Penn State College of Medicine recently held its 50th annual white coat ceremony to welcoming its incoming class of 152 future doctors.

The medical school is located just outside Lancaster County and is affiliated with Penn State Hershey Milton S. Hershey Medical Center, which is located on the same campus.

The class included 55 Pennsylvania residents, including several from Cumberland, Dauphin and Lancaster counties.

The white coats marked their entrance to the medical profession as student physicians.

The medical school said the students were selected from a pool of 8,615 applicants. The 82 women and 70 men had 71 different undergraduate majors, have been to more than 50 countries and speak more than 25 languages.

It also noted that more than 40 percent of the incoming students identify as part of an ethnic minority -- and on a lighter note, that three play the ukulele.

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From 8615 applicants, Penn State College of Medicine welcomes incoming class of 152 - LancasterOnline

Ancel Keys, arguably the most influential nutrition scientist of the past half-century, died in 2004 at the age of 100. Keys invented the K ration, named for him, that provided our deployed military with portable and complete nutrition. He was among the first, if not the first, to hypothesize that heart disease was not an inevitable consequence of aging but likely related to diet and lifestyle.

Obvious as that now seems, someone had to be the first to consider it and that someone was Ancel Keys. He developed and directed the Seven Countries Study, a colossal undertaking that tested the above hypothesis, concluding that variation in dietary sources of saturated fat notably meat and dairy contributed importantly to cardiovascular risk.

Throughout most of his life, Keys was celebrated as a public health hero. He graced the cover of TIME Magazine as such in 1961. In the years leading up to his death, however, and in the decade since, much of the public commentary about Keys, his lifes work, his seminal Seven Countries Study, and his integrity has been derogatory. There are five apparent reasons for this.

The first is perhaps best described as Newtonian: for every action, an equal and opposite reaction. Maybe we simply cant resist the inclination, whenever someone settles securely on a pedestal weve placed under them, to shift our efforts to knocking them down.

The second might best be described as Aesopian, as in the Aesops Fable that says: we are all judged by the company we keep. The latter years of Keys life, and those since his death, were concurrent with misguided forays into low-fat dietary boondoggles, and somebody had to be blamed for Snackwells. In many quarters, that somebody wound up being Ancel Keys, for having pointed out the harms of dietary fat albeit only certain dietary fat in the first place.

The third reason is that everyone seems to love a good conspiracy theory. So, there were careers to launch and books to sell, as there are today, by telling us all that everything authorities had advised was wrong, that the real truth was being concealed, distorted or suppressed. As one of the worlds preeminent epidemiologists, Keys was among such authorities, and thus an obvious target of conspiracy theory, revisionist history and alternative facts.

The fourth reason was the advent of the internet.

Once upon a time, you needed actually to know something to broadcast expertise, because an editorial filter stood between you and the public at large. There were ways around this, of course, such as the reliance on celebrity as an alternative to content knowledge as a basis for selling books, lotions, potions or programs. But even so, the means of disseminating messages favored those with some claim to genuine merit.

Now, anyone with internet access can broadcast opinion, masquerading as expert opinion, into the echo chambers of cyberspace, where those who own the same opinion already will amplify it. So, for instance, those totally devoted to eating or selling meat, butter and cheese are also apt to eat up, and regurgitate, any allegations against those pointing out the related liabilities.

The fifth is the most obvious: along with not wearing plaid, dead men dont fight back very effectively, either. Keys has mostly been turned into a scapegoat since dying. By way of reminder, he lived to 100 and applied what he thought he knew about diet and lifestyle to himself. That alone would make him a candidate for both celebrity and expert status today. One imagines the book: Diet of the Century.

The popular allegations against Keys are: (1) he cherry picked countries to enroll in his study to align with the beliefs he already held; (2) he fudged or selectively presented data to make a case aligned with the beliefs he favored; (3) he either failed to study sugar or misrepresented findings about it; and (4) he advocated for a now generally discredited low-fat dietary pattern.

The True Health Initiative, a 501c3 nonprofit organization I founded to identify and disseminate the fundamental truths about lifestyle and the health of people and planet alike, based on the weight of evidence and the global consensus of experts, commissioned a White Paper to determine the veracity of these claims. The paper, with its extensive and fully transparent bibliography of primary source material, was just released, and is accessible to all. The basic conclusion is that all popular disparagements of Keys and his research are demonstrably false.

Lies, repeated often enough, can smother the truth. After a decade of lies about Ancel Keys and the Seven Countries Study, its time for the truth to break free, and strike back clad in plaid or otherwise.

Dr. David L. Katz;www.davidkatzmd.com; founder, True Health Initiative

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Dr. David Katz, Preventive Medicine: Ending a decade of diet lies - New Haven Register

Certified physician assistant Cathy Noble, along with Jen Schuster and Leah Boyer with Almond Aesthetic Medicine in Klamath Falls have all recently completed the Continuing Education Learning Program and passed the written examination for the Laser Training Institutes course in Aesthetic Laser Procedures, according to a news release. This course focuses not only on laser hair removal, but also light based non-ablative skin rejuvenation and the treatment of benign pigmented lesions and red vascular lesions. They also received updates on their academic training in skin and hair biology, laser and intense pulsed light use and energy concepts, tissue optics and laser effects and laser hazards and safety.

With the completion of the Aesthetic Laser Procedures course, Schuster has also applied for and received her advanced aesthetician certification from the state of Oregon.

Almond Aesthetic Medicine offers laser and intense pulsed light use procedures, dermal fillers and injectables, multi-derm abrasion and SkinPen collagen treatments, medical-grade chemical peels and skincare products. They are also partners with Allergans Brilliant Distinctions patient rewards program.

Almond Aesthetic Medicine is at 2613 Almond St. and is open 9 a.m. to 5 p.m. Wednesday through Friday. For more information, call 541-887-8229 or visit facebook.com/almondaestheticmedicine.

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Almond Aesthetic Medicine staff complete program - Herald and News

has more than 20 years experience

CFP Care Group has announced that Dr. Jose Santiago, left, has joined Dr. John Potomski, right, in his Brevard County offices, located at 720 East New Haven Avenue, suite 11 in Melbourne.

BREVARD COUNTY MELBOURNE, FLORIDA CFP Care Group has announced that Dr. Jose Santiago has joined Dr. John Potomski in his Brevard County offices, located at 720 East New Haven Avenue, suite 11 in Melbourne.

He will be practicing in rehabilitation, skilled nursing, assisted living and independent living facilities throughout the Space Coast.

Dr. Santiago is a graduate of Ponce School of Medicine in Ponce, Puerto Rico. He completed his residency in internal medicine at Highland Hospital University of Rochester, New York.

He is Board Certified in Internal Medicine and is a Fellow of the American College of Physicians. Dr. Santiago has more than 20 years experience in the Primary Care and General Internal Medicine. Dr. Santiago moved to Brevard County in 2004 and was formerly associated with a group practice in the area.

We are so privileged to have such an experienced and compassionate physician of his caliber to join our practice, said Dr. Potomski.

Dr. Santiagos professional interest include geriatrics, cardiovascular disease, diabetes, quality assurance and managed care, as well as Clinical Research and Medical Education.

For more information, or to make an appointment with Dr. Santiago, please call the CFP Care Group at 321-724-4545.

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Internal Medicine Physician Dr. Jose Santiago Joins Dr. John Potomski's CFP Care Group - SpaceCoastDaily.com

KOKOMO Community Howard Regional Health announced recently that Dr. Mary Apiafi, a physical medicine and rehabilitation physician trained in sports medicine, has joined the hospital and is now seeing patients in Kokomo, according to a Community Howard Regional Health press release.

