To learn more about Historic Yates Mill County Park see page 12
Evolution and Homo Electronics
WCMS New Members
By L. Jarrett Barnhill, MD
North Carolina Medical Society Leadership in Medicine By Robert W. Seligson, CEO, North Carolina Medical Society
10 Tara Farms Annual Picnic
Publisher Wake County Medical Society Editor Paul Harrison Wake County Medical Society Officers and Executive Council
2015 President | Andrew Wu, MD Secretary | Robert Munt, MD Treasurer | Robert Munt, MD Past President | Patty Pearce, MD Founding Editor | Assad Meymandi, MD, PhD, DLFAPA
Council Terry Brenneman, MD Members Maggie Burkhead, MD Warner L. Hall, MD Ken Holt, MD Assad Meymandi, MD, PhD, DLFAPA Robert Munt, MD Patricia Pearce, MD Derek Schroder, MD Michael Thomas, MD Brad Wasserman, MD Andrew Wu, MD WCMS Marilu Thordsen Alliance President
Wake County Medical Society 2500 Blue Ridge Road, Suite 330 Raleigh, NC 27607 Phone: 919.792.3644 Fax: 919.510.9162 firstname.lastname@example.org www.wakedocs.org
â€œThe Wake County Physician Magazine is an instrument of the Wake County Medical Society; however, the views expressed are not necessarily the opinion of the Editorial Board or the Society.â€? 2 | OCTOBER 2015
L. Jarrett Barnhill, MD is a professor of Psychiatry at the UNC School of Medicine and the director of the Developmental Neuropharmacology Clinic within the Department of Psychiatry. He is a Distinguished Fellow in the American Psychiatric Association and Fellow in the American Academy of Child and Adolescent Psychiatry.
For the last 20 years, Robert
has served as Executive Vice President, CEO of the North Carolina Medical Society, the largest and oldest professional association in the state, representing nearly 13,000 physicians and physician assistants throughout North Carolina. He also serves as CEO of the North Carolina Medical Society Foundation, the philanthropic arm of the Medical Society.
Wake County Physician Magazine (WCPM) is a publication for and by the members of the Wake County Medical Society. WCPM is a quarterly publication and is digitately published January, July, April, and October. All submissions including ads, bio’s, photo’s and camera ready art work for the WCPM should be directed to:
he Wake County Medical Society is inviting its members to write articles for upcoming issues of the Wake County Physician Magazine. Wake County Medical Society members wishing to write an article for publication are asked to submit a brief five sentence proposal. Proposed article summaries could focus on your first person accounts of the personal side of practicing medicine (e.g., a patient overcoming all odds and achieving a positive outcome, experience with grief/ overcoming grief, your best day practicing medicine, or care management success stories, etc.) or any other human interest story that might appeal to our readership- keeping in mind that anything resembling promotion of a current practice or practitioner, or taking a political stance would not be useable, with the final say on such matters resting with the editorial board. Please email your brief proposal to Paul Harrison, editor, by December 10, 2015 at email@example.com. We would like to include your article in our next publication—January 2016, which will be posted on our website. Thanks!”
Tina Frost Graphic Editor WCPM firstname.lastname@example.org 919.671.3963 Photographs or illustrations: Submit as high resolution 5” x 7” or 8” x 10” glossy prints or a digital JPEG or TIF file at 300 DPI no larger than 2” x 3” unless the artwork is for the cover. Please include names of individuals or subject matter for each image submitted. Contributing author bio’s and photo requirements: Submit a recent 3” x 5” or 5” x 7” black and white or color photo (snapshots are suitable) along with your submission for publication or a digital JPEG or TIF file at 300 DPI no larger than 2” x 3”. All photos will be returned to the author. Include a brief bio along with your practice name, specialty, special honors or any positions on boards, etc. Please limit the length of your bio to 3 or 4 lines. Ad Rates and Specifications: Full Page $800 1/2 Page $400 1/4 Page $200
WAKE COUNTY PHYSICIAN | 3
Homo electronicus By L. Jarrett Barnhill, MD
impact scores and evidencebase studies. In the eyes of the old timers, this new generation resemble literaturequoting, journal-thumping fundamentalists. To the young and enlightened, the older sort are degenerate arm chair speculators and gurus of the anecdote. It seems that we are trapped between shamans and the smart youngsters armed to
my dystopian angst. Kirk and the gang encountered an alien who appeared aboard the Enterprise (breached the shields), took Spockâ€™s brain and led the crew on a chase through the universe. The intrepid crew found a simple people who obviously who were incapable of performing such neurosurgery. Through his usual charm, Kirk learned from
do not. The great debate at times resembles a group of Medieval Scholastics. Modern medicine is based on a new faith- one bound by scientific/ statistical rigor of papers, high
the teeth with technological wonders.
