CVMS Bulletin

“So I told them the truth: the hours are terrible, the pay is terrible, the conditions are terrible; you’re underappreciated, unsupported, disrespected and frequently physically endangered, but there’s no better job in the world.”
---Anonymous

Welcome to the seventh edition of the CVMS Bulletin bringing you updates on the status of healthcare in Eastern Virginia. We hope you find it interesting, informative and enjoyable. Please let us know if there is anything we can do to make it better: admin@cvmedicalsociety.org.

URGENT ADVOCACY ALERT!! TIME SENSITIVE ISSUE!

By Keith Berger, MD

The US House of Representatives is considering health legislation known as the PATIENT ACT OF 2023 which makes price transparency for hospitals and healthcare organizations mandatory.  Although there is already a presidential order and now a VA statute governing transparency, the vast majority of hospitals have either ignored or been non-compliant with the legislation.  HR 3561 would allow more effective enforcement of price transparency. 

PLEASE CONTACT YOUR US congressional representative and ask them to co-sponsor the PATIENT ACT OF 2023. 

The success (or failure) of this bill will greatly affect efforts toward hospital transparency.  As physicians of the newly formed Coastal Virginia Medical Society, this is our first real opportunity as our new society to make a difference by supporting this legislation as a cohesive group and asking our elected representative (who is Jennifer Kiggans for most all of us) to vote pro-healthcare.  Below is the letter I sent to her website.  The easiest way to do this is to click on the RED icon below and it will take you to the website. 

Here is the letter:

Dear Congresswoman Kiggans:

I am Dr Keith Berger and I've been in continuous medical practice here in Virginia Beach for the past 42 years. Since I operate an independent, open access endoscopy center, I have 1st hand experience of the impact of hospital consolidation, anticompetitive CON laws and unfair price gouging that hospitals regularly engage in. Transparency would be a great step forward in reinventing healthcare to actually serve the people who pay for it and are impacted by it (that would be nearly everyone!).

Key Points:
1) this is a BIPARTISAN issue, as it concerns everyone. 90% of voters repeatedly surveyed want to know the price of their healthcare up front. As a nurse practitioner, I'm sure you have seen the downside of this.
2) The Bill passed through the Energy and Commerce Committee by a vote of 49 to zero.
3) Opponents of HR 3561 want people to think that this is a partisan issue when clearly it is not.

PLEASE strongly consider co-sponsoring HR 3561. We need the support of legislators like yourself who promised to serve the people who voted for you (I did) and we need to start reforming healthcare NOW.

Members: Please send in your own comment in the RED link below.

You can also become a supporter of POWER TO THE PATIENTS. A non-profit patient advocacy group that has been very active lobbying across the country for price transparency in healthcare.

Dr. K. Berger is a practicing gastroenterologist in Virginia Beach, Delegate to the Medical Society of Virginia, and a CVMS Board Member. Questions or comments: email to admin@cvmedicalsociety.org.

CVMS Status Update

By Greg Warth, MD, Editor

 The Board is currently studying the history of the Certificate of Need (CON) laws in Virginia and finding out how other states have been able to eliminate or at least modify them to remove the known unintended consequences and prevent the abuses that have occurred as a result of discovered loopholes. 

In addition, we are continuing to advocate for price transparency among all medical institutions and providers so that the free market can discover independently which clinics can provide the most efficient, best quality service at the most affordable price. Currently, patients are paying either directly, or indirectly through insurance premiums, much higher costs for their healthcare than they need to be. This just drives up the overall cost of care for everyone, and lines pockets of middlemen. See article by Dr. Keith Berger above.

CVMS intends to create its own proposals and recommendations on these important issues and others while garnering support from legislators, patients and healthcare providers alike, so the next time they come up in the General Assembly, there may be a different outcome.

We are very pleased to announce that the Honorable Delegate Karen Greenhalgh has joined our Advisory Board, is sympathetic to our cause, and can provide the legislative support that we need to move us closer to our goals.

If you have comments or any new ideas that you believe should be near the top of our long list of advocacy items, please let us know. Send an email to admin@cvmedicalsociety.org or fill out the form on the Contact Us page.

Where is Mental Health Care Going in Hampton Roads?
Suggestions for Action!

By Jerome S. Blackman, MD, FIPA

Mental Health is not the problem; it’s mental illnesses, especially severe mental illnesses, which are affecting almost all our medical specialties, not just psychiatry. Emergency Departments are plagued with overwhelming numbers of people with serious mental Illnesses (SMI), essentially people who suffer with psychosis, substance abuse, and/or suicidal propensities.

Because of a lack of government-run psychiatric hospital beds (they have been closed over the past 50 years due to concerns with “least restrictive environment”), SMI patients are also crowding our jails and prisons, where their care is woefully poor. Uncounted numbers of SMI patients become homeless, threatening our environment, and endangering themselves and others (although not “imminently” or “substantially”). Internists are overwhelmed with psychiatric patients, which tends to interfere with their ability to tend to medically ill people.