Dr. Apiafi joins orthopedic physicians Clifford Evans, Courtney Holland and Mohammad Nekoomaram at Community Howard Orthopedic Center, located at 3512 S. Lafountain St. in Kokomo. Dr. Apiafi will practice in Kokomo full-time and will specialize in sports medicine and the treatment of chronic and acute orthopedic or musculoskeletal injuries, according to the press release.

Dr. Apiafi comes to Community Howard with experience working with high school, college and professional athletes, having provided coverage for both the Cleveland Cavaliers and Cleveland Indians. In addition to her sports medicine experience, Dr. Apiafi is skilled in interventional procedures from the spine to the peripheral joints. She is also trained in regenerative medicine and shockwave therapy.

Dr. Apiafi graduated from the Sports Medicine fellowship program at Cleveland Clinics Sports Health Center in June 2017 after earlier completing a residency in Physical Medicine and Rehabilitation from the Albert Einstein College of Medicine in New York City.

To schedule a consultation with Dr. Apiafi call 765-865-6633.

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Community Howard hires physical medicine and rehabilitation physician - Kokomo Tribune

Donald Trump pauses before speaking at the Big Sandy Superstore Arena in Huntington, West Virginia. Photograph: Saul Loeb/AFP/Getty Images

Country roads, take me home To the place I belong West Virginia, mountain mamma Take me home, country roads

The crowd erupted as John Denvers 1971 song filled the arena. Behind a black curtain, beneath a blue Make America great again! sign, Donald Trump was preparing to make his grand entrance.

I know when hes waiting to come out his heart is pounding because hes coming to a field of love, said Gene Huber, 47, a former used car salesman who was attending his seventh Trump rally. The rallies fuel him up.

Enter the showman, big, besuited, orange-topped, slowly traversing a black ramp to centre stage. The American president was greeted by roars as if for a rock star or sporting hero. He clapped in time to chants of Trump! Trump! Trump! from the 9,000-strong crowd. When he held aloft a black sign that said Trump digs coal, the cheers somehow became even louder.

The election might have finished nine months ago but Trump is still on the road and still bashing Hillary Clinton. Thursday nights rally in Huntington, West Virginia, was his seventh since becoming president, each in a different state that voted for him. With a formidable domestic and foreign policy in-tray waiting for him back at the White House, why does he still do them?

Trumps ego, his love of televised spectacle, his need for a shot of adrenaline and his hunger for another victory in 2020 are all part of the story, but in Huntington there appeared to be a more utilitarian some would say sinister purpose. Hours after it was revealed that special counsel Robert Mueller had convened a grand jury in Washington to investigate the Trump campaigns alleged collusion with Russia, the president rallied his base against what he claimed is a politically motivated ruse.

We didnt win because of Russia; we won because of you, he insisted. Have you seen any Russians in West Virginia or Ohio or Pennsylvania? Are there any Russians here tonight, any Russians?

There was laughter from the spectators. The president warned: Theyre trying to cheat you out of the leadership that you want with a fake story that is demeaning to all of us and most importantly demeaning to our country and demeaning to our constitution.

The tactic was straight from the playbook he used last year to claim, without evidence, that the election was being rigged against him. This time it was a pre-emptive strike to delegitmise those investigating the Russia links the media, Congress and Mueller by implying that they are hostile to Trump and therefore, by extension, hostile to his supporters. It was a calculated attack on the anti-Trump elites purportedly once again subverting the popular will.

As ever, the response on the pro-Trump Fox News was instructive. The conservative commentator Charles Krauthammer said: I think that the appearance that he did in West Virginia tonight is a way of saying, My numbers may be down, but I command a formidable army.

Trump followed up the next morning on his Twitter account by highlighting a prediction from another Fox News presenter, Jeanine Pirro, of a national uprising if a member of the presidents family is indicted.

West Virginians are always overlooked but he hasnt overlooked us. The people love him

Each Trump rally is a slickly choreographed cavalcade of God, the military, patriotism, politics, baby boomer rock and the magic trick in which a New York billionaire sells himself as a working class hero. As pop concerts and festivals show, digitally saturated culture has done nothing to diminish the publics appetite for live performance, for breathing the same air as your idol. Trumps focus on so-called flyover states that feel deprived of the action may have been crucial in his election win.

Now the monthly ritual sees roads closed off by police around a music venue or sports arena and a small but determined band of protesters singing and waving signs such as, Grab Trump by his Putin and I know, I know, I stand up for people, Im such a bitch. Occasionally Trump supporters standing in line shout abuse, or sing rival songs such as Build the wall!. Seldom is there violence.

Inevitably in the global capital of capitalism, the rallies are also a chance to make a buck. On Thursday Frado Smith, 47, had taken a break from selling merchandise at a series of Phish concerts in New York to stand on a street corner hawking Adorable deplorable for Trump T-shirts and Hillary for prison 2016 badges.

People want to be seen, people want to be heard, he said. You cant do that in your own house.

Among those wanting to be seen and heard was AC Cordell, 45, a musician. He said of Trumps motivation for coming: Part of it is about trying to maintain the hype around the pre-election. Theres been a lot of resistance and negativity but this is like medicine for him. Trump is a rallyer: he loves to build businesses and he loves to build people up too. He relishes the moment to be in the public eye and be the entertainer. Hes a rock star or professional athlete: they all like to get the crowd riled up.

Lynette Kennedy McQuain, 57, a retail merchandiser, said: West Virginia could not have dreamed a president would come back to us. West Virginians are always overlooked but he hasnt overlooked us. The people love him: he connects with the average American. Money doesnt distance him from the ordinary desires of people. Hes just a man and he just wants whats best for the country.

Trumps demotic self-expression has always been part of the appeal. He tells it like it is, has been a common refrain from Trump supporters for two years. McQuain said: Hes not a politician and I believe when hes talking he talks like he would at the dinner table. People dont want political talk. They want someone who understands what theyre going through.

John Perdue, 49, an unemployed former coal company worker, was wearing a T-shirt with the message: Trump digs coal. Black gold. He recalled a campaign rally in nearby Charleston where the then candidate donned a miners helmet and pretended to dig. The gesture has been much mocked in the media ever since. But to Perdue it signalled recognition and respect.

It was just a very special moment to see him put the miners hat on and support the miners, he said. Hillary was against coal [all] the way. He was the first person who cared about us. Hes very much in touch with the ordinary neighbourhood person thats trying to make a living.

Inside the packed venue, signs said Promises made and Promises kept amid three giant flags bearing the stars and stripes. The playlist booming from loudspeakers included the Beatles, Celine Dion, Elton John and the Rolling Stones. An elderly woman wearing a pink Women for Trump T-shirt danced with her husband, earning cheers from a group of young women and girls who swayed to the music while holding Drain the swamp placards. Children wore Make America Great Again hats. The crowd reflected the local area in its lack of racial diversity.

Warm-up acts included an invocation prayer (make America good again); the pledge of allegiance to the flag led by a 93-year-old veteran of Iwo Jima (our president Donald Trump is making America great again); a rendition of the Star-Spangled Banner; a sports coach (he said he would help our coal miners and he has); a state senator (he hasnt let the fake news slow him down); an ex-marine and farmer (I appreciate Donald Trumps down-to-earth manners); and Trumps pregnant daughter-in-law Lara.

This man is a good man. Hes got a backbone. Hes got real ideas. He cares about America

Im so proud that I can welcome my son into a world where Donald Trump is our president, she said.

After his rapturous welcome and a chorus of USA! USA!, the president boasted that the stock market was at an all-time high. Why did a crowd in West Virginia, one of the poorest states in the union, celebrate plutocrats on Wall Street? Trump assured them it will be good for their retirement savings: Have you all been helped? I think so!

