June/2016
Issue: 53

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The JUNE of Our Discontent!
John Steinbeck's last full length novel, "The Winter of Our Discontent," is a scathing denunciation of the moral depravity of America. The main character, Ethan Allen Hawley, passes an anonymous tip to the Immigration and Naturalization Service which leads to the deportation of his undocumented, law-abiding employer. Sound familiar?
 
Hawley says, "I wonder how many people I've looked at all my life and never seen." 
 
This quotation captures where we Americans scandalously find ourselves today. A nation of immigrants, we are trying hard to ignore, exclude, deport, and ostracize those who are unlike us. And now the British, with whom we indeed have a special relationship, are doing the same! The consequences are dire as we saw in Orlando, the horrendous murder of Jo Cox, a British MP, and the assassination of Amjad Sabri, a Pakistani Sufi singer shot dead in Karachi by the Taliban.
 
At least some are taking a stand.  On Friday, June 24, George Will, the celebrated columnist, baseball historian, and apologist for the Republican Party said: "This is not my party." and registered as unaffiliated. A life-long Republican, I am compelled by conscience to do the same. 

John A. Schmidt, MD 
Internist
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Philadelphia Freedom (from sweetened soft drinks!)
Now for some good news. As reported by Philadelphia Magazine on June 16, Philadelphia is the first major city to successfully pass a "Soda Tax" on sugary drinks and diet sodas (1.5 cents per fluid ounce).  Many notables, including the illustrious former Mayor Blumberg of New York City, tried ardently and failed despite the clear evidence that sugary beverages are at the heart of the obesity and diabetes epidemic victimizing our children. Philadelphia City Council voted 13-4 in favor of the measure, vindicating the new mayor, Jim Kenney, and his beleaguered predecessor, Michael Nutter, both of whom worked tirelessly to enact the measure. (Private Note: Messrs. Kenney and Nutter are both graduates of St. Joseph's Preparatory School, my alma mater, located in the impoverished heart of North Philadelphia-Go Prep!)
 
How did Mayor Kenney overcome the local bottlers who boasted a 45-1 record going into the debate?  He pledged that the funds would be used to benefit the same victimized children by funding universal pre-K, rec-centers, parks, and libraries. Bravo! 
Philadelphia Magazine asks, "Will Philly's Soda Tax Make Coca-Cola the Next Phillip Morris?"  
Philadelphia Magazine points out that the movement to ban smoking in public places began in Arizona way back in 1973.  Four years later, Berkeley, CA, became the first city in the nation to limit smoking in restaurants and other public places.  Soon thereafter, the state of California, San Francisco, and New York City enacted their own smoking bans. Fast forward to today, the magazine writes, "thirty-states and 812 municipalities have smoke-free laws on the books!"  Philadelphia, already the birthplace of freedom, has taken decisive action to free its citizens from the scourge of diabetes!
 
You might ask why I am devoting so much space to such a "non-medical" issue.  Answer: If there is anything we have learned as physicians, it is that public health measures are the real game changers: clean water, public sewage, clean air, and smoking cessation have had the broadest impact!  Hopefully, the movement arising in Philadelphia will be the next public health measure to significantly raise our standard of health!
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Advances in Hearing Aid Technology
I was recently sitting in a noisy restaurant and wished I could read lips. The noise from the kitchen completely obscured the voice that was no more than 18 inches from my face. Oddly, I noticed that a person with a behind-the-ear hearing aid was having no trouble at all!  How could this be?  Amplification would only make things worse and probably unbearable! 

The answer lies in an article by Ann Liming writing for the Michigan State Chapter of the Hearing Loss Association of America. She points out that most modern hearing aids (except the small ones that fit into the ear canal) have a device known as the (mighty) telecoil. She writes, "When using a hearing aid on the telecoil (t-coil) setting, background noise can be mostly eliminated and incoming sounds ... are heard louder and more clearly." The telecoil functions as an antenna and can also receive input from "loops" that circle a room and can be installed almost anywhere including churches, theaters, buses, subways, or around your neck. When you see a sign with an ear and a "T" (see graphic in the margin), the space has been equipped with a loop that will send sound to the telecoil in your hearing aid. See also an excellent article from Patricia B. Kricos, Ph.D., from the University of Florida entitled, "Tips for Hearing in Noise."
 
The Federal Communications Commission (FCC) has adopted hearing-aid compatibility (HAC) requirements for digital wireless phones. The T-rating describes how well a given digital phone model couples with hearing aids operating in telecoil mode. Only T3 or T4 are considered acceptable. The M rating describes compatibility with hearing aids set to the acoustic (simple amplification) mode. The settings feature on the iPhone allows one to choose "Hearing Aid Mode."
 
