houston - Husch Blackwell

Transcription

Serving Harris, Galveston, Brazoria and Fort Bend Counties
HOUSTON
September Issue 2012
Special Report: Pain Meds the Epidemic
Inside This Issue
2012 Houston Heart Walk
see page 9
INDEX
Legal Health..................pg.3
Marketing Essentials.......pg.4
Money Matters..............pg.5
The Framework..............pg.6
New Technology...........pg.8
Research.....................pg.12
Hospital News..............pg.14
Weight training found to lesson type 2
diabetes in men
see page 10
By Jason Powers,
MD
Chief Medical
Officer
The Right Step,
San Cristobal
And Spirit Lodge
I can tell you without hesitation
that painkillers are among the
most common reason
why people enter
treatment
today.
Many people had
no idea how
power f ully
addictive
painkillers
were when
they first
put on
t hem
b y
Just when I think the “growing
epidemic” of painkiller abuse in this
country has finally peaked, I find that
it keeps getting worse. I get bored with
media sensationalism and even the
way of phrasing America’s incredible
issue with painkiller abuse biases my
thinking. Are we really having such
an enormous problem? And if so, can
we figure out why so we can perhaps, t h e i r
optimistically even, do something doctors.
about it?
Some folks
On a daily basis, I witness the legitimately
problems of all addictions. It is clear needed pain
that painkiller use is huge. I have the medications
data to prove that we are in fact but many did
enormously entrenched in the not and some
quagmire of painkiller abuse. But my were treated too
firsthand experience is more useful. aggressively.
Numbers can help prove what we see, Many of them were put on
but nothing is as good as the insight painkillers that were too powerful
gained from hands-on experience.
for their amount of pain. This
Why am I qualified? I was among judgment comes from their mouths
the first physicians ever to become and my experience. People do deserve
Board Certified by The American pain relief, but there has been such an
Board of Addiction Medicine, I have overwhelming push to treat any and
been working for ten years in the field all pain, many of us have gone
as an Addiction Medicine Specialist, overboard.
interventionist, national speaker, and Other people develop addiction
recently can add the title of author to through the medical use of painkillers
my qualifications as my first book, because they either had the latent
When the Servant Becomes the predisposition, enjoyed them too
Master, was recently published by much, or where in recovery and simply
Central Recovery Press.
got primed and triggered.
occurs in the working population of
adults. Addiction affects soccer moms,
doctors, teachers, teenagers, police,
and others with equal force and equal
abandon.
And the withdrawal from painkillers
is the worse withdrawal a human can
endure, no matter why they started
taking them in the first place. The
withdrawal symptoms are so terribly
wretched, in fact, that the vast majority
of dependent people continue taking
The small minority of those I treat
them merely in order to avoid
with physical dependence to pain
killers simply need to get off them withdrawal. The high is gone, the
because they recognize how their lives pain relief is gone, and all that is left is
have becomes worsened instead of a lifestyle defined by attempting to
aided by these tools. These minority avert pain and suffering of
of folks do not have addiction and do unfathomable proportion.
very well with a short course of
Here are the facts I promised you:
detoxification.
The epidemic of pain killer abuse is
not limited to junkies or wayward kids.
Most of the painkiller abuse I see
1. The estimated number of
emergency department (ED) visits
See PAIN MEDS THE EPIDEMIC Page 18
PRSRT STD
US POSTAGE
PAID
PERMIT NO 1
HOUSTON TX
Houston Medical Times
Page 2
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Now you can choose the time and place to take the courses you need and want.
We’ve made it easy to take free CME courses online. We offer 24/7 access to
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Taking New Steps
• Children with Diabetes
• Children with Asthma
• Newborn Screening
• Developmental Screening
• Many others
Referral Guidelines
• Pediatric Depression
• High Blood Pressures
in the Office
• Atopic Dermatitis
• Gastroesophageal Reflux
in Infants
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STEPS-0379 OPE_BlueDoc_9n5x12n375_August_V1.indd 1
September 2012
• When to Refer to a Geneticist
• Exercise-Induced Dyspnea
• Referral Guidelines Overview
8/23/12 9:33 AM
medicaltimesnews.com
Legal Health
Page 3
diligence, even if an M&A transaction
is not immediately contemplated,
Advance Preparation for a Future Physician Practice Sale – physician owners will be better
Getting the House in Order Before an M&A Transaction
prepared for future opportunities.
Because definitive purchase documents
usually include schedules and exhibits
Albert Lin
home. When circumstances change, containing all of the below information,
Transactional
however, the home may need to be having such information readily
Healthcare
sold. Homeowners maximize their available greatly eases the process.
Attorney
sales price by ensuring all problems,
Brown McCarroll,
Review Underlying Corporate
major and minor, are fixed – plumbing, A.
L.L.P.
roofing, windows, doors – and Formation/Governance Documents
increasing a home’s “curb appeal” and Confirm Good Standing/
Corporate Existence.
works wonders.
A recent study by Modern Healthcare,
following enactment of the Patient Those considering selling their private Buyers of the physician practice will
Protection and Affordable Care Act as practice to a third party should want to know that an incorporated
amended by the Health Care and approach the prospect just like a home practice entity has current and executed
Education Reconciliation Act of 2010 sale. This means taking inventory of formation/governance documents and
(“PPACA”), shows that 86% of those the physician practices’ internal is in good standing in the state of
surveyed see an increase in mergers & foundation well before a third party existence; i.e. Texas.
acquisition (“M&A”) activity in examines the practice, which will
Such documents consist of the
upcoming years. Increased access to maximize value and make the overall
certificate of formation filed with the
capital,
improved
information M&A transaction proceed smoothly
secretary of state, along with bylaws,
technology offered by larger groups, and efficiently. And, perhaps, even
company agreements, partnership
economies of scale, and negotiation maximize the purchase price as buyers
agreements, stock transfer restriction
leverage are but some of the advantages appreciate an exceptionally organized
agreements, and anything else
prompting M&A acquisition in the practice.
governing equity ownership. A critical
healthcare industry.