There exist many other serious problems, but let’s start with these five:

1.         The need for the state government to build some type of facilities to house and treat SMI.

2.         The need to make involuntary commitment much easier.  This could be done without impugning patients’ rights, but perhaps the “pre-screeners” are anachronistic at this point, and could be eliminated or their roles removed from the commitment process.

3.         SMI patients should not be taken care of in ED’s or jails. 

4.         Action now will prevent homelessness here as it is now in San Francisco.

5.         Some limitations on liability should be extended to psychiatrists and other physicians who involve themselves in the commitment process.

The time is now to face the critical need for action by state legislators and senators. Would you be willing to spend time with me meeting with our elected representatives?

To volunteer, email Dr. Blackman at  admin@cvmedicalsociety.org.

Dr. Blackman is a Professor of Clinical Psychiatry, Eastern Virginia Medical School, Norfolk, and a member of the CVMS Board.

Evidence-Based Policies

By G.J. Warth, MD

Here is a novel idea:

Why not develop policies from the government and large health care institutions based on scientific study and actual evidence, rather than on conjecture, subjective thought, and who has the biggest lobby?

We have been doing this in medicine for decades. If there is good, hard, scientific, peer-reviewed evidence for a specific treatment, based on facts, and/or subjected to rigid statistical probability review, we use it and make it a guideline. We do extensive trials to see if a specific treatment or policy is successful before approving it for wide distribution (usually, except in "Emergency Use" situations).  If there is no evidence for it, or if it is later proven not to be of benefit, we stop using it or at least don't promote it or make it mandatory. Indeed, if we find evidence that some particular treatment is more harmful than beneficial, we immediately stop using it and provide strong mandates against its use, or take it off the market.

The CON (Certificate of Need) laws are not evidence-based. They never were. And now there is copious evidence that they do not work and actually cause harm to patients, decrease access to care, reduce efficiency, and increase costs. 

So why do we still use them other than to support self-interest groups who make more money from them, monopolize healthcare, and reduce competition? As long as CON laws are on the books and still legal, those who profit from them will continue to support them; that's just good business, though not very altruistic. We should not expect them to do otherwise.

We want our healthcare institutions to be strong and financially solvent, but not at the expense of impairment of public healthcare delivery and higher cost. Unfortunately, that is what's happening. The incentives are just lined up in the wrong direction. It will not change until the Virginia State Legislature changes the law, just like the Federal Government did when they realized that CON laws caused more harm than good. 

We have the evidence now that CON laws do not do what they were intended to do. In fact, they do exactly the opposite. They are harmful to our healthcare system, are being abused, are costing too much and are impairing access to care. These facts have already been proven. Please consider writing to your state representatives to support removal of CON laws.

CAN WE COMBAT MEDICAL MISINFORMATION?

‘When the global threat of misinformation online and everywhere effects medical care in Hampton Roads, what can you do about it?’

Dr. Alexandria Peck Berger

How did it all start? When was the first transgression? Was it Hilary Clinton campaigning against Barak Obama for President in 2008 who said, she got off the plane in Bosnia 12 years ago, recounting a landing under sniper fire, not Croatia, or Serbia, or Montenegro, or in one of those insignificant countries that used to make up a bigger country like Yugoslavia, and claimed they “had to run with our heads down,” but video footage of the arrival shows Clinton and her daughter walking calmly from the plane; or was it broadcast anchor managing editor of NBC Nightly News Brian Williams who admitted making up a “false” story in 2015, that he was “a war correspondent in 2003 and was caught in a skirmish and ‘they were taking on fire power,” while covering the invasion of Iraq, not Vietnam or Cambodia or Siem Rip or one of those Asian countries, not Hilary’s fire power but really good fire power, because as he described it, he was on a chopper that was hit by enemy fire and forced down – a story he retold in a televised tribute to a retired soldier during a New York Rangers hockey game.

I think it was Hilary Clinton though, who replied when confronted with her fabrication that she, “misspoke,” which at the time was a new fabricated word to show her “foreign policy expertise.” Williams read a 50-second statement apologizing for his ‘characterization of the episode.’ “After a groundfire incident in the desert during the Iraq war invasion, I made a mistake in recalling the events of some 12 years ago,” he said. “It did not take long to hear from some brave men and women in the air crews who were also in that desert. I want to apologize. . . I said I was traveling in an aircraft that was hit by [rocket-propelled grenade] fire. I was instead in a following aircraft.” Williams was humiliated, with damaged credibility, but time and a great ability to read a teleprompter brought him back to the networks as if nothing happened. Clinton went on to coin other such phrases when misspeaking still in the lexicon today.

Reviewing such incidents years later is fodder for our ridicule. Still depending on your position, it’s sad. Because you know both were lying, no matter what you call it, and both were manipulating the public’s thinking about them without respect for their audience. So now that you see from a distance how cavalier America started to become with truth, fact, veracity, ethics, and a moral compass, you can follow further into the abyss of freestyle marketing for the profit motive and see how the medical industrial complex got on board.

