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March 2009; Volume 3, Issue 5

Official e-Newsletter of the Medical Society

Keeping you InforMed about the latest health care news!

In This Issue
Two huge victories in Arizona medicine!
Obama budget sets stage for refrom of health care system
Docs seek gag orders to stop patients' reviews
Scope of practice expansions fuels legal battles
Scientists identify a potential target that may provide a new approach to melanoma
Non-Infectious Prion Protein link to Alzheimer's Disease
Pri-Med Access Phoenix
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Have you ever considered becoming a mentor and role model to a first-year medical student?  Here's your chance!
 
The University of Arizona College of Medicine-Phoenix, in partnership with Arizona State University, places a high priority on early and continuous clinical training.  All first- and second-year medical students spend one half-day, every other week, in a primary care setting working with a physician mentor.  This part of the curriculum is called the Longitudinal Clinical Experience (LCE).
 
Physician mentors are primary care internists, pediatricians and family physicians.  Mentors work with the same student for two years.  This provides the opportunity to develop a close and long lasting relationship.  Being a mentor allows you to be involved in medical education and shaping the career of a young physician, with a time commitment that is very manageable.  The student works with the mentor in their clinical setting, gradually assuming an increasing level of patient care responsibilities.
 
There are a number of benefits to being a physician mentor, in addition to the satisfaction of forming a long lasting relationship with a young physician in training.  As a mentor, you will receive a UA College of Medicine faculty title that allows full electronic access into the medical library and a discount at the UA bookstore.
 
Anyone interested in being a mentor or in learning more about this possibility should contact Greg Lewis, M.D. by emailing or calling the LCE Coordinator, Candace Johnston, at johnstonc@email.arizona.edu or 602-827-2006.
 
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TWO HUGE VICTORIES IN ARIZONA MEDICINE!
In an unprecedented procedural move the Arizona House and Senate passed legislation on Thursday that restores the Graduate Medical Education (GME) and Hospital DSH and Rural Hospital Reimbursement funding.  At a time when continued cuts are inevitable, having the legislature restore funding is both remarkable and a huge victory for healthcare in Arizona. ArMA, along with the Arizona Osteopathic Medical Association, the Arizona Hospital and Healthcare Association, the Arizona College of Emergency Physicians, the Maricopa Integrated Healthcare System, Mayo Clinic, Banner Health, St. Joseph's Hospital, Scottsdale Healthcare and other health care groups as well as the Arizona State Chamber of Commerce and Industry, worked diligently to urge legislators to vote to restore this critical funding.  The measure passed both houses with the two-thirds bipartisan vote necessary to enact it with an emergency clause allowing it to become law upon the signature of the Governor yesterday. This is the first positive news for healthcare funding this session and it bodes well for the 2010 budget as it is being developed.  Congratulations to all who worked to restore the funding to these vital programs and thanks to all the legislators who stood up for physician training and our health care safety net.
 
Over the last 6 months, ArMA spearheaded an AMICUS effort along with the Maricopa County Medical Society to challenge an Arizona Appellate Court decision that knocked down a critical component of our tort reform success, "qualifications of expert witnesses". On Friday, the Arizona Supreme Court found in our favor and held that ARS 12-2604 is substantive and does not violate the separation of powers doctrine, effectively reinstating the expert witness qualifications statute.
 
Stay tuned for further information as it develops.
Obama budget sets stage for reform of health care system, Medicare pay
President Obama on Feb. 26 offered a $3.56 trillion fiscal 2010 budget outline calling for sweeping changes to health spending and tax policy, including a recognition that Medicare's physician pay cuts mandated by law are not practical.

The budget proposal, if adopted by Congress, also would set aside a $634 billion reserve fund over a decade to start paying for expanded access to health care. Obama would pay for the fund in part by fulfilling campaign pledges of increasing taxes on higher-income earners and requiring competitive bidding among private Medicare plans. While past presidents generally offered five-year spending proposals, Obama's looks ahead for a decade, through 2019.

Physician organizations, including the American Medical Association, cheered the change in tactics from President Bush's budget proposals, which did not include the cost of preventing annual Medicare physician pay cuts. Obama's budget is a "huge step forward," said AMA President Nancy H. Nielsen, MD, PhD.