At the beginning of an M&A element is to make sure that all past
For many physicians, their years of transaction, buyers will request “due and current owners of the physician
investment in their own practice has diligence” from the physician owners practice have their equity ownership
resulted in an emotional tie to the prior to a sale. By reviewing and documented. The failure to show
practice not unlike ties to a beloved addressing the below elements of due properly documented departures and
“buy-in” transactions for new
physicians is a common hurdle to
overcome as buyers will want a clear
chain of title if they purchase the
practice. Verifying all necessary owner
signatures are present is an easy step
but one that is commonly overlooked.
“Good standing” generally means
that the entity has filed all required
state tax returns, as failure to do so
will result in the secretary of state
“revoking” the corporate charter of the
entity.
B.
Conduct Inventory of all
Material Contracts, Written and Oral
Agreements.
The value of a physician practice is
often in provider agreements and other
arrangements with third parties.
Buyers will want a comprehensive list,
along with the names of the parties to
the agreements, and will request
complete, signed copies of such
agreements. The physician owners
should review each one for
completeness. Often, contracts lapse
with no formal renewal agreement.
Renewals should be obtained and sign
such that all contractual arrangements
are current. This process is useful for
See Legal Health page 19
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September 2012
Page 4
Marketing Essentials
professional peers.
Our 3 Top Reasons Why Doctors Need to Keep an Open
Mind About Social Media
becoming mainstream also.
Many hospitals, health plans, and
medical and healthcare product
manufacturers seem to be among the
leaders in social media marketing.
But not so with doctors as a group.
By Stewart Gandolf and Lonnie Hirsch, Although we will quickly add the
caveat that social media isn’t
MBA
appropriate to every situation,
Social media is a means for patient
physicians and healthcare providers
and provider to interact, to
who aren’t using these tools need to
humanize institutions, to learn
keep an open mind.
from each other and to support a
patient-centered system. It is a When we bring up the subject of
means to speak, listen, understand social media marketing, healthcare
and begin a relationship.
providers quickly divide themselves
into three distinct camps. Please let
Social media isn’t just for socializing,
us know if we’ve missed a category,
in the frivolous and inconsequential
but the main categories seem to be:
meaning of the term. In fact social
media—Facebook, Blogs, Twitter, ∙∙ The Early Adopters are a relatively
LinkedIn and many other channels—
small percentage of providers
is now mainstream in American
who are actively using one or
society.
more social media channels to
communicate with patients,
Further, the Internet, and social
colleagues and the public at large.
media in particular, play a meaningful
Many in this category have been
and expanding role in healthcare
doing so for some time, and some
delivery
and
provider-patient
of them endorse the idea for their
interaction. And that role is quickly
September 2012
∙∙ The Sideliners are, we
estimate, the largest sector.
For various reasons these
individuals
are
not
prepared to leave the
sidelines...at least not until
the rules of the game are
well understood and the
momentum is clear. Social
media policies-if they exist
at all-are in a formative
stage, and respect for
important issues, such as
privacy, reimbursement
and liability, deserve a
conservative approach.
∙∙ The Not-Me Group is a sometimes
vocal, and we hope small, group
that appears to be firmly antisocial media. We’ve written
previously about the surprisingly
in this corner.
For the physicians and others who
are still “on the fence,” here are three
of our top reasons to keep an open
mind and perhaps take another look
at social media marketing.
social network. Respected studies,
including the Pew Internet &
American Life Project, tell us for
example that 80 percent of Internet
users have looked online for
information about any of 15 health
topics such as a specific disease or
treatment. This translates to 59% of
all adults. Fifty-five percent of
consumers report using the Internet
to find treatment information,
according to a Deloitte Center for
Health Solutions survey.
What’s more, social media
It’s where your patients look for (Facebook being the dominant
information. Over 60 percent of all platform) is a primary resource for
Americans have joined at least one
See Marketing Essentials page 20
Page 5
Money Matters
Managing retirement assets during a job transition
By Kim Fontenot
Financial Advisor
Morgan Stanley
Smith BarneyHouston
When you leave a job, whether
planned or unplanned, your retirement
accounts and investments you have
with that employer still belong to you.
It is important not to neglect those
assets during your job transition. Many
of us have changed jobs multiple times,
and for that reason still have multiple
401(k), 403(b) or IRA accounts out
there. When you have a job transition,
there are decisions to make in regards
to what happens to those funds.
For many people, an employersponsored retirement plan is likely a
key component of their retirement
strategy. Due to the fact it represents
a key source of future retirement
income, it is important to carefully
consider your alternatives for
administering these assets. During a
job transition, you will usually have
three options: take a lump-sum
distribution, leave your assets in the
employer-sponsored plan or move
your assets into a Rollover IRA.
Taking a direct, lump-sum
distribution. This means the funds
in your plan are distributed directly
to you in a lump sum, which
provides you with immediate access
to that money. Depending on your
While it may be tempting to focus short-term needs, this may appear to
more on your immediate needs, you be an attractive option. However, a
need to think of how these decisions distribution will likely result in
will affect your long-term goals and substantial income taxes and a 10%
IRS penalty tax, which can
retirement savings.
significantly reduce the amount you
Some Basic Decisions
actually
receive.
The
plan
administrator must withhold up to
20% of the distribution for federal
income tax purposes since they would
be paying you directly. In addition to
that, the assets would not be taxdeferred, which potentially could
reduce the amount ultimately available
to you at retirement.
new employer’s retirement plan, if they
accept rollovers. With this option
though, your investment choices and
control may be restricted because
employer plans typically have limited
investment choices compared to those
of other types of retirement accounts.
Creating a Rollover IRA. A Rollover
Keep the status quo. You can decide IRA addresses the issues of tax-deferred
to do nothing and leave your assets in status, flexibility and control, and may
your (now) former employer’s plan. hold significant benefits for you
That will protect the tax-deferred status because of that.
of your assets and allow you to transfer
the account assets at a later time to a If your assets are transferred directly
See Money Matters page 22
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Page 6
The Framework
to the VA hospital in Houston have
more than doubled. The new wing is
When vacated, the current space yet another demonstration of
Houston VA Builds New Hospital Wing
occupied by the Urology Clinic and MEDVAMC’s commitment to provide
Dermatology Clinic will be used to the best care anywhere to Veterans in
A new hospital wing is in the works general population.
expand the hospital’s surgical operating southeast Texas.
for the Michael E. DeBakey VA
suite and primary care, respectively.
