February
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Lucius M. Lampton, MD EDITOR D. Stanley Hartness, MD Michael O’Dell, MD ASSOCIATE EDITORS Karen A. Evers MANAGING EDITOR PUBLICATIONS COMMITTEE Dwalia S. South, MD Chair Philip T. Merideth, MD, JD Martin M. Pomphrey, MD Leslie E. England, MD, Ex-Officio Myron W. Lockey, MD, Ex-Officio and the Editors THE ASSOCIATION Randy Easterling, MD President Tim J. Alford, MD President-Elect J. Clay Hays, Jr., MD Secretary-Treasurer Lee Giffin, MD Speaker Geri Lee Weiland, MD Vice Speaker Charmain Kanosky Executive Director JOURNAL OF THE MISSISSIPPI STATE MEDICAL ASSOCIATION (ISSN 0026-6396) is owned and published monthly by the Mississippi State Medical Association, founded 1856, located at 408 West Parkway Place, Ridgeland, Mississippi 39158-2548. (ISSN# 0026-6396 as mandated by section E211.10, Domestic Mail Manual). Periodicals postage paid at Jackson, MS and at additional mailing offices. CORRESPONDENCE: JOURNAL MSMA, Managing Editor, Karen A. Evers, P.O. Box 2548, Ridgeland, MS 39158-2548, ph.: (601) 853-6733, FAX (601)853-6746, www.MSMAonline.com. SUBSCRIPTION RATE: $83.00 per annum; $96.00 per annum for foreign subscriptions; $7.00 per copy, $10.00 per foreign copy, as available. ADVERTISING RATES: furnished on request. Cristen Hemmins, Hemmins Hall, Inc. Advertising, P.O. Box 1112, Oxford, Mississippi 38655, Ph: (662) 236-1700, Fax: (662) 236-7011, email: cristenh@watervalley.net POSTMASTER: send address changes to Journal of the Mississippi State Medical Association, P.O. Box 2548, Ridgeland, MS 391582548. The views expressed in this publication reflect the opinions of the authors and do not necessarily state the opinions or policies of the Mississippi State Medical Association. Copyright© 2010, Mississippi State Medical Association.
FEBRUARY 2010
VOLUME 51
NUMBER 2
SCIENTIFIC ARTICLES Recurrent, Transformed Non-Hodgkin’s Lymphoma Presenting as Chiasmal Syndrome with Hyperprolactinemia and Hypopituitarism
PRESIDENT’S PAGE Be Careful What We Ask for, We Might Get It
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Randy Easterling, MD; MSMA President
EDITORIALS Dignity
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Michael O’Dell, MD; Associate Editor
Will Politicians Ever Change?
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Myron W. Lockey, MD; Editor Emeritus
RELATED ORGANIZATIONS Mississippi State Medical Association Mississippi State Department of Health University of Mississippi Medical Center
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DEPARTMENTS New Members Deaths Personals Physicians’ Bookshelf Numbers Count Information for Authors Una Voce Placement/Classified
43 45 46 54 56 61 63 64
ABOUT THE COVER: “UPPSALA CATHEDRAL” - Artist John J. Jackson, MD painted this original oil on canvas of the Uppsala Cathedral in 1962 while performing a medical genetics fellowship at the Institute for Medical Genetics at the University of Uppsala, Sweden. The Uppsala Cathedral was begun in 1287 A.D. The dome to one side sits atop the administration building of the University and was constructed by a Swedish anatomist, Olaus Rudbeck, for anatomical demonstrations. Rudbeck was one of the pioneers in the study of lymphatic vessels. According to his supporters in Sweden, he was the first to discover the lymphatic system and is documented as having shown his findings at the court of Queen Christina of Sweden in the spring of 1652. However, he did not publish anything about it until the fall of 1653, after Danish scientist Thomas Bartholin had published a description of a similar discovery of his own. Rudbeck's research led to the Queen's support of his career. To facilitate his studies of human anatomy, he had a cupola built on top of Gustavianum, a university edifice, and in it was built an arena-like Theatrum anatomicum, where dissection could be carried out in front of students. The cupola still remains and is a landmark in Uppsala. The "Gustavianum" stands in front of the cathedral and is still part of the university. Dr. Jackson taught Medical Genetics and Internal Medicine for 30 years at the University of Mississippi Medical Center and retired in 1992 as chairman of the Department of Preventive Medicine.❒ February
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Official Publication of the MSMA Since 1959
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Ashley Sumrall, MD and Vince Herrin, MD
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• SCIENTIFIC ARTICLES •
Recurrent, Transformed Non-Hodgkin’s Lymphoma Presenting as Chiasmal Syndrome with Hyperprolactinemia and Hypopituitarism Ashley Sumrall, MD and Vince Herrin, MD
A
CASE REPORT
BSTRACT
A 69-year-old white female with past medical history of follicular cell lymphoma presented to her local physician with new neurological findings. She was subsequently diagnosed with a pituitary lesion comprised of diffuse large B cell lymphoma. Non-Hodgkin's lymphoma (NHL) affecting the pituitary uncommonly appears as metastatic disease from a concurrent systemic lymphoma. This case represents the first case of recurrent, transformed NHL as chiasmal syndrome with hyperprolactinemia and hypopituitarism in the American medical literature.
KEY WORDS:
CHIASMAL SYNDROME, PITUITARY LYMPHOMA, HYPOPITUITARISM, NON-HODGKINS' LYMPHOMA, DIFFUSE LARGE B CELL LYMPHOMA
INTRODUCTION Non-Hodgkin’s Lymphoma (NHL) is a group of disorders comprised of malignant proliferation of lymphocytes. Within this group, both low and high grade variants are seen. Because this group of disorders affects lymphocytes, it may affect any organ of the body.1, 2 Follicular lymphoma, a low grade lymphoma, transforms to more aggressive large cell lymphoma in up to 60% of cases. A new clone of cells emerges, losing the previous follicular architecture and becoming more difficult to treat. Multiple genetic abnormalities have been described, but there are no methods to prevent this transformation yet.1, 2 AUTHOR INFORMATION: Dr. Sumrall is a third-year fellow in Hematology and Oncology at the University of Mississippi Medical Center. Dr. Herrin is Associate Professor of Hematology and Oncology at the University of Mississippi Medical Center. He is also Program Director for the Internal Medicine Residency Program at the University of Mississippi Medical Center. CORRESPONDING AUTHOR: Ashley Sumrall, MD, University of Mississippi Medical Center Department of Hematology, 2500 N. State St. Jackson, MS 39216.
A 69-year-old white female with past medical history of follicular cell lymphoma presented to her local physician with new complaints of vision loss, nausea, and headaches in November 2007. Evaluation by her ophthalmologist yielded visual acuity of 20/100 in the right eye, 20/80 in the left eye, elevated intracranial pressure, and bitemporal inferior quadrantanopia. MRI of the brain revealed an enhancing mass in the sella, extending into the suprasellar cistern and compressing the optic chiasm (figure 1). The lesion measured 2.1 cm x 2.8 cm in maximum diameter. Serological evaluation for activity of the tumor yielded: prolactin of 92.8 ng/ml (elevated), adrenocorticotropic hormone of <10 pg/ml (decreased), morning cortisol of 2.5ug/dl (decreased), follicle-stimulating hormone of 0.6 miu/ml (decreased), thyroid-stimulating hormone of <0.006 uiu/ml (decreased), insulin-like growth factor-1 of 56 ng/ml (elevated). Initially the mass was thought to be a macroadenoma or prolactinoma causing hypopituitarism. She was referred to a neurosurgeon who promptly excised the mass via transsphenoidal resection. She tolerated the operation well, but her postoperative course was complicated by postsurgical localized hemorrhage, diabetes insipidus, pulmonary embolism, hypothyroidism, clostridium difficile colitis, and acute renal failure. Pathological examination of the tumor revealed a diffuse large B cell lymphoma. On flow cytometry, the cells were positive for CD10, CD 20, CD79a, kappa, and showed light chain restriction (monoclonal). CT scans for staging revealed hepatomegaly with a hypodensity in the left lobe of the liver. Multiple hypodensities were seen throughout the spleen and both kidneys. Portacaval and perisplenic lymphadenopathy was present. Nodular thickening in the fundus of the stomach was seen also, most consistent with lymphomatous involvement. Bone marrow aspirate showed hypocellular marrow with no evidence of lymphoma. Cytogenetics were limited due to only 6 analyzed metaphases, but appeared abnormal. FEBRUARY
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At this time, review of her past medical history was completed. According to her local hematologist, she was diagnosed with B cell follicular lymphoma in April 2005. She presented for initial evaluation with right-sided neck and parotid, and left-sided submandibular lymphadenopathy. She was started on chlorambucil but subsequently developed abdominal lymphadenopathy. Four cycles of CHOP-R (cyclophosphamide, doxorubicin, vincristine, prednisone, rituximab) were given, but persistent neutropenia and pneumonia prevented additional systemic treatment. Right-sided neck lymphadenopathy recurred in June 2007, for which the patient received palliative external beam radiation. Within two weeks of her diagnosis, she was started on treatment with ProMACE- CytaBOM.3 She tolerated this cycle well and was discharged home. She returned to clinic for chemotherapy, but ultimately became too ill for treatment. Hospice care was initiated, and the patient died shortly thereafter.
Symptoms of hypopituitarism are vague and include: fatigue, muscle weakness, nausea, constipation, weight loss or gain, decreased appetite, headache, or temperature sensitivity. Hyperprolactinemia may produce vision changes, headaches, galactorrhea, irregular menstrual cycles or infertility in premenopausal women, and sexual dysfunction in men.
DISCUSSION
2.
Background Because pituitary adenomas are the most common sellar masses, this tumor was surprisingly lymphomatous. Sellar masses may include craniopharyngioma, arachnoid cysts, epidermoid cysts, chordomas, germ cell tumors, meningiomas, aneurysms, infections or abscesses, sarcoidosis, and lymphocytic hypophysitis.4 Non-Hodgkin’s lymphoma (NHL) affecting the pituitary occurs as a primary CNS tumor or, less commonly, as spread from a concurrent systemic lymphoma. This is usually observed in immunocompromised patients such as those with HIV. Once felt to be an extremely rare condition, several cases of pituitary lymphoma in immunocompetent patients have been reported in the last few years. It is suggested that up to one-third of NHL patients may develop CNS involvement with lymphoma.4-7 A search of the English language medical literature identifies several series of pituitary lymphoma patients. An autopsy series including 165 patients who died from hematological malignancies found pituitary lymphoma in 38 cases. No documented cases of hypopituitarism were seen in this population. In a series of 1120 patients with sellar masses, only one case of pituitary lymphoma was identified. The total number of pituitary lymphoma cases in the English language literature approaches 30. Of those, 15 cases of secondary sellar lesions are present, of which 12 were NHL. This case represents the first case of recurrent, transformed NHL as chiasmal syndrome with hyperprolactinemia and hypopituitarism in the American medical literature.4
3.