“Misspeaking” became “Fake News,” which has become its own acceptable brand, “Misinformation.” 30 years ago, we’d call it gossip, backstabbing, blue smoke and mirrors, sabotaging, or just plain faking it and storytelling. Same lie, different terminology. Same advertising concepts, only more sophisticated, fool the eye and ear kind of stuff. First you hear it then you don’t. Then you see it. Now you won’t. That nothing was off limits means nothing was off limits, and medicine, the oft untouchable became the prize to be disintegrated, destroyed, vandalized, and immobilized. It was deftly subtle. Now it’s just blatant.

The internet officially began January 1,1983, when a new communications protocol was established called ‘Transfer Control Protocol/Internetwork Protocol (TCP/IP). Prior to that, in 1967 Marshall McLuhan’s book entitled The Medium is the Message, was published and became a best seller with a cult following. McLuhan laid before us, the all-powerful all-encompassing industry that entrepreneurship and technology would unleash on the world. It would captivate us, envelop us, control us, and the form of the message whether print, visual, or musical, would determine the ways in which that message would be perceived. In other words, we’d come to discover ‘the medium from which we choose to communicate holds more value than the message itself. The medium can be the message itself if it delivers content that would otherwise be impossible to access.’

Facebook, Twitter, TikTok, YouTube, Bing, Instagram, What’s app, Google Duo, all media dissemination, all the time. Ask a teenager where he gets his news, or a 20 something potential voter, they’ll tell you TikTok. Cesspools of medical misinformation float through these canals waiting to offload their wares with just the click of someone’s mouse. As such, medical marketing doesn’t necessarily sell the product, it sells the idea of the product, and offers the product as an incentive to join the system. It sees the truth, veracity, facts, ethics as insignificant to the outcome of the product and if the information is bogus, so be it. A medium regardless of its content, exerts power in the world. It becomes the force around which people move. It requires people to adapt themselves to it. (‘Understanding Marshall McLuhan,’ The Vim Blog, post/9/13/20 Zach). 

“Nowadays, communication disruption is present in all organizations – private and government: unilateral and multilateral. Digital technology is rapidly disrupting institutions and corporations. New technologies and innovative start-ups emerge every day. Simply put: the balance of power has changed. Artificial intelligence (AI) is the big gorilla on the block. The reputation of a brand can be severely damaged in minutes. Brand loyalty, reputation, credibility, and trust are increasingly influenced by people’s experiences." (Papagianneas, Stavos.‘Is the Medium the Message?’ StP Communications, 2/23/22). 

(continued in right column)

CVMS Event Board

Also see MSV Calendar of Events for more information.

Contact Us

Here is your chance to let us know what is on your mind. What problems with healthcare in this area are you most concerned about? What benefit or service can we provide to help you the most with regard to your well being or that of your patients?

Just send an email to admin@cvmedicalsociety.org.

Related Links

Association of American Physicians and Surgeons

Virginia Department of Health Professions

Virginia General Assembly

Medical Society of Virginia

Virginia Health Department

Virginia Beach Health Department

Chesapeake Health Department

Chesapeake Care Clinic

Norfolk Health Department

Center for Disease Control

CDC Stats for Virginia

COVID-19 in Virginia

NIH - Pub Med

American College of Physicians/Advocacy

American College of Surgeons/Advocacy

AMA HealthCare Advocacy

Centers for Medicare and Medicaid Services

Virginia Legislative Agenda for 2023 Session

VDH Certificate of Public Need Program

AMA: Certificate of Need: Evidence for Repeal

Mercatus Center: CON Laws

Fierce HealthCare

Educational Sites

Eastern Virginia Medical School

Business Courses

MedScape CME

Virginia CME Packages

MedScape References

Medical Legal Partnerships

Medical Ethics

JAMA Network

Vu-Medi

CDC Updates

HEADS UPdates:

Centers for Disease Control:

• June 30, 2023: The CDC, the Mexican Ministry of Health, and U.S. state and local health departments are responding to a multinational outbreak of fungal meningitis among patients who had procedures under epidural anesthesia in Matamoros, Tamaulipas, Mexico from January 1 through May 13, 2023. Officials identified two clinics associated with the outbreak: River Side Surgical Center and Clinica K-3. Although these clinics were closed May 13, 2023, it can take weeks or months for symptoms to start. If your patients have had procedures at these clinics please notify them. Many Hampton Roads residents frequent these areas for procedures. As of June 29, 2023, there are nine confirmed cases, 10 probable cases, and 15 suspected cases. Seven patients have died, and several more remain critically ill. Most exposed people (81%) are from Texas, but dozens of additional state or jurisdictional health departments from across the United States have been involved in investigating potential cases.

• West Nile Virus - - Health officials around the country are reporting cases of positive samples of the West Nile Virus. In 2022 more than 1,125 human cases were reported. Be aware, that reporting systems across the U.S. are poor. Many clinicians may not know the symptoms of West Nile Virus. Many patients may not come to your practice when feeling sick.