Medical Center (MEDVAMC). The “We strive to continuously improve
project, scheduled to begin in access to health care for our Nation’s In the last ten years, outpatient visits
September, will allow the Dermatology heroes,” said Bryan T. Bayley, M.H.A.,
and Urology Clinics to relocate into F.A.C.H.E., acting medical center
much needed, larger spaces late next director. “We are excited to soon have
enhanced facilities for Veterans who
year.
need medical treatment for dermatology
“Our Veteran population is and urology issues.”
particularly susceptible to certain skin
diseases,” said J. Kalavar, M.D., The new wing, located on the second
Medical Center Chief of Staff. “While floor of the hospital, will be
on active duty, Servicemembers may approximately 22,000 square-feet.
be subject to extreme temperatures, Each new clinic will be about 8,000
extensive sun exposure, unsanitary square-feet. The new Urology Clinic
living conditions, poor nutrition, will have six exam rooms and four
combat wounds, chemical agents, and rooms intended for procedures and
many other challenges known to treatment; the Dermatology Clinic,
eight exam rooms, four procedure
contribute to skin disease.”
rooms, two laser rooms, and one light
Additionally, prostate cancer is the therapy room. The remaining space
most common noncutaneous cancer on the wing will be used to expand the
among males. Although prostate nearby Prosthetics Department.
cancer can be a slow-growing cancer,
thousands of men die of the disease The project will be completed in two
each year. Prostate cancer is the second phases. The first phase will encompass
most common cause of cancer death in the structure and outer walls. The From left, Acting Medical Center Director Bryan T. Bayley, Urology Chief Donald P. Griffith,
males. Veterans, particularly Vietnam second phase focuses on the interior M.D., Facilities Management Executive Jeanette Butler, Construction Chief Mouris Ibrahim,
Veterans, have a higher than average with finished walls and utilities. The and Dermatology Chief Theodore Rosen, M.D. look over the plans for the new hospital wing.
incidence of prostate cancer than the estimated completion date is September
September 2012
2013.
New Technology
Robotic Surgery Open House Gives Public Hands-on
Experience
Page 7
incisions versus traditional open or movement that human’s hands would
laparoscopic surgery. In addition, have, surgery is more precise.
because the robot can hold instruments
without any of the fine motor
Members of the public and physicians
had the opportunity to get first-hand
experience with a da Vinci® Robotic
Surgical System during an open house
held recently at Houston Northwest
Medical Center. Visitors first heard a
short presentation to learn about
robotic surgery, which involves using a
computer that remotely manages tiny
instruments attached to a robot. They
then were then able to sit down at the
controls to see what it is like to perform
this type of surgery.
During robotic surgery, the physician
sits at a computer station and directs
the robotic movements. Small
instruments attached to the robot’s
arms that have been inserted into the
patient through small cuts match the
doctor’s hand movements. The
physician can see highly magnified,
three-dimensional images of the body
shown on a monitor by using a camera
attached to the end of a thin tube.
Surgeries currently being performed at
Houston Northwest Medical Center
using the da Vinci system include
“Houston Northwest Medical Center gynecological operations for uterine
has shown their commitment to their fibroids,
ovarian
cysts
and
patients and surgeons by investing in hysterectomies, as well as urological
the da Vinci Robotic Surgical System,” and general surgery procedures.
says Derek DeSola, representative for
Intuitive Surgical, Inc., the company This type of surgery uses smaller
that manufactures the da Vinci system. incisions than traditional surgery and
“This technology will provide their is associated with faster recovery time,
surgeons the ability to perform less pain and bleeding, less risk of
minimally invasive surgery to a broad infection, and shorter hospital stays.
base of patients, and provide their Robotic instruments also can be used
Robotic surgery demonstration photo – Brian Kiscoe, representative for Intuitive Surgical, Inc.,
community with a high level of medical to access hard-to-reach areas of the the company that manufactures the da Vinci surgical system, demonstrates how easy it is to peel
care.”
body more readily through smaller a grape with the robot.
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September 2012
Page 8
Healthy Heart
Why Do You Walk?
Have fun and help us save lives at the Houston Heart Walk
By Amber Baker
Senior VP of AHA
Southwest
Affliate
That’s the big picture, but why
should you walk?
consider donating or raising funds
as you walk. The Houston Heart
Walk fundraising goal is $2.2
million!
farthest point of the parking lot and
walk the difference. If you take the
bus, get off two stops earlier. Take a
10-minute walk during your lunch
break, another during your coffee
The Heart Walk isn’t just a one-day break and fit in another 10 minutes
event. It’s also a great way to jump- after dinner. Walk in place while
start a lifetime of physical activity watching TV. Being active helps
that can make you feel better while burn more calories, which helps you
avoiding deadly diseases.
manage your weight and other
The Heart Walk is part of the cardiovascular risk factors.
American Heart Association’s My “I can’t stay motivated.”
Heart. My Life.™ healthy living
initiative that strives to help families, A Walking Club can be a built-in
communities and corporations live support system to help you stick to a
healthier. We focus so much on fitness routine. American Heart
walking because it’s one of the easiest Association research shows that
and cheapest things you can do for American adults are 76 percent more
your heart.
likely to take a walk if another person
is counting on them. Going to www.
Of course, we know starting – and MyWalkingClub.org is the perfect
maintaining – a fitness regimen can way to connect with others who
be difficult. Fortunately, we also share your goals, lifestyles, schedules
have solutions to those nagging and hobbies. Join an existing club,
“limitations” to healthy activity.
or start your own. It’s easy, free and
“My schedule is too hectic. I don’t it could be a big step toward
improving your health.
have time.”
You can walk to serve as a great
example for your family. Walk
because your nephew was born with
a congenital heart defect, yet because
of scientific research he can play
Walking is one of the best ways to baseball at age eight. Walk because
stay healthy, but did you know you your dad had a heart transplant and
can also save lives simply by walking? walked you down the aisle on your
The American Heart Association’s wedding day. Walk in memory of a
Houston Heart Walk is set for Nov. loved one. Walk for yourself.
