Med Monthly October 2013

Med Monthly OCTOBER 2013

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MIND OVER MECHANICS pg. 40

Clinical Trials and Network Meta-Analysis (NMA): Side by Side pg. 42

the

Medical Research

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contents

features

MIND OVER MECHANICS

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40 MIND OVER MECHANICS 42 CLINICAL TRIALS AND NETWORK META-ANALYSIS (NMA): Side by Side 46 REALITY: MIND-CONTROLLED LIMBS They’re Here!

insight 10 DISPELLING THE MYTHS ABOUT PALLIATIVE CARE 14 VERSATILE PROTEINS COULD BE NEW TARGET FOR ALZHEIMER’S DRUGS 16 MEDICAL-GRADE DISPLAY MARKET SOARS AS DEMAND RISES IN DISPARATE REGIONS

research and technology 26 NIH SCIENTISTS PURSUE NEW THERAPIES TO IMPROVE RARE DISEASE DRUG DEVELOPMENT 30 BRUKER ANNOUNCES THE WORLD’S FIRST PRECLINICAL MAGNETIC PARTICLE IMAGING (MPI) SYSTEM 32 NEW MEDICAL DEVICE TREATS URINARY SYMPTOMS RELATED TO ENLARGED PROSTATE

practice tips

legal

18 NEW AND SATISFYING TYPE OF MEDICAL PRACTICE

34 IRS ISSUES PROPOSED REGULATIONS ON THE INFORMATION REPORTING UNDER THE ACA

20 YOUR PRACTICE’S PHONE PLAN

36 LEGAL ISSUES IN KEEPING PATIENT’S CREDIT CARD INFORMATION ON FILE

22 INCREASING PATIENT-TO-PATIENT REFERRALS FOR YOUR MEDICAL PRACTICE

international 24 EXTENSIVE RESEARCH ON THE INDIAN MEDICAL DEVICE MARKET

CLINICAL TRIALS AND NETWORK META-ANALYSIS (NMA): SIDE BY SIDE

42

38 FEDERAL DISTRICT COURT ORDERS FDA TO PRODUCE RECORDS REGARDING NEW DRUG APPLICATION

the arts 50 PAINTING WITH FEELING

healthy living 52 FLOUR-LESS PEANUT BUTTER CHOCOLATE CHIP BLONDIES 54 CIDER BRINED AND SMOKES GAME HENS

in every issue 4 editor’s letter 8 news briefs

60 resource guide 80 top 9 list

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editor’s letter

Medmonthly’s October issue is one to be remembered. Exciting innovations in the realm of medical research can be found in every article. Breakthroughs in neural engineering have made it possible for people to literally control external objects with their minds. Another feature describes how a John’s Hopkin’s surgeon has been able to connect a robotic arm to a person’s amputated arm. As far as developments in clinical research trials go, forward thinking studies are now evaluating new drugs against the safety and efficacy of existing ones.

Is it science fiction that people can control a robot with their minds? Deane Morrison in her article “Mind Over Mechanics” elaborates on professor Bin He’s technology that uses a noninvasive BCI to do just that. The electrical currents in the brain allow persons to think about movement and make it happen without any other assistance. Dr. He illustrates these phenomena by using a flying robot.

Another amazing development is a robotic arm that is surgically attached to an amputated one can be controlled by the mind. The feature “Reality: Mind-controlled Limbs” by Laura Maaske discusses how patients with nerve damage can access motor signals in their brain to control an artificial limb. If the cortical signals are developed enough through repetition, there is great potential for rebuilding them. Laura also illustrated this month’s fantastic cover art to accompany her article.

Finally, Goran Medic’s article “Clinical Trials and Network Meta-Analysis (NMA): Side by Side” informs us about the progress of drug development. Although pre-clinical trials are the industry standard, the enormous cost of bringing a new drug to the market has led to other studies that focus on how well it performs relative to drugs that treat similar illnesses.

The brain is an intricate and malleable organ, one that doctors such as the ones in our October features have been able to manipulate to help people who are disabled. Their amazing discoveries have and will continue to change people’s lives dramatically for the better.

Don’t forget to check out November’s issue as well.

MedMonthly will give readers the opportunity to explore County Health Departments & Community Health Centers.