More information....
Docs seek gag orders to stop patients' reviews
The anonymous comment on the Web site RateMDs.com was unsparing: "Very unhelpful, arrogant," it said of a doctor. "Did not listen and cut me off, seemed much too happy to have power (and abuse it!) over suffering people." Such reviews are becoming more common as consumer ratings services like Zagat's and Angie's List expand beyond restaurants and plumbers to medical care, and some doctors are fighting back.

They're asking patients to agree to what amounts to a gag order that bars them from posting negative comments online.  "Consumers and patients are hungry for good information" about doctors, but Internet reviews provide just the opposite, contends Dr. Jeffrey Segal, a North Carolina neurosurgeon who has made a business of helping doctors monitor and prevent online criticism.

Read complete article...
Scope of practice expansions fuel legal battles
Physicians are going to court to fight what they call an onslaught of scope of practice expansions by a growing number of allied health professionals.

Increasingly, the medical profession is mounting legal challenges against state boards and others on issues such as nurse anesthetists performing interventional pain management and podiatrists being allowed to treat ankles as well as feet.

"There is this overall push by allied health professionals to try to increase their scope of practice, and what's landing people in the courts is when they actually meander outside of their scope into areas considered the practice of medicine," said Timothy Miller, the Federation of State Medical Boards' senior director of government relations and policy.

Read more....
Scientists identify a potential target that may provide a new approach to melanoma treatment
In a new study released today, researchers have shown that a specific protein plays an important role in inhibiting the development and spread of melanoma tumors in mouse and in human skin models. Increased expression of the protein, SOX9, may also decrease the resistance of melanoma cells to retinoic acid, which is used to treat several other types of cancer. The ability to increase sensitivity to retinoic acid by stimulating SOX9 expression could lead to new approaches for treating melanoma and other cancers. The study, led by researchers at the National Cancer Institute (NCI), part of the National Institutes of Health, appears online March 9, 2009, in The Journal of Clinical Investigation.

Melanoma, which begins in cells called melanocytes, is the most deadly form of skin cancer. Current approaches to treating melanoma include the use of conventional therapies, such as radiation therapy and chemotherapy, or stimulating the immune system to inhibit cancer growth. 


Read More....
Non-infectious prion protein linked to Alzheimer's Disease
The prion protein, notorious for causing fatal neurodegenerative disorders such as Creutzfeldt-Jakob disease and mad cow disease, may also be an accomplice in Alzheimer's disease, according to a new study. In this case, it's not the infectious misfolded prion protein causing the problem but the cellular form, whose function is relatively unknown.

Alzheimer's disease is marked by clumps of protein fibers called amyloids that accumulate into "plaques" around nerve cells in the brain, leading to the progressive loss of function. The main protein fragment found in these plaques, amyloid-ß peptide, is created by the improper cleavage of a protein called amyloid precursor protein (APP). Over time, amyloid-ß peptides transform into small clusters known as oligomers, which then develop into the long, sticky fibers that form plaques around brain cells. Scientists are uncertain if amyloid-ß oligomers act directly or through cell surface receptors to affect thinking and decision-making, but most agree that they're toxic to brain.

Read complete article...
Pri-Med Access Phoenix
April 1-2, 2009
Phoenix Convention Center (West Building)

Pri-Med Access is the newest innovation in primary care CME, offering a national curriculum on the toughest clinical challenges facing primary care medicine today.

Topics will include:
  1. Cardiovascular Disease
  2. Managing Risk: Navigating Complexities in Blood Pressure and Lipids Management to Attenuate Cardiovascular Risk
  3. Diabetes & Obesity
  4. Our Obesogenic Culture: Addressing the Epidemics of Diabetes and Obesity
  5. Immunizations
  6. Vaccine-Preventable Diseases:  Achieving Success Is Every Clinician's Responsibility
  7. Dependency Disorders
  8. Focused Consults: Addressing Dependency Disorders in a 15-minute Visit
For more information and to register, visit Pri-Med Phoenix.