3 at Reliant Stadium. More than The Heart Walk is a 5K non25,000 people are expected for this competitive walk, but it’s also a
fun day of physical fitness for the celebration. You can help raise
whole family, and money raised from awareness, generate lifesaving funds
the event goes toward research, for research, celebrate survivors,
education and various programs to improve the health of our families
fight heart disease and stroke.
and honor those who have lost their
battle to heart disease and stroke.
The American Heart Association
needs you to join us because heart The walk starts at 8:30 a.m. There
disease kills more Americans than will be heart-healthy giveaways, tasty You have lots of opportunities to fit
any other disease, and stroke ranks treats and heart-pumping family walking into your schedule, even if
fourth.
activities. While it’s free to register at you don’t have time to go to a gym.
www.houstonheartwalk.org, please If you drive to work, park at the
September 2012
“I don’t know where to walk.”
Available for iPhone and Android
See Healthy Heart page 22
Page 9
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For more information or to register
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September 2012
Page 10
Weight training found to lessen type 2
diabetes risk in men
The greatest reduction occurred in those who combined
lifting with aerobic exercise, a study says. Researchers are
examining if the results apply to women.
By CHRISTINE S. MOYER,
The greatest reduction occurred in those
who combined lifting with aerobic
exercise, a study says. Researchers are
examining if the results apply to women.
Physicians should encourage male
patients to add moderate weight lifting to
their fitness regimens to help prevent the
development of type 2 diabetes, says the
author of a recent Harvard School of
Public Health study. Men who do weight
training for 30 minutes, five days a week,
might be able to reduce their risk of
developing the chronic disease by up to
34%, said the study, published online in
Archives of Internal Medicine.
But even modest lifting, such as 20
minutes, two or three times a week, can
decrease a man’s diabetes risk, said senior
study author Frank B. Hu, MD, PhD.
“It’s pretty well-established that
increasing aerobic exercise is beneficial to
diabetes prevention,” said Dr. Hu, a
professor of nutrition and epidemiology
in the Dept. of Nutrition and
Epidemiology at Harvard School of Public
Health in Boston. “But no epidemiological
studies have looked at weight training and
diabetes risk. This study provides some
very clear evidence that weight training is
beneficial for diabetes prevention,
independent of aerobic exercise.”
Researchers are conducting a similar
analysis of women to see whether weight
lifting also helps reduce their risk of
developing the disease.
walking, jogging, swimming and tennis,
was obtained from questionnaires at the
start of the study and then every two years
during follow-up.
The study found 2,278 new cases of type
2 diabetes during that period. Weight
training was associated with a significantly
lower risk of contracting the disease.
Men who engaged in the activity for up
to 59 minutes a week had a 12% reduced
risk of developing diabetes compared
with those who didn’t lift weights. Weight
training for an hour to 149 minutes a
week was associated with a 25% lower
risk . The greatest risk reduction was seen
among participants who combined weight
training and aerobic exercise. Men who
did more than 150 minutes of aerobics
and at least 150 minutes of lifting a week
had a 59% lowered risk of developing
diabetes. The two exercises don’t have to
be performed during the same session,
Dr. Hu said.
The association of weight training with
lowered diabetes risk weakened in men
65 and older and among those with a
family history of the disease.
“The take-home message is that both
weight training and aerobics are
beneficial,” Dr. Hu said. “The
combination of those two exercises can
confer even greater benefits.”
Diabetes has been rising steadily in the
United States since 1980, when 5.6
million people were diagnosed with the
condition, according to the Centers for
Disease Control and Prevention. The
figure more than quadrupled by 2010,
swelling to about 25.8 million Americans.
An estimated 7 million of those
individuals are not aware they have the
disease.
Researchers examined data on 32,002
men 40 and older who were observed as
part of the Health Professionals Follow-up
Study between 1990 and 2008. Men
were excluded if they had cancer, diabetes,
myocardial infarction or stroke, among
other conditions.
Weekly time spent on weight training
and aerobic exercise, including brisk
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Research
Therapeutic Avenues for Parkinson’s Investigated at UH
Body’s Own Hormone Shows “LXRbeta performs an important
Promise in Protecting Dopamine, function in the development of the
Leading to Possible Treatments
central nervous system, and our work
indicates that the presence of LXRbeta
Scientists at the University of
promotes the survival of dopaminergic
Houston (UH) have discovered what
neurons, which are the main source
may possibly be a key ingredient in
of dopamine in the central nervous
the fight against Parkinson’s disease.
system,” said CNRCS director and
Affecting more than 500,000 people professor Jan-Åke Gustafsson, whose
in the U.S., Parkinson’s disease is a lab discovered LXRbeta in 1995.
degenerative disorder of the central “The receptor continues to show
nervous system marked by a loss of promise as a potential therapeutic
certain nerve cells in the brain, target for this disease, as well as other
causing a lack of dopamine. These neurological disorders.”
dopamine-producing neurons are in a
To better understand the relationship
section of the midbrain that regulates
between LXRbeta and Parkinson’s
body control and movement. In a
disease, the team worked with a
study recently published in the
potent neurotoxin, called MPTP, a
Proceedings of the National Academy
contaminant found in street drugs
of Sciences (PNAS), researchers from
that caused Parkinson’s in people
the UH Center for Nuclear Receptors
who consumed these drugs. In lab
and Cell Signaling (CNRCS)
settings, MPTP is used in murine
demonstrated that the nuclear
models to simulate the disease and to
receptor liver X receptor beta
study its pathology and possible
(LXRbeta) may play a role in the
treatments.
prevention and treatment of this
progressive neurodegenerative disease. The researchers found that the
September 2012
absence of LXRbeta increased the
harmful effects of MPTP on
dopamine-producing
neurons.
Additionally, they found that using a
drug that activates LXRbeta receptors
prevented the destructive effects of
MPTP and, therefore, may offer
protection
against
the
neurodegeneration of the midbrain.
the neurons,” Gustafsson said.