He spoke of reviving beautiful, clean coal and yanking the US out of the Paris climate agreement a line likely to elicit boos in New York or Washington but cause for roars of approval here. And as if from muscle memory, he slammed Clinton over her use of a private email server while secretary of state, eliciting familiar but still shocking jeers of Lock her up!

Trump gleefully paraded West Virginia governor Jim Justice who, defecting from the Democrats to the Republicans, said of the president: This man is a good man. Hes got a backbone. Hes got real ideas. He cares about America. He cares about us in West Virginia. And most importantly of all, you know what, he has made us, as common everyday Americans, feel good and be proud of who we are.

That last sentence explains much of the Trump phenomenon. As the crowd whooped in awe and admiration, it was hard to believe the presidents worst week the collapse of healthcare legislation, his communications director uttering profanities and later departing, wayward tweets about transgender troops had ever actually happened. Offering drama, swagger and the illusion of certainties in an uncertain world, the rallies are vital in sustaining this alternate reality.

Drew Lichtenberg, resident dramaturg and literary manager at the Shakespeare Theatre Company in Washington, said: Trump understood on some level the campaign rally is its own genre of performance and self-consciously aestheticised it. Hes interested in the form itself of the campaign rally rather than what hes there to say.

Lichtenberg compared Trumps post-election rallies to a provincial touring show trying to recapture the glories of its Broadway run, with the reference to Clinton a bit that can be relied on to kill with audiences.

He obviously enjoyed running for president because of the adulation of the crowd. He enjoys playing the role of president more than being president. He now wants to stage an encore performance of his campaign rallies. Its a very strange way to govern.

Trumps supporters frequently condemn safe spaces on university campuses but the rallies are his own safe space, far from the intrigue, factional infighting and Russia investigations in Washington.

Gwenda Blair, a Trump biographer, said: In front of a rally he has to be a performer. Theyre there because he might say something unexpected. Thats what hes very good at and hes done it very successfully his whole career. The soundbite, the unexpected lurch, often attacking some sacred cow like John McCain or the pope, showing he wont stop at anything to defend his people.

Blair characterised Trumps langage at rallies as typically a blend of incomplete thoughts, simple vocabulary and repetition laced with bullying, threats and grievance.

Thats a very compelling message, she added. That language is about telling you what you want to hear, not the truth and the facts. Hes found it works most of the time in business but not so well from the White House.

Continued here:

Why Trump still needs the love of the crowd: 'This is like medicine to him' - The Guardian

Posted 04 August 2017 By Michael Mezher

In an article in the New England Journal of Medicine on Thursday, former director of the US Centers for Disease Control and Prevention Thomas Frieden calls for greater use of alternative data sources, other than randomized controlled trials (RCTs), for health care decision making.

"For much, and perhaps most, of modern medical practice, RCT-based data are lacking and no RCT is being planned or is likely to be completed to provide evidence for action. This 'dark matter' of clinical medicine leaves practitioners with large information gaps for most conditions and increases reliance on past practices and clinical lore," Frieden writes.

The article comes as the US Food and Drug Administration (FDA) looks to flesh out a framework for the use of so-called real world evidencesuch as data from observational studies, routine safety surveillance, patient registries and insurance claimsto evaluate drugs and medical devices.

Last week, FDA announced it will hold a public workshop in collaboration with the Duke-Margolis Center for Health Policy in September focused on the development of such a framework.

While RCTs are considered the "gold standard" for generating evidence to support the approval of new drugs, Frieden argues that in some cases, observational studies may be more appropriate for determining health outcomes.

"Although they can have strong internal validity, RCTs sometimes lack external validity; generalizations of findings outside the study population may be invalid," Frieden writes.

But, Vinay Prasad, a hematologist-oncologist and assistant professor of medicine at the Oregon Health and Sciences University, told Focus that this assertion somewhat misses the mark.

"When are randomized trials desperately needed? To prove that at least in some circumstances a therapy can work you have to show that something can work under some circumstances to move forward. You cannot assume this. Only an RCT can tell you this unless the effect size is huge," Prasad said. Prasad also said that sponsors can increase the external validity of RCTs by loosening their inclusion criteria to allow for a more varied patient population.

Frieden also argues that RCTs often have insufficient study periods and small sample sizes, which can lead to unanswered questions about treatment effect duration and rare adverse events that are only answered after a product enters the market.

As an example, Frieden points to the case of FluMist, the live attenuated influenza vaccine nasal spray, which was shown to be superior to inactivated influenza vaccine in children in multiple RCTs. Despite the effect shown in those studies, a later observational study found that FluMist was less effective than previous studies showed.

Here, Prasad argues that RCTs are still necessary to hash out the effect of the two treatments. "Most interventions, including the ones discussed by Frieden have modest effect sizes. For these things you need RCTs to separate true effect from your bias," Prasad said.

Frieden also points to a number of issues that limit the practicality of conducting RCTs, including their high cost and difficulty to plan and implement. As a tradeoff, Frieden says these constraints can lead sponsors to rely on surrogate markers or recruit patients from high-risk patient populations that might not reflect the broader patient population to speed along their studies.

But, Prasad says these issues are not inherent with RCTs, arguing that innovations could be made to bring down their costs and startup times.

Despite these issues, Frieden says that "current evidence-grading systems are biased toward RCTs, which may lead to inadequate consideration of non-RCT data." Though, while advocating for greater use of other data sources, Frieden says FDA's standards for evaluating safety and efficacy should be lowered.

Rather, "there should be rigorous review of all potentially valid data sources," Frieden writes.

NEJM

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Former CDC Director: Medicine Should Look Beyond Randomized ... - Regulatory Focus

Posted 9 hours ago in Arts, Music

Photos submitted by Luke Jensen.

Several bands from around the state will find their way to the Junction of Highways 287 and 487 this weekend, when the town of Medicine Bow hosts the 9th Annual Battle of Old Wyoming.

It is not an actual Battle of the Bands,' says Casper record store clerk and one of the Battles organizers, Brandon Schulte. Im loathe to use the word festival, because theres too many festivals, that word gets thrown around too often these days. Its a party. Its an underground celebration of underground music and culture, focused on the state of Wyoming.

Article continues below...

The Battle of Old Wyoming began as a collaborative effort between Schulte and his friends, Thomas French and Charlie Stewart. In an archival interview from the first Battle of Old Wyoming, French explains that he was inspired by a trip to Laramie when he stopped in Medicine Bow for lunch. Exploring Medicine Bows historic Virginian Hotel, he was inspired to buyout the hotel and throw a free rock show. The tradition has maintained now for 9 consecutive years.

Weve never charged cover charge. This is not about ticket sales, its not about the organizers getting anything, its a 100% volunteer effort, explains Schulte. This is basically the one gathering in Wyoming where all of the weirdos are the ones that come to center-stage. Its about experimental electronic, its about death metal. Its about giving great punk bands and great hardcore and post-rock, and death-rock, and avant garde and experimental bands to play for a large, receptive audience.

Schulte goes on to say that he and the other organizers have traditionally viewed the Battle as a community service, and not a way to make money. As far as money, its more important to me and to the people who have helped this thing grow and survive, that the money goes to the fine people of Medicine Bow.

Medicine Bows Tara Johnson works at the hotel during the Battle, and had high praise for the event. Johnson confirmed that the party serves as one of the main summer weekends for the hotel.

During the early 1900s, The Virginian hotel was the largest hotel between Denver and Salt Lake City. The hotel was named after the famous Owen Wister novel, which takes place in the areas surrounding Medicine Bow. Across from the Virginian Hotel is the Owen Wister Cabin, which was to the are, log-by-log and now serves as a museum.