Contracting West Nile Virus confers immunity for life. However, this immunity may decrease over time or with conditions that compromise the immune system. The long-term effects of West Nile Virus most reported are depression, memory loss, and motor dysfunction which can persist for the rest of a patient’s life. Transmission is by way of the Aedes Culex or the Anopheles mosquito, and is a Flavivirus, part of the family of viruses responsible for Yellow Fever, Dengue Fever, Japanese Encephalitis, Zika Virus and West Nile Encephalitis.  West Nile Virus can also infect horses, birds, dogs and other mammals. However wild birds acting as hosts harbor and replicate the virus. Serologic testing to detect immunoglobulin M (IgM) antibodies is the best means of diagnosing a West Nile Virus infection. Caution your patients to wear mosquito protection when they leave their homes and are outside at ANY time, and to remove any standing water outside their homes. There are no vaccines to prevent or medications to treat this virus.

• Malaria - -June 26, 2023. The CDC is warning doctors and public health officials about locally acquired cases of Malaria in Florida and Texas. There has not been a case of locally acquired Malaria in the United States in the last 20 years.  Although there are usually about 2,000 cases of Malaria reported in the U.S. each year none of them have been locally transmitted. Until now, all cases have been from travelers who’ve contracted the disease abroad or were immigrants. Officials are watching closely for additional cases. Hampton Roads clinicians should be on the lookout for Malaria cases here. Early American medical history reports this area was endemic for this disease because of its swampy areas and sea level hazards. With travelers now free to tour the globe once more, and the demographic changing due to massive immigration, emerging illnesses like Malaria are back in the U.S. Caution any travelers to Malaria endemic areas that they must take prophylaxis prior to traveling, during their trip, and for several weeks on their return. Medication for this purpose should be provided for them along with a prescription should they lose or have this prophylactic medication stolen.

• Tropical Sprue - - (TS) is a syndrome characterized by acute and chronic diarrhea, weight loss, malabsorption of nutrients, and megaloblastic anemia. It occurs in residents of or visitors to the tropics, tropical climates, and subtropics, throughout the world. It can also be caused by environmental factors, like walking through fields of wheat sheeves which are being thrown in the air to sift the seed pods. The first description of tropical sprue was made in 1759 by William Hillary who described his account of diarrhea while in Barbados. Diagnosis is clinical and by small-bowel biopsy. Patients not responding to treatments for Giardia, should be tested or trialed for Tropical Sprue. The definition has been expanded to include malabsorption of two different substances when other causes are excluded. Treatment of tropical sprue is tetracycline 250mg orally QID for one to two months, then TID for up to six months, depending on disease severity. Doxycycline 100mg orally BID can be used instead of tetracycline. Also, Folic Acid 5mg orally can be taken for the rest of a patient’s life, or in combination with antibiotics for 6 months. Unavailable in the U.S. Folic Acid 5mg tablets can be obtained from CanadaonlineHealth.com. or 1(800) 399-3784.

• Dengue Fever - - A vaccine for children 9 through 16 years old has been approved to prevent Dengue Fever with laboratory confirmed previous Dengue infection and living in endemic areas. In the U.S. those are areas with tropical temperatures even if seasonal, periods of heavy rain which accrue standing water, and already require mosquito control methods. Immigration from endemic countries has created a new population of children who have already had this and other diseases like West Nile Virus, Zika or Chikungunya. It’s important if they have had an initial Dengue infection to get children vaccinated, since this population, including infants, adolescents are at greatest risk from the effect of a second infection which can lead to death as are the elderly population. You can have Dengue up to 4 times in your life.

Extra caution on seeing traveled patients: June 21, 2023: Northern Peru is currently reeling from an outbreak of Dengue Fever, also called ‘breakbone disease,” because when contracted it feels like every bone in your body is broken. Other symptoms range from bleeding gums, headache, gastrointestinal issues, and fever. According to the Pan American Health Organization, so far there have been over 150,000 cases with more than 248 deaths. This is by far Latin America’s most intense Dengue outbreak.

They are not alone. This disease is on the rise around the globe. Cases have been reported in 120 countries including Canada, France, Croatia and here. The World Health Organization says reported cases jumped from 505,430 in 2000 to 5.2 million in 2019. Most first cases are asymptomatic or result in only mild sickness. But a number of patients do go on to develop severe Dengue, which can be fatal in up to 13% of untreated patients, according to the Centers for Disease Control.

Dengue Fever: Symptoms

• Fever up to 104 F
• Swollen glands
• Pain behind the eyes
• Severe headache
• Nausea, Vomiting
• Muscle and joint pain
• Rash

There is no cure. University of Queensland in Australia has developed a mosquito which eats the Aedes aegypti mosquito, and eradicated Dengue in the city of Townsville in 2022. Treatment of the symptoms revolves around keeping patients hydrated and administering acetaminophen in the U.S. and Canada as Tylenol, paracetamol in England, Europe, Australia, New Zealand, and India as Panadol (acetaminophen=paracetamol), but not other painkillers, which can make the patient worse. Recovery typically takes about a week. A report by the Rockefeller Foundation notes that the Aedes mosquito can now "overwinter in more regions," thanks to rising temperatures — which also "enhance dengue virus replication within the insect, speed up the growth of larvae and cause adult mosquitoes to "bite more frequently."