“Microglia are the police of the brain,
keeping things in order. In Parkinson’s
disease the microglia are overactive
and begin to destroy the healthy
neurons in the neighborhood of those
neurons damaged by MPTP. LXRbeta
calms down the microglia and
prevents collateral damage. Thus, we
have discovered a novel therapeutic
“LXRbeta is not expressed in the
target for treatment of Parkinson’s
dopamine-producing neurons, but
disease.”
instead in the microglia surrounding
e
up
v
Sa
to
Page 13
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September 2012
Page 14
Hospital News
UTMB receives $1.2 million to provide HPV vaccine to
low-income Galveston County women
University of Texas Medical Branch at
Galveston’s Dr. Abbey Berenson has
been awarded a $1.2 million grant to
start a program that will provide a
vaccination against cervical cancer to
many hundreds of low-income women
who receive health care services at
UTMB.
recommended course of the vaccine,
after the initial shot, is a second shot
four to eight weeks later and a final shot
four months after the second. However
completion rates of this vaccine have
been very low in many parts of Texas,
including Galveston County.
federal or state programs, including
CPRIT. Berenson said she anticipates
that this innovative system change will
allow UTMB to provide the vaccination
series in 900 postpartum women over
two years.
Berenson is director of UTMB’s
Center for Interdisciplinary Research in
Women’s Health and holds the Ruth
Hartgraves Chair in Obstetrics and
Gynecology. Her research on the HPV
vaccine, published recently in the
journal Cancer, showed that many
women who begin the HPV vaccine do
not return for the second or third dose.
This is a significant problem because
fewer than three doses may not provide
complete protection against cervical
cancer.
To address the completion rate
problem, she has developed a partnership
with additional clinics that see the
mothers and their babies for postpartum
visits and infant vaccinations.
“These partnerships will allow us to
coordinate the timing of their subsequent
doses with their postpartum visits and
their children’s visits to their
pediatricians,” said Berenson. “We
anticipate that this prevention project
will show that administering the HPV
vaccination postpartum decreases
barriers and that follow-up injections
should be given at postpartum or infant
visits. We feel certain this plan can
provide a model for reducing the
number of women who experience
cervical cancer and its devastating
consequences.”
A survey of low-income pregnant
women from Galveston County who
were seen at UTMB, indicated that
their HPV vaccination rates are far lower
than those reported among the general
population by the Centers for Disease
According to the National Cancer Control. Seventy percent of the lowInstitute, cervical cancer affects nearly income pregnant women UTMB serves
half a million women worldwide each are Hispanic and thus at high risk for
year and kills more than 250,000. cervical cancer.
Hispanic women have almost twice the
risk of cervical cancer as white women. Reasons for the low inoculation rate
In 2006, the FDA approved an HPV among this population, according to
vaccine that when properly administered, Berenson, include a lack of awareness
is extremely effective, 96 to 100 percent, about the vaccine, limited access to
against four virulent strains of the HPV vaccination sites and high cost.
virus – the main cause of cervical cancer Berenson’s CPRIT grant project will
and genital warts.
improve vaccination rates by addressing
all three barriers. Galveston County
The complete vaccine series consists of women who receive prenatal care at
three shots and is recommended for UTMB clinics will receive information
girls between 11 and12, before sexual about the HPV vaccine during their
activity has commenced. But even for pregnancy and again after they deliver.
women who already have become Injections will be available on the Dr. Abbey Berenson talks with new mother Ana Palacios, 24. Berenson, with the
sexually active, the vaccination is still postpartum ward, which will improve help of interpreter Irma Rabago, tells Palacios the HPV vaccine is 96 to 100 percent
recommended for those up to 26. The access. All costs will be covered by effective at preventing four strains of a virus that causes cervical cancer and genital
warts.
Berenson, a physician who specializes
in pediatric and adolescent gynecology,
received the grant from the Cancer
Prevention Research Institute of Texas.
September 2012
Page 15
September 2012
Page 16
Hospital News
Experts propose ‘cyber war’ on cancer
Researchers at Rice, Tel Aviv and
Johns Hopkins universities aim to
break cancer’s codes for social
networking
cells use advanced communications to
work together to enslave normal cells,
create metastases, resist drugs and
decoy the body’s immune system.”
In the face of mounting evidence that
cancer cells communicate, cooperate
and even engage in collective decisionmaking, biophysicists and cancer
researchers at Rice University, Tel Aviv
University and Johns Hopkins
University are suggesting a new
strategy for outsmarting cancer
through its own social intelligence.
Ben-Jacob, Levine and Donald Coffey,
a noted cancer researcher at Johns
Hopkins, suggest in the article that
cancer researchers act like modern
generals and go after their enemy’s
command, control and communication
capabilities. The article is in volume
20, issue 9, pages 403-410 of the
journal.
“We need to get beyond the notion
that cancer is a random collection of
cells running amok,” said Herbert
Levine, co-director of Rice’s Center for
Theoretical Biological Physics (CTBP)
and co-author of the cover article in
this week’s Trends in Microbiology
that pulls together dozens of recent
discoveries about the social behavior of
cancer cells. “These cells lead
sophisticated social lives.”
“It’s time to declare a cyber war on
cancer,” said Ben-Jacob, who, along
with Coffey, is speaking today at a
workshop titled “Failures in Clinical
Treatment of Cancer” at Princeton
University.
dormant state. Similar signals are later Levine, Rice’s Karl F. Hasselmann
used to sound the “all clear” and Professor in Bioengineering, and fellow
reawaken cells inside the tumor.
CTBP co-director José Onuchic were
recruited to Houston last year, thanks
“If we can break the communication in part to a grant from the Cancer
code, we may be able to prevent the Prevention and Research Institute of
cells from going dormant or to Texas (CPRIT) that was designed to
reawaken them for a well-timed spur new thinking about cancer and
chemotherapeutic attack,” Ben-Jacob foster collaborations between CTBP
said. “This is just one example. Our scientists and cancer specialists in the
extensive studies of the social lives of Texas Medical Center.
bacteria suggest a number of others,
including sending signals that trigger “This opinion article reflects the
the cancer cells to turn upon themselves multidisciplinary strategy of the CTBP
and kill one another.”
-- to communicate and work together
with researchers across disciplines for
The article cites numerous examples solving the biomedical challenges of
of similarities between the behavior of our time,” said Onuchic, Rice’s Harry
bacterial colonies and cancerous C. and Olga K. Wiess Professor of
tumors.