Attendees of the Battle have booked out the Virginian hotel entirely, many other attendees camp-out nearby, some still are known to sleep in their vehicles. Music fans can also belly-up to the notable Virginian Hotel bar, which in years past has been run out of Pabst Blue Ribbon and Wild Turkey before the end of the Battle.

The party is held over two nights, August 4th and August 5th. Bands featured include:

If the years have taught me anything, its that theres already such unbelievably interesting music here in the state of Wyoming, Schulte says. So many people leave a Battle of Old Wyoming saying oh my god, I had no idea that this kind of thing happens in this state. And it does, it totally does.

The Battle of Old Wyoming will kick off tonight, August 4th at 6 pm, go until night, then will resume at noon on Saturday until late.

Tagged: Battle of Old Wyoming, Carbon, Carbon County, Medicine Bow, Owen Wister, The Virginian Hotel, Thomas French

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Wyoming Underground Bands Gear Up for Battle In Medicine Bow - Oil City

The Marshall University Joan C. Edwards School of Medicine conducts its white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch The incoming students line up before the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch The incoming students line up before the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch The incoming students converse while waiting for the Marshall University Joan C. Edwards School of Medicine white coat ceremony to begin on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Vice dean Bob Miller, M.D., welcomes the audience at the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Hayden Ansinelli introduces the keynote speaker at the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Paul B. Ferguson, M.D., delivers the keynote address during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Paul B. Ferguson, M.D., delivers the keynote address during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch The incoming students take to the stage during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Timothy C. Adkins receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Halley J. Alberts receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Kara V. Anderson receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Hannah B. Asebes receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Hannah B. Asebes receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Mercy O. Babatope receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Nathan A. Baisden receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch David E. Bartlett receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Adam N. Bicak receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Adam N. Bicak receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Heather M. Bucur receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Meagen M. Carter receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Mark T. Castle receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Mark T. Castle receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Zachary L. Casto receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Matthew J. Cincotta receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Amanda R. Clark receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Amanda R. Clark receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Carly A. Clark receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Kevin A. Clark receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Sarah L. Cole receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Ryann N. Conley receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Ryan F. Cooper receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Madison N. Crank receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Hannah Rose Datz receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Jordan N. Dever receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Samuel P. Dungan receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Mohamed A. Feliachi receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Mohamed A. Feliachi receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Benjamin J. Frear receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Ifeoluwatomi Fuwape receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Ifeoluwatomi Fuwape receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Logan R. Godfrey receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Sydney M. Graham receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Sydney M. Graham receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Angela M. Haikal receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Angela M. Haikal receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch William A. Hayes receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch William A. Hayes receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Harsha S. Iyer receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Harsha S. Iyer receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Daniel S. Jayasuriya receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Daniel S. Jayasuriya receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Madison M. Jennings receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Samuel A. Kaplan receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Shefali Khanna receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Shefali Khanna receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Shefali Khanna receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Ruth V. Knouse receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Timothy M. Kocher receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Nicholas W. Lehman receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Hannah R. Leport receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Hannah R. Leport receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Jesse C. Lewis receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Jesse C. Lewis receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Jett A. MacPherson receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Evan M. McClanahan receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Colin E. McCorkle receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Colin E. McCorkle receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Richard B. Miller receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Ibrahim A. Mohammed receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Ibrahim A. Mohammed receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Ibrahim A. Mohammed receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch David Mounts receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Noor Mozahem receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Caitlin M. Mulvihill receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Cherishma Nagisetty receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Cecilia M. Nease receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Nicholas Joseph E. Newell receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Nicholas Joseph E. Newell receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Katina K. Nicoloudakis receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Charity C. Powers receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Mohammed I. Ranavaya II receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Mohammed I. Ranavaya II receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Jonathan W. Ray receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch James F. Richey Jr. receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Kayla S. Rodriguez receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Benjamin T. Russell receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Matthew S. Schade receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Drake A. Securro receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Scott T. Thiesfeldt receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Allison C. Thompson receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Landon D. Thompson receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Rachel L. Wargacki receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Rachel L. Wargacki receives her white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Dylan S. Weaver receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Samuel C. Wood receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Samuel C. Wood receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch Anthony S. Workman receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch John D. Young receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

Ryan Fischer/The Herald-Dispatch John D. Young receives his white coat during the Marshall University Joan C. Edwards School of Medicine white coat ceremony on Friday, August 4, 2017, at the Joan C. Edwards Playhouse in Huntington.

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Photos: Joan C. Edwards School of Medicine White Coat Ceremony - Huntington Herald Dispatch

The US$100 billion, 1,400-hectare mixed development aims to serve 700,000 residents, and the health facility could lure medical tourists to the Iskandar development zone near the border with Singapore

By Bhavan Jaipragas

4 Aug 2017

Forest City, the sprawling US$100 billion property development being built on artificial islands in Malaysias version of Shenzhen bordering Singapore, is already slated to have seafront high-tech office complexes, schools and hotels.

Now, its Chinese developer, Country Garden Holdings, has unveiled plans to launch a traditional Chinese medicine hub to serve its future population of 700,000 people, many of whom will be from China.

Country Garden Pacificview, the joint venture holding company that owns Forest City, said in a statement on Friday that it had signed an agreement with the Foshan Hospital of Traditional Chinese Medicine to establish a satellite facility within the still-developing city.

Forest City is a 1,400-hectare mixed development being built on the southern tip of Malaysia, just off the border with Singapore. The area surrounding it the Iskandar development zone is seen as Malaysias answer to Shenzhen.

The hospital has a particular focus in orthopaedics and traumatology, thanks to its in-house research institute and a research laboratory focused on traditional Chinese medicine, Country Garden Pacificview said.

The agreement paves the way for the establishment of Foshans first hospital outside China, and potentially the largest traditional Chinese medicine hospital in Malaysia, it added.

There are also plans for Forest City to help Malaysian health authorities draw Chinese medical tourists to the Southeast Asian country, including those seeking assisted reproductive treatment. This is in line with burgeoning interest from the Chinese in medical tourism, said the developer.

The homebuilder on Friday also unveiled what it billed as the worlds largest industrialised building system facility. It said the facility would house the entire production base for the construction of Forest City, and integrate construction design, precast concrete production, transportation, processing of accessories, assembly construction, as well as materials research and development.

The facility streamlines the production of building parts through digitisation and automation.

While the initial focus of the facility will be to accelerate the development of Forest City, excess capacity will also be used to support the growing construction opportunities in Southeast Asia, Forest City Pacificview said. The Hong Kong-listed homebuilder also announced a tie-up with PCCW Global for the development of a new data centre.

The announcements come months after the high-profile Forest City development came under intense scrutiny following Beijings aggressive measures to tighten capital controls.

Some of its Chinese buyers were stranded, unable to make payments due to the annual US$50,000 foreign exchange quota for Chinese nationals. The developer said it offered to refund payments made by these buyers.

In an interview with the South China Morning Post this week, Yu Runze, the president and chief strategy officer of Country Garden Pacificview, said: The project is progressing very smoothly as planned. Its first tranche of apartments are due to be ready next year, but the entire project will not be completed until 2040. Forest City is a joint venture involving Country Garden and Esplanade Danga 88, a Malaysian holding company controlled by Ibrahim Ismail, the influential monarch of the Johor province.

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Malaysia's Forest City adds traditional Chinese medicine to its grand plan - South China Morning Post

Thousands of low-income patients may have to scramble to find new doctors this month after University of Chicago Medicine became the latest major health system to break up with IlliniCare Health, an insurer that administers benefits for the state's Medicaid program.

