Today's Christian Doctor - Summer 2007

Paid Advertisement

When tension hurts‌

Manages pain while addressing tension and anxiety in patients with musculoskeletal disease.

Reduces pain-aggravating tension and anxiety due to favorable effects of aspirin plus meprobamate.

Offers the unique combination of aspirin and meprobamate, providing greater pain relief 1,2 than either agent alone.

EquagesicÂŽ is contraindicated for pregnant women and nursing mothers, in patients with acute intermittent porphyria and patients with allergic or idiosyncratic reactions to aspirin, meprobamate, or related compounds.

The most frequently observed adverse reactions include fever, hypothermia, and thirst. Aspirin should be used with caution in the presence of peptic ulcer or coagulation abnormalities. May be habit forming.

Please see adjacent full prescribing information.

References: 1. Gilbert MM, Koepke HH. Relief of musculoskeletal and associated psychopathological symptoms with meprobamate and aspirin: a controlled study. Curr Ther Res. 1973;15:820-832. 2. Kantor TG, Laska, E Streem A. An apparent algesic effect of meprobamate. J Clin Pharmacol. 1973;13:152-159

www.leitnerpharma.com

866-590-7600

(200 mg meprobamate and 325mg aspirin tablets)

Paid Advertisement

prescribe the only product that:

Equagesic® (meprobamate and aspirin tablets)

C IV

only Description Each tablet of Equagesic, for oral administration, contains 200 mg meprobamate and 325 mg aspirin. Chemically, meprobamate is 2-methyl-2-propyl-1,3-propanediol dicarbamate. Its molecular formula is C9H18N2O4 with a molecular weight of 218.25.

Chemically, aspirin is benzoic acid 2-(acetyloxy)-. Its molecular formula is C9H8O4 with a molecular weight of 180.16. It occurs as an odorless white, needle like crystalline or powdery substance. When exposed to moisture, aspirin hydrolyzes into salicylic and acetic acids, and gives off a vinegary odor. It is highly lipid soluble and slightly soluble in water. The structural formulas of meprobamate and aspirin are: MEPROBAMATE ASPIRIN

The inactive ingredients present are cellulose, D&C Yellow 10, FD&C Red 3, FD&C Yellow 6, hydrogenated vegetable oil, magnesium stearate, polacrilin potassium, and starch.

Clinical Pharmacology Meprobamate is a carbamate derivative which has been shown (in animal and/or human studies) to have effects at multiple sites in the central nervous system, including the thalamus and limbic system. Aspirin is a nonnarcotic analgesic with antipyretic and anti-inflammatory properties.

Indications and Usage As an adjunct in the short-term treatment of pain accompanied by tension and/or anxiety in patients with musculoskeletal disease. Clinical trials have demonstrated that in these situations relief of pain is somewhat greater than with aspirin alone.

Equagesic is not intended for use longer than 10 days.

Paid Advertisement

Contraindications Usage in Pregnancy and Lactation An increased risk of congenital malformations associated with the use of minor tranquilizers (meprobamate, chlordiazepoxide, and diazepam) during the first trimester of pregnancy has been suggested in several studies. Because use of these drugs is rarely a matter of urgency, their use during this period should almost always be avoided.

Because of the known effect of non-steroidal anti-inflammatory drugs (NSAIDs) on the fetal cardiovascular system (closure of the ductus arteriosus), use during the third trimester of pregnancy should be avoided. Salicylate products have also been associated with alterations in maternal and neonatal hemostasis mechanisms, decreased birth weight, and perinatal mortality. The possibility that a woman of childbearing potential may be pregnant at the time of institution of therapy should be considered. Patients should be advised that if they become pregnant during therapy or intend to become pregnant they should communicate with their physicians about the desirability of discontinuing the drug. Meprobamate passes the placental barrier. It is present both in umbilical-cord blood at or near maternal plasma levels and in breast milk of lactating mothers at concentrations two to four times that of maternal plasma. When use of meprobamate is contemplated in breast-feeding patients, the drug’s higher concentrations in breast milk as compared to maternal plasma levels should be considered.

Equagesic is contraindicated in patients with acute intermittent porphyria and in patients with allergic or idiosyncratic reactions to aspirin, meprobamate, or related compounds, such as carbromal, carisoprodol, mebutamate, nonsteroidal anti-inflammatory drug products, salicylates, or tybamate. Equagesic is also contraindicated in patients with the syndrome of asthma, rhinitis, and nasal polyps. The aspirin component of Equagesic may cause severe angioedema, bronchospasm (asthma), or urticaria.

Reye’s syndrome: Aspirin should not be used in children or teenagers for viral infections, with or without fever, because of the risk of Reye’s syndrome with concomitant use of aspirin in certain viral illnesses.

Warnings Equagesic should be prescribed cautiously and in small quantities to patients with suicidal tendencies.

Additive Effects: Since CNS-suppressant effects of meprobamate and alcohol or meprobamate and other psychotropic drugs may be additive, appropriate caution should be exercised with patients who take more than one of these agents simultaneously.

Alcohol Warning: Patients who consume three or more alcoholic drinks every day should be counseled about the bleeding risks involved with chronic, heavy alcohol use while taking aspirin.

Coagulation Abnormalities: Even low doses of aspirin can inhibit platelet function leading to an increase in bleeding time. This can adversely affect patients with inherited (hemophilia) or acquired (liver disease or vitamin K deficiency) bleeding disorders.

Gastrointestinal Side Effects (GI): GI side effects include gross GI bleeding, heartburn, nausea, stomach pain, and vomiting. Although minor upper GI symptoms, such as dyspepsia, are common and can occur anytime during therapy, physicians should remain alert for signs of ulceration and bleeding, even in the absence of previous GI symptoms. Physicians should inform patients about the signs and symptoms of GI side effects and what steps to take if they occur.

Peptic Ulcer Disease: Patients with a history of active peptic ulcer disease should avoid using aspirin, which can cause gastric mucosal irritation and bleeding.

Potentially Hazardous Tasks Patients should be warned that meprobamate may impair the mental and/or physical abilities required for performance of potentially hazardous tasks, such as driving a motor vehicle or operating machinery. Such tasks should be avoided while taking this product.

Precautions General Equagesic should be prescribed with caution in certain special-risk populations, such as elderly or debilitated patients and those with acute abdominal conditions, Addison’s disease, coagulation disorders, elevated intracranial pressure, head injuries, hypothyroidism, impairment of liver or kidney function, prostatic hypertrophy, or urethral stricture. Meprobamate is metabolized in the liver and excreted by the kidney.

To avoid its excess accumulation, caution should be exercised in the administration to patients with compromised liver or kidney function. Meprobamate occasionally may precipitate seizures in epileptic patients.

Information for Patients Patients should be informed that Equagesic contains aspirin and should not be taken by patients with an aspirin allergy.

Patients with a predisposition for gastrointestinal bleeding should be cautioned that concomitant use of medications containing aspirin and/or alcohol may have an additive effect in this regard.

Drug Interactions Angiotensin Converting Enzyme (ACE) Inhibitors: The hyponatremic and hypotensive

effects of ACE inhibitors may be diminished by the concomitant administration of aspirin due to its indirect effect on the renin-angiotensin conversion pathway.

Acetazolamide: Concurrent use of aspirin and acetazolamide can lead to high serum concentrations of acetazolamide (and toxicity) due to competition at the renal tubule for secretion.

Alcohol, General Anesthetics, Narcotic Analgesics, Sedative Hypnotics, Tranquilizers such as Chlordiazepoxide, or Other CNS Depressants: The effects of these substances may be enhanced, causing increased CNS depression.

Anticoagulant Therapy (Heparin and Warfarin): Patients on anticoagulation therapy are at increased risk for bleeding because of drug-drug interactions and the effect on platelets. Aspirin can displace warfarin from protein binding sites, leading to prolongation of both the prothrombin time and the bleeding time. Aspirin can increase the anticoagulant activity of heparin, increasing bleeding risk.

Anticonvulsants: Salicylates can displace protein-bound phenytoin and valproic acid, leading to a decrease in the total concentration of phenytoin and an increase in serum valproic acid levels.

Beta Blockers: The hypotensive effects of beta blockers may be diminished by the concomitant administration of aspirin due to inhibition of renal prostaglandins, leading to decreased renal blood flow and salt and fluid retention.

Corticosteroids: In patients receiving concomitant corticosteroids and chronic use of medications containing aspirin, withdrawal of corticosteroids may result in salicylism because corticosteroids enhance renal clearance of salicylates and their withdrawal is followed by return to normal rates of renal clearance.

Diuretics: The effectiveness of diuretics in patients with underlying renal or cardiovascular disease may be diminished by the concomitant administration of aspirin due to inhibition of renal prostaglandins, leading to decreased renal blood flow and salt and fluid retention.

6-Mercaptopurine and Meth-otrexate: Bone marrow toxicity and blood dyscrasia may result from displacing these drugs from secondary binding sites, and in the case of methotrexate, also reducing its excretion.

Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): The concurrent use of aspirin with other NSAIDs should be avoided because this may increase bleeding or lead to decreased renal function.

Oral Hypoglycemics: Moderate doses of aspirin may increase the effectiveness of oral hypoglycemic drugs, leading to hypoglycemia.

Uricosuric Agents (Probenicid and Sulfinpyrazone): Salicylates antagonize the uricosuric action, reducing their effectiveness in the treatment of gout. Aspirin competes with these agents for protein binding sites.

Laboratory Test Interactions Aspirin may interfere with the following laboratory determinations in blood: blood urea nitrogen, cholesterol, elevated hepatic enzymes including aspartate aminotransferase (AST), fasting blood glucose, hyperkalemia, prolonged bleeding time, protein, prothrombin time, serum amylase, serum creatinine, and uric acid. Aspirin may interfere with the following laboratory determinations in urine: 5-hydroxyindoleacetic acid, diacetic acid, Gerhardt ketone, glucose, proteinuria, uric acid, spectrophotometric detection of barbiturates, and vanillylmandelic acid (VMA).

Carcinogenesis, Mutagenesis, Impairment of Fertility: Administration of aspirin for 68 weeks at 0.5 percent in the feed of rats was not carcinogenic. In the Ames Salmonella assay, aspirin was not mutagenic; however, aspirin did induce chromosome aberrations in cultured human fibroblasts.

Pregnancy: Teratogenic Effects. Pregnancy Category X. See Contraindications.

Labor and Delivery Aspirin should be avoided during the third trimester of pregnancy and during labor and delivery because it can result in excessive blood loss at delivery. Prolonged gestation and prolonged labor due to prostaglandin inhibition have been reported.

Nursing Mothers Nursing mothers should avoid using aspirin because salicylate is excreted in breast milk. Use of high doses may lead to rashes, platelet abnormalities, and bleeding in nursing infants. Because of the potential for serious adverse reactions in nursing infants, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance of the drug to the mother (See also Contraindications).

Pediatric Use Safety and effectiveness have not been established for pediatric patients under the age of 12 years (See Contraindications).

Geriatric Use Clinical studies of meprobamate with aspirin did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. In general, dose selection for an elderly patient should be cautious, usually starting at the low end of the dosing range, reflecting the greater frequency of decreased hepatic, renal, or cardiac function, and of concomitant disease or other drug therapy.

Adverse Reactions Body as a Whole Fever, hypothermia, thirst.

Allergic or Idiosyncratic Severe hypersensitivity reactions, including anaphylaxis, angioneurotic edema, anuria, asthma, bronchospasm, bullous dermatitis, chills, erythema multiforme, exfoliative erythroderma, laryngeal edema, oliguria, proctitis, purpura, Stevens-Johnson syndrome, stomatitis, and urticaria. Milder reactions are characterized by an itchy, erythematous maculopapular, or urticarial rash which may be generalized or confined to the groin. Other reactions have included acute nonthrombocytopenic purpura, adenopathy, cross-sensitivity between meprobamate/mebutamate and meprobamate/carbromal, ecchymoses, eosinophilia, fixed-drug eruption with cross-reaction to carisoprodol, leukopenia, peripheral edema, and petechiae.

Cardiovascular Various forms of arrhythmia, hypotension, palpitation, syncope, tachycardia, and transient ECG changes.

Central Nervous System Agitation, ataxia, cerebral edema, coma, confusion, dizziness, drowsiness, dysphoria, euphoria, fast EEG activity, headache, impairment of visual accommodation, lethargy, overstimulation, paradoxical excitement, paresthesias, sedation, slurred speech, subdural or intracranial hemorrhage, seizures, vertigo, and weakness.

Fluid and Electrolyte Dehydration, hyperkalemia, metabolic acidosis, and respiratory alkalosis.

Gastrointestinal Abdominal pain, constipation, diarrhea, dyspepsia, epigastric discomfort, gastric distress, gastrointestinal bleeding, heartburn, hepatitis, nausea, pancreatitis, Reye’s syndrome, transient elevations of hepatic enzymes, ulceration and perforation, and vomiting.

Hematologic (see also “Allergic or Idiosyncratic”) Agranulocytosis and aplastic anemia have been reported, although no causal relationship has been established, coagulopathy, disseminated intravascular coagulation, exacerbation of porphyric symptoms, hemolytic anemia, iron deficiency anemia, occult blood loss, prolongation of the prothrombin time, thrombocytopenia, and thrombocytopenic purpura.

Musculoskeletal Rhabdomyolysis Metabolism Hyperglycemia and hypoglycemia Reproductive Prolonged pregnancy and labor, stillbirths, lower birth weight infants, and antepartum and postpartum bleeding.

Respiratory Acute airway obstruction, hyperpnea, pulmonary edema, and tachypnea.

Special Senses Hearing loss and tinnitus.

Urogenital Interstitial nephritis, papillary necrosis, proteinuria, and renal insufficiency and failure.

