Poll Shows Few Kentuctuckians Support the New Optometric Law

The first bill to be signed into law in the 2011 General Assembly didn’t go over well with a majority of Kentuckians surveyed in the cn|2 Poll.

And it wasn’t by an eyelash.

Just 15% of the 804 respondents in this week’s cn|2 Poll said they agreed with the proposal that now allows optometrists to perform certain eye surgeries. Up to the passage of Senate Bill 110, optometrists were licensed to perform eye exams, diagnose problems and prescribe corrective lenses.

S.B. 110, which Gov. Steve Beshear signed into law last week, allows optometrists to perform certain surgeries including several using lasers. That had been the domain of ophthalmologists — eye doctors who have medical degrees.

In the cn|2 Poll, 79% of respondents said any surgery should be performed by ophthalmologists.

But the cn|2 Poll results showed the most opposition to optometrists performing surgeries came in the most rural areas. In the 1st Congressional District covering western and southern Kentucky, nearly 87% said surgeries should be performed by an ophthalmologist and nearly 84% said that in the 5th Congressional District in eastern Kentucky.

Via cn|2 Poll: Few in Ky. support optometrist bill that was first to pass legislature in '11

It is time for physicians to be united to put the patient's safety first in order to thwart the special interest groups to advance their agenda and dictate how to practice medicine. Collective bargaining right of union workers have been on all over the news, where is the physicians' collective bargaining right? We are facing the impending medicare and medicaid reimbursement cuts at the mercy of the politicians.

Time for MDs and DOs to Stop The Infightings Among Each Other: We Are All Physicians After All!

Dr. Niall McLaren, a psychiatrist practicing in Australia, embraces the holistic approach of osteopathic medicine. Holistic approach to mental disorders or diseases should be emphasized instead of the reductionist approach which places priority of bio-chemical imbalances.

"In a thoughtful commentary, Delengocky offered three reasons why osteopathic medicine should remain parallel to but distinct from allopathic medicine.

First, there is the widespread and growing interest in complementary and alternative medicine (CAM) in the United States. For a number of reasons, osteopathic medicine is an alternative to the reductionist biological tradition of allopathic medicine. Osteopathic medicine places great emphasis on the fact that the body is a self-regulating unit in which structure and function are reciprocally interrelated, providing a basis for a rational, holistic therapy.

Second, he argued that because of the prevalence, the morbidity, and the huge cost of musculoskeletal disorders, there is a place for a form of medicine that sees a need to manage these debilitating conditions as more than “simply pains.”

Third, he saw a political advantage in medicine having two “separate but equal” traditions to counter the aggressive push by nonmedical professions for equal rights (eg, laboratory investigation, prescribing, procedures) with physicians within their narrowly defined areas. Medicine must see the patient as a whole, must advance by rational scientific research and must be distinct from the paramedical professions, which seek to advance themselves by legislative advantage. Medicine is strengthened, not weakened, by having the two traditions of allopathic reductionist biology and osteopathic holism."

AMA Foundation Award Recipient Terrie E. Taylor, DO

As part of a continued effort to eliminate the scourge of malaria in the southern African nation of Malawi, a Michigan State University-led research team will use a $9.1 million federal grant to create new prevention and control strategies in the small, landlocked country.

Terrie Taylor, an MSU University Distinguished Professor of internal medicine and an osteopathic physician, is leading the project, which aims to establish a self-sustained research entity capable of implementing and evaluating anti-malaria strategies. The research project is funded by the National Institutes of Health's National Institute of Allergy and Infectious Diseases.

"Successful malaria prevention and elimination activities require sustained, effective and well-targeted interventions," said Taylor, who spends six months each year working at the Queen Elizabeth Central Hospital in Blantyre, Malawi. There she treats malaria patients - predominantly children - and conducts research on the disease that kills as many as one million children in sub-Saharan Africa every year.

Using new molecular and genomic tools in conjunction with established approaches, Taylor and her team will study patients, malaria parasites, the mosquitoes that infect people with the parasite, and the individuals who carry the parasite and infect mosquitoes but manifest no symptoms themselves. The work will be carried out in three ecologically varied locations in Malawi, representative of geographic regions across southern Africa.