U. of C. Medicine follows Northwestern Medicine and Advocate Health Care in walking away from IlliniCare Health, one of 12 Medicaid managed care organizations in the state. Medicaid managed care organizations are insurers that handle benefits for Medicaid, a state- and federally funded health insurance program for the poor.

When the contract ends next month, about 8,000 IlliniCare members will no longer be able to get in-network services from U. of C. Medicine or University of Chicago Physicians Group, according to U. of C. Medicine. IlliniCare pegs that number closer to 4,000 patients.

That includes members who are part of a program serving women, children and adults who gained coverage as part of Medicaid expansion under the federal Affordable Care Act as well as a program serving older adults, people who are blind, and people who are disabled.

"After nearly two years of working to resolve payment issues, we are disappointed to announce that our current contract with IlliniCare Medicaid is scheduled to end Sept. 3," U. of C. Medicine spokeswoman Lorna Wong said in a statement.

But Michael Marrah, IlliniCare plan president and CEO, disputes the allegation of "payment issues" between it and the health system.

"There is a challenge with being reimbursed by the state but IlliniCare has continued to pay all of its providers in well under 30 days and with 99.9 percent accuracy," Marrah said.

He said it's not totally clear to IlliniCare why U. of C. Medicine is terminating its partnership with the insurer, though both parties say they're open to further talks.

Jennifer Smith Richards, Annie Sweeney and Jason Meisner

Both IlliniCare and U. of C. Medicine say they're working to help affected patients as they transition to new care. The health system has been getting about 100 to 200 calls a day from patients concerned about the termination after sending out notice last month.

Representatives from Northwestern and Advocate didn't elaborate on the reasons their systems no longer contract with IlliniCare.

Though it's unclear how large a role payment problems played in the U. of C. dispute, other Medicaid managed care organizations have struggled to pay their bills because of the state's budget problems. It's a situation that is "dramatically reducing the Medicaid recipients' access to health care," according to a June court order forcing the state to pay the insurers more money.

About 2 million Illinois residents get coverage through Medicaid managed care organizations.

Another Medicaid managed care organization, Family Health Network, had paid "virtually none of its providers since February," according to the June court order. Three large hospital systems and four hospitals left Family Health Network's provider network as a result. A spokeswoman for Family Health Network declined to comment.

Yet another Medicaid managed care organization, Aetna Better Health of Illinois, has threatened to leave the program if it doesn't receive more state payments.

Since lawmakers approved a budget last month, the state has started to pay the insurers more, but it still owes Medicaid managed care organizations about $3.5 billion.

Gov. Bruce Rauner announced in February that he planned to overhaul the state's Medicaid managed care program partly by narrowing the number of insurers that participate. Advocates of the change have said that would save money, streamline the program and improve health care.

The idea behind Medicaid managed care, in general, is to improve patients' health and spend money more efficiently.

Eight of the current 12 insurers responded to a request for proposals to participate. The state has not yet announced which insurers will be part of the revamped program.

lschencker@chicagotribune.com

Twitter @lschencker

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University of Chicago Medicine severs ties with Medicaid insurer IlliniCare - Chicago Tribune

Posted on 8/4/2017

MORGANTOWN, W.Va. A.J. Monseau, M.D., WVU Medicine Emergency Medicine and Sports Medicine physician, has been selected to serve as head team physician and medical director for WVU Athletics.

WVU Athletics are a point of pride for all of us in West Virginia, and as a WVU alumnus, Dr. Monseau embraces the Mountaineer spirit, Albert Wright, president and CEO of the West Virginia University Health System, said. An athlete himself, Dr. Monseau has dedicated his career to caring for athletes, so we know he will do a great job.

Last year, Dr. Monseau served as the team physician for WVU Mens Basketball. He also served as team physician for USA Wrestling at the 2016 Olympic Games in Rio de Janeiro, Brazil.

As head team physician and medical director for WVU Athletics, Monseau will lead the Universitys staff of team physicians and will work in conjunction with the athletic training staff to provide healthcare to all student-athletes. This includes injury prevention, treatment, rehabilitation, education, and counseling.

Medical care for our student-athletes is of the utmost importance to us, Director of Athletics and Associate Vice-President Shane Lyons said. Athletics has had a long-standing relationship with WVU Medicine that has spanned generations, and we look forward to that great relationship continuing for many years to come. I want to thank Albert Wright, (WVU Medicine Vice President and Chief Ambulatory Officer) Darin Rogers, and (WVU Health Sciences Vice President and Executive Dean) Clay Marsh for all their help, and we are excited to have A.J. in this new role.

Originally from the Northern Panhandle, Monseau received his medical degree from and completed his residency training at the WVU School of Medicine. He then completed fellowship training in primary care sports medicine at the University of Michigan School of Medicine. He returned to his alma mater upon completion of his fellowship in 2011.

Currently, Monseau is an associate professor in the WVU Department of Emergency Medicine. In addition to working as an attending physician in the J.W. Ruby Memorial Hospital Emergency Department, he also sees sports medicine patients through WVU Medicine Orthopaedics. He is board certified in emergency medicine and primary care sports medicine.

Athletics have always been a part of Monseaus life. After completing a three-sport career at Wheeling Park High School, Monseau carried his love of sports through his undergraduate education, during which he competed on the West Liberty University (then West Liberty State College) Wrestling Team for his father, who is a National Wrestling Hall of Fame coach. Though he gave up competing when he began medical school, he made sure to choose a specialty that would allow him to remain connected to competitive sports.

As a native West Virginian and WVU fan, it is an honor to be chosen for this position. I was fortunate enough to go into a field that affords me the opportunity to combine my two passions: medicine and sports, and now I have the privilege of leading the medical care for Mountaineer athletics, Monseau said. Im grateful to Mr. Lyons and Mr. Wright for the faith they have in me, and I hope to make them proud. I look forward to working with the other medical staff and athletic trainers to provide our athletes with the best possible care. Lets go, Mountaineers!

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WVU Medicine's Dr. AJ Monseau to serve as head team physician and medical director for WVU Athletics - WVU Medicine (press release)

NAMPA Family Medicine Residency of Idaho and Saltzer Medical Group in Nampa have announced a new affiliation for pediatric care.

Through the new affiliation, patients will have improved access to additional services including behavioral and mental health professionals, nutritional services and care coordination, according to a press release from Family Medicine Residency. Pediatricians will continue to provide primary care to Medicaid and uninsured pediatric patients.

Tremendous efforts have been made to make this transfer of patient care as seamless and smooth as possible for the former Saltzer patients and families, the press release stated. The same high-quality care will occur in the same locations with the same friendly faces.

The pediatric clinics will have locations in Nampa and Meridian in existing Saltzer Medical Group practices. The Nampa clinic is at 215 E. Hawaii Ave., and the Meridian clinic is at 3277 E. Louise Drive, Suite 200. Both are scheduled to open Sept. 1.

Family Medicine Residency of Idaho is affiliated with the University of Washington School of Medicine. Saltzer pediatricians will have the opportunity to teach and participate in other scholarly activities with the new affiliation.

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Saltzer pediatricians will affiliate with Family Medicine Residency of Idaho - Idaho Press-Tribune

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ORLANDO, Florida Disabled veterans rely on a team of doctors, nurses, and therapists to make their recovery.

Now they can rely on horses as well.

Francesca "Frankie" Langston had never been around horses until recently. Now she and Brooks are building a bond.

"If you say 'Hey Brooks' and he looks up, he knows you're here," she explained.

In 2004, Frankie was a Marine, serving in Iraq. She still gets emotional thinking about her deployment and her return to civilian life in 2005.

"Feels like you're dropped out here by yourself to be honest," she recalled. "You have a unit, a platoon that you're connected with. Then you're out here by yourself."