Drug Abuse and Dependence Physical dependence, psychological dependence, and abuse have occurred. Chronic intoxication from prolonged ingestion of, usually, greater-than-recommended doses is manifested by ataxia, slurred speech, and vertigo. Therefore, careful supervision of dose and amounts prescribed is advised, as well as avoidance of prolonged administration, especially for alcoholics and other patients with a known propensity for taking excessive quantities of drugs. Sudden withdrawal of the drug after prolonged and excessive use may precipitate recurrence of preexisting symptoms, such as anorexia, anxiety, or insomnia, or withdrawal reactions, such as ataxia, confusional states, hallucinosis, muscle twitching, tremors, vomiting, and, rarely, convulsive seizures. Such seizures are more likely to occur in persons with central nervous system damage or preexistent or latent convulsive disorders. Onset of withdrawal symptoms occurs usually within 12 to 48 hours after discontinuation of meprobamate; symptoms usually cease within the next 12- to 48-hour period. When excessive dosage has continued for weeks or months, dosage should be reduced gradually over a period of 1 to 2 weeks rather than abruptly stopped. Alternatively, a long-acting barbiturate may be substituted, then gradually withdrawn.

Overdosage Treatment of overdose with Equagesic is essentially symptomatic and supportive. In cases where excessive doses of Equagesic have been taken, sleep ensues rapidly and blood pressure, pulse, and respiratory rates are reduced to basal levels. Any drug remaining in the stomach should be removed and symptomatic treatment given. After emesis and/or lavage, activated charcoal may reduce absorption of both aspirin and meprobamate. Should respiration or blood pressure become compromised, respiratory assistance, central nervous system stimulants, and pressor agents should be administered cautiously as indicated. Diuresis, osmotic (mannitol) diuresis, peritoneal dialysis, and hemodialysis have been used successfully in removing both aspirin and meprobamate. Alkalinization of the urine increases the excretion of salicylates. Careful monitoring of urinary output is necessary, and caution should be taken to avoid overhydration. Relapse and death, after initial recovery, have been attributed to incomplete gastric emptying and delayed absorption. Salicylate toxicity may result from acute ingestion (overdose) or chronic intoxication. Signs and symptoms include abdominal pain, acid-base disturbances with development of metabolic acidosis, convulsions, delirium, hyperpnea, hyperthermia, hypoprothrombinemia, restlessness, tinnitus (ringing in the ears), and vomiting. The early signs of salicylic overdose (salicylism), including tinnitus, occur at plasma concentrations approaching 200 μg/mL. Plasma concentrations of aspirin above 300 μg/mL are clearly toxic. Severe toxic effects are associated with levels above 400 μg/mL. A single lethal dose of aspirin in adults is not known with certainty but death may be expected at 30 g. For real or suspected overdose, a Poison Control Center should be contacted immediately. Careful medical management is essential. In acute aspirin overdose, severe acid-base and electrolyte disturbances may occur and are complicated by hyperthermia and dehydration. Respiratory alkalosis occurs early while hyperventilation is present, but is quickly followed by metabolic acidosis. Treatment of aspirin overdose consists primarily of supporting vital functions, increasing salicylate elimination, and correcting the acid-base disturbance. Gastric emptying and/or lavage is recommended as soon as possible after ingestion, even if the patient has vomited spontaneously. After lavage and/or emesis administration of activated charcoal, as a slurry, is beneficial, if less than 3 hours have passed since ingestion. Charcoal adsorption should not be employed prior to emesis and lavage.

Severity of aspirin intoxication is determined by measuring the blood salicylate level.

Acid-base status should be closely followed with serial blood gas and serum pH measurements. Fluid and electrolyte balance should also be maintained. In severe cases, hyperthermia and hypovolemia are the immediate threats to life. Children should be sponged with tepid water. Replacement fluid should be administered intravenously and augmented with correction of acidosis. Plasma electrolytes and pH should be monitored to promote alkaline diuresis of salicylate if renal function is normal. Infusion of glucose may be required to control hypoglycemia.

Hemodialysis and peritoneal dialysis can be performed to reduce the body drug content. In patients with renal insufficiency or in cases of life-threatening intoxication, dialysis is usually required. Exchange transfusion may be indicated in infants and young children. Suicidal attempts with meprobamate have resulted in ataxia, coma, drowsiness, lethargy, shock, stupor, and respiratory and vasomotor collapse. Some suicidal attempts have been fatal. The following data have been reported in the literature and from other sources. These data are not expected to correlate with each case (considering factors such as individual susceptibility and length of time from ingestion to treatment) but represent the usual ranges reported. Acute simple overdose (meprobamate alone): Death has been reported with ingestion of as little as 12 grams meprobamate and survival with as much as 40 grams.

BLOOD LEVELS 0.5 to 2 mg percent represents the usual blood-level range of meprobamate after therapeutic doses. 3 to 10 mg percent usually corresponds to findings of mild to moderate symptoms of overdosage, such as stupor or light coma. 10 to 20 mg percent usually corresponds to deeper coma, requiring more intensive treatment. Some fatalities occur. At levels greater than 20 mg percent, more fatalities than survivals can be expected. Acute combined overdose (meprobamate with other CNS psychotropic drugs or alcohol): Since effects can be additive, a history of ingestion of a low dose of meprobamate plus any of these compounds (or of a relatively low blood or tissue level) cannot be used as a prognostic indicator.

Dosage and Administration The usual dosage of Equagesic is one or two tablets, each tablet containing meprobamate, 200 mg, and aspirin, 325 mg, orally 3 to 4 times daily as needed for the relief of pain when tension or anxiety is present. Equagesic is not recommended for patients 12 years of age and under.

How Supplied Equagesic® (meprobamate and aspirin tablets) Tablets, 200 mg meprobamate and 325 mg aspirin, are available as follows: NDC 10551-091-10, pink and yellow, double-layer, round, scored tablet marked “WFHC” and “91”, in bottles of 100 tablets.

Store at controlled room temperature, 20°-25°C (68°-77°F).

Protect from moisture.

Keep tightly closed.

Protect from light.

Dispense in light-resistant, tight container.

Manufactured for: Leitner PharmaceuticalsTM, LLC Bristol, TN 37620 www.leitnerpharma.com 999A00

02/05 1-0047-1

Please visit our website at www.leitnerpharma.com, call us toll free at 866-590-7600 or write to us at 340 Edgemont AVE., STE. 300, Bristol, Tennessee 37620.

Publication 1-0150-1. Equagesic ® is a registered trademark of Leitner Pharmaceuticals.® ©2007 Leitner Pharmaceuticals®. LLC.

Editorial

by David Stevens, MD, MA (Ethics) – Chief Executive Officer

Who Is Going To Clean Up This Mess?

I

suspect it was the daily room inspections back in my high school boarding room days, but whatever the reason, I can’t stand a mess. Add to my credo, “A place for everything and everything in its place.”

Don’t get me wrong, I’m not OCD or a neat freak but I just function better if there is reasonably ordered environment around me. I’m more relaxed, focused and efficient.

I think many docs are the same way, which makes it difficult for all of us to live and function in the mess that medicine is in these days. Practice is complicated, unpredictable and lots of extraneous things keep us from taking care of patients. It is messy to get paid. It is messy to get treatments approved. It is messy to deal with ever changing practice standards and government regulations.

So you work harder, you work smarter, you work longer but it still doesn’t seem to get much better. You for sure aren’t relaxed, focused, and efficient!

It reminds me of mowing my lawn the other day. First, I had to throw all the sticks out of the lawn that my two Labradoodles had drug in from the woods. Some were chewed into a dozen pieces. But before I got back from the first lap with the mower, my dogs had dragged more sticks into the lawn. They were making a mess faster than I could clean it up and get my job accomplished.

In the midst of trying to provide excellent care for our patients, we have a highly charged political atmosphere, an increasing lack of collegiality, a potently adversarial malpractice environment, decreasing professionalism, and a loss of ethical consensus.

Who is going to clean up this mess?

It is obvious that none of us is going to be able to do it alone. We don’t have the time, the expertise, the power, or the experience. In fact, no group, professional or government, has all these necessary, but that doesn’t mean they aren’t going to attempt it . . . which in itself is worrisome.

As bad as things are now, we have a built in inertia into further change fed by fear that the solution could be worse than the problem. “Better the devil we know than the one we don’t know.”

In this issue of Today’s Christian Doctor, we take a look down the road of medicine and do our best to see where it

is going. If we know the path, we can be better prepared for the journey and perhaps even take a different route.

One thing is clear. In these troubled times we need Christian doctors to mutually support and encourage each other. We need colleagues that can remind us to keep our eyes on the Savior instead of our own anxieties and burdens. We need to remember that all potential solutions need to adhere to biblical principles. We need a united voice in order to have a place at the table where the decisions are made.

Like heading west to settle, it is too dangerous to travel alone. The best safety is banding together in a wagon train with those of like mind and common purpose who will support and care for each other.

If we ever needed CMDA, we need it now.

That is one reason why in this issue we are introducing a new paradigm to grow our organization. It is simple, compelling, and doable. I believe it will take us to over 25,000 members in the next few years - not to build an institution, but to grow this movement of Christian doctors who need each other in these difficult times.

• Only together can we bring up the next generation of Christian doctors.

• Only together can we be an effective voice into medicine and our culture.

• Only together can we help each other to not lose sight of why we went into medicine and dentistry.

• Only together can our individual candles merge into a bright light and become an even greater witness for God. We need each other and other Christian doctors need us.

The river is raging. It is difficult if not impossible to row alone, but the more people we get into the boat manning the oars the better off we all will be.

As you read this issue, think about that and personally commit to using our new tools to tell a Christian colleague about CMDA. We will all be better for it.

And then rest in this. No matter how big the mess, we have a hope and a confidence in a Savior who not only offers God sized solutions, but also can give us a peace that passes understanding. ✝

I n t e r n e t w e b s i t e : w w w. c m d a . o r g

•

Summer 2007

5

table of

CONTENTS V OLUME 38 , N O. 2

Summer 2007

( T C D ’s 5 8 t h Y e a r )

The Christian Medical & Dental Associations —Changing Hearts in Healthcare—since 1931.

SM

Features 12 Special Report New Membership Drive CMDA seeks to double its membership within the next decade

14 The Changing Role of the Doctor

by Richard A. Swenson, MD Job churn, pluralism, and the vanishing Coriolis effect, where is it all taking us?

18 The Business of Medicine Clinical Practice Committee Established Eight questions on our members’ minds

21 The Whole Truth about Stem Cells and Related Therapies

by David A. Prentice, PhD

Beyond the hype, there is hope for effective treatments

25 Spectators or Saints Which Will We Be?

by David L. Stevens, MD, MA (Ethics) Human trafficking - modern day slavery - is something that demands action from us all

28 Reconciling a Good God with an Evil World (Fourth in a Series)

by Robert W. Martin III, MD, MAR Can the existence of evil prove the existence of God?

Departments 7 30 6

T o d a y ’s C h r i s t i a n D o c t o r

Progress Notes Advertising Section

Editor: David B. Biebel, DMin Editorial Committee: Gregg Albers, MD, Ruth Bolton, MD, Elizabeth Buchinsky, MD, John Crouch, MD, William C. Forbes, DDS, Curtis E. Harris, MD, JD, Rebecca Klint, MD, Samuel E. Molind, DMD, Robert D. Orr, MD, Matthew L. Rice, ThM, DO, Richard A. Swenson, MD Vice President for Communications: Margie Shealy Classified Ad Sales: Gloria Gentry 423-844-1000 Display Ad Sales: Gloria Gentry 423-844-1000 Design & Pre-press: B&B Printing CMDA is a member of the Evangelical Council for Financial Accountability (ECFA).

TODAY’S CHRISTIAN DOCTOR®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Summer 2007, Volume 38, No. 2.

Printed in the United States of America.

Published four times each year by the Christian Medical & Dental Associations at 2604 Highway 421, Bristol, TN 37620.

Copyright © 2007, Christian Medical & Dental Associations . All Rights Reserved.

Distributed free to CMDA members. Non-members (U.S.) are welcome to subscribe at a rate of $35 per year ($40 per year, international).

Standard presort postage paid at Bristol, Tenn.

SM

SM

Postmaster: Send address changes to: Christian Medical & Dental Associations, P.O. Box 7500, Bristol, TN 37621-7500.

Scripture references marked (NASB) are taken from the New American Standard Bible. Copyright © 1960, 1962, 1963, 1968, 1971, 1972, 1973, 1975, 1977 by the Lockman Foundation. Used by permission.

Scripture references marked (KJV) are taken from King James Version. Scripture reference marked Living Bible is from The Living Bible © 1971, Tyndale House Publishers. All rights reserved. Undesignated biblical references are from the Holy Bible, New International Version ®. Copyright © 1973, 1978, 1984 by the International Bible Society. Used by permission.

All rights reserved.

Other versions used are noted in the text.

For membership information, contact the Christian Medical & Dental Associations at PO Box 7500, Bristol, TN 37621-7500; Telephone: 423-844-1000 or toll free, 888-230-2637; Fax: 423-844-1005; E-mail: memberservices@cmda.org; Website: http://www.joincmda.org.

Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product, or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same.

Implementation of the same is the decision of the reader and at his or her own risk.

CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice, or instruction.

George C. Gonzalez, MD is the New President-Elect Every two years, the CMDA membership elects a new President-Elect, who serves in this capacity until replacing the outgoing President two years later, with his or her term commencing with the annual CMDA national conference. This year, in Orlando, outgoing President Ruth Bolton, MD, will hand the gavel to incoming President Bruce MacFadyen, MD. CMDA recently announced the result of this year’s election. The new President-Elect is George C. Gonzalez, MD. Dr. Gonzalez is the Vice-President/CFO of Peachwood Medical Group, a multi-specialty group practice in Fresno, California. He has been active with CMDA since his UCLA Medical School days. For the last twenty years, he has developed and grown the Fresno CMDA Chapter into an active group which meets monthly. Dr. Gonzalez is also a team leader for GHO and for the last three years has led a team to the Dominican Republic of which half of the group is from the Fresno chapter. In addition, he is a board member and medical director of the Pregnancy Care Center in Fresno, Vice President and board member for Medical Missions International, and Sunday School teacher at his local church. Dr. Gonzalez has served as a CMDA Trustee since 2004.

