Today's Christian Doctor - Winter 2003

2003 ANNUAL report

CONTENTS V OLUME X X X I V , N O.4

( O u r 5 3 r d Ye a r )

Winter 2003

The Christian Medical & Dental Associations ––changing hearts in healthcare—since 1931.

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Features

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Servant of Christ: Paul Wilson Brand Special tribute to a remarkable man of God

by David B. Biebel, D. Min.

CMDA’s 2003 Annual Report

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Doctors after God’s own heart

Departments 4 Progress Notes

28 Advertising Section

June 9 - 13, 2004 Gaylord Opryland Texas Resort and Convention Center Grapevine, Texas (Dallas area)

For more information, call the Meetings Department at 1-888-230-2637 or visit the website at http://www.cmdahome.org TODAY’S CHRISTIAN DOCTOR®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Winter 2003, Volume XXXIV, No. 4. 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 © 2003, Christian Medical & Dental Associations . All Rights Reserved. Distributed free to CMDA members. Non-member doctors may receive a complimentary six-month membership upon request or by referral by a patient or other healthcare professional. Non-doctors (U.S.) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tenn. Postmaster: Send address changes to Christian Medical & Dental Associations, P.O. Box 7500, Bristol, TN 37621-7500. Editor: David B. Biebel, D. Min. Editorial Committee: Gregg Albers, M.D., Ruth Bolton, M.D., Elizabeth Buchinski, M.D., John Crouch, M.D., William C. Forbes, D.D.S., Curtis E. Harris, M.D., J.D., Warren S. Heffron, M.D., Rebecca Klint, M.D., Samuel E. Molind, D.M.D., Robert D. Orr, M.D., Matthew L. Rice, Th.M., D.O., Richard A. Swenson, M.D. Director of Communications: Margie Shealy. Classified Ad Sales: Patti Kowalchuk (423) 844-1000. Display Ad Sales: Patti Kowalchuk (423) 844-1000. Design & Pre-press: B&B Printing. CMDA is a member of the Evangelical Council for Financial Accountability (ECFA).

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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.

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. 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.

For membership information or to request your first year's membership for half price, contact the Christian Medical & Dental Associations at PO Box 7500, Bristol, TN 37621-7500; telephone: (423) 844-1000 or toll free, (888) 231-2637; fax: (423) 844-1005; e-mail: main@cmdahome.org; Web site: http://www.cmdahome.org.

J. Raymond Knighton Jr. 1922-2003 J. Raymond Knighton Jr., former Executive Secretary (1951-1965) of the Christian Medical Society (now CMDA), died Saturday, August 30, in Brunswick, Georgia, after a month-long illness. He was 81.

Born in Chicago, Illinois, Mr. Knighton was raised in Chicago as well. While serving with CMS, Mr. Knighton began the Medical Assistance Programs as an arm of CMS to match surplus medicines and supplies donated from U.S. pharmaceutical companies with needs at mission hospitals around the globe.

In 1965 Medical Assistance Programs became an independent agency known as MAP International. Knighton resigned his position with CMS in order to become president of MAP, a position he held until 1980. He was supported in that work by a number of the original board members of MAP, including former U.S. Surgeon General, Dr. C. Everett Koop. After 1980, Mr. Knighton remained active with MAP

in a number of ways.

Two years ago MAP published the memoir “Serving the Servants,” written by Mr. Knighton to chronicle the first 25 years of the organization’s history.

Today MAP provides nearly $150 million a year in essential medicines and supplies to organizations serving Ray and Beth Knighton some of the world’s poorest communities. The organization will celebrate its 50th anniversary in 2004.

Mr. Knighton is survived by his wife of 59 years, Beth, four children and 12 grandchildren.

Addressing the needs of those who lack access to quality health “ care is a passion of mine. As I looked into residency programs, I discovered that In His Image Family Practice has that vision, also.

Residency encouraged my passion to serve as I helped In His Image and others establish Good Samaritan Health Services.

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GSHS and local churches now use a mobile medical van to deliver Christ-centered health care to the under-served in our city.

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I encourage medical students who have the boldness to follow their God-given passion of serving others to apply to In His Image.

Catrell Owens-Agbeibor, MD

The Good Samaritan Mobile Medical Unit

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CMAsm Condemns RU-486 Regimen Associated with Teen’s Death CMA condemned the Food and Drug Administration approval process of the abortion drug RU-486, after the death of Holly Patterson of Livermore, Calif., a San Francisco-area teenager who died on Sept. 17 after taking the chemical abortifacient provided to her by a Planned Parenthood clinic.

“Abortion clinics are moving even further away from physician oversight by having women take this dangerous drug at home,” noted Dr. Gene Rudd, Associate Executive Director of the CMA. “Many women will not be able to distinguish between the drug’s typi-

cal side effects of bleeding and cramping with symptoms of a potentially fatal situation.

“Unless the FDA acts now to recall the drug pending a safety review,” Dr. Rudd added, “women are at serious risk of falling victim to a lax drug regimen that stresses access at the expense of medical safety.”

Fourteen television stations across the U.S. picked up an Associated Press interview with Dr. Rudd on this subject.

He also did interviews with “Janet Parshall’s America,” Citizen magazine, United News & Information, American Family Radio and World magazine.

For more on this story, and downloads related to RU-486, see: http://www.cmdahome.org.

Unique Help for Your Addicted Patients HOLY SMOKES Inspirational Help for Kicking the Habit Jean Flora Glick “Embedded within this Christian mother's letters to her smoking addicted daughter, are the scientific do’s and don’ts of breaking this addiction. These are strengthened by interspersed Bible verses.”

More Washington Bureau Appointments

—Fred S. Stockinger, MD, FACS, FCCP, FACC Assistant Professor of Thoracic and Cardiovascular Surgery The Ohio State University

Yvonne Moore, M.D.

Advisory Committee on Infant Mortality Beverly B. Nuckols, M.D. National Advisory Committee on Violence Against Women Russ Robertson, M.D. Council On Graduate Medical Education Richard Kent Zimmerman, M.D. Advisory Committee on Immunization Practices

Paid Advertisement

by Jennifer Pickel

You can review most federal government boards and commissions of the U.S. Department of Health and Human Services boards and commissions at http://www.facadatabase.gov/public.asp. Then e-mail your CV, indicating your preferences, to: washington@cmdahome.org. Thank you!

Tell your church about this new free resource from CMDA—an easy to understand, succinct guide to the biggest questions about abortion, stem cell research, cloning, genetics, physician-assisted suicide, and faith and health. Great background material for use in Sunday school classes. You can even download it for your church’s Web site, under its own banner. See the Web site: www.cmdahome.org, Publications - Standards 4 Life.

Internet Web site:

Available from most local and online booksellers or from Kregel at 800-733-2607.

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by David B. Biebel, D.Min.

About 400 years ago, English clergyman John Donne wrote: “No man is an island...any man’s death diminishes me, because I am involved in mankind; and therefore never send to know for whom the bell tolls; it tolls for thee.”

On July 8, 2003, humankind, enriched for years by the charity, kindness, generosity, creativity, hospitality and wisdom of Paul Wilson Brand, was diminished by his passing. And around the world, millions who had been touched, directly or indirectly, by this remarkable man, mourned.

A Simple Beginning The son of missionary parents Jesse and Evelyn Brand, Paul Brand spent his

Author’s Note: The last words Dr. Paul Brand said to me were, "I love you." This was his message to everyone—family, friends, colleagues, students, patients, people of great repute, people of no repute—a message expressed in word or deed, often both.

As a result, he was loved in return.

This is not a biography or an obituary, for those may be found elsewhere.

It is but an introduction to Paul W. Brand—who he was; what he accomplished. Its theme is how God made and used a humble surgeon to show the world that He is real. Indeed, Paul Wilson Brand was one follower of Christ worth following—for there is much yet to be done by we who remain.

—DBB

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early years in the mountains of southwest India. There were no roads, no electricity, no plumbing, no radio or TV. There was only one manufactured toy in the house. Yet for Paul this was a period with intense delight, as he and his sister, Connie, would run around barefoot, playing with rocks and sticks as their toys, making up games to play in a world they thought of as rich, textured and full of wonder. In retrospect, Dr. Brand attributed his creativity to those early years when he had to develop and employ his creative imagination.

When Dr. Brand was 9, he and Connie (who was then 7) were sent to London in order to acquire a better education. When they left India, the children never dreamed it would be the last time they would see their father, who died six years later of blackwater fever. In a letter written about a month before his death, Jesse Brand included some advice for his son—advice that would become a guiding light for Paul: “God means for us to delight in his world. It isn’t necessary to know botany or zoology or biology in order to enjoy the manifold life of nature.

Just observe. And remember. And compare. And be always looking to God with thankfulness and worship for having placed you in such a delightful Paul and C onnie wit corner of the universe as the planet parents in In h their Earth.” dia.

A Builder First, T hen a Doctor “Your father, dear, always wanted to be a doctor,” his mother reminded him.

“I know he would be pleased if you….”

After seeing his father working with ulcers, pus and blood, Paul W. Brand knew that while he might someday become a missionary, he certainly did not want to become a doctor!

So, in December 1930, having finished his studies at University College School, Paul became a building apprentice. Over the next five years he learned all aspects of the building trade—planning, estimating, contracting, foundations, framing, roofing, plumbing, and (his favorite) masonry—skills that would later prove invaluable in ways that he could not possibly have imagined at that time.

By the time Paul was 21, he felt he was ready to go to India as a missionary. But to his great surprise and consternation, the mission board said he was not ready. He needed to complete some Bible school training and a short course in tropical medicine. To his amazement, he loved both the work and the study required of participants in this course provided by Livingstone Medical School—including learning to pull teeth!

Next he entered a missionary training colony in 1936, an experience through which he realized that what had birthed his missionary zeal was primarily love for his father. If the son were really going to help people tangibly, it wouldn’t be through evangelism or preaching. It would be through medicine.

In the fall of 1937, Paul entered the University College Medical School, where he met Margaret Berry over a chemistry laboratory bench to which they had been assigned alphabetically. By the end of that term, Paul was second in the class—to Margaret! Through medical training and residency their relationship developed.

They were married in 1943.

Back to the Future In 1946, a telegram came from India: “There is an urgent

need for a surgeon to teach at Vellore. Can you come immediately on short-term contract? Cochrane.”

Paul responded that he was going into the army, in no position to take a teaching post, and that they were expecting their second child. But Robert Cochrane, the foremost leprosy specialist in the world at that time, refused to take no for an answer. Within a short time, all obstacles were overcome and all arrangements made.

Margaret stayed behind for a time, to tend to the children—Christopher and Jean, who was born while Paul was in the very act of packing his bags for India.

opher, Jean, Granny, Paul, Christ t, re ga M ar (back, l. to r.) g Pauline ia, Estelle holdin Mary (front) Patric

Partial List of Honors and Distinctions

Elected Hunterian Professor of Royal College of Surgeons of England in 1952 and 1962 Received Albert Laskar Award for “Outstanding Leadership and Service in the Rehabilitation of the Handicapped” (1960) Appointed “Commander of the Order of the British Empire”

by Queen Elizabeth (1961) Received Medal of the American Association of Plastic Surgeons (1966) Received the Founder’s Medal of the National Rehabilitation Association (1967) Received the Servant of Christ* Award from the Christian Medical & Dental Associations (1982) Received the Surgeon General’s Medallion, Department of Health and Human Services (1986) Honored as “Pioneer in Hand Surgery” by the Third Congress of the International Federation of Societies for Surgery of the Hand; Tokyo, Japan (1986) Past President, International Christian Medical & Dental Association Immediate Past President, The Leprosy Mission, International; London, England *The organization was then the Christian Medical Society; the Award was then known as the “Man of the Year.” This was Dr. Brand’s most valued award.

Internet Web site:

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From an anonymous leprosy sufferer: Dear Dr. Brand, I’m unknown to you, but through books that I’ve read about your work I feel as if I’m connected to you.

You brought hope and life to many people in my situation.

Somebody in my church lent me the book “Ten Fingers for God.” I wept my way through many of the pages.

You gave of your life unreservedly; You gave when it hurt; You gave that we could have a better life, be more acceptable to others and be respectfully integrated into society.

We learned so much more about leprosy and understood so much more of what we lived through.

When I read some of the tributes to you, again I was drawn into your life.