Dr. Manette Monroe is an expert in Equestrian Therapy and P-T-S-D. She says horses have a lot in common with traumatized people.

"They're hypervigilant," said Mr. Monroe who is an Assistant Professor of Pathology at the University of Central Florida.

"They're always watching for danger; always watching for something to happen around them," she explained. "When a horse hears a loud noise around them, they jump. For a veteran with PTSD, when they hear a loud noise, they're going to have the same reaction."

Dr. Monroe and her colleagues are studying the impact of horses on soldiers. So far, more than 70 veterans have gone through a formal, ten-week program to retrain the brain to stay calm.

"Because the veterans want that interaction with the horse they learn to self soothe," said Dr. Monroe.

THERE'S A LOCAL CONNECTION: A group called Sundance for Our Soldiers offers Equine-Assisted Learning Services to active military, reserves, and veterans of all ages and dependents. Located in Cambridge, the group also offers private lessons at Schone's Friendship Farm in Milan as well as at the SOS facility in Henry County.

"It's helped me step out and not be in my house in a comfortable zone," noted Frankie Langdon.

"Grooming. Riding. It's all good. It makes my heart happy."

Dr. Monroe says a significant number of the 70 soldiers in the research study reported improvements in depression symptoms and improved interpersonal relationships following the ten-week horse therapy sessions in conjunction with medication and other therapies.

TREATMENT: Typical treatments for PTSD can be costly and time consuming, and do not always offer results. Researchers are looking into other therapeutic options. Combat veterans diagnosed with PTSD were less depressed and experienced fewer symptoms after participating in a therapeutic horseback-riding program, according to a study conducted by the University of Central Florida, College of Medicine. The study followed eight Central Florida veterans who sustained physical and emotional injuries through combat in Iraq, Afghanistan or Vietnam. They were the first to go through an eight-week Horses and Heroes equestrian program coordinated by UCF, Heavenly Hoofs, and SADLES of Umatilla. The study found that by working with horses that are ultrasensitive to emotions and nonverbal communication, the veterans increased their emotional awareness, elevated their mood and better modulated their emotions. In the future, the study will expand to determine whether equestrian therapy aids 'neuroplasticity,' the idea that the brain changes and atrophies because of environmental factors such as stress. (Source: https://today.ucf.edu/horse-therapy-ves-shows-positive-early-results/)

If this story has impacted your life or prompted you or someone you know to seek or change treatments, please let us know by contacting Jim Mertens at jim.mertens@wqad.com or Marjorie Bekaert Thomas at mthomas@ivanhoe.com.

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YOUR HEALTH: Horses are good medicine - WQAD.com

Gallery: Ground broken on Ringgold sports medicine facility

North Georgia politicians hope the opening of a new medical practice will spur more development in the Ringgold area.

City councilmen and Catoosa County commissioners broke ground Tuesday with doctors and other representatives of the Center for Sports Medicine and Orthopaedics. Located on the 4700 block of Battlefield Parkway, the center is across the street from Battlefield Imaging, where Hutcheson Medical Center's former ambulatory surgical center once stood.

The center specializes in surgeries, non-invasive work and rehab for bones and muscles. With six locations already in Tennessee dating back to 1979, this will be the first center in Georgia. CEO Becky Farmer said the center hopes to open the 17,000-square-foot facility by early next year.

"The residents of North Georgia have come to us for a long time," she said Monday. "This was a no-brainer."

Randall Peters, chairman of the Catoosa County Economic Development Authority, said this was one of the smoothest projects to land. Developer Larry Armour approached the EDA about bringing the center to Battlefield Parkway less than a year ago. Both sides completed the necessary paperwork for the facility a couple of months ago.

The property is part of Project Jump, a partnership between the local governments and Armour. Using a no- interest loan from the developer, the Authority bought about 20 acres in November and December of last year. The local government entity bought half the land from the Ringgold Church of Christ in November for $850,000 and the other half from Brice Holland in December for $1.7 million.

The authority, the city of Ringgold and Catoosa County are splitting the cost of site development, which includes road and intersection improvements, land grading and installing utilities and a storm water system. The total cost of the work is about $1.9 million, said Authority Spokeswoman Katie Sponberger.

Armour has provided a financial guarantee that sales and property taxes from new businesses here will cover the site development cost within seven years. Armour is helping the authority recruit companies.

"We feel like this is kind of the start," Peters said Tuesday morning.

The facility will have four healthcare providers on site, as well as about five physical therapists. Dr. Bradford Mitchell, a non-operative orthopedist, said the center will be a great spot to heal sprains, strains, broken bones, concussions, joint pain and muscle aches.

Compared to surrounding municipalities, Catoosa County has a slightly wealthier population. The median household income sits at $51,000 about in line with the state average. According to Census data, that figure is about 15 percent higher than Walker and Whitfield counties, as well as about 6 percent higher than Hamilton County.

Contact Staff Writer Tyler Jett at 423-757-6476 or tjett@timesfreepress.com. Follow him on Twitter @LetsJett.

Originally posted here:

Officials break ground on sports medicine facility in Ringgold, Ga. - Chattanooga Times Free Press

Traditional medicine, such as Ayurveda is used by 6580 percent of the worlds population as their primary form of health care, the World Health Organization estimates.

Ayurvedic medicine (also called Ayurveda) is one of the worlds oldest medical systems. Originating in India more than 5,000 years ago, this holistic medicine system uses herbal compounds, special diets and other health care practices to augment conventional preventative and disease treatments. Now,Kattesh Katti, a researcher at theUniversity of Missouri, has developed a non-toxic delivery method using gold nanoparticles that may revolutionize Ayurveda. His technique for producing the nanoparticles recently was licensed by Dhanvantari Nano Ayushadi (DNA), a company base in Tamil Nadu, India.

Ayurveda uses combinations of chemicals derived from natural herbs, spices, fruits and vegetables in combination with various metals including gold, silver and copper. Together, the chemicals and metals are aimed at treating various disorders. Traditional medicine, such as Ayurveda is used by 6580 percent of the worlds population as their primary form of health care, the World Health Organization estimates.

In the past, metals predominantly used in holistic medicine have been crushed and burned; caregivers grind the ash with herbs to produce an ingestible treatment, said Katti, Curators Distinguished Professor of Radiology and Physics in theMU School of Medicineand theCollege of Arts and Scienceand senior research scientist at theUniversity of Missouri Research Reactor(MURR). However, the ways in which those metals are procured often involve mercury; other toxic means to extract the gold or other alloys can be deadly if ingested in the wrong amounts. The gold nanoparticle production methods use a green technology that effectively eliminates the toxicity associated with these treatments.

Katti and his team helped develop green nanotechnologies to produce phytonano medicines, which are compounds that form the basis for Indias Ayurvedic medicine. Scientists mix gold salts with cinnamon and stir the mixture with water to synthesize gold nanoparticles. These green therapies are less toxic to the body and could provide alternatives to current treatments for diseases including cancer, arthritis and diabetes among others.

The technology is patent pending and Kavita Katti, a senior research scientist at MU Radiology, recently demonstrated the production methods in the DNA labs in India, which has licensed the technology from Katti and the University of Missouri.

These successful production runs within the DNA premises and the efficient training of our personnel fully fulfill the requirements signed in our contract, said Abhaya Kumar Jain, CEO and president of DNA. We look forward to a long-term working and collaborative relationship with Dr. Katti and his team as we collectively advance the field of nano-Ayurvedic medicine to develop the next generation of health care products for the care and treatment of patients across the world.

We are therefore, excited to be the first company in the world to apply principles of green nanotechnology to validate Ayurvedic principles and bring nano-Ayurvedic products to market for the care and savings of human lives suffering from cancer and various diseases/disorders in the world, Jain said.