In his vision statement posted online and adapted here, Dr. Gonzalez said, “I believe CMDA, as an organization, is on the right tract, representing Christ our Lord, at a time of confusion and increasing ethical moral debate in the healthcare field. At such a time as this, we need a strong medical/dental organization that can unify the numerous and diverse health professionals and stand for biblical righteousness, addressing the issues of our day. I believe we are fortunate to have an excellent working staff at our national headquarters that are not only skilled, but also committed and godly.

“I am committed to working with the fellow elected board members to prayerfully develop and implement a strategic plan that will advance the Kingdom of God through our role as healthcare providers, teachers, and community role models. Our leadership role is to inform, equip, and encourage medical/dental students, residents, and other community physicians and dentists to recognize that it is the Lord Jesus who is able to bring healing and transformation to individuals and society. It is my prayer that we stay the course, continue the work, and grow in numbers so that our impact on the national and international medical and dental fields would be great for Christ’s sake and to His glory.”

Planning a Saline Solution Seminar in Your Hometown The Saline Solution is a course curriculum that teaches healthcare professionals how to effectively and appropriately share faith in Christ within their busy practice schedules. This FREE guidebook is provided by the Christian Medical & Dental Associations for groups or individuals seeking to host a “live” Saline Solution seminar. For more information contact Melinda Mitchell at: melinda.mitchell@cmda.org, or download this FREE resource online at: www.cmda.org.

I n t e r n e t w e b s i t e : w w w. c m d a . o r g

•

Summer 2007

7

Siestas and Fiestas - Rest and Joy in the Christian Life Women in Medicine and Dentistry Annual Conference 2007 September 20-23, 2007 – San Antonio, Texas The St. Anthony, A Wyndham Historic Hotel

Dr. Margaret Brand

This year’s annual conference will be held in San Antonio, Texas at the St. Anthony Hotel, an elegant, historic property located a few short steps away from the famed San Antonio Riverwalk. Feature attractions like The Alamo, Witte Museum, McNay Art Museum, and dozens of other attractions are minutes away. In addition to the local flavor and relaxing surroundings, you will bask in WIMD fellowship as we encourage one another in our pursuit of rest and joy in the Christian walk.

This year's conference speakers include: Margaret Brand, MD – Banquet speaker: “Things I Have Learned and Things I Am Still Learning” Cindi McMenamin – Plenary Sessions: “Finding Rest & Joy in His Love”; “Finding Rest & Joy in Him”; “Finding Rest & Joy in Life” Patsy Sulak, MD – Plenary Speaker: “The Journey of Rest and Joy” Linda Flower, MD - Luncheon Speaker - “Women in the Healing Professions: The Legacy and The Call” Al Weir, MD – Sunday Worship Speaker Pre-conference CME sessions are planned; in addition, more than a dozen workshops will be presented on various topics, including: Gifts and Talents of Women Leaders, Cross Cultural Evangelism, Communicating Bad News to Your Patients, Preventing

Cindi McMenamin

Burnout, The Medical Marriage Dance, The Mysteries of Prayer, Expectations Christian Women Place on Each Other, Nutritional Supplementation – Help or Hype?, Personality Disorders, Pride and Self-Reliance: Mortal Enemies of Rest and Joy; and, Proverbs 31 Woman: Can a Physician Be One? For more information or to register, go to: www.cmda.org/go/wimd.

CMDA’s Medical Malpractice Ministry is looking for members to minister to other CMDA members during one of the most devastating times of their lives—a medical malpractice lawsuit, which can wreak havoc on a doctor’s family, career, and emotional and spiritual well-being.

For twenty years, CMDA’s malpractice ministry has intervened with prayer, educational resources, and a commission of doctors who have faced malpractice suits themselves. If you are interested in participating in this ministry, contact Dr. Robert Agnew at BobCVS@mac.com.

“Life Support” is a free MP3 audio magazine produced specifically for students and residents. It is currently on two websites: www.cmdastudents.org and www.cmda.org.

8

T o d a y ’s C h r i s t i a n D o c t o r

Paid Advertisement

Medical Malpractice Ministry Seeks Participants

The Christian Doctor’s Job Description respect to everyone: Love the brotherhood of believers, fear God, honor the king” (1 Pet. 2:13-17).

Ruth Bolton, MD President - CMDA

This issue of Today’s Christian Doctor has a theme of “Where is Medicine Going?” One way to keep our bearings amidst all the change is to review, from time to time, our “job description” as Christian doctors. Here’s my best shot at that: Job Title: Christian Doctor Reports To: God. “Whatever you do, work at it with all your heart, as working for the Lord, not for men, since you know that you will receive an inheritance from the Lord as a reward.

It is the Lord Christ you are serving” (Col. 3:23-24).

Line of Authority: “Submit yourselves for the Lord’s sake to every authority instituted among men: whether to the king, as the supreme authority, or to governors, who are sent by him to punish those who do wrong and to commend those who do right. For it is God’s will that by doing good you will silence the ignorant talk of foolish men. Live as free men, but do not use your freedom as a cover-up for evil; live as servants of God. Show proper

Qualifications: Repentant believer who understands the relationship he or she has with the living God and a loving Savior.

Credentials: MD, DO, DDS, DMD, or comparable degree (or in training for one of these).

Expectations: 1. Be holy. “Therefore, prepare your minds for action; be self-controlled; set your hope fully on the grace to be given you when Jesus Christ is revealed.

As obedient children, do not conform to the evil desires you had when you lived in ignorance. But just as he who called you is holy, so be holy in all you do; for it is written: ‘Be holy, because I am holy’” (1 Pet. 1:13-16).

2. Live the life. “He has showed you, O man, what is good. And what does the Lord require of you? To act justly and to love mercy and to walk humbly with your God” (Micah 6:8).

3. Be compassionate and caring.

“Love is patient, love is kind. It does not envy, it does not boast, it is not proud. It is not rude, it is not self-seeking, it is not easily angered, it keeps no record of wrongs. Love does not

Regional Ministries

delight in evil but rejoices with the truth. It always protects, always trusts, always hopes, always perseveres” (1 Cor. 13:4-7).

4. Communicate honestly. “A truthful witness gives honest testimony, but a false witness tells lies” (Prov. 12:17).

5. Have integrity in all areas of your life and work.

6. Practice what you preach. Live a healthy lifestyle.

Continuing Education Requirements: “…grow up in your salvation…”

(1 Pet. 2:2).

Other Duties as Assigned.

Following this job description will be useful at your final evaluation, when you stand before our Lord on Judgment Day. Take it seriously. God and your fellow man are watching.

Working with you for Him,

Ruth A. Bolton, MD President, CMDA P.S. It has been my privilege to serve as CMDA president these last two years. I pray that wherever medicine is going, Christian physicians and dentists are a part of medicine’s future as we continue to serve our fellow-“man.”

Western Region Michael J. McLaughlin, MDiv PO Box 2169 • Clackamas, OR 97015 Office/Cell: 503-522-1950 michaelm@cmdawest.com

Central Region Douglas S. Hornok, ThM 13402 S 123rd East Place Broken Arrow, OK 74011 Office/Cell: 918-625-3827 • 918-455-6036 CMDACentral@cs.com

Northeast Region Scott Boyles, MDiv P.O. Box 7500 • Bristol, TN 37621 Phone: 423-844-1092 Fax: 423-844-1017 scott.boyles@cmda.org

Midwest Region Allan J. Harmer, ThM 9595 Whitley Dr., Suite 200 Indianapolis, IN 46240 Office: 317-566-9040 • Fax: 317-566-9042 cmdamw@sbcglobal.net

Southeast Region William D. Gunnels, MDiv 106 Fern Drive • Covington, LA 70433 Office: 985-867-9987; Cell: 985-502-4645 wdgunnels@charter.net

I n t e r n e t w e b s i t e : w w w. c m d a . o r g

•

Summer 2007

9

New CMDA Vice President of Stewardship Development Jamey Campbell is pleased to call East Tennessee his home again as he returns to the area as the Vice President of Stewardship Development for Christian Medical & Dental Associations.

Jamey has spent the past twelve years in development, most recently as Vice President of Development for Precept Ministries, an international ministry in over 140 countries. Previously, as Director of Development at East Tennessee State University, his alma mater, Jamey worked in the health sciences division raising funds that supported medicine, nursing, and public allied health programs.

“When Jamey told me that he believes that the only thing that stands between where we are and where we

want to be is finances and his job is to help facilitate that movement, I knew he was the right person for the job,” said Dr. David Stevens, CEO for CMDA. Jamey added, “I’m a vision caster. I believe people want to be part of something that is bigger than they are. And the synergy of 16,000+ members can do more together for the Kingdom than any one of us can individually. I’m very excited about being part of this growing ministry.”

Jamey’s responsibilities include supporting the efforts of CMDA members, raising money for CMDA ministries, providing stewardship education for our membership, and coming alongside our area and regional staff to raise money to support their ministries.

Jamey and his wife, Janeen, have two daughters, Rachel and Emily. They reside in the Tri-City area. He may be reached at: 423-844-1033, or by e-mail at: jamey.campbell@cmda.org.

Global Health Outreach (GHO) All We Have to Say

by Samuel E. Molind, DMD, Director, GHO

The mission is God’s, for it is He The living God of the Bible is a who calls and He who sends. The sending God. He sent forth challenge comes within the context Abraham, commanding him to go of our faith in Jesus Christ. “Do you from his country, promising to bless believe that I am able to do this?” him and to bless the world through He asked two blind men who had him if he obeyed (see Gen. 12:1-3).

He sent Joseph, Moses, and a contin- come to Him seeking healing. “Yes, Lord,” was their reply. And His uous succession of prophets with response was, “According to your words of warning and of promise to His people. Then when the time had faith will it be done to you” (see Matt. 9:28-29). fully come, God sent His Son. God These men had their blind eyes is a sending God. opened because they believed that Missions are the mandate of Jesus.

“As the Father has sent me,” He said, “I am sending you” (Jn. 20:21). Missions are about fulfilling God’s plan and purposes.

“All authority in heaven and on earth has been given to me,” Jesus said, “Therefore, go and make disciples of all nations...”

(Mt. 28: 18-19).

He is sending us to do His work – a job He could handle on His John Butler, MD, examines an Afghan street child at own, but one He has entrusted to a school where we have been providing medical us. This is the heartbeat of GHO. and dental care for the past five years.

the Lord could do the seemingly impossible. When we look at the world’s need of physical and spiritual healing today, the task can seem overwhelming, leaving us “blind” to the possibilities.

Yet, in terms of the Lord fulfilling His mission through us, His question remains the same. It is not, “Do you believe that YOU are able to do this?” but “Do you believe that I am able to do this?” All we have to say is, “Yes, Lord.”

He asks, “Would you allow yourself to be a vessel through which I will ‘make people see?’”

He asks, “Will you be the hands that bring a ‘cup of cool living water’ to the needy in my name?”

All you have to say is, “Yes, Lord.”

Join GHO as we partner with national pastors and physicians and other healthcare workers in the mission of making disciples. Take a step out of your comfort zone, resting on the promise of Jesus, and “According to your faith will it be done to you.”

*FOR INFORMATION ABOUT GHO OPPORTUNITIES SEE WWW .CMDA.ORG/GO/GHO 10

T o d a y ’s C h r i s t i a n D o c t o r

Dr. Ernie Steury’s Biography Published Dr. Ernie Steury’s remarkable life and ministry as a medical missionary in Tenwek, Kenya, is recounted in this compelling biography. A humble Indiana farm boy, Ernie built one of the most successful medical mission facilities in the world. Ernie’s influence, however, went beyond tending to physical needs. Not content merely to heal bodies, Ernie sought to change lives as well through the ministry of the gospel.

Through the story of Ernie Steury, readers will be inspired to follow his example as dedicated servants of a loving, living God who is anx-

ious to show the world what great things He can accomplish with an individual totally committed to Him. Published by Discovery House (June 2007), this book is available through CMDA at: 888-231-2367 or via our website: www.shopcmda.org.

“Dr. Ernie Steury was my mentor and role model for over 30 years,” said Dr. David Stevens, CEO of CMDA. “God used this humble and compassionate servant physician to save countless lives and change tens of thousands of hearts. His life changed mine. His biography could change yours.”

Medical Education International

Multiplying Teachers Jesus’ Way Jesus’ practice was to choose a small number of people to spend time with and train before sending them out to do the same with others. MEI’s partnership with the Christian Medical Fellowship (CMF) of Kenya is increasingly following this model. MEI’s first three teams focused primarily on training medical personnel in separate courses on the principles of advanced life support for cardiac and trauma patients. These courses were extremely well received, are accredited by Kenyan authori-

ties responsible for resuscitation training, and have increased the CMF’s visibility, recognition, and opportunities for ministry in Kenya. Unfortunately, though, the courses were so popular that many of those wanting to take them had to be turned away due to instructor limitations.

This year’s team added a cardiac life support “train the trainer” course prior to the courses on initial management of cardiac and trauma patients. Top students from past cardiac life support courses were selected to train as instructors. The six newly trained instructors can now reproduce the cardiac life support course for their colleagues and, unlike the visiting MEI team, live and work in the country year round! These efforts

Dr. Bill Cayley (r.), 2007 Team Leader, observes Kenyan instructor teaching cardiac life support principles.

should greatly multiply opportunities for East Africans to be trained in initial management of cardiac patients.

It will also increasingly free up MEI instructors to take this training and use this multiplication model to assist other nations requesting cardiac and trauma resuscitation training. To date, approximately 200 students have participated in each of the advanced life support courses. For more information, e-mail: mei.director@cmda.org.