I saw clawed fingers being straightened; I heard you in discussion with other colleagues, sharing your new and unaccepted ideas and then being proved correct. I believe the Lord gave you insight.

Thank you for persevering on our behalf. There are millions of leprosy sufferers who are now better off because of you.

Dr. Brand, I look forward to meeting you in glory.

For Paul, returning to India was a voyage into the past. The language returned quickly. The smells, sounds and sights were familiar—until Dr. Cochrane invited him to the Lady Willington Leprosy Sanatorium in Chingleput in early 1947.

Dr. Cochrane showed him around the grounds, pointing out cases that were of special interest to him as a dermatologist.

But Paul’s focus was hands. “Look here, Bob,” he said.

“Tell me about these hands. What’s the matter with them?

How did they get this way? What do you do about them?”

“Sorry, Paul,” Dr. Cochrane replied. “I don’t know.”

“Don’t know!” Paul replied. “Here you’ve been a leprosy specialist all these years, and yet you say you—you don’t know! Surely something can be done for these hands!”

Then sticking his finger in Paul’s chest, Dr. Cochrane responded with a message that Paul felt was straight from God. “And whose fault is it, I ask you, that I don’t know?” Cochrane replied. “I’m a skin man. But it’s you, not I, who are the orthopedic surgeon! I wonder if you can explain to me why, when there are more than ten million leprosy patients in the world…not one, I repeat, not one orthopedic surgeon has ever really studied the deformities of leprosy.”

hazard? Was the flesh of these patients “bad flesh,” or might surgery help? Did the fingers and toes rot away and fall off— and if so, why?

Over time it became clear that he would have to find the answers himself. So he assembled a small team, with whom he began to research the primary questions. As a result of their careful examination of about 2,000 patients, a pattern of progression of paralysis was identified. There were indeed some “good” muscles that might be useful in reconstructive surgery. But would incisions heal? Would sutures hold? After painstaking research and analysis, the answer was: It should.

By 1947 Dr. Brand was ready to perform the first-ever attempted reconstructive surgery on a person with leprosy, in this case a young Hindu named Krishnamurthy, whose condition was so extreme that even unsuccessful surgery would not worsen things. Dr. Brand started with the feet, and after initial success, moved to Krishnamurthy’s hands, which were eventually returned to a significant degree of usefulness through a series of surgeries.

T he Crusade Surprisingly, about two months after being discharged,

Krishnamurthy returned, sadly holding out his “new” hands. “They are bad hands, Sahib doctor,” he said. “Bad begging hands.” People wouldn’t hire him because he still bore the marks of leprosy. And they no longer would give him alms out of pity, because now his hands were useful.

Another patient returned and said, ”Sahib doctor, do you know how much you have harmed me?”

The solution was simple, but its implementation complicated. The former beggars must acquire new means of supporting themselves, trades they could take back to their own villages. A place would have to be built, skilled instructors hired, and physiotherapists found to help match each individual’s abilities to a specific trade.

There was space available at Vellore, but opposition to the plan at first, since some senior physicians disapproved of having leprosy patients on the campus with medical

T he Quest These and other

questions launched Dr. Brand’s search—to understand and to help. Yet, unbelievable as it seemed, there was no reliable data on record to answer the most pertinent questions: Was the progression of paralysis hap-

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Dr. Brand at Carville, with Dr. C. Everett Koop (left, center), Dr. Ronnie Matthews (right), and members of their team.

He Aimed at Heaven...and Got Earth Thrown In At one of the memorial services, Dr. Brand’s long-time friend and coauthor Philip Yancey eulogized: “In Psalms it says, ‘Precious in the sight of the Lord is the death of His saints.’ It’s not precious to us. It hurts… because we lack God’s point of view. To us, Paul Brand is precious in a different sense of the word—rare, like a precious gem.

“C.S. Lewis said, ‘If you read history, you will find out that the Christians who did most for this present world were precisely those who thought most of the next. Aim at heaven, and you get earth thrown in.

Aim at earth, and you get neither.’

“Throughout his life, Paul Brand aimed at heaven. And because of that, the earth will always be a spectacularly, and gratefully, different place.”

CMDA Resources Related to Dr. Paul Brand Audio Tapes Paul Brand Classics 5 Tapes in vinyl cover The Biblical Basis For Healthcare; Having Your Feet On The Ground;Having the Mind of Christ; Having Eyes That See; Having Hands That Touch AC-126 $25.00

Books students. Dr. Brand the pioneer became Dr. Brand the advocate for persons with leprosy—a role he fulfilled until his death. Only after it was promised that a barbed wire fence would enclose the new buildings (it was later torn down by the medical students), that no patients would enter the main campus, and that all patients would be noninfective was permission to proceed obtained. A generous gift funded the small cluster of mud-walled buildings—”The New Life Center.”

Pain as a Gift The mystery of the disappearing digits

began to be solved soon after the center’s founding, when Paul observed a young “New Life” patient seriously injure his hand without even being aware of it. This observation launched the scientist on a path of investigation that led, over the years, to the preservation of countless limbs and digits in people with leprosy (and, to some degree, in people with diabetes). There were many twists and turns along the way, and some reversals, yet the primary fact remained that people without the “gift” of pain were at risk of unknowingly wounding themselves repeatedly to the point where scar tissue accumulated under the skin, slowly replacing fat and blood vessels. No fingers ever “fell off” as a result of leprosy (though some were bitten off in the night by rats). But many were injured by burns, abrasions, overexertion of pressure, splinters, tacks, broken tool handles, and the like. As a result, over

time, a sort of shrinking process took place.

Other conundrums of leprosy remained to be pursued, but the concept of pain as a gift led to some interesting connections. About 30 years ago, a young author named Philip Yancey showed up to visit Dr. Brand at Carville, Louisiana, where Dr. Brand had moved in 1966 to become chief of rehabilitation at the National Leprosarium run by the U.S. Public Health Service (a post he held until his retirement in 1986). Yancey, collecting material for his book Where is God When It Hurts?, had read a pamphlet

by Paul entitled “Escape From Pain” published by the Christian Medical Fellowship of England.

During that visit, Dr. Brand on impulse gave Yancey a copy of a manu-

Fearfully & Wonderfully Made Brand & Yancey BK-036 $12.99

The Gift of Pain Brand & Yancey PAR-0117 $12.99

God’s Forever Feast Dr. Paul Brand BK-203 $12.99

In His Image Brand & Yancey BK-054 $13.00

Granny Brand Dorothy C. Wilson BK-202 $12.00

Ten Fingers for God Dorothy C. Wilson BK-201 $12.00

Video A Single Vision - VHS Drs. Paul and Margaret Brand (Interview) VC-1040 $20.00

To order call toll free (888) 231-2637

Setting of the video interview “A Single Vision”

Internet Web site:

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script he’d been developing for years. Over time, this became their first co-authored book: Fearfully and Wonderfully Made (1981), which was followed by In His Image (1984) and then

by The Gift of Pain (1993). Through these books and many other writings, millions have been blessed and encouraged (see the ad, page 9, for resources by, about, or related to Dr. Brand).

T he Legacy Creating this brief tribute has seemed, at times, similar to John’s challenge in writing about the words and works of Jesus. “If every one of them were written down,” John concluded his gospel, “I suppose that even the whole world would not have room for the books that would be written.”

Dr. Paul Brand achieved many remarkable things, but his primary legacy may be that the whole world is dotted with people whose lives he touched in one way or another.

There is Sadagopan (see the video “A Single Vision”), a person with leprosy (in a sense, representing all persons with leprosy) who showed up one day at Vellore, looking for Dr. Paul Brand. Since he had paid his last “penny” for transportation, and Paul was out of town, Margaret invited Sadagopan to stay overnight—this in a day when very little was known about how the disease was spread.

There are his students, who picked up his habits of posture and listening to the point where, as doctors, they reflect Paul Brand when they see their own patients.

There are other students, many of them whom he (and Margaret) have encouraged to pursue academic medicine, where they could be involved in a ministry of multiplication like the Brands have had.

There are colleagues—legions of them—who were chal-

One day I shall experience a sickness that is unto death. I shall sense my mortal frame has no more strength to fight and that my pathway is leading into the valley of the shadow. Let me not feel the despair of one who is losing a battle, or that a triumph of evil is ahead. Focus within me, O Lord, the light of your eternal Spirit.

Show me again that my body, for all that it is wonderful, is but the mantle of a greater wonder, my soul. Hold me, Lord, in such awareness of your presence and your love that my parting from my body shall be but the opening of a more vivid intimacy and union with the spirit of my Savior. He who has been the inspiration of my stumbling body shall now be the very light and substance of my soul.

From “I Thank God for My Immune System” —Litanies of Praise, Copyright Paul Brand; 1993

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Paul and Margaret Brand in Colorado (photo by David Biebel) lenged by Dr. Brand’s willingness to follow Christ—no matter at what cost.

There is his family—six children, twelve grandchildren— who have inherited Dr. Brand’s values and will carry on in their own individual ways.

There is Margaret, who recently told us: “As I try to go through Paul’s clothes, it is his shoes that affect me most. As I look at them I can hear his step, so confident and with a happy note to it. It’s been precious to me for 60-plus years. I can see him standing, teaching, walking with his family; all precious, tender and evocative memories. But I wonder: Can anyone really fill those shoes?

“I praise the Lord that he has taught so many people and they will carry on his teaching. I praise the Lord that his inspiration will always be with us in the tapes and videos he has made. I praise Him for the books and articles he left us.

Most of all I praise Him for the person He made Paul to be...to show us Jesus.

“I know I can never fill Paul’s shoes but I can and must be all that Jesus wants me to be. I am sure I can hear Paul say, ‘That’s the way to go.’ ” And, there is a child (unborn at the time) to whom Paul addressed this message (in a small group setting) two days before the fall that led to his death: “I agree with Margaret’s wish for your spirit and your faith. Now my wish is for your body! May you grow well, and learn about the wonderful way you have been designed and made. Now take care of yourself and when you get sick or break a leg, make it an occasion to appreciate your amazing healing cells.

With love, Paul Brand.”

Sources: Ten Fingers for God, by Dorothy Clarke Wilson; “A Single Vision” (CMDA Resource); memorial services video; various obituaries. Photos courtesy of the Brand family and Gary Benson (55th Anniversary photo). Special thanks to Molly Coyner Cozens, secretary to the Brands, and to Catherine and Barry Baker, parents of David, to whom the message at the end of the article was addressed.

2003 ANNUAL report

2003 ANNUAL report Dear CMDA members and friends, God is doing something in healthcare today. We shouldn’t be surprised. He does His best work in the midst of crises when His children, at the end of their rope, reach out to Him. In the middle of assaults on the doctorpatient relationship, cost inflation, stratospheric malpractice rates, ethical capitulations and mushrooming bureaucracy, God is changing the hearts of healthcare professionals and teaching us to be more like Him. And He is using doctors to reach out to patients who are as sick at heart as they are sick in body.

Be assured that the Lord knows how we feel, faced with more patients and crises than we have time or energy to handle. Jesus cared for pressing crowds of sick patients and met their spiritual needs under incredible pressures. That reassures me. You and I don’t have to figure out how to fix the entire healthcare system overnight. We just need to be like Jesus, employ His principles, and minister—in His power—one-by-one to the individuals He puts in our path.

Like He raised up Gideon as a valiant warrior, God is using the Christian Medical & Dental Associations to help insure that men and women “of God may be thoroughly equipped for every good work.” He is using us to build a Christian community in healthcare—a community from which to reach out with God’s love and Good News to our colleagues, our communities and our patients.

His hand has been evident this past year, as we have experienced growth in ministry and influence in doctors’ offices, in churches, in the halls of gov-

Evangelism ernment and around the world. Wherever you find CMDA ministries, you will find a driving force—a central mission, summed up in this Scripture: “Go therefore and make disciples of all the nations, baptizing them in the name of the Father and the Son and the Holy Spirit, teaching them to observe all that I commanded you…” (Matthew 28:19, NASB).

This annual report divides CMDA ministries into several categories: Discipleship, Service, Equipping and Voice. Evangelism, however, is more than a category; it is our overriding mission. Evangelism pervades every one of our over 50 ministries, everything we do at CMDA. Evangelism motivates and energizes our campus chapters around the country. Graduate members across the country form grad chapters and local councils to reach their colleagues and communities for Christ. Our medical mission program shares the Gospel with needy patients, in the process providing evangelistic experience for docs who may never have shared their faith before. Our resource ministries provide evangelistic tools and training to help you share your faith more effectively and winsomely. And our media initiatives seek to impact our culture with biblical principles and the “aroma of Christ,” as we show why life itself has meaning.