Michigan State University News: Research team awarded $9.1 million to battle malaria in Malawi

Meet the first Emergency Physician, Joe Heck, DO, elected to Congress

Joe Heck, DO is the only DO physician among a few other MD physicians to serve in the U.S. Congress. He represents Nevada’s 3rd congressional district and is a member of the Republican Party. He was a State Senator of Nevada.

Understanding Insurance: Will a Public Option or Co-op Get Us Where We Want?

Editorial by Debra A. Smith, DO, MIHM, MBA

Dr Smith is president-elect of the American Osteopathic College of Occupational and Preventive Medicine, and adjunct assistant professor at the University of North Texas Health Sciences Center— Texas College of Osteopathic Medicine in

 A “public option” (ie, allowing individuals to purchase government run health insurance) has been proposed as a solution for achieving universal health coverage in the United States. Politicians have told us not to fear a public option because government-run programs such as Medicare work well—without any of the dreaded rationing of care that critics claim would occur. Recent town hall meetings have demonstrated that many elderly Americans are satisfied with their Medicare coverage and will fight fiercely to protect it.

Medicare does provide good benefits—with the working population paying for current retirees. Today, however, Americans are living an average of 4.3 years longer than they were in 1965, when the program started.1,2 In addition, the percentage of the US population receiving benefits has jumped from 9.5% at the program’s inception to 13% today3—a 37% increase.

As more and more “baby boomers” retire, the Medicare-eligible population is projected to expand to 16% by 2020 and to 19.3% by 2030.3 According to a May 2008 speech by Richard W. Fisher, president and chief executive officer of the Federal Reserve Bank of Dallas, the present value of unfunded liabilities for Medicare Part A (hospitalizations) is $34.4 trillion; for Medicare Part B (physicians), $34 trillion; and for Medicare Part D (drug benefits), $17.2 trillion.4 These numbers represent a grand total of $86 trillion of unfunded entitlements that our children and grandchildren will be paying for us.4

Increased longevity and demographic shifts account for part of the funding dilemma. The continued expansion of benefits and increased demand for costly new medical technology account for the rest of the problem. Given the extent of our current obligations, is the proposal of another publicly funded healthcare program responsible?

There are three things that people want in any health plan. First, the plan should be responsibly administered and financially solvent. Second, it should provide good coverage at an affordable

price. Third, the plan should not bankrupt the country, the insurance companies, or the individuals paying

for it. A key issue to keep in mind is that a public program must be underwritten correctly or it will lose money. Nationwide, health insurers have been operating with only about a 2% profit margin in recent years.5,6 Although we want everyone covered, do we really believe that government is more efficient than

the private sector?

Nonprofit and For-Profit Private Options

Where is the money in private health insurance going? About 85% of each premium dollar goes to pay claims (ie, the medical-loss ratio), and roughly 10% goes to administrative costs.7Highmark Blue Cross Blue Shield, a nonprofit insurer based in Pittsburgh, Pennsylvania, has an explicit policy to keep its

medical-loss ratio near 90%.7 Nonprofit insurers are granted this special tax status because they provide a

needed public service. Nonprofits are good for the insurance industry because they help keep the for-profit insurers honest in premium pricing. Conversely, the for-profit insurers have incentive to reduce administrative costs to remain competitive in the marketplace and eke out a profit. The for-profit competitors force the nonprofits to keep their administrative costs from ballooning.

Politicians claim that public health programs have cheaper administrative costs than programs in the private sector. An examination of the evidence, however, casts doubt on that assertion.

via Journal of Osteopathic Medicine: Understanding Insurance: Will a Public Option or Co-op Get Us Where We Want?

                   
                                                              http://healthcaresolved.net/

State CME Requirements for MDs and DOs

Source from AMA

American Academy of Ophthalmology: Kentuckians’ Vision Jeopardized with Governor’s Stroke of Pen

Despite an aggressive campaign waged by a coalition of medical groups to educate him on the inherent risks contained in the optometric surgery legislation that flew through the Kentucky legislature, Gov. Steve Beshear turned a blind eye to the dangers and signed SB 110 into law this afternoon. Beshear claims three reasons as the basis for signing the legislation into law, despite the vehement opposition of the Academy, the Kentucky Academy of Eye Physicians and Surgeons and the Kentucky Medical Association and so many of you who contacted him. His reasons for signing SB 110:

• “Access to quality health care across the state”
• The overwhelming, bipartisan vote
• The “little or no fiscal impact on the Medicaid budget”

The bill arrived on Gov. Beshear’s desk after the Kentucky House of Representatives voted last Friday to approve the legislation, which threatens the vision of all Kentuckians; the Senate took similar action the previous week. SB 110 grants optometrists authority to perform:

• Laser procedures, including laser trabeculoplasty, peripheral iridotomy, iridoplasty and capsulotomy, YAG capsulotomies, LASEK and laser “only” clear-lens extraction, as well as other laser procedures
• Scalpel procedures, with exceptions
• All methods of administering pharmaceutical agents including injection procedures, except schedules I and II
• Anesthesia, except general anesthesia
• Emergency inoculations, as requested by the commissioner of health

Healthcare Reform: Civic Education Needed

The following excerpt from the book "Healthcare Solved-Real Answers, No Politics" by Debra A. Smith, DO

Office visit vs. urgent[1] vs. emergent[2] care

Health classes have failed to teach our citizens what is and is not an emergency. Too many people with urgent or emergent problems wait until their doctor’s office opens or worse yet until the office secretary gives them an appointment. Far too many people, without urgent, let alone real emergencies, go to the emergency room for care. More than once while working in the ER, a person has come in requesting a Band-Aid for a small cut on his finger, insisting that he had a right to treatment. In England, he would have been thrown out; here he will be seen. No country can afford this kind of access.

I will not attempt to go through a list of real emergencies here, but a good rule of thumb is anything that interferes with basic bodily functions, such as airway, breathing, circulation (heart beat/chest pain), for starters, or anything that causes an excessive loss of any bodily fluids from an orifice (natural or man-made), particularly the wrong bodily fluids (other than what would normally be expected), is an emergency.

While covering the emergency room at Deaconess Hospital in Cincinnati, a patient came in via squad with his family in what is referred to as agonal breathing, also known as the death rales or rattles.[3] As the name suggests, it is typical of the type of breathing that occurs close to death; the patient is not conscious of their environment at that point. I asked the patient’s wife how long he had been like this. She answered a few hours. When a person is not breathing well and is not arousable, this should immediately indicate a problem. Our people do not need to be great diagnosticians to learn the basics of what is or is not an emergency. Our schools should be teaching this. Schools should also teach students how to find a family physician, how to make an appointment, and when to use an urgent care center[4] vs. an emergency room. Too many emergency rooms have beds tied up with non-emergency care, such as sinus infections, urinary tract infections, sexually transmitted diseases. In my experience, easily two-thirds of the care is non-emergent.

Access to care and the “lack” of it

Catch Me If You Can: A Pilot has played as a cardiologist

Milwaukee, WI - A former educator and researcher at William Beaumont Hospital in Michigan has been exposed as a bogus cardiologist [1]. While there is no suggestion that William Hamman—who is a trained pilot—took care of any patients, the news that he does not hold the medical and postdoctoral degrees or have the clinical experience he claimed to have has embarrassed many cardiologists and institutions.

Hamman, who is 58, led seminars teaching cardiologists what they could learn from simulation training and from his experience as a pilot. The irony is that he could have done this job without ever claiming to have a medical degree, Dr Douglas Weaver, former American College of Cardiology (ACC) president, told Marilynn Marchione of the Associated Press (AP) yesterday: "He could have been successful without titling himself. He really didn't need to be a physician to do what he was doing. He made a very serious mistake."

Via TheHeart.org: Pilot posing as cardiologist ran training seminars

That is very impressive that he was able to fool every credentialing process, very burdensome to physicians, and claimed to be a cardiologist for some 20 years. Credentialing process for a physician to practice in a new state usually takes between 6-12 months.

How Meditation May Change the brain

But now, scientists say that meditators like my husband may be benefiting from changes in their brains. The researchers report that those who meditated for about 30 minutes a day for eight weeks had measurable changes in gray-matter density in parts of the brain associated with memory, sense of self, empathy and stress. The findings will appear in the Jan. 30 issue of Psychiatry Research: Neuroimaging.