Research and product development using the green nanotechnology techniques developed in Kattis lab will continue at the facility in India. Using Indian Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) guidelines, DNA will continue to test formulations that could provide complementary therapies to chemotherapy, radiation and other traditional treatments, Katti said.

We are excited that two great minds, Mr. Abhaya Kumar Jain, a pioneer in the Indian pharmaceutical industry, and Professor Kattesh V Katti, globally recognized as the Father of green nanotechnology, have come together to bring nano-Ayurvedic Medicine technology to India, said Anantkumar Hegde, who is an elected member of the Indian Parliament. This is a marriage made in heaven because India and the world needed the intervention of green nanotechnology for the development of Ayurvedic products through scientifically rigorous methodologies.

The nano-Ayurvedic medicine approaches are built on rigorous scientifically validated methods, Katti said. I am excited to be a part of this important journey using nano-Ayurvedic medicine approaches for treating, healing and curing various diseases. I have always dreamed of helping humanity through my science, I can now see that I am able to use my interdisciplinary green nanotechnology approaches for the development of Ayurvedic products.

During the past five years, companies commercializing MU technologies have secured hundreds of millions of dollars in investments and grants to advance their commercialization efforts. In 2016, the Office of Technology Management and Industry Relations reported that Mizzou received $14.9 million in revenue from more than 40 technology licenses.

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MU School of Medicine partners with Indian company to study holistic medical treatments - Lakenewsonline.com

I

t is easy to mock the ridiculous and potentially harmful health advice and product lines promoted by Gwyneth Paltrow and her team at Goop. Sleeping near healing crystals, lugging around jade eggs in the vagina, swilling moon juice, undergoing raw goat milk cleanses, dabbing on sex dust, and snapping photos of your aura are just some of the ridiculous treatments and remedies offered at high prices to those looking for health ideas from a movie star.

The mocking may be a bit understated. How does this company and other equally daffy outfits pull off these highly lucrative health scams?

Mainstream medicine is partly to blame.

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Some of the most prestigious hospitals and clinics in North America offer many of the same kinds of treatments that Goop promotes. And some of the practitioners who advise the company, those Goop calls the best doctors and experts in the field for advice and solutions, work at these same institutions.

Why is this? And isnt it time for all of mainstream health care to condemn rather than tolerate doctors who are advising the Goop-like companies of the world that are growing rich by peddling a potent mix of glamor, hipness, and mumbo jumbo?

Several thousand years ago, whether you were an Egyptian pharaoh with migraines or a feverish Spartan soldier, chances are your doctor would try to cure you by bloodletting. He would open a vein with an unsterilized knife or sharpened piece of wood, causing blood to flow into a handy bowl. If you had a high-tech doctor, he might have used leeches instead of a knife.

Despite the fact that bleeding did not work and probably killed a fair number of those who got it, this treatment was a mainstay of medicine for thousands of years. It wasnt until late in the 20th century that doctors began to argue that tradition, custom, and patients willing to pay were a lousy foundation upon which to base medical care. Evidence, in the form of objective clinical trials, needed to be the basis upon which doctors treated their patients.

Still, the twisted logic that ancient therapy means effective therapy can be found on both Goop.com to justify cupping, essential oils, and jade vagina eggs and, incredibly, on many academic and university websites pushing alternative practices.

Today, all medical education from medical school through continuing professional education preaches the value of evidence-based medicine, with one exception. Up in medicines attic, the crazy uncle of medical practice, alternative and complementary medicine, is allowed to offer aromatherapy, crystals, herbal remedies, homeopathy, reiki, detoxification, and other nostrums and elixirs at many of the finest hospitals and clinics in North America. Neither evidence nor scientific plausibility are required. Custom, cultural beliefs, and fairy dust are deemed sufficient to entice patients willing to pay for the equivalent of bleeding.

Think we are kidding? In fact, many universities and academic health centers throughout North America have provided either explicit or implicit support for everything from spoon bending to homeopathy to reiki.

Worse, some of these institutions also endorse the supernatural underpinnings of these therapies. The Cleveland Clinic, to cite just one example, suggests that energy therapies like reiki work by promoting balance and flow in the bodys electromagnetic and subtle energies. Ridiculous? Yes. But not very different from the much-mocked language that Goop and Gwyneth use to market wearable stickers that target our bodies energy imbalances, because, as the Goop website explains, human bodies operate at an ideal energetic frequency.

Little wonder that Goop and its ilk are flourishing. Medicine is sitting inside a glass pyramid from which it is tough to throw stones at alternative and complementary medicine.

A team of researchers recently published a wonderful study outlining how primary school children in Uganda could be taught critical thinking skills in the context of health claims. Teaching a few basic concepts that testimonials are not evidence and that ancient and/or popular does not mean a therapy is effective had a significant impact on how the children assessed claims about health remedies. Perhaps Gwyneth and a few of the leaders of our best academic health institutions should take the same course.

Arthur L. Caplan heads the Division of Medical Ethics at NYU School of Medicine. Timothy Caulfield is the Canada Research Chair in Health Law and Policy at the University of Alberta and author of Is Gwyneth Paltrow Wrong about Everything?

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Mainstream medicine is partly to blame for the ridiculous 'treatments' Goop promotes - STAT

The citys public hospitals are facing a shortage of at least 100 doctors specialising in internal medicine amid growing demand arising from the peak flu season and the ageing population, according to the Hong Kong College of Physicians.

College president Professor Philip Li Kam-tao, who revealed the statistics on Tuesday, called on the government to hire more public doctors as the existing number had failed to catch up with the growth in patient numbers over the past few years.

How worried should you be about Hong Kongs unusual flu outbreak?

Doctors working in internal medicine are said to be significantly overloaded at a time when the city is being hit with the summer flu peak. A total of 427 patients have either died or been admitted to intensive care units because of severe flu.

Li said currently each doctor had to take care of up to 25 patients in a medical ward, while an ideal ratio should be 12 to 15 patients.

Official statistics show that a total of 1,081 people were admitted to public medical wards through emergency units on Monday, more than the average 850 patients received during non-peak periods. The overall bed occupancy rate stood at 112 per cent.

In some hospitals, the number of extra beds added to medical wards could fill up an additional three to four wards, Li said, adding that each ward accommodated around 40 beds.

While the number of patients treated at internal medicine specialist clinics had increased by 20 per cent, from close to 600,000 in 2011 to more than 720,000 last year, the number of doctors in that speciality had only increased by 15 per cent, Li said.

Carrie Lam issues action call in Hong Kong hospitals flu crisis

There has also been a 23 per cent increase in the number of occupied bed days for inpatients in medical wards, from 2.48 million to 3.06 million days.

The Hospital Authority has hired only 72 doctors for internal medicine so far this year compared with 91 last year and 93 in 2015.

If the working environment or workload in the medical wards is not improving but continues to worsen, we are worried that green doctors will consider [joining other specialities], Li said.

While the consultation time with patients has been reduced, Li said it was also getting more difficult for doctors to take leave for speciality examinations.

An authority spokeswoman said the authority expected the manpower problem to ease when an additional 420 medical graduates complete their internship training in 2019.

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Hong Kong public hospitals need additional 100 internal medicine doctors, college says - South China Morning Post

Pain is a universal human experience and one of the most common reasons people see a doctor. It has repeatedly been in the news due to the current opioid epidemic that is taking the lives of more than90 people a dayin the United States.

On May 31stthe head of the National Institutes of Health, Dr. Francis S. Collins, and the head of the National Institute on Drug Abuse, Dr. Nora Volkow, published an article intheNew England Journal of Medicine titled,The Role of Science in Addressing the Opioid Crisis. Sadly, the only science addressed concerned pharmaceutical drugs.