Signs and symptoms Vision is frequently affected in these patients. Varying degrees of optic chiasm involvement have been described such as: bitemporal hemianopsia, diplopia, and total blindness. These findings may result from pituitary compression of the chiasm or from direct involvement of the optic nerve as the tumor spreads. Additional cranial nerve involvements due to extension of the pituitary lymphoma into the cavernous sinus have also been reported. Up to one-fourth of reported patients with pituitary lymphoma have impairment of cranial nerves II, III, IV, and VI.4
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Histopathology The most commonly reported histology affecting the pituitary is large B cell NHL. Involvement of the anterior pituitary is usually seen. Patients with NHL of pituitary origin reportedly have a better prognosis than those with pituitary metastases.5
REFERENCES 1.
4.
5.
6.
7.
Lossos IS, Alizadeh AA, Diehn M, et al. Transformation of follicular lymphoma to diffuse large-cell lymphoma: Alternative patterns with increased or decreased expression of c-myc and its regulated genes. Proc Natl Acad Sci U S A. 2002;99(13):8886–8891. Hillman R, Ault K, and Rinder H. Hematology in Clinical Practice. 4th ed. New York, NY: McGraw-Hill Co; 2005:277-279. Fisher R, Gaynor E, Dahlberg S, et al. A phase III comparison of CHOP vs. m-BACOD vs. ProMACE-CytaBOM vs. MACOP-B in patients with intermediate- or high-grade non-Hodgkin's lymphoma: results of SWOG-8516 (Intergroup 0067), the National High-Priority Lymphoma Study. Ann Oncol. 1994;5(1) (Suppl):S291-S295. Buchler T, Ferral C, Virgili N, et al. A relapsed non-Hodgkin lymphoma presenting as panhypopituitarism successfully treated by chemotherapy. Journal of Neuro-Oncology. 2002;59(1):35–38. Giustina A, Gola M, Doga M, et al. Primary lymphoma of the pituitary: an emerging clinical entity. J Clin Endocrinol Metab. 2001;86(10):45674575. Megan Ogilvie C, Payne S, Evanson J, et al. Lymphoma metastasizing to the pituitary: an unusual presentation of a treatable disease. Pituitary. 2005;8:139-46. Mathiasen R, Jarrahy R, Cha S, et al. Pituitary lymphoma: a case report and literature review. Pituitary. 2000;4:283-287.
Mark Your Calendar! The 142nd Annual Session of the MSMA House of Delegates and Medical Affairs Forum 2010 will be held
June 3-6, 2010 in Natchez.
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• MSMA •
June 3-6, 2010 in Natchez 142nd Annual Session of the MSMA House of Delegates atchez is the place to be June 3- 6, 2010 for the 142nd Annual Session of the MSMA House of Delegates June 3-6, 2010 at the Grand Hotel in Natchez and the Natchez Convention Center. The 2010 Medical Affairs Forum will feature eight hours of Continuing Medical Education credit on current topics to interest physicians in all specialties. Medical Assurance Company of Mississippi (MACM) is planning a Thursday afternoon golf tournament that’s sure to get you going green. Special efforts are underway for fun family and kids activities so plan to bring the whole family. Historical cemetery tours are sure to creep you out and a county fair will feature a dunk-the-president booth and pie toss that even the adults will love! The MSMA Alliance is planning a Friday night fundraiser for medical school scholarships that will feature paintings, pottery, jewelry and other fine arts by physicians and their
N
family members. Be sure to contribute your own work of art to this worthy cause. Then enjoy the display and silent auction showcasing the many artistic talents of the Mississippi medical community. Mark your calendars now and be sure to save the dates June 3 thru 6, 2010 for the 142nd Annual Session of the MSMA House of Delegates. The Saturday night Gala Dinner Dance will feature the official inauguration of MSMA’s 143rd President Dr. Tim J. Alford of Kosciusko. Dr. Alford will be sworn and present his inaugural address at the Gala. Then it’s dinner and dancing in the ballroom at the Natchez Convention Center overlooking the bluffs of the Mississippi River. The House of Delegates will convene on Friday, June 4th for policy talks and Sunday, June 6, 2010 to elect officers and mark the course for the coming year. Save the date. June 3-6, 2010 Natchez Grand Hotel Natchez Convention Center FEBRUARY
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CALL FOR ENTRIES
Seeking Nominations for the 2010 MSMA Award for Community Service The Annual Physician Award for Community Service, sponsored by Mississippi State Medical Association, is designed to provide recognition to members of the association who are actively engaged in the practice of medicine, for the many and varied services above and beyond the call of duty which they render to their respective communities.
Each recipient of the award is nominated by his or her component society and selection is made by the members of the Council on Public Information. The intent of the program is to honor only living persons, and to honor no person more than once. Presentation is made at the annual meeting of the association’s House of Delegates. Every society has many members worthy of this distinguished award. It is your society’s responsibility to see that they are nominated. A nomination form is avaiable on the MSMA Web site. All nominations should be submitted to the Mississippi State Medical Association by May 1, 2010.
The award is a handsome plaque which features a cast bronze medallion. The medallion’s design symbolizes the close relationship between medicine and the community. A $500 contribution is also made by the association to a civic organization designated by the award recipient.
Nominations should be submitted in writing. Since the award is for outstanding community service it is important that all accomplishments of the nominee in this regard be presented in detail. The Council on Public Information encourages you to seek the assistance of your local MSMA Alliance in preparing the written nomination and supporting materials.
Nomination supporting documents may include all or some of the following: a narrative about the person and his community involvement, newspaper clippings, letters of support from community leaders, newspaper or magazine articles written about the person, photographs and other materials that show the physician’s community involvement.
Nominations should be sent to MSMA, P.O. Box 2548, Ridgeland, MS 39158-2548, as soon as possible, but no later than May 1, 2010. For further information contact: Karen Evers, Director of Communications, (601) 853-6733 or 1-800-898-0251, or KEvers@MSMAonline.com.
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• NEW MEMBERS • AFZAL, SYED M., Brandon; Born 4/10/1962 Pakistan; Graduated MD Dow Medical College, University of Karachi, Pakistan 1987; Specialty: Family Practice; MS Family Doctors.
DILLARD, BENJAMIN, Jackson; Born 8/5/1971 Tupelo, MS; Graduated MD University MS School of Medicine, Jackson 1997; Specialty: Pediatric Emergency Medicine; University Physicians, PA.
ALBERS, TIMOTHY A., Tupelo; Born 11/14/1964 Poplar Bluff, MO; Graduated MD University of Missouri School of Medicine, Kansas City 1990; Specialty: Internal Medicine; North MS Medical Center Inc. d/b/a Med Serve.
DUNN, THOMAS J., Columbus; Born 1/1/1972; Graduated DO University of Health Sciences - College of Osteopathic Medicine, Kansas City 1999; Specialty: Nephrology; Nephrology Associates, PC.
ARNOLD, TIMOTHY L., Laurel; Born 2/14/1951 Newark, NJ; Graduated DO University of Medicine & Denistry of New Jersey, New Jersey 1997; Specialty: Psychiatry; Arnold Psychiatry Center, LLC. ASHER, FREDERICK, Jackson; Born 2/20/1975 Gulfport, MS; Graduated MD University of MS School of Medicine, Jackson 2002; Specialty: Internal Medicine; University Physicians, PA. BORGANELLI, SANTO, Jackson; Born 6/14/1958; Graduated MD University of Texas Southwestern Medical School, Dallas 1984; Specialty: Cardiovascular Disease. BRIEN, G. ANTHONY, Flowood; Born 12/7/1974; Graduated MD University of MS School of Medicine, Jackson 2003; Specialty: Orthopaedic Surgery; Capital Orthopaedic and Sports Medicine Center. BROWN, JULIAN ARTHUR, Aberdeen; Born 8/8/1955; Graduated MD University MS School of Medicine, Jackson 1982; Specialty: Forensic Medicine; Family Medical Clinic. CAIN, GEORGE L., Corinth; Born 1/22/1957; Graduated MD University MS School of Medicine, Jackson 1986; Specialty: Family Practice.
FREEMAN, TIJUANA L., Biloxi; Born 12/21/1968; Little Rock, AK; Graduated MD University of Arkansas School of Medicine, Little Rock 1995; Specialty: Pediatrics; Gulf Coast Children's Clinic. GUILD, CAMERON, Jackson; Born 1/16/1974 Jackson, MS; Graduated MD University MS School of Medicine, Jackson 1999; Specialty: Cardiovascular Disease; University Physicians, PA. HANNA, SHAHIRA, Biloxi; Born 9/1/1959 Cairo Egypt; Graduated MD University of Pennsylvania School of Medicine, Philadelphia 1985; Specialty: Obstetrics & Gynecology; Woman's Clinic, PA. HENSON, TERRI H., Southaven; Born 11/27/1960 Memphis, TN; Graduated MD University of Tennessee College Medicine, Memphis 1993; Specialty: Dermatology. HOLLAND, DANIEL, Hattiesburg; Born Leland, IA; Graduated MD University MS School of Medicine, Jackson 1983; Specialty: Emergency Medicine. HOLLIS, LEANNA LINDSEY, Tupelo; Born 4/29/1955 Starkville, MS; Graduated MD University MS School of Medicine, Jackson 1986; Specialty: Internal Medicine; The Wound Healing Center.
COLE, THOMAS P., Hattiesburg; Born 3/22/1973 Poplarville, MS; Graduated MD University MS School of Medicine, Jackson 1999; Specialty: Radiology; Hattiesburg Radiology Group, PLLC.
JEFFERSON, GINA D., Jackson; Born 4/20/1972 Cleveland, Ohio; Graduated MD Case Western Reserve University School of Medicine, Cleveland 2000; Specialty: Otolaryngology; University Physicians, PA Otolaryngology.
CORNELIUS, KIMBERLY D., Clinton; Born 1/3/1978 Jackson, MS; Graduated MD University MS School of Medicine, Jackson 2005; Specialty: Family Practice; Baptist Health Systems.
JONES, JOHN H., Indianola; Born 3/8/1975 Hattiesburg, MS; Graduated MD University MS School of Medicine, Jackson 2003; Specialty: Family Practice; Indianola Family Medical Group.
COX, ROBERT D., Jackson; Born 11/20/1954, Chicago, IL; Graduated MD University of Texas Southwestern Medical School, Dallas 1985; Specialty: Emergency Medicine.
JONES, KEITH O., Jackson; Born 5/17/1976; Graduated MD University MS School of Medicine, Jackson 2004; Specialty: Neurology; Baptist Neurological Associates.
CRIGLER, LAKISHA A., Clarksdale; Born 2/26/1977 Ruleville, MS; Graduated MD Meharry Medical College of Medicine, Nashville 2005; Specialty: Obstetrics & Gynecology; The Woman's Clinic.
JONES, OSCAR BARRETT, Laurel; Born 1/25/1977 Vicksburg, MS; Graduated MD University MS School of Medicine, Jackson 2004, Jackson; Specialty: Family Practice.
CROSBY, ROBERT L., McComb; Born 4/8/1954; Graduated MD University MS School of Medicine, Jackson 1985; Specialty: Pulmonary Disease; Southwest Pulmonary Medicine.