Ashley Austin Managing Editor

4 | OCTOBER 2013

Med Monthly October 2013 Publisher Philip Driver Managing Editor Ashley Austin Creative Director Thomas Hibbard Staff Illustrator, Writer and Journalist Laura Maaske Contributors Ashley Acornley, MS, RD, LDN Karen Albright John Ash Gert Bergman Elissa Flynn-Poppey Kelly L. Frey Barbara Hales, M.D. Eline Huisman Helen McNeal Goran Medic, MPharm Deane Morrison Scott F. Roberts, Esq. Nisha Salim Feike van der Scheer

Med Monthly is a national monthly magazine committed to providing insights about the health care profession, current events, what’s working and what’s not in the health care industry, as well as practical advice for physicians and practices.

We are currently accepting articles to be considered for publication. For more information on writing for Med Monthly, check out our writer’s guidelines at medmonthly.com/writers-guidelines P.O. Box 99488 Raleigh, NC 27624 medmedia9@gmail.com Online 24/7 at medmonthly.com

contributors Karen Albright owns and operates BodyLase Skin Spa, www.getbodylase.com, an award-winning medical spa that has been serving the Research Triangle area of North Carolina for over 11 years, with her husband, Daniel Albright, MD a board-certified surgeon. She is also the CEO of Medspa Consulting Group, a consulting business dedicated to ensuring the success of physicians starting or expanding new medical spas.

Barbara Hales, M.D. is a skilled expert in promoting your health services. As seen on NBC, CBS,ABC and FOX network affiliates as well as Newsweek, Dr. Hales writes all the content you need to promote your medical services. Her latest book is on the best seller list and she can do the same for you. Check out her site at www.TheWriteTreatment.com

Helen McNeal

is the Executive Director of the California State University Institute for Palliative Care at CSUSM. Prior to joining CSUSM, Helen served as Vice President of San Diego Hospice and The Institute for Palliative Medicine (SDHIPM) where she was responsible for all of the operations of The Institute for Palliative Medicine (IPM). She is also the co-author of Module IV: Palliative Care of A Comprehensive Guide to the Care of Persons Living with HIV/AIDS.

Goran Medic, MPharm is a pharmacist specialized in health economics with more than 6 years of hands-on experience in market access and reimbursement across Europe. He has developed numerous budget-impact and cost-effectiveness models. He is writing documents to communicate health economics and other value messages, as well as performing systematic literature reviews and network meta-analysis. Website: www. mapigroup.com

Nisha Salim is a freelance writer who specializes in writing factually accurate, research-backed healthcare articles.

General science, education, social media and content marketing are her other areas of interest. Take a look at her website, NishaSalim. com, to learn more about her.

MEDMONTHLY.COM |5

designer's thoughts From the Drawing Board Albert Einstein stated, “If we knew what it was we were doing, it would not be called research, would it?” In the “Research & Technology” section this month are three articles on cutting edge research in the field of medicine and health care and the introduction of new medical devices to improve quality of life.

The National Institute of Health (NIH) is participating in four new pre-clinical drug projects that were selected for their potential to treat specific rare diseases and to help scientists uncover new information that can be shared with other researchers as reported in “NIH Scientists Pursue Therapies to Improve Rare Disease Drug Development”. Two projects employ therapeutic approaches to developing a treatment for retinitis pigmentosa, a severe form of hereditary blindness. The third project focuses on a potential treatment for hypoparathyroidism, a hormone-deficiency syndrome that can lead to cardiac problems and convulsions. And the fourth project aims to develop a possible therapeutic that targets a cardiac disorder associated with LEOPARD syndrome, an extremely rare genetic disease that affects many areas of the body.

“New Medical Device Treats Urinary Symptoms Related to Enlarged Prostate”, explains how the FDA authorized the first permanent implant by UroLift to relieve low or blocked urine flow in men over 50 years of age with enlarged prostates. Their studies showed a 30 percent increase in urine flow and a steady amount of residual urine in the bladder with the device.

Another article, “Bruker Announces the World’s First Preclinical Magnetic Particle Imaging (MPI) System” the company, in collaboration with Royal Philips, introduced an entirely new technology for preclinical imaging. The addition of MPI as a complementary preclinical imaging technique for disease studies, translational research and drug discovery, has significant potential in helping researchers gain new insights into disease processes at the organ, cellular and molecular level.

MedMonthly will continue in its endeavors to report on the latest medical research and technology. If there are topics or insights on advances in medical research or technology you would like to share with us for future issues, please contact us at medmedia9@gmail.com.

