The Human Toll of Russian Roulette Medicine

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With all the changes in medicine, we sometimes forget the human toll of todays healthcare system. The lack of coordination and communication endemic steals peoples quality of life, not to mention money from their pocketbook. In the past, Ive written about the physician-entrepreneurs who are reinventing healthcare delivery. In particular, they are addressing the Hot Spotters that consume the majority of our healthcare dollars.

One of the physicians mentioned in the original New Yorker Hot Spotters article is Rushika Fernandopulle. His organization, Iora Health, is the living embodiment of the old adage an ounce of prevention is worth a pound of cure in the way they have reinvented primary care.

The payoff has been significant for their patients. The individual described in the story (Maria) was costing her Union Trust dearly. A key reason the union teamed up with Iora was saving money meant they could cover more people and actually give them raises since there is a direct tradeoff between wages and benefits. The union has looked in the eye of thehealthcare cost beastand vanquished it.

Rushika described his patient as playing Russian Roulette with the uncoordinated care she was receiving in his account below. He also highlighted how old approaches fell short. One of the impressive things about Iora Health is they have such a cost effective model, its being offered on a private-pay basis to immigrants not addressed by the Affordable Care Act. Clearly, if its affordable for a low-income immigrant, this is a model that can scale anywhere. [See Nobel Prize Winner Sets Sights on Fixing U.S. Healthcarefor more.]

Rushika Fernandopulle, MD: A few months ago I had the pleasure of caring for Maria, a 68 year old woman from Central America who still worked as a room attendant in a Las Vegas casino. She came to us directly from the hospital, where she had been admitted a week earlier for a fainting episode. She was lethargic and glassy eyed, disheveled and was pushed in a wheelchair by one of her daughters. She was on 27 different medicines prescribed by 11 different doctors, who obviously never communicated with each other. She was, for instance, on 7 different anti-hypertensive drugs, including 2 different doses of the same one, lisinopril.

I asked her daughter how on earth she was able to give her mother so many medicines- and she sheepishly admitted- Well doctor, I actually didnt give her all of them because I thought it was too many. She was right- that many meds would kill a horse.

So what did you do? I asked.

I let God decide, she replied. Each day Id say a prayer, and then reach into the bag and pull out 5 medicines. So on a day when she got one diabetes med, one anti-seizure med, and one or two anti hypertensive meds, her mom did fine, but on the day God wasnt paying attention and she pulled out 4 or 5 blood pressure pills- bam- fainting spell and to the hospital.

It took us about 2 hours that day to get old records, make a number of calls, and figure out what was really going on. I literally threw away 20 of her 27 medicines, told her to stop seeing 10 of the 11 doctors she was going to, and had our health coach spend another hour with the family explaining their conditions and what was needed to be done. We worked over the next few months on titrating her diabetes and blood pressure medicines, and got her on a healthier diet. I saw her last week- she walked in with a new hairstyle and makeup and had a twinkle in her eye. Her blood pressure and sugar were fine, and she felt great.

This story may be a bit extreme, but the basic outline is all too familiar. Patients too often are led to think the way to get good quality health care is to see a number of specialists for each organ system- a cardiologist to manage their hypertension, a pulmonologist to manage their asthma, a GI doc for their reflux, and so on. Unfortunately, as in this case, these docs usually only communicate by sending letters to a primary care doc who is often the most out of the loop, and so you end up with awful outcomes like Maria.

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The Human Toll of Russian Roulette Medicine

Medicine Hat Mayor Ted Clugston Banned From Driving For One Year

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MEDICINE HAT, Alta. - The mayor of a city in southeastern Alberta has been banned from driving for one year after pleading guilty to impaired driving.

Ted Clugston entered his plea today in Medicine Hat provincial court.

He was also fined $1,000.

Court heard police observed a vehicle drifting between lanes and said Clugston exhibited signs of impairment, such as glossy eyes, a red face, and slow speech after he was pulled over on Feb. 13.