KATZ, HOWARD T., Jackson; Born 3/8/1956 Memphis, TN; Graduated MD University of Tennessee College of Medicine, Memphis 1982; Specialty: Physical Medicine & Rehabilitation; University Physicians, PA.
DEW, JAMES, Pearl; Born 7/28/1978; Graduated MD University MS School of Medicine, Jackson 2004; Specialty: Forensic Medicine; MEA, PA. DEWS, ROBERT C., Hattiesburg; Born 1/07/1974 Hattiesburg, MS; Graduated MD University of MS School of Medicine, Jackson 2003; Specialty: Orthopaedic Surgery; Southern Bone & Joint Specialists, PA.
KENNEDY, E. JEFF, Flowood; Born 5/17/1958 Florida; Graduated MD University MS School of Medicine, Jackson 1980; Specialty: Orthopaedic Surgery; Capital Orthopaedic & Sports Medicine Center. KIRK, H. ALDEN, Oxford; Born 3/23/1976 Jackson, MS; Graduated MD University MS School of Medicine, Jackson 2002; Specialty: General Surgery; Surgery Consultants of Oxford. FEBRUARY
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LAI, MICHELLE, Lumberton; Born 4/30/1975 Vietnam; Graduated MD University of Arkansas School of Medicine, Little Rock 2003; Specialty: Internal Medicine; Southeast MS Rural Health Initiative, Inc.. LAKE, CHESTER H., Flowood; Born 7/30/1954; Graduated MD University MS School of Medicine, Jackson 1983; Specialty: Anesthesiology; Anesthesia Consultants, PA. LANDSDOWN, CHRISTOPHER E., Biloxi; Born 12/4/1976 Pensacola, FL; Graduated MD 2005; Specialty: Family Practice; North Bay Family Medical Clinic, PA. LEMYRE, MARTIN, Laurel; Born 3/28/1976, North York, Ontario, Canada; Graduated MD Saba University School of Medicine, Netherland Antilles 2006; Specialty: Internal Medicine; Jefferson Medical Associates. LEWIS, SCOTT F., Jackson; Graduated DO West Virginia School of Osteopathic Medicine, Lewisburg 2004; Specialty: Rheumatology; MS Arthritis Clinic, PLLC. LIPSON, STEPHEN DUNCAN, Biloxi; Born 2/2/1948 Boston, MA; Graduated MD University of Cincinnati College of Medicine, Cincinnati 1974; Specialty: Urology; Biloxi Bay Urology Center, PLLC. LUM, RITA, Meridian; Born 9/6/1946 Jackson, MS; Graduated MD University MS School of Medicine, Jackson 1972; Specialty: Child and Adolescent Psychiatry. MADAKASIRA, SUDHAKAR, Jackson; Born 8/13/1951 India; Graduated MD Sri Venkatesvara Medical College, Sri Venkatesvara University, Tirupa 1975; Specialty: Psychiatry; Psycamore Psychiatric Partial Program. MCGEE, ROBERT R., Clarksdale; Born 12/12/1949 Louann, AK; Graduated MD University of Tennessee College Medicine, Memphis 1946; Specialty: Internal Medicine; Region One Mental Health.
OWEN, JULIAN LEE, Madison; Born 8/10/1933 Greenville, MS; Graduated MD Vanderbilt University School of Medicine, Nashville 1958; Specialty: Pediatrics; Madison Ridgeland Children's Clinic, PA. PARKER, JOHN M., Shelby; Born 9/21/1930 Biloxi, MS; Graduated MD University MS School of Medicine, Jackson 1957; Specialty: Dermatology. PARRILLA, ZORAYA, Jackson; Graduated MD University of Puerto Rico School of Medicine, San Juan 1994; Specialty: Physical Medicine & Rehabilitation; Methodist Rehabilitation Center. PICKERING, TREVOR R., Jackson; Born 12/31/1967 Encino, CA; Graduated MD Duke Unversity School of Medicine, Durham 2002; Specialty: Orthopaedic Surgery; MS Sports Medicine & Orthopaedic Center. PIERCE, PAUL W., Vicksburg; Born 7/22/1970 Jackson, MS; Graduated MD University MS School of Medicine, Jackson 1999; Specialty: Cardiovascular Disease; River Region RHC - Vicksburg. POWELL, MARGARET O., Jackson; Born 3/26/1957; Graduated MD University MS School of Medicine, Jackson 1991; Specialty: Family Practice; Hinds Internal Medicine. PRUETT, JACK BRUCE, Gulfport; Born 3/5/1951 Gainesboro, TN; Graduated MD University of Tennessee College of Medicine, Memphis 1977; Specialty: Vascular Surgery. PULLEN, ASHLEY B., Madison; Born 10/12/1979 Greenwood, MS; Graduated MD University MS School of Medicine, Jackson 2006; Specialty: Family Practice; Medical Foundation of Central MS. RAFF, JOHN B., Gulfport; Born 7/17/1954 Chicago, IL; Graduated MD University of Michigan Medical School, Ann Arbor 1980; Specialty: Orthopaedic Surgery; Memorial Hospital Group. RAUCHER, SANJA, Jackson; Born 8/27/1965 Osijek, Croatia ; Graduated MD University of Zagreb, Croatia 1990; Specialty: Anesthesiology; Surgical Anesthesia Associates, PA.
MCINTOSH, DAVID G., Jackson; Born 10/5/1955 Fort Sill, OK; Graduated MD University of Texas Southwestern Medical School, Dallas 1980; Specialty: Obstetrics & Gynecology; University Physicians, PA.
RENO, WILLIAM L., Hattiesburg; Born 1/21/1970 Jackson, MS; Graduated MD University MS School of Medicine, Jackson 1996; Specialty: Plastic Surgery; Plastic Surgery Center of Hattiesburg.
MCVEY, EMILY S., Jackson; Born Eglin Air Force Base, FL; Graduated MD University MS School of Medicine, Jackson 1983; Specialty: Anatomic Pathology.
REYNOLDS, CHRISTOPHER, Booneville; Born 4/4/1971 Atlanta, GA; Graduated MD Mercer University School of Medicine, Georgia 1999; Specialty: Forensic Medicine; North MS Medical Clinic, INC.
MOAZZAM, NAUMAN, Tupelo; Born 2/26/1975 Pakistan; Graduated MD King Edward Medical College, Lahore Pakistan 2000; Specialty: Hemotology/Oncology; Hematology and Oncology Associates.
RHODEN, HEATHER, Ocean Springs; Born 10/11/1973 Urbana, IL; Graduated MD University of Maryland School of Medicine, Baltimore 1999; Specialty: Pediatrics; Gulf Coast Children's Clinic.
NEWMAN, FARRAH, Jackson; Born 2/22/1977 Amory, MS; Graduated MD University of MS School of Medicine, Jackson 2005; Specialty: Ophthalmology; University Physicians, PA.
RICHARDSON, LAKEISHA M., Canton; Born 1/16/1978; Graduated MD University of Tennessee College of Medicine, Memphis 2005; Specialty: Orthopaedic Surgery; Delta Regional Medical Center.
O'BRIEN, JOHN P., Natchez; Born 2/26/1935 Mobile, AL; Graduated MD New York Medical College, Valhalla 1961; Specialty: Internal Medicine.
SCHIAVI, FRANK, Pass Christian; Born 11/14/1934 New Orleans, LA; Graduated MD Louisiana State University School of Medicine, New Orleans 1962; Specialty: Orthopaedic Surgery.
OSWALT, KENNETH E., Jackson; Born 8/24/1953 Greenville, MS; Graduated MD University MS School of Medicine, Jackson 1979; Specialty: Anesthesiology; University Physicians, PA.
SHERMAN, RANDALL L., Hattiesburg; Born 6/13/1949 Tulsa, OK; Graduated MD University of Oklahoma College of Medicine, Oklahoma 1978; Specialty: Addiction Medicine; Forrest General Hospital.
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SIDDIQUE, AFSHEEN, Ocean Springs; Born 1/16/1977 Karachi, Pakistan; Graduated MD AGA Khan Medical College, Pakistan 2001; Specialty: Pediatrics; Gulf Coast Children's Clinic.
•
DEATHS
•
SIDDIQUI, OBAID A., Ocean Springs; Born 11/21/1965 Pakistan; Graduated MD 1990; Specialty: Pediatrics; Gulf Coast Children's Clinic, PA.
Bobo, William B., Clarksdale
Died October 18, 2009
Buchanon, Jr. Ben H., Tupelo
Died October 4, 2009
SLOAN, NEIL B., Corinth; Born 3/7/1949 Lookout Mountain, Ga; Graduated MD Ross University, Dominica 1989; Specialty: Internal Medicine; Easy Care Medical Clinic, PLLC.
Giles, William G., Hattiesburg
Died December 16, 2009
Graham, James C., Enterprise
Died September 2, 2009
SMITH, DENNIS EARL, Tupelo; Born 3/1/1973 Batesville, MS; Graduated DO University of Missouri School of Medicine, Kansas City 2003; Specialty: Family Practice; North MS Medical Center.
Kahlstorf, Jack H., Tupelo
Died December 12, 2009
Krestensen, James G., Natchez TAYLOR, MAX R., Tupelo; Born 9/29/1950 Jackson, MS; Graduated MD University MS School of Medicine, Jackson 1976; Specialty: Internal Medicine; IMA Foundation, Inc. THOMAS, CATHERINE A., Hattiesburg; Born 7/31/1963; Graduated MD University of South Alabama College of Medicine, Mobile 1989; Specialty: Internal Medicine; Southeast MS Rural Health Initiative, Inc.. THOMPSON, FREDA D., Jackson; Born 9/16/1975 Greenville, MS; Graduated MD Ross University School of Medicine, Dominica 2004; Specialty: Obstetrics & Gynecology; Central MS OB-GYN Assoc., PLLC. TRINCA, DOMINICK, Greenville; Born 1/21/1960 New York, NY; Graduated MD Albany Medical College of Union University, Albany 1990; Specialty: Gynecology; Dominick Trinca, MD. WALTERS, GLORIA, Jackson; Born 8/17/1955 New York, NY; Graduated MD Eastern Virginia Medical School, Norfork 2001; Specialty: Neuroanesthesia; University Physicians, PA. WILKINS, FRANCESCA A., Brandon; Born 5/30/1968 Clarksdale, MS; Graduated MD University MS School of Medicine, Jackson 2005; Specialty: Internal Medicine; Care Plus Medical Clinic-Brandon. WILLIAMS, WILLIAM T., Jackson; Born 9/23/1976 Little Rock, AR; Graduated MD University of MS School of Medicine, Jackson 2003; Specialty: Pulmonary Disease; Premier Medical Group. WINDHAM, BEVERLY, Jackson; Born 2/19/1969 Bay Springs, MS; Graduated MD University MS School of Medicine, Jackson 1996; Specialty: Internal Medicine; UMC-Dept of Internal Medicine.
