Category Archives: Internal Medicine

Internal Medicine

Facing doctor shortage, BayCare to train hundreds more in Tampa Bay – Tampa Bay Times

Published Feb. 1|Updated Yesterday

With Florida facing a shortage of doctors, Tampa Bays largest health care system plans to bring hundreds more to the region for training, hospital officials announced Thursday.

BayCare Health System, which runs 16 hospitals, will launch at least seven multiyear-residency programs to train young physicians at seven medical centers in Hillsborough, Pinellas, Pasco and Polk counties, said Sowmya Viswanathan, BayCares chief physician executive.

The health system currently has four residency programs with 77 positions, Viswanathan said. By 2029, BayCare plans to have more than 650 positions, according to a news release, with the planned and existing programs bringing close to 200 new resident physicians and fellows to the region each year.

The new programs will focus on internal medicine, family medicine, surgery, child and adolescent psychiatry, addiction medicine and emergency medicine.

Two of them were approved last week by the Accreditation Council of Graduate Medical Education, a nonprofit that evaluates residency programs. They will launch this summer, Viswanathan said.

St. Josephs Hospital in Tampa and St. Josephs Hospital-North in Lutz will be home to a new 117-resident internal medicine program. St. Josephs Hospital-South in Riverview will host a 48-resident family medicine program in partnership with Tampa Family Health Centers.

The other BayCare programs are pending approval from the accreditation council, Viswanathan said.

Completing a residency is required for young physicians to practice independently in Florida, she said. BayCare expects many doctors entering its new programs to stay in Tampa Bay.

Tampa is facing a physician shortage after its pandemic-era population boom, Viswanathan said. Demand for doctors outweighs the supply.

A January report from Florida TaxWatch found that the states number of general internal medicine doctors is expected to meet only 65% of demand in 2030.

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Facing doctor shortage, BayCare to train hundreds more in Tampa Bay - Tampa Bay Times

Internal Medicine

NYU Langone Health in the NewsThursday, February 1, 2024 – NYU Langone Health

News from NYU Langone Health NYU Langone Health Opens Ambulatory Center in Former Bloomingdales, Sears. (Becker's ASC Review)

Beckers ASC Review (1/31) reports, New York City-based NYU Langone Health has opened a 260,000-square-foot ambulatory center in Garden City, N.Y., in a former Bloomingdales and Sears building. The new facility is NYU Langone Healths largest ambulatory care site on Long Island, and contains 260 patient rooms, an expanded adult ophthalmology service and 32 clinical specialties, including cardiology, dermatology, endocrinology, gastroenterology, internal medicine, surgical specialties, OB-GYN, pediatrics, radiology and pulmonology.

Crains New York Business (2/1) reports that Andrew W. Brotman, MD, executive vice president and vice dean for clinical affairs and strategy, and chief clinical officer at NYU Langone Health indicated that the new facility emphasizes the trend of hospitals moving toward having more services provided by outpatient facilities, saying, We consider ourselves an ambulatory network with a few hospitals as opposed to a hospital network that adds on ambulatory . ... A vast majority of patients frankly dont need a hospital. Also reporting are the Radiology Business Journal (1/31) and 12-TV (1/31).

Beckers ASC Review (1/31) publishes a listicle of the top hospitals for gastrointestinal medical care in 20 states according to Healthgrades, including NYU Langone Healths Tisch Hospital in New York City. Also reporting in a second story is Beckers ASC Review (1/31).

CNN (1/30) Robert Montgomery, MD, DPhil, the H. Leon Pachter, MD, Professor of Surgery, chair, Department of Surgery, Division of Transplant Surgery, NYU Langone Transplant Institute at NYU Langone Health, who was the recipient of a heart transplant after seven cardiac arrests and still not deemed sick enough to be able to draw an organ, said, We need a sustainable, renewable source of organs from something else other than humans dying.

CNN (2/1) Access to medications for opioid use disorder has been an ongoing issue for people in the United States, said Noa Krawczyk, PhD, assistant professor, Center for Opioid Epidemiology and Policy, Department of Population Health at the NYU Grossman School of Medicine and a member of the Center for Opioid Epidemiology and Policy.

Neurology Live (1/31) Research by Orrin Devinsky, MD, professor, Departments of Neurology, Neurosurgery, Psychiatry, director, Comprehensive Epilepsy Center, and colleagues, suggested that an accurate diagnosis of sudden unexplained deaths of toddlers is limited by pathognomonic evidence of terminal seizure because autopsies may be normal or show incidental findings, which he discusses in an interview.

ANI News (IND) (1/31) In a collaboration between researchers at NYU Grossman School of Medicine and scientists at Rocket Pharmaceuticals (a biotechnology company), the new work revealed that untreated mice engineered to lose PKP2 gene function died within six weeks after the gene was silenced, but all but one of those that received a single dose of a gene therapy, carrying the normal version of the gene, lived for more than five months. Study co-lead author Chantal van Opbergen, PhD, postdoctoral research fellow at NYU Langone Health said, Our findings offer experimental evidence that gene therapy targeting plakophilin-2 can interrupt the progression of a deadly heart condition. Study co-senior author Mario Delmar, MD, PhD, the Patricia M. and Robert H. Martinsen Professor of Cardiology, Department of Medicine, professor, Department of Cell Biology said, These results suggest that this gene-therapy method may combat arrhythmogenic right ventricular cardiomyopathy in both early and more advanced stages of the condition. Study co-senior author and cardiologist Marina Cerrone, MD, research associate professor, Department of Medicine at NYU Langone Health, said, Such promising findings in animal models pave the way towards exploring this treatment option in humans. Also reporting is Drug Target Review (UK) (1/31).