As you read the following pages, I trust you will take encouragement from what God is doing through this movement of Christian doctors. With over 50 different outreaches from which to choose, you will surely find one or more that uniquely meets your personal and professional needs. I challenge you to look for a place where you can use your unique skills to mentor the next generation, reach out to the needy, reach your colleagues or speak out as a righteous voice in our culture. I hope you will also share this annual report with your Christian colleagues and encourage them to join this movement.

Working together, we can make a difference for His kingdom. And that’s Good News.

In Him,

David Stevens, M.D.

2003 ANNUAL report Did you know?

Community-based ministries leaders are using grant funds to expand campus evangelism outreach. The outreach includes distribution of and follow up CD’s and DVD’s on academic, scientific, cultural and spiritual issues; conducting evangelism training; teaching apologetics (rationale for faith); and, leading Bible studies.

Membership in the CMDA movement of Christian doctors grew 6.2% in the last year— from 16,479 to 17,503 members.

CMDA students have opportunities to work side by side with Christian doctors, as did the students pictured on this page.

CMDA launched a new international ministry, Global Health Services (GHS), this year to motivate, train and equip medical missionaries for effective ministry. GHS plans to help medical missionaries with funding, management training and ministry support; help individuals launch medical missionary careers; and, implement a broad HIV-AIDS ministry through missionary members and churches in Africa.

Of 48,063 patients seen during Global Health Outreach mission trips, 10,962 indicated a commitment to Christ. Ten percent of GHO teams served in the “10-40 window.”

—Photos courtesy, Summer Medical Institute Northwest

Discipleship Will the next generation of doctors treat their patients with principled compassion or with an eye fixed on the ledger? Will their marriages survive the pressures of residency and establishing a practice? Will they see faith as anti-science superstition or an integral factor in healthcare?

How students today answer these and other questions related to values, ethics and spirituality will determine the future of the profession.

While some medical and dental schools are attempting to address these issues, they typically refrain from using the moral compass—namely, the Scriptures—that can lead students to answers.

The student ministries of CMDA stand in this gap, providing access to biblical truth, Christian fellowship, dynamic worship and personal counseling. It all adds up to lifestyle discipleship.

Such campus ministries may well be the best hope for building a generation of doctors who will honor and advance life in the tradition of our faith and our profession.

2003 ANNUAL report

Like most students, Lisa Crisafulli’s packed schedule allowed little time for contemplating, much less planning and taking, a mission trip on her own. So when she came into contact with the Christian Medical Association’s San Antonio chapter, she jumped at the chance to join an already planned trip to Acuña, Mexico.

CMA’s San Antonio Area Director Roger Matkin regularly uses mission trips as a way to help students deepen their relationship with God by leaving their comfort zones and putting their faith into action.

As Roger

explains, “Mission trips provide the opportunity to be obedient to the One who said to the original 12 disciples in Luke 9, ‘go out and preach and heal.’ Christian healthcare providers are the only disciples on the face of the earth who literally can do that. These kind of trips offer life-altering experiences.”

Unlike the demanding, critical patients many U.S. doctors sometimes face, Acuña residents welcomed the mission team with open arms. “The people of Acuña were amazing!” Lisa recalls. “The love and compassion and sheer gratitude they showed us all was breathtaking.”

Lisa added, “For too long, I had put off and waited to answer God’s calling. Now my only wish is that I may give back something to the people we serve, perhaps to be more useful on the trips to come. So I checked off every date for the mission trips for both the spring and the fall semesters. If there is room for an extra set of hands, I am ready.”

“Jesus went through all the towns and villages, teaching in their synagogues, preaching the good news of the kingdom and healing every disease and sickness. When he saw the crowds, he had compassion on them, because they were harassed and helpless, like sheep without a shepherd. T hen he said to his disciples, ‘T he harvest is plentiful but the workers are few. Ask the Lord of the harvest, therefore, to send out workers into his harvest field.’”

Matthew 9:35-38

2003 ANNUAL report Did you know?

CMDA currently has representation on over 80 percent of all medical and dental campuses.

The community-based ministries staff, which leads campus and graduate programs, has grown from eight roughly ten years ago to nearly 50 today. Community-based ministries staff are pursuing the goal of exposing every first-year student in medical and dental schools nationwide to the Gospel of God’s love in Jesus Christ.

The Christian Dental Association installed its first director this year, Dr. Jack Shuler. CDA published a dental brochure, distributed a dental audio CD and designed display booths for professional dental meetings. Dr. Shuler traveled to 13 dental schools to meet with students and grads and contacted by mail over 5,000 prospective new members. Membership in CDA has reached nearly 1,000.

Five Regional Directors help expand and enhance community-based ministries: Scott Boyles, M.Div. (Northeast Region); Allan Harmer, Th.M. (Midwest Region); Will Gunnels, M.Div. (Southeast Region); Doug Hornok, Th.M. (Central Region); and Michael McLaughlin, M.Div. (Western Region and also Director of Community Based Ministries).

Testimonials CMDA has been a constant companion since 1963 when I entered dental school. What a significant source of encouragement for me during dental school, but especially when I neared the end of U.S. Air Force duty and sought practice options!

CMDA leaders and regular members surrounded me with practice possibilities and good old fashioned friendship. Genuine Christian colleagues for a lifetime has been the result.

––T. Bob Davis, D.M.D. I was pleased to be asked to serve as a mentor to a family practice resident here in my town — she's an intern in the program I just graduated from last year! We've just begun to meet, but I was so encouraged by our first prayer time together. I can pray for her with deep empathy! Thank you for coordinating this program.

—Joanna Branum, M.D. (mentor)

2003 ANNUAL report

Service Writer and theologian Colin Morris once said, “Theology is what you are when the talking stops and the action starts.” Believing that faith and works go together like fire and heat, the Christian Medical and Dental Associations provide a host of opportunities for members to show Global Health Outreach proChrist’s love in practical vides opportunity for service ways. Global Health to hundreds of physicians, Outreach, CMDA’s misdentists and others annually. sion arm, sends hundreds of physicians, dentists, and their staff and family members overseas each year to care for needy patients while sharing God’s Good News. The Domestic Missions Commission promotes doing the same for needy persons in U.S. communities. Medical Education International facilitates overseas trips for U.S. doctors to share expertise and a Christian witness with their counterparts in developing countries.

nosis required a workup far beyond the meager health facilities of the shelter. Like many of the city’s poor, Richard was caught in a Catch-22: his deteriorating health rendered him unable to work using his handyman skills, and the lack of a job rendered him unable to obtain health care, as hospital after hospital refused to treat him without insurance.

Dr. Kim prayed with Richard, and with his wife and daughter. He also took action. He contacted a

As the raggedy man slouched into the homeless shelter on Lower Manhattan, his slumping shoulders and plodding gait suggested an age of about 70—not mid-to-late 50’s, as Dr. David Kim would soon discover in an examination. “Richard” had traveled to New York City from Boston with his wife and daughter, who now spent the nights apart from him in a women’s shelter. Richard’s general state of ill health suggested to Dr. Kim and his colleagues the possibility of cancer, but a proper diagDr. Kim examines Milton Perkins, while being observed by medical students Donnie Beaubrun (l) and Sharon Daniel.

2003 ANNUAL report physician colleague from church who worked at a city hospital. The colleague arranged with hospital administrators to see Richard on a no-fee basis. Blood work, CAT scans, a colonoscopy and biopsy revealed a case of celiac sprue—easily treatable with diet modifications and supplements. After two weeks of inpatient care and subsequent help from the shelter, Richard and his family ultimately found work and moved into an apartment in Brooklyn.

“Last I heard, Richard and his family were doing very well,” relates Dr. Kim. “The sad thing was that if Richard had had insurance and been able to see a doctor before coming to the shelter, his celiac sprue would have been diagnosed much earlier. Instead, it took almost nine months and drained his resources and energy.”

Ten years ago, David Kim was embarking on medical school with a dream of caring for the underserved. “I knew that I wanted to be a doctor,” he said, “but I didn’t want to fall into the trap of treating medicine as a business, as many of my teachers and peers had done.”

After much waiting and prayer, an assemblage of medical and non-medical individuals formed in 1999, which eventually developed into Arukah Ministries (from the Hebrew word for healing and restoration).

Arukah networks with Dr. Kim, left, and Keith Chu, a range of Christian a medical student volunteer, urban ministries to set check the blood pressure of up faith-centered Wallace Burnett. health services, recruit

Pediatric cardiologist Allison Cabalka, M.D., lecturing in Nigeria during a Medical Education International mission.

volunteers, and mentor Christian healthcare professionals and students. After volunteering part-time with Arukah for several years, this past year Dr. Kim decided the time had come to enhance Arukah’s ministry by leaving the private practice where he had worked for two years and pursue a long-dormant vision of launching a faith-based health center in Staten Island, to serve the underserved in Christ’s name.

“I wanted a way to dovetail my love for New York, medical missions and my professional career into one whole unit,” explains Dr. Kim. “To practice faith-based medicine, in my view, meant to treat patients with the best services modern medicine can provide while at the same time offering spiritual, biblical answers to the real illnesses people face.”

Meanwhile, the Christian Medical Association had joined with Christian Community Health Fellowship and others to receive Global Health Outreach participants saw over 48,000 patients this year.

2003 ANNUAL report

“... if you spend yourselves in behalf of the hungry and satisfy the needs of the oppressed, then your light will rise in the darkness, and your night will become like the noonday.”

Isaiah 58:10

and dispense, through training and direct grants to startup and struggling clinics, over $3.2 million in federal Compassion Capital Fund grants.

Encouraged by CMA Domestic Missions Commission members Drs. Rick Donlon and Bill Crevier, Dr. Kim applied for and received a Compassion Capital Fund grant of over $40,000.

Coupled with part-time work with the Staten Island Hospital home visit program, which allowed him to keep up his insurance standing, Dr. Kim finally saw the green light to launch the dream.

“I couldn’t resist the call any longer,” explains Dr. Kim. “Although some of my colleagues thought I was committing professional suicide, what overrode everything was my need to obey the Lord’s calling—to take that step of faith and go. The peace God gave me was absolutely incredible.

“I have never looked back since that day I walked out of the office for the last time,” he added. “I have absolutely no regrets. As (missionary and martyr) Jim Elliot said, ‘He is no fool who gives up what he cannot keep to gain that which he cannot lose.’”

David Strycker, D.D.S., has served in Russia seven times with Medical Education International.

Did you know?

The Domestic Missions Commission partnered with the Christian Community Health Fellowship to help channel over $600,000 in federal grants to nearly 30 new and struggling Christian health ministries, providing direct financial grants and technical and administrative assistance.

A total of 638 doctors, their family members and staff put their faith into action overseas through Global Health Outreach medical and dental missions this past year. Thirty-two GHO teams ministered in 11 different countries.

Through Medical Education International this past year, 116 participants— more than double the number serving last year—traveled to 14 countries.

MEI seeks to “build relationships with physicians, dentists and students in other countries through medical education and training, to the glory of God.”

Testimonials "Our teaching was intended to encourage, but behind our academic face was the compelling motive to show Christ in the way we behaved and in the words we spoke."

—Larry Norton, M.D. Medical Education International team leader “We worked in eight different prisons delivering almost 9,000 prescriptions of medicine and treating 3,000 prisoners. Even though I went to minister and encourage these men, it was I who was challenged, encouraged, loved, and I who learned what love, sacrifice and service really are."

—Holly Johansen, Zambia

2003 ANNUAL report Equipping When Christian doctors and students need resources to equip them to integrate their faith and profession, the PDR and campus bookstore offer little help. That’s why CMDA makes it a top priority to bring you the best in Christian teaching, counsel and encouragement. From books to videos, speakers to interactive DVD’s, conferences to specialty groups, CMDA provides the Christian doctor with biblically sound, professionally reliable resources to meet your need.

Dr. Clydette Powell is Medical Officer for Tuberculosis in the Division of Infectious Diseases at the U.S. Agency for International Development in Washington, D.C. “CMDA equipped me from the time I set foot in medical school in 1972,” Dr. Powell recalls. “I was concerned that at medical school, I would be a young Christian in a very rigorous academic environment. That summer, the Christian Medical Fellowship (Christian Medical Association today) at Johns Hopkins School of Medicine sent a letter to every incoming medical student and invited me to a fellowship dinner in somebody’s home. This was sent from heaven–it was wonderful! Those people helped guide me through the demands of four years at Hopkins. I still am in touch with people from this fellowship group 31 years ago.”