Lott, Ramon C., Columbus
Died August 29, 2009 Died October 31, 2009
Moore, B. O., Amory
Died August 13, 2009
Posey, E Leonard, Jackson
Died September 5, 2009
Russell, Randy H., Oxford
Died May 15, 2009
Schmieg, Jr. Robert E., Jackson
Died October 23, 2009
Stonnington, Henry H., Wiggins
Died May 31, 2009
Stringer, Willie F., Poplarville
Died July 21, 2009
Thompson, F. Ed, Jackson
Died December 1, 2009
Tillman, Clifford, Natchez
Died November 11, 2009
Triplett, R. Faser, Jackson
Died January 28, 2010
Vice, Jr. Guy T. , Jackson
Died December 14, 2009
Werkheister, Edwin B., Madison
Died December 16, 2009
Wood, W. M., Meridian
Died September 14, 2009
[Please send MSMA member obituaries to Karen Evers, JMSMA managing editor: KEvers@MSMAonline.com.] —ED.
WYATT, JULIE, Ridgeland; Born 8/31/1979; Flowood, MS; Graduated MD University MS School of Medicine, Jackson 2005; Specialty: Dermatology; Face and Skin Center. ZANONE, MICHAEL T., Horn Lake; Born 8/15/1947 Memphis, TN; Graduated MD University of Tennessee College Medicine, Memphis 1973; Specialty: General Practice.
[If you recently paid new member dues and your name is omitted here, your membership file may be incomplete. Please send a copy of your current curriculum vitae to MSMA Membership, P.O. Box 2548, Ridgeland, MS 39158-2548 or email it to: SAshley@MSMAonline.com.] —ED. FEBRUARY
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• PERSONALS •
ALFORD
ARIAS
BEACHAM
Timothy Alford, MD, MSMA President-elect, of Kosciusko, was nominated by the Mississippi Academy of Family Physicians last year as the American Academy of Family Physicians Torch Bearer for the 2010 Olympic Torch Relay. The MAFP submitted a 200 word essay on how Dr. Alford helps others live positively by staying active and physically fit; working to make good things happen in the community; and helping the planet by recycling or donating time to a recycling program. Dr. Alford won, and he carried the Olympic Flame in Strathmore, Canada on Tuesday, January 19. Dr. Alford was chosen the winner out of 17 competing essays. He was a guest on Mississippi Public Broadcasting Radio’s “Mississippi Edition,” to discuss his participation in the Olympic Torch Relay. The show aired Wednesday, January 20. To listen to the interview go to: http://msafp.org/upload/ file366_Torch.MP3. Erich Arias, MD, has joined Purvis Family Practice Clinic. Hattiesburg Clinic welcomes Dr. Arias, who completed his medical degree at the University of Monterrey, Mexico. He completed his internship in preliminary surgery at University Medical Center, University of Nevada, in Las Vegas, Nev. He completed his residency in family medicine at Latrobe Area Hospital, Thomas Jefferson University, in Latrobe, Pennsylvania. Dr. Arias is board certified by the American Board of Family Physicians. He is a member of the American Academy of Family Medicine, AMA, and the MSMA. He joins Michael O’Neal, MD, and Sarah Tucker, CFNP, at Purvis Family Practice Clinic. Dr. Arias is available for the treatment of minor illnesses, injuries, allergic reactions, physicals, x-rays, and lab services. Purvis Family Practice Clinic is open Monday-Friday, 8 a.m. – 5 p.m. It is located at 102 Shelby Speights Drive in Purvis, phone: 601-7948065. Timothy J. Beacham, MD, MSMA Board of Trustees resident/fellow member, has been awarded one of ten Resident/Fellow AMA Foundation Leadership awards. Dr. Beacham is a resident and pain fellow in the Department of Anesthesiology at the University of Mississippi School of Medicine. The award is presented to those who have demonstrated strong non-clinical leadership skills in medicine or community affairs and have an interest in further developing these skills within organized medicine. The objective of the award program is to encourage involvement in organized medicine and continue leadership development among the country's brightest and most energetic medical students, residents, early career physicians and established physicians. The award will be presented March 1st in Washington DC at the Grand Hyatt Washington. This presentation is in conjunction with the AMA National Advocacy Conference March 1st3rd. Dr. Beacham said, “I am humbled yet honored to represent MSMA and the UMC family for this prestigious award.” Barry Berch, MD, assistant professor of surgery, and John Cross, MD, assistant professor of medicine, have joined University of
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BERCH
CROSS
DOBBS
Mississippi Medical Center. They will see patients through University Physicians, part of University of Mississippi Health Care. Dr. Berch received the B.S. magna cum laude from Millsaps College in 1996 and the M.D. magna cum laude from the University of Mississippi Medical Center in 2001. He completed an internship in general surgery in 2002, and served as junior resident in general surgery from 2002-04, senior resident in general surgery from 2005-06 and chief resident in general surgery from 2006-07 at Vanderbilt University Medical Center, where he completed a surgical research fellowship in 2005. He also served a pediatric surgery fellowship at Monroe Carell, Jr. Children's Hospital at Vanderbilt from 2007-09. Dr. Berch received the Grave's Resident Teaching Award as chief resident at Vanderbilt University Medical Center in 2007 and the Pediatric ED Consultant of the Year Award at Vanderbilt Children's Hospital in 2008. Dr. Cross, whose father, Maj. Gen. Harold Cross, is adjutant general of Mississippi, received the B.S. cum laude from Mississippi State University in 2000 and the M.D. from UMMC in 2006. He completed residency training in internal medicine at UMMC in 2009. Before attending medical school, Cross served as an electrical and computer engineer in the Department of Physiology. Donald V. Conerly, MD; Robert F. Heath, MD; Rodney N. Lovitt, MD; and Keith M. Simnicht, MD are now seeing patients at their new facility, Petal Family Practice Clinic, a service of Hattiesburg Clinic. The new 11,300 square foot facility will feature 17 exam rooms and an updated layout to better accommodate patient flow. The new location will also offer easier accessibility for patients and additional ancillary services. “The practice at Petal Family Practice Clinic has continued to grow,” said William Allen, Assistant Administrator at Hattiesburg Clinic. “We recognized a need to expand in order to accommodate new physicians. The new facility will allow us to prepare for the expanding population of Petal as well meet the needs of the current population base. As the practice continues to grow, the design of the new facility gives us the capabilities for expansion in the future.” The new facility is located at 50 Parkway Lane in Petal. Petal Family Practice Clinic is open Monday – Friday 8 a.m. – 5 p.m. The clinic also provides after hours and weekend care from 5 p.m. – 8 p.m. Monday – Friday; 9 a.m. – 5 p.m. on Saturdays; and 1 p.m. – 5 p.m. on Sundays. Appointments can be made by calling (601) 544-7404. Thomas E. Dobbs, III, MD, MPH of Laurel, has been appointed health officer for the Mississippi State Department of Health’s Southeast and Southwest public health districts 7 and 8. Dr. Dobbs holds a Doctorate of Medicine from Emory University, and a Master's in Public Health Degree from the University of Alabama at Birmingham. He is certified by the American Board of Internal Medicine as a Diplomate in Internal Medicine and Infectious Disease. Prior to joining the Department of Health, he practiced as an infectious disease physician and served as past secretary of the South Mississippi Medical Society. His professional affiliations include membership in
GRIFFIN
LIECHTY
SELLERS
the AMA, the MSMA and the Infectious Diseases Society of America, as well as serving on the Clinical Advisory Committee of the National HIVQUAL Project of the U.S. Health Resources and Services Administration. James Griffin, MD, a family physician with Wesley Medical Center, has recently completed the requirements for certification as a Diplomate of the American Board of Family Medicine. Dr. Griffin received his medical degree from Indiana University School of Medicine. He completed residencies in obstetrics and gynecology at the Medical College of Ohio in Toledo, and in family medicine at the Family Medicine Residency Program at North Mississippi Medical Center in Tupelo. In addition to AMA and MSMA membership Dr. Griffin is a member of the American Academy of Family Physicians, Mississippi Academy of Family Physicians and the Mississippi State Medical Association. He is an active participant in and a board member of the Hattiesburg Civic Light Opera. Kenneth Wayne Liechty, MD, a pediatric surgical specialist, joined the University of Mississippi Medical Center faculty as an associate professor of surgery. He will see patients through University Physicians, a part of University of Mississippi Health Care. A 1989 graduate of the University of Utah, Dr. Liechty received the M.D. from the University of Utah School of Medicine in 1994. He completed a general surgery residency at the Allegheny University of the Health Sciences, Philadelphia, in 1996, a pediatric surgery research fellowship and fetal surgery fellowship at the Children's Institute for Surgical Science, Children's Hospital of Philadelphia, in 1999, a general surgery residency at the Hospital of the University of Pennsylvania, Philadelphia, in 2002 and a pediatric surgery fellowship at Children's Hospital of Philadelphia in 2004. He served as an instructor of surgery from 1999-2003 and as an assistant professor of surgery from 2004-09 at the University of Pennsylvania School of Medicine, Philadelphia. A fellow of the American College of Surgeons and the American Academy of Pediatrics and a member of the American Academy of Pediatrics, the Wound Healing Society and the Association for Academic Surgery, Dr. Liechty has received numerous awards for his research activities. He has served as an ad hoc reviewer for several professional journals, including the Journal for Clinical Investigation, the Journal of Pediatric Surgery and Pediatric Research. He has received more than $600,000 in extramural funding for research and is the co-author of more than 40 articles in peer-reviewed research publications. Thurman Neal Polchow, MD of Pascagoula; Gary Gorden, MD of Meridian; Wendall Helveston, MD of Hattiesburg; William Kroos, MD of Jackson and Paul Moore, MD of Pascagoula recently received the AMA Physicianâ&#x20AC;&#x2122;s Recognition Award (PRA). The PRA award recognizes physicians who earn at least an average of 50 credits per year from educational activities that meet the AMA standards. The award is a way to demonstrate to colleagues and patients that one is committed to expanding continually knowledge and improving skills by participating in continuing medical education. Please visit the AMA
SIMS
THOMPSON
Web site at www.ama-assn.org/go/pra for more information about the AMA PRA and other topics of interest to the CME community. To obtain an application (print or online) for AMA PRA direct credit activities: Web: www.ama-assn.org/go/cme , e-mail: pra@ama-assn.org or phone: (312) 464-5296. Brian Sellers, DO, RPVI has joined Hattiesburg Clinic Vascular Specialists. Dr. Sellers received his medical degree from the University of Health Sciences College of Osteopathic Medicine in Kansas City, Missouri. He completed his internship in general surgery at Greenville Hospital System in Greenville, South Carolina. He completed his residency in general surgery at Medical College of Georgia in Augusta.. Dr. Sellers also completed a fellowship in vascular surgery at Carolinas Medical Center in Charlotte, North Carolina. He joins Lewis E. Hatten, MD, FACS, and J. Keith Thompson, DO, FACOS, RVT, at Hattiesburg Clinic Vascular Specialists. Shane M. Sims, MD has joined the medical staffs of River Oaks Hospital and Woman's Hospital. He specializes in obstetrics and gynecology. Dr. Sims has bachelor's degrees in chemistry and biology from William Carey University and a medical degree from the University of Mississippi. As a resident he received the Robert S. Caldwell, MD Award given by Medical Assurance Company of Mississippi in recognition of excellence in medical care, record keeping, leadership, and the teaching of medical students and fellow residents. J. Keith Thompson, DO, FACOS, vascular specialist with Hattiesburg Clinic, recently became the first vascular specialist in Mississippi to perform a new surgical technique known as carotid flow-reversal. This advanced technique, which is used to open blocked neck arteries that can often cause strokes, involves temporarily reversing blood flow to part of the brain while safely opening the neck artery with a balloon and a stent. This technique is considered to be the next generation of carotid artery intervention by reducing strokes caused by severe neck artery blockages. Dr. Thompson performed this procedure in the new Vascular Suite at Forrest General Hospital. He is a fellowship trained vascular specialist that specializes in the comprehensive treatment of aortic aneurysms and peripheral artery disease (PAD). He is one of the leading authors in the state regarding the minimally invasive treatment of aortic disease. Dr. Thompson was the first physician in the state to perform minimally invasive surgery to repair potentially traumatic injuries to the aorta that sometimes occur in severe car wrecks. He also recently co-authored a study published in the International Journal of Injury on the topic of traumatic vascular injuries to the arteries of the kidneys. This research was performed in collaboration with physicians at Ohio's largest trauma hospital - Grant Medical Center in Columbus, Ohio. Dr. Thompson completed his vascular surgery fellowship at University of Cincinnati Medical Center in Cincinnati, Ohio. He is board certified in vascular surgery. Dr. Thompson is originally from Magee.