*FOR INFORMATION ABOUT MEI OPPORTUNITIES SEE WWW .CMDA.ORG/GO/MEI I n t e r n e t w e b s i t e : w w w. c m d a . o r g

•

Summer 2007

11

CMDA Aims to Double Membership Special Report

C

ivil War general Nathan Bedford Forrest, known for his aggressive and effective battlefield maneuvers, summed up his military strategy simply: “Get there first with the most men.”

The Christian Medical & Dental Associations represents an army of Christian doctors—a movement that God is using to reach out to individuals with the love of Christ and to speak God’s truth to a culture that is sprinting away from its spiritual moorings.

After aggressively engaging in the cultural wars as a voice for Christian doctors in 1994, CMDA roughly doubled its membership over the next decade. That growth in membership spurred parallel growth in ministry, allowing deeper investments in campus and community ministries, world missions, and member services and resources. The surge in membership numbers heightened CMDA’s impact on public policy issues, thrusting the movement into a national leadership role on issues including abortion, assisted suicide, stem cell research, and human trafficking.

CMDA CEO Dr. David Stevens observed, “Membership is influence—influence in your personal life to help you become all God has designed you to be, and influence as an organization with larger numbers to fight for the soul of medicine. Membership is banding together as transformed doctors to transform the world.”

A Gift for Your Colleagues With current membership hovering at just over 16,000, doubling that number again over the next ten years will require God’s grace and empowerment as well as effective growth strategies. The Board of Trustees recently enthusiastically endorsed a membership growth plan that features one-on-one, word-ofmouth marketing and puts resources into the hands of current members to reach out to their Christian colleagues.

One of those resources is Practice by the Book, a potentially life-changing and career-changing book that addresses the core of CMDA’s ministry—helping Christian doctors integrate their faith and practice. The book addresses the most important need identified in surveys of current CMDA members: Over three out of five say they joined to integrate their faith and practice.

Edited by CMDA leaders Drs. Gene Rudd and Al Weir, Practice by the Book covers topics ranging from spiritual foundations to time management to practical

12

T o d a y ’s C h r i s t i a n D o c t o r

ways to turn your practice into a ministry. The book includes chapters on a Christian doctor’s character and competence, ministering to the poor, medical ethics, malpractice, marriage, and more.

“Membership is influence - influence in your personal life to help you become all God has designed you to be, and influence as an organization with larger numbers to fight for the soul of medicine.”

Phase 1: Physicians The first phase of the new membership growth plan focuses on physicians; subsequent phases will focus on dentists, students, and other sub-groups of the membership. CMDA is currently providing physician members with complimentary copies of Practice by the Book to give as gifts to their colleagues. The book

Dr. Stevens noted, “I hope members reading this will request gift books right now to share with colleagues.

You will be happy to know you have helped a colleague deepen his or her Christian walk while also increasing the influence of this movement of Christian doctors. With all that is going on in medicine, we desperately need both.” ✝

To order your gift books today to share with colleagues, e-mail: memberservices@cmda.org or call Member Services toll-free at: 1-888-230-2637.

For more information about the new membership effort, visit: www.joincmda.org.

CMDA Membership

includes a Best of Christian Doctor’s Digest CD, a DVD about membership, and printed materials including an application. Members are encouraged to give the book as a gift to colleagues, personally inviting colleagues to join the CMDA movement.

Besides giving Practice by the Book as a gift, members will also be able to give their colleagues a 25 percent discount off their first year of membership. All the colleague needs to do to receive the discount is to mention the referring member’s name on the membership application. Group discounts are also available.

Referring members will receive a $25 thank-you coupon for each referred colleague who joins. The coupons can be applied to dues, CMDA resources and logo wear, and CMDA meeting registration fees.

A new web page, www.joincmda.org, will guide prospective members through membership application and will also equip current members with resources to use in recruiting new members. Current members can use the website to order gift editions of Practice by the Book to share with colleagues.

During the first phase of the membership growth strategy, which focuses on physicians, members can get complimentary copies of Practice by the Book to give as gifts to Christian physician colleagues.

I n t e r n e t w e b s i t e : w w w. c m d a . o r g

•

Summer 2007

13

The Changing Role of the Doctor

Job Churn, Pluralism, and the Vanishing Coriolis Effect

by Richard A. Swenson, MD

S

omeone took the lid off the blender of my life,” one splayedout physician told me, “and that stuff on the wall is not a mirage.” Couple this with Toffler’s “a bomb has gone off in our communal psycho-sphere,” and you have the unglued mindscape of today’s besieged doctors. The enormous change dynamic of modernity extends into nearly every quadrant of medicine, dentistry, and healthcare, and it shows no sign of abating. What we had is gone; what will be is not yet here. Doctors are reeling, attempting to find their balance in stormy seas. The arrival of our future is long overdue. Meanwhile we wait, and pray, and fret. And we adapt.

In the not-too-distant past, we went through our famously rigorous training and attempted to become a clone. The Great Machine brought forth new doctors each after its kind, and it was good.

Students went willingly into the funnel, descending into the vast social Coriolis effect, swirling downward into an ever-narrowing vortex, and in the end all coming out in the same place—yet another good doctor in the long tradition of good doctors, entering an esteemed profession, pouring our lives out on the altar of caring and healing. In turn, we were highly reimbursed in every conceivable way by a grateful populace.

“

Today’s “new normal” is an unglued mindscape for some doctors, an exciting opportunity for others. How Christian doctors relate to limitless change will be governed primarily by the quality of their relationship with the One who never changes and their trust that they really are His work in progress.

14

T o d a y ’s C h r i s t i a n D o c t o r

What Is, and Was, and Will Be Let’s explore together some specifics of what this looks like, as well as the various shapes it might assume in the future: Full speed ahead – Many doctors continue to do what they’ve always done, in much the same way, and report high satisfaction. God bless them, each one. They have the enormous privilege of sustainability with joy. Iowa Congressman Jim Leach asked a small town 74-year-old physician when he was going to retire. “I couldn’t possibly retire!” exclaimed the doc, “. . . at least not until my father does.”

Early retirement – Others have folded up shop early. At one large medical institution, by survey, 40 percent of the internists have contemplated retiring. After accepting the plaque and gold watch, some are sad—they miss it more than they thought. They keep up their licenses, volunteer in free clinics, and travel to missions work. Others are glad—

they wish they’d quit earlier. They love golfing every day, or managing their investments from the beach house, or visiting with grandkids. One 48-year-old physician told me he retired to manage apartment complexes.

Off the grid – Some doctors have dropped off the grid and stopped taking insurance, Medicare, or Medicaid. It’s cash only. The cost of care is less, administrative expenses are much lower, billing is minimal. Patients are better educated about their costs of service, and each person is treated the same—no HMO discounts or insurance strong-arming. Some doctors even practice out of their homes, keeping matters as straightforward and elementary as possible. The very bold have “gone bare,” forsaking malpractice insurance.

Hospital only – When the muon was first discovered in 1937, Nobel Prize-winning particle physicist Isidor Isaac Rabi greeted its arrival with a surprised, “Who ordered that?” In much the same way, hospital-only practices—hospitalists, intensivists, laborists, ER docs—arrived on the scene almost by immaculate conception. But the timing was right, and they have blossomed and will continue as an important practice option. The development, while perhaps resulting in decreased continuity of care and diminished revenues for nonhospital physicians, has allowed for greater life-balance all around.

The Changing Role of the Doctor

Then came the blender. It had to happen, of course. Any honest examination of the cost curve yielded an early diagnosis of unstable angina for the entire system. As each doctor attempted compensation, the clone approach to practice style quickly dissolved into a wild pluralism. Practices today are not only dissimilar—they don’t even seem to belong to the same venerable family tree. Furthermore, stigma to these previously anomalous behaviors is blunting.

Individualism and variation are now increasingly accepted as normal reactions to healthcare volatility. It’s every man and every woman for himself or herself. The new normal.

Mobility – “Job churn” is seen across our nation as never before—in 2005, 40 percent of Americans changed their employment, fifty-five million in all—and this increasingly

The Emerging Democratization of Healthcare A new partnership will arise between doctor and patient as technology permits a radical democratization of healthcare. Autonomy and teamwork, once possible, are always preferred— witness the modern paradigm for diabetes care. Doctors, at first, will find the arrangement strange. Later, after appropriate boundaries are defined, doctors will discover significant advantages for themselves as well.

Patients in the future will: • become their own primary care providers • have full access to and/or control of their medical records, at home and away • routinely use inexpensive home medical computers for dozens of medical functions, from B/P monitoring to dietary advice to diagnostic algorithms to paying bills to reordering prescriptions • be able to access ALL healthcare information via the Internet • use e-mail to communicate with doctors • have access to hundreds of reliable home laboratory tests • use walk-in self-referral lab and x-ray centers • purchase a much wider variety of OTC meds

I n t e r n e t w e b s i t e : w w w. c m d a . o r g

•

Summer 2007

15

The Changing Role of the Doctor

“magnetized” water and testosterone ointment in antiaging ads; an ob-gyn and three anesthesiologists who became financial analysts.

Specialities – Some things in life are simple, some are complex. In medicine, complexity has won, as evidenced by the AMA’s listing of 110 National Medical Specialty Society websites. This trend is called differentiation, and it is a relentless subset of progress, virtually unstoppable. As complexity escalates, so will specialization, subspecialization, and super-subspecialization, offering ever more varied professional opportunities to peel down the onion.

Omphalology, here we come.

Variations on a theme – When the chronic intensity of daily practice exceeds the willingness of the practitioner, change happens. Some negotiate part-time practice, or find another doctor to job-share (many husband-wife doctor couples have chosen this option). Concierge medicine (or retainer medicine, boutique medicine, executive health programs, platinum practices) has been controversial though unbowed by condemnation. Flat fee clinics—where, for example, $500 per year buys unlimited outpatient visits— are yet another recent permutation.

Where Will It Lead and How Will It End? includes physicians and dentists. While mobility has been with us for decades, never have we witnessed these dimensions. Uprooting and heading toward greener grass is always a stressor, but one many risk willingly. Mid-career changes don’t even register a blip on our Richter scale.

Some doctors sign on with the competition across town, or go into hospital administration, or do solely pharmaceutical clinical trials, or practice at on-site workplace clinics (more than 25 percent of the nation’s 1,000 largest employers will offer in-house health services by 2008), or join franchised retail clinics in Cub Foods (or Eckerd Drugs, Target, WalMart, SuperValu, Piggly Wiggly, Hy-Vee, ShopRite, Food City, CVS, Osco, Walgreens, or Kroger). Some join a locum tenens organization—one acquaintance recently went to Australia for a year to do locums work. Many Christian doctors have explored the option of missions work for the second half of their careers.

Making ends meet – Moonlighting has a long and proud history among debt-strapped residents—a chance to pick up quick cash while gaining valuable clinical experience.

But increasingly, many established doctors are taking on “side businesses” to augment their income. A recent Time article (2-27-07) detailed the specifics: one NY cardiologist who earns more after-hours by removing ladies body-hair with laser; an otherwise brilliant pathologist who sells

16

T o d a y ’s C h r i s t i a n D o c t o r

What are we to make of such pluralism? Is it a sign of vigor or of desperation? Are doctors pursuing individualism to find their preferred pace and practice, or are they flailing after an elusive ever-receding answer?

There’s little doubt that what we are witnessing is historically unprecedented. No one knows what shape healthcare will find itself in when the mountain quits shaking— only that it will be different. At $2.2 trillion a year (and growing $150 billion annually), our healthcare spending exceeds the national GDP of all but five countries. Few people grasp the scale and complexity confronting us.

The paradigm is changing because it must change— there’s no other option. The question is who will win the tug-of-war: single-payer, private-sector, or hybrid/mosaic.

The shape of our future depends much on that outcome, and doctors are passionately divided.

In a single payer system—perhaps resembling Kennedy’s “Medicare for all”—the government will not own the clinics,

No one knows what shape healthcare will find itself in when the mountain quits shaking - only that it will be different.

The Changing Role of the Doctor

hospitals, doctors, and pharmacists, but it will be the payer.

Money will come in from both individuals and corporations to be distributed according to formula.

On the positive side, such a system will have simplicity (as opposed to 1,500 payers today), uniform paperwork, and universal coverage. Practitioners will begin to settle into a new equilibrium, even if not their political preference. On the negative side, doctors will dislike the formula (since when did we ever like Medicare’s distribution?) and will chafe at the annual adjustments, arbitrary cutoffs, bureaucracy, mandates, disincentives, payment delays, and new forms of taxation.

In a private sector system, a panoply of diverse practice styles will continue and possibly expand. Corporations from GM to 3M will perhaps switch from defined benefit to defined contribution, meaning employees Johnny and Susie will now have the $15,000 in their pocket with first-dollar decision making. This will greatly affect how they spend the dedicated healthcare monies, where they will buy insurance (millions would choose faith-based programs), and which type of practitioners they visit.

On the positive side, we will see responsiveness, cost competition, pricing transparency, individual responsibility, accountability, and autonomy. On the negative side, there will be problems with complexity, too many payers, risk pooling, uneven coverage, high costs for sick and elderly, inequities, and excessive profits.

Only God Knows To call this existential whiplash would be a diagnostic bulls-eye. It’s reassuring to know that God is not confused.

He never makes mistakes, never loses battles, and is not taking Prozac.

He would reassure us with advice like this: Do not worry about tomorrow. Don’t be afraid. Don’t be anxious about anything. Guard your heart against hardness. Give your expectations to Me. Run toward Love, not money. Always walk uprightly before a watching world.

No matter what change the future brings, certain fundamentals remain—doctors will always be needed; always practice a glorious profession; always be highly reimbursed in both finances and prestige; always be given authority and granted a platform from which to influence patients and culture; and, always have abundant opportunity for service.