Labiotech (1/31) A phase 2b trial was recently conducted in patients with focal epilepsy by researchers at NYU Grossman School of Medicine which showed that patients who added an investigational epilepsy drug, called XEN1101, to their current antiseizure treatments saw a 33% to 53% drop in monthly seizures, depending on their dose. Study lead author Jacqueline A. French, MD, professor, Department of Neurology, Comprehensive Epilepsy Center said in NYU Langone Healths press release, that one of the major benefits of this new drug is that it takes more than a week to break down, so levels in the brain remain consistent over time.

The Consultant Live (1/31) Shoshana H. Ballew, PhD, member of the faculty, Departments of Population Health, and Medicine at New York University Grossman School of Medicine, and colleagues wrote, eGFRcr levels of 60 mL/min/1.73 m2 or lower are less strongly associated with adverse outcomes in older adults than in young persons.

The ASCO Post (1/31) In the phase IIb KEYNOTE-942 trial reported in The Lancet, Jeffrey S. Weber, MD, PhD, the Laura and Isaac Perlmutter Professor of Oncology, Department of Medicine, Division of Hematology and Medical Oncology, Perlmutter Cancer Center at NYU Langone Health, and colleagues found that the addition of adjuvant mRNA-4157 a novel mRNA-based individualized neoantigen therapy to pembrolizumab numerically improved recurrence-free survival in patients with completely resected high-risk cutaneous melanoma.

Boston (1/31) The timing of the effects of an edible can vary even for experienced cannabis consumers, because the contents of your stomach affect how quickly an edible kicks in, said Collin Reiff, MD, clinical assistant professor, Department of Psychiatry.

Black Enterprise (1/31) According to Brendan Parent, JD, assistant professor, Department of Population Health, Division of Medical Ethics, and Department of Surgery, Transplant Institute, The idea that the warden of a prison is authorizing the recovery of bodies and of organs without that individuals authorization during their life and without the familys authorization is a total moral failing and probably a legal failing, too.

InStyle (1/31) You want to have the heel of a shoe positioned directly underneath your heel bone, instead of the back of the shoe, which is important because it distributes your weight more evenly, creating a more comfortable shoe overall, says podiatrist and high heel designer Mika Hayashi, DPM, podiatrist at NYU Langone Health a NYU Langone Orthopedic Hospital-affiliated podiatrist and heel designer at Mika Hayashi.

HuffPost (UK) (1/31) Humidifiers can relieve nasal dryness, a dry cough and even dry skin or eczema, Kanwaljit Rupam Brar, MD, associate professor, Department of Pediatrics, Division of Pediatric Allergy & Immunology at New York University Grossman School of Medicine, told HuffPost.

Yahoo! Lifestyle (1/30) In some cases of Crohns, inflammation in the small intestine impairs lactase activity and causes lactose intolerance, Arielle Leben, RD, registered dietician, Inflammatory Bowel Disease Center, told Womens Health.

HerFamily (IRL) (1/31) Researchers at NYU Grossman School of Medicine looked at the brain circuits of a dozen female mice and are believed to have discovered the reason for lactation occurring when the sound of a baby crying is heard, as hearing the sound of a newborns wail can trigger the release of oxytocin, a brain chemical that controls breast milk release in mothers.

The Ottawa Citizen (CAN) (1/31) Although overdose deaths in Oregon have continued to rise since 2020, a recent study led by NYUs Grossman School of Medicine found no link between decriminalization policy and overdose deaths.

Fox News (1/31) Fox News medical contributor Marc K. Siegel, MD, clinical professor, Department of Medicine, Division of General Internal Medicine of NYU Langone Health on the potential to treat chronic pain and prevent addictions and the latest findings from Alzheimers research.

In a second segment, Fox Business (1/31) medical contributor Marc K. Siegel, MD, clinical professor, Department of Medicine, Division of General Internal Medicine of NYU Langone Health discusses how prepared hospital ERs are to treat kids and the side effects of weight loss drugs on The Big Money Show.

Omny FM (1/31) In an embedded podcast, Arthur L. Caplan, PhD, the Drs. William F. and Virginia Connolly Mitty Professor, Department of Population Health, Division of Medical Ethics, joins Megan discussing Artificial Intelligence and if it has the ability to predict when you are going to die.

Well and Good (1/31) Making healthy choices when youre younger is like investing in a 401K, says Allison B. Reiss, MD, associate professor, Departments of Foundations of Medicine, and Medicine, NYU Long Island School of Medicine and a member of the Alzheimers Foundation of America Medical, Scientific & Memory Screening Advisory Board.

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NYU Langone Health in the NewsThursday, February 1, 2024 - NYU Langone Health

Internal Medicine

Dr. Ben Gallagher Receives SGIM Northeast Region’s Award for Excellence in Clinician Education – Yale School of Medicine

Benjamin Gallagher, MD, assistant professor (general medicine), recently received the Society for General Internal Medicine (SGIM) Northeast Regions Award for Excellence in Clinician Education. This honor highlights his contributions to medical education and patient care.