Physics and Astronomy and professor
“The parallels between the communal of chemistry.
behaviors of bacteria and cancer cells Ben-Jacob, the Maguy-Glass Chair in
suggest that bacteria can serve as a Physics of Complex Systems and
valuable model system for studying professor of physics and astronomy at
cancer,” said Coffey, professor of Tel Aviv University, worked previously
urology, oncology, pathology and with Levine and Onuchic on a number
pharmacology and molecular sciences of groundbreaking studies about the
at the Johns Hopkins University underlying biophysics of bacterial
School of Medicine. “We believe this social behavior. He joined Rice
approach could be particularly valuable University this summer as senior
for investigating intractable
investigator of the CTBP and adjunct
Ben-Jacob said cancer cells have been
shown to cooperate to elude
chemotherapy drugs, much like
bacteria that communicate and act as a
team to resist attacks from antibiotics.
Article co-author Eshel Ben-Jacob, a He said some cancers appear to sense
senior investigator at CTBP, said, when chemotherapy drugs are present problems like metastasis, relapse and
“Cancer is a sophisticated enemy. and sound an alarm that causes cells multiple drug resistance.”
There’s growing evidence that cancer throughout a tumor to switch into a
September 2012
professor of chemistry and cell biology.
Page 17
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September 2012
Page 18
PAIN MEDS THE EPIDEMIC
Continued from page 1
Zach is
grateful to
blood donors
for helping
save his life.
Gulf Coast Regional Blood Center is encouraging individuals
to Commit for Life. It takes three simple steps:
• Donate once per quarter; • Allow us to contact you; and
• Spread the word.
More than 1,000 blood donations are needed every day. There
is no substitute for blood, and it’s the blood on the shelf that
saves lives today.
Commit for Life and save up to three lives with one donation
at any of Gulf Coast Regional Blood Center’s Neighborhood
Donor Centers.
To schedule your donation or to find a convenient location near you, visit
www.giveblood.org or call 1(888) 482-5663.
Sprinkle in money
and serve up some time.
Food fights hunger and so do volunteers and donations. We always welcome food,
but if you can spare an hour, you can spare the hungry. And if you can spare $1
you can provide 3 meals for someone who doesn’t have
enough to eat. Go to houstonfoodbank.org
to volunteer or donate money and food.
HFB_MedCenterTimes.indd
September
2012
1
Visit our new home at 535 Portwall
10/19/11 12:47 PM
related to the nonmedical use of
opioid pain killers increased 79%
from 201,280 in 2006 to 359,921
in 2010, according to the most
recent data from the Drug Abuse
Warning Network (DAWN).
Most painkillers, though, are opioids
because they are not natural but are
synthetic or semi-synthetic compounds
derived from the same general
molecular structure as codeine, opium,
or morphine.
2. According to George Joseph,
CEO Right Step/Spirit Lodge
there were an estimated 254
million Opioid prescriptions
written in 2010 - enough to keep
all of America numb around the
clock. The Physician’s for
Responsible Opioid Prescribing
report that 25% of those on this
medication meet criteria for
addiction. I suspect this number
is too low because physicians
often lack proper training in
recognizing
symptoms
of
addiction.
Hydrocodone and Oxycodone are the
most widely abused painkillers. In the
pipeline for the future, at least one drug
company is working on a pure form of
Hydrocodone, which would mean that
for the first time in our history could we
see patients have access to one of the
most abused formulations already.
Today, the only way they can get this is
to take it in a combination form with
Tylenol (acetaminophen) so that they
are limited in how many they can take
on a daily basis in order to protect their
liver from excess damage.
We do have an epidemic of painkiller
3. Hydrocodone abuse has shot up abuse and the future does not look like
from 19,221 in 2000 to 86,258 in things will be getting better any time
2009, according to data compiled soon.
by the Drug Enforcement
So, what do we do when we discover
Administration.
that there is a problem? The best thing
4. Emergency room visits related to to do is to refer to a specially trained
Hydrocodone abuse have shot up medical professional. Less than one
from 19,221 in 2000 to 86,258 in percent of medical school curriculums
2009, according to data compiled are devoted to learning about addiction
by the Drug Enforcement and often medical professionals carry a
Administration.
lot of bias against addicts so that not
only do they not recognize it, they do
Specific medicines mentioned above not extend compassion to those
are known as opiates or opioids. These suffering with the disease of addiction,
are a broad category of drugs that are and they think that treatments are
known to most people in everyday ineffective.
language as painkillers. Opium was
the original painkiller human beings The truth is, treating addiction is
used for years. Opium and other effective, it saves lives, saves money,
natural occurring opiates come from heals families, and enables individuals
the poppy plant.
and communities the best resources in
order to thrive.
Painkillers block our experience of
pain. Pain is a survival mechanism Jason ZW Powers, MD is an
and pain is not optional in life. Addictionologist. He is a physician
Suffering comes from our perspective, who specializes in treating addictions
or relationship, to our pain. Some and was among the first group of
people can make the most of what they doctors certified by the American Board
have more easily than others. Successful of Addiction Medicine, the highest
pain management includes discovering credentialing board in the country. Dr.
ways to help the individual form a good Powers is one of the only physicians
relationship with all aspects of their who also does interventions. He is
lives, increase mobility and function in passionate about treating addiction in
their life, and decrease pain by 50%.
all its aspects and has a unique
perspective because he is also an addict
Here is an alarming factoid: Americans in recovery.
use almost 99% of the world’s supply
of Hydrocodone.
Dr. Powers is also board certified by
the American Board of Family
Are we in that much pain? Or, Medicine. He is the author of When
perhaps, do we have a cultural the Servant Becomes the Master,
perspective that states no one should published by Central Recovery Press.
ever have to feel any pain, at any cost? I
suspect discovering the answer to that He also serves as the Chief Medical
question will bear amazing fruit and Officer of Right Step, San Cristobal
help millions of people every year.
See PAIN MEDS THE EPIDEMIC Page 19
Page 19
PAIN MEDS THE EPIDEMIC
and Spirit Lodge, with over 20 drug
and alcohol treatment facilities
throughout Texas and New Mexico.