During her senior year at Hopkins, Dr. Powell worked at a mission hospital in Zaire (now the Democratic Republic of Congo), with medical missionary and CMA member Dr. Dan Fountain. “Dan helped me see how my faith could best

be shared in a public health and preventive medicine setting. It wasn’t so much his words but his own passion—a conviction that the most appropriate outreach for people was at a public health, community-based level,” she said.

“In the developing world,” Dr. Powell observes, “many TB patients are poor, in prison, marginalized. These are the very people to whom Christ would have reached out in His day. That’s why I have a passion to help where I can.”

Besides her USAID work, Dr. Powell still practices clinical medicine, volunteering in Washington, D.C., at the clinic for pediatric AIDS patients at Children’s National Medical Center and at the TB Clinic for the Department of Health.

Upper photo: Dr. Powell in Cambodia with new believer, Vanny Yame. Lower photo: Dr. Powell in Albania, with 10-year-old Elda, who could not walk or stand. “The Lord placed us side by side,” Dr. Powell said, “so that one who could walk (me in this instance) could help her stand—in hope.”

2003 ANNUAL report Dr. Al Weir, CMDA’s immediate past president, speaks to students during the National Conference on “The Doctor as Comforter.”

Dr. Powell also sees open doors for ministry in the office. “My work here at USAID has been as much sharing a message of hope and faith at an individual level as it has been doing the same thing around the world. People will see the Bible verse on my desk and ask, ‘What does that mean—to trust in the Lord, and not lean on your own understanding?’”

Additionally, some of Dr. Powell’s most satisfying volunteer work comes through the Commission on Medical and Dental Education (CMDE), a CMA ministry that sponsors educational and spiritual retreats for medical and dental missionaries in Asia and Africa.

“These missionaries have been working in some difficult settings,” Dr. Powell explains. “Through

Did you know?

The Commission on Medical and Dental Education’s 24th International Conference in Chiang Mai, Thailand was the largest conference in its history, with 377 attending from 24 countries in Asia, SE Asia, the Middle East and the USA. Attendees could earn up to 60 hours of CME or CDE credit.

A total of 641 individuals attended CMDA national meetings this past year, including over 100 attendees who sailed through the Winter Conference at Sea aboard the Golden Prince. Next year’s national convention is slated for June 9-13, 2004, at the Gaylord Opryland Resort near Dallas.

The Women in Medicine and Dentistry page of the CMDA Web site (www.cmdahome.org) got a makeover, and members now enjoy a list-serve and monthly e-mail devotionals.

Over 100 physicians and dentists contacted the Medical Malpractice Ministry last year. The “Medical Malpractice Ministry Resource Kit,” provided free of charge, offers legal, practical and spiritual counsel. “Physician Heal Thyself,” a new resource by Curtis E. Harris, M.S., M.D., J.D., includes a PowerPoint presentation with sound.

CMDA’s Continuing Education program granted 487 CE hours, held 16 joint conferences and 11 direct conferences. The Academy of General Dentistry was again approved through December 2006 as a PACE program provider.

The Psychiatry Section holds a fellowship meeting every year at the APA convention, including this year’s meeting in San Francisco. The mission of the Psychiatry Section is “to encourage Christian psychiatrists to integrate their faith with the practice of psychiatry.”

Jody and David Stevens, M.D., enjoy a relaxing moment during the National Conference

The Marriage Commission held six Marriage Enrichment Weekends in 2002, with 67 couples attending. The Commission’s goal is “to stimulate an ongoing process of marital growth by teaching couples, from a biblical perspective, skills to refocus, rekindle and recommit to each other as marriage partners and to Jesus Christ as their common bond and Lord.”

Some medical schools in developing countries require students and residents to read CMDA’s SCAN, an electronic monthly scientific digest provided to medical and dental missionaries. SCAN, which often focuses on tropical diseases, is compiled by a team of dedicated CMDA members and staff after reviewing dozens of medical journals.

The Paul Tournier Institute serves as CMDA’s educational resource center. Publishing highlights this year included the best-selling health book in Christian Booksellers Association markets, Ten Essentials for Highly Healthy People by Walt Larimore, M.D., and When Your Doctor has Bad News by Al Weir, M.D. The Placement Service matched 40 doctors with like-minded practices this year.

2003 ANNUAL report CMDE, we offer spiritual encouragement and professional updates. We provide close to 60 CME hours of training at these meetings. It’s intense and exciting. I get to enjoy fellowship with people I’ve known now for over a decade—it’s like having heaven before I actually arrive. CME activities also provide a time for physical and spiritual renewal.

We have fun—a lot of laughter and spontaneity, and friendships are deepened each year.”

Testimonials “The conference was wonderful! The children’s program was good, the accommodations and food good, the connections and fellowship refreshing, and the plenary sessions uplifting and soul-satisfying. We were encouraged to get more active in missions, renewed in family calling in medicine, were spiritually fed, made new friends, saw old ones, and I haven’t laughed so hard in a long time.

That alone renews body and soul.”

—National Convention attendee

“It was great to read from the women’s ministry of CMDA. I am really thankful to the Lord to belong to this wonderful family the family of the redeemed of the Lord. God bless you.”

—Emelda Ngong; Cameroon, Africa

CMDA conferences are a great time of fun, fellowship and inspiration. The groups shown on this page attended the National Conference at Schroon Lake, New York.

—National Conference photos courtesty of Jack Lu, M.D.

“Thank you for your effort and work on the SCAN. As we are rather isolated with no internet access I appreciate your support in supplying valuable medical information!

I’m without any medical journals at this rural outpost.”

—Medical missionary “My partner and I posted our available position with CMDA. We then prayed to the Lord to send us help.

Within six months the new physician began working with us. God had brought us a perfect match for our practice. We are convinced Christ personally picked this physician for us.”

—Emidio Novembre, M.D.; Elkin, N.C. “This morning, I was reading in the book Jesus, MD, by Dr. David Stevens, where he described working ‘like a machine’ to get through his long line of patients, until patient Arap was in front of him. At that moment, it was as if God said: ‘I knew when I brought this man here that you couldn’t help him medically, but what about his spiritual cancer?’

“Work in the ER is tough, and I, too, sometimes feel like a ‘machine’ as I work as fast as humanly possible to get my patients seen, treated and dispositioned. There always seems to be another ‘triage’ waiting.

“I am praying for God to fill up my very dry well with His sweet water and help me care for and love those patients that are so very difficult and unlovable by the world’s standards.”

—Darilyn Falck, M.D.

2003 ANNUAL report Voice The statesman Edmund Burke once observed, “All that is needed for the triumph of evil is for good men to do nothing.” In the bioethical war of ideas, our culture desperately needs to hear doctors articulate a reasoned, life-honoring perspective that brings both science and ethics to bear on topics such as human cloning, abortion, assisted suicide

and stem cell research. While CMDA staff frequently appear on national television and radio shows, we also train our members to serve as media spokespersons.

The Christian Medical Association also impacts national policy through its Washington Bureau, which serves as a liaison between the membership and Congress and the Administration. The Washington Bureau networks with like-minded policy groups, working in coalitions to provide expertise and increase our impact. The net result of these efforts is a clear voice for Christian values, presented with scientific integrity and compassion.

One of those voices has been Jean Wright, M.D., M.B.A. She has testified in both houses of the United States Congress, served on federal commissions, appeared in numerous media outlets including Fox News’ “The O’Reilly Factor,” and leads CMDA seminars on how to impact public policy.

She currently serves as Executive Director of the Backus Children’s Hospital in Savannah, Ga. In a recent interview with Today’s Christian Doctor, Dr. Wright traced how God has changed her life through public policy action.

How did God prepare you before the first call came to give testimony in Congress?

At the time, I was serving as division director of a six-person physician team. Besides clinical work, we focused on research. We had recently added an expert in fetal pain—a world-class scholar who was really on the cutting edge of the field. So I was getting an education in my day-to-day work, not even thinking about where it might lead.

My main speaking to that point had been in lecturing at our Sunday School class at First Baptist Church in Atlanta. It was a tough crowd of single professionals who really knew how to put you on the spot with questions—a lot like a congressional panel. I had Adopted embryos press no thought of getting into public conference. Sign to left reads “Hannah is policy; I was just doing my job.

Adopted & Grows Up” What did you think when the call came to testify?

I remember standing at my desk when the phone call came from Rep. Henry Hyde’s office, asking me to testify in the U.S. House of Representatives about abortion.

They wanted a

2003 ANNUAL report

“For if you remain silent at this time, relief and deliverance for the Jews will arise from another place, but you and your father’s family will perish. And who knows but that you have come to royal position for such a time as this?”

Esther 4:14

pediatric anesthesiologist with expertise in fetal pain. In what I call my “Esther Moment,” I realized that if I didn’t say yes, God would find someone else to give that testimony—and I would miss out on the opportunity.

Looking back now, I would have missed out on all the excitement, the thrill and the blessing that I have experienced as a result of testifying. I would never have found myself standing, months after my testimony, as a guest in the East Room Jean Wright, M.D. of the White house.

How has God directed your life since the hearings?

My experience in public policy has been a huge faith builder. As I have seen what God has done, my life has been changed. And my institution has benefited, too. Spending time lobbying in Washington, testifying in Congress and serving on federal commissions has taught me how to advocate and work for change in a large system. That’s something that many of us doctors—who are trained to make autonomous decisions—aren’t very good at.

You have to put your ego on the shelf, too. You want to see the Senator and you end up talking to a 25-year-old staffer. But those staffers are often the ones making things happen behind the scenes in Congress.

What do you see your role as in the future?

God doesn’t necessarily call us to be successful— just to be obedient. Early on in my public policy endeavors, I learned about William Wilberforce, the

great English statesman who almost single-handedly brought down the slave trade in his country. It took him over 20 years of persevering in the battle.

That’s why I’ve named a little boat I got recently, Wilberforce. That boat is a reminder to me that God has put me in this battle for the long haul. I just want to be found faithful.

“There had been a shooting at the Capitol recently and security was tight, with heavy security and menacing policemen everywhere. The reality of the battle we were facing was hitting home to me. I began to realize that this was about spiritual warfare.

The night before my testimony, I had a dream in which I testified and then walked out on the steps of the Capitol and got shot. Given the intensity of the debate over abortion, for all I knew, everyone in the hearing room could be blown away.”

—Jean Wright, M.D., on her Senate hearing testimony, given on the 25th anniversary of Roe v Wade.

2003 ANNUAL report Did you know?

Through its Washington Bureau, the Christian Medical Association has became a trusted “go-to” source for appointments to prestigious U.S. Health and Human Services Department commissions, where over a dozen CMA members are now impacting national public policy.

CMDA received nearly 400 media hits this year. Interviews with radio networks provide national coverage that aren’t reflected in this number. Highlights included: the Reformatorisch Dagblad (a Netherlands newspaper); Washington Times; Washington Post; San Francisco Chronicle; “Breakpoint with Chuck Colson;” Diversion magazine; Associated Press; United News & Information; Salem Radio Network; Voice of America; and, CNS News.

The Ethics Commission re-crafted the Dentist’s Oath, and plans statements on “Moral Complicity with Evil,” “Non-Traditional Family and Adoption or Procreation” and “Healthcare Rights of Conscience.”

CMA’s Washington Bureau networks with many like-minded groups and individuals such as Chuck Colson, shown here greeting Joni Eareckson Tada prior to a Senate hearing.

Over 400 radio stations nationwide air CMDA’s public service announcements.

Major newspapers including USA Today, the Washington Post, Chicago Sun-Times, Denver Post, Washington Times and other leading newspapers—with a cumulative readership nearing 10 million—published 20 CMDA Washington Bureau commentaries.

CMA members in Hawaii, with support from the national office, helped stop an assisted suicide bill the legislature was poised to pass this year, while members in Vermont helped organize a coalition to fight efforts to legalize physician-assisted suicide in that state.

Testimonials “On May 1st, I was confirmed for the appointment by President Bush to the Board of Regents of Uniformed Services University of the Health Sciences in Bethesda and they’re putting me right to work. Thanks for your part in making this possible. It’s an honor, and I will try to serve well with the Lord’s help.”