Being recognized among so many distinguished academic medical centers in this region is incredibly humbling and gratifying, Gallagher said. Its an honor to stand out in such a competitive field.

Gallagher's academic and professional journey reveals a consistent pattern of distinction and commitment. After graduating from Yale College with a bachelors degree in molecular Biophysics & Biochemistry, he pursued medical education at the Columbia University College of Physicians & Surgeons, where he stayed on for internal medicine residency. During his residency at Columbia, Gallagher developed a passion for general internal medicine and a keen interest in medical education, as demonstrated by his participation in the Advanced Clinician Educator program and receipt of multiple teaching awards.

During my medical student days, the vastness and variety of internal medicine captivated me, Gallagher said. Its a sentiment echoed by many in academic general internal medicinea love for imparting knowledge and discussing our specialty.

Since returning to Yale School of Medicine after residency training, Gallagher has been a pivotal figure at the New Haven Primary Care Consortium (NHPCC). Clinically, he has focused his efforts on the management of hypertension. Within Yale New Haven Health, he contributed to developing the Care Signature Pathway and established a Chronic Disease Management clinic for residents.

Gallagher's commitment to patient care extends beyond his clinical duties. At the NHPCC, his exceptional teaching of residents has been recognized through the Teacher of the Year Award, which he has won three times. He also plays a critical role in teaching medical students at Yale through his responsibilities as a Clinical Skills Lead and service on several education committees. Outside of Yale, Gallaghers scholarly pursuits in medical education and hypertension curriculum development have resulted in publications and the creation of educational resources.

This award from SGIM identifies Dr. Gallagher as one of Yales most gifted clinician educators and as a leader nationally in the field of general internal medicine, said Patrick G. OConnor, MD, MPH, MACP, Dan Adams and Amanda Adams, Professor of Medicine and Chief, General Internal Medicine. Ben has excelled in every aspect of his career at Yale, from master clinician to master educator, and is a wonderful academic leader and role model for trainees at all levels and for faculty. He brings great pride to us all!

Since first joining SGIM as a resident, Gallagher has regularly contributed at the regional and national levels throughout his career.

I've made it a priority to remain actively involved at the regional level with SGIM, Gallagher said. Whether its evaluating abstracts, presenting, or playing a role in moderation and judging, each opportunity has allowed me to contribute to the society and learn immensely from my peers.

At the SGIM Northeast Regions yearly meeting in November 2023, Gallagher supported the launch of an inaugural teaching competition for trainees and junior faculty to demonstrate their teaching methodologies and share innovative practices.

The new teaching competition allowed clinician-educators to show how they teach rather than just what they teach, Gallagher said.

Gallagher aims to continue his impactful work at Yale School of Medicine, the NHPCC, and SGIM through his clinical care and medical education initiatives.

I am privileged to be able to care for patients and to share my enthusiasm for patient care and general internal medicine, along with the knowledge Ive acquired over the years, Gallagher said.

General Internal Medicine is committed to the core missions of patient care, research, education, and community health from the generalist perspective and is one of the 11 sections within Yale School of Medicines Department of Internal Medicine. To learn more about their mission and work, visit General Internal Medicine.

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Dr. Ben Gallagher Receives SGIM Northeast Region's Award for Excellence in Clinician Education - Yale School of Medicine

Internal Medicine

Tulsa Doctor Shares 7 Steps To A Healthier Heart – News On 6

There are some simple steps to take to help ensure your heart is strong. Dr. Stacy Chronister is an internal medicine specialist with OSU Medicine and she's here to walk us through 7 steps to a healthier heart.

Monday, January 29th 2024, 10:19 am

By: News On 6

February is almost here and that's heart health month. There are some simple steps to take to help ensure your heart is strong.

Dr. Stacy Chronister is an internal medicine specialist with OSU Medicine. She joins us at 9 in the morning to walk us through 7 steps to a healthier heart.

Dr. Chronister goes over the following steps:

Quit smoking or using tobacco

"All forms of tobacco, if you are struggling with that addiction, it is very difficult to break. Please reach out to a physician. We have ways to help if you haven't been successful before, to try to get you to get off of the tobacco," Dr. Chronister said.

Exercise

"For heart health, what we know is that 150 minutes a week. That averages out to 30 minutes over the, you know, Monday through Friday. So five days a week, 30 minutes.

But really, when we talk about it, that's hard to do. It's hard for a lot of people, especially if it's not already in your life, to stop and say, 'now I'm going to dedicate 30 minutes to this.'

So the good news is that we can add it all together. So it can be 10 minutes here. It can even be five minutes. And really it's even those people that keep moving throughout the day that actually have even better heart health," Dr. Chronister said.

Eat a heart-healthy diet

"You know, there's a lot of different things that we can look at. And of course, we want to eat fresh as much as we can. A great way to to look at that is to look at our salt content. So let's keep our salt content under two grams a day. That comes from things like bags, boxes, cans are gonna be a lot higher in sodium. Sodium increases our blood pressure.

And so if we can avoid the foods that are high in sodium, we're probably eating a healthier diet, and we're healthy on our blood pressure too. The nice thing is that actually bananas, or foods that are higher in potassium, can lower your blood pressure. So absolutely grab something that's a little bit higher in potassium," Dr. Chronister said.

