Wayne County Medical Society of Southeast Michigan

March 9, 2009

In My Opinion: Physicians Are Afraid To State The Truth
Economist Weighs In On Stem Cell Research
Karmanos Announces Interim Leadership Team
Fourth-Year WSU Med Student Wins Trip To Annual Meeting
Health Authority, Primary Care Association Look To Expand Care
Dr. Lusher Earns Lifetime Achievement Award
AMA Lauds Obama's Commitment To Health Care Reform
FDA Advises Doctors On Tainted Peanut Issue

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In My Opinion: Physicians Are Afraid To State The Truth

By ALLAN DOBZYNIAK, MD
Primary care specialties have suffered more than others. Regulation and compensation have moved rapidly in opposite directions. Tragically, the ability to simply make a living providing primary care is more than challenging in many locations. With this reality, the following comments may seem harsh. But explaining the agendas motivating the development of the Patient Centered Medical Home (PCMH) deserves clarity. There is no shame in self advocacy, but honesty necessitates transparency.

Requests for information. Requests for action. Payments assured. Payments revoked. Reward conferred. Reward withheld. Sanctions and incentives systematically applied. This is where physicians are headed. This is the bureaucratic nightmare designed for physicians by the financiers of subservience.

The PCMH is a smokescreen. It is a parade of rationalizations aimed at securing budgetary allocations from those who cannot distinguish between lives and budget lines; by those who actually believe the practice of medicine can be supplanted, not supplemented, by electronic methodology. If there were a Mohs scale for ineptitude and attitudes of futility in proclaiming value, physicians would be at the pinnacle. Value in this context has a deeper meaning. It is not only defined by cost, quality and service but by lives saved and suffering averted.

Most other societal groups would have a visceral revulsion to the punishment already inflicted and planned in the future for the medical profession. They would engage more effectively than through game theory. The game represented by The PCMH is unfortunate. The model inflicts additional regulation as the non-physicians continue their attempt to practice medicine. In a budget neutral environment, attempts to divert compensation from other specialties to primary care is a fools game. As long as the primary payer is government, with the other insurers (if they survive) following suit, there will never be negotiation without onerous, heavy handed, regulatory mandates aimed at financial chicanery.

Primary care is in the power position and can take the initiative to create change benefiting all specialties. There is no distinction between protecting the physician-patient relationship and the vitality of the medical profession. The two are inseparable. To position primary care or any other specialty for perceived victory in the self-destructive internecine battles between specialties will result in lost opportunity as the real war for value-driven care is lost.

This may be too revolutionary to present, and therein lies the problem. Physicians are afraid to state the truth.

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Economist Weighs In On Stem Cell Research

By PAUL NATINSKY
Wayne State University Economist Allen Goodman’s timing couldn’t have been better. As President Barack Obama prepared last week to sign an executive order to roll back restrictions on stem cell research, Goodman, PhD, summarized the economic impact study he did for supporters of Michigan’s successful ballot proposal on the issue last fall.

Goodman’s analysis focused on the changes that would result from a 1 percent decrease in the cost of medical care as a benefit of stem cell research. The percentage reduction is arbitrary – there is no proof yet that embryonic stem cell research will result in cures or less expensive treatments for diseases and conditions such as diabetes, Parkinson’s disease, spinal cord injury, heart attack or stroke. Goodman said he chose the diseases on which stem cell research is expected to have the likeliest impact, according to established medical researchers.

The annual cost of treating patients suffering from those diseases and conditions is about $8 billion, according to Goodman’s analysis. A 1 percent savings would reduce Michigan’s health care cost burden by about $80 million.

Goodman likened his “impact analysis” to the effect of a “dry” county that sells no alcoholic beverages converting into one that does. Changes to the economy, including increased liquor sales, new restaurants bars and liquor stores would exist side-by-side with the possibility of increased traffic accidents and family problems. Impacts could be both positive and negative.

