Health Happenings: Georgia News Update

There is an abundance of national news headlines regarding the medical field and health policy decisions to catch your attention in recent months. However, there are also important stories happening closer to home regarding patient health and the policies and legislation being implemented to address such concerns. What follows is a brief synopsis of some of the current events happening in the healthcare field right here in Georgia.

1. Maternal Mortality

Several years ago it was reported that Georgia had the highest maternal mortality rate in the country at 28.7 maternal deaths per 100,000 live births in 2011. Maternal mortality is defined as maternal death during pregnancy or within 42 days of the end of the pregnancy. In response, the Georgia General Assembly formed a maternal mortality panel to investigate the matter further and identify areas for improvement. The first report from that investigation has detailed 25 pregnancy-related deaths and 60 pregnancy-associated deaths from 2012 data. Several key elements of the report include: 1) Errors in classification of deaths, suggestion that improved standardization of reporting is needed; 2) African-Americans were represented at a much higher rate in the group; 3) Obesity, chronic medical conditions, and lack of access to care were cited as possible contributing factors in many incidences. The committee will continue to review cases from subsequent years and the Department of Public Health has begun work to improve clinical outcomes and reduce errors in reporting with the data already provided.

2. Cannabis Oil Research

Dr. Yong Park has been leading trials at the Medical College of Georgia regarding the use of cannabis oil in treatment of seizures after approval by the legislature and Governor Nathan Deal late last year. Updated data from the studies will be available in December but preliminary results have shown significant improvement in patients with severe forms of epilepsy, with over 200 families currently qualifying for the medical marijuana registry. The state’s Commission on Medical Cannabis met recently to study the effect of the law and whether it should be expanded to allow growth and distribution of cannabis oil within the state of Georgia. As it stands now, families may be able to possess cannabis oil but the sale of any form of marijuana still remains illegal in the state.

3. Medicaid Expansion

In the June 2012 Supreme Court ruling on the Affordable Care Act, the provision that required states to expand their Medicaid rolls was deemed unconstitutionally coercive by a majority of the court and the expansion became optional for states. The state of Georgia was one of those states that opted out under Governor Nathan Deal. Some lawmakers, however, are working to introduce legislation to expand Medicaid via the General Assembly next year. Georgia remains among the 5 states with the highest number of uninsured in the nation.

If your curiosity has been piqued by some of these topics, I encourage you to keep reading about the statewide stories that may affect medical students and providers.  Applying for and attending the Medical College of Georgia’s Advocacy Day is also a great opportunity to meet with legislators and get a first hand look at how the political process works and how decisions made in the capitol can affect the patients and the medical community throughout the state.

Jaimie Huntly is a fourth year medical student based on the Southeast campus. She is currently applying for residency in Obstetrics and Gynecology. Her interests include health policy, global health, travel, languages, running, and reading.

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Pharmaceutical Price Gouging, The People Behind It, and Why It Needs To Stop

The pharmaceuticals industry has made recent controversial headlines concerning the cost of drugs for patients. The discussion was catalyzed by the actions of CEO Martin Shkreli of Turing Pharmaceuticals, who recently raised the price of Daraprim (pyrimethamine) from $13.50 to $833 per pill after purchasing the marketing rights. Daraprim is an important for treating multiple protozoal agents, including Toxoplasma gondii infections in immunocompromised AIDS patients. This is one instance in a continuing trend of the pharmaceutical industry increasing the prices for drugs that are critical for treating patients who have to either burden the enormous cost or go without the medication they need.

Shkreli faced widespread criticism and backlash to the price increase, and despite public statements that he would lower the price, Daraprim still costs over $800 per pill. This issue is not limited to one person though. There have been many similar instances where companies have dramatically increased the prices of specialty drugs, including the cancer drug Imatinib/Gleevec from Novartis and the anti-parasitic drug albendazole, whose marketing rights were acquired by Amedra Pharmaceuticals in 2010. Furthermore, the pharmaceuticals industry wields significant power that allows these actions to be completely legal. Last year, the industry spent over $250 million dollars and employed over 1400 lobbyists to influence politicians and campaigns. Additionally, many companies spent more money on advertising than research and development, reaping billions in profits per year.

As members of the medical community, our primary objective should be to advocate for the well-being and longevity of patients under our care. While the pharmaceutical industry is crucial towards the development of new and more effective treatments and even cures for diseases, it is, at the end of the day, driven in part by the whims of people like Martin Shkreli and so many other unknown yet powerful corporate entities. Those whims are geared towards profits without regard for life, the bottom line over the impact on families, and most importantly, uninhibited capitalism. Given the power of the pharmaceutical industry and its vice-like grip over so much of medicine, physicians have a responsibility to be the voice for the millions of patients that cannot afford their medications.