“Strong global El Niños, like the one predicted to take effect later in 2023, typically hail warmer global averages the following year,” warns Gavin Schmidt, director of NASA's Goddard Institute for Space Studies, one of the world's leading climate change research centers. That means that 2024 could potentially be the hottest year on record. 

It might even mean that it could be the first year that mean global temperatures exceed preindustrial averages by more than 1.5°Celsius, the limit set by the United Nations as necessary to avoid devastating climate change.

• July 6, 2023: FDA grants full approval to Biogen and Eisai Pharmaceuticals for their breakthrough drug, Leqembi, for early-stage Alzheimer’s Disease. The drug which targets protein beta-amyloid slows the rate of decline in Stage three (3) clinical trials by 27% over an 18-month period. It is dosed by IV every two weeks and trials show it slows the rate of decline for about five months at a cost of $26,500 per year. 80% is to be covered by Medicare with a 20% co-pay to qualifying patients, who must fill out specific forms to receive this reimbursed designation. NOTE: Leqembi will carry a Black Box warning stating this drug can lead to seizures and death.

Questions or Comments: Email Dr. A.Berger at cvmedsoc@gmail.com

Mosquito Magnets

• What makes people mosquito magnets? Why do some people get bitten more than others?

Scientists estimate that 20% of people are more likely to attract mosquitos and thus get bitten more often. Here’s why:

1.     Blood Type, according to research published by the National Library of Medicine. If you have TYPE O blood, you will attract more mosquitos than all other blood groups. Type A is the next most popular for mosquitos, followed by Type B.

2.     Your Scent, according to researchers at New York’s Rockefeller University who designed the experiment. People who are mosquito magnets have high levels of certain acids on their skin. Those people who attract mosquitos based on smell tend to get bitten over and over. Scientists don’t yet know why mosquitos prefer certain body scents.

3.     Your metabolism: Mosquitos can detect carbon dioxide from a distance up to 50 meters. The faster your metabolism, the more carbon dioxide you exhale. So those people with a faster metabolism are more likely to get bitten. Mosquitos also prefer pregnant women because they have a higher metabolic rate and tend to exhale more CO2.

4.     Your clothing choices: Mosquitos are attracted to heat, and dark colors hold in heat more than light colors. Colored clothing makes it easier for mosquitos to find you. Light

colored clothing reflects the heat. Tell your patients to wear light colored cottons and linens that are not easily pierced, arms and legs covered, pants and long sleeve shirts.

5.     Your drink selection: Several studies have shown that mosquitos are more attracted to people after they drink beer. You could be breathing harder, or giving off more ethanol in your sweat when you’ve been drinking and that could be the lure for mosquitos.

• HEAT: As the world heats up, no matter the cause, i.e., climate change or El Niños, in many regions of the U.S. this can mean death. Two weeks ago, temperatures reached into the 100s in Texas. At least 112 people have died because of “natural extreme temperatures” since March in Mexico. Many of the towns, cities, and regions, where temperatures are soaring as high as 113 degrees Fahrenheit, are frequented by many Hampton Roads residents, who go on tours or pick up cruise ships, own time shares, condos, and family homes. Quintana Roo, Oaxaca, Tabasco are some areas where this is happening. Scorching temperatures in both Mexico and the Southern US states including our own are harbingers of things to come. You know the drill to prevent dehydration. Think about sharing that information along with mosquito protection tips as a conversation base with your patients not only for them but to remind yourself.

Questions or Comments:

Email Dr. A.Berger at admin@cvmedicalsociety.org

‘THE MEDICINE MAKERS’

Clinical Trials and FDA approvals:

Each month CVMS will publish highlights from recent FDA approvals, CDC Advisories and current available clinical open trials, as ‘The Medicine Makers.’ A second monthly column of emergent diseases, that may or will affect our region, their status, and ancillary information is shown above as ‘Heads UPdates.’

For the FDA approvals archive from 2002 forward for quick reference go to: drugs.com and scroll down to the end of NEW DRUG APPROVALS. You will find this a loaded website. Search the U.S. Government database at: clinical trials.gov. The ‘Center for Information and Study on Clinical Research Participation’ will do free clinical trial research for you, go to: www.ciscrp.org. and fill out the form. The World Health Organization Clinical Trials Registry Platform gathers all clinical trial information on its member nation registries from the globe: trialsearch.who.int And that’s just the beginning. . .

• June 30, 2023: The CDC Advisory Committee on Immunization Practices (ACIP) recommends both new FDA approved respiratory syncytial virus (RSV) vaccines from GSK, Arexvy, (RSVpreF3 antigen) and Pfizer, Abrysvo, bivalent RSV prefusion(RSVpreF) vaccine for people aged 60 years and older.

•  First approved in 2009, given expanded use in 2018, repurposed in 2022, the drug has been repurposed again in 2023, with an FDA approval for its use as the first intravenous Iron Replacement Therapy for adults with heart failure, iron deficiency, in those who are sensitive to iron dextran. Feraheme (ferumoxytol), AMAG Pharmaceuticals states half of a complete replacement dose can be given in 17 seconds, making it extremely convenient. This drug is reserved for anemia of chronic renal failure, and there is no data as yet for complete use.