Thomas Hibbard Creative Director

6 | OCTOBER 2013

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news briefs

ADP Helps Businesses with Affordable Care Act Requirements ADP®, a leading global provider of Human Capital Management (HCM) solutions, today announced the availability of information, enhancements and solutions designed to help small, midsized and large businesses in the United States manage their compliance with the evolving requirements of the Affordable Care Act (ACA). ADP can help companies approach their ACA compliance strategically by providing solutions, resources and expertise around employee communications, eligibility, reporting and enrollment.

“ADP sits at the intersection of payroll, time and attendance, and benefits administration. We process payroll for one in six Americans and manage benefits for more than 10 million American workers, which means we have the knowledge and resources to help businesses manage ACA compliance,” said Carlos Rodriguez, President and CEO, ADP. “In fact, we’ve been helping our clients with ACA compliance since its enactment in 2010. As requirements continue to evolve, ADP will expand and enhance our solutions to help businesses stay compliant and avoid penalties associated with missed deadlines or incomplete information.”

ADP Helps Businesses Comply with ACA Requirements ADP has been helping companies of all sizes navigate complex legislation and regulatory requirements for more than 60 years. With the Notice of Coverage Options deadline of October 1, 2013 less than a month away, ADP is continuing to help make it possible for clients to proactively manage ACA mandates.

• In 2013: ADP introduced enhancements to HCM platforms and enterprise resource planning (ERP) plug-ins, including a service that helps businesses communicate the Notice of Coverage Options, as well as functionality to support the employer “Shared Responsibility” mandate.

• In 2014: ADP will continue to release additional functionality and enhance the suite of ACA solutions designed to help businesses make critical decisions around applicability, employee eligibility, and public exchange communications.

• From 2015 – 2018: ADP will help companies manage requirements and communications around the employer mandate and possible penalties, automatic plan enrollment, expanded insurance exchange availability, excise tax on high-cost coverage and other critical milestones. In addition, ADP will help automate reporting with the Internal Revenue Service (IRS).

In addition, ADP will continue to provide robust analyt8 | OCTOBER 2013

ics that include benchmarking, decision support tools and dashboards to assist clients with taking a strategic, real-time view of ACA compliance and related activity.

As ACA guidance continues to be released, ADP will issue announcements regarding its flagship offerings, including ADP Vantage HCM® for large businesses, GlobalView global HCM, ADP Workforce Now® midsized business HCM, RUN Powered by ADP® small business payroll, tax and human resources, ADP Resource® small business administrative services organization (ASO), ADP TotalSource® small/midsized business professional employer organization (PEO), and ADP SmartComplianceSM for integration with payroll, HR and enterprise resource planning (ERP) systems.  Source: http://www.pressreleasepoint.com/adp-helps-businesses-affordable-care-act-requirements

SOON COMING ONTHLY IN MED M

coming In the up e, Med r 2013 issu Novembe be w theme ill Monthly’s nts & e m rt alth Depa e H ty n u Co Centers ity Health Commun

The Latest Developments in Clinical Trials Report Expert analysis of key elements and trends shaping the biomarkers landscape This quarter’s Developments in Clinical Trials report focuses on the increasing importance of biomarkers. Now, more than ever, scientists are looking to biomarkers for their potential to assist in early disease diagnosis, as well as their ability to help us understand the safety and efficacy of new and existing pharmaceuticals. Because biomarkers indicate biological processes, researchers are relying on them to help determine disease progression and outcomes, when and how to begin drug treatment, as well as drug therapy necessity and effectiveness.

With new insights into biomarkers, scientists may be able to create medications to stop disease progression altogether, or at the very least, limit the duration of current treatments with pharmaceutical improvements or even customized treatment options.

Advances in fields like genomics and proteomics have led to new evidence connecting different disease pathways to potentially new biomarkers. The next steps are to create new medications, based on the intelligence gathered through biomarker research, and to launch clinical trials.

The report also looks at recent conferences analyzing two significant developments: • The first clinical trial for rituximab/hualuronidase being tested in patients with non-Hodgkin’s lymphoma.

• A case report of the first fully documented functional cure of an HIV-infected infant with very early antiretroviral therapy.

Emerging biomarkers as they relate to multiple disease predictions and their progression, drug creation, treatment protocols, as well as safety and efficacy are also explored. Because validation of these biomarkers as surrogate endpoints is difficult to prove, we also connect this new information to data from clinical trials currently underway — pulling together and analyzing information from multiple sources. Thomson Reuters Cortellis Clinical Trials Intelligence allows us to correlate biomarker discovery with clinical trial evidence pertaining to the fight against existing, common ailments such as cancer, cardiovascular disease, dementia, HIV and more.  Source: http://www.pressreleasepoint.com/latestdevelopments-clinical-trials-report. 