Compassion, integrity, and acknowledgement of the significance of human life are the staples of the medical professional, and it is time to bring those concepts to the pharmaceutical industry as well. When the effectiveness of pharmaceuticals are measured by how much profit they can generate over a number years instead of how many years of life it can extend, it is clear that a radical change in the culture of that industry is necessary. Although pharmaceutical companies do not need to become charities overnight, reductions in the cost of medications, reductions in spending on advertisement, increasing spending on R&D and development of cost-effective manufacturing techniques, and limits on spending for political lobbying would be a great first step towards building an industry that works for humanity instead of at the expense of it.

Subhendu De is a 2nd year medical student in Augusta. His interests include medical innovation, healthcare journalism, and current technology. This hobbies include exercising, cooking, and various sci-fi and fantasy media.  

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Hump Day Humor

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Women in Medicine: Thoughts from Two Docs on Laney Walker

Earlier this year, Academic Medicine reported the results of the AAMC’s Women in Medicine and Science Benchmarking Survey.  This Survey was initiated in 1983, and represents a mature and comprehensive data set with over 90% (119) of the 129 medical schools in the U.S. responding.  Together, these AAMC  (American Association of Medical Colleges) data reflect a hopeful, yet slow moving change in the healthcare industry for women across all levels of academic medicine.  The proportion of female faculty new hires rose, but female faculty departures increased as well. The proportion of full-time female professors increased, but only by 7% since 2003, and this increase was offset by an increase in departures from the academe (5%).  More females are applying to medical school, but the number of male applicants also has risen.  Women still represent fewer than 50% of all medical school applicants.

Although these AAMC data do not promote much optimism, female health care professionals in the beginning, middle and end of their careers must continue striving for a seat at the table.  Consider these 4 tips from two senior MCG faculty members who served as faculty participants during this forum:

1. It’s Vital to Know Your Mission and Purpose

Reflect on your life story and identify your passions.  The way you deal with early challenges in your life often defines you.  So ask yourself:  What is my life story?  What parts of this story have shaped the person I am today – have resulted in the values I treasure?  What am I truly passionate about?

It is likely that your passions, if authentic, will intensify and converge into a short ‘list’ over the years.  This narrowing can serve as a compass on your career path, helping you to define your priorities – both personal and professional.

2. Take Charge of Your Career

You are in charge of and responsible for your own career.  If you decide to sit idle and let your career “happen” the outcome is uncertain.  However, if you take the reins and guide your journey mindful of your purpose, with your specific goals in sight, and also remain open to support from others; you will determine your own destiny and legacy.

• What are my near term career goals?
• Who provides support for me in my network as I strive to achieve these goals?
• Who are my mentors?
• Who are my advocates/sponsors/champions?

3. Know your Priorities – both Personal and Professional.  What are your boundaries at home and work and always operate within them. 

4. Learn How to Negotiate.  When it comes to negotiation, confidence is not masculine or feminine.  It’s a practice.

As Steven Covey has advised us:   “Begin with the end in mind.”  And of course, enjoy the journey, too!

Honoring the light in you all -

Nita & Caryl

This is a guest post from Drs. Maihle and Hess.  Thank you for sharing your great wisdom with us!

Dr. Nita Maihle is a cancer biologist who was recruited to GRU in 2013 to develop educational programming for the GRU Cancer Center. She also runs a research laboratory where she studies breast, ovarian and other women’s cancers, with a focus on biologically targeted therapies and biomarkers for early detection. She was on faculty at the Mayo Clinic for 15 years, and Yale University for over a decade. During her career she has served in numerous leadership capacities, including service on the Board of Scientific Counselors for the National Cancer Institute, as well as President of Women in Cancer Research, a ~7,000 member Council of the American Association for Cancer Research.

Dr. Caryl Hess joined GRU in 2014 as  the Director of the Office of Leadership Development.  She oversees the GRU Leadership Academy, a program which promotes the development of leadership skills and abilities.  She is the former director of the Cleveland Clinic Academy where she oversaw the leadership and management curriculum and courses for 43,000 physicians, nurses, and administrators and directed various external, revenue-generating programs, including the Samson Global Leadership Academy, Cleveland Clinic's global leadership program for healthcare executives.  She has conducted research, presented and spoken to diverse audiences on the topics of leadership development, curriculum and technology.  

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The Away Rotation: Demystified

So you want to do an away rotation. Or at least, you think you do… Here’s a quick guide from a fourth year, who’s been there, and done that, twice.