Maintain a healthy weight

"The fact that we're asking you to move a little bit more, eat less salt, eat a little bit healthier, will naturally play a role with you losing a little bit of weight, or keeping or holding weight maintenance. Because that has a lot to do with our heart health," Dr. Chronister explained.

Get enough quality sleep

"We need to be getting at least six to eight hours. Now as you age, sleep becomes a little bit different. You don't need nearly as much. But you might find yourself kind of cat napping throughout the day. That's perfect if you only get about four or five hours. But if you can get it, that nap during the day, that will be very helpful. Avoiding alcohol is a really big key, and (avoiding) caffeine before you go to bed. And if you find yourself snoring, get it checked out. Talk to a doctor," Dr. Chronister said.

Blood pressure control

"So what we really want is that systolic blood pressure, that upper number to be less than 130. And the lower number to be less than 80. So if we can keep those numbers low, that helps out the back of our eyes, our kidneys, our brains, our heart from having to work so hard, and from getting damaged from those high blood pressures," Dr. Chronister explained.

Get screened for high cholesterol and diabetes

"In addition to having high blood pressure and our weight, the biggest things that we can look for is diabetes and high cholesterol. Because that is what is contributing to bad heart health. The cholesterol embeds itself into the vessels of the heart. And that is where we get a lot of the plaques and the hardening of our hearts. So if we can keep our cholesterol lower, all the better," Dr. Chronister said.

"So if you know that you have somebody in your family with heart disease, you are more at risk as well. So easier to get checked out much earlier, especially if anyone under the age of 50 in your family who's had a heart attack or stroke. That is a much higher risk than someone who's had maybe a heart attack or stroke in your family, upper ages; 70, 80," Dr. Chronister said.

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Tulsa Doctor Shares 7 Steps To A Healthier Heart - News On 6

Internal Medicine

Perceptions of X+Y Scheduling Among Combined Internal Medicine-Pediatrics Residency Trainees: A Qualitative … – Cureus

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Perceptions of X+Y Scheduling Among Combined Internal Medicine-Pediatrics Residency Trainees: A Qualitative ... - Cureus

Internal Medicine

Taskforce works to end racialized differences in medical education and practice – Wayne State University

The Wayne State University School of Medicines End Race-Based Medicine Taskforce is working to dispel and extinguish the misguided belief that individual races are biologically distinct groups determined by genes, and terminate medical practices and research that adhere to that concept.

Co-created by Ijeoma Nnodim Opara, M.D., assistant professor of Internal Medicine and Pediatrics, and Latonya Riddle-Jones, M.D., M.P.H., assistant professor of Internal Medicine and Pediatrics, the taskforce includes representation from institutional leadership, students, residents, faculty, and community members and leaders, including those from the School of Medicine, Wayne Health, the Detroit Medical Center, the Barbara Ann Karmanos Cancer Institute, the Detroit Health Department and the Michigan State Medical Society.

"Race-based medicine is the practice of medicine and other forms of health care grounded in racial essentialism, which is the false belief that races are biologically distinct groups determined by genes," Dr. Opara said. "It is a key component of structural and systemic racism in medicine and has perpetuated multiple generations of harm to Black, as well as other minoritized and structurally excluded communities."

The group has delineated three primary goals to accomplish within its two-year mission:

Discontinue and de-adopt race-based medicine, including "race correction" in practice, teaching and research.

Lead the adoption and institutionalization of racism-conscious medicine in practice, education, policy and research, and provide support for clinicians and health care workers.

Organize stakeholder community roundtables and symposia on ending race-based medicine.

The taskforce is supported by Dean Wael Sakr, M.D.; the Michigan State Medical Society Taskforce to Advance Health Equity; the School of Medicines Office of Inclusion, Diversity, Equity and Access; the Health Equity and Justice in Medicine initiative at the School of Medicine and the Detroit Medical Center; and the WSU Department of Internal Medicine.

The work of this taskforce is critical to health care in our city, our state and our nation, and lives in the very soul of our Wayne State University School of Medicine and our mission, Dean Sakr said. The promise of equitable health care for all people is deeply embedded in the mission and values of the university and its health science schools. We need to lead the way in this effort.

The task force, Dr. Opara said, will consider its work successful by the measurement of several factors, including:

Removal of racialized reporting from electronic health records in areas such as Glomerular Filtration Rate, or eGFR, a test in renal function.

The discontinuation of the "race corrective" function of pulmonary function tests.

The discontinuation of inputting race as a risk factor in the atherosclerotic cardiovascular disease calculator.

The discontinuation of relying upon race as a reason for offering different medical treatments.

We will conduct regular practice and teaching audits to track the frequency of practice and teaching of these domains of race-based medicine, and when we are at zero, we will know our mission is completed, Dr. Opara said.

One impetus for the taskforce lies in the publication of a paper calling for the end of race-based medicine.

In 2021, Dr. Opara, Dr. Riddle Jones and Nakia Allen, M.D., FAAP, clinical associate professor of Pediatrics, published an article in which they called upon the medical and scientific communities to confront and end a legacy of scientific racism in research, medical education, clinical practice and health policies by de-pathologizing and humanizing American Black bodies.

In Modern Day Drapetomania: Calling Out Scientific Racism,published in the Journal of General Medicine, the physicians noted that racism in medicine has deep historical roots in white supremacy and anti-Blackness, particularly the pathologizing of Black bodies through pseudoscientific claims of the biological significance of the sociopolitical construct that is race, which is often incorrectly conflated with genetic ancestry. Those roots, they wrote, developed branches that continue to reach into medical science and medicine to this day, particularly in the ways science frames racial health disparities as a result of biological differences among racial categories.

