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The end of the century being only a few weeks away provides a time to reflect on our achievements and the directions we'll take upon entering the 21st century. Medically, this has been a most remarkable 100 years. When the century began, physicians could hardly treat any condition. Microbe-hunters taught us about germs, but no real treatments were yet available. My mother was especially happy when anti-tubercular drugs became available, as her brother had passed away from tuberculosis at age 23, in the mid 1930's. For me personally, I was proud to be a "Polio Pioneer" with my certificate from President Eisenhower informing me that I was one of the original young Americans who received the initial vaccine. The synthesis of penicillin, at the end of World War II, changed many lives and ushered in a new era. In 1921, Bantang and Best discovered insulin, It took another 45 years for insulin to be synthesized. Our hope is that islet cell implants will improve the treatment of the metabolic aberrations of diabetes. Medications that help so many and prolong life today were not available even 25 years ago. Beta-blockers, calcium channel blockers, ACE inhibitors, psychotropics, and inhibitors of viral replication, to mention only a few, play an important role in prolonging life and changing the natural history of many conditions. I believe the great biologic discovery of this century came in 1953 with the deciphering of DNA by James Watson and Francis Crick. Students today should read The Double Helix as a generation before read The Microbe Hunters. Another great leap forward recently came with the sequencing of the 22nd chromosome. It is hoped that with the next decade the remaining chromosomes will also be deciphered. Dr. Francis S. Collins, Director of the Human Genome Project, has put forth the concept of "pharmacogenomics" or gene-based medicine. A sample of DNA would be sent for chromosomal analysis. On the basis of the genes involved, a genetics counselor could focus on healthcare and risk. Prophylactic medical treatment could then be instituted to reduce the risk if a high-risk gene were present for a specific condition. The concept of preventative medicine, genetically individualized, would be a significant contribution to healthcare. As physicians, we're helping to change the course of human disease. Biological agents are poised to treat rheumatoid arthritis and many other conditions. Monoclonal antibodies will soon be available for an array of diseases. Twenty years of MRI imagining has opened up new vistas in diagnosing many conditions. New applications of technologies will further expand our horizons in the years to come. Many new challenges confront physicians on a daily basis. The dilemmas presented by assisted suicide, cloning, the use of genetic information, and patient confidentiality, will necessitate facing new moral and ethical issues. This new era of medical possibilities will truly improve the human condition. Yet, with all that has been accomplished in the past 25 years alone, some people seem less than satisfied with our available treatments. People today have a huge interest and spend massively on remedies and treatments, which have yet to be scientifically proven to be beneficial. Is this a frustration with today's medicines or a fear of potential adverse reactions? Some people believe that what is "natural" might be safer, even if unproven. Sometimes others reject conventional medicine for less traditional remedies in an effort to exert control over their medical care. Hopefully, controlled studies in the years ahead will tell us about the effectiveness of these unproven remedies. The last century brought us great
scientific and technological advances. This next century will bring a
brave new world of biological progress. The instruction book of life
will soon be available with the sequencing of chromosomes. It will be
our responsibility to maintain moral and ethical standards in applying
our new knowledge. The next century will be an exciting time in medicine
as the secrets of nature unfold.
Newsday's thought-provoking series on inappropriate medical care raised a number of issues concerning physicians, managed care organizations and physician discipline. Nobody is more concerned about providing patients with the best possible care, and weeding out the bad physicians, than the physician community itself. It may interest your readers to know that four years ago the physicians of the Medical Society of the State of New York actually requested that New York State increase physician licensing fees to enable better funding of the State's disciplinary process. Your articles fail to acknowledge that the application and screening process for hospital credentials in New York State is among the most arduous in the country. Physicians in New York State are among the best in the country since those with poor training or skills are precluded from hospital affiliation and thus an ability to practice in New York. Are there physicians who should not be practicing medicine in New York State? Of course, and the [MSSNY] is the first to demand that incompetent physicians be denied credentials to practice in the state. Clearly, the safety of patients and the rendering of competent medical care must be paramount in judging the right of a physician to maintain a license to practice. But the continual supervision of practicing physicians by medical staff review boards, the state Office for Professional Medical Conduct, specialty groups and medical society peer review boards makes it unlikely that a poorly skilled physician will operate for very long. There are just too many people constantly gauging a physician's competence. Undeniable, during a lifetime of patient care, a physician will makes errors. But serious medical incompetence is rare and the ongoing careful scrutiny makes the state's health care delivery system among the best in the country. As your series points out, the patients should take every opportunity to know as much as possible about physicians, and other health care providers on whom they depend for medical services. Patients seeking a qualified physician should call their local county medical society which maintains a roster of qualified physicians by specialty and location. John A. Ostuni, MD
The AMA filed a lawsuit on December 2, 1999, charging HHS Secretary Donna Shalala with acting contrary to the intent of Congress by refusing to exercise her authority to correct errors in the system used by Medicare to pay physicians for care provided to the nation's elderly. The AMA maintains that HCFA had the statutory authority to implement annual reconciliations for shortfalls created by erroneous projections in the growth of Medicare spending. HCFA promised that the difference between its projections and actual data would be corrected in future years, but it reneged on this promise a year later. Failure to correct the projection errors has resulted in an unlawful fiscal burden for physicians estimated at $3 billion. If successful, the lawsuit would require HCFA to compensate physicians for the under calculation that took place in 1998 and 1999 by adjusting the annual update of payments for physicians services under Medicare.