•  June 29, 2023: The FDA approved BioMartin’s Roctavian (valoctocogene roxaparvovec- rvox) Suspension for Intravenous Infusion for treatment of severe Hemophilia A.

•  June 28, 2023: The FDA approved Lantidra (donislecel-jujn), CellTrans,Inc., the first allogeneic (donor) pancreatic islet cellular therapy made from deceased donor pancreatic cells for the treatment of Type 1 Diabetes whose symptoms are not well controlled.

•    June 27, 2023: The FDA approved Pfizer’s Ngenia (somatrogon-ghla) Injection for pediatric growth hormone deficiency, which is a long-acting HGH analog.

•    June 26, 2023: The FDA approved Pfizer’s Litfulo (Ritlecitinib) Capsules in a 50mg dosage for the treatment of alopecia areata in individuals age 12 years and older. It’s the first and only approved treatment for severe alopecia areata in adolescents for this autoimmune disease. Trials show the drug achieves significant scalp hair regrowth. Pfizer states the drug “will become available within the coming weeks.”

•    June 22, 2023: A new study published in the shows, the extended use of an N95 mask in daily life can cause various cardiopulmonary stresses, such as reduced respiration, elevated heart rate and blood pressure, and increased energy expenditure.

•    June 22, 2023: The FDA approved Suflave (polyethylene glycol 3350, sodium sulfate, potassium chloride, magnesium sulfate, and sodium chloride) Colonoscopy Preparation, Sebela Pharmaceuticals, that tastes similar to a sports drink.

•    June 21, 2023: Amgen’s Blincyto (blinatumomab) was first approved in 2014 with full approval in 2017. It also received Orphan Drug designation, which provides incentives to assist and encourage the development of drugs for rare diseases. It has now received expanded full approval to treat adults and pediatric patients with CD-19 positive B-cell precursor acute lymphoblastic leukemia (B-ALL) in first or second complete remission with minimal residual diseases (MRD.)

•    June 20, 2023: Vyvgart Hytrulo ( efgartigimod alfa and hyaluronidase-qvfc) Halozyme Therapeutics, inc., is a new dosage form for myasthenia gravis.

•    June 16, 2023: Lodoco (colchicine) tablets, AGEPHA Pharma USA, LLC now FDA approved, is the first anti-inflammatory approved for heart disease that targets residual inflammation as an underlying cause of atherosclerotic cardiovascular disease (ASCVD). This upgrades this drug’s efficacy.

•    June 15, 2023: The FDA approved Genentech’s Columvi ( glofitamab-gxbm)Bispecific Antibody for the treatment of Relapsed or Refractory Diffuse Large B-Cell Lymphoma.

(Continued in right column)

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The Roman Fasces was a symbol of strength and power occurring as a result of many binding together. It was made of multiple elm or birchwood rods about 5 feet long tied together and sometimes including an axe. It was carried by attendants to soldiers or powerful figures in ancient Rome. For us, it symbolizes that we are stronger and more powerful if we bind together in supporting our goals.

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Includes a section on what to tell your patients

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COVID Trends in Virginia

Leqembi: New Drug for Alzheimers Dementia

A new medication just recently approved by the FDA for early Alzheimer's Disease (AD), Leqembi, holds some promise for this dreaded affliction. See article on "CDC Updates" in this issue.

Read more about it here...

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   The Official Newsletter of the Coastal Virginia Medical Society

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3. CVMS Bulletin March 2024

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   Medical News, Updates, and Commentary for Coastal Virginia.

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Reading of a Poem by Robert Frost

Submitted by Dr. Alexandria Berger

From an interview with Robert Frost. . . 

by Mark Harris, the author of “Bang the Drum Slowly.” 1961

. . . “I’d hate to look back and feel a disillusionment about it. He was turning pages looking for a poem he suddenly wanted. I’m always struggling to say it better. It’s a kind of a gratification that I’m after. “This, he said - - a book, Complete Poems of Robert Frost, he meant, his life’s labor - “This isn’t just amateur apprentice work that I’ve been writing”. . . he found his page - - 

The Fear of God - - and he removed his hearing glasses in favor of his seeing glasses, and read softly, conversationally, . . .

If you should rise from Nowhere up to Somewhere,

From being No one up to being Someone, 

Be sure to keep repeating to yourself

You owe it to an arbitrary god

Whose mercy to you rather than to others

Won’t bear to critical examination.

Stay unassuming. If for lack of license

To wear the uniform of who you are, 

You should be tempted to make up for it

In a subordinating look or tone

Beware of coming too much to the surface,

And using for apparel what was meant

To be the curtain of the inmost soul. 

“That’s all I’m answerable to,” he said, and he closed the book. 