Racism, not race, is the vector of disease and health disparities. Racist policies, such as redlining and the war on drugs and war on crime, inform systems of housing, education, criminal justice, health and the economy, and determine a communitys exposure to the social and environmental factors that drive health disparities through direct effects, chronic toxic stress and epigenetic mechanisms, the physicians wrote. This is the contemporary version of pathologizing Blackness and normal responses to chronic intergenerational trauma, oppression and exploitation. It reinforces the bogus theory of supposed Black inferiority. It is the modern Drapetomania.

Now recognized as pseudoscience nonsense, Drapetomania was first concocted by Dr. Samuel Cartwright in 1851 to pathologize runaway enslaved Blacks. He claimed that enslaved Blacks had inherently smaller brains and blood vessels that accounted for indolence and barbarism. His prescribed cure and prophylactic treatment for the faux condition was whipping the devil out of them. The nonsensical condition remained in some medical texts into the early 1900s, and was used along with other false claims to support racist perceptions and attitudes toward Black Americans. Some of those perceptions continue in medicine, despite the fact that in 2003 the Human Genome Project showed race has no genetic basis and human beings are 99.9% identical genetically.

The belief that differences in disease outcomes are due to genetic differences between racialized groups still plagues contemporary medicine and science, and unfortunately continues to be funded, published, taught and practiced, they state. The use of race to measure human biological differences stubbornly persists and, consequently, these structures and systems are absolved of responsibility, reinforced and perpetuated.

To eliminate scientific racism, the physicians called for identifying and excising it from clinical algorithms and medical decision-making equations; expunging it from the publication process through anti-racist peer review and editorship; transforming medical, health care professions, and scientific education in both clinical and social sciences from undergraduate studies through faculty development and curricular revision; and advocacy among academic partnerships with patients, marginalized communities and policymakers that prioritize social and structural determinants of health to positively impact health outcomes.

Our oath as clinicians is to first do no harm, Dr. Riddle-Jones said. When we practice race-based medicine, knowingly or unknowingly, we are performing harm on our beloved patients and communities. The time to end race-based medicine is past due. The time is now.

A number of national and international regulatory agencies, including the National Institutes of Health, the U.S. Centers for Disease Control and Prevention, the Accreditation Council for Graduate Medical Education, the Association of American Medical Colleges, the American Medical Association, the National Kidney Foundation and the American Academy of Pediatrics have called for an end to race-based medical practices and many have published updated guidelines reflecting this change. More importantly, Dr. Opara said, medical students, trainees, patients and communities are demanding this change.

Many clinicians are already on board for the change, she added. They just need support and guidance to de-adopt these established practices and adopt better ones.

Dr. Opara said that it is important to note that the taskforce is not advocating for color-blind medicine or science as there are notable differences in health outcomes among racialized groups. Instead, we are advocating for critical racism-conscious medicine, science, research, policy, education and practice that understands that the reason and context for those differences are as a result of racism and other inequitable and unjust systemic/structural factors and not as a result of mythical inherent biological differences. Research that appropriately categorizes populations and explains the basis of population categorization and how they account for racialized differences decoupled from biology is what is called for. Eliminating iatrogenic (health care-induced) disparities in order to actualize health equity is what is urgently called for.

For more information, contact Dr. Opara at innodim@wayne.edu or Dr. Riddle-Jones at lriddle@med.wayne.edu. A presentation on the task force is available at https://www.youtube.com/live/G8QYtRhlZAM?feature=share

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Taskforce works to end racialized differences in medical education and practice - Wayne State University

Internal Medicine

Against Physician-Assisted Suicide: A Physicians Letter to His Legislator – Word on Fire

Home Articles Against Physician-Assisted Suicide: A Physicians Letter to His Legislator

The committee hearings begin today, January 25, 2024, on the End-of-Life Option Act (SF 1813/HF 1930). If passed, this bill would allow residents in Minnesota access to physician-assisted suicides.

To whom it may concern:

My name is Tod Worner, and I am a practicing internal medicine physician in the Minneapolis area. I live in Plymouth, MN, and vote in District 43A. I am opposed to the proposed bill legalizing physician-assisted suicide.

I find myself in a curious position. As a physician who has spent decades trying to heal patients, I find myself imploring my duly elected representatives not to usher in the most seismic cultural and ethical transformation in modern medical practicethe act of taking life instead of comforting or saving it.

As you know, there are currently ten states (to date) in which physician-assisted suicide is legalized (California, Colorado, Oregon, Vermont, New Mexico, Maine, New Jersey, New Mexico, Hawaii, and Washington) and Washington, D.C. Montana has legalized it by court ruling. Furthermore, a number of them have weakened residency requirements so as to encourage a grim form of medical suicide tourism. Physician-assisted suicide is also legalized (to date) in Canada, Belgium, Luxembourg, Spain, Germany, Switzerland, and the Netherlands. Pediatric euthanasia has already been carried out in Belgium, the Netherlands, and is being pursued by interest groups and legislators in Canada, among other locales. And now, alas, physician-assisted suicide is, once again, knocking on Minnesotas door.

What are we becoming? What does it mean to heal?