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• PRESIDENT’S PAGE • Be Careful What We Ask for, We Might Get It write this President’s Page less than 24-hours after returning from the American Medical Association’s 2010 state legislation strategy conference in Palm Springs, California (I know, here we go again, warm weather and cool drinks). While most of you were wrapping pipes and shivering in 15-degree temperatures, Dr. Claude Brunson (chair of the MSMA Council on Legislation) and myself were being warmed by the mid-70’s weather in southern California. However, most of the heat I felt came as my blood began to boil while being confronted with the stark reality of what the present health system reform legislation will do to our already struggling state economy. The most “chilling” presentation came from Dr. Lynn Nichols, an Arkansas native and highly respected health care economist who presently directs the New America Foundation Health Policy Program. This foundation has as its core objective to expand health care coverage to all Americans while reigning in costs and improving the efficiency of the overall health care system (a noble, but almost impossible RANDY EASTERLING, MD objective to obtain, in my opinion). 2009-10 MSMA PRESIDENT After earning a PhD in economics from the University of Illinois in Chicago, Dr. Nichols chaired the economics department at Wellesley College in Wellesley, Massachusetts and served for several years as senior advisor for health policy at the office of management and budget during the Clinton administration. Having grown up in Star, Arkansas (just outside Dumas, Arkansas), Dr. Nichols explained in a very homespun manner that the United States economy could no longer “afford” the escalating cost of health care as we know it today. “Clearly, the expense of maintaining our present system,” he explained, “is not in the best interest of either providers nor recipients of this state of the art care that we have all grown to know and love.” While I found it refreshing to hear a speaker at an AMA conference that did not have an accent, I confronted Dr. Nichols at the question and answer time as to the obvious conundrum that he had just presented. “While you make a compelling argument that the present health care system is driving America to an economic abyss,” I ask, “Could one not make an equally sound case that the present one trillion dollar — (yes, that’s a trillion with a capital T) pending health care legislation might well escalate this country’s fall off the proverbial economic cliff.” He agreed, kind of sort of. The answer to my question was simple. The states will be asked to pay for and implement a good portion of this so called health system reform. It was at this point that I once again began scratching my head and asking, “What is wrong with this picture?” After all, we were having this intellectual debate in the state of California, whose “governator” (talk about accent) had just that morning announced on a local Sacramento news show that his state was staring down a ninety-two billion dollar budget deficit. I know he said it, I was there, I heard it with my own two Mississippi born and raised ears. The National Governors Association and the National Association of State Budget Officers recently released the following data:
I
1. For the first time, states will face back-to-back reductions in general fund expenditures (negative 4.8 percent in 2009 and at least negative 4 percent in 2010). 2. State revenues declined about 8 percent in 2009. 3. States have had to close a collective budget gap of 250 billion dollars between physical year 2009 and physical year 2011. 4. State budgets show no evidence of recovery until at least 2012. It is at this point that I will remind you that 49 states (including Mississippi) are bound by law to balance their budgets. Fast forward backwards to June 16, 2009 when President Barack Obama, live and in person, rolled out to the AMA House of Delegates his intentions to reshape, redefine, and reconstruct the American health care system. During this 55-minute speech he made no mention or reference to states being required to pick up the tab for even a portion of his proposal. I know he didn’t, I was there! I saw it with my own two Mississippi born FEBRUARY
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and raised eyes. Now, 7 months later, it is becoming clear that much of the burden of health system reform will flow downstream from Washington, D.C. to Sacramento, California; Austin, Texas; Jackson, Mississippi, etc. Let’s be specific. Of the 30-something million additional Americans to be covered under the present health system reform debate, around 15 million of those will be insured by expansion of each state’s Medicaid rolls. This will come at a huge expense to state budgets that, as previously mentioned, all are already gasping for air. There are, of course, two notable exceptions. The states of Nevada and Louisiana will be spared the full weight of this federal edict due to the United States Senators selling their votes for a reprieve from this Washington mandate. Wait a minute; I thought you could go to jail for such goings on! Well, my bad. How will this likely affect the Magnolia state? Chew on these numbers! The present Senate proposal will expand Mississippi Medicaid by a minimal of 250 thousand recipients. This will likely drive our percentage of Medicaid population from 26 percent (already the highest in the United States) to close to 33 percent. Mississippi is presently close to 200 million dollars in the hole and would need a direct infusion of the same amount of state funding for the state portion of Medicaid for 2011 to offset an anticipated deficit. The federal fix for our present health system will likely add an additional 200 million dollars to our states portion of the Mississippi Medicaid program. This comes out to around a 400 million dollar deficit for Medicaid alone. At this point, take a deep breath, relax - but don’t take your blood pressure! It gets worse. The only way to capture the additional 400 million dollars is to cut back on services provided to Medicaid recipients, decrease provider reimbursement, and or raise taxes. Of course, we could always take the money from teachers’ pay, corrections, department of public safety, highways, etc., all of which or any combination thereof will hurt the very people health system reform is designed to help. How does health system reform sound now? As I reflect on the past 7 months, I am bothered by a gut feeling that when it is all said and done, we may well end up with a system that is just as expensive as our present delivery of health care, but not as good. I hope not! We have all expressed in some way, shape, or form a desire to see the present system changed in some manner. I wonder if we may get what we well want at the expense of losing what we have. I hope not! Remember, we should be careful what we ask for, we might get it. Your partner in making Mississippi healthier,
Randy Easterling, MD President, Mississippi State Medical Association
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Let Us SHOWCASE Your ARTWORK by donating it to the Silent Auction to be held at Annual Session Silent Auction Annual Session June 3-6, 2010 Natchez, Mississippi Benefiting the University of MS Medical Center AMA Foundation Scholars Fund for M3’s and M4’s
MSMA & MSMA ALLIANCE ALL types artwork welcome: photography, paintings, pottery, ceramics, woodwork, jewelry, sculpture, etc. Contact Amy Gammel, AMA Foundation Chair, at fivegammels@bellsouth.net
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• EDITORIALS •
Dignity abel appeared as a person in command of the clinic. She would arrive on time for her appointment, always better dressed than the occasion would demand. She exuded a presence that, however calm and impeccably polite, clearly indicated she was not a person to take lightly or cross. She terrified the residents and staff, although in a way similar to generals and admirals bringing to attention hundreds of soldiers and sailors. I could never discover a time that Mabel had cursed or been unruly in her intimidation of anyone at the clinic. I first met Mabel after I had returned from three year’s of active duty in the Navy and was finishing my final two years of residency training. There was no doubt why I had been assigned Mabel. The unspoken understanding was that I had been toughened with those years of dealing with Marines and serving as the medical officer for the Navy’s brig at Treasure Island. None of the other current residents had been quite so seasoned and annealed. The stated complaint against Mabel appeared to be two fold: she was indigent and could not pay for her care; she demanded samples of every medication prescribed on an ongoing basis. But it was the unstated that made Mabel so different from many other patients. There was dissonance created by the staff’s expectation and Mabel’s actual responses to the staff. The staff expected a maudlin style of gratitude from our indigent patients in return for services being given away. Mabel received these services as if they were her imperial right. The staff expected some degree of groveling but instead received the impression they were outranked. Mabel was not a favorite patient at the clinic. I did not expect much satisfaction from my first encounter with Mabel. She did not give the impression of expecting much from me either on first meeting. As is my habit with any new patient to me, I began by retaking her history. As much as I respect my colleagues, I have repeatedly found that our records often perpetuate errors, and besides, something about hearing from the patient directly helps form better thoughts for me. Recent reports about the impact of family history and social history indicate these are not helpful. However, such reports neglect the importance of understanding family and social settings in building a relationship of trust with patients. It was from that history, the social history, that my perception of Mabel and our future relationship were built. Understanding Mabel’s social circumstances served as a springboard for me to more broadly appreciate justice and forgiveness in wider society, Mabel had fallen in love early in her life, only to find later that her now husband was irrationally jealous and eventually abusive. She was imprisoned in her home, including a shotgun strategically placed by the kitchen door. Her husband had repeatedly told her he would shoot her with that gun should she leave the house. After a particularly violent night, as her husband came for her chest with her butcher knife, Mabel’s instinct for survival pulled both triggers on that shotgun as she lay battered against her kitchen door. Troubled, poor, and likely poorly represented, she was labeled a felon with a manslaughter conviction. I fear that being African American may also have played a role in her conviction. Ten years of prison did not serve as ample enough penalties for her actions though. As a felon, she could not find stable employment, and various problems were encountered with the welfare system. The myriad of odd jobs, ironing and such, that she took on barely fed her and certainly could not provide her with needed medical care. What I came to understand about Mabel was this: she had nothing left but her dignity, and she clung to that dignity fiercely. What I came to understand about our larger society was that our inability to forgive, even when a penalty has been paid, costs us dearly in lives lost. I was not a member of the jury that convicted Mabel and, having heard one side, I can suspend my disbelief and entertain a notion that the sentence was just. But if Mabel or anyone else has served a justly applied sentence, let alone was one that smacks of injustice, I find little to be gained for society in permanently prohibiting persons like Mabel from re-entering society. Mabel’s commitment to her dignity preserved our society in countless ways. It prevented the downward spiral into further crime that desperate and jobless felons spiral into everyday. Providing samples and free care was the least I could do to repay Mabel for her commitment to leading an honest and dignified life. I saw Mabel for many years after our first meeting. I am the richer for that meeting, despite no payment to the clinic for our services. Mabel, thank you for teaching me so much about respect and dignity. —Michael O’Dell, MD JMSMA Associate Editor
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The Pen is Mightier than the Sword! Express your opinion in the JMSMA through a letter to the editor or guest editorial. The Journal MSMA welcomes letters to the editor. Letters for publication should be less than 300 words. Guest editorials or comments may be longer, with an average of 600 words. All letters are subject to editing for length and clarity. If you are writing in response to a particular article, please mention the headline and issue date in your letter. Also include your contact information. While we do not publish street addresses, e-mail addresses or telephone numbers, we do verify authorship, as well as try to clear up ambiguities, to protect our letter-writers.