Perhaps a two-fold summary might look like this: • Care for each patient as completely and compassionately as Jesus would; • Let God be God. We cannot control the future, but we can wrestle our motives in the direction of obedience to Christ. Perhaps, in the end, we’ll discover that God’s project in all this change was . . . us. ✝

Richard A. Swenson, MD,

OPHTHALMOLOGY Scott & White Health System and Texas A&M College of Medicine Central Texas The Scott & White Department of Ophthalmology and The Texas A&M University System Health Science Center College of Medicine are currently seeking an outstanding BC/BE fellowship trained Vitreo-Retinal Surgeon. Additionally, the Department is also looking to add a Therapeutic Optometrist. The Department presently consists of 10 full-time Ophthalmologists and 4 full-time Optometrists committed to quality care delivery enhanced by resident and student education and research. Academic appointment and rank is commensurate with experience and qualifications. Basic and clinical research opportunities are available for interested candidates.

Scott & White is the largest multi-specialty practice in Texas, with more than 530 physicians and research scientists who care for patients at Scott & White Memorial Hospital in Temple and within the 15 regional clinic system networked throughout Central Texas. Over $250 million in expansions are currently underway, including two new hospitals and three regional clinics. Led by physicians with a commitment to patient care, education and research, Scott & White is listed among the "Top 100 Hospitals" in America and serves as the clinical educational site for The Texas A&M University System Health Science Center College of Medicine. Additionally, the 180,000member Scott & White Health Plan is the #1 health plan in Texas.

Paid Advertisement

is a full-time futurist, physician-researcher, author, and educator.

As a physician, his current focus is “cultural medicine,” researching the intersection of health and culture. As a futurist, his emphasis is fourfold: the future of the world system, western culture, faith, and healthcare.

He has authored six books, including the best-selling Margin: Restoring Emotional, Physical, Financial, and Time Reserves to Overloaded Lives and The Overload Syndrome: Learning to Live within Your Limits, both award-winning, and More than Meets the Eye, which is the basis of a CMDA DVD by the same title, available at: www.shopcmda.org.

Dr. Swenson and his wife, Linda, live in Menomonie, Wisconsin. They have two sons, Matthew and Adam, a daughter-inlaw Maureen, and a granddaughter Katja.

Scott & White offers a competitive salary and comprehensive benefit package, which begins with four weeks vacation, three weeks CME and a generous retirement plan. For additional information, please call or send your CV to: Dr. Glen Brindley, MD, Chairman, Department of Ophthalmology; c/o Jason Culp, Physician Recruiter, Scott & White Clinic, 2401 S. 31st, Temple, TX 76508. (800) 725-3627 jculp@swmail.sw.org Scott & White is an equal opportunity employer. A formal application must be completed to be considered for this position. For more information on Scott & White, please visit our web site at: www.sw.org

I n t e r n e t w e b s i t e : w w w. c m d a . o r g

•

Summer 2007

17

The Business of Medicine Developing a Christian Practice — Questions on our Members’ Minds

W

hen Dietrich Bonhoeffer was living out his final months in a Nazi prison, prior to his execution, he wrote many letters to his family and friends that were later compiled in the book, Letters and Papers from Prison. In these letters he decries our attempts as the church to place God “in the gaps.” Bonhoeffer recognized that there will always be a gap between that which we desire to happen and that which we, in our own capacity, can bring to pass. It is within that gap that we most often find God to be useful, so we tend to place Him there and leave Him there. As our knowledge, technology, and social systems expand, the gap where we think we need a God grows smaller and smaller. Our tendency, even as people of faith, is to do all that we can for ourselves until we reach the boundaries of our capability and then call on God to do the rest. Bonhoeffer’s plea was that we should release God from the “gaps” and walk with Him in every area of our lives. “I should like to speak of God not on the boundaries, but at the centre,” he wrote.

Similarly, Christian doctors sometimes “bring God in” when our treatments don’t work, or when we face malpractice or experience business failure. But we tend to leave God out when it comes to the everyday business of running our practices. CMDA would echo Bonhoeffer’s plea and ask Christian doctors to “bring God in” to all aspects of our lives, including all aspects of our practice. Since God is certainly present, regardless, the necessity is to acknowledge His presence and walk beside Him as He leads. We need to ask ourselves, “If Jesus joined our practice, what would He change?”

To that end, one of our newly developed CMDA resources is the establishment of a Clinical Practice Committee, to assist doctors in doing the business of their practices well and in a Christlike manner. Dr. Gregg Albers, a family physician from Lynchburg, VA, is chairing this committee with the responsibility to provide resources to help your practice prosper in Christ while demonstrating the presence of Christ.

CMDA plans to develop an active consultation service over the next year. We are developing resources that will be web based and readily available to assist you in this vital area of your life. As we initiate the work of this committee, we have asked Dr. Albers to address very briefly a few of the practice questions that doctors struggle with, in order to allow you to understand somewhat the scope of this initiative.

18

T o d a y ’s C h r i s t i a n D o c t o r

Can we design our office to “care” for our patients, always keeping their needs as the highest priority?

Many offices are getting away from the waiting room concept, turning it instead to a place for patient health education, collection of patient information, or giving practice information.

In Christian offices, the types of reading material or programs on TV or computer can all give spiritual information that may increase a patient’s interest.

How many patients should I schedule to see in my office each day?

Scheduling depends on a number of factors, including type of practice, usual time spent with patients, needs of the patient, and office flow. If we try to always fill our time, then we probably will be running late, have our schedule overbooked, with

Should I commit to seeing uninsured patients in my practice?

Scripture compels us to “care for the poor,” so we must honor that mandate deliberately. Some of the uninsured may be between jobs, have decided not to carry insurance, and may be willing to pay even without insurance. For those who can’t pay all at once, or can’t afford the total bill, working out a payment plan can often keep a good family appreciating your care.

Since it takes time to build relationships and build spiritual trust, the more of these patients we can keep, the more spiritual opportunities we will be provided.

In our practice we have used the tithing or ten percent principle when seeing “non-paying patients.” We encourage them to pay; but, if they cannot, we will continue to see them, and later forgive their debt, hoping to use this as a lesson about Christ’s forgiveness of our sins.

budget cuts can help to keep it balanced.

These are often poor and needy patients, and God can use our “gift” of increasing the numbers of these patients we see to open their hearts toward His “gift” of His Son.

How do I decide how much to pay my office staff?

We all want to be treated fairly when it comes to pay, benefits, promotions, and job descriptions. Try to get information from other offices for comparative jobs so that you can pay your people adequately. Then look at your overall budget, your expectations for visits, charges, and reimbursement. Try to keep your salaries, rent, utilities, supplies, and other office costs within 50-60 percent of your total budget, using the remaining 40 percent for salaries for the providers.

Profit should be shared by all who contribute, based on their salary percentage, or more. God will bless the practice that cares for its staff as well as its patients.

What is a good process to set in place to evaluate my employees’ performances?

A good evaluation looks at job performance based on the job description, employee attitude, attendance or

absences, and how they work with others. Employees always dread the evaluation, so make sure that you start with as many positives as you can, and end with the areas that “need improvement.”

These areas should not be surprises to the employees, rather should have been dealt with in an ongoing fashion through the year. Encourage them when you have seen improvement in their actions. This should be a time of reaffirmation, goal setting, and plans for further training. Use other “rewards” such as “employee of the month” to motivate employees to have a good attitude and to do their job well throughout the year.

Praying with them often - about family or personal needs, about needs in the office, or patient problems - will motivate even non-believing employees to perform well as they see God working around them.

The Business of Medicine

little time for polite conversation, spiritual matters, or further health questions.

Try to schedule some holes in your day for phone calls, catch-up, and for spiritual time for you to pray for patients you have seen and their needs. Look back over your past year and decide with God whether you have ministered to your patients in the way that God would approve. If you have not, because of time constraints, consider increasing the time allotted for each visit.

How do I know how our collections are going? Benchmarks?

Numerous ways exist to see how “collections” are going. Keep track of visits, average charges, average collection, and patients seen per day. We need to keep those who are collecting accountable for their time, and going over these figures with them monthly does that.

Lack of accountability and oversight usually results in poor collections.

Can I increase the number of Medicaid and Medicare patients without hurting our finances?

There are ways to increase the percentage of Medicaid/Medicare patients that we care for without severe financial reversal. Using visit space that is not full helps to improve your overall collections. Making sure that you are doing as much as you can with each visit, and coding for it also helps. If you are procedure oriented, this often will increase your income. Planning your budget around these changes is very prudent so that if there is a negative effect, other I n t e r n e t w e b s i t e : w w w. c m d a . o r g

•

Summer 2007

19

The Business of Medicine

When the king left talents with his servants, he expected the servants to use them productively. The king held the servants accountable, and requested a report. The one who was not productive “lost his job.” Even Scripture suggests that we work fairly, work hard, and use what God has given us for His glory.

Are there alternatives to the spiraling upward cost of malpractice insurance?

There are alternatives to buying malpractice coverage from a standard carrier. A group of doctors can, usually with the hospital’s help, form a “self insurance” captive. These captives are administered by a legal entity, and can reduce the cost by 50 percent or more.

Sufficient numbers of doctors are required, multiple specialties are covered, and a legal process to get it up and operational has to be initiated by the group to get it going.

Some doctors are able to save significant money by shopping for malpractice insurance in other states. God always calls us to be good stewards with what He gives to us. ✝

20

T o d a y ’s C h r i s t i a n D o c t o r

Note from CMDA: These questions and the brief replies from Dr. Albers are not meant to represent definitive discussions on the issues, but to provide just a taste of the issues that this new CMDA committee wishes to develop in full for you. We certainly don’t have all the answers and really want your input and ideas. As medicine becomes increasingly deprofessionalized and competitive, as we face ethical tsunamis and pressures that seek to mold us into the world’s way of doing things, we need to proactively transform our practices into shining lights in a darkening landscape.

Pray for us as we move forward in this new direction - that God will be honored and that Christian doctors will find new avenues for peace and effectiveness in their practices. If you have questions for the committee or wish to contribute to the work of the committee, please contact us at: clinicalpractice@cmda.org.

The Whole Truth about Stem Cells and Relevant Hope Without the Hype Therapies

by David A. Prentice, PhD

The evidence is clear adult stem cells, not embryonic stem cells, hold the promise of medical advancement.

S

tem cell research continues to be an emotionally charged debate, heavy on emotion and light on actual facts. Despite many claims and promises, most people—the public, policymakers, and physicians alike—do not know the whole truth about stem cell research and its near cousin, cloning. Many are surprised to learn that there are actually many sources of stem cells, though they can generally be divided into two main types—embryonic or adult stem cells.

Unfortunately most of the media and political attention has focused on embryonic stem cells, and most have heard little about adult stem cells.

Embryonic Stem Cell Therapy – Hype Plus Questionable Ethics Embryonic stem cells are taken from early embryos within the first few days of life. At that stage of our life, about one week after conception, we resemble a hollow ball with some cells inside, a stage of our developing life called the “blastocyst.” It is at that point that we can implant into the uterine wall and start obtaining nutrition from our mother’s womb. This is also the point at which scientists harvest embryonic stem cells, which involves breaking apart the embryo, resulting in his or her death.

Though we often hear that embryonic stem cells have the “potential,” “promise,” “possibility,” and “hope” to treat millions of people for a wide range of diseases, that hope has been wildly, even deceptively, oversold by some politicians and scientists that want to do research on embryos.

Embryonic stem cells actually have little to offer for real treatment of disease. Their supposed advantages—unlimited growth, and the pluripotent potential for forming most or all tissues of the body—are actually hindrances when it comes to cell transplants to repair damaged and diseased tissue.

Despite over twenty-five years of work trying to control the growth and differentiation of embryonic stem cells, when transplanted into experimental animals the embryonic stem cells often continue this untamed growth, with a tendency to form tumors or unwanted tissues. For example, an attempt to treat diabetes in mice using supposedly differentiated embryonic stem cells showed that the cells did not even form true insulin-secreting cells, but they did form tumors. And a recent attempt, this time at treating rats with Parkinson’s disease, showed improvement in some rats, but 100 percent of the animals started to form tumors, formed by the nerve cells made from embryonic stem cells.

The scientific literature is filled with similar results from animal studies. Clearly, any potential treatments remain problematic. Researchers have failed to provide even one successful treatment for human patients with embryonic stem cells, and many of the scientists now quietly note that it will be decades, at best, before any possible treatment

I n t e r n e t w e b s i t e : w w w. c m d a . o r g

•

Summer 2007

21

The Whole Truth About Stem Cells

might become available. Calls for the creation of more human embryonic stem cell lines (with attendant destruction of thousands of human embryos) and greater funding are simply unjustified, as research on the current embryonic stem cells shows insufficient evidence that they are either safe or effective for human trials.

Other claims that the available human embryonic stem cell lines are contaminated and unstable, and so unfit for research or potential clinical trials, omit the mention that leading embryonic stem cell researchers have shown that the available cells are actually quite stable and can have any contamination removed. In terms of the science, proponents of embryonic stem cell research are playing on the emotions of vulnerable patients—lacking facts and making empty promises about possible treatment of diseases.

The implication that embryonic stem cells will soon provide life saving cures is patently false, and cruelly deceives the patients and families who hope so much for cures. When asked why the claims persist, regarding Alzheimer’s disease, one noted scientist simply said, “People need a fairy tale.”

Ethically, those who promote embryo research simply dismiss the biological fact that a human embryo is a living human organism, a member of the human species. Far more than just a “ball of cells”, the human embryo looks just as he or she should at that point in our life, a stage of life in which we have all existed. If size, age, or stage of development becomes a distinguishing characteristic by which we can assign differing values of human worth, we are all at risk for becoming less than human and targets for experimentation and harvesting of useful

CMDA holds the position that all human life has inestimable value because every human being is made in God’s image and is a person from the moment of conception. Jesus Christ became an embryo and sanctified every stage of human development. We reject the utilitarian rationales underlying embryonic stem cell research and human cloning. We advocate to the media, government, churches, and the scientific community a moral path to the cures we all seek through regenerative medicine.