Since entering the field of addiction
medicine, he has embraced nearly every
aspect of the field and has readily been
in demand as a national speaker and
expert for various local and national
media outlets. He also has an addiction
medicine private practice in Houston,
Texas. Prior to joining Right Step in
2006, Dr. Powers served as an attending
physician at Memorial Hermann
Prevention and Recovery Center and as
an assistant professor in the department
of family and community medicine at
Baylor College of Medicine.
scholarships including the Kellogg
Foundation Academics Scholarship
and the Student Senate Endowed
Academic Scholarship. Dr. Powers an
Addictionologist (M.D.) and was voted
one of Houston's "Top 50 Doctors" for
three years running by H Texas
magazine. In 2008, he was awarded the
Compassion Award by Sierra Tucson.
Dr. Powers has also served as the local
expert and steering committee member
for the Partnership for a Drug Free
America.
An extension of his engaging
personality, he takes time to understand
his patients and work with their
families. Dr. Powers enjoys family time
Dr. Powers received his medical degree with his beautiful wife, Amy, and three
from Texas Tech University Health amazing children, Sarah, Danyel, and
Science Center. While in school, he Mia. He also enjoys yoga and camping.
was the recipient of several academic
Legal Health
identifying other glaring holes – such
as contractual arrangements that are
actually the name of an individual
physician, rather than the physician
practice.
Hopefully the physician practice will
not be subject to litigation, actual or
threatened, but disclosure of such
litigation is necessary in all M&A
transactions. In large practices a
current listing of such lawsuits, along
with attorney names, insurance policy
coverage, and a brief description of the
lawsuit or claim will be useful.
Insurance companies can provide
“loss runs” which show claims made
over a period of years.
Contracts to review also include loan
documents and leases – there should
be complete copies of all such
outstanding contracts, signed by all
parties. The practice owner should be
aware of any liens outstanding against
assets and equity interests. The buyers
Review Employee Matters
may require that these liens be E.
terminated prior to closing, or at least (Policies & Procedures, Benefits).
simultaneously with closing.
While most practices will be well
C.
Maintain Listing of All aware of the number of employees and
Required
Licenses/Permits/ independent contractors they have, not
all employees may be “at-will.”
Regulatory Matters.
Employment
and
contractor
Buyers of a physician practice need to agreements should be reviewed to
know all licenses and permits necessary ensure signed copies exist and are
to conduct the practice. This includes current and unexpired.
Renewal
not only state board licenses but also agreements should be in place.
CLIA
(Clinical
Laboratory Immigration status of any foreign
Improvement Amendment) certificates, national employees should be reviewed
Medicaid and Medicare numbers, as well – particularly since many M&A
provider numbers, pharmacy licenses, transactions can impact visa processes.
ASC (ambulatory surgery center)
Review Status of Financial
licenses, as well as state sales & use tax F.
permits,
even
motor
vehicle Statements, Audits, Tax Compliance.
registrations for company-owned
Finally, the financial records should
vehicles.
be reviewed; an outside certified public
D.
Maintain Listing of All accountant might be retained for a
Litigation.
See LEGAL HEALTH Page 20
September 2012
Page 20
Legal Health
consultation. Buyers may prefer
financials be kept in accordance with
generally-accepted accounting principles
(GAAP), and ask for audited financial
statements. For smaller practices they
may waive GAAP financial statements
if the finances are at least consistent and
present fairly the financial status of the
company. The physician owners should
be prepared to explain all elements
shown within the financial statements,
including any outstanding debt owed to
equity owners.
practices formed as registered
limited liability partnerships (LLPs)
and professional associations (PAs)
should verify that they are current
with information filings with the
Texas Secretary of State
G.
Conclusion.
The M&A transaction involving a
physician practice is a new experience to
many. Frequently, the owners of a
practice are overwhelmed at the amount
of information that a buyer expects.
Buyers will review tax returns of the Identifying all relevant materials early,
practice. Normally, definitive agreements and having them organized and easily
will provide that tax liabilities will accessible, will make the negotiation and
remain with the sellers after closing. The actual purchase experiences in the
physician practice’s accountants and/or M&A transaction easier for all involved.
bookkeeper should keep track of all
notices received from the Internal
Revenue Service (IRS) and state taxing
authorities. In particular, Texas
Marketing Essentials
users searching for health information.
Over 40 percent of respondents in a
survey by National Research Corp. rely
on social networking for health info,
and nearly all of those people (94
percent) turn to Facebook. Americans
using social media for healthcare are
affluent, and on average, 41 years old.
Modern medicine is all about the
patient. “Participating, partnering and
developing a professional relationship is
paramount,” writes media consultant and
health expert Barbara Ficarra. “Dynamic
health and medical professionals engaged
in social networking...are on the front-line
of new modern medicine. Social
networking sites and blogs are a powerful
and phenomenal platform to educate
patients, raise awareness of health issues
and it offers a forum to collaborate and
connect.”
Relationships, like communications, are
a two-way street. As healthcare delivery
systems evolve with the person/patient
taking a more active role in their own
wellbeing, social media tools humanize
and personalize how healthcare and
society interact. Social media is a means
for patient and provider to interact,
humanize institutions and support a
patient-centered system. It is a means
to speak, listen, understand, learn
September 2012
from each other
relationship.
and
form
a
And here’s a bonus reason: You might
just put yourself ahead of the
competition. Taking a leadership role—
while others remain on the sidelines—
is a competitive opportunity that’s worth
looking at closely.
Healthcare delivery isn’t trapped in an
ivory tower that’s beyond the reach of
people, society and “socializing.” Both
illness and wellness are personal, daily
living conditions that are inseparable
from a societal environment. Doctors,
nurses, hospitals and health systems
that may be undecided should remain
open to the benefits that can improve
the system and patient outcomes.
Page 21
We do what no other medical
liability insurer does. We reward
loyalty at a level that is entirely
unmatched. We honor years spent
practicing good medicine with the
Tribute® Plan. We salute a great
career with an unrivaled monetary
award. We give a standing ovation.
We are your biggest fans. We are
The Doctors Company.