The more tangible side of Goodman’s presentation centered on job creation, specifically in biotechnology. He estimated the creation of 443 direct jobs and another 354 “induced,” or support jobs not directly related to biotech positions. Goodman estimates the total payroll for these 797 jobs to be about $51 million per year.

For perspective, Michigan’s state government will spend about $44 billion this fiscal year; so the impact is not like opening a few new manufacturing facilities or relocating a major company’s world headquarters to Michigan. Goodman did factor productivity gains from less worker absenteeism and fewer premature deaths, and wound up with total gains of almost $28 million a year from those two categories. He avoided considering potential money from royalties and patents, arguing that such numbers were too murky (some other states have included them). Ultimately, the total economic impact he predicted was less than $200 million per year.

Goodman did not place a dollar value on the quality-of-life improvement to those whose lives potentially are improved by the research, nor a value on the “well-being of loved ones.”

While the advertising campaign in support of Proposal 2, presented a strong emphasis on economic benefits to Michigan in its advertisements, Goodman said the potential economic boost for Michigan was always a secondary concern to finding ways to improve quality of life for patients.

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Karmanos Announces Interim Leadership Team

The Barbara Ann Karmanos Cancer Institute and Karmanos Cancer Center boards of directors announced that effective March 5, Ann G. Schwartz, PhD., has been appointed interim president and chief executive officer, and Paul Broughton has been appointed interim chief operating officer.

“Dr. Schwartz is an excellent choice to lead us during this period of transition,” said Alan S. Schwartz, chairman of the Karmanos Cancer Institute Board of Directors. “As interim president and chief executive officer, Ann will focus on leading the institute’s scientific direction, while continuing our outstanding world-class research in basic, clinical and population sciences.”

Having rejoined the Karmanos faculty 10 years ago, Dr. Schwartz, who is unrelated to Alan Schwartz, has extensive experience and knowledge of the institute.

Previous to this appointment, Dr. Schwartz served as the associate center director for Population Sciences at Karmanos since 2002. Her research focuses on the genetics underlying lung cancer risk. She has a master’s degree in biology from Wayne State University, a master’s in Pulbic Health in Environmental Health from the University of Michigan and a doctorate degree in epidemiology from the University of Michigan School of Public Health.

As interim chief operating officer, Broughton’s main responsibilities include the smooth and efficient operation of the Karmanos Cancer Center to ensure the delivery of high quality care at the hospital and all of the Karmanos clinical operations while continuing their profitability.

Broughton served on both Karmanos boards through December 2007 and was a member of the institute’s Finance and Compensation committees. Prior to his retirement, he was president and chief executive officer of Harper Hospital and Children’s Hospital of Michigan.

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Fourth-Year WSU Med Student Wins Trip To Annual Meeting

Alexandria Conley, a fourth-year student at the Wayne State University School of Medicine, has received the sanofi-aventis Minority Scholars Award from the American Academy of Neurology Foundation.

Conley, 27, will receive a travel stipend to attend the AAN annual meeting in Seattle, Wash., April 25 through May 2, paid registration for the meeting and will be able to register for educational programs at the junior member rate. She will receive a certificate of recognition and be acknowledged during the AAN and AANF awards luncheon.

“Attending the AAN meeting is an honor for me,” said Conley, of Detroit. “I am grateful that the sponsors have created an opportunity to increase diversity in the neurosciences, and I feel very privileged to have won this award.

“The theme of this year's AAN meeting is ‘Better practices, better outcomes,’ an important concept that I believe applies to physicians across all disciplines,” she added. “However, I am particularly excited to learn more about the research and clinical work that is being done to help improve prognosis and quality of life for patients suffering from neurological disease.”

William M. Coplin, MD, an associate professor of Neurology & Neurological Surgery for the School of Medicine, and chief of Neurology and medical director of Neurotrauma & Critical Care for Detroit Receiving Hospital, nominated Conley for the award. Conley worked with Dr. Coplin during her fourth-year neurocritical care/neuro-trauma elective.