M.R.I. brain scans taken before and after the participants’ meditation regimen found increased gray matter in the hippocampus, an area important for learning and memory. The images also showed a reduction of gray matter in the amygdala, a region connected to anxiety and stress. A control group that did not practice meditation showed no such changes.

Via New York Times: How Meditation May Change the brain

Healthcare Reform: How to Be Better Patients?

The following excerpt from the Book "Healthcare Solved" by Debra A. Smith, DO

Becoming better patients

Many well meaning people have not seen a doctor in years, primarily because they do not want to be a hypochondriac like …. Fill in the blank with the name of whatever family member who nearly drove the rest of the family to madness complaining of their real or mostly imagined symptoms and illnesses.

Patients have the greatest responsibility for their own health. No one else has more to lose. This is not being a hypochondriac. Good health is so often taken for granted, until it is not there.

As an occupational medicine physician, I have done many pre-employment physicals. These exams are generally on healthy people who have been offered a job contingent on passing the physical. Most of the time, they are fairly healthy. But on occasion, I will find new-onset diabetes, hypertension, skin cancer, poor lung function (usually due to a history of smoking for more than 10 years) or any number of other problems. I tend to find most of the patients with positive findings do not have a personal physician or have not seen a doctor in years. When asked why, they generally say “I am healthy,” or “I don’t want to be a hypochondriac like…” More goofy family members have stopped patients from getting preventive check-ups and early diagnosis than any lack of health insurance.

Patients have an obligation to themselves to have a periodic preventive health examination as recommended by the US Guide to Preventive Services Task Force (USPSTF).[1]

Major Philanthropists to the Healthcare Field

Private donations key to major projects

A number of wealthy Americans have contributed to hospitals and medical research facilities in recent years.  These major gifts reduce the need for state and local taxpayer dollars to finance major capital projects, including the construction of new medical schools.  A summary of significant charitable giving (from 2009) is below.  The summaries and amounts are featured in Slate.com’s “Notable Charitable Giving in 2009.”[1]

Major donors to medical schools and medical research facilities in 2009:

9^th Largest: William P. Clements Jr.—$100 million to the University of Texas Southwestern Medical Foundation. “Clements, 92, founded Sedco, an oil and gas drilling corporation, and served two terms as governor of Texas. He pledged $100 million to the University of Texas Southwestern Medical Foundation to support the university's medical center. Clements, who placed no restrictions on how the money should be used, plans to pay the entire commitment over the next four years.”

15^th Largest: Patrick Soon-Shiong and Michel B. Chan—$65 million to Saint John's Health Center Foundation. “Dr. Soon-Shiong is a surgeon who founded Abraxis BioScience, a pharmaceutical-development company in Los Angeles. Chan is an actress. Dr. Soon-Shiong and his wife have pledged $65 million to Saint John's Health Center Foundation in Santa Monica, Calif. Of the total, the health center plans to use $55 million for research at its John Wayne Cancer Institute and to support joint research projects with other institutions. The remaining $10 million will be used to recruit physicians and scientists.  The couple previously pledged $35 million to the center in 2007. Soon-Shiong and Chan have paid a total of $45 million toward both pledges and plan to pay the remainder over the next five years, said officials at Saint John's.”

17^th Largest: Delores Jordan, who made a total of $52 million in charitable contributions in 2009, “gave $9.8 million apiece to Children's Hospital & Research Center Oakland, in California, and St. Rose Hospital, in Hayward, Calif.”

Le Figaro: Coffee may have protective effect on Alzheimer and Parkinson' s Diseases

The effects of caffeine on the brain, heart and some diseases are becoming better known. 

The debate on the virtues of caffeine and coffee is regularly revived at a rate of (many) scientific publications. The latest, published in the Journal of Pediatrics , is concerned about his heavy drinking among children and its disruptive effects on sleep.

This study points out that American children consume a significant amount of caffeine through the colas and other sodas. Of 228 children aged 5 to 12 years, 75% use it daily average of 52 mg per day in 5-7 years, the equivalent of a cup of tea. The average consumption is 109 mg per day for 8-12 years, the equivalent of a cup of coffee. Being American children, we can assume that their consumption is higher than that of young French. But in the absence of national standards, it is better to refer to the maximum dosage specified by the Canadian Ministry of Health: no more than 45 mg / day for 7 years, no more than 85 mg / day for 12 years.