Lest we find ourselves reassured by a burgeoning tendency to legalize this dark practice, let me borrow from Mark Twain when he said, Whenever you find yourself on the side of the majority, it is time to pause and reflect.

Indeed.

George Orwell once sighed, We have now sunk to a depth at which restatement of the obvious is the first duty of intelligent men.

And so let me begin.

As a physician,mydaily practice is to heal the sick and prevent disease. In so doing, I try to uphold thedignity of eachpatienttreating them with respect while working in partnership to achieve a rich quality in concertwith a reasonable quantity of life. Of course, I recognizethe value of autonomy to afford patient choice, but that means a choice insofar as it simultaneously comports with the practice of safe, sound, and ethical medicine. To be sure, patient choice must be just and the care they receive beneficent, but that same choice must notby slippery euphemism and crafty manipulation, emotional appeal and legal maneuveringsI repeat, must not compel a physician to commit a maleficent act, especially one that runs against centuries of common law and customs, statutory law and social contract, as well as the sacred conscience and sound judgment of the physician in the relationship.

So what does this mean when it comes to physician-assisted suicide?

In a few words, it means that a patient has many rights, but he does not have the right to demand that I assist him in killing himselfany more than he can demand I prescribe himunnecessary narcotics, unwarranted antibiotics, or ill-considered surgery. To demand these measures indiscriminately would be to violate the dignity of the patient with risky (or fatal) outcomes as well as compromise my dignity (and conscience) as a trained and seasoned physician to thoughtfully consider the best care for the patient.

That is why, as a physician, I am opposed to physician-assisted suicide. Furthermore, allow me to offer these threearguments against this concerning practice:

When Julius Caesar illegally ledhis army into Italy in defiance of the Roman Senate, he had topass through a river known as the Rubicon, which separatedItaly from the province of Gaul. When he crossed the Rubicon and became a traitor to his state, he uttered the die is cast and knew there was no going back. Once medicine has transformed itself from a vocation whose first and only priority is to heal and comfort into a profession that is willing to kill, we will have crossed the Rubicon. We will have wandered away from the oath to First, do no harm and to give no deadly medicine to any one if asked, nor suggest any such counsel. Henceforth, the consequences would be both unintended and grave to patients, physicians, and society. We must stop, once again, and reconsider just what it means to be physicians, to be healers. And we must remember what it means to be human. If we forget the fundamental, uncompromising, and ineradicable value intrinsic to human life, can we still call ourselves physicians?

The popular press, judicial activists, and enterprising legislators have grown increasingly sympathetic to the physician-assisted suicide movement. As such, anecdote after anecdote highlight people with grave medical maladies offering poignant interviews or writing last letters articulating their sincere fears of unremitting pain and incomparable suffering. They see only two alternatives: one is to suffer a prolonged, painful, and humiliating death, while the other is to proactively commit dignified suicide under the sympathetic eyes of their physician. Thats it. What is striking, however, is how little conversation there is about Palliative Care and Hospice.

Designed fully around the notion of providing dignity, autonomy, and symptom management in the face of terminal illness, Palliative Care and Hospice provide extraordinary end-of-life care to the very people who feel they have no fate but suffering ahead. These physicians and clinicians are well-trained and deeply committed to the care of those very patients that physician-assisted suicide advocates specifically target. In over two decades of practicing internal medicine, I have had a number of patients enroll in these services. I have yet to find one family who didnt gratefully describe the profound dignity, loving kindness, and tender management of pain, anxiety, and symptoms they witnessed in the waning days of their loved ones life. Surely, that is not to say that there cant be patients with symptoms that could be difficult to manage. But does that mean that we should then move to a widespread, systemic legalization of physician-assisted killing? With the oft untapped and unrecognized virtues of Palliative Care and Hospice, I think we are rushing to providea dangerous solution desperately in search of a problem.

Invariably, when legislation such as physician-assisted suicide is considered, concerns are raised about the slippery slopethat is, the unintended consequences and abuses that result from permitting such a policy at all. Enlightened minds that know better shake their heads and tut-tut that our concernsare overreactions. We would have safeguards against abuses, we are told, We would craft laws protecting minors or the mentally ill or the demented or the handicapped or others without terminal illness from ever being considered for physician-assisted suicide. It would be a rare event. Economics (a patients draining resources, the burden on the medical system) would never be a factor in a merciful act devoted to preserving the dignity of the individual.

2024 Lenten Gospel Reflections

To be sure, all of these reassuring arguments sound good and have been made in countries and states that have legalized physician-assisted suicide. And, too often, they have been wrong. People with mental illness and no terminal disease have been allowed to die. Minors in Belgium and the Netherlands have died under this policy. Physicians have been more aggressive in utilizing this option in the ill, but not terminally ill. Patients have reported fear of being hospitalized lest they become victims to a crusading doctors zeal. Exploding costs for end-of-life care and budgets groaning under the weight of the perpetually ill have a conscious or unconscious impact on a system where physician-assisted suicide is an option.