Earlier this week, Clugston's lawyer entered a not guilty plea in court, but a few hours later, the mayor sent out a statement saying he changed his mind against the advice of his lawyer.

Clugston apologized in his statement, saying he "exercised very poor judgment'' and had to take responsibility for his actions.

The mayor also said his lawyer told him he had a good chance of being acquitted, but Clugston said he wanted to save his family and city from the humiliation of a trial.

"I will take time to reflect and learn from this in the coming months and years. Hopefully some good can come of this. Since this incident occurred I have continued to work and attend all public events and functions where possible and I intend to continue to do so."

(CJCY, The Canadian Press)

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Medicine Hat Mayor Ted Clugston Banned From Driving For One Year

Quinnipiac University Frank H. Netter MD School of Medicine Student Profile: Katelyn Norman – Video

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Quinnipiac University Frank H. Netter MD School of Medicine Student Profile: Katelyn Norman
All students in Quinnipiac University #39;s Frank H. Netter MD School of Medicine take the Scholarly Reflection and Concentration/ Capstone course that allows them to create a personal curriculum,...

By: Quinnipiac University

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Quinnipiac University Frank H. Netter MD School of Medicine Student Profile: Katelyn Norman - Video

U. of I. trustees approve new medical school

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The University of Illinois board of trustees Thursday approved a new medical school for the Urbana-Champaign campus, a unique engineering-focused program that could enroll students as soon as fall 2017.

The idea of an engineering-based medical school has been championed for a year by campus Chancellor Phyllis Wise, who has called it a "game changer" and one that is necessary for the university to compete in fields such as biomedicine. The new school would be separate from the university's existing College of Medicine, which is overseen by the University of Illinois at Chicago campus.

The board's approval means the campus can begin steps to open the school, including entering into a contract with partner Carle Health System. With up to 50 students per class, the school will draw on the university's strengths in engineering and technology to graduate physician-scientists and engineers who may work in clinical practice but also would have the skills and inclination to develop new medical equipment and innovations.

"We have the capacity to be able to truly redesign medicine," Wise said in an interview with the Chicago Tribune this week. "We have such a strong College of Engineering that can inform the next generation of doctors and therefore inform the next generation of health care."

As proposed, the new school would not rely on state funding. It would be supported in part through a partnership with Carle. The health system has pledged $100 million over the first 10 years. Other revenue would come from tuition, donors, grants and contracts, patient fees and the commercialization of medical technology. Wise said the goal is to secure $135 million from donors in the first 10 years.

Wise has said that without a medical school, the state's flagship public campus is at risk of falling behind its peers, as it can't compete for certain grants or attract and retain researchers and scientists whose work relies on a medical school.

Trustees said little about the medical school before approving it at their meeting Thursday, but they voiced their support at a committee meeting a day earlier. "We are taking some risks, but I think they are mitigated risks," said trustee Ricardo Estrada. U. of I. President Robert Easter said he was initially "skeptical" of the financial feasibility of the plan but has come around.

Wise has lobbied trustees for a year, and she has been met with opposition from officials at the university's sister campus in Chicago. UIC officials had said that a second medical school is unnecessary but this week pledged to collaborate on medical education.

The U. of I. system's College of Medicine is the largest public medical school in the country, with about 1,350 students at four regional sites throughout the state. Some of the students are assigned to the Urbana-Champaign campus, including those getting a joint M.D./Ph.D. in the Medical Scholars Program, and that relationship will continue, Wise said. The board has asked for more details about the future of those students.

The board also asked for a progress update at its May meeting, including on the submission of a comprehensive business plan. The campus now plans to negotiate an agreement with Carle.

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U. of I. trustees approve new medical school

District looks to partner Clifton High School with incoming medical school

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CLIFTON The Clifton Board of Education is seeking to form a "medical arts academy" curriculum for students of Clifton High School and eventually form a partnership with an incoming medical school.