David Prentice, a leading voice in the stem cell wars, provides us and the rest of the country critical information that looks beyond the hype and tunes into the hard facts. It is important that each of us as Christian scientists be able to articulate and defend our position in the public square. In this battle, we can do that on two levels – by affirming that human life should be valued and protected; and, by affirming that the safest, quickest, cheapest, and most acceptable way to life saving therapies for our patients in this arena is through adult stem cell research. In this case, the utilitarian argument is on our side!

For more information go to: www.stemcellresearch.org - news, commentary, scientific literature review www.cmda.org - for PowerPoints, Talking Points, AV resources, ethical statements, analysis www.Standards4Life.org - downloadable web pages for your church’s website.

Or, visit www.shopcmda.org and purchase: “The Truth about Stem Cells,” “Basic Questions on Genetics,” “Stem Cell Research & Cloning,” “Manufacturing Life,” “The Christian Physician’s Oath,” “The Christian Dentist’s Oath,” “Christian Healthcare Professional Oath.”

22

T o d a y ’s C h r i s t i a n D o c t o r

cells and organs. Should some human beings be sacrificed for the potential benefit of others? Embryonic stem cell research destroys the youngest, most vulnerable members of the species. Is the remote possibility that medical treatments might arise from some research worth the cost of cannibalizing other human beings? Rather, it is essential that we value all human life.

Cloning and Its Impact on the Discussion The prospect of cloning has raised similar wild claims and deceptive terminology. But cloning starts with creation of a new embryo. The process, termed “somatic cell nuclear transfer” or SCNT for short, involves removing the chromosomes from an egg cell, and transferring the chromosome-containing nucleus of a body cell (a somatic cell) into that egg cell. What results is a new embryo, containing the genetic information of the person who supplied the body cell. All human cloning is reproductive. It creates—reproduces—a new developing human intended to be virtually identical to the person who was cloned.

Some proponents of embryo research try to distinguish between what has been termed “reproductive cloning” and “therapeutic cloning,” but these are not different types of cloning, simply different uses for the cloned embryo. Both use exactly the same SCNT technique to create a new embryo, grown in the laboratory for several days. Then the cloned embryo is either implanted in the womb of a surrogate mother in hopes of a live birth (“reproductive cloning”) or destroyed to harvest its embryonic stem cells for experiments (“therapeutic cloning”).

It is the same embryo, but used for different purposes. In fact, the cloned embryo at that stage of development cannot be distinguished under the microscope from an embryo created by joining egg and sperm in fertilization.

And “therapeutic cloning,” which has produced no therapies whatsoever, is obviously not therapeutic for the embryo—the new human is specifically

Adult Stem Cell Therapy – Hope Plus Unquestionable Ethics The lack of success of embryonic stem cells should be compared with the real successes of “the other stem cells”— adult stem cells. Adult stem cells are found not only in adults, but in virtually every tissue of our body, as well as in umbilical cord and cord blood, the placenta, and amniotic fluid. Unlike destructive embryo research, harvesting adult stem cells does not require that the donor be killed.

Hundreds of scientific studies over the last few years document that adult stem cells provide real promise for repair of diseased tissue. In fact, at least two dozen studies now indicate that some adult stem cells can form virtually all tissues of the body, a characteristic that means embryonic stem cells are not unique.

The most recent example comes from scientists at Wake Forest, who announced in January 2007 that they had isolated stem cells from amniotic fluid and placenta that showed all the characteristics that most scientists claim they want in a stem cell—easily obtained, easily grown in the lab, with the ability to form the tissues of the body, yet these stem cells also did not produce any tumors. More importantly, adult stem cells have been shown repeatedly to be effective at treating disease. Studies in animals over the last several years have proven their ability to heal and repair

The implication that embryonic stem cells will soon provide life saving cures is patently false, and cruelly deceives the patients and families who hope so much for cures. damage from diseases such as diabetes, stroke, spinal cord injury, Parkinson’s disease, and retinal degeneration.

But the biggest news, largely unreported, is that adult stem cells are already being used successfully to improve the health of human patients. While still early in clinical studies, thousands of patients have now benefited from adult stem cell treatments. These include reparative treatments with various cancers, autoimmune diseases such as multiple sclerosis, lupus, arthritis, and anemias including sickle cell anemia.

Adult stem cells are also being used to treat patients by growing new corneas (using adult stem cells from the patients’ eyes, or even their oral mucosa) to restore sight to blind patients, and development of potential treatments for stroke. Numerous published studies now document success with adult stem cells in repairing cardiac damage after heart attacks. Adult stem cells have grown new blood vessels to prevent limb amputation from gangrene, and stimulated growth of new cartilage and bone to replace that lost through accident or disease. Adult stem cells have also been used to prevent life-threatening problems from genetic diseases for children, including Krabbe, Hunter, and Hurler syndrome. Spinal cord injuries have also shown improvement, with patients regaining some movement and sensation, and some even walking again with the aid of braces. British doctors have shown in early trials that bone marrow adult stem cells have potential to regenerate damaged liver. And a Harvard Medical School team now has FDA approval to begin patient trials for juvenile diabetes, after they showed in mice that adult stem cells could achieve “permanent reversal” of diabetes.

An advantage of using adult stem cells is that in most cases the patient’s own stem cells can be used for the treatment, circumventing the problems of immune rejection, and adult stem cells do their repair work without causing tumor formation. Interestingly, in some studies no stem cells are removed, cultured, or injected, but rather the patient’s endogenous stem cells are stimulated to begin the repair, by injecting growth factors to stimulate the existing adult stem cells in the tissue. National Institutes of Health scientist Dr. Ron McKay notes that harnessing the body’s own stem cells could offer an enticing alternative to attempts to harvest them from other sources, such as embryos, saying, “This is where stem-cell biology needs to be.” Cardiologist Douglas Losordo at Tufts University said that bone marrow “is like a repair kit. Nature provided us with these tools to repair organ damage.” He also noted that “embryonic stem cells are going to fade in the rearview mirror of adult stem cells.”

I n t e r n e t w e b s i t e : w w w. c m d a . o r g

•

Summer 2007

The Whole Truth About Stem Cells

created in order to be destroyed as a source of cells for experiments.

Cloning research also poses a significant health threat to women. The process requires a tremendous number of human eggs to create a single clone, conservative estimates that at least 100 eggs would be needed for each patient, even if the process could ever be shown to work. A simple calculation reveals staggering numbers—to treat just the 17 million diabetes patients in the United States will require at least 1.7 billion human eggs, and approximately 85 million women of childbearing age to “donate” eggs. Harvesting of human eggs will subject huge numbers of women to significant health risks from high hormone doses required to stimulate egg formation. The result will be that human eggs will become a commodity and poor women will be especially targeted for exploitation on a global scale.

This fact was highlighted by the cloning scandal in South Korea. The scientist, Woo-Suk Hwang, received global accolades when he announced in 2004 and 2005 that he had produced cloned human embryos and harvested their embryonic stem cells. The shameful push for this unethical science was brought into public view when his discovery was uncovered as an outright fraud. While in fact he did not produce any embryonic stem cells from cloned human embryos, he did use over 2,000 human eggs in the experiments, in some cases paying women for their eggs, in some cases coercing young students to donate to the experiments.

A large number of the women experienced significant health problems in the attempts to harvest large numbers of their eggs for experiments.

23

These quiet successes, using the patients’ own adult stem cells, are advancing rapidly and producing the therapies about which embryonic stem cell advocates can only speculate. We don’t yet understand exactly how adult stem cells work their repair magic, but they continue to surprise even the scientists. As Robert Lanza, a proponent of embryonic stem cells and cloning has noted, “there is ample scientific evidence that adult stem cells can be used to repair damaged heart or brain tissue . . . if it works, it works, regardless of the mechanism.” That’s certainly the attitude of the patients who have experienced the real benefits of adult stem cells.

A Morally and Medically Superior Choice Overwhelmingly the evidence reveals that it is adult stem cells that hold the promise of medical advancement, not embryonic stem cells. The contrast between embryonic stem cells and adult stem cells is one of hype versus hope, empty promises versus real results, and life-destroying research versus life-saving medicine. Adult stem cell research is daily proving capable of helping patients, without moral difficulties. If we truly care about suffering patients, we should put our resources behind that research which shows real promise, without crossing ethical lines. ✝

David A. Prentice, PhD, is senior fellow for life sciences at the Family Research Council and a founding member of Do No Harm: The Coalition of Americans for Research Ethics. Previously he spent almost twenty years as Professor of Life Sciences at Indiana State University, and Adjunct Professor of Medical and Molecular Genetics, Indiana University School of Medicine. He was selected by the President’s Council on Bioethics to write the comprehensive review of adult stem cell science for the Council’s 2004 publication “Monitoring Stem Cell Research,” and a defense of adult stem cell treatments with extensive literature documentation was published by Science in January 2007. He has been a member of CMDA since 2002.

For more information: Prentice, D.A. (2006). The current science of regenerative medicine with stem cells. J Investig Med. 54: 33–37, 2006; available at: http://journals.bcdecker.com/pubs/JIM/volume%2054,%202006/issue%2001, %20January/JIM_2006_05043/JIM_2006_05043.pdf.

Prentice, D.A. and Tarne, G. (2007). Treating diseases with adult stem cells.

Science. 315: 328.

Letter and supplementary material can be downloaded at: http://www.stemcellresearch.org/facts/scienceletter.htm.

For current clinical trials with adult stem cells, see: http://www.clinicaltrials.gov/ct/search?term=stem+cell (initial search shows clinical trials recruiting patients; click box in upper left to show all trials, including those no longer recruiting patients.

For more information and resources, consult the CMDA website as described in the sidebar box, pg. 22.

24

T o d a y ’s C h r i s t i a n D o c t o r

Paid Advertisement

The Whole Truth About Stem Cells

Adult stem cells are already being used successfully to improve the health of human patients - thousands of patients have benefited from adult stem cell treatments.

T

he power brokers of 19th Century England derisively called this small group of evangelical Christians “The Saints.” Their evidence exposed evil. Their calls for justice annoyed most. Their eloquence and shrewdness mobilized public opinion. Their persistence irritated. They never gave up, but year after year, for almost half a century, they fought slavery. They lost. They lost. They lost again . . . until they finally won and slavery was outlawed in the British Empire in 1833.

That was not all that William Wilberforce and his “Saints” accomplished. They started the Church Mission Society, the Bible Society, and the Society for Bettering the Conditions of the Poor. They successfully sponsored a law requiring the East India Company to allow missionaries access to India, got King George III to issue a “Proclamation for the Discouragement of Vice,” and much more. They were lawyers, itinerant evangelists, politicians, professionals, and average folk.

Their extraordinary impact is told well in the movie, Amazing Grace. If you have not seen it run, don’t walk, to your nearest video rental store. Show it to your family and discuss it with your kids. I thought this movie was so moving that I shut down the office here at CMDA headquarters for a few hours and loaded all of our staff in a bus one afternoon to take them to see the movie. I wanted to get their attention, increase their understanding, and mobilize the troops.

It was inspiring and irritating. It was both a blessing and a boot in the pants, because today we need another band of faithful saints to take up the banner that Wilberforce and Lincoln faithfully carried and gave their lives for. We need some modern day abolitionists.

Slavery Today Today, it is estimated that there are over 28 million men, women and children held in slavery. Close to six million are children bonded into labor or forced into brothels.

Almost one million slaves are trafficked across international borders each year. This scourge on the freedom and souls of the helpless has contributed greatly to our epidemic of sexually transmitted diseases including AIDS and hepatitis, abortions, suicides, substance abuse, assault related trauma, and murder.

Why has slavery reared its ugly head again?

The foundational cause has not changed from the slavery business centuries ago – money. Modern day slavery generates 44 billion dollars a year, which is more than the annual Gross Domestic Product (GDP) of two-thirds of the world’s countries.

But the problem is much more than dry statistics. A CMDA board member and his wife recently took their family on a mission trip. While there, they met three girls, just

Spectators or Saints - Which Will We Be?

by David Stevens, MD, MA (Ethics)

Human trafficking today is a 44 billion dollar a year industry. With over 28 million humans in slavery worldwide, it is likely that Christian doctors will encounter one or more victims in their practice. We can make a difference, if we care and dare.

I n t e r n e t w e b s i t e : w w w. c m d a . o r g

•

Summer 2007

25

Spectators or Saints

days after they had been rescued from a brothel. Initially these girls were cowed and fearful, but they finally began to play like children with the couple’s three young girls at a meal. Emboldened by the love they had been shown, they revealed the shocking truth that all of them were thirteen years old or younger.

If you want your blood to boil, imagine you or your daughter at that age being sexually abused day after day.

Prostitution is not a “victimless” crime, as some organizations proclaim. Prostitutes in Sydney, Australia reported the following:1 65 percent-physical assault 40 percent-rape at gunpoint 33 percent-rape without a weapon 29 percent-robbery 53 percent-drug use to numb their minds 87 percent-mild or moderate depression 54 percent-current severe depression symptoms 74 percent-suicidal ideations 42 percent-have attempted suicide 47 percent-met criteria for Post Traumatic Stress Disorder currently or in the past

A Worldwide Problem

We Can Make a Difference

Many CMDA missionary members work in countries where girls and boys being forced into labor and held in sexual captivity is common. But don’t kid yourself. It is not just a problem “over there.” Much of it happens here in the West.

Over 15,000 victims are trafficked into the U.S. each year, held in bondage. Many are lured by promises of jobs and money, but instead they are raped, beaten, and their money and documents confiscated. Ruthless pimps capture runaways with drugs and money and then dominate their lives.

What we need today is a new grass roots movement to continue Wilberforce’s vision to eliminate slavery, and it needs to begin in healthcare. A study in Europe revealed that one fourth of those held in bondage had been taken to a doctor’s office or emergency room when they were too sick to work, but the doctor and nurses providing treatment failed to recognize that these patients were being held in slavery.2 Dr. Jeff Barrows, an OB/GYN member from Ohio, and Jonathan Imbody, our representative in Washington, are

Over 15,000 victims are trafficked into the U.S. each year, held in bondage.