You can submit your letter via email to KEvers@MSMAonline.com or mail to the Journal office at MSMA headquarters: P.O. Box 2548, Ridgeland, MS 39158-2548.
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Will Politicians Ever Change? n the fourteenth century Franco Sacchetti, an Italian short story writer, published “The Two Ambassadors.” This is a tale of two politicians selected by their local authorities to meet with “Bishop Guido” the controlling authority of the region. In a hastily convened meeting the local authorities elected two men as ambassadors to meet with the bishop and instructed them on what they wanted from him. They departed early the next morning, and after traveling all day, each confessed to the other he had forgotten their instructions. It was decided they would continue to the next Inn, have wine and a meal, and see if they could recall the details of their assignment overnight. On arousing themselves once more, one of them inquired of the other whether he had yet succeeded. “I know not” was the reply; “but I know that our host’s is the best wine I ever drank: the truth is, I have never thought about it since dinner, and now I hardly know where I am.” “And I declare it has been the same with me,” answered his friend; “the Lord only knows what we shall do! However, we shall stay here today and tonight, for the night is always favorable to memory; we cannot fail to recollect the whole.” To this the other agreed; and they stayed there the remainder of the day, repeating the experiment of the wine, frequently finding themselves in the clouds, where, however, they found nothing of their mission. The same story was repeated at supper; and they afterwards with difficulty found their way to bed. At breakfast the next morning the inquiry was vainly repeated, both declaring that they had not so much as dreamed about the matter, and that they had not got the most distant notion of it, having never slept so soundly in all of their lives. “The devil is in the wine, I think,” cried one; “ let us mount horse again, and see what that will do; it will come when we are not thinking about it on the road.” After further travel neither of them could recall the assignments of their mission, yet it was decided they would continue, meet with the bishop, and tell him the truth; they had forgotten what their people wanted from him. This they did. So trusting to fortune, they requested an audience with the bishop, saying they had some matters of importance to communicate to him; and being introduced into his presence, they made a very low obeisance, and remained silent. Upon this the bishop with great dignity approached them, and taking them by the hand, said “You are welcome gentlemen; what tidings of import may you bring?” Each of the ambassadors now looked at the other, and bowing, said “Do you speak!” “No, sir,” was the reply; “do you speak, sir; I cannot think of it;” till at length the boldest of the two, addressing the bishop, observed: “We come, my lord, as ambassadors from your poor servants of Casentino, and I can assure your Grace that both those who sent us and we who are sent are equally devoted to you; but , please your Grace, we are all of us men of fact, but of few words: our mission was intrusted to us in haste; and what ever may be the occasion of it, either our assembly must have informed us wrong, or we have in some way misunderstood them. Nevertheless, we humbly recommend both them and ourselves to your Grace’s good offices; though what possessed them to send us on such a mission, or ourselves to come, we cannot exactly say.” The good bishop, like a wise man, only patting them on the shoulder, said, “Well, well, my friends. It is all right; go home, and say to my dear children of Casentino that I shall always be happy to serve them every way in my power; so much so, that henceforeward they need be at no expense in appointing ambassadors to my court; let them only write to me, and I will reply agreeably to their wishes.” The bishop then taking leave of them, our ambassadors resumed their way, saying as they went. “Let us take care not to fall into the same error on our return.” “But,” said one, “we cannot easily do that; we have got nothing to remember.” “Yet we must have our wits about us,” returned the other; “for they will ask us what we said in our oration, and what was the reply. For if the good people were to suspect that our embassy, like many others, was all a joke, they would never employ us again; and farewell to our occupation--it is gone.” To this the more politic of the two replied, “Oh, leave this to me; we will continue in office, trust me. I will tell them such a story about the embassy, and what was passed on both sides, as would deceive wiser heads than theirs. The bishop shall say such polite things of them as shall make them in good humor with themselves for an age to come.” After traveling several days, the end of the journey “brought them into the presence of their employers, where, finding it easier to recollect their own lies than the truths which had been reposed in them, they mystified the good people in such a manner that they were highly pleased with the success of the embassy. They talked in so bold and lofty a tone of the orations they had delivered, that some in the audience compared them to Tully and Quintilian; and the thanks of the assembly being unanimously voted to them, they were afterwards promoted to other offices of great honor and emolument. Nor will this appear very extraordinary if we reflect upon the sort of people, of a higher rank than our heroes, whom we every day see entrusted with public missions, and who are about as much suited to their business as a common trooper taken from the ranks; and yet they write long letters, assuring the Government that they are busied day and night in the affairs of the nation, and that all lucky events which fall out are wholly to be imputed to their skill. Did they tell the truth, however, they would own that they had as little merit in bringing them about as a cabbage, or any other vegetative substance, though they are richly recompensed and promoted to the highest of honors, in consideration of the ingenious lies and forgeries which they pass upon their countrymen.” Have politicians changed over the last seven hundred years? Looking at the current scene in Washington; what do you think? —Myron W. Lockey, MD Editor Emeritus
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• PHYSICIANS’ BOOKSHELF • Kings of Tort: The True Story of Dickie Scruggs, Paul Minor, and Two Decades of Political and Legal Manipulation in Mississippi. By Alan Lange and Tom Dawson. Hardcover, 255 pages, $27.95 ISBN: 9781597252447 Battle Ground, WA , Pediment Publishing, 2009.
his book about greed and corruption proves the adage, “Truth is stranger than fiction.” While the basis for “Kings of Tort” may read like a John Grisham novel, sadly it is no fictitious courtroom drama. Sadder still, the story happened right here in Mississippi. While many physicians know the fallout from lawsuit abuse in Mississippi, many of us may not know the history leading up to the downfall of the state’s so-called kings of tort. This book tells a well documented story of the rise and fall of Dickie Scruggs, Paul Minor, and others in their efforts to influence judges and the outcomes of Mississippi court cases. Written by a Jackson businessman and political blogger (Alan Lange) and a former federal prosecutor (Tom Dawson), their book gives a detailed account of how three separate federal investigations netted three judges, one former district attorney, a former state auditor and a number of well-connected trial lawyers. One of the most interesting things about reading this book is learning how wildly successful the tort kings were in amassing their money and influence, and how unbelievably corrupt they were in using both to cause their own failure. Greed and an arrogant sense of invincibility were the ultimate causes of the downfall of these very talented men. King Scruggs described his crafty method to influence the outcomes of legal cases in a speech in 2002, which co-authors Lange and Dawson quote as follows:
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[W]hat I call the “magic jurisdiction”…[is] where the judiciary is elected with verdict money… It’s almost impossible to get a fair trial if you’re a defendant in some of these places. The plaintiff lawyer walks in there and writes the number on the blackboard, and the first juror meets the last one coming out the door with that amount of money… The cases are not won in the courtroom. They’re won on the back roads long before the case goes to trial. Co-author Dawson, who was the lead prosecutor in the Scruggs case, commented in a recent speech that he believed this was the first time a future criminal defendant had ever confessed to a crime nearly five years before it was actually committed. Sadly for Scruggs, members of his own circle of tort kings benefited from his successful methods, yet turned on him and cooperated with federal prosecutors to bring about the convictions of Scruggs, his son, and several others.
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â&#x20AC;&#x153;Kings of Tortâ&#x20AC;? is a factual account of a sordid chapter in Mississippiâ&#x20AC;&#x2122;s legal and political history. The book reads easily, but it contains some terms, persons, and events that may not be familiar to some readers. Nevertheless, Mississippi physicians are likely to find the book an interesting read, for the detailed descriptions of the tort kingsâ&#x20AC;&#x2122; manipulations and the sad ironies of their lives.
Forthcoming: â&#x20AC;&#x153;The Fall of the House of Zeusâ&#x20AC;? by Curtis Wilkie Another book about the downfall of the kings of tort is due out later this year from Curtis Wilkie, an Associate Professor of Journalism, Cook Chair and Overby Fellow at the University of Mississippi. Random House anticipates that its publication of â&#x20AC;&#x153;Fall of the House of Zeusâ&#x20AC;? will benefit from Wilkieâ&#x20AC;&#x2122;s interviews with his friend Dickie Scruggs that Lange and Dawson were not able to obtain. Zeus was the nickname of Scruggs in college. JMSMA readers may wish to be alert for the publication of this work in order to gain another perspective on this intriguing story.
â&#x20AC;&#x201D;Philip Merideth, MD, JD MSMA Committee on Publications member
We specialize in the business of healthcare t t t t t t t t
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Alan Lange is a native of Jackson and is actively involved in a variety of business and community interests. He is the founder of YallPolitics, one of the largest political interest websites in the Southeast. YallPolitics became ground zero for documenting the Scruggs and Minor scandals. He is also president of Kinetic Staffing, a southeast regional legal and accounting recruiting firm. Along with his wife, Holly, and their sons Ford and Jake, they live in Jacksonâ&#x20AC;&#x2122;s Fondren community â&#x20AC;&#x201C; not far from their alma mater, Millsaps College.
Photo by James Patterson
About the Authors
ALAN LANGE AND TOM DAWSON
Tom Dawson is a 36-year veteran federal prosecutor, having served as a trial attorney with the Department of Justice in Washington, D. C., Associate Independent Counsel and Assistant U.S. Attorney. Since his retirement in January 2009, he has been widely recognized by his peers for his role as lead counsel in the investigation and prosecution of the Scruggs cases. Tom and his wife Susan reside in Oxford. FEBRUARY
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• NUMBERS COUNT • t the December ’09 meeting of the MSMA Board of Trustees, Dr. H. Vann Craig, Director of the Mississippi State Board of Medical Licensure (MSBML) provided the following statistics on Mississippi licensees. All of this information may be accessed on the licensure board’s Web site: MSBML.State.MS.US. From the home page, click: Licensure. On this page at the lower right click: Statistical Information. Here you will find all you want to know about licensure by specialty, county distribution, age, etc. Dr. Craig noted in 2009, the MSBML issued 407 new licenses (370 MD and 37 DO).