FOOTHOLD TECHNOLOGY ANNOUNCES PARTNERSHIP WITH INTERSYSTEMS TO PROVIDE EHR SOLUTIONS Foothold Technology, a leading provider of electronic health record (EHR) software for behavioral health and human service providers, announced a new partnership with InterSystems, a global leader in software for connected care.

Foothold will use the InterSystems HealthShare® strategic informatics platform to enable interoperability with regional health information exchanges (HIEs), human service agencies, and healthcare providers nationwide using Foothold’s AWARDS behavioral health software for human service providers.

The partnership coincides with Foothold’s preparations to launch its Interoperability Center in the fall of 2013. The Foothold Interoperability Center will enable healthcare providers in a Health Home or other Continuum of Care settings to participate in safe, secure, HIPAA-compliant data exchanges using Foothold’s AWARDS software.

The Affordable Care Act of 2010 created an optional Medicaid State Plan benefit for states to establish Health Homes to coordinate care for people with Medicaid who have chronic conditions.

Health Homes are care providers that operate under a “whole-person” philosophy by integrating and coordinating all primary, acute, behavioral health, and long-term services and support to treat the whole person.

“Our partnership with InterSystems aligns with our commitment to liberate human service providers from the burdens of recordkeeping, offering them the freedom to focus on their missions,” said Marlowe Greenberg, Foothold’s founder and CEO. “As the landscape of healthcare changes rapidly, we are preparing our clients to face the challenges ahead with the most advanced technology available. Many of the agencies we serve would not be able to afford this level of sophistication on their own, but can leverage our product and service as part of a larger community.”

Paul Grabscheid, Vice President of Strategic Planning at InterSystems, said,”Foothold Technology has the high standards of excellence and customer focus that we look for in our partners. We are pleased to work with Foothold to support the interoperability and data exchange needs for a new community of behavioral healthcare providers, further extending the benefits of connected healthcare.”  Source: http://www.newswiretoday.com/ news/132541/ MEDMONTHLY.COM |9

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Dispelling the

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Myths About Palliative Care

By Helen McNeal Executive Director, California State University Institute for Palliative Care at CSUSM

MEDMONTHLY.COM |11

A

lmost everywhere you turn today in the media, there is some reference to palliative care.

Therefore, it is surprising how much confusion exists within health care in general but particularly amongst physicians about what it is, why it’s important, when to refer, etc. And, generally, I see much more of an ostrich-like posture about the response to this confusion on the part of many health care providers than one would expect. Given our aging population and data that demonstrates that palliative care increases longevity, reduces readmissions and improves outcomes, if this were a drug, everyone would be prescribing it. Instead, for many patients and families, getting a referral seems like hand-to-hand combat. For palliative care teams, education and building a referral base is a strategic, needlessly timeconsuming one-on-one relationship building process. Isn’t it time we all got on the same page?

Let’s make a start by debunking some of the popular myths heard in health care circles about palliative care.

It all begins with the idea that palliative care equals hospice. Quite simply, it does not. Nor is palliative care only for terminal patients, a frequent corollary. Palliative care is appropriate for any patient with a serious or chronic illness and their family, from point of diagnosis onward, regardless of the patient’s age or prognosis. To be crystal clear, palliative care improves the quality of life for patients and families facing serious or chronic illness — whatever the diagnosis or prognosis. It prevents and relieves suffering by addressing pain as well as the physical, emotional, psycho-social and spiritual problems associated with serious and chronic conditions. This is the fullest, most inclusive definition of palliative care. If one looks at palliative care as a continuum from diagnosis to death and then bereavement, hospice is part of the palliative care continuum. It shares the same interdisciplinary, holistic focus and philosophy. What is different is that hospice patients must be within six months of death if the disease follows its normal progression and must give up curative treatment.

To be honest, in some settings, a narrower definition of palliative care is used. Most frequently, this occurs because palliative care staffing is limited, or it is viewed as an expense rather than as means of reducing cost while improving outcomes and satisfaction. But even in settings with resource constraints, palliative care works with patients who are not within the “less than six months” window.