As far as being rare, according to the BMJs Journal of Medical Ethics (10/27/2023), there was an over sixteen-fold increase in physician-assisted suicide cases in Oregon from 1997 to 2022 while there was a drop in coinciding psychiatric assessments (evaluating the patients emotional state for such a decision) from 31.1% to 1.1%. The author of the paper, David Albert Jones, concludes, We now have twenty-five years of data from Oregon and data from an increasing number of other states with similar laws. However, the more we know, the less reassuring the Oregon model of assisted suicide seems to be. Nonetheless, those promoting this law will reassure us. Weve thought of these concerns and, if need be, we will enact further laws to protect patients from abuse. To this reasoning, I would ask, How will the small laws protect us, when the big law (against physician-assisted suicide) has been able to fall? When it comes to the institutionalization of physician-assisted suicide, mark my words, telling us that everything will be okay is a misguided, if not dangerous, philosophy.

For the last twenty-four years, it has been an honor and privilege to practice internal medicine. I love my patients, enjoy my colleagues, and cherish my calling. But that calling will fundamentally change if we devolve from a vocation that heals to a vocation that kills.

Most of what I have written today in opposition to physician-assisted suicide is fairly obvious. And I am here, simply and sadly, to restate it.

In having to do so, it is hard not to ask,What are we becoming? What does it mean to heal?

Heaven help us if we dont know the answer.

Thank you for your time and consideration.

Tod Worner, MD

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Against Physician-Assisted Suicide: A Physicians Letter to His Legislator - Word on Fire

Internal Medicine

Medical Mystery Case: What Landed This Pregnant Woman in the Hospital? – Medpage Today

Internal medicine and rheumatology specialist Siobhan Deshauer, MD, reviews the case study of a pregnant woman who was hospitalized.

Following is a partial transcript of the video (note that errors are possible):

Deshauer: Hey, guys. I'm Siobhan, an internal medicine and rheumatology specialist. Today, I'm going to tell you about Emma. She is a 31-year-old woman who landed her dream job, first violinist in a prestigious orchestra, and she has never had any health issues until recently.

Emma and her husband have been struggling to get pregnant over the past 2 years and she is now seeing a fertility specialist. Anxious to find a treatment that would work for her, Emma also started seeing another health practitioner who recommended various supplements that she was told were safe and effective. Unfortunately, she has been hiding this from her doctor and little did she know that decision would land her in the hospital and change the next few years of her life.

Over the past few weeks, Emma has had abdominal pain, nausea, and vomiting. She had a glimmer of hope thinking she might be pregnant, but the tests kept coming back negative. Her symptoms just kept getting worse and it was starting to affect her ability to perform at the orchestra. She was sure that her colleagues were starting to notice. After one particularly poor performance, she decided to go to the doctor. Her doctor checked her vitals, ordered some blood work, along with an abdominal ultrasound. Everything looked fine, so her doctor thought it might just be stress from the new job, but the pain and nausea worsened to the point that she was barely able to eat anything.

Finally, after a horrible episode of vomiting, her husband brought her to the emergency department. Her blood work showed mild anemia. Her red blood cells were a bit too low. After her vitals were normal and her imaging was normal, she was sent home with an iron supplement and told to follow up with her family doctor in about 2 weeks.

Over the next few days, her symptoms just continued to progress. She had to call in sick from work and was spending most of the day in bed exhausted and in pain. But Emma didn't want to go back to the hospital, wait for hours, and then just get sent home again. Then one day she was getting out of bed, she became so dizzy that she fell to the ground on her knees. Her husband heard the sound, ran upstairs and found her on the ground. That was it. They were heading back to the hospital.

In the emergency department, her heart rate was a little bit fast, but it was her blood work that was alarming. Emma's hemoglobin was much lower than before, so low that she required a blood transfusion. Emma was actually relieved to hear that they had found something to explain her symptoms, but the question remains why was her hemoglobin dropping so dramatically? The emergency doctor explained that she might be bleeding from her stomach. That would explain her abdominal pain and the drop in her hemoglobin. The plan this time was to admit her to hospital.

A few hours later, a tired-looking internal medicine resident came to assess Emma. When asked about medications, Emma responded that she is taking levothyroxine, a thyroid supplement, and follitropin alfa injections for infertility. When asked about supplements, she only mentioned her prenatal vitamins.

Now, remember Emma is also taking supplements for infertility, but she didn't want to tell the doctor because she was worried about being judged and she couldn't imagine that it was relevant in this situation. Emma's blood tests not only showed that she was anemic with too few red blood cells, but that the cells were too small. We call this microcytic anemia. In situations like this, her bone marrow should be going into overdrive, pumping out as many new red blood cells as possible, but another test called the reticulocyte count proved that this wasn't the case for Emma.

When I see a patient like this with microcytic anemia, a whole bunch of causes come to mind. But by far, the most common cause is iron deficiency, especially in a young woman. Think about iron deficiency like this: either you're not eating enough iron, your body is not absorbing that iron, or you're bleeding and then losing the iron.

Emma's blood work is consistent with iron deficiency with a ferritin level lower than expected. This suggests that she has a low amount of iron stored away in her body and maybe the bone marrow wasn't creating enough red blood cells because it didn't have enough iron available. But iron deficiency itself doesn't cause abdominal pain, so her doctors wondered if she might be bleeding somewhere in her abdomen, maybe a bleeding peptic ulcer.

In the emergency department, Emma already had a CT scan of her abdomen and an ultrasound, both of which were normal. You may be surprised to learn that often a CT scan or an MRI won't actually find the cause of a GI bleed. Often the bleeding is coming from an erosion in the protective layer of the gut and you really need to camera down the GI tract to be able to see that.