The Board voted to begin discussions with Hackensack University Medical Center (HUMC) and Seton Hall University, which in January signed a memorandum of understanding to establish a private medical school on a portion of the Nutley and Clifton land formerly occupied by Hoffmann-La Roche.

The school is slated to be run out of buildings 123 and 123A leased from Roche, which houses about $500,000 million of equipment in 500,000 square feet. If the plan remains on schedule, the new medical school expects to instruct its first students in 2017.

"I think it's an excellent opportunity to develop a relationship and develop a curriculum for a medical arts academy," said School Board commissioner, James Daley, who first proposed the partnership for the high school last month.

Currently Clifton High School is affiliated with two area colleges: Montclair State University (MSU) and Passaic County Community College (PCCC).

Both programs provide students dual enrollment, meaning they earn college and high school course credits for taking the college-level courses. Eligible seniors must meet GPA requirements and be in good disciplinary standing.

Most offered courses are general education without prerequisites, but certain programs allow students to begin business tracks, criminal justice courses, and art electives.

"It offers students a great opportunity to experience college and obtain college credit that's transferable to any state college or university," said Peter Cumba, who handles senior year options at the high school.

Students who dual enroll pay a reduced tuition for the courses and have abbreviated high school schedules. MSU-enrolled students take courses on the college campus; PCCC-enrolled students take courses at the high school at the end of the school day.

Cumba said students in the program generally take one course in the fall and two in the spring. The school also provides students with an option for "very intense" EMT training program, contingent on GPA requirements, rigorous field work, and a final exam.

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District looks to partner Clifton High School with incoming medical school

Building a genomic GPS

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UMMS scientists develop multicolored CRISPR/Cas9 labeling system to precisely measure the distance between chromosomes and genetic elements

WORCESTER, MA - A new "app" for finding and mapping chromosomal loci using multicolored versions of CRISPR/Cas9, one of the hottest tools in biomedical research today, has been developed by scientists at the University of Massachusetts Medical School. This labeling system, details of which were published in PNAS and first presented at the American Society for Cell Biology/International Federation for Cell Biology annual meeting in Philadelphia in December, could be a key to understanding the spatial and temporal regulation of gene expression by allowing researchers to measure the precise linear distance between two known points on different chromosomes or two locations on the same chromosome in live human cells.

The nucleus of every cell in our bodies (with the exception of gametes and red blood cells) must pack into it 23 pairs of chromosomes, tight bundles of extremely long strands of DNA wound around protein knobs. For a gene to be transcribed and expressed, it must be accessible on the chromosome. Scientists have long suspected that the position of a chromosome within the nucleus affects gene accessibility and plays a critical role in everything from embryonic development to cancer.

Knowing the location and the intra-nuclear conformation of chromosomes is critical to understanding how genes actually work because the human cell nucleus is a very crowded place, according to study authors Thoru Pederson, PhD, professor of biochemistry and molecular pharmacology, and research specialist Hanhui Ma, PhD, at UMass Medical School.

By deploying pairs of fluorescent tags from their three-color system, Pederson and colleagues showed that it's possible to plot where a chromosome is inside the cell nucleus and where it is in relation to other chromosomes. Their CRISPR app can also measure the distance between two points on the same chromosome, giving a read-out of chromosome compaction, which is a key factor in gene expression.

Precisely locating chromosomes in the nucleus of living cells has been a holy grail in cell biology since 1968, when Joseph Gall and Mary Lou Pardue first demonstrated the detection of specific loci. That discovery helped open the era of genetic testing, but the early techniques required "fixed," i.e. dead, cells. In the intervening years, researchers have adapted new methods to probe live cells including transcription activator-like effectors (TALEs), which Ma and Pederson had recently introduced for lighting up genetic loci in living cells. But they subsequently came to believe that the rapidly emerging CRISPR system promised a more accurate map of a living nucleus and would be easier for scientists to employ.