List of Concerns Requiring Study, Advocacy and Action  

This is a list of concerns and recommendations from the Board of Directors that require focus, advocacy, and action as we move along in our mission to improve the lives of our physicians and patients in coastal Virginia. Please feel free to comment on or add to this list using the Comment Box at the bottom.

* Highest Priority

      a.    Certificate of Need*

      b.    Price Transparency*

      c.     Prior Authorizations

      d.    “Peer to Peer” reviews with insurance companies

      e.    Reducing physician workload/paperwork/computer work, or get paid for it.

      f.      Easier communication with patients and colleagues- encrypted.

      g.    Physician burnout and depression issues – moral dilemma*

      h.    Office scheduling and practice management seminars to improve patient access and patient-centric routines.

      i.      Better Patient Care / Access to care /Eliminate barriers*

      j.      Public/patient mental health issues.*

      k.     Firearm concerns

      l.      Connect with American College of Physicians Advocacy Program

      m.  Selection of Delegate(s) to attend MSV Annual Meeting in October. Will need delegates on standby for the August 10 2nd district caucus. MSV will begin working on delegate count allotments in July. Reach out to MSNVA for collaboration and “learning the ropes”.

      n.    Working with external forces – hospital policies, pharmacies, allied professionals

      o.    Poor Medicare reimbursement for this area.

      p.    Staff shortages physicians and nurses.

      q.    “Scapegoats” for opioid crisis – lack of specialists and community resources.

      r.     Pain management.*

      s.     Fact checking service. Dispelling myths and medical misinformation.

      t.     Inpatient vs observation – incentivizes longer hospital stays.

      u.    3-day stay for patients who require rehab.

      v.     Requirement for us to discharge patient when the hospital wants to discharge them.

       x.   Need to regain respect as leaders in the healthcare system*

Board of Directors

Our current Board of Directors is as follows:

Greg Warth, MD,  President and Communications Director, Newsletter Editor

Keith Berger, MD, Vice President and Advocacy Director

_______________Secretary/Treasurer - and Finance Director - open position

Lisa Barr, MD, Collegiality/Networking Director

Dr. Alexandria Peck Berger, Director of Public Health and Research

Jerome Blackman, MD, Director of Mental Health

Cynthia Romero, MD, Director of Education, Liaison to EVMS and ODU

Joel Bundy, MD, Director-Liaison to Sentara

_______________Director of Marketing, Benefits, and Services - open

Brenda Musto, Executive Director, non-voting

Advisory Board (non-voting):

• Karen Greenhalgh, State Delegate
• Charlotte Dunn, Professional Risk
• Juan Montero, II, MD, FACS

Please note there are two important vacancies on the Board - one for Secretary-Treasurer, which actually could be two positions on its own, and one for Director of Marketing, Benefits and Services. Here is your opportunity to become a leader in the community, to actually make a difference in improving healthcare in eastern Virginia. If you are at all interested in either of these positions, please let us know.

Contact us:

Email:admin@cvmedicalsociety.org

Phone: 757-816-8399

FAX: 757-486-2208

(MISINFORMATION: continued from middle column)

Therefore, with, no talent, no education, no skills, no training, and armed with the belief that the ends justify the means, instead of truth, veracity, ethics and a moral code, you now have young people, bored middle-aged people, ‘wanna be’ politicians, and groups with destructive agendas disrupting commerce, and calling themselves influencers, seeking fame above all else, power to influence without effort, and an upgraded education in street smarts, who are armed to manipulate people and the system, through the glitz and glamor of digitizing. You can move people’s thinking, distort their constructs, realign their concepts, and counter everything to flow into your belief system. Recently even Arnold Schwarzenegger jumped back into the field of fitness pumping iron and promoting all things muscle to fight to be the next big bulked-up body building influencer. (Men’s Health, July/August 2023).

One page away from Arnold’s article is an article entitled, “Are We at Peak Influence?” The top subhead reads, “Social media is more powerful than ever, affecting every aspect of our lives. Now AI influencers want in on the action.” (Taylor Lorenz, Men’s Health). Then, there’s a clip from Mercury News with a headline that reads, ‘Joe Biden’s brother says President is “very open-minded’ about psychedelics for medical treatment.” It goes on, Frank Biden added, he had “done a great deal of research on the issue, because I’m a recovering alcoholic for many, many years. . . . I don’t want to speak. I’m talking brother-to-brother. Brother to brother. . . The question is, is the world, is the U.S. ready for this? We are on the cusp of a consciousness that needs to be brought about to solve a lot of the problems in and around addiction, but as importantly, to make us aware of the fact that we’re all one people.”

Frank Biden may see himself as an influencer but I’m not sure his brother, the President would want him to make comments about drugs. Medical misinformation is one of the most threatening challenges to global health. Misinformation can hinder the cohesiveness of societies by increasing existing social inequities, stigmas, gender disparities, and generational rifts. To a fatigued physician, discussing misinformation may seem futile, but the power of the physician-patient relationship should not be underestimated. Physicians are considered the most trusted messengers of medical information. (Shajahan, MD, "Countering Medical Misinformation.") As such we are left to continue to communicate with our patients to explain accurately and honestly medical conditions or any such medical information for which they have concerns. Certainly, that will go a long way in creating a solid foundation, and it’s imperative if we want to continue to bring people together that we not use rapid deployment to tear them apart.