26

T o d a y ’s C h r i s t i a n D o c t o r

◗ Educating healthcare providers to recognize Trafficking In Persons (TIP) victims through free online CME (available on www.cmda.org); ◗ Publishing a systematic review of the medical literature regarding the health consequences of human trafficking in the next year; ◗ Reviewing the medical records of TIP victims to gather data for use in development of protocols to screen and treat future victims of human trafficking; ◗ Actively involve CMDA members in providing postrescue medical and dental treatment; ◗ Providing “talking points” (posted on www.cmda.org); ◗ Working with the White House, State Department, and USAID on this issue.

Contact Dr. Jeff Barrows if you would like to be more deeply involved in these efforts at: jeffreybarrows@yahoo.com.

Which will it be?

I am reminded of Abigail Adams words to her husband John in the midst of the trials of the War of Independence: “You cannot be, I know, nor do I wish to see you, an inactive

spectator.... We have too many high sounding words, and too few actions that correspond with them.”

Righteousness means not only sharing Christ with the lost and treating the sick, but also being a modern day prophet for truth, justice, and compassion in the public square. We need to rescue the perishing. As Isaiah said, believers have an obligation before God “... to break the chains of injustice, get rid of exploitation in the workplace, free the oppressed...” (Isaiah 58:6, The Message).3 The problem seems daunting. Change will not happen overnight. What can one individual do? If, like Wilberforce, you are willing to be persistent, evidence based, sometimes annoying, and always faithful, who knows what God might do through you?

As for me, I rather be accused of being a saint than a spectator. Count me in! ✝

Spectators or Saints

leading CMDA’s multifaceted efforts to abolish modern day slavery, which include:

Notes: 1. Roxburgh, A. Degenhardt L. and Copeland, J. “Posttraumatic Stress disorder among female street based sex workers in the greater Sydney area, Australia.” BMC Psychiatry 2006, 6:24: http://www.biomedcentral.com/1471-244X/6/24.

2.Turning Pain into Power: Trafficking Survivors’ Perspectives on Early Intervention Strategies. Family Violence Prevention Fund in Partnership with the World Childhood Foundation, March 2005: http://www.biblegateway.com/versions/?action=getVersionInfo&vid=65.

3. Peterson, Eugene H. The Message (MSG), Copyright © 1993, 1994, 1995, 1996, 2000, 2001, 2002: http://www.messagebible.com.

David Stevens, MD, MA (Ethics),

Paid Advertisement

is the Chief Executive Officer for the Christian Medical & Dental Associations. From 1981 to 1991, Dr. Stevens served as a missionary doctor in Kenya, helping to transform Tenwek Hospital into one of the premier mission healthcare facilities in that country.

Subsequently, he served as the Director of World Medical Mission, the medical arm of Samaritan’s Purse, assisting mission hospitals and leading medical relief teams into war and disaster zones.

As a leading spokesman for Christian doctors in America, Dr. Stevens has conducted hundreds of television, radio, and print media interviews.

Dr. Stevens holds degrees from Asbury College and the University of Louisville School of Medicine. He is board certified in family practice. He earned a master’s degree in bioethics from Trinity International University in 2002.

I n t e r n e t w e b s i t e : w w w. c m d a . o r g

•

Summer 2007

27

APOLOGETICS SERIES Reconciling a Good God with an Evil World

by Robert W. Martin III, MD, MAR Note: This is the fourth article in a series on apologetics.

The pages are designed for ease in copying for personal study, discussion in a group setting, or for distribution to colleagues and staff. For the sake of space savings, notes refer to books listed in the bibliography in each case.

Installment five is planned for the Spring 2008 issue of Today’s Christian Doctor.

I. Introduction “Why would a loving God allow my child to die? Why do I have to suffer, when I have done nothing wrong? All the evil in the world proves there is no God!” No issue strikes at the heart of Christianity more than the seeming paradox of an all-loving God and the existence of evil, suffering, and illness. The following apologetic for the existence of God helps us understand how an omnibenevolent God allows evil.

II. Evil Proves God’s Existence To paraphrase C. S. Lewis, “It is the very existence of evil that proves the existence of God” (Mere Christianity). The “Moral Law Argument” for the existence of God follows: Premise 1—Moral Law implies a Moral Lawgiver (principle of causality).

Premise 2—There is an objective Moral Law. Conclusion—Therefore, there is an objective Moral Lawgiver (Geisler, ST, 36-38).

This argument is based on the law of causality (i.e., every effect has a cause). Just as every prescription has a prescriber, every painting a painter, every sculpture a sculptor and every piece of legislation a legislator, then every moral law has a moral lawgiver. Therefore if there is an absolute moral law (an obligatory, prescriptive, “good in itself” duty that is binding on all people, at all times and in all circumstances) than there must be an Absolute Moral Law Giver (God).

Most critics take exception with premise 2 because they do not believe that absolutes exist. However, absolutes are unavoidable. It is contradictory to claim, “I am absolutely sure there are no absolutes.” In fact the “Moral Law” impresses instinctively and immediately upon virtually every society, past and present, that some things are absolutely wrong (Lewis, Abolition of Man, Appendix).

28

T o d a y ’s C h r i s t i a n D o c t o r

Anyone who is absolutely sure there is injustice in the world invokes an absolute standard of justice (God). For instance, an angry student confronted Ravi Zacharias with, “There is too much evil in this world; therefore, there cannot be a God.” Ravi replied, “If there is such a thing as evil, aren’t you assuming there is such a thing as good? [And] when you accept the existence of goodness, you must affirm a moral law on the basis of which to differentiate between good and evil. But when you admit to a moral law, you must posit a moral lawgiver. For if there is no moral lawgiver, there is no moral law. If there is no moral law, there is no good. If there is no good, there is no evil. What, then, is your question?” (182-183, excerpted).

“It is the very existence of evil that proves the existence of God.” — C.S. Lewis This “Moral Law” may not be the standard by which we treat others, but it is nearly always the standard by which we expect others to treat us (Legislating Morality, 42).

Unbelievers best illustrate this distinction by their reactions when forced to confront the outworking of their worldview.

For example, the libertarian demands justice when someone else intrudes, harms, or inconveniences him. The pacifist protests all wars, yet demands the very safety bought by the sacrifice of others. The pluralist claims homosexuality is normal, but may be disappointed to learn her child is gay. The relativist argues there are no “absolute values” but “absolutely values” his right to push his agenda on you!

Their reactions (not actions) speak louder than words, in demonstrating the Moral Law.

III. Reconciling an Omnibenevolent God with the Existence of Evil Norman Geisler answers many additional questions raised in this challenging area (BECA, 219-224; TRE).

God freely created everything perfect and gave human beings the perfection of free choice to love Him (Gen. 1:31; 1 Tim. 4:11; 2 Pet. 3:9). God will not force anyone against their will to love Him (forced love is a contradiction). Morally free creatures can choose to hate God and

do evil and God will grant them their free choice forever— hell. God did not create imperfect creatures. God made all creatures good with the freedom to choose to love Him. Yet some free creatures became evil by their own choice.

The power of free choice is a good power; the fact that men abuse freedom does not make freedom bad.

God is the author of good, not evil. Man freely chooses to do evil. Evil is not a “thing” or substance, but the absence of the God-ordained good that should be there.

Evil is a real privation/absence of good; like blindness is the real privation of sight. Evil exists like a hole in a board exists only because it is deprived of the wood that should be there.

Claiming that if God exists, He would destroy evil ignores the reality that evil cannot be destroyed without destroying man’s free choice. But love is impossible without this freedom. Further, just because evil has not yet been defeated does not mean that it will not be defeated in the future.

Although some believe that no good comes from suffering, an omniscient God must have a good purpose for everything. In fact, suffering can keep us from self-destruction, warn us of greater evil, bring about greater good, and will eventually defeat evil (Jesus’ substitutionary atonement).

Suggesting God could have created a world that would not sin confuses what is logically possible with what is actually achievable. Some free creatures will inevitably use their freedom to choose to be lost.

Finally those who argue that God should save all men ignore the fact that God does desire all men to be saved (2 Pet. 3:9), but He will not force anyone to love Him (forced love is a contradiction).

All who go to hell choose to go there (they choose it even if they don’t want it) by rejecting Christ. Those rejecting God have their freedom respected and are given their own freely-chosen destiny—hell. It is not one person in hell that would make it evil, but one more than is really necessary! A world with some in hell is not the best world conceivable, but it is the best world achievable with morally free creatures.

IV. Conclusion Grieving and suffering people need compassion more than a lecture or even an apologetics presentation. Our patients do not care how much we know until they know how much we care.

David Biebel offers physicians excellent counsel in caring for grieving patients: ◗ Loving a heartbroken person may put your love and faith to the ultimate test and cost you time, energy, and love. ◗ Go to your heartbroken friend rather than waiting for her/him to call.

◗ Your love must be sincere, making her/his problem YOUR problem. ◗ Compassion is “your pain in my heart.” ◗ Meet the person where he/she is. ◗ Say nothing if you don’t know what to say. ◗ Being there is more important than almost anything else. A heartbroken person will recall very little of what was said, some of what was done, but he/she will never forget the one(s) who came and stayed, some times without saying much at all beyond, “I love you,” or “I’m sorry.”

Help your grieving friend or patient see: ◗ The way to gain control is by giving it to God. ◗ The way to wholeness after being broken is to allow themselves to be put back together by the Lord. ◗ The “mission” of a person who has been heartbroken is to develop deeper faith so that he/she will be able to connect with our broken world far better than a thousand three-point sermons (How to Help).

Look to the cross for reconciling an omnibenevolent God with the problem of pain and suffering. The cross represents the hatred and sinfulness of man, the amazing grace of God, and the reality that Jesus Christ is not unaware of or distant from pain and suffering. ✝

References Biebel, David. If God is So Good, Why do I Hurt So Bad? Grand Rapids: Baker, 2004. ________. How to Help a Heartbroken Friend: What to Do and What to Say When a Friend Is Going Through Tough Times.

Pasedena: Hope, 2004.

Geisler, Norman L. Baker Encyclopedia of Apologetics. Grand Rapids: Baker, 1999. ________ and Frank Turek. Legislating Morality. Minneapolis: Bethany House, 1998. ________. The Roots of Evil. 2nd ed. Dallas: Probe Books, 1989.

Lewis, C.S. Abolition of Man. New York: Macmillan, 1955. ________. Mere Christianity. New York: Macmillan, 1952.

Zacharias, Ravi. Can Man Live without God? Dallas: Word Publishing, 1994.

Robert W. Martin III, MD, MAR, lives in Lafayette, Indiana, where he practices Dermatology and Dermato-pathology. He is married, with four children. He has served on the faculty of Johns Hopkins, Case Western Reserve, and now Indiana University and Purdue Pharmacy School. He has a Masters in Religion from Southern Evangelical Seminary. His Just Add Water (Volume 3.1: Apologetics for the Health Professional), available via CMDA’s website, utilizes Norman Geisler's twelve-point “Classical Apologetic” approach fashioned after Paul’s apologetic in Acts 17. Dr. Martin may be reached by e-mail at: martinr@arnett.com.

I n t e r n e t w e b s i t e : w w w. c m d a . o r g

•

Summer 2007

29

Overseas Missions

CLASSIFIEDS

Ghana - Year round opportunities for medical service, most specialties, ST/LT. Baptist Medical Center in “bush” of NE Ghana with 3 full time MDs on staff. Busy clinic & surgical service.

E-mail: Mamprusi_HMT@yahoo.com, Earl Hewitt, MD.

fits package will be offered. Call will be every fourth week. Hospitalist takes care of admitted patients. Please call 800-430-4424 or 954-785-6700. You may fax your CV in confidence to 954-786-0473 or e-mail: jgable@gablehealthcare.com.

tains and the beach; live here and enjoy all four seasons. Please contact our Medical Director, Dr. Chris Wilkinson at 308-865-1403 or e-mail: cwilkinson@kearneyortho.com. Our clinic manager, Vicki Aten, can be reached at 308-865-2512 or vaten@kearneyortho.com.

Family Practice - Minnesota-Willmar - Do you wish to integrate your values and beliefs with your medical training to lift your profession to a higher plane? Contact 1-800-967-2711 or vmeyer@hutchtel.net to request a family practice opportunity profile.

Practices for Sale

382/0746/2483

381/0645/2457

Guatemala - Small 3-room clinic (Todos Santos) northwestern Guatemala. Serving large Mayan population. Christian couples needed - FPs, PAs, RNs for ST/LT missions. Spring-like weather year round. Contact William Smith, MD; 518-623-2403; billsmith6@mailstation.com.

382/0742/2471

382/0671/2474

Pakistan - Christian physicians urgently needed for ST/LT in rural Shikarpur Christian Hospital: female (GP/FP, OB/GYN, GS) for OB/general; male/female pediatrician, OB/GYN for ST teaching GYN surgery. Contact Bill Bowman, MD; 714-963-2620; drbillbow@aol.com.

382/0361/2427

Positions Open

General Surgery - Prescott, AZ - Join two Christian surgeons in a thriving “bread and butter” practice in central Arizona; mile high elevation and pine forests with mild four seasons make Prescott a highly desirable location; income potential in top decile; ER call one in seven; minimal trauma as most trauma is flown to Phoenix; opportunities for missions; contact drbrian@northlink.com for further information.

382/0504/2469

Anterior Segment Surgeon - Midwestern ophthalmology practice desires an additional anterior segment surgeon due to rapidly increasing surgery volumes. A fellowship in glaucoma or oculoplastics is desired. Candidate must be able to perform 300+ cataracts in first year and display a servant attitude toward patients. Practice has been recognized as “best in region” for several years: beautiful office, excellent staff, well equipped with technology. Located in rapidly growing suburb of a metropolitan community.

Practice is committed to performing surgical care at the NW Haiti Christian Mission. Please send info to Karen at: kkennedy@moyeseye.com; Fax: 816-587-3555.