the priestess that she plugged into a massive computer chocked full of advanced learning and technology. That knowledge rapidly degraded and she reverted to
lamented over what exactly do we know and how did we come to know it. 2400 years later we are pursuing these same questions, but with a twist. The 21st century version involves the struggle between the disciples of knowledge in the box (exotic breeds of hand held devices), and those who
4 | OCTOBER 2015
For many years this aging Star-Trekkie found comfort in an episode that reinforced
her baseline simplicity. Kirk et al resolved the problem of Spock’s displaced brain by plugging Dr. McCoy into the computer. It worked and he restored the missing brain to its rightful owner. Unfortunately Dr. McCoy quickly regressed back to his persona as a cantankerous “old family doc”.
using machines- yet they depend on the technology. Their ancestors still rely on their older inefficient brains to store and retrieve information. We ought to be using the technology, but many can’t give up the old ways.
But there is ongoing research that might support my nightmare scenario. There seems to be a great divide in terms of storing and retrieving information. The old Luddites remember things in our heads; the techno-docs rely on search engines to access the same
Neuroscientists are now focusing on how computers and electronic devices affect brain development- changes in patterns of neuroplasticity arising from early exposure to electronic technologies. Their findings suggest a possible shift in human evolution. Natural and cultural selection are now being influenced by these electronic devices. If
knowledge. We store the information; they know where to find it. This division creates a paradox. Youth have faster cognitive processing speed and a capacity to store and access information without
this trend continues man, the tool maker, will become Homo electronicus and the philosophical metaphor of a “brain in a vat” may take on new meaning. There is a rub- computer skills may
not provide a reproductive advantage. These issues seduced my inner evolutionary biologist and paleo-anthropologist. The human brain expanded and reorganized to accommodate increasingly complex social relationships. Biology limited brain size, so as populations grew, our ancestors slowly changed how they managed information. Communication evolved from pantomime, dance; and signaling by gestures into spoken language and verbal memories- more efficient methods for exchanging information. These cognitive
and linguistic transformations allowed for sharing innovations within larger social units that included elders, grandparents and [continued on page 12] WAKE COUNTY PHYSICIAN | 5
WakeCountyMedicalSociety welcomes our newest members
Paul W. Becton, PA-C Chelsea Fletcher - PA-C Chad C. Greer, MD Brittany Harris, PA-C Katherine Marhalik, PA-C Ashley Mason, PA-C Kyle Pelligra, PA-C Spyro P. Vulgaropulos, MD David W. Zaas, MD Sebastian Abadie, MD Sagir Ahmed, MD Donna G. Anderson, MD Michael J. Azrak, MD Jeffrey K. Bray, PA-C Robert Brownstein, MD George T. Clark, III, MD Christopher T. Coughlin, MD Rebecca J. Daumen, MD Amy A. Destefano, MD Robert A. Dilorenzo, MD James E. Fogartie, Jr. MD Andrea L. Haas, PA-C Seung Won Kim, MD
6 | OCTOBER 2015
John D. Lilley, MD Michele H. McMillan, MD Elliot J. Poole, PA-C Robert J. Porter, PA-C Brian S. Quigley, MD Grace w. Rose, MD Allison H. Schmitt, MD Robert J. Starkenburg, MD Sherill L. Steen, PA-C Lori A. Tackman, MD Dori J. Thomas, MD Brett L. Wilson, MD Christopher L. Wilson, MD Kelly T. Blount PA-C Ann Bommareddi, MD John L. Burkard, Jr. MD Michael H. Wesinstein, MD PHD David R. Bierman, MD Kristin L. Donaghue, MD Vandana Nayal, MD Richard J. Pacca, MD Harman, Debra L. MD
October is breast cancer awareness month Breast Cancer Awareness Month, marked in countries across the world every October, helps to increase attention and support for the awareness, early detection and treatment as well as palliative care of this disease. There are about 1.38 million new cases and 458 000 deaths from breast cancer each year (IARC Globocan, 2008). Breast cancer is by far the most common cancer in women worldwide, both in the developed and developing countries. In lowand middle-income countries the incidence has been rising up steadily in the last years due to increase in life expectancy, increase urbanization and adoption of western lifestyles. Currently there is not sufficient knowledge on the causes of breast cancer, therefore, early detection of the disease remains the cornerstone of breast cancer control. When breast cancer is detected early, and if adequate diagnosis and treatment are available, there is a good chance that breast cancer can be cured. If detected late, however, curative treatment is often no longer an option. In such cases,
palliative care to relieve the suffering of patients and their families is needed. National Breast Cancer Awareness Month is a chance to raise awareness about the importance of early detection of breast cancer. Make a difference! Spread the word about mammograms and encourage communities, organizations, families, and individuals to get involved. How can National Breast Cancer Awareness Month make a difference? We can use this opportunity to spread the word about steps women can take to detect breast cancer early. Encourage women ages 40 to 49 about when to start getting mammograms. Encourage women ages 50 to 74 about getting mammograms every two years. THINK PINK! ยง
By Robert W. Seligson, CEO, North Carolina Medical Socity
ince April 2013, the North Carolina Medical Society (NCMS) has been intimately involved in the debate over Medicaid reform in our state – how to ensure access to quality care for our state’s most vulnerable citizens. We have always advocated for a system that puts doctors in the key decisionmaking roles when it comes to providing quality patient care.
