ennsylvania Physician General Rachel Levine, MD, spoke about the continuing opioid abuse crisis at the Pennsylvania Medical Society’s (PAMED) Specialty Leadership Cabinet Meeting on Feb. 9.

“This crisis hits everyone—our mothers, fathers, brothers, sisters, sons, daughters, rural, urban, suburban,” she said. “We have to get past the idea that this is someone else’s problem. We have to get people into treatment and recovery. Addiction is a disease; we have to erase the stigma.” She said a multi-pronged approach is needed to address the epidemic that involves physicians, health care organizations such as PAMED, and patients.

EDUCATION

“We want to educate medical students, residents, new physicians, and current physicians,” said Dr. Levine.

The 2014 Pennsylvania Coroners Association’s report found that about seven people a day die of overdoses in Pennsylvania. That number is expected to be even higher in 2016. 34 Philadelphia Medicine : Spring 2016

Dr. Levine talked about PAMED’s new CME series—“Addressing Pennsylvania’s Opioid Crisis: What the Health Care Team Needs to Know”—that was developed in collaboration with other stakeholders, including the state and 11 other health care-related organizations.


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Steps physicians can take to Help solve opioid crisis

The first two courses in the series on the state’s opioid prescribing guidelines and naloxone law are now available. Courses on the warm hand-off/referral into treatment and the controlled substances database are coming soon. She encouraged all Pennsylvania physicians to take advantage of this CME, which is free for PAMED members. “Opioid CME is not currently mandated by the state, but one way to ensure it stays that way is for Pennsylvania physicians to use the voluntary opioid guidelines and take this voluntary CME,” she said. During the American Association of Medical Colleges meeting in Baltimore last November, PAMED convened deans and leaders from each of Pennsylvania’s 10 medical schools to meet with Dr. Levine, Secretary of the Department of Drug and Alcohol Programs Gary Tennis, and other state leaders to discuss opioid abuse and pain management curriculum development for physicians-in-training and other opioid related issues across the Commonwealth. Dr. Levine also talked about the specialty-specific voluntary prescribing guidelines that currently exist for health care providers: • For the treatment of chronic, non-cancer pain

• For treatment of pain in the emergency department • For dental practice

• Dispensing guidelines for pharmacists

• For obstetrics and gynecology pain treatment • For geriatric pain

She said that new guidelines are coming on benzodiazepine, orthopedics and sports medicine, pediatrics and adolescent medicine.

TREATMENT

Dr. Levine said there is funding in the state budget for substance abuse disorder health homes, whose emphasis will be on improving access to medication-assisted treatment.

How did we get here? According to Dr. Levine, it was the perfect storm. The emphasis from many different agencies and in the

field on pain. In the late 1990s to early 2000s, pain became the fifth vital sign.

The emphasis on fully evaluating pain and treating pain, but at same time, development of very powerful, long acting, and very addictive, opioid medications.

The influx of tremendously cheap, plentiful, and very powerful heroin.

“Put together, this combusted into the epidemic we are seeing now,” said Dr. Levine. “We have to act. Physicians have to act, or it will be superseded by legislative actions.”

Get tools to help you combat the opioid abuse crisis in PAMED’s Opioid Abuse Resource Center at www.pamedsoc.org/OpioidResources.

In this issue of Philadelphia Medicine, “Bridge to Nowhere: the Deadly Prescription Drug Epidemic” gives a firsthand account of the city’s illegal prescription drug epidemic from the DEA agent in charge of the Philadelphia division.

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Pamed Section Updates

Out-of-Network Surprise Billing: Issue Is Much Broader than Balance Bill

he Pennsylvania Department of Insurance’s proposed solution to the “surprise billing” problem was the primary topic of the Pennsylvania Medical Society’s (PAMED) Board of Trustees’ meeting on Feburary 9. PAMED testified at a hearing on this issue last fall. A common sentiment among the PAMED Board was that this issue was much more complicated than just out-of-network (OON)