—Shari Falkenheimer, M.D. “Thanks for your insightful and poignant comments on the problems that face anyone interested in the truth of some of these medical-ethical issues. As I recently read George Will describe it, there is a kind of ‘intellectual vertigo’ that seems to substitute for careful moral reasoning on these issues. You have spelled out some of the issues. Thanks for all you do.”

—John Crouch, M.D.

2003 ANNUAL report Finances at a glance

How Funds Support Ministries Donated Services & Supplies 31%

For the fiscal year ending June 30, 2003, CMDA realized a net income in the General Fund (operating budget) of $4,287. Net income in combined funds totaled $621,136. This combined net income represents the result of total income for operating and restricted funds of $10,714,692 and total expense of 10,093,556.

Total assets - $14,450,677 Total liabilities - $ 3,897,407 Net assets (for all companies) $9,932,134 (includes new facilities)

Programs 19% Donations 31% Other 2% Dues 17%

Total income in the General Fund (without considering donated services and medical supplies and the facilities) totaled $5,717,076. Non-budgeted operating funds of donated services and medical supplies and facilities together realized income of $3,886,561. So total income from operations was $9,603,637. Using the same guidelines, expense in the General Fund was $5,712,789 and for donated services and medical supplies the amount was $3,209,316 for total expense from operations of $8,922,105.

An independent audited financial report is available upon request.

Did you know?

How Funds Support Ministries Missions 13%

Education 3%

National Ministries 9%

Campus Ministries 18%

Publications 4% Conferences & Seminars 5%

Expended donations med. supplies/services 40%

Membership Development 4% Fund-raising & Development 4%

By the end of the fiscal year (June 30, 2003) the “Heart Changers” capital campaign had received pledges of $8,776,396 toward the $10 million goal, with $6,493,863 in pledges already given. The campaign was launched in 2002 to fund a national headquarters, expanded world mission outreach, enhance regional and campus ministries and strengthen the “voice of Christian doctors.”

CMDA gave $8,900 in Westra grants, $18,950 in Short-term mission grants and $2,000 in Gilson Fund grants during fiscal year 2003.

In addition, $62,500 was given through the Steury Scholarship Fund, which helps pay toward medical school expenses in agreement for service on the mission field.

2003 ANNUAL report

Officers of CMDA Executive Director David L. Stevens, M.D., M.A. (Ethics) Associate Executive Director Gene Rudd, M.D. Chief Financial Officer Colette T. Davis, CPA Controller Connie Fox

Testimonials Our involvement with CMDA (for 40-plus years) has been worth every spent second, every spent effort and every dollar given. For these have been multiplied many times over, and our voice has been amplified to the world. This is by God’s grace and by God’s community in CMDA. In other words, this is as it should be.

––Dr. and Mrs. Robert B. Scheidt

Board of Trustees Robert F. Agnew, M.D. Inis Bardella, M.D. Ruth A. Bolton, M.D. John R. Crouch, M.D. Terry R. DeGroot, M.D. Curtis E. Harris, M.D. Warren Heffron, M.D.—President Angela R. Jackson, M.D.—Resident Trustee Bruce MacFayden, M.D. Robert Orr, M.D. Clydette Powell, M.D. J. Scott Ries, M.D. Neal Smith, D.D.S. David L. Stevens, M.D., M.A. James Thompson, M.D. Alva B. Weir, III, M.D. Carl H. Wierks—Student Chris Wong, D.D.S.

There’s an adage that says: “What comes up in the bucket reflects what’s down in the well.” I am thankful that it is true at CMDA. The CMDA well is filled with leadership and staff committed to changing the face of healthcare by changing the hearts of doctors. The CMDA bucket comes up brimful of opportunities for its members to serve and to share the good, heart-changing news of Christ’s marvelous mercy and grace through the mediums of medicine and dentistry. What a privilege to support and share in those opportunities!

––Dr. and Mrs. Lynn Colip Contact Information: Christian Medical & Dental Associations P. O. Box 7500 Bristol, TN 37621-7500 Phone: (423) 844-1000

CMDA Announces New Resource—New Light on Depression New Light on Depression, the most recent resource in the continuing CMDA/Zondervan publishing partnership, is a comprehensive, reliable, readable and practical Christian book on all aspects of depression.

Authored by Today’s Christian Doctor editor David B. Biebel, D. Min. and psychiatrist Harold G. Koenig, M.D., New Light on Depression is designed for those who are depressed, their family and friends, and professional caregivers. The book draws upon its authors’ personal and professional experience, describing in easily understandable terms the wide variety of counseling and medical treatments available, without endorsing one school of thought or another on depression and its treatment. Some of the more common styles of counseling are represented in dialogues between counselors and clients.

The authors advocate a multidisciplinary team approach tailored to the true needs of the depressed person, stressing the critical need for greater cooperation among religious and medical providers of treatment and counseling. “The chapter on myths and misconceptions is worth the price of the book,� Dr. David Stevens says, in his foreword. “Among other things, the authors pull the mask off the belief that real Christians don’t become depressed.�

Each chapter includes a set of questions for reflection and/or discussion in a group setting. Many of the chapters also include practical and useful tools, such as: personal

wholeness self-check, depression self-check, suggestions and guidelines for choosing a therapist, suggestions for what to do if a depressed person seems suicidal, straight talk with your doctor, notepad for things to discuss with a professional treatment provider, and a decision-making checklist.

The last section of the book is especially designed to nudge believers toward a different way of viewing depression, which can be (like physical pain) a “gift,� which God, in His grace, can transform into compassionate ministry to others and a powerful witness to the world. In summary, the authors wish to facilitate, for those with depression, the experience described by the poet, Dante (The Divine Comedy: Inferno, Canto 34), as he returns from the dark depths of hell and sees “the shining world�: “And so we came forth, and once again beheld the stars.� “As a physician,� Dr. Stevens wrote, “I’ve taken care of many patients with depression and read widely on the topic.

This is the best resource I’ve ever put my hands on. Putting it into the hands of doctors, patients and family members will provide much more help than a mere prescription for Prozac.

So get a cup of something hot, curl up in your favorite chair and be ready for large doses of insight, gripping stories and practical suggestions. You are about to have your thinking on this subject transformed.�

Available from CMDA Life & Health Resources and Prescribe A Resource. Price: $15.99. Call (888) 231-2637.

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Advertising Section

DENTAL

Bellevue, Washington. Dentist seeking committed Christian to buy large 28 year established family practice based on Biblical principles. Owner desires to work part-time while also seeking mission opportunities. Contact Dr. Lawrence Bouma evenings; by phone: 425-883-8507 or e-mail: lmbouma@earthlink.net. 341/0588/2045 Dental Associate interested in future partnership. New facility being built in growing community located in Branson, Mo. Strong patient base can provide opportunity for great personal and professional growth. Contact: Dr. Richard Tallon; 417-336-8478; e-mail: drtallon@bransondental.com. 344/0629/2246 General practice of 32 years including all phases of dentistry. Office actively uses Cerec 30 and Biolese water laser.

Seeking associate leading to partnership and eventual buyout. Contact: Edward W. Hesse, DDS; phone: 513738-2606; fax 513-738-3020; e-mail: ehesse@cinci.rr.com.

334/0630/2296

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

Johnson County, Kansas. Immediate opening for a Dentist 3 to 4 days a week. Modernly equipped with Adec Ops, intra oral cameras, computer management software, Panorex and Nitrous Oxide. Contact Dr. Paul Mabe by phone at 913-707-5337 or e-mail: pmdds@comcast.net.

334/0617/2244

Dental Director/Dentist – Full-time in community health center for underserved people in Eastern Colorado.

New operatories, two dental assistants.

Competitive salary, benefits. Contact Jay Brooke, High Plains Community Health Center, 201 Kendall Drive, Lamar, CO 81052; 719-336-0261; e-mail: jbrooke@highplainschc.net. 334/0627/2243

MISCELLANEOUS Clinical Tropical Medicine and Parasitology Course - Diploma course accredited by the ASTMH. 6/158/6/04. Sponsored by the West Va. Univ. School of Medicine Office of CME and the International Health Program.

Contact: Nancy Sanders 304-293-5916; e-mail: nsanders@hsc.wvu.edu. 311/0028/1086

OVERSEAS MISSIONS

Nigeria – Looking for physicians and nurses interested in missionary work in Nigeria. Fax 410-686-3417 or e-mail: AgnesHealthCare@aol.com 344/0607/2242

POSITIONS OPEN Anesthesia!

LET CMDA PLACEMENT SERVICE FIND A POSI- FL (AN-131), NC (AN-133), NM (MS-103) & (AN-135), NY (AN136), OR (MS-213), TX (AN-128), WA (AN134) & (MS-182). CONTACT CATHY MOREFIELD, CMDA PLACEMENT SERVICE AT 888-690-9054, FAX CV TO 423-844-1005, OR TION FOR YOU! OPENINGS IN

E-MAIL: CATHY@CMDAHOME.ORG.

344/0059/2275

Cardiologist Once in A Lifetime Opportunity.

Energetic and motivated cardiologist needed for an expanding hospital in Mississippi. Join us as we build a new hospital on 180 acres. Requirements include BC (or BE with the intent of

Advertising Section certifying), and the willingness to open an outlying clinic. Income guarantee with potential well above national average. You will be supported by a fullservice hospital with progressive cardiology and cardiac surgery program. Please send CV, along with 3 letters of recommendation to: DPM, PO box 4739, Greenville, MS 38704-4739.

334/0626/2240

CARDIOLOGY OPPORTUNITIES! PRACTICE IN BEAUTIFUL NORTHWEST WASHINGTON! EXCELLENT COMPENSATION & BENEFITS. OVER 3 WEEKS PAID TIME OFF! NEEDED IMMEDIATELY! ADDITIONAL OPPORTUNITIES IN OVER 20 LOCATIONS! CONTACT AARON PAULUS 888-690-9054. 344/0059/2262

Cardiovascular Surgeon Mississippi - We are seeking a cardiovascular surgeon with at least 10 years experience in heart surgery. This includes significant experience in ascending and aortic arch aneurysm

replacement, thoracic surgery, redo CABGs , and vascular surgery. We are a public hospital in western Mississippi with Level II trauma. The individual selected will act as lead surgeon, as well as first assistant to the established heart surgeon. The call is 1:2, with every other weekend off. Must be BC in thoracic surgery. CV and 3 letters of recommendation needed. Send to Delta Practice Management, LLC, PO Box 4739, Greenville, MS 38704-4739.

344/0626/2241

Emergency Medicine South Carolina (EM-105).

Fully democratic, fee-for-service Emergency Medicine group seeking a residencytrained BC/BE physician. One of the most stable groups in the SE, emphasizing physician wellness and family time. Contact Gloria Gentry at 888-6909054, fax CV to 423-844-1005, or e-mail: gpgentry@cmdahome.org.

344/0059/2286

ENT

Building a Facial Plastics Practice?

Multiple physicians with Facial Plastics and Reconstructive Surgery fellowships seeking to practice in a Christian environment! Contact Aaron Paulus today for a CV! 888-690-9054.

344/0059/2264

Family Practice Eastern Kansas (FP-692). Two physician practice looking to add 3rd FP with OB in rural town of 8,000. Call is 1:4.

Contact Allen Vicars for information: 888-690-9054; fax CV to 423-844-1005; or e-mail: allen@cmdahome.org. 344/0059/2292 Eastern Pennsylvania (FP-511).

Independent group in Lancaster Co. searching for FP, no OB. Call is 1:7.

Contact Allen Vicars for more information: 888-690-9054; fax CV to 423-8441005; or e-mail: allen@cmdahome.org.

344/0059/2294

Loma Linda University Family Practice Residency Come to Southern California and experience an exceptional whole-person care residency.

Witness the best-of-both-worlds combination of an intimate community hospital with an academic medical center for excellent patient care and teaching. Explore our rural and preventative medicine tracks. Join in our whole-person care rounds. Watch doctors and patients pray together…you’ll love what God is doing here.

Loma Linda Family Practice Residency will have an opening for a PGY-2 resident in July, 2004. Qualified applicants are invited to inquire immediately at 909-558-6688 or www.llu.edu/llumc/family Applicants interested in other Loma Linda residency training opportunities may visit www.llu.edu/llumc

Internet Web site:

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Advertising Section Kentucky group seeking new associate for faith-based healthcare ministry in southeast Ky. This medical practice provides an environment in which to share the love of God through Christ with patients, staff, and one another.