within this hybrid system. You may not be aware of some of the items the NCMS fought mightily to be included in the recent Medicaid reform legislation to help ensure a value-based, patient-centered approach. Here are several measures of particular note. Health Information Exchange (HIE) The legislation requires the use of a statewide and state-controlled HIE Network. As the NCMS outlined originally in our response to the North Carolina Department of Health and Human Services request for information on the Medicaid program back in April 2013, data exchange is crucial to proper care coordination and efficiency.
While some may view the legislature’s recent decision to create a hybrid system with managed care organizations and providerled entities (PLE) as the end of this lengthy process, we are actually just at a midpoint. Countless decisions are yet to be made as the reform framework the legislature set up evolves into a working Medicaid program. The NCMS In our lobbying efforts an HIE was top priority, remains committed to this process and will “Medicaid reform is challenging, and we understand the difficulty continue to fight to of the decisions legislators are facing. We oppose the General protect your ability Assembly’s decision to involve corporate managed care in our to provide the highest Medicaid program. Including some of the patient protections we quality of care for requested such as performance standards based on quality, cost your patients. and patient experience is an improvement. This is not the end of the Medicaid reform debate. We will continue to work with our Now our efforts partners and the state’s leaders on the many decisions that lie will turn to more ahead to enable the delivery of high value medical care to our fully detailing how state’s most vulnerable citizens.” to implement value--Robert W. Seligson, CEO, North Carolina Medical Society, based, patientStatement to the media on the legislature’s Medicaid reform bill centered care models on Sept. 17, 2015. for Medicaid patients 8 | OCTOBER 2015
and one in which already burdened physician practices would not be left holding the check. The state’s budget provides $8 million matched by $8 million in federal funding for the next two fiscal years to establish the HIE. Medicaid providers will then need to be connected by Feb. 1, 2018 with all other entities that receive state funds for health services on-line by June 1, 2018. Gradually over time, the HIE Network will become 100 percent receipt-supported by establishing reasonable participation fees. Defined measures to achieve the Triple Aim Under the new legislation, whether with a PLE or a managed care organization, any capitated contract must be built on defined measures and goals for risk adjusted health outcomes, quality of care, patient satisfaction, access and cost to achieve the Triple Aim. The Triple Aim is improving the patient experience of care, improving the health of the particular population and reducing the per capita cost of health care. The NCMS has been working on many fronts in addition to Medicaid reform to educate and provide resources to our members to help them achieve the Triple Aim goals. At the start of the Medicaid debate, we advocated that any model be based on this approach. Through a lengthy process of ongoing discussion with the McCrory administration and key legislators we were able to educate lawmakers on the benefits of a value-based system. The fact that the federal government as well as many commercial payers are moving toward a ‘pay for quality’ reimbursement, also was influential. Requiring the managed care organizations to abide by these measures should help ensure the focus remains on patient care.