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Physicians Licensed by the Mississippi State Board of Medical Licensure In Mississippi
Out of State
All Licensees
5,234
3,229
8,463
307
143
450
Podiatrists 24.6% female
65
25
90
Physician Assistants 50% female
68
9
77
Medical Doctors Osteopaths
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â&#x20AC;˘ MSDH â&#x20AC;˘ Mississippi Reportable Disease Statistics
November 2009
* Totals include reports from Department of Corrections and those not reported from a specific district NA - Not available (temporarily)
For the most current MMR figures, visit the Mississippi State Department of Health web site: www.HealthyMS.com FEBRUARY
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• MSDH •
Dr. Mary Currier Named State Health Officer
For a bird’s eye view on medicine follow MSMA on
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n its regular quarterly
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meeting held January 13, the Mississippi State
Board of Health named Dr. Mary Currier to the post of State Health Officer, effective immediately. Currier will serve a six-year term. Dr. Currier became Interim State Health Officer early last month after the death of former State Health Officer Dr. Ed Thompson. Currier began her Mississippi State Department of Health tenure in 1984 and has served in various capacities including two terms as State Epidemiologist, from1993 to 2003, and again since 2007. “I am very honored and excited to be appointed State Health Officer. I look forward to continuing to pursue the goals Dr. Thompson outlined during his tenure, which include lowering tuberculosis, syphilis and infant mortality rates,” said Dr. Currier. “Public health is my passion, and the Mississippi State Department of Health is where I belong.” A graduate of the University of Mississippi School of Medicine, Dr. Currier received her master’s degree and preventive medicine residency training in Public Health from the Johns Hopkins School of Hygiene and Public Health. Currier’s bachelor’s degree is from Rice University, and she attended Trinity College in Dublin. Board Chairman Dr. Luke Lampton said the Board had a robust discussion about filling the position of State Health Officer, including the possibility of conducting a nationwide search within a short time frame. “The Board is very grateful that we have someone of Dr. Currier’s caliber willing and able to fill this position. The Board unanimously felt that Dr. Currier was the best and most qualified individual to be our next State Health Officer,” said Dr. Lampton. Lampton added, “The fact that Dr. Mary Currier is a Mississippian and has over 20 years of public health experience – much of it under the leadership of Dr. Ed Thompson – is an added benefit.” Currier has 25 years of state service experience and 20 years serving in public health. Prior to serving as State Epidemiologist, Dr. Currier was a
There’s a lot going on in organized medicine so it’s easy to miss something if you’re on the go. To help you stay in touch no matter where you are, MSMA is now communicating via “Twitter.” In about three minutes, you can set up a free Twitter account for yourself. Simply visit www.twitter. com and submit your name, email address and mobile phone number (optional, standard text messaging rates apply). Once you’re signed up with Twitter, you can add MSMA by going to the following web page http://twitter.com/ MSMA1 and clicking “Follow” next to the MSMA icon.
medical consultant with the Mississippi State Department of Health, where she began her career as a staff physician for the prenatal care, family planning, STD, and pediatrics programs. Currier is a member of the American Medical Association, the Mississippi Central Medical Society, the American Public Health Association, and is Board certified in General Preventive Medicine and Public Health.
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MSMA1
• UMMC •
Stringer, Robbins Named Finalists for UMMC Vice Chancellor ACKSON - Two finalists have been named in the search for a new vice chancellor for health affairs and dean of the medical school at the University of Mississippi Medical Center. The finalists include one internal and one external candidate. They are Dr. Robert C. Robbins, chair of the Department of Cardiothoracic Surgery at Stanford University School of Medicine, and Dr. Scott Stringer, chair of the Department of Otolaryngology and Communicative Sciences at UMMC. Dr. Robbins, a specialist in heart and lung transplantation, graduated from medical school and completed residency training in surgery at UMMC. He completed a fellowship in cardiothoracic transplantation at Columbia Presbyterian Medical Center in New York and additional residency training in cardiothoracic surgery at Stanford University Hospital. He is director of the Stanford Cardiovascular Institute. Dr. Stringer, a specialist in rhinology and head and neck oncology, graduated from medical school and completed residency training in general surgery and otolaryngology at the University of Texas Southwestern Medical Center. He received a Master of Science in administrative medicine from the University of Wisconsin-Madison. He is president of the faculty practice, University Physicians, and the associate vice chancellor for clinical affairs. A national search firm that specializes in placing top level executives in academic medicine presented a slate of candidates with a broad range of specialties and geographic locations. Dr. LouAnn Woodward, chair of the search committee, said she was thrilled with the national interest in Mississippi. “These two gentlemen are extraordinarily well-rounded, intelligent and proven leaders in academic medicine who are poised to lead the Medical Center into the new decade,” Dr. Woodward said. The candidates had a final round of interviews and made presentations to faculty, staff and students in late January. Following that, the search committee forwarded their recommendation to Dr. Dan Jones, chancellor of the University of Mississippi, for the final selection, which is expected by mid-February.
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DR. ROBERT C. ROBBINS
DR. SCOTT STRINGER
• UMMC SOM •
Profile of an Entering Medical School Class very August, another entering class of first year medical students arrives at the University of Mississippi Medical Center (UMMC) in Jackson. Emotions range from eager anticipation to anxiety; but these quickly fade as orientation concludes and course work commences in earnest. Who are these students? Where are they from? Why were they selected? Data averaged from the past decade (2000-2009) enable construction of a profile of what will be referred to as the “Class of the Aughts.”
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• UMMC SOM • Applicants to the UMMC School of Medicine (SOM) are restricted to legal residents of Mississippi, as defined by By-laws and Policies of the Board of Trustees of State Institutions of Higher Learning, State of Mississippi. The process used to evaluate SOM applicants and applications is outlined at http://som.umc.edu/admissions.html#EvalApps. Due to ongoing class expansion [100 students through 2004, 105 in 2005, 110 from 2006 to 2008 and 120 in 2009), the average “Class of the Aughts” consists of 106 students. It was selected from a pool of 262 applicants from which 173 were interviewed based on a combination of Biology, Chemistry, Physics, and Math (BCPM) grade point average (GPA) and Medical College Admissions Test (MCAT) scores. To fill the class, offers were made to 119 applicants; 13 elected to attend medical school elsewhere. All members of the “Class of the Aughts” have earned a baccalaureate degree; over 70% were earned at one of 10 institutions of higher learning in Mississippi, the remainder from one of 18 out-of-state schools. Twelve percent have graduate degrees. Two year colleges have contributed to this class; 39% of the students have taken at least one science or math course, 12% have completed at least one academic year and 5% have acquired an associate’s degree at a community or junior college before enrolling at a four year college or university. While 39% of the class majored in biology, the remainder earned one of 27 other baccalaureate degrees. The average age is 23 (range 19-43), 43% are female, and 15% are minorities including 9% that belong to a racial or ethnic group that is under-represented in medicine in Mississippi (African American, Hispanic or Native American). Eight percent are disadvantaged, 28% come from rural counties and 75% from counties that are medically underserved. Fifteen percent are children of physicians. The “Class of the Aughts” has strong metrics; the average BCPM GPA is 3.6 and the average MCAT sum is 28; however, the range of these numbers (2.5 to 4.0 for BCPM GPA; 19 to 42 for MCAT sum) is evidence that other factors contribute to the selection process. For example, during one-on-one interviews with three members of the medical school admissions committee, applicants responded to questions and scenarios that contributed to the evaluation of their motivation for medicine, vision of practice, respect for others, critical thinking, integrity, accountability, altruism, awareness of ethics, strive for excellence, setting priorities for medical school preparation, self appraisal, coping skills, support system, listening and relational skills, maturity and honesty. Faculty evaluation letters also contribute to these assessments. Students in the “Class of the Aughts” have a remarkable record of accomplishment that reflects extensive interaction with diverse people and superb time management skills. On average, they participated in 24 activities outside the classroom. All have acquired some knowledge, exposure to and experience in delivery of healthcare, 80% regularly participated in volunteer or community service activities, and 55% had other significant time commitments such as employment, research, artistic endeavors and varsity athletics. Attention is given to the distance that applicants traveled on the pathway to medical school. Some are educationally disadvantaged because they graduated from a secondary school whose funding and performance, for example, as reported in the Mississippi report card (http://www.msreportcard.com/), is below average for the state. Others come from a socioeconomically disadvantaged background due to the level of parental education, household size and income, and hometown location. A holistic review that includes consideration of these factors revealed applicants who in a head-to-head comparison appeared less competitive yet whose relative achievements were truly remarkable. Finally, 29% of the “Class of the Aughts” consists of students whose first or second medical school application was unsuccessful. These students typically sought post-application counseling offered by the SOM admissions office and followed advice offered on how to improve the competitiveness of a subsequent application. Past data indicate these students will perform as well as students who were accepted when they first applied. The medical school admissions committee has the daunting task of annually selecting applicants that comprise an incoming class. This dedicated group of professionals is committed to the institution’s mission, is unaffected by external influences, and assures that every applicant is given an equal opportunity to be evaluated by identical admissions criteria. What this committee knows better than anyone outside of the admissions process is that while metrics such as BCPM GPA and MCAT scores might identify “the brightest” individuals, they do not define the “best” applicants who will succeed in medical school and, more importantly, become the licensed physicians to whom one would entrust treatment of family. Decades of data support the notion that no pre-admission metric predicts the class rank of our medical school graduates; however, the combination of criteria discussed above enables selection of a diverse group of qualified and compassionate medical students capable of completing a rigorous training program and willing to provide quality healthcare to all Mississippians. The UMMC SOM admissions committee has a remarkable track record; past performance predicts that 95% of the “Class of the Aughts” will graduate with the M.D. degree and two thirds of them will practice medicine in Mississippi.