Emphasis on whole person care, with practice-based chaplain. Full scope of procedures, with OB optional. Medical missions trips encouraged. Federal and State loan repayment options. Contact Steven J. Sartori, 606-523-2005, e-mail: sjsartori@pol.net, or see the Web site: www.bfhc.org.

334/0521/1934

-RAPTIM TRAVE L $AVING CHURCH/MISSION WORKERS SINCE 1947 AL L YOU NEED TOKNOW

AFRICA-ASIA-CENTRA L AMERICA-EUROPE ORIEN T-RUSSIA-SOUTH AMERICA &WORLD WIDE

TOL L FREE 1-800-777-9232 • FAX1-800-766-2881 E-MAIL: raptim@raptimusa.com LEWIS TON • NEW YORK • 14092

Montana - Well established 6 Dr. FP Clinic in Bozeman, Montana seeking a female colleague interested in doing OB. Start date is approx.

Aug., 2004. Call is light - approx. 3 weekdays per month, & every 8th weekend. Good compensation includes vacation, insurance, CME allowance, production incentive, and partnership after initial employment. Great family oriented community 90 mi. north of Yellowstone Park offering excellent schools and many mountain recreation opportunities.

For more info. contact Marsha Bolin, Administrator; 406-5874242; fax CV 406-587-3507.

344/0628/2245

Embryo Factory: The Stem Cell Wars

anovel byRe v. Richard A.Humphrey and Dr. Loren J.Humphrey

A pastor and aphysician present religious and scientific sides tothemost crucial issue facing modern man.

They use fictional characters toentertain and force thereader to wrestle with soul-searching questions: Isa stem cellabeing?

When isafetus abeing?

Isevery medical advance moral initsuse?

Does myfaith give clear guidance tomytheological and ethical answers forthisissue?

“I found the novel most intriguing and compelling. I enjoyed the turn from romance to tragedy to celebration. The authors rival Hitchcock....”

Richard A. Looney Bishop, United Methodist Church President, The Foundation for Evangelism Special forCMDA: $10+$2(S/H) from Jenkins LTD, 503 Nifong, #201 Columbia, MO 65201-3717

30

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

Northwest Ohio (FP-885). Hospital owned practice needing FP, OB optional, to assume office from physician leaving area.

Inpatient and outpatient work required. Contact Allen Vicars for more information: 888-690-9054; fax CV to 423-844-1005; or e-mail: allen@cmdahome.org.

344/0059/2289 Southern West Virginia (FP-660). Independent practice searching for FP, no OB. Missions encouraged. NHSC site and loan repayment available. Contact Allen Vicars for more information: 888-690-9054; fax CV to 423-844-1005; or e-mail: allen@cmdahome.org.

344/0059/2293 Sunny Central Washington! Group of 2 FPs seeking 3rd FP to replace senior partner in successful physician owned practice. OB optional, 1:9 call, 4 day work week, missions encouraged. Two excellent local hospitals and easy access to specialists. Family community with great Christian schools.

Yakima Valley, only 2 hours to Seattle, has everything the outdoor enthusiast desires. Dr. Ross Bethel, 509-307-2868, Dr. Jim Zingerman, e-mail: JZingerman@cwmed.com. 344/0625/2239 Western Maryland (FP-871). Independent practice searching for FP with OB and C-section experience. Call is 1:3. Contact Allen Vicars for more information: 888-690-9054; fax CV to 423-844-1005; or e-mail: allen@cmdahome.org.

344/0059/2291 Western New York (MS-245). Family practice located next to Christian college searching for FP, no OB. Call is 1:5. Only 30 minutes from Rochester. Contact Allen Vicars for information: 888-690-9054; fax CV: 423-844-1005; or e-mail: allen@cmdahome.org.

344/0059/2295

GASTROENTEROLOGY OPPORTUNITIES! PRACTICE IN SUNNY FLORIDA ON THE BEAUTIFUL ATLANTIC OCEAN WITH A FELLOW CMDA MEMBER! ADDITIONAL OPENINGS IN OVER 15 STATES! FL, TX, WA, CA, HI. CONTACT AARON PAULUS 888-690-9054 OR VIEW OPPORTUNITIES ONLINE AT www.cmdahome.org.

344/0059/2260

Advertising Section General Surgery

Alabama (MS-226). Solo Practice has physician retiring. Medical center will offer assistance in securing quality office personnel, provide office space to be rented at a reasonable market price, promote practice and the introduction of the physician.

Call coverage shared with surgeon in area. Contact Cathy Morefield, CMDA Placement Service at 888-6909054, fax CV to 423-844-1005, or email: cathy@cmdahome.org. 344/0059/2266

Ohio (SG-159). Single specialty group that is very busy and growing. Practice is 25% Vascular Surgery. Modern 200 bed hospital with 10 ORs. Surgeonowned surgery center. Call schedule 1:3. Perfect opportunity to establish yourself as a successful surgeon.

Contact Cathy Morefield, CMDA Placement Service at 888-690-9054, fax CV to 423-844-1005, or e-mail: cathy@cmdahome.org.

344/0059/2271

Hematology/Oncology

GENERAL SURGERY!

OPENINGS!

LET CMDA PLACEMENT SERVICE FIND A POSITION FOR YOU! OPENINGS IN - AL (MS-226); AZ (SG-223); CA (SG-230); CO (SG-227); FL (MS228); IA (MS-187), (MS-240), (SG-212); IN (FP284), (SG-207); KS (SG-171), (SG-228); MD (SG-157); MI (SG-169), (SG-210), (MS-244); MN (MS-233), (SG-221); NC (SG-166), (SG177), (SG-232); NY (SG-220); OH (MS-150), (SG-206), (SG-225), (SG-159); OR (MS-213), (SG-215); PA (MS-211); TN (MS-154); TX (MS186), (SG-216); UT (SG-224); WA (MS-182), (SG-178), (SG-202), (SG-205), (MS-207); WI (MS-229). CONTACT CATHY MOREFIELD, CMDA PLACEMENT SERVICE AT 888-690-9054, FAX CV TO 423-844-1005, OR

GROWING LIST OF OPPORTUNITIES IN CHRISTIAN ENVIRONMENTS. OPPORTUNITIES IN FL, GA, OR, WA. CONTACT AARON PAULUS 888-690-9054. 344/0059/2261

e-mail: cathy@cmdahome.org.

344/0059/2265

Internal Medicine

POSITIONS! - FINISHING RESIDENCY? CONSIDERING RELOCATION? CONTACT US TODAY FOR FURTHER INFORMATION ON OVER 50 EXCELLENT OPPORTUNITIES! CONTACT AARON PAULUS 888-690-9054 OR VIEW OPPORTUNITIES ON LINE AT

www.cmdahome.org.

344/0059/2263

Internet Web site:

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Winter 2003

31

Advertising Med/Peds

Contact Rose Courtney for information: 888-878-2133; fax CV to: 423-844-1005; e-mail: rose@placedocs.com. 344/0059/2247

Nurse Practitioner OPPORTUNITIES IN CA CT, GA, HI, MA, NC, OH, OR, PA, TN, TX, VA, WA, WI. CONTACT ROSE COURTNEY FOR MORE INFORMATION: 888878-2133; FAX CV TO 423-844-1005; OR

e-mail: rose@placedocs.com.

344/0059/2248

OB/Gyn Florida - (OB-254). Practice searching for an OB/Gyn physician to join their prestigious group. The group consists of 3 physicians and an Advanced Registered Nurse Practitioner. This is a salaried position with partnership opportunity, bonus incentives and offering an inclusive benefit package.

Contact Rose Courtney for information: 888-878-2133; fax CV to: 423-844-1005; e-mail: rose@placedocs.com. 344/0059/2251

OPPORTUNITIES

Seeking fellowship-trained Retinal Specialist, Pediatric Ophthalmologist, or General Ophthalmologist to join 5doctor practice in Virginia. Send CV to ET# 258, PO Box 7500, Bristol, TN 37621; e-mail: patti@cmdahome.org, subject ET#258.

333/0349/1927

Orthopedic LET CMDA PLACEMENT SERVICE FIND A POSITION FOR YOU! OPENINGS IN - AL (OS-104), AZ (OS188); CA (MS-192); CO (OS-157); (MS-220); GA (MS-173); IN (OS-148); LA (IM-222); MI (OS-180); (MS-244); MN (MS-133); NC (MS238); NE (OS-179); NM (MS-103); OR (OS-178); SC (OS-172); TN (MS-154), (MS-195); TX (MS143), (MS-221); WA (OS-163). CONTACT CATHY MOREFIELD, CMDA PLACEMENT SERVICE AT 888690-9054, FAX CV TO 423-844-1005, OR E-MAIL:

cathy@cmdahome.org.

344/0059/2277

Pediatrician North Carolina.

BC Pediatrician needed for Hispanic pediatric practice in Burlington, N.C. Must be bilingual.

Competitive salary and benefits. Reply to: infamclin@aol.com. Phone 336-5700010; fax 336-570-0012.

331/0551/1727

PutYour Faith Into

Practice

THE PURPOSE

The Valley Baptist Family Practice Residency exists to prepare physicians to reach the world for Christ. Our international community on the Texas-Mexico border provides the setting. Our high-tech, busy clinic and hospital provide the resources.

The Word of God provides the vision.

THE PREPARATION

IN AL, CA, CO, FL, GA, IL, IN, MD, MN, MO,

NV, NC, OH, OK, TN, VA, WA, WI. CONTACT ROSE COURTNEY FOR MORE INFORMATION: 888878-2133; FAX CV TO 423-844-1005; OR E-MAIL:

rose@placedocs.com.

344/0059/2249

Washington - (OB-258).

Multispecialty group consisting of 2 OB/Gyns, 1 FP and 2 Pediatricians searching for another OB/Gyn who is interested in a domestic mission type situation. This is a hospital-owned secular clinic with no religious affiliation. The clinic does pride itself on holistic healthcare and therefore spiritual issues are addressed on an individual basis. Contact Rose Courtney for more information: 888-878-2133; fax CV to 423-844-1005; or e-mail: rose@placedocs.com.

344/0059/2252

OPHTHALMOLOGISTS CONTACT ROSE COURTNEY FOR MORE INFORMATION: 888-878-2133; FAX CV TO 423-844-1005; OR E-MAIL:

rose@placedocs.com.

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344/0059/2253

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

California - Southern (PD-207). Solo pediatric practice. Physician searching for someone to join him and eventually take over the practice. Call is about 1:7; and 1:6 weekends. Practice is 27 years old. Contact Rose Courtney for more information: 888-878-2133; fax CV to 423-844-1005; or e-mail: rose@placedocs.com.

344/0059/2255

Colorado - (PD-209). Busy 3-doctor practice expanding office space and seeking to add 4th pediatrician. This practice strives to offer exemplary, compassionate, Christ-oriented care to their patients and their families. Call is 1:7. Contact Rose Courtney for more information: phone 888-878-2133; email: rose@placedocs.com; or fax CV to 423-844-1005.

344/0059/2256

An energetic, experienced faculty works sideby-side with the residents in our apprenticeship-model teaching environment.

Procedures, surgeries, deliveries, and plenty of pathology are the daily fare of our Family Medicine team. Discipling of residents and their families occurs during daily prayer times, weekly Bible studies, spousal support groups and retreats.

THE PRACTICE

Residents are encouraged and trained to share the Gospel and to pray with patients.

We believe that medical outreach should be a part of the resident’s routine. Our weekly Mexico Mission trips, monthly health fairs, abstinence programs, and sports medicine events provide the backdrop for exciting and effective evangelism.

Valley Baptist Family Practice Residency

2222 Benwood Street • Harlingen, Texas 78550 956/389-2448 • Fax: 956/389-2498 • www.vbfpr.com

Advertising Section OPPORTUNITIES

IN CA, CO, FL, GA, IL, KS, KY, MA, MO, NJ,

NM, NC, PA, SC, TN, WA, WY. CONTACT ROSE COURTNEY FOR MORE INFORMATION: 888878-2133; FAX CV TO 423-844-1005; OR

e-mail: rose@placedocs.com.

344/0059/2254

South Carolina - (PD-208). Solo practitioner searching for an associate who is compassionate and missionaryminded to join him in his rapidly expanding practice. Practice is 1 year old. Contact Rose Courtney for information: e-mail: rose@placedocs.com; phone 888-878-2133; fax CV to 423844-1005.