Tribute®
Plan
5
Richard E. Anderson, MD, FACP
Chairman and CEO, The Doctors Company
We created the Tribute Plan to provide doctors with more than just a little gratitude for a career spent
practicing good medicine. Now, the Tribute Plan has reached its five-year anniversary, and over 22,700
member physicians have qualified for a monetary award when they retire from the practice of medicine.
More than 1,300 Tribute awards have already been distributed. So if you want an insurer that’s just as
committed to honoring your career as it is to relentlessly defending your reputation, request more
information today. Call (800) 686-2734 or visit us at www.thedoctors.com/tribute.
www.thedoctors.com
Tribute Plan projections are not a forecast of future events or a guarantee of future balance amounts. For additional details, see www.thedoctors.com/tribute.
September 2012
Page 22
Money Matters
HOUSTON
to another plan administrator, rather
than directly to you, the Rollover IRA
eliminates the withholding requirement
and penalties that may result from a
lump-sum distribution. The entire
rollover amount can be invested
immediately, according to the strategy
you specify. All of that money and any
future earnings continue to have the
potential to grow tax-deferred until you
retire and begin taking withdrawals
from the account.
distribution choices.
What if I already have multiple
accounts from previous jobs?
This is also an excellent time to deal
with multiple IRAs you may have
opened over the years, or with account
balances you may have left in the plans
of former employers. Together, these
assets may represent a significant sum,
and there are several reasons to
consider consolidating them all in a
Although not guaranteed, you may Rollover IRA.
also gain access to a wider range of An overall investment strategy. It
investment options and more can be difficult to maintain an effective
retirement planning and distribution investment strategy when assets are
flexibility than you had with your spread among multiple accounts at
employer plan. For example, different financial institutions. When
investment products in an employer you consolidate, your financial
plan may be limited to mutual funds professional can help you ensure that
and company stock. With a Rollover these assets are part of your overall
IRA, you can work with your financial asset allocation strategy and long-term
professional to create a portfolio using retirement goals.
stocks, bonds, annuities and other
investments. Plus, your retirement Greater flexibility. As mentioned
strategy can be further tailored with a earlier, a self-directed IRA generally
wide range of beneficiary selection and offers a wider range of investment
products, including stocks, bonds,
mutual funds, annuities and more.
Simplified tracking & lower costs. It
is easier to monitor your progress and
investment results when all your
retirement savings are in one place,
because you will receive one statement
instead of several. Also, reducing the
number of accounts may also reduce
your account fees and other investmentrelated charges.
Dealing with one account rather than
several also simplifies the complex
minimum distribution rules when you
reach age 70½. You also avoid the
risk of losing track of your retirement
accounts if your former employer
merges with another company or goes
out of business.
Whether your job change is expected
or not, you may find that this time of
transition holds benefits for your
retirement assets. However, it is up to
you to make the decisions necessary to
help your money grow.
Healthy Heart
“Not fast enough. Not far enough.
Not for me.”
A huge myth is that exercise is
useless unless it’s strenuous and
leaves us exhausted. But one of the
simplest types of physical activity —
walking — is also one of the most
beneficial. Just 30 minutes of brisk
walking, at least five days a week can
lower your risks for heart disease,
stroke and diabetes. And research
September 2012
indicates that for each one hour of
regular exercise you get, you’ll gain
about two hours of additional life
expectancy.
Editor
Sharon Pennington
Associate Editor
Lorraine McColley
Creative Director
Lorenzo Morales
Account Executives
Sharon Dunn
Dave Pierce
Distribution Director
Angelo Rose
Accounting
Liz Thachar
Office: 281-338-6560
Fax: 281-316-9403
For Advertising
advertising@medicaltimesnews.
com
devices, the American Heart
Association has developed real-time
tools to help increase motivation.
Users can search for walking paths
using GPS technology, create walking
paths, save favorite paths to use
regularly, attach a photo to a path or
share paths via social networks and
email. You can find a Walking Path
for practically anywhere you want to
go! You can also keep track of your
progress by logging walks into a
tracking tool.
Published by Texas Healthcare
Media Group Inc.
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We hope you join us for the
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energy level and helps manage restaurants and Jenny Craig, and
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locally by ConocoPhillips and FMC
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depression
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∙∙ Helps you fall asleep faster and houstonheartwalk.org for a full list
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Editor
[email protected]
Houston Medical Times is
Published by Texas Healthcare
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Page 23
Two Paths To Alcohol And Drug Recovery.
If you have made the decision to end your dependency on
drugs and alcohol, we envy you. Because your life is out there,
waiting for you with the enormous potential of happiness and
fulfillment. And as challenging as the road ahead may
seem—and in fact may be—we’re with you.
Every step of the way.
What does that mean? It means understanding, compassion,
and support. It means 20 locations, 96% client approval and
accredited by the highest standard in healthcare, The Joint
Commission, which recognizes only seven percent of behavioral
health facilities nationwide. Make the right choice.
Take the Right Step.
Tailor-made for adults 26 and over, our addiction-recovery
program is based on the Twelve Step model, after detox guests
typically stay at Spirit Lodge for 35-60 days.
While traditional Twelve Step methods will evolve the way your
mind processes substance abuse, we’ll also reshape your body to
new ways of living. Recovery fitness, expressive arts and spiritual
guidance are fundamentals of Spirit Lodge’s holistic healing.
You will be assigned a primary therapist to be your personal
recovery coach, not only while you stay with us, but for an
entire year. This level of aftercare is one of the many premium
benefits afforded to guests of Spirit Lodge.
www.RightStep.com
www.SpiritLodge.com
September 2012
fashion royal
Personalize your uniforms with fun looks from
Cherokee • Crocs • Grey’s Anatomy • Koi • Landau
Med Couture • Urbane and many more
Ask about Payroll Deduction for
your facility! We make it easy!
ScrubsAndBeyond.com
VISIT THE COUNTRY’S LARGEST SCRUB STORE AT
VISIT OUR SECOND LOCATION TOO!
Mon. - Fri. 8a- 8p • Sat. 9a - 6p • Sun. 11a - 5p
Mon. - Sat. 10a- 8p • Sun. Noon - 6p
7205 Fannin Street (the old Majors Books)
Houston, TX • 713-791-9434
2573 Town Center Blvd.
Sugar Land, TX • 281-242-2490

houston - Husch Blackwell

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