—Steven T. Case, PhD Associate Dean for Medical School Admissions Professor of Biochemistry
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• INFORMATION FOR AUTHORS • The Journal of the Mississippi State Medical Association welcomes material for publication submitted in accordance with the following guidelines. Address all correspondence to the Editor, Journal of the Mississippi State Medical Association, P.O. Box 2548, Ridgeland, MS, 39158-2548. Contact the managing editor with any questions concerning these guidelines. Articles should be consistent with AMA style. Please refer to explanations in the AMA Manual of Style: A Guide for Authors and Editors. 10th ed. New York, NY: Oxford University Press; 2007. MANUSCRIPTS should be of an appropriate length due to the policy of the Journal to feature concise but complete articles. (Some subjects may necessitate exception to this policy and will be reviewed and published at the Editor’s discretion.) The language and vocabulary of the manuscript should be understandable and not beyond the comprehension of the general readership of the Journal. The Journal attempts to avoid the use of medical jargon and abbreviations. All abbreviations, especially of laboratory and diagnostic procedures, must be identified in the text. Manuscripts must be typed, double-spaced with adequate margins. (This applies to all manuscript elements including text, references, legends, footnotes, etc.) The original and one duplicate hard copy should be submitted. In addition, the Journal also requires manuscripts in the form stated above be supplied in IBM-compatible digital format. You may email digital files as attachments to KEvers@MSMAonline.com or supply a compact disk with the files burned to it. All graphic images should be included as individual separate files in TIFF, PDF or EPS format. Please identify the word processing program used and the file name. Pages should be numbered. An accompanying cover letter should designate one author as correspondent and include his/her address and telephone number. Manuscripts are received with the explicit understanding that they have not been previously published and are not under consideration by any other publication. Manuscripts are subject to editorial revisions as deemed necessary by the editors and to such modifications as to bring them into conformity with Journal style. The authors clearly bear the full responsibility for all statements made and the veracity of the work reported therein. REVIEWING PROCESS. Each manuscript is received by the managing editor, and reviewed by the Editor and/or Associate Editor and/or other members of the MSMA Committee on Publications. The acceptability of a manuscript is determined by such factors as the quality of the manuscript, perceived in-
terest to JMSMA readers, and usefulness or importance to physicians. Authors are notified upon the acceptance or rejection of their manuscript. Accepted manuscripts become the property of the Journal and may not be published elsewhere, in part or in whole, without permission from the JMSMA. TITLE PAGE should carry [1] the title of the manuscript, which should be concise but informative; [2] full name of each author, with highest academic degree(s), listed in descending order of magnitude of contribution (only the names of those who have contributed materially to the preparation of the manuscript should be included); [3] a one- to two-sentence biographical description for each author which should include specialty, practice location, academic appointments, primary hospital affiliation, or other credits; [4] name and address of author to whom requests for reprints should be addressed, or a statement that reprints will not be available. ABSTRACT, if included, should be on the second page and consist of no more than 150 words. It is designed to acquaint the potential reader with the essence of the text and should be factual and informative rather than descriptive. The abstract should be intelligible when divorced from the article, devoid of undefined abbreviations. The abstract should contain: [1] a brief statement of the manuscript’s purpose; [2] the approach used; [3] the material studied; [4] the results obtained. Emphasize new and important aspects of the study or observations. The abstract may be graphically boxed and printed as part of the published manuscript. KEY WORDS should follow the abstract and be identified as such. Provide three to five key words or short phrases that will assist indexers in cross indexing your article. Use terms from the Medical Subject Heading list from Index Medicus when possible. Available at: http://www.nlm.nih.gov/mesh/meshhome.html.
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SUBHEADS are strongly encouraged. They should provide guidance for the reader and serve to break the typographic monotony of the text. The format is flexible but subheads ordinarily include: Methods and Materials, Case Reports, Symptoms, Examination, Treatment and Technique, Results, Discussion, and Summary. REFERENCES must be double spaced on a separate sheet of paper and limited to a reasonable number. They will be critically examined at the time of review and must be kept to a minimum. You may find it helpful to use the PubMed Single Citation Matcher available online at: http://www.ncbi.nlm.nih.gov/entrez/query/ static/citmatch.html to find PubMed citations. Abbreviate and italicize journal titles in accord with PubMed abbreviations. All references must be cited in the text and the list should be arranged in order of citation, not alphabetically. Reference numbers should appear in superscript at the end of a sentence outside the period unless the text cited is in the middle of the sentence in which case the numeral should appear in superscript at the right end of the word or the phrase being cited. No parenthesis or brackets should surround the reference numbers. Personal communications and unpublished data should not be included in references, but should be incorporated in the text. The following form should be followed: Journals [1] Author(s). Use the surname followed by initial without punctuation. The names of all authors should be given unless there are more than three, in which case the names of the first three authors are used, followed by “et al.” [2] Title of article. Capitalize only the first letter of the first word. [3] Name of Journal. Abbreviate and italicize, according to the listing in the current Index Medicus available online at http://www.nlm.nih.gov/bsd/aim.html. [4] Year of publication. [5] Volume number. Do not include issue number or month except in the case of a supplement or when pagination is not consecutive throughout the volume. [6] Inclusive page numbers. Do not omit digits. Example: Bora LI, Dannem FJ, Stanford W, et al. A guideline for blood use during surgery. Am J Clin Pathol. 1979;71:680-692. Books [1] Author(s). Use the surname followed by initials without punctuation. The names of all authors should be given unless there are more than three, in which case the names of the first three authors are used followed by “et al.” [2] Title. Italicize title and capitalize the first and last word and each word that is not an
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article, preposition, or conjunction, of less than four letters. [3] Edition number. [4] Editor’s name. [5] Place of publication. [6] Publisher. [7] Year. [8] Inclusive page numbers. Do not omit digits. Example: DeGole EL, Spann E, Hurst RA Jr, et al. Bedside Examination, in Cardiovascular Medicine, ed 2, Smith JT (ed). New York, NY: McGraw Hill Co; 1986:23-27. ILLUSTRATIONS require high resolution digital scans to be provided. Printed copies should also be submitted in duplicate in an envelope (paper clips should not be used on illustrations since the indentation they make may show on reproduction). Legends should be typed, double-spaced on a separate sheet of paper. Photographic material should be high-contrast glossy prints. Patients must be unrecognizable in photographs unless specific written consent has been obtained, in which case a copy of the authorization should accompany the manuscript. All illustrations should be referred to in the body of the text. Omit illustrations which do not increase understanding of text. Illustrations must be limited to a reasonable number (four illustrations should be adequate for a manuscript of 4 to 5 typed pages). The following information should be typed on a label and affixed to the back of each illustration: figure number, title of manuscript, name of senior author, and arrow indicating top. TABLES should be self-explanatory and should supplement, not duplicate, the text. Each should be typed on a separate sheet of paper, be numbered, and have a brief descriptive title. Tables should be on individual pages separate from manuscript body text with placement indicated within. ACKNOWLEDGMENTS are the author’s prerogative; however, acknowledgment of technicians and other remunerated personnel for carrying out routine operations or of resident physicians who merely care for patients as part of their hospital duties is discouraged. More acceptable acknowledgements include those of intellectual or professional participation. The recognition of assistance should be stated as simply as possible, without effusiveness or superlatives. GALLEY PROOFS will be emailed to the principal author for review. Corrections should be clearly marked and returned promptly. To order reprints please request a price quote for reprinting and place your order when you return your galley proof. ❑
• UNA VOCE •
Eavesdropping
R. Scott Anderson, MD t’s not nice to eavesdrop. We all grew up with that admonition. If your parents caught you lurking around in the hall while they were discussing something in whispered tones about the new neighbors, you were pretty sure that you were going to get whopped in the back of the head. They would tell you to knock it off and if it was still light you were sent out into the backyard. I tell my kids that. Parent: “Do you want people to think you’re creepy, or something?” Child: “No.” Parent: “Then don’t eavesdrop, it’s creepy.” I don’t whop them much anymore. It’s too much trouble with girls. Besides, these kids need all the brain cells they can keep. So, we all agree. Eavesdropping is not nice, it’s creepy, it’s sneaky, and a whole bunch of other bad stuff. Unless, of course, you’re a parent, then it’s essential. Eavesdropping has always been a parent’s main source of information about what happened that day at school, who did what to who, who cheated on a test, all the stuff you need to know. For a parent the best place to eavesdrop on kids has always been in the car. You can hear everything they say. And if you’ve got the technique down, which is to never butt in or mention anything that you overhear until later, your kids think you’re too deaf to hear them so they keep on talking like you’re not even there. Several times I’ve mentioned something I’ve overheard in the car later in the evening and had a kid say, “Where’d you hear about that?” My wife Charlene had a pat answer: “the mother network.” The kids never questioned it. See, I told you we needed to preserve as many neurons as possible. Unfortunately, all that’s changing. Kids don’t talk anymore. They text. All you can hear is clickety click click click, clickety click. If you’re like me you don’t have any idea what all the clicks mean or even why they do it when they’re sitting right next to the person they’re texting. My two daughters do that constantly. They’re sitting next to each other in the car and start having a texting argument. Then one of them eventually screams then the other complains. “Sissy texted me a brat!” Of course, being the wise benevolent father that I am, I have the perfect solution. “Put those stupid phones up or I’m going to throw them out of the window.” “If you throw my phone out the window, can I get an I-phone?” “Of course not, why would I get you an I-phone if I had to throw your phone out of the window?” “What about the new Blackberry?” “NO! Now put ‘em up!” “I don’t know why I can’t have internet service?” “Because you’re ten. What do you need to get on the internet for anyway?” “To go on Facebook.” “You’re not allowed to go on Facebook.” “I could if you got me an I-phone.” “No you can’t…” You get the idea, see, in the past you would have spent all that time socking away valuable bits of parental intelligence, now it’s wasted on electronic warfare.
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My wife objects to using warfare related terms to describe parenting techniques. I don’t know why. The way I look at it they (the children and sometimes I think my wife) are trying to kill me. That’s why they say these things, to try and give me a stroke. I don’t know if they’re working individually or collectively. That’s another reason I have to eavesdrop on them. But sometimes it’s purely for the entertainment of it. I love to listen to my children play. Tonight was a classic. Maddie and Holton were in the next room. I’m not sure what they were playing. Maddie was a lady with a horse farm and the horses. Holton was apparently a general and an alien invader. Lady voice: “I’m going to town to get some hay for supper. Does anyone want to go with me?” Horse voice: “Neigh neigh. I do. I do.” General voice: “Battlefield command request permission to launch a rocket strike on this location to destroy the aliens.” Alien voice: “They’re requesting an air strike. Deploy the disrupters.” Maddie: “What are you doing? We’re playing horses.” Holton: “I know, but the horses are stuck in the middle of an interplanetary conflict.” Maddie: “You can’t launch rockets if horses are in the way.” General voice: “I’ll clarify that. Launch control, launch control, we have livestock on the battlefield. I repeat livestock on the battlefield.” Reply: “General, this is the president. I repeat: this is the president. Launch your rockets…launch your rockets. We cannot let the safety of the world be endangered by livestock.” Maddie: “Holton that’s not the way you play horsies. Besides, what kind of idiot president would let them blow up horses? You didn’t even tell him they were horses; you said livestock. He probably thought they were pigs.” General voice: “I’ll get further clarification. Blue Eagle, Blue Eagle, this is Sly Fox One. The livestock in question are horses, I repeat, not pigs, horses.” Reply: “General you have your orders. It is sure a shame that the horses have to die, but we can build a statue in memory of the brave horses that gave their lives to save the world.” Maddie: “You and your army are a bunch of idiots. I’m going to be with the aliens.” Alien voice: “Save the horses. We eat them for desert on our planet.” Maddie: “What kind of planet eats horses?”
•
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Holton: “You’re so stupid. Ours does. They make them into dog food too.” WHAP Holton: “Owww owww owww. You’re not allowed to hit people with the horses. They’re hard.” Me: “Maddie, you better not be hitting anybody with those horses.” Maddie: “I didn’t. The horses were just defending their selves.” Just another slice of my life, —R. Scott Anderson, MD
[R. Scott Anderson, MD, a radiation oncologist, is medical director of the Anderson Regional Cancer Center in Meridian, and vice chair of the MSMA Board of Trustees. Additionally, he is an accomplished oil-painter and also dabbles in the motion-picture industry as a screen-writer and helped form P-32, an entertainment funding entity. “Una Voce” (With One Voice) is a column in the JMSMA designed by Dr. Dwalia S. South, MSMA past president and chair of the Committee on Publications. “Una Voce” features the selected prose of MSMA members. If you are a writer and would like to submit your work for consideration please send us your contribution or contact one of the editors.]—ED. 64
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