Using their multicolored system, they were able to determine common locations for several chromosomes. Among their findings was that gene-rich chromosome 19 tends to be located in the middle of the nucleus, whereas gene-poor chromosome 18 is at the periphery. Also staying close to the center of the nucleus were chromosome 17 and five of the so-called acrocentric chromosomes, which have their distinctive centromeres close to the ends of one arm. One of the five acrocentrics is chromosome 21; the presence of an extra copy of chromosome 21 is called trisomy 21, and is the diagnostic marker for Down syndrome. Meanwhile, chromosomes 3 and 7 were at or close to the nuclear periphery.

The researchers were also able to distinguish the different locations for each diploid copy of the genes involved in organizing the nucleolus. The researchers say that they have plans to further tweak their two-color technique to study translocations--the abnormal switching of chromosomal segments--in human tumor cells.

Ultimately, the GPS app will provides scientists a new toolkit for "studying the 4D nucleome and the regulation of eukaryotic gene expression across a broad landscape of cell types and stages of development, differentiation and human disease," the authors state in their publication.

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Building a genomic GPS

Private medical school plan for New Jersey advances

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1 arrest Arrest in savage beating inside McDonald's Arrest in savage beating inside McDonald's

Updated: Friday, March 13 2015 5:50 AM EDT2015-03-13 09:50:20 GMT

Shocking cell phone video of a teenage girl savagely beaten by a group of girls inside a McDonald's in Brooklyn has gone viral.Police have arrested a 16-year-old girl who goes to the same school as the victim but are seeking other suspects connected to the beating. Cops hope witnesses come forward because the victim and others refused to cooperate with the investigation.

Shocking cell phone video of a teenage girl savagely beaten by a group of girls inside a McDonald's in Brooklyn has gone viral.Police have arrested a 16-year-old girl who goes to the same school as the victim but are seeking other suspects connected to the beating. Cops hope witnesses come forward because the victim and others refused to cooperate with the investigation.

Updated: Thursday, March 12 2015 10:17 PM EDT2015-03-13 02:17:18 GMT

A teenager apparently jumping across roofs in Brooklyn plummeted to his death Thursday afternoon, police said.Witnesses said the boy fell four stories at 1153 President Street in Crown Heights at about 4:30 p.m., police said. Medics responded to the scene, but the boy was dead, the FDNY said.

A teenager apparently jumping across roofs in Brooklyn plummeted to his death Thursday afternoon, police said.Witnesses said the boy fell four stories at 1153 President Street in Crown Heights at about 4:30 p.m., police said. Medics responded to the scene, but the boy was dead, the FDNY said.

Updated: Thursday, March 12 2015 9:57 PM EDT2015-03-13 01:57:17 GMT

In 1945, Olivia Hooker, a 30-year-old black woman from Tulsa, Oklahoma, joined the U.S. Coast Guard. The now-Dr. Olivia Hooker holds a PhD in psychology, worked until she was 87, and just turned 100 in February. But 70 ago when she enlisted she became the Coast Guard's first African-American woman on active duty. Thursday, Coast Guard brass honored her by naming a dining hall on Staten Island in her honor.

In 1945, Olivia Hooker, a 30-year-old black woman from Tulsa, Oklahoma, joined the U.S. Coast Guard. The now-Dr. Olivia Hooker holds a PhD in psychology, worked until she was 87, and just turned 100 in February. But 70 ago when she enlisted she became the Coast Guard's first African-American woman on active duty. Thursday, Coast Guard brass honored her by naming a dining hall on Staten Island in her honor.

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Private medical school plan for New Jersey advances

Tony Perkins in Senate Testimony: Religious Liberty Vital to U.S. Foreign Policy – Video

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Tony Perkins in Senate Testimony: Religious Liberty Vital to U.S. Foreign Policy
Family Research Council President Tony Perkins testified about the priority religious liberty should be to American foreign policy before the U.S. Senate Appropriations Subcommittee on State,...

By: Family Research Council

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Tony Perkins in Senate Testimony: Religious Liberty Vital to U.S. Foreign Policy - Video