An even more recent development are the "Made for iPhone" hearing aids.  These Hearing Aids can be programmed from your iPhone and thereby "tuned" to optimize your listening experience.
Cholesterol Lowering in Intermediate-Risk Persons without Cardiovascular Disease Saves Lives
The long awaited results of the HOPE-3 trial were published in the May 26 issue of the New England Journal of Medicine. The study showed among 12,705 participants in 21 countries that taking only 10 mg daily of rosuvastatin, the generic of Crestor, resulted in a 24% lower risk of cardiovascular events (death from cardiovascular causes, nonfatal myocardial infarction, and non-fatal stroke). The median follow up was 5.6 years. The study was a primary prevention trial meaning that the patients had no history of cardiovascular disease. They were nevertheless considered to be of intermediate risk if they had at least one of the following risk factors: elevated waist-to-hip ratio (> 0.85 in women and > 0.90 in men), a low level of high-density lipoprotein cholesterol (the good cholesterol), current or recent tobacco use (within the past five years), abnormal fasting blood glucose, history of premature coronary artery disease in first degree relatives (men <55 years or women <65 years), or mild renal dysfunction (creatinine > 1.4). Patients taking rsosuvastatin were more likely to have muscle complaints (5.8% vs. 4.7%) and cataract surgery (3.8% vs. 3.1%).  

Bottom Line: Rosuvastatin saves lives among patients without known cardiovascular disease if they have at least one risk factor.
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Medical Errors
A study by researchers at Johns Hopkins University published on May 3 in the BMJ (formerly the British Medical Journal) claims that medical errors should rank as the third leading cause of death in the United States behind heart disease and cancer, ahead of emphysema. The study reminds me of the excellent book by Atul Gawande entitled, "Better: A Surgeon's Notes on Performance." He argues, correctly and cogently, that standardization of health care practices will safeguard patients.
 
In medical school, we are taught and take an oath that says, "Do no harm." No physician, nurse, or pharmacist intentionally injures a patient. Having said this, patients need to realize that hospitals are very complex environments with many actors and many hand-offs from one tired shift-worker to the next, interrupting the Continuity of Care that is your best insurance policy against medical errors. 
 
I sympathize with patients with complex medical histories and medication lists who have been forced to change physicians because of a change of address or a change in their insurance policy. Such patients are medical orphans. Such changes make it difficult to provide the Continuity of Care that patients deserve and require if mistakes are to be avoided. 
 
What can you do?  First of all, take the steps necessary to keep yourself out of the hospital.  Do not ignore worrisome symptoms such as chest pain, temporary paralysis, or rectal bleeding.  Become familiar with the generic names of your medicines, keep a list of your medicines and doctors, keep your out-patient appointments, and develop relationships with your pharmacist, as well as all of your caregivers. Also try to avoid those detrimental behaviors that might unnecessarily land you in the ER/hospital surrounded by well-meaning medical strangers. If you are ill, call me on my cell at (908) 256-9439. I can help you over the phone or meet you in the ER to help coordinate your care.
 
I smile at patients who say, "Remember me, I saw you three years ago," or appear in the ER never having made an appointment. Such reckless behavior is dangerous and the harm, self-inflicted. I will attempt to do my part but please realize that it will take valuable time to get to know you and your medical history, time you may or may not have to spare. 

Bottom Line: Superior outcomes can be achieved if you and I work together on a regular basis! Continuity of Care is your best defense against medical errors!
Now Hear This!
As announced by NJ.com, the merger of the Hackensack University Health Network and Meridian Health uniting 11 hospitals was finalized on June 21. The new entity will be known as Hackensack Meridian Health and the merger goes into effect on July 1.  

Hackensack Meridian Health will be the second largest hospital network in New Jersey following the marriage of Barnabas Health and Robert Wood Johnson Health System in March.  Hackensack Meridian Health and Seton Hall University will launch a new medical school and enroll its first class in the fall of 2018.  I will continue my staff role at Jersey Shore University Medical Center and look forward to welcoming medical students from the new medical school.
 
The office will be closed on Monday, July 4th, in observance of the birth of our nation in Philadelphia in 1776! 
 
On a personal note, our third and recently married daughter, Dr. Rita Butler, and her wonderful husband, Dr. Andrew, are moving to Philly to take up new positions at the Hospital of the University of Pennsylvania (HUP) and the Children's Hospital of Philadelphia (CHOP), respectively.  Am I proud?  You know it!
 
Valerie, Monica, Morgan, and I wish you - wherever you come from and whatever your faith, ethnicity, immigration status, gender or sexual preference, a truly wonderful celebration of the values that bind us together as Americans!  Happy Fourth of July!
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In This Issue
The JUNE of Our Discontent!
Philadelphia Freedom (from sweetened soft drinks!)
Will Philly's Soda Tax Make Coca-Cola the Next Phillip Morris?
Advances in Hearing Aid Technology
Cholesterol Lowering in Intermediate-Risk Persons
Medical Errors
Now Hear This
  
John A. Schmidt Jr., M.D.
Board Certified Internist
 
Dr. Schmidt is one of the leading internists in Monmouth County offering Medical Home services.  

He is an Associate Attending in the Department of Medicine, Jersey Shore University Medical Center, and  Clinical Assistant Professor in the Department of Medicine, Rutgers Robert Wood Johnson Medical School.

  
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"Freedom has its life 
in the hearts, the 
actions, the spirit of 
men and so it must be daily earned and 
refreshed - else like 
a flower cut from its 
life-giving roots, 
it will wither and die." 

Dwight D. Eisenhower

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Telecoil Loop Area




 
John A. Schmidt Jr., MD
Meaningful Medicine in Your Medical Home
709 Seventh Avenue
Belmar, NJ 07719
 
Phone:  732-282-8166  
Fax:  732-280-0147 
  
  
Disclaimer: The articles in Healthy Living are for general information only and are not medical advice.
Discuss all medical concerns and treatment options with your physician.