Another corollary of this is that palliative care is only in hospitals and hospice is at home. In California and across the nation, this is changing. Between the concepts of the Accountable Care Organization, the Patient Centered Medical Home and CMS’ drive to reduce readmissions, there are a number of initiatives focused on providing both outpatient and community-based palliative care. These are

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initiatives that move outwards from hospital-based systems or upstream from hospices striving to create the continuum from their end. In every system and community, palliative care and hospice each have a role, and work together to keep the focus on addressing the needs of the patient and family and ensuring the best care possible, regardless of setting.

What particularly makes palliative care appealing to many patients, and sadly complicates the referral process for some physicians, is that palliative care goes hand-inhand with curative treatment. The myth that a referral to palliative care means giving up active treatment or, its familiar partner in the eyes of family, giving up hope, needs to be debunked by physicians, nurses and health care providers everywhere. Research1 consistently indicates that palliative care when it accompanies curative treatment enhances its effectiveness. Patients live longer and, as a bonus, are demonstrably more satisfied with the care that they receive2.

Because relief of pain is such a focus for every patient and provider, and palliative care has been successful in this arena, many feel that palliative care is only about pain and physical symptoms. Once again, this is not the case.

If there is “magic” in palliative care, it is made possible by the use of an interdisciplinary team that focuses on both the patient and their family, and not just physical pain but on emotional, psycho-social and spiritual “pains” as well.

One of my favorite palliative care examples is of a physician who at wits’ end called for a consult on a woman with intractable pain from advanced breast cancer. The team, including a Spanish-speaking social worker, talked to the woman and learned that she was concerned about what would happen to her children after she died. She wanted

her children raised by her mother in Mexico not their father in the U.S. Once this was negotiated with the family, her pain was manageable with minimal use of medication.

This is just one story but it is one that happens every day.

Simply by addressing the patient’s emotional needs, along with her physical needs, the need for pain medication was reduced and her quality of life improved. The family is supported and the patient’s satisfaction with her physician’s care improves.

There is one large elephant in the room that remains to be addressed. Some physicians believe that asking for a palliative care consult means giving up caring for the patient. Hence, my comment above about the co-delivery of palliative care with curative treatment complicating referrals for some physicians. With palliative care workforce shortages, increasing demand and limited reimbursement for their services, palliative care teams must of necessity focus on “consulting”. While those who work in palliative care tend to be passionate about the needs of patients and families, and like all human beings their skill at being a consultant versus taking charge may vary, their goal is NOT to take a patient away from their primary provider or even their specialist. Their goal is to ADVISE AND ASSIST health care providers to provide the best care possible. On-going responsibility for care, and the reimbursements associated with on-going care, rightfully remain with the referring provider … unless or until that provider indicates the desire for it to be otherwise.

When I am talking with consumers, I am often asked “Isn’t palliative care just good medical care?” My answer is always “Yes, but...” The concept of attending to a patient’s quality of life is not new. In fact, before the last century, this was largely what medicine was defined to be for those

who developed a serious or chronic illness. Clearly, every physician should always be seeking to ensure optimal quality of life for their patients. The “but” is because sometimes this statement has been made to the consumer by someone who sees no need to refer to palliative care.

This diminishes the role of what is decidedly a specialty area. If we are going to care for the growing number of Americans who have these serious illnesses, then every physician will need to know about palliative care at a generalist level. Every physician will need to know how to have advance care planning discussions, how to discuss palliative care with patients and other basics, as well as where and how to refer as with any other specialist consultation.

But, palliative care is more than just good medical care.

It is about focusing on the care needs of both the patient and the family, and addressing all the various forms of suffering… physical, emotional, psychological, social and spiritual that impede both quality of life, as that patient defines it, and achieving the best possible outcomes for the patient and family. At its very best, palliative care challenges every provider to take their ego off the table, be present to what that patient and their family feels are the optimal goals of care, and then bring the best skills and resources available to achieve those goals. In that, it is more than “just good medical care”, it is the best medical care.  _______________ 1 Reference to the NE Journal of Medicine 2 Add reference About Helen B. McNeal Helen McNeal is the Executive Director of the California State University Institute for Palliative Care at CSUSM. Prior to joining CSUSM, Helen served as Vice President of San Diego Hospice and The Institute for Palliative Medicine (SDHIPM) where she was responsible for all of the operations of The Institute for Palliative Medicine (IPM).

Prior to joining SDHIPM in 2007, Helen was Founder and President of Naria LLC as well as Vice President of Strategic Partners, Inc. During the 1990s, Helen was the National Director of Training & Development for the American Diabetes Association in Washington, D.C.; President, Managing Partner and co-founder of Bridgepoint: The Centre for Human Resource Development in Toronto, Canada.