344/0059/2257

Physicial Medicine & Rehab Oregon (PMT-100) Independent single specialty (multidisciplinary) practice seeking a Physical Medicine & Rehab physician. Minimal call share allows time for family and weekend

events. Contact Gloria Gentry by phone at: 888-690-9054, by e-mail: gpgentry@cmdahome.org; or fax CV to 423-844-1005.

344/0059/2287

PHYSICIAN ASSISTANT – OPPORTUNITIES IN CA, CT, GA, HI, NC, OH, OR, PA, TN, TX, VA, WI. CONTACT ROSE COURTNEY FOR MORE INFORMATION: 888-8782133; FAX CV TO 423-844-1005; OR E-MAIL:

rose@placedocs.com.

344/0059/2258

PLASTIC SURGERY! LET CMDA PLACEMENT SERVICE FIND A POSITION FOR YOU! OPENINGS IN TENNESSEE (MS154). CONTACT CATHY MOREFIELD, CMDA PLACEMENT SERVICE AT 888-690-9054, FAX CV TO 423-844-1005, OR E-MAIL:

cathy@cmdahome.org

344/0059/2284

Psychiatry OPPORTUNITIES. CONTACT ROSE COURTNEY FOR MORE INFORMATION: 888-878-2133; FAX CV TO 423-844-1005; OR E-MAIL:

rose@placedocs.com.

344/0059/2259

SPINE SURGERY! LET CMDA PLACEMENT SERVICE FIND A POSITION FOR YOU! OPENINGS IN TN (MS-154).

CONTACT CATHY MOREFIELD, CMDA PLACEMENT SERVICE AT 888-690-9054, FAX CV TO 423-844-1005, OR E-MAIL:

cathy@cmdahome.org.

344/0059/2285

Vascular Surgery

W

hether short-term or full-time, Blessings International assists Medical Missions by being a source for: 1. Pharmaceuticals and medical supplies 2. Expertise in selecting needed medications 3 Guidance in building medical teams and operating short-term clinics

:

For a pharmaceutical application and bulletin, contact:

Blessings International P.O. Box 35292, Tulsa, OK 74146-0292 918-250-8101; BlessingsInt@blessing.org www.blessing.org

Washington (MS-207). Prominent North Central Washington multispecialty clinic is seeking a BC/BE Vascular Surgeon for one of its clinics.

The 170 physician owned and led practice offers a high quality life-style with time to enjoy a full range of outdoor recreation activities. Contact Cathy Morefield, CMDA Placement Service by phone at 888-690-9054, email: cathy@cmdahome.org, or fax CV to 423-844-1005.

344/0059/2274 LET CMDA PLACEMENT SERVICE FIND A POSITION FOR YOU! OPENINGS IN - OH (VS-106), VA

(SG-165), MN (SG-221), WA (MS-207).

CONTACT CATHY MOREFIELD, CMDA PLACEMENT SERVICE AT 888-690-9054, FAX CV TO 423-844-1005, OR

e-mail: cathy@cmdahome.org.

344/0059/2272

Internet Web site:

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Winter 2003

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Paid Advertisement

Custom Tailored

®

12 Accudose strengths.

All color-coded and easy to titrate. ®

LEVOXYL®’s thyroid gland-like shaped Accudose® tablets are scored for simplified dose titration. For customized hypothyroid therapy, there is no substitute for LEVOXYL®.

Time after time, LEVOXYL®’s proven stabilized formation is always on the level.

25 mcg

50 mcg

75 mcg

88 mcg

100 mcg

112 mcg

125 mcg 137 mcg

LEVOXYL® is indicated for thyroid hormone replacement or supplemental therapy for hypothyroidism. LEVOXYL® is contraindicated in patients with untreated thyrotoxicosis, uncorrected adrenal insufficiency, or hypersensitivity to any of its inactive ingredients. Adverse reactions are primarily those of hyperthyroidism due to overdose. Use with caution in patients with cardiovascular disease.

150 mcg

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WARNING: Thyroid hormones, including LEVOXYL®, either alone or with other therapeutic agents, should not be used for the treatment of obesity. In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction. Larger doses may produce serious or even life-threatening manifestations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects. Please see brief summary of full prescribing information on adjacent page for a more detailed discussion of important safety information.

34

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

™

Brief Summary (for full prescribing information see package insert).

For Oral Administration LEVOXYL® (levothyroxine sodium tablets, USP)

WARNINGS WARNING: Thyroid hormones, including LEVOXYL®, either alone or with other therapeutic agents, should not be used for the treatment of obesity or for weight loss. In euthyroid patients, doses within the range of daily hormonal requirements are ineffective for weight reduction.

Larger doses may produce serious or even life threatening manifestations of toxicity, particularly when given in association with sympathomimetic amines such as those used for their anorectic effects.

Levothyroxine sodium should not be used in the treatment of male or female infertility unless this condition is associated with hypothyroidism.

PRECAUTIONS General Levothyroxine has a narrow therapeutic index. Regardless of the indication for use, careful dosage titration is necessary to avoid the consequences of over- or under-treatment. These consequences include, among others, effects on growth and development, cardiovascular function, bone metabolism, reproductive function, cognitive function, emotional state, gastrointestinal function, and on glucose and lipid metabolism.

Effects on bone mineral density – In women, long-term levothyroxine sodium therapy has been associated with decreased bone mineral density, especially in postmenopausal women on greater than replacement doses or in women who are receiving suppressive doses of levothyroxine sodium. Therefore, it is recommended that patients receiving levothyroxine sodium be given the minimum dose necessary to achieve the desired clinical and biochemical response.

Patients with underlying cardiovascular disease – Exercise caution when administering levothyroxine to patients with cardiovascular disorders and to the elderly in whom there is an increased risk of occult cardiac disease. In these patients, levothyroxine therapy should be initiated at lower doses than those recommended in younger individuals or in patients without cardiac disease (see WARNINGS; PRECAUTIONS, Geriatric Use; and DOSAGE AND ADMINISTRATION). If cardiac symptoms develop or worsen, the levothyroxine dose should be reduced or withheld for one week and then cautiously restarted at a lower dose. Overtreatment with levothyroxine sodium may have adverse cardiovascular effects such as an increase in heart rate, cardiac wall thickness, and cardiac contractility and may precipitate angina or arrhythmias. Patients with coronary artery disease who are receiving levothyroxine therapy should be monitored closely during surgical procedures, since the possibility of precipitating cardiac arrhythmias may be greater in those treated with levothyroxine. Concomitant administration of levothyroxine and sympathomimetic agents to patients with coronary artery disease may precipitate coronary insufficiency.

Patients with nontoxic diffuse goiter or nodular thyroid disease – Exercise caution when administering levothyroxine to patients with nontoxic diffuse goiter or nodular thyroid disease in order to prevent precipitation of thyrotoxicosis (see WARNINGS).

Associated endocrine disorders Hypothalamic/pituitary hormone deficiencies – In patients with secondary or tertiary hypothyroidism, additional hypothalamic/pituitary hormone deficiencies should be considered, and, if diagnosed, treated (see PRECAUTIONS, Autoimmune polyglandular syndrome) for adrenal insufficiency.

Autoimmune polyglandular syndrome – Occasionally, chronic autoimmune thyroiditis may occur in association with other autoimmune disorders such as adrenal insufficiency, pernicious anemia, and insulin-dependent diabetes mellitus. Patients with concomitant adrenal insufficiency should be treated with replacement glucocorticoids prior to initiation of treatment with levothyroxine sodium. Failure to do so may precipitate an acute adrenal crisis when thyroid hormone therapy is initiated, due to increased metabolic clearance of glucocorticoids by thyroid hormone. Patients with diabetes mellitus may require upward adjustments of their antidiabetic therapeutic regimens when treated with levothyroxine (see PRECAUTIONS, Drug Interactions).

Other associated medical conditions Infants with congenital hypothyroidism appear to be at increased risk for other congenital anomalies, with cardiovascular anomalies (pulmonary stenosis, atrial septal defect, and ventricular septal defect,) being the most common association.

Drug Interactions Many drugs affect thyroid hormone pharmacokinetics and metabolism (e.g., absorption, synthesis, secretion, catabolism, protein binding, and target tissue response) and may alter the therapeutic response to LEVOXYL®. In addition, thyroid hormones and thyroid status have varied effects on the pharmacokinetics and action of other drugs. A listing of drug-thyroidal axis interactions is contained in Table 2.

The list of drug-thyroidal axis interactions in Table 2 may not be comprehensive due to the introduction of new drugs that interact with the thyroidal axis or the discovery of previously unknown interactions. The prescriber should be aware of this fact and should consult appropriate reference sources. (e.g., package inserts of newly approved drugs, medical literature) for additional information if a drug-drug interaction with levothyroxine is suspected.

Table 2: Drug-Thyroidal Axis Interactions Drug or Drug Class Effect Drugs that may reduce TSH secretion – the reduction is not sustained; therefore, hypothyroidism does not occur Dopamine / Dopamine Agonists Use of these agents may result in a transient reduction in TSH secretion when administered at Glucocorticoids the following doses: Dopamine (> 1 mcg/kg/min); Glucocorticoids (hydrocortisone > 100 mg/day Octreotide or equivalent); Octreotide (> 100 mcg/day).

Drugs that alter thyroid hormone secretion Drugs that may decrease thyroid hormone secretion, which may result in hypothyroidism Aminoglutethimide Long-term lithium therapy can result in goiter in up to 50% of patients, and either subclinical or Amiodarone overt hypothyroidism, each in up to 20% of patients. The fetus, neonate, elderly and euthyroid Iodide (including iodine-containing patients with underlying thyroid disease (e.g., Hashimoto’s thyroiditis or with Grave’s disease Radiographic contrast agents) previously treated with radioiodine or surgery) are among those individuals who are particularly Lithium susceptible to iodine-induced hypothyroidism. Oral cholecystographic agents and amiodarone are Methimazole slowly excreted, producing more prolonged hypothyroidism than parenterally administered Propylthiouracil (PTU) iodinated contrast agents.

Sulfonamides Long-term aminoglutethimide therapy may minmally decrease T4 and T3 levels and increase TSH, Tolbutamide although all values remain within normal limits in most patients.

Drugs that may increase thyroid hormone secretion, which may result in hyperthyroidism Amiodarone Iodide and drugs that contain pharmacologic amounts of iodide may cause in euthyroid patients Iodide (including iodine-containing with Grave’s disease previously treated with antithyroid drugs or in euthyroid patients with thyroid Radiographic contrast agents) autonomy (e.g., multinodular goiter or hyperfunctioning thyroid adenoma). Hyperthyroidism may develop over several weeks and may persist for several months after therapy discontinuation.

Amiodarone may induce hyperthyroidism by causing thyroiditis.

Drugs that may decrease T4 absorption, which may result in hypothyroidism Antacids Concurrent use may reduce the efficacy of levothyroxine by binding and delaying or preventing - Aluminum & Magnesium Hydroxides absorption, potentially resulting in hypothyroidism. Calcium carbonate may form an insoluble - Simethicone chelate with levothyroxine, and ferrous sulfate likely forms a ferric-thyroxine complex. Administer Bile Acid Sequestrants levothyroxine at least 4 hours apart from these agents.

- Cholestyramine - Colestipol Calcium Carbonate Cation Exchange Resins - Kayexalate Ferrous Sulfate Sucralfate Drugs that may alter T4 and T3 serum transport – but FT4 concentration remains normal; and, therefore, the patient remains euthyroid Drugs that may increase Drugs that may decrease serum TBG concentration serum TBG concentration Clofibrate Androgens / Anabolic Steroids Estrogen-containing oral contraceptives Asparaginase Estrogens (oral) Glucocorticoids Heroin / Methadone Slow-Release Nicotinic Acid 5-Fluorouracil Mitotane Tamoxifen Drugs that may cause protein-binding site displacement Furosemide (> 80 mg IV) Administration of these agents with levothyroxine results in an initial transient increase in FT4.

Heparin Continued administration results in a decrease in serum T4 and normal FT4 and TSH Hydantoins concentrations and, therefore, patients are clinically euthyroid. Salicylates inhibit binding of T4 and Non Steroidal T3 to TBG and transthyretin. An initial increase in serum FT4 is followed by return of FT4 to Anti-Inflammatory Drugs normal levels with sustained therapeutic serum salicylate concentrations, although total-T4 levels - Fenamates may decrease by as much as 30%.