With Covid came confusion, disenchantment, dissatisfaction, fear, major disbelief, distrust, and total disregard for truth by government officials. Without governmental stability, people globally were left to their own beliefs receiving no real documentable solid vetted consistent information. People fear the unknown, and ignoring the unknown and making up answers created an opaque wall penetrating nothing. No credible government programs provided reasonable explanations. Politicians jockeyed for position and profit. Pharmaceutical companies were allowed to rule the country without appropriate clinical trials. Any credible detractors were quickly pushed to the side and denigrated without respect of their first amendment rights to descent and be heard. The longer this went on, the more this was left to fester, the more medical misinformation became the jewel in the crown of those activists waiting to explode with outrageous falsehoods and conspiracy theories.

Poor to no public health services left vaccination programs to pharmacies, fire departments, FEMA, and others ill-equipped services to handle mass vaccination programs. Yet the government did not use its resources to pull the country together, instead dividing it further making those who became sick, sicker with anxiety, and those that were well, looking for another place to live. ‘Battling misinformation has become daunting for physicians and can lead to burn-out and harm the physician-patient relationships. (Shajahan, Asha, et.al. "Countering Medical Misinformation Online and in the Clinic" (Editorials). American Family Physician, Vol. 106, Number 2, August 2022).

As Covid has cooled, new emerging infections have surfaced, and it seems in Hampton Roads people are more malleable now when it comes to discussing disease treatments. Perhaps because they were isolated and denied access to friends and family during long periods, the time is now to reconnect and that means communicating without fear of becoming ill.  However, the threat of blossoming periods of medical misinformation is writ large should the U.S. and in particular our own region be placed in a stressful position again dealing with a communicable disease requiring vaccinations or specific protocols. 

On May 24, 2023, more than 200 researchers from 55 countries gathered in Washington, DC with a similar sense of urgency and alarm as the threat of global warming looms. In the first report, the group questioned the effectiveness of fighting falsehoods online with content moderation being one of the most common strategies to combatting misinformation, saying other tactics had more scientific evidence behind them. We are drawn to echo chambers where news is bifurcated and TikTok influencers give us health advice. Even outside of conspiracy theorists there’s a segment of society today that questions the need for experts when Google’s vast servers can store information for us. We no longer need to memorize the numerical value of pi or the capital of North Dakota.  This sense of our own intellectual infallibility has led to an extreme lack of humility in all sorts of people from politicians to celebrities to social media influencers. Einstein taught that time is relative depending on your frame of reference. Is it possible that truth itself has also become relative?  (Benyamin Cohen, ‘Einstein and the Theory of Disinformation,’ New York Times, June 12, 2023.)

Dr. A. Berger is a 1997 Pulitzer Prize Nominee, and former Award-winning syndicated columnist for “The Imperfect Navigator.”® distributed by Time Warner/Knight Ridder Co. Sd 2006 to The McClatchy Company. She is also a CVMS Board Member.

(MEDICINE MAKERS -continued from left column)

•    According to the MDA research arm, 2023 may see the approval of more new gene therapies for more diseases that any year in history. In the past six years, the FDA gave its approval for 12 such therapies – five in 2022 compared to zero a decade ago. Among the new class of treatments is Zolgensma, a $2.1 million one-time infusion approved in 2019 to treat spinal muscular atrophy (SMA). On June 22, 2023, the FDA approved Elevidys (delandistrogene moxeparvovec-rokl), Sarpeta Therapeutics, Inc., indicated for the treatment of ages 4 through 5 with Duchenne muscular Dystrophy (DMD) with a confirmed mutation gene.

•    In the pipeline two expected Eli Lily blockbuster drug launches for 2023 approval: donanemab and lebrikizumab, two monoclonal antibody therapies indicated for Alzheimer’s disease and atopic eczema respectively.

•  Also in the pipeline for 2023: 16 oral drugs, 6 drugs delivered by injection, 6 drugs for breast cancer, 3 for non-small cell lung cancer (NSCLC), including Veliparib and Tovorafenib for breast cancer.

•    Researchers at Synchron are seeking individuals living with paralysis from muscular dystrophy, amyotrophic lateral sclerosis (ALS), spinal muscular atrophy (SMA), stroke, and spinal cord injury to participate in a study to evaluate the safety and feasibility of a motor neuroprosthesis (implanted medical device) to improve neural communication. To participate individuals must be aged 21 to 75 years have severe quadriparesis, be able to give consent, have a caregiver who can assist and meet additional criteria. Contact study coordinators Marta Lapinska: (646) 689-1776 or Marta.Lapinska@MountSinai.org, or Aidan Rogers (718) 308-9450 or Aidan.Rogers@MountSinai.org.

•    Other available neuromuscular disease clinical trials:  mda.org.clinical-trials.

• Tip: Pharmacists are over-looked travel specialists.

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Questions?

- admin@cvmedicalsociety.org