Conley serves as a class representative on the Student Senate, is a member of the Aesculapians service honor society, the Gold Humanism Honor Society and the Black Medical Association/Student National Medical Association. She also is a member of the American Medical Association, the American College of Physicians and the World Health Student Organization.

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Health Authority, Primary Care Association Look To Expand Care

A study, undertaken through the Primary Care Network Council by the Michigan Primary Care Association and Detroit Wayne County Health Authority, has identified 12 areas of high need for new or expanded health care services in Detroit . The study recommends six priority areas for considering establishment of new primary care facilities, and it recommends the expansion of existing health care facilities and services in an additional six priority areas. The Council's Safety Net Expansion Committee also identified eight additional areas in the Greater Detroit Wayne County area that it recommended for consideration as possible locations for new health care facilities.

The Council's Safety Net Expansion Work Group, chaired by Wayne Bradley, CEO of Detroit Community Health Connection, established four principles that will guide implementation of the expansion/establishment of facilities:

Establish the Primary Care Network Council as a forum for encouragement and support of expanded Federally Qualified Health Center (FQHCs) services, specifically encouraging the cooperation of existing FQHCs.

Identify and prioritize geographic areas on the basis of need for new or expanded health care services.

Adopt a multi-faceted strategy for primary health care safety net expansion

Encourage any organization seeking to expand access to quality health care as long as the propose expansion will not result in a diminution of services to the underserved.

For more information, contact Joslyn Pettway at 313-871-3751 or jpettway@dwcha.org.

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Dr. Lusher Earns Lifetime Achievement Award

Jeanne M. Lusher, MD, Distinguished Professor of Pediatrics and the Marion I. Barnhart Chair of Hemostasis Research for the Wayne State University School of Medicine, will receive the Lifetime Achievement Award from the Hemophilia & Thrombosis Research Society.

Dr. Lusher, who also serves as co-director of the Division of Hematology/Oncology and medical director of the Special Coagulation Laboratory of Children’s Hospital of Michigan, will accept the award at the society’s annual meeting April 17 in Chicago.

“I feel very honored to be receiving the society’s major award, which has been awarded only three times before,” Dr. Lusher said.

Her major field of work is in hemostasis -- clinical, laboratory methodology and clinical research -- with particular interest in Factor (F) FVIII and FIX inhibitors in hemophilia. She has written numerous scientific articles concerning inhibitors, their antibody nature, detection, kinetics, etiology, natural history and management. She has also written articles covering variations in FVIII assay results depending on reagents and standards used, and on the unique properties of FIX inhibitors in people with Hemophilia B (FIX deficiency).

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AMA Lauds Obama's Commitment To Health Care Reform

The AMA issued the following statement attributable to President Nancy Nielsen, MD, in reaction to President Obama’s recent speech:

“America’s patients and physicians want meaningful progress on health system reform this year, and the American Medical Association applauds President Obama’s commitment to achieving that goal.

“In these tough economic times, the need for health system reform that provides coverage and high quality, affordable health care for all Americans has never been more clear. We must strengthen the public-private mix of health insurance, and achieve greater value from the nation’s health care spending. President Obama’s call for greater investments in research, preventive care and electronic health records will help physicians keep patients healthy.

“We pledge to work with President Obama and Congress to improve the health care system for all Americans.”

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FDA Advises Doctors On Tainted Peanut Issue

The Food and Drug Administration (FDA) is asking physicians to remind patients who have bought peanut-containing products that are on the federal recall list to discard those products in a manner that prevents others from eating them. So far the federal government has announced recalls covering hundreds of peanut-containing products related to an outbreak of salmonella in states across the country.

Physicians can point their patients to http://www.accessdata.fda.gov/scripts/peanutbutterrecall/index.cfm for details from the FDA about the recalls, including a list of recalled products.

Some pet foods and pet treats may contain contaminated peanut butter, including dog biscuits and bird food. The Centers for Disease Control & Prevention (CDC) has developed a fact sheet to inform people how this outbreak might affect their pets.

Visit http://www.cdc.gov/salmonella/typhimurium/salmonella_pets.html to view the CDC Web site.

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