- Phenylbutazone Salicylates (> 2 g/day) Drugs that may alter T4 and T3 metabolism Drugs that may increase hepatic metabolism, which may result in hypothyroidism Carbamazepine Stimulation of hepatic microsomal drug-metabolizing enzyme activity may cause increased hepatic Hydantoins degradation of levothyroxine, resulting in increased levothyroxine requirements. Phenytoin and Phenobarbital carbamazepine reduce serum protein binding of levothyroxine, and total- and free-T4 may be Rifampin reduced by 20% to 40%, but most patients have normal serum TSH levels and are clinically euthyroid.

Drugs that may decrease T4 5’-deiodinase activity Amiodarone Administration of these enzyme inhibitors decreases the peripheral conversion of T4 to T3, leading Beta-adrenergic antagonists to decreased T3 levels. However, serum T4 levels are usually normal but occasionally be slightly - (e.g., Propranolol > 160 mg/day) increased. In patients treated with may large doses of propranolol (> 160 mg/day), T3 and T4 Glucocorticoids levels change slightly, TSH levels remain normal, and patients are clinically euthyroid. It should be - (e.g., Dexamethasone > 4 mg/day) noted that actions of particular beta-adrenergic antagonists may be impaired when the hypothyroid Propylthiouracil (PTU) patient is converted to the euthyroid state. Short-term administration of large doses of glucocorti-

Anticoagulants (oral) - Coumarin Derivatives - Indandione Derivatives

Antidepressants - Tricyclics (e.g., Amitriptyline) - Tetracyclics (e.g., Maprotiline) - Selective Serotonin Reuptake Inhibitors (SSRIs; e.g., Sertraline) Antidiabetic Agents - Biguanides - Meglitinides - Sulfonylureas - Thiazolidediones - Insulin Cardiac Glycosides Cytokines - Interferon-α - Interleukin-2

Growth Hormones - Somatrem - Somatropin Ketamine Methylxanthine Bronchodilators - (e.g., Theophylline) Radiographic Agents Sympathomimetics

Chloral Hydrate Diazepam Ethionamide Lovastatin Metoclopramide 6-Mercaptopurine Nitroprusside Para-aminosalicylate sodium Perphenazine Resorcinol (excessive topical use) Thiazide Diuretics

Addition of levothyroxine to antidiabetic or insulin therapy may result in increased antidiabetic agent or insulin requirements Careful monitoring of diabetic control is recommended, especially when thyroid therapy is started, changed, or discontinued.

Serum digitalis glycoside levels may be reduced in hyperthyroidism or when the hypothyroid patient is converted to the euthyroid state. Therapeutic effect of digitalis glycosides may be reduced.

Therapy with interferon-α has been associated with the development of antithyroid microsomal antibodies in 20% of patients and some have transient hypothyroidism, hyperthyroidism, or both.

Patients who have antithyroid antibodies before treatment are at higher risk for thyroid dysfunction during treament. Interleukin-2 has been associated with transient painless thyroiditis in 20% of patients. Interferon-β and -γ have not been reported to cause thyroid dysfunction.

Excessive use of thyroid hormones with growth hormones accelerate epiphyseal closure. However, untreated hypothyroidism may interfere with growth response to growth hormone.

Concurrent use may produce marked hypertension and tachycardia; cautious administration to patients receiving thyroid hormone therapy is recommended.

Decreased theophylline clearance may occur in hypothyroid patients; clearance returns to normal when the euthyroid state is achieved.

Thyroid hormones may reduce the uptake of 123I, 131I, and 99mTc. Concurrent use may increase the effects of sympathomimetics or thyroid hormone. Thyroid hormones may increase the risk of coronary insufficiency when sympathomimetic agents are administered to patients with coronary artery disease.

These agents have been associated with thyroid hormone and / or TSH level alterations by various mechanisms.

Oral anticoagulants – Levothyroxine increases the response to oral anticoagulant therapy. Therefore, a decrease in the dose of anticoagulant may be warranted with correction of the hypothyroid state or when the LEVOXYL® dose is increased. Prothrombin time should be closely monitored to permit appropriate and timely dosage adjustments (see Table 2).

Digitalis glycosides – The therapeutic effects of digitalis glycosides may be reduced by levothyroxine. Serum digitalis glycoside levels may be decreased when a hypothyroid patient becomes euthyroid, necessitating an increase in the dose of digitalis glycosides (see Table 2).

Drug-Food Interactions – Consumption of certain foods may affect levothyroxine absorption thereby necessitating adjustments in dosing.

Soybean flour (infant formula), cotton seed meal, walnuts, and dietary fiber may bind and decrease the absorption of levothyroxine sodium from the GI tract.

Drug-Laboratory Test Interactions – Changes in TBG concentration must be considered when interpreting T4 and T3 values, which necessitates measurement and evaluation of unbound (free) hormone and/or determination of the free T4 index (FT4I). Pregnancy, infectious hepatitis, estrogens, estrogen-containing oral contraceptives, and acute intermittent porphyria increase TBG concentrations. Decreases in TBG concentrations are observed in nephrosis, severe hypoproteinemia, severe liver disease, acromegaly, and after androgen or corticosteroid therapy (see also Table 2).

Familial hyper- or hypo-thyroxine binding globulinemias have been described, with the incidence of TBG deficiency approximating 1 in 9000.

Carcinogenesis, Mutagenesis, and Impairment of Fertility – Animal studies have not been performed to evaluate the carcinogenic potential, mutagenic potential or effects on fertility of levothyroxine. The synthetic T4 in LEVOXYL® is identical to that produced naturally by the human thyroid gland. Although there has been a reported association between prolonged thyroid hormone therapy and breast cancer, this has not been confirmed. Patients receiving LEVOXYL® for appropriate clinical indications should be titrated to the lowest effective replacement dose.

Pregnancy – Category A – Studies in women taking levothyroxine sodium during pregnancy have not shown an increased risk of congenital abnormalities. Therefore, the possibility of fetal harm appears remote. LEVOXYL® should not be discontinued during pregnancy and hypothyroidism diagnosed during pregnancy should be promptly treated.

Hypothyroidism during pregnancy is associated with a higher rate of complications, including spontaneous abortion, pre-eclampsia, stillbirth and premature delivery. Maternal hypothyroidism may have an adverse effect on fetal and childhood growth and development. During pregnancy, serum T4 levels may decrease and serum TSH levels increase to values outside the normal range. Since elevations in serum TSH may occur as early as 4 weeks gestation, pregnant women taking LEVOXYL® should have their TSH measured during each trimester. An elevated serum TSH level should be corrected by an increase in the dose of LEVOXYL®. Since postpartum TSH levels are similar to preconception values, the LEVOXYL® dosage should return to the pre-pregnancy dose immediately after delivery. A serum TSH level should be obtained 6–8 weeks postpartum.

Thyroid hormones do not readily cross the placental barrier; however, some transfer does occur as evidenced by levels in cord blood of athyreotic fetuses being approximately one-third maternal levels. Transfer of thyroid hormone from the mother to the fetus, however, may not be adequate to prevent in utero hypothyroidism.

Nursing Mothers – Although thyroid hormones are excreted only minimally in human milk, caution should be exercised when LEVOXYL® is administered to a nursing woman. However, adequate replacement doses of levothyroxine are generally needed to maintain normal lactation.

ADVERSE REACTIONS Adverse reactions associated with levothyroxine therapy are primarily those of hyperthyroidism due to therapeutic overdosage. They include the following: General: fatigue, increased appetite, weight loss, heat intolerance, fever, excessive sweating; Central nervous system: headache, hyperactivity, nervousness, anxiety, irritability, emotional lability, insomnia; Musculoskeletal: tremors, muscle weakness; Cardiac: palpitations, tachycardia, arrhythmias, increased pulse and blood pressure, heart failure, angina, myocardial infarction, cardiac arrest; Pulmonary: dyspnea; GI: diarrhea, vomiting, abdominal cramps; Dermatologic: hair loss, flushing; Reproductive: menstrual irregularities, impaired fertility.

Pseudotumor cerebri and slipped capital femoral epiphysis have been reported in children receiving levothyroxine therapy. Overtreatment may result in craniosynostosis in infants and premature closure of the epiphyses in children with resultant compromised adult height.

Seizures have been reported rarely with the institution of levothyroxine therapy.

Inadequate levothyroxine dosage will produce or fail to ameliorate the signs and symptoms of hypothyroidism.

Hypersensitivity reactions to inactive ingredients have occurred in patients treated with thyroid hormone products. These include urticaria, pruritus, skin rash, flushing, angioedema, various GI symptoms (abdominal pain, nausea, vomiting and diarrhea), fever, arthralgia, serum sickness and wheezing. Hypersensitivity to levothyroxine itself is not known to occur.

OVERDOSAGE The signs and symptoms of overdosage are those of hyperthyroidism (see PRECAUTIONS and ADVERSE REACTIONS). In addition, confusion and disorientation may occur. Cerebral embolism, shock, coma, and death have been reported. Seizures have occurred in a child ingesting approximately 20 mg of levothyroxine. Symptoms may not necessarily be evident or may not appear until several days after ingestion of levothyroxine sodium.

Acute Massive Overdosage – This may be a life-threatening emergency, therefore, symptomatic and supportive therapy should be instituted immediately. If not contraindicated (e.g., by seizures, coma, or loss of the gag reflex), the stomach should be emptied by emesis or gastric lavage to decrease gastrointestinal absorption. Activated charcoal or cholestyramine may also be used to decrease absorption. Central and peripheral increased sympathetic activity may be treated by administering β-receptor antagonists, e.g., propranolol (1 to 3 mg intravenously over a 10-minute period, or orally, 80 to 160 mg/day). Provide respiratory support as needed; control congestive heart failure; control fever, hypoglycemia, and fluid loss as necessary. Glucocorticoids may be given to inhibit the conversion of T4 to T3. Because T4 is highly protein bound, very little drug will be removed by dialysis.

MANUFACTURER JONES PHARMA INCORPORATED (A wholly owned subsidiary of King Pharmaceuticals, Inc.) St. Louis, MO 63146 Revised December 2001

Wholly Owned Subsidiaries of King Pharmaceuticals™, Inc.

Publication 1-2015-1 © 2003 King Pharmaceuticals, Inc., 501 Fifth Street, Bristol, TN 37620. All rights reserved. LEVOXYL is a registered trademark of Jones Pharma Incorporated. Monarch Pharmaceuticals®, Inc. and Jones Pharma™ are wholly owned subsidiaries of King Pharmaceuticals Inc. For more information call 1-866-LEVOXYL or visit us at www.LEVOXYL.com.

Internet Web site:

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CONTRAINDICATIONS Levothyroxine is contraindicated in patients with untreated subclinical (suppressed serum TSH level with normal T3 and T4 levels) or overt thyrotoxicosis of any etiology and in patients with acute myocardial infarction. Levothyroxine is contraindicated in patients with uncorrected adrenal insufficiency since thyroid hormones may precipitate an acute adrenal crisis by increasing the metabolic clearance of glucocorticoids (see PRECAUTIONS). LEVOXYL® is contraindicated in patients with hypersensitivity to any of the inactive ingredients in LEVOXYL® tablets. (see DESCRIPTION, INACTIVE INGREDIENTS.)

coids may decrease serum T3 concentrations by 30% with minimal change in serum T4 levels.

However, long-term glucocorticoid therapy may result in slightly decreased T3 and T4 levels due to decreased TBG production (see above).

Miscellaneous Thyroid hormones appear to increase the catabolism of vitamin K-dependent clotting factors, thereby increasing the anticoagulant activity of oral anticoagulants. Concomitant use of these agents impairs the compensatory increases in clotting factor synthesis. Prothrombin time should be carefully monitored in patients taking levothyroxine and oral anticoagulants and the dose of anticoagulant therapy adjusted accordingly.

Concurrent use of tri/tetracyclic antidepressants and levothyroxine may increase the therapeutic and toxic effects of both drugs, possibly due to increased receptor sensitivity to catecholamines.

Toxic effects may include increased risk of cardiac arrhythmias and CNS stimulation; onset of action of tricyclics may be accelerated. Administration of sertraline in patients stabilized on levothyroxine may result in increased levothyroxine requirements.

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