balance billing. That’s why the board tasked PAMED’s new payer advocacy task force and representatives from affected specialties with examining these issues further. PAMED will be sending an initial comment letter to the Pennsylvania Department of Insurance in the coming weeks concerning network adequacy issues. It will also comment on how transparency of the process and patient education effect OON balance billing. PAMED’s task force will discuss what solutions will work best for Pennsylvania physicians and their patients. “You can’t look at OON billing in isolation,” said Dennis Olmstead, PAMED’s senior advisor of health economics and policy. “There are a lot of other factors that intersect with this issue such as network adequacy, complex benefit design that many consumers don’t understand, narrow/tired networks, assignment of benefits, and transparency—transparency between the insurer and physician, physician and patient, and insurer and consumer. “Balance or surprise billing issues are part of the aftermath of weaknesses in the current network adequacy, patient education, and insurance contracting processes in Pennsylvania,” he said. “If you don’t address the underlying problems, you’re never going to enact meaningful change.” Network adequacy has been an issue for PAMED for quite some time. Several years ago, physicians were terminated from 2014 Medicare Advantage (MA) plan networks of UnitedHealthcare and other insurers in select markets. At that time, PAMED worked with UnitedHealthcare, other MA plans and the Pennsylvania Department of Health, Bureau of Managed Care to address termination issues. The Centers for Medicare and Medicaid Services and others—in response to advocacy efforts by PAMED and other state and national organizations—are beginning to address network adequacy. PAMED will continue to advocate on behalf of Pennsylvania physicians and patients.

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PAMED Updates

Bill Aims to Streamline Physician Credentialing in Pennsylvania Rep. Matt Baker (R-Tioga) has introduced a bill designed to make the credentialing process easier and quicker for physicians, by in part creating a more uniform procedure for insurers. The credentialing process can be long and burdensome, often taking several months before a physician is able to see patients. This bureaucratic and time-consuming process is frustrating for physicians and their patients. House Bill 1663 is awaiting consideration by the House Health Committee. We need YOU to take action! Send a message directly to your representative and ask him/her to support HB 1663 when it comes up for a vote. Please be sure to share examples of frustrations you’ve experienced during the insurer credentialing process.

Physician Advocacy Pays Off: DHS Announces Medicaid Will Recognize & Pay for Observation Status The state Department of Human Services (DHS) has announced that Medicaid will start recognizing and reimbursing for observation status sometime this summer. Observation status occurs when a patient is in the hospital but not actually admitted as an inpatient. Guidance and specifics, such as codes and billing indications, have not yet been announced. As soon as DHS releases more details, the Pennsylvania Medical Society (PAMED) will make sure its members have all the information they need. If you would like to receive an update, email us at stat@pamedsoc.org and write “Observation Status Reimbursement Update” in the subject line. PAMED’s advocacy efforts included leading discussions with DHS, PAMED’s Medical Directors Forum, and the American Medical Association.

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Feature

Exciting Advances in Gastroenterology

By Rising Stars in the Field

Saturday, April 16, 2016

The Philadelphia County Medical Society Headquarters 2100 Spring Garden Street, Philadelphia, PA 19130

Registration: 7:30 AM • Program: 8 am — 12 pm

NO FEE! REGISTER TODAY! Program Director:

Harvey B. Lefton, MD, FACP, FACG, AGAF, FASGE, Past President, PCMS

Who should attend: • physicians • nurses • fellows • physician assistants • medical students • psychologists

Earn up to 4.0 AMA PRA Category 1 Cred it™

FREE

• students • allied health care professionals

What You Will Learn • Appreciate advancements in the technologies available for evaluation and treatment of esophageal disorders, with a focus on Barrett’s esophagus.

• Utilize the 2016 AASLD/IDSA Guidelines for testing, managing and treating patients with hepatitis C and NASH.

• Apply new therapeutic options and hear about emerging therapeutic agents on the near horizon in order to combat biologic failures and to improve patients’ satisfaction, adherence and clinical outcome when treating IBD, functional GI and motility disorders.

• Consider therapies in development for NASH and assess the clinical utility for techniques such as MR elastography for staging liver fibrosis.

Program Topics & Guest Speakers  New Frontiers in the Management of Barrett’s Esophagus

 Emerging Therapeutics in IBD

Michael S. Smith, MD, MBA

Neilanjan Nandi, MD

 Update in Liver Disease 2016

 Functional Bowel Disease

David A. Sass, MD, FACP, FACG, AGAF, FAASLD

Stephanie Moleski, MD

Associate Professor of Medicine, Medical Director, Esophageal Program Gastroenterology Section, Lewis Katz School of Medicine at Temple University

Associate Professor of Medicine, Division of Gastroenterology and Hepatology Medical Director, Liver Transplant Program, Jefferson University Hospitals