The next day she was wheeled down to the endoscopy suite and sedated. First, a camera was inserted into her throat, no signs of bleeding. Then she had a colonoscopy and again totally normal. Okay, so no bleeding in the GI tract where we can see.

Another thing we have to consider in a woman who is having abdominal pain and unexplained anemia is endometriosis, which is a disease where tissue similar to the lining of the uterus grows elsewhere in the body. Just like the uterus does, the tissue thickens up, breaks down and then bleeds with each menstrual cycle. This could be a hidden source of blood loss. It can also cause severe pain, especially in the pelvis, and it can also cause infertility. This could actually tie together all of Emma's symptoms including her recent diagnosis of infertility. Endometriosis is notoriously difficult to diagnose and it can be missed on imaging, which is why surgery is often needed to help make the diagnosis. Emma agreed to go ahead with the exploratory laparoscopy and a few days later she was taken to the operating room.

She was put under general anesthetic and the surgeons got to work. They poked small holes in her abdomen and inserted a small tube with a light and camera attached. They also insert another tube that pumps air into the abdomen. This raises up the abdominal wall so it's possible to look around at the organs and then operate if necessary.

The surgeon carefully examined each of Emma's organs, looking for any signs of endometriosis, which would look something like this. But they only found one abnormality, a simple cyst on her ovary, far from a slam-dunk diagnosis and probably unrelated to her symptoms. But nonetheless, the surgeons took a biopsy of the cyst and sent it off to the pathology lab to be examined. But if it doesn't look like endometriosis, what else could it be?

Emma's medical team went back to the drawing board to rethink her case. She eats a diet containing enough iron. She has no signs of malabsorption and they couldn't find any signs of bleeding, so maybe the blood work showing iron deficiency is just a red herring and there is another cause for her anemia that hasn't been considered. Could this be a production problem, an issue stemming from the bone marrow where the red blood cells are made? Well, there is only one way to find out, going straight to the source.

Emma was prepped for a bone marrow biopsy where a needle is inserted into the bone to take a sample of the semi-solid tissue inside. Making over 500 billion blood cells per day, our bone marrow is constantly working hard to keep us alive. Now, it's a waiting game. The results from the bone marrow won't be back for a few weeks, so Emma was discharged home with a diagnosis, anemia NYD (not yet diagnosed). But on a positive note, her abdominal pain had improved and as she was leaving the hospital she was told to restart her usual home medications and to come back if things got worse. When she got home, she restarted her fertility injections and those fertility supplements again.

Emma was still really tired and soon she developed a new headache and she was never someone to get headaches. Plus, tinnitus, that high-pitched ringing in her ears that just wouldn't go away. She kept track of her symptoms until she had her follow-up appointment 2 weeks later. Hearing about her new neurological symptoms, the internal medicine team decided to expand their diagnostic search to include another rare cause, porphyria.

This is a very rare group of conditions that affects how your body makes heme, an important part of hemoglobin, and some patients experience porphyria attacks, which can include anemia, neurological symptoms, and abdominal pain. It was a stretch and they knew it. But if you never look for those rare causes, you'll never find them, so her doctors ordered a urine test to screen for the disease.

Two weeks later Emma had another follow-up appointment to go through results. She was nervous, but hopeful that she might walk away with some answers this time. First, the surgical biopsy. It was normal, no endometriosis or cancer. Good. Next, the bone marrow results. It showed some increase in iron stores, but it was otherwise normal, so again no diagnosis.

Then a result that finally gave them a lead, Emma's porphyria screening show high levels of copper porphyrin III and delta-ALA. Okay. Now, porphyria screening is a whole can of worms that we don't have time to unpack right now, but the key point is that this particular result really narrows things down to either porphyria or lead poisoning.

Emma was sent back to the lab this time to have her blood lead levels drawn. Two days later, Emma got a phone call from her doctor's office. Her blood lead levels were off the chart. Finally, she has a diagnosis. Emma is suffering with lead poisoning. This explains all of her symptoms: abdominal pain, nausea, and vomiting. These are classic, early signs of lead toxicity.

Neurological symptoms take some time to develop, which explains why her headache and tinnitus came on later. This also explains her anemia. Lead accumulates in the bone marrow, blocking certain enzymes that produce heme, an important part of hemoglobin. Less heme means smaller red blood cells and it also limits the bone marrow's ability to create more cells, ultimately causing hypoproliferative microcytic anemia.

But why did her porphyria testing come back positive? Well, as lead blocks important enzymes that produce heme, that leads to a buildup of byproducts. Think of it like the conveyor belt in the factory that's making heme is broken and as a result there is a buildup of raw materials. Those raw materials are copper porphyrin III and delta-ALA. That's why her porphyrin screening came back positive. It's so cool, right? Everything leads back to lead poisoning. Had her doctors ordered a blood lead level earlier, it would have saved Emma so many needless investigations.

Siobhan Deshauer, MD, is an internal medicine and rheumatology specialist in Toronto. Before medicine, she was a violinist, which is why her YouTube channel is called Violin MD.

The rest is here:

Medical Mystery Case: What Landed This Pregnant Woman in the Hospital? - Medpage Today

Internal Medicine

NYU Langone Health in the NewsWednesday, December 27, 2023 – NYU Langone Health

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NYU Langone Health in the NewsWednesday, December 27, 2023 - NYU Langone Health