1. Talk to the advisor in your specialty of interest. They will give you honest, accurate advice on the positives and negatives of rotating away from MCG. For many fields, away rotations are a great way to earn an interview, and some programs will let the month serve as your interview, guaranteeing the option to put that program on your rank list. Also, the month will give you a good “feel” for the training program at that institution. For some competitive fields, away rotations are almost an unofficial requirement. However, some specialties may recommend not doing away rotations at all, as the benefit may not be worth the time, expense, and travel.

2. Research programs. Again, talk to your advisor. Ask where previous MCG students have had success matching and if they have any recommendations on specific programs. Most away rotations are listed on VSAS, but if you do not see a specific program you are interested in, be sure to check that school’s website, as many programs have separate, individual applications.

3. Decide on where to apply, and remember, they can be competitive. Plan your finances accordingly, as most cities with medical schools are more expensive than Augusta, and you will have to find a place to sublet since most schools do not guarantee housing for visiting students.  Rotatingroom.com, craigstlist.com, and airbnb.com are good sites to search. Contacting old college friends on facebook and organization list-servs are also good options to find housing. You can also offset costs by listing your own apartment on such sites for medical students visiting MCG. Once you decide on a list, plan on filling out A LOT of immunization forms, visiting your doctor for signatures, and possibly acquiring letters of recommendation or writing a personal statement. Yes, this part is a headache.

4. Accept a rotation, (or 2 or even 3). Review MCG’s curriculum requirements frequently to ensure the rotation will count towards graduation. As of Fall 2015, two “off-campus” electives can count towards graduation, as long as they are “sufficiently different” in content. The away rotation is a great way to demonstrate to residency programs you are willing to leave the South, so consider programs in a different part of the US (or even internationally).

5. Complete away rotation(s), and bring your A game. Remember, the rotation functions like a month-long interview, and you should try your best to show you are interested, engaged, and knowledgeable. In addition to reading about your patients, asking thoughtful questions, and arriving to all activities promptly and ready to work, interact with as many faculty members as you can. If you can, try to set up brief, private meetings with attendings, and bring your transcript, CV, and personal statement. While some programs may allow such meetings to serve as your interview, for those that don’t, the impression you make may score you a formal interview a few months later. It may be reasonable to ask a faculty member you worked closely with for a letter of recommendation. Getting involved with a case report may be a viable option, as well. All this being said, avoid being overbearing, obnoxiously “gunning”, or hard to work with, and have fun. While programs want smart, enthusiastic residents, they also want people who are easy to work with and have interests outside of medicine. Take advantage of your free time to explore a new city, catch up with old friends, and above all, enjoy yourself.

Caroline Lewis is a fourth-year medical student based out of the Southeast campus. She is currently applying to residency in Dermatology. Outside of school, she enjoys yoga, cooking and trying new restaurants, and seeing live music.

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Naturally Distracted

Athens is a great place for a medical student to be distracted. Even if immune to the temptations of the well-known nightlife, musical and sporting scenes in this town, the natural setting of Athens can get a student's attention during the day.

What do I mean by natural setting? While certainly a bustling city, Athens is surrounded by woods and farmland and has not quite been phagocytized by the Atlanta metropolitan area. Attractive natural settings like the Georgia Botanical Gardens and the Sandy Creek Nature Center are as accessible as Kroger and Publix. Sometimes the wonders of nature can be difficult to escape. My backyard, within the Athens city limits and near the medical campus, has hosted a wide variety of avian species - at least 21 since I started keeping track.

Visually appealing and aurally grating in similar measure, Blue Jays have a way of making their presence known that can test the nerves. Today, I sat at my desk trying to tune out a typical Blue Jay ruckus while I stared at a schematic of the clotting cascade. Then, all of the sudden, the Blue Jays started going nuts. I looked out my window in irritation and counted about five in the thicket that protrudes into my yard. As I peered, wondering why they had to be such jerks and contemplating banging on the window, I noticed some large yellow talons on a tree branch in the thicket and then spotted the rest of the raptor just as it launched out, Blue Jays in pursuit. I was able to get a good enough look as it did so to ID it (with the help of the Audubon Society website) as a Cooper's Hawk: chest markings much like a Brown Thrasher's, adapted for camouflage in thick cover, and a banded tail. Backyard species #22.

Brown Thrashers hang out in my backyard; I'll see one at least half the time I look out the window. During the occasional stressful day of my first year, I'd get a kick out of watching them peck the ground in what looks like stop motion animation/agitation. Fast forward a year and I'm stuffing crunchy peanut butter into a laundry pole for the woodpeckers before class. My habit of paying attention to birds that has developed may be blamed on Athens, myself or perhaps even the emergence of a physician's eye for details. But since I wish to use such an eye as a physician - and I'm not one yet - I now abandon that inquiry and return to the clotting cascade.

Emerson Floyd is a second-year Athens student who grew up in Macon, GA and is trying to use his time wisely. 

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