Not everyone is equal before the caffeine

Chemically, caffeine is a methylxanthine such as theophylline and theobromine tea chocolate ... This explains its molecular structure effects bronchodilators (relaxing the bronchial tubes), potentially interesting in asthmatics. And above all its virtues and psycho-awakening, praised by many consumers. At least by those who are sensitive because we are not equal before the caffeine. For some, it would have stimulant effects, among other anxiogenic action. Some enzymes are involved in the body that vary genetically and influence its metabolism. "Caffeine, which has anxiogenic effects, is transformed by an enzyme in liver paraxanthine, a metabolite that is him, anxiolytic, explains Professor ^Dr. Jean Costantin, a pharmacologist at the University Hospital of Rouen (1). This enzyme anxiolytic effects is very active in people who feel particularly psychostimulant effects of caffeine. It is much less in others, which will be very sensitive especially to the anxiogenic effects of coffee. "Unsurprisingly, coffee lovers rather belong to the first group ...

It is also well known that caffeine accelerates the heart rate slightly, which makes it inadvisable for people prone to tachycardia. It is also mildly hypertensive. "But the epidemiological data are somewhat contradictory, says epidemiologist Tobias Kurth (INSERM U708, Paris). We need more precise studies to understand the cardiovascular effects of caffeine. "

Prenatal Surgery: Performing Surgery of The Fetus!

In the study, the prenatal procedure was typically done at 24 weeks gestation. Surgeons make an incision in the abdomen and take out the uterus to get access to the fetus's lower spine. They apply a patch and put the fetus and uterus back in the mother. The baby is delivered, ideally at close to full term, by Caesarean section.

At 12 months old, 40% of babies who had the surgery in the womb needed a shunt to drain fluid from the brain, compared with 83% in the post-natal group. That was the most significant benefit, researchers said. Revising or changing shunts can subject spina bifida patients to a childhood of surgeries. "If you can avoid a shunt, that in itself is a wonderful thing," said Scott Adzick, surgeon-in-chief at Children's Hospital of Philadelphia and lead author of the study.

At 30 months, 42% of babies in the prenatal group and 21% in the post-natal group were able to walk without crutches or other devices, researchers said.

Via Wall Street Journal: Study Backs Prenatal Fix

I am still amazed everyday how medicine makes head way to cure or treat diseases. Truly amazing that to take the fetus out to perform the procedures and put the fetus back in the womb. Those cutting-edges physicians, surgeons, researchers, and other healthcare professionals are truly the heroes!

The Good and The Bad of Healthcare Law

by Donald J. Crane, MD and Beverlee L. Gilmore

Crane Gilmore & Associates, Inc

» THE GOOD

• Standardized healthcare plan
• Everyone covered 
• No denial for pre-existing conditions 
• No lifetime limits on healthcare expenditures 
• No rescission
• More emphasis on primary care
• Comparative effectiveness research 
• Transparency in provider financial relationships
• Increased premium for smoking 
• Co-pay waiver for prevention
• Limit on deductibility for insurance company executive salaries.

» THE BAD

• Unintelligible
• Defensive medicine unaddressed
• Cost
• Problems with SGR formula
• Problems with research agenda
• End-of-life guidelines dropped
• Employer involvement
• Agenda to encourage a single payer system
• Excise tax on drugs, medical equipment and insurance companies.

THE BAD
And now, for those parts of the legislation that we don’t like, or that need to be massaged:

1. It’s unintelligible. The two bills signed by President Obama and not read by members of Congress before passage are well over 1,000 pages and riddled with references to other laws and regulations, making them too complex for mere mortals. Even those with years of experience in the health insurance business cannot understand many of the provisions in the legislation—nor the logic for many of them. Several of the regulations and procedures ensuing from the legislation are still in the formative stages. Plus, the cost to other governmental agencies outside of Health & Human Services that are providing support is still being realized. For example, the Internal Revenue Service is requesting billions more per year in order to scrutinize income tax forms to determine who should be fined for not carrying health insurance. How many other governmental agencies, both state and federal, will require an infusion of resources—money, staffing, hardware, software, office space, etc.—not accounted for in the original legislation?
   