As part of the New York State Cancer Surveillance Improvement Initiative, maps have been released by the New York State Cancer Registry showing cancer incidence rates in Nassau County. The maps are based on data collected for the five-year period, 1992-1996, for lung, breast, and colorectal cancers. These are the leading causes of death in Nassau County.
Copies of the current cancer maps can be accessed on the Internet at www.health.state.ny.us. Reprints of the maps as well as the new report, "Cancer Trends in Nassau County, 1992-1996 Update", which covers data on lung, breast, colorectal and other cancers, are also available at the Nassau County Department of Health at 571-1515.
On December 2, the New York State Court of Appeals ruled 7-0 that the Physician's Desk Reference (PDR) cannot be read to the jury in a medical malpractice trial as evidence that the physician failed to follow the accepted standard of care in prescribing medications to a patient. The decision affirms the prior rulings of a trial court and an appellate court which held that offering the PDR as evidence of a physician's standard of care constitutes inadmissible hearsay. The New York State Court of Appeals noted that it has long been the rule that the standard of care for physicians is one established by the medical profession itself and not recommendations in the PDR, and that if the PDR is admissible into evidence in a medical malpractice action, the standard of medical care would be established by drug manufacturers instead of the medical profession. MSSNY submitted an amicus curiae brief to the Court of Appeals warning that if the PDR was held to establish the standard of medical care for prescribing medications, it would have a chilling effect on the exercise of clinical judgement by physicians. Further disclaimers by both the PDR and Food and Drug Administration state that the PDR and drug package inserts do not limit the manner in which a physician may use an approved drug.
MSSNY supports an extension of the Health Care Reform Act (HCRA) of 1996, which authorizes insurers and other payors to negotiate the rate of payment for inpatient hospital services, as well as establishing a payment mechanism to provide funding for "public good programs" which benefit society at large. Funding for these "public good" programs under HCRA is derived from an 8.18% surcharge on payments that insurers make for services rendered on hospitals, diagnostic and treatment centers and clinical labs, as well as a regional "covered lives assessment" on insurers for all the individuals or families they insure. Among the public goods funded by HCRA, are reimbursement for uncompensated health care provided by hospitals, graduate medical education costs to teaching hospitals, the physicians and resident loan repayment program, Child Health Plus and several other initiatives at a cost of $2.7 billion a year.
The Department of Health (DOH), Bureau of Controlled Substances (BCS), advises that the new single-part official prescription form required to be used by providers pursuant to Chapter 537 of the Laws of 1998 will likely begin to be issued in March of 2000. By then, the DOH anticipates the regulations required for implementation will be adopted. At this time, the implementation date is still not certain, given that most proposed regulations have not yet been published. BCS advises that the regulations will likely permit physicians to use their old triplicate prescription forms through the end of the year 2000. BCS also advises that, prior to the implementation date for the new single-part form, physicians should not order any more triplicate forms than needed for the year 2000. More specific information will be provided as it becomes available.
The Credentials and Awards Committee of the Academy of Medicine invites all members of the Academy to consider nominating a fellow Academy member for Fellowship in 2000. You have the opportunity to honor as Fellows, those of your colleagues who have contributed their time and effort to their specialties, their communities, to medicine and to the Nassau Academy of Medicine. Please consider the achievements of those whom you believe to be outstanding in these areas. Nominees must be current members of the Nassau Academy of Medicine. Your input and prompt cooperation will be very much appreciated. Send your nominations in writing to:
John F. Aloia, MD, was elected to Winthrop University Hospital's Board of Directors at its most recent meeting. Dr. Aloia is Chief Academic Officer at Winthrop. He is former Chairman of the hospital's Department of Medicine. In addition, he serves as Associate Dean and Professor of Medicine at SUNY Stony Brook School of Medicine. Paul Friedmann, MD, has been named Medical Director of the Lynbrook Dialysis Center. He serves as attending physician at the following hospitals: South Nassau Communities Hospital, Oceanside, Mercy Medical Center, Valley Stream and Long Beach. He is a member of the American Society of Nephrology and the American Medical Association.
If your practice has received insurance carrier payments which have been inappropriately "bundled", please report this to the NCMS Peer Review Committee. The Committee is working in close concert with several carriers and is able to assist members in adjudication of disputed payments. It is also important that we be able to document cases of inappropriate "bundling" in order that these problems can be brought to the attention of both the carriers and the governmental agencies assigned to prevent this practice. Your reports must be in writing and mailed to: Peer Review Committee
In order to meet the needs of the membership and to be able to respond to telephone calls more quickly, the Society and Academy have installed a new telephone system. In short, the main telephone number will remain the same: 832-2300. All departments and staff will now be assigned a specific extension off the main number. They are as follows:
A Roledex Card with all department and personnel extensions was mailed out with the November meeting notice. Please look for it and keep it handy.
The Nassau County Medical Society is pleased to welcome the following new members who were elected at the September 28, membership meeting:
Our congratulations to all these new members. We encourage you to become active participants in the activities of the Society through committee membership and grassroots efforts.
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