Prepaid Health Plans (PHP). The legislation also gives the state, through the NC Department of Health and Human Services, the power to establish appropriate rate floors for in-network primary care physicians, specialist physicians and pharmacy dispensing fees. And it requires the managed care organizations and PLEs develop and maintain provider networks that meet access to care requirements for their enrollees. These entities may not exclude providers from their networks except for quality reasons or refusal to accept network rates. This is just a brief overview of some of the key provisions in this complex legislation. As you can see there are numerous details to be worked out. The devil is in the details, and over the next three to five years, those will become clearer. We at the NCMS have a laser focus on ensuring our physicians and their patients have the necessary protections against bad outcomes other states have experienced when managed care organizations have been invited into the Medicaid program. NCMS members have access to the specifics of this process as it unfolds. Members also have the opportunity to participate through our grassroots efforts. Please consider joining us to stay informed as well as to help influence how Medicaid will look five years from now. Get more information about membership at our website, www.ncmedsoc.org. §
Other Patient and Provider Protections With the state no longer assuming the risk for Medicaid, it is important patients have the proper protections under the law when insured by these entities. To that end, the legislation stipulates that Chapter 58 commercial insurance requirements will apply to all participating
WAKE COUNTY PHYSICIAN | 9
Dr. Keith Nance, Dr. Steven Carter, & Dr. Russell Wilson
Susan Hammer and Betty Griffin
Dr. Newton & Betty Griffin & Marie
Zohra Osman, Dr. Mohammed Farouk and son
Jane Patterson, Dr. Dwayne Patterson and Kimberly Durland
10 | OCTOBER 2015
Dorothy Nance, Hetal Wasudev
Marilu Thordsen and Zohra Osman
Dr. Al and Sue Jenkins
A special thanks to all those who helped make the WCMS Annual Tara Farms Picnic another huge success! Fun was had by all. Dorothy, Nicole, Keith, Jr and Keith Nance, Sr
Larry King, Susan Hammer & Paul Harrison WAKE COUNTY PHYSICIAN | 11
[Evolution & Homo Electronicus continued from page 5] nonfamily neighbors. These contributed to accelerated information exchange for new technologies, ideas and knowledge. Yet even these innovations had limitations. Our species needed new storage and retrieval methods. Cave art, symbols and notched reindeer antlers became the super computers of the Paleolithic. But evolution involves populations. Fitness is not defined by computer savviness- but by outreproducing your competitors. Have you ever worried that as the number of computer dating/perfect match venues expands, old fashioned competition and mate selection will become extinct?. Will “texting” replace romantic love and dating as a means of getting to know someone? Will our humanity be condensed to Facebook bios and “selfies”. In that world, the norm may be romance by proxy. Mate selection may be digitalized into video games starring modern cave men bonking future mates on the head (or drugging them). Darwin once argued that females were the limiting factor in mate selection so choice may shift to digital narcissists or braindead video zombies. Thinking way ahead, computer dating might lead to holographic sexual relationships with God knows what sort of 3-D printed offspring. In this nightmare, 12 | OCTOBER 2015
I shudder to think of how Romeo and Juliet might sound in “text-ese”. So what will future eugenicists worry about? Did the Star Trek gang get it right? The elite will realize that reproducing requires more than a computer interface. Love and passion in cyberspace might limit our options to artificial insemination (the rancher’s approach), mate selection and breeding by stealth (Plato’s approach in the Republic) or assembly line in vitro fertilization. But what if the baby-popping beasts in the streets out reproduce the elite? A Machiavellian solution is to put smart TVs, hand held computer devices, reality video games etc. in the hands of the reproducing rabbits. After several generations, the rabbit people will transforms into captives who are too preoccupied with screens to have sex; reproductive rates will drop and the rare offspring will be delivered at random by drone storks. In time, the reproducing classes will regress into simpletons and leave the ruling class with exclusive access to the nanotechnologies and quantum computing. Voila. We have a space ship Earth zooming through the galaxy with everyone but the priests happily engaged in dumbing down with each new generation. To survive the upper echelon will need new
generations of automated, self/repairing artificially intelligent systems. In time, living in this world will look like a kindergarten class on a field trip. Our only hope: a star ship crew that will help us undo the grave miscalculations of the ancient ones (namely us). So how will contrarians survive? I propose that we will write manuals on Luddite survival. One chapter is devoted to the immediate purging of Smart TV, laptops, hand held devices and watches. The second step, develop self-teaching modules for making good thrusting spears, darts and atlatls. The third is how to build welllighted caves. The fourth, learn how to avoid beer drinking Neandertal, vegans, and hipsters feasting on Paleodiets of mostly roasted red meat and shrubberies. Our new tribes will seek out nice isolated lake or river front abodes. In this Eden, a day is filled with strolling without devices, listening to crickets, enjoying an uninterrupted meal, talking directly with a friend or lover, and escaping the loneliness of electronic symbiosis. Au revoir.