Letter to WSJ Editor: Nurse Practioner Claims Same Equivalent Competencies As Primary Care Physicians

With the nation facing a severe shortage of M.D.s, particularly in the specialties our population increasingly requires, it would be folly to cut off the quality professionals who are fulfilling primary-care needs, and who allow M.D.s to pursue the careers they are best educated for.

PAs provide, extend and support medical care in every specialty. They are essential to the medical needs of this country.

The NP work force has evolved rapidly in the past six years toward doctoral education for nurses practicing in independent primary care. Although Dr. Brown may have "sadly watched these nonphysicians take over," he should look carefully at the facts. A randomized clinical trial reported in the Journal of the American Medical Association in 2000 showed the equivalence of specially educated NPs compared with MDs in primary care. That specialized training is now incorporated in doctor of nursing practice degrees, and the graduates have, since 2008, been passing a certification exam which the National Board of Medical Examiners says measures the same competencies as physician exam takers following medical school.

These nursing graduates also bring unique competence in public health, prevention and health promotion to their patients. Years of training is a poor predictor of competence. Physicians in primary care have, on average, seven years of education and residency postcollege; doctorally prepared nurses in primary care have five years.

The underpinnings necessary for specialty medical practice are part of every physician's training, even if they never pursue those paths. For nurses, education and residency for primary care are targeted from year one, and the outcome evidence shows they are doing it right.

Prof. Mary O'Neill Mudinger

Via Wall Stree Journal: The Future Is Now for Physician Assistants and Nurses

Eye Health Stats

Sometimes I am surprised by some eye trivia. For example, the American Academy of Ophthalmology publishes some interesting and trivial facts about blindness and eye health. It is sobering to realize that eye care has progressed in the last 100 years and that we just now learning how to treat many of the eye maladies. But comparing the US to the rest of the world really shows how lucky we are to live in the United States.

A Cost Analysis of the Proposed MD Program at UNTHSC

Spending More Texas $$$ and Getting Less


The University of North Texas (UNT) is attempting to place a second medical school (UNTMD) on the same campus as their already established nationally recognized medical school, the Texas College of Osteopathic Medicine (TCOM). The existing medical school has produced more than 3,000 physicians, most of whom practice primary care in Texas. If the Texas Legislature allows this UNT power grab, it will waste state money and harm TCOM’s cost effective production of highest quality physicians.

FACT: The cost to educate an M.D. medical student is much higher than the cost to educate a D.O. medical student.

Open letter to TCOM alumni from TCOM alumni association president

the following letter by John Wright, DO

Let us be sure that those who come after will say of us in our time, that in our time we did everything that could be done. We finished the race; we kept them free; we kept the faith.   (Ronald Reagan)

Dear TCOM alumni:

As members of the Texas College of Osteopathic Medicine (TCOM) Alumni Board, we feel it is very important that you receive further information about the proposed plan of the University of North Texas (UNT) Board of Regents to create an MD school through UNT, to be placed on the campus of the University of North Texas Health Science Center (UNTHSC) in Ft. Worth. If approved, this new MD school would share (state provided) resources with TCOM. 

Your Alumni Board has voted against organizing this plan.  We have also had a vote of "no confidence" for Scott Ransom, D.O., the president of the UNTHSC for leading the push towards achieving this goal.
The American Osteopathic Association (AOA) has stopped funding administrative revenues for the Osteopathic Research Center (ORC), and the AOA House of Delegates and the American College of Osteopathic Family Physicians (ACOFP) Congress of Delegates have passed resolutions against the proposal. Texas Osteopathic Medical Association (TOMA) House of Delegates have also passed  a resolution against this proposal.

Vodka Eyeballing

What is vodka eyeballing? It is a new fad of alcohol drinking has been taking place among young people. It supposedly started in Britain and is now gaining popularity in the US. The “eyeballers” pour vodka directly onto their eyes in the hope of obtaining quick high from the alcohol. They claim that “vodka eyeballing” induces drunkenness faster than drinking the vodka. The urban myth is that the alcohol passes easily through the mucous membrane and enters the bloodstream directly through veins at the back of the eye. This could not be more wrong. The volume of vodka absorbed by the conjunctiva and cornea is too small to have that effect.