382/0725/2473

Dentist – Seek experienced associate for general practice in Nyack, Rockland County, NY. Excellent opportunity lead to partnership or sale.

201-445-3105 or send resume to 349 Queens Court Ridgewood, NJ 07450.

General Surgery/Western PA - Busy practice seeks 4th partner. Hospital assistance with cost of malpractice. Reputation for high-quality, compassionate care; we never turn away patients regardless of ability to pay. Partners begin each week with Bible study and prayer. We make less than the average general surgeon but more than 99% of the people in the world. Call 724-843-3800, Evenings 724-495-6144, Fax 724-843-4799, or e-mail: paburkes@msn.com.

382/0467/2472

For Sale - Established family practice in southcentral PA seeks family physician/internist to assume care of full panel of patients. Current physician leaving by September to enter religious life. Office is 3900+ sq.ft. Five exam rooms, fully equipped. Excellent staff. Price/terms negotiable.

Questions welcomed. Could talk by phone at a mutually convenient time. Contact Judy Jacobus, MD: yometer@atlanticbb.net.

382/0729/2478

Internal Medicine Practice For Sale - Planning ahead? Busy IM practice serving two physicians in Central N.J. Turn-key opportunity to manage your own instead of negotiating salary and buyin. Available July 2008. E-mail at therightpersonlag@gmail.com.

382/0743/2477

Miscellaneous Assistant CFO - Federally qualified Christian Health Center seeking assistant CFO to transition to CFO. CPA, MBA minimum 5 years experience in public accounting and/or health industry.

Forward resume to nmast@familychc.org.

382/0744/2480

382/0740/2470

Internist - Bible-believing, Board-certified Internist passionate about ministering to patients (praying with patients, sharing the Gospel) seeks to start/join practice with like-minded physician(s) in the Dallas area. Missions heart/Spanish-speaking a plus! 214-642-4420, grantbeckham@tx.rr.com.

382/0745/2481

Dermatologist - Exceptional opportunity in beautiful Asheville, NC. Busy solo derm in well established practice recruiting for BE/BC general dermatologist as well as cosmetic. Mohs would be a plus. Great area to raise a family with many outdoor opportunities. Competitive compensation package including salary guarantee and incentive and benefits. Send CV/cover by e-mail to: ehorner@charter.net.

382/0567/2476

Neurologist – North Carolina Sandhills Neurologist, PA is seeking two BC/BE Neurologist, exclusively out-patient practice.

Fellowship in stroke and pain management welcomed, but not required. This practice is interested in the physical and spiritual needs of the patient. Located in south central NC. Worldrenowned golfing resort, family-oriented community with large draw area. Approx. 2.5 hrs from beaches and mountains. Contact: sandhillsneuro@earthlink.net.

382/0581/2482

ENT - Exceptional opportunity in beautiful Scottsdale, Arizona. Rewarding and busy 3physician ENT practice in a single state-of-the-art office seeking BC/BE general ENT candidate.

Excellent salary, incentive and benefits. E-mail CV/cover to entegrity@cox.net.

382/0720/2475

Family Practice – Augusta, GA. Join busy, well established, highly respected private practice with two Family Practitioners, a PA, Office Manager and well-trained support staff. Highly competitive salary, productivity bonus and bene-

30

T o d a y ’s C h r i s t i a n D o c t o r

Orthopedist - Well-established practice of three orthopedists committed to providing orthopedic care with compassion as well as excellence.

Time off for short term missions. Would like to talk with general and subspecialty orthopedists about the possibility of joining us in practice.

On-site surgery center; local hospital within walking distance. Located in a family-oriented city where many recreational and cultural activities are available. Less than a 10 minute commute from any area of the city. Low malpractice rates and cost of living. Vacation at the moun-

Paid Advertisement

382/0738/2479

Paid Advertisement

Toll Free Call - 888-690-9054 Fax - 423-844-1005 E-mail: Placement@cmda.org website: www.cmda.org

Family Medicine allen.vicars@cmda.org

Donna Fitzgerald Cardiology Dermatology Emergency Medicine Endocrinology Gastroenterology Hematology/Oncology Internal Medicine donna.fitzgerald@cmda.org

Med/Peds Nurse Practitioner OB/GYN Ophthalmology Pediatrics rose@placedocs.com

Cathy Morefield General Surgery Anesthesia Orthopaedic Vascular Surgery Cardio-Thoracic Dentistry cathy.morefield@cmda.org

This section represents a small portion of our opportunities.

To view a complete listing, go to the Placement Section on our website: www.cmda.org

32

T o d a y ’s C h r i s t i a n D o c t o r

General Surgery

Rose Courtney

GA – OB-291 Twenty-five-year-old, independent, single specialty practice seeking an OB/Gyn. There are currently 6 other physicians, 4 CNM’s and 2 NP’s. They feel led to follow the teachings of Christ and the precepts of their specialty to provide quality care for women in all phases of their life in a warm, compassionate and nurturing environment.

MD – OB-274 Independent practice seeking an OB/Gyn provider.

Practice located in Annapolis, MD. Currently one physician on staff and does a rotating call schedule with 5 other physicians.

AL – MS-486 Opportunity #1 Solo physician in practice for 24 yrs. is looking to expand. Volume exceeds 500 cases. Practice provides vascular, thoracic and bariatric services.

Call 1:6.

AL – MS-486 Opportunity #2 Solo physician in practice is looking to expand practice. Would prefer physician with 2 yrs. experience and trauma background is preferred.

Call 1:5.

AZ – SG-259 “Bread & Butter” Surgery opportunity with minimal trauma in one of the most desirable communities in AZ. Currently 2 physicians. A physician owned ambulatory surgery center.

CA – SG-265 Independent, SS group. Currently 2 physicians in practice. Three admitting hospitals.

MT – MS-459 “Bread & Butter” Surgery. Opportunity for a surgeon trained in laparoscopic procedures, & capable of doing upper & lower endoscopy procedures. Located near Glacier National Park.

CA – SG-265 Located NW of Pittsburgh. SS practice associated with multi-surgical specialty group for administrative purposes & billing. Laparoscopic, vascular and endoscopic desirable. Two admitting hospitals.

Internal Medicine

Allen Vicars

OB/GYN

Placement Services SC – IM-282 A 4-year-old, independent, single specialty practice of 1 physician is seeking an Internal Medicine provider. Outpatient only with 24/7 backup by phone and electronic records available to the ER or Hospitalists. The community exudes a strong sense of pride and Southern hospitality. Conveniently located 1.5 hours from Myrtle Beach and only 2 hours from the mountains.

AR – MS-403 Provide Christ-like healing to the community in this hospital owned, single specialty practice of 2 Internal Medicine physicians.

Geriatrics certification needed.

Inpatient/outpatient optional teaching and research. Full time or part time. Northeast Arkansas about 1 hour from Memphis, TN. IA – MS-263 Provide quality health care services to people throughout northeast Iowa in a hospital owned, multi-specialty group committed to living out the healing ministry of the Judeo-Christian tradition. Family– friendly community of safe neighborhoods offering a variety of attractions, recreational, and cultural entertainment. Low cost of living.

Orthopaedic Surgery GA – OS-196 Independent, SS, practice is seeking an Orthopaedic Surgeon with emphasis on Sports Medicine in beautiful SE GA. Call 1:3. Located near GA’s coast & invites you to share in the natural beauty of their waterways. Approximately 25 miles from Savannah.

IN – OS-198 Independent, MS group is looking for an Orthopaedic Surgeon.

Located within the Michiana region.

Practice currently has 2 orthopaedic physicians, 12 years old with 6 exam rooms.

Home of Notre Dame Football.

Number of opportunities per state: AL– 5, CA– 1, CO– 2, GA– 4, IA– 1, ID– 1, IL– 3, IN– 3, MI– 1, MN– 1, MO– 1, MS– 1, MT– 1, NC– 5, NE– 1, NY– 1, OK– 1, PA– 1, TN– 2, TX– 5, WA– 2, WV– 1

Toll Free Call - 888-690-9054 Fax - 423-844-1005 E-mail: Placement@cmda.org website: www.cmda.org

Placement Services

Dentistry

CA – MS-385 Three opportunities!

Each located around San Joaquin Valley.

GA – DT-215 Independent practice located NE of Atlanta.

IN – DT-244 Independent practice located 16 miles from Indianapolis.

MI – DT-226 Practice located along the beautiful shores of Lake MI. Looking for 3rd associate.

MS – DT-253 Located in the NE corner of MS. Independent, 17 1/2 year old practice.

OH – DT-221 Christian practice seeking to add 3rd associate to become partner.

PA – 6 opportunities.

VA – DT-256 Practice for sale in southwest Virginia.

WA – 1 opportunity.

WI – DT-255 25-year old practice located SE WI between Milwaukee & Madison seeking 3rd dentist.

Peds

WA – PD-237 Independent, single specialty group seeking another Pediatrician to join growing practice.

Inpatient and outpatient with call of 1:10. Admitting hospital has a level II Nursery and 250 beds.

WA – PD-205 Centralia Group of seven pediatricians and two nurse practitioners seeking another Pediatrician. This is a Christ-centered general pediatrics practice, serving patients birth through adolescence.

Cardiology NC – MS-303 Multi-specialty, physician owned practice has an immediate opening for experienced board certified Interventional Cardiologist. Located in the coastal plane only one hour from the Atlantic Ocean. Premier location to raise a family and enjoy a high quality of life.

Family Medicine NC – MS-483 4 physician practice north of Greensboro seeking FP, no OB. Option of doing inpatient/outpatient medicine or outpatient only. Call 1:4. Willing to accept full or part-time physicians. Short-term mission work encouraged.

KY – FP-716 Primary Care group in southeastern Kentucky seeking new associate faith-based healthcare ministry. Outpatient only. Located between Lexington, KY and Knoxville, TN. Mission statement is “Ministering the love of God through healthcare.” Practice consists of 4 board-certified FPs, a gynecologist, a FNP, and a biblical counselor. Medical missions trips encouraged. Federal and state loan repayment options.

NY – FP-612 7 physician group in western New York desires to employ family physician, OB optional. Full or part-time physicians welcomed. Inpatient/outpatient required. Electronic medical records fully implemented. Short-term missions encouraged and sabbatical time for mission work provided.

CO – FP-1056 Option for family physician to do inpatient/outpatient or outpatient only with Christian practice in scenic San Luis Valley in south central Colorado. Family oriented community with excellent schools and strong home schooling association.

PA – FP-1105 Ministry and mission minded practice located just west of Philadelphia searching for FP, no OB. Inpatient/outpatient required with 1 in 4 call. Practice has adopted a village in Africa and encourages mission work both domestically and abroad.

WI – MS-499 Hospital owned multi-specialty group in central Wisconsin seeking family physicians, OB optional. Inpatient/outpatient required with call schedule of 1:6. Excellent salary and benefits. Family oriented community with many outdoor recreational activities, moderate cost of living, safe and low crime.

SC – FP-922 Only 5 miles from North Carolina border and 20 minutes south of Charlotte, this 6 physician Christian group needs a FP, no OB. Physician can do either inpatient/outpatient medicine or outpatient only. All physicians have participated in short-term missions.

NC – FP-1063 Practice only 15 minutes from Charlotte, NC searching for FP with OB. Inpatient/outpatient work with light call schedule. Practice feels that every patient should be treated as if they were Jesus in a caring, conscientious, thorough manner. Short-term mission work encouraged.

Dermatology TX – DM-119 Opportunity to join a 6 year old, independent, single specialty practice of 1 full time, 1 part time Dermatologist and a PA. Outpatient only. Located 30-minutes from Dallas and Fort Worth with endless cultural opportunities available. Prayer with patients is encouraged; the use of “faith flags” throughout the office is supported.

MT – MS-481 An independent, multi-specialty group is seeking a second Dermatologist.

Nestled in the Rocky Mountains in central Montana. Good public and private schools, promotion of the arts, history, and culture; recreational opportunities abound.

Nephrology TX – NP-113 Independent, single specialty Nephrology group of 3 seeks a Nephrologist BC in Internal Medicine and BC/BE in Nephrology. Licensure in Texas and Oklahoma required.

Inpatient/outpatient. Christian partners. Physicians and staff are encouraged to pray with patients. Northeastern Texas in an ideal place to raise a family, the residents are dedicated to preserving the unique history, flavor and personality of the area.

PA – NP-114 Growing, independent, single-specialty practice is seeking a BC Internal Medicine, BC/BE Nephrologist. Added competence in Critical Care is desired. Built around its families, schools, and places of worship, this area is home to a wide variety of historic attractions, sporting venues, arts centers, and natural areas. The practice seeks to attend to the whole patient - physical, emotional, spiritual - while providing medical services to patients in Northeastern Pennsylvania.

I n t e r n e t w e b s i t e : w w w. c m d a . o r g

•

Summer 2007

33

addition to spiritual growth, In His Image Family Practice “ InResidency has given me indepth medical training. We have traditional teaching rounds at the hospital and one-on-one clinical precepting. One afternoon each week is devoted to medical lectures, morbidity and mortality presentations, journal club and board review.

I've been well prepared in the sorts of procedures that are needed in the U.S. as well as overseas. We get a variety of hands-on experiences and training from Family Practitioners and numerous subspecialists. Frequently in our Family Practice clinic I do exercise treadmill tests, colposcopies, and flexible sigmoidoscopies. In the hospital I've done multiple central lines, delivered numerous babies, and performed various other in-patient procedures.

Residents have the option to do elective rotations and receive extra training in various fields and procedures of personal interest like C-sections.

In His Image has given me the ability to learn and the encouragement to do so.

�

- Rodney Burrow, M.D.

CHRISTIAN MEDICAL & DENTAL ASSOCIATIONS P.O. Box 7500 Bristol, TN 37621-7500

Nonprofit Org. U.S. Postage

PAID Bristol, TN Permit No. 1000