Historic Yates Mill County Park
The centerpiece of the 174-acre park is Historic Yates Mill, which is the last operable water-powered gristmill in Wake County (more than 70 water mills once existed in the area). The Mill and the property surrounding it were purchased in 1963 by NC State University. The Mill was placed on the National Register of Historic Places in 1974 and was restored to working order through a grassroots community effort by 2005. The water-powered gristmill was an important economic and social center for residents of Wake County from colonial times through the early 1900s. Gristmills provided the important service of grinding corn and wheat into meal and flour. This Mill operated for more than 200 years. In rural areas of North Carolina, before towns or crossroad-stores developed, gristmills served as public gathering places for scattered rural populations. Millponds were popular locations for fishing, swimming and picnicking. Yates Millpond is again a popular gathering place, as it once was in the past.
4620 Lake Wheeler Road Raleigh, NC 27603 Phone: 919-856-6675 Fax: 919-856-6674 For more information about Yates Mills or orther Wake County Parks visit http://www.wakegov. com/parks/yatesmill/Pages/default.aspx
WAKE COUNTY PHYSICIAN | 13
The Wake County Medical Society (WCMS) is a 501 (c) 6 nonprofit organization that serves the licensed physicians and physician assistants of Wake County. Chartered in 1903 by the North Carolina Medical Society.
CURRENT PROGRAMS Project Access - A physician-led volunteer medical specialty service program for the poor, uninsured men, women, and children of Wake County. Community Care of Wake and Johnston Counties CCWJC has created private and public partnerships to improve performance with disease management initiatives such as asthma and diabetes for ACCESS Medicaid recipients. CapitalCare Collaborative - The CCC program is a membership of safety net providers working corroboratively to develop initiatives to improve the health of the regionâ€™s medically underserved such as asthma and diabetes for Medicaid and Medicare recipients.
Become a Member of Wake County Medical Society and help support the indigent care and community service programs of the Society. WHY JOIN
BENEFITS OF MEMBERSHIP
Membership in the Wake County Medical Society is one of the most important and effective ways for physicians, collectively, to be part of the solution to our many health care challenges. A strong, vibrant Society will always have the ear of legislators because they respect the fact that doctors are uniquely qualified to help form health policies that work as intended. Itâ€™s heartening to know the vast majority of Wake County physicians, more than 700 to date, have chosen to become members of the Wake County Medical Society.
HOW TO JOIN To become a member of the Wake County Medical Society contact Deborah Earp, Membership Manager at dearp@ wakedocs.org or by phone at 919.792.3644 A portion of your dues supports to the volunteer and service programs of WCMS. Membership is also available for PAâ€™s. There is even an opportunity for your spouse to get involved by joining the Wake County Medical Society Alliance.
WCMS MISSION To serve and represent the interests of our physicians; to promote the health of all people in Wake County; and to uphold the highest ethical practice of medicine.
Service Programs - The spirit of volunteerism is strong in Wake County. Hundreds of local physicians volunteer to help our indigent. The Society coordinates several programs that allow low income individuals access to volunteer doctors and to special case management services for children with diabetes, sickle cell anemia or asthma. Publications - Members receive the peerreviewed The Wake County Physician Magazine four times a year, and we keep you informed regularly via pertinent emails. The magazine focuses on local health care issues in Wake County, the Wake County Medical Society and the WCMS Alliance, a companion organization composed of physician spouses and significant others. Socializing with your physician colleagues - Many physicians feel too busy to do anything except work long hours caring for patients. But, the WCMS provides an opportunity for physicians to nourish relationships through social interaction with one another at our dinner meetings featuring prominent speakers and at other events. Finally, joining the WCMS is plain and simple the right thing to do - Physicians and the community benefit from our membership and our leadership in local affairs.
Are you interested in becoming a Wake County Medical Society member? Simply visit our website at www.wakedocs.org and complete the online application or contact us by phone at 919.792.3644.
A portion of your dues joining the Wake County contributes to the volunteer Medical Society Alliance. and service programs of WCMS. Membership is also available for PAâ€™s. There is even an opportunity for your spouse to get involved by
The Wake County Physician Magazine is a quarterly publication for and by the members of the Wake County Medical Society. The magazine focuse...
Published on Oct 4, 2015
The Wake County Physician Magazine is a quarterly publication for and by the members of the Wake County Medical Society. The magazine focuse...