Assistant Professor of Medicine, Associate Program Director, Division of Gastroenterology, College of Medicine Drexel University

Assistant Professor of Medicine, Associate Program Director, Fellowship Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital

For Program Information & to Register go to: www.philamedsoc.org or call (215) 563-5343 X 113 Accreditation/Designation Statement: This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of the Pennsylvania Medical Society and the Philadelphia County Medical Society. The Pennsylvania Medical Society is accredited by the ACCME to provide continuing medical education for physicians. The Pennsylvania Medical Society designates this live activity for a maximum of 4.0 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

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Schedule 4.16.2016 THE PHILADELPHIA COUNTY MEDICAL SOCIETY

7:30 AM REGISTRATION OPENS

2016 Upcoming Events & Programs

7:50 AM GREETINGS: Michael DellaVecchia, MD, PhD, President, PCMS

OPENING REMARKS: Harvey Lefton, MD, FACP, FACG, AGAF, FASGE, Clinical Professor of Medicine, Drexel University School of Medicine; Program Chair, Moderator & Past President, PCMS

8:00 AM LECTURE I — NEW FRONTIERS IN THE MANAGEMENT OF BARRETT’S ESOPHAGUS

Speaker: Michael S. Smith, MD, MBA Associate Professor of Medicine Medical Director, Esophageal Program, Gastroenterology Section, Lewis Katz School of Medicine at Temple University

9:00 AM LECTURE II – UPDATE IN LIVER DISEASE 2016

Speaker: David Sass, MD, FACP, FACG, AGAF, FAASLD Associate Professor of Medicine Division of Gastroenterology and Hepatology, Medical Director, Liver Transplant Program, Jefferson University Hospitals

All programs held at PCMS HQs unless noted

APRIL

 6 Editorial Review Board Meeting

Determine e-newsletter and quarterly magazine content.

12:30 PM – 1:30 PM

16 GI Update Seminar—Exciting Advances in Gastroenterology Half-day educational program, topics include:

7:30 AM – NOON

New Frontiers in the Management of Barrett’s Esophagus, Update in Liver Disease 2016, Emerging Therapeutics in IBD, Functional Bowel Disease

20 PCMS Executive Committee Meeting

5:00 PM – 6:00 PM

21 Tools for Success Conference for Practice Managers

7:30 AM – 6:00 PM

Meets once a month to plan PCMS meeting, agenda; conduct business between quarterly Board of Directors meetings.

All day program for Practice managers at Villanova Conference Center.

MAY

10:00 AM REFRESHMENT BREAK— Visit Sponsors

10:30 AM LECTURE III — EMERGING THERAPEUTICS IN IBD

11 Child Abuse Training Program Approved 2 hour courses for child abuse recognition

6:00 PM – 8:30 PM

18 Public Health Grand Rounds Program

5:00 PM – 6:30 PM

Speaker: Neilanjan Nandi, MD

Assistant Professor of Medicine Associate Program Director Division of Gastroenterology & Hepatology, Drexel University

11:30 AM LECTURE IV — FUNCTIONAL BOWEL DISEASE

Speaker: Stephanie Moleski, MD

Harvey Lefton, MD, FACP, FACG, AGAF, FASGE

NOTE: All lectures will be followed by questions and answers. All Attendees should complete the program questionnaire.

Determine e-newsletter and quarterly magazine content.

12:30 PM – 1:30 PM

and reporting training for physicians that is required for medical license renewal.

“The Opioid Epidemic in Philadelphia”

Held at the College of Physicians of Philadelphia.

25 PCMS Executive Committee Meeting

Assistant Professor of Medicine Associate Program Director, Fellowship Division of Gastroenterology and Hepatology, Thomas Jefferson University Hospital

12:30 PM CLOSING REMARKS

 4 Editorial Review Board Meeting

Meets once a month to plan PCMS meeting, agenda; conduct business between quarterly Board of Directors meetings.

5:00 PM – 6:00 PM

JUNE

 1 Editorial Review Board Meeting

12:30 PM – 1:30 PM

 9 PCMS Board of Directors Meeting

5:00 PM – 6:30 PM

Determine e-newsletter and quarterly magazine content.

Meets quarterly to make financial decision on behalf of the Society.

Spring 2016 : Philadelphia Medicine 39


Philadelphia Medicine Spring 2016  
Philadelphia Medicine Spring 2016  

Official Magazine of the Philadelphia Medical Society