For example, the American College of Physicians, which represents internal medicine doctors, publishedpractice guidelinesfor low-back pain in February 2017 stating:

For patients with chronic low-back pain, clinicians and patients should initially select non-pharmacologic treatment with exercise, multidisciplinary rehabilitation, acupuncture, mindfulness-based stress reduction (moderate-quality evidence), tai chi, yoga, motor control exercise, progressive relaxation, electromyography biofeedback, low-level laser therapy, operant therapy, cognitive behavioral therapy, or spinal manipulation (low-quality evidence).

It is, therefore, extremely disconcerting to read the complete omission of non-pharmacologic treatment by the leadership of NIH and NIDA, who have enormous influence on what is researched and therefore on what is brought into policy and practice.

Cannabis and deep brain stimulation are mentioned in the article;however, cannabis has legal challenges at the federal level as well as in multiple states, and deep brain stimulation is highly invasive. The most cost-effective and least invasive practices, which need and deserve further research, are completely ignored.

Opioids are the best medications we have for moderate-to-severe acute pain; used appropriately, they are effective and relatively safe. As stand-alone treatment for chronic pain, however, they neither safe nor effective.With more and more patients seeking relief from chronic pain syndrome, doctors have come to understand that it is fundamentally different from acute pain.

As pain becomes chronic, brain areas that perceive it begin to change physically and communicate with nearby areas that normally have nothing to do with pain. Involvement of these other regions appears to be related to difficult symptoms that often accompany chronic pain, such as fatigue, disturbed sleep, depression, anxiety, and cognitive impairment. These co-morbidities greatly complicate the management of chronic pain. In many settings, unfortunately, patients with chronic pain syndrome are still treated as if they had acute pain.

The newer, integrative approach stresses individualized treatment, using many different modalities coordinated by a team of healthcare professionals.Analgesic medication is a component of this approach but never the sole component or even the most important one.

An example is theOregon Pain Management Commissions integrativeinitiative. Based on the costs and poor outcomes of a medication-focused approach, the state passed an initiative in 2016 to provide integrative therapies for chronic pain syndrome in addition to conventional care, including acupuncture, massage, manipulation, yoga, and supervised exercise and physical therapy. It left out mind/body therapies, such as hypnosis, biofeedback, and mindfulness-based stress reduction, which can be both cost- and time-effective.

TheVeterans Administration (VA)has also backed away from reliance on opioids to manage chronic pain syndrome and is now actively promoting comprehensive care that includes acupuncture, yoga, mindfulness meditation, and physical therapy. Other states should follow the lead of Oregon and the VA, mandating policies that address the new science of chronic pain with integrative approaches rather than punishing users or prescribers of analgesic medication.

Additional policy changes would support funding not only for pharmaceutical-government partnerships as promoted by NIH leaders, but also for cost and clinical effectiveness outcomes research that could be carried out in partnership between innovators and insurers.

In addition, funding is needed to assess the impact of new educational programs on integrative pain management. These would evaluate changes in prescribing behavior of providers and the use of opioids as well as satisfaction with care amongst the patients they serve.

Broadening our perspective so as to address prevention, training, and best medical practices is critically important for the institutions that determine research priorities and drug policy.

Andrew Weil, MD, is director of the University of Arizona Center for Integrative Medicine and author ofMind Over Meds: Protect Yourself from Overmedication by Knowing When Drugs Are Necessary, When Alternatives Are Better, and When to Let Your Body Heal on Its Own. Victoria Maizes, MD, is the executive director of the University of Arizona Center for Integrative Medicine and a professor of medicine and public health.

The views expressed by contributors are their own and not the views of The Hill.

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We need to implement better policies on pain science and integrative medicine - The Hill (blog)

Doctors were urged yesterday not to overreact to a recent case in which a paediatrician was suspended for failing to diagnose that a child had the rare Kawasaki disease.

Senior Minister of State for Health Lam Pin Min reminded them that it is part of their work to exercise "good clinical judgment" when treating their patients.

They should avoid practising defensive medicine, which would raise healthcare costs unnecessarily, he added.

Dr Lam was replying in Parliament to Dr Lim Wee Kiak (Sembawang GRC), who had asked if there were guidelines for doctors to "send all cases for detailed diagnostic tests to avoid misdiagnosing rare medical conditions".

Dr Lim cited the case of the paediatrician, whose suspension led more than 1,000 doctors to sign a petition to the Health Ministry and the Singapore Medical Council (SMC), saying that the punishment was too severe for misdiagnosing a rare disease.

Dr Chia Foong Lin, who is in private practice, had appealed against the disciplinary tribunal's judgment, but the Supreme Court upheld it.

Feb 25, 2013

A one-year-old child suffering from red eyes and high fever for three days is hospitalised at Gleneagles Hospital.

Dr Chia Foong Lin diagnoses him as having a viral infection.

Feb 27

The child is fretful, his lips turn bright red and he develops a rash.

Dr Chia considers Kawasaki disease, but does not do any supportive tests for this (there is no specific diagnostic test for Kawasaki disease), nor does she tell his parents.

Feb 28

The boy's fever spikes in the morning and his lips are red and cracked.

March 1

His fever appears to have settled and Dr Chia discharges him. His red eyes have improved and he has no rashes, but his lips are still red and cracked.

March 3

He is reviewed by Dr Chia as an outpatient at her clinic. His parents say the child's fever has continued in the past two days.

March 4

The boy's parents seek a second opinion from Dr Lee Bee Wah, another paediatrician in private practice.

Dr Lee notes that the boy is irritable, has a rash on his upper body, redness on his palms and soles, prominent lymph nodes on the right side of the neck, and a heart murmur.

She orders blood tests and an echocardiogram, which shows that the blood vessels of the heart are already affected.

She treats the boy for Kawasaki disease and he responds well.

Salma Khalik

Dr Lim asked whether the ministry would issue guidelines, if none exists, for diagnosing potentially rare illnesses.

Dr Lam said internationally accepted guidelines for Kawasaki disease have been in existence since 2004. They state that a prolonged fever, with two other symptoms, warrants checking for the disease.

The one-year-old boy Dr Chia was treating had fever and three other symptoms: red eyes, a rash, and lips that were red and cracked.

The tribunal found that "Dr Chia fell short of the reasonable standard expected of a senior paediatrician by not ordering tests to support the diagnosis or discussing with the parents this possible diagnosis which she had considered", said Dr Lam.

It judged her actions as "serious negligence", he added.

Kawasaki disease, if untreated, results in 15 per cent to 20 per cent of children - usually under five years old - developing serious medical problems including heart disease, or dying.

Between them, National University Hospital and KK Women's and Children's Hospital see 160 to 190 cases of Kawasaki disease a year.

Ms Tin Pei Ling (MacPherson) had asked about the basis for Dr Chia's suspension.

Dr Lam said that in deciding on the three-month suspension, the tribunal took into account her 23 years of experience as a paediatrician, and her unblemished record.

It also looked at eight precedents of doctors missing or giving a wrong diagnosis. Six of them were suspended.

Ms Tin also asked whether studies had been done on defensive medicine and potential implications if it was practised here.

Dr Lam said that there is no such local study, but when a doctor deviates from sound medical practice for fear of a malpractice suit, it adds unnecessarily to healthcare costs, he added.

"As part of their work, doctors are expected to exercise good clinical judgment to manage patients appropriately," he said.

Dr Lam added that doctors need to keep abreast of medical knowledge and international guidelines. That is why the SMC requires all doctors to have mandatory continuing medical education.

He said he was aware the case has caused concern among many doctors. He urged them "to stay calm and not overreact", and to read the tribunal's rationale for the penalty.

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Avoid practising defensive medicine, docs told - The Straits Times