McNeal is also the co-author of Module IV: Palliative Care of A Comprehensive Guide to the Care of Persons Living with HIV/AIDS. She has consulted with the National Hospice and Palliative Care Organization on state hospice organization initiatives and led a national project to look at end of life care in the American prison system.

In addition to a degree in Business Administration from the University of Michigan, she has done post-graduate study in business, psychology and organizational development.

MEDMONTHLY.COM |13

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Versatile Proteins Could Be New Target For Alzheimer’s Drugs NIH-funded discovery began with asking how the brain learns to see A class of proteins that controls visual system development in the young brain also appears to affect vulnerability to Alzheimer’s disease in the aging brain. The proteins, which are found in humans and mice, join a limited roster of molecules that scientists are studying in hopes of finding an effective drug to slow the disease process.

“People are just beginning to look at what these proteins do in the brain.

While more research is needed, these proteins may be a brand new target for Alzheimer’s drugs,” said Carla Shatz, Ph.D., the study’s lead investigator.

Dr. Shatz is a professor of biology and neurobiology at Stanford University in California, and the director of Stanford’s interdisciplinary biosciences program, BioX. She and her colleagues report that LilrB2 (pronounced “leer-bee-2”) in humans and PirB (“peer-bee”) in mice can physically partner with beta-amyloid, a protein fragment that accumulates in the brain during Alzheimer’s disease. This in turn triggers a harmful chain reaction in brain cells. In a mouse model of Alzheimer’s, depleting PirB in the brain prevented the chain reaction and reduced memory loss.

The research was funded in part by the National Eye Institute, the National Institute on Aging (NIA), and the National Institute of Neurological Disorders and Stroke (NINDS), all part of the National Institutes of Health.

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PirB (red) is heavily concentrated on the surface of growing nerve cells. Courtesy of Dr. Carla Shatz, Stanford.

It is reported in the Sept. 20 issue of Science.

“These findings provide valuable insight into Alzheimer’s, a complex disorder involving the abnormal buildup of proteins, inflammation and a host of other cellular changes,” said Neil Buckholtz, Ph.D., director of the neuroscience division at NIA. “Our understanding of the various proteins involved, and how these proteins interact with each other, may one day result in effective interventions that delay, treat or even prevent this dreaded disease.”

Alzheimer’s disease is the most common cause of dementia in older adults, and affects as many as 5 million Americans. Large clumps — or plaques — of beta-amyloid and other proteins accumulate in the brain during Alzheimer’s, but many researchers believe the disease process starts long before the plaques appear. Even in the absence of plaques, beta-amyloid has been shown to cause damage to brain cells and the delicate connections between them.

Dr. Shatz’s discovery took a unique path. She is a renowned neuroscientist, but Alzheimer’s disease is not her focus area. For decades, she has studied plasticity — the brain’s capacity to learn and adapt — focusing mostly on the visual system.

“Dr. Shatz has always been a leader in the field of plasticity, and now she’s taken yet another innovative step — giving us new insights into

the abnormal plasticity that occurs in Alzheimer’s disease,” said Michael Steinmetz, Ph.D., a program director at NEI. “These findings rest squarely on basic research into the development of the visual system.” NEI has funded Dr. Shatz for more than 35 years.

During development, the eyes compete to connect within a limited territory of the brain — a process known as ocular dominance plasticity. The competition takes place during a limited time in early life. If visual experience through one eye is impaired during that time — for example, by a congenital cataract (present from birth) — it can permanently lose territory to the other eye.

“Ocular dominance is a classic example of how a brain circuit can change with experience,” Dr. Shatz said. “We’ve been trying to understand it at a molecular level for a long time.”

Her search eventually led to PirB, a protein on the surface of nerve cells in the mouse brain. She discovered that mice without the gene for PirB have an increase in ocular dominance plasticity. In adulthood, when the visual parts of their brains should be mature, the connections there are still flexible. This established PirB as a “brake on plasticity” in the healthy brain, Dr. Shatz said.

It wasn’t long before she began to wonder if PirB might also put a brake on plasticity in Alzheimer’s disease. In the current study, she

pursued that question with Taeho Kim, Ph.D., a postdoctoral fellow in her lab, and Christopher M. William, M.D., Ph.D., a neuropathology fellow at Massachusetts General Hospital in Boston. Bradley Hyman, M.D., Ph.D., a professor of neurology at Mass General, was a collaborator on the project.

First, the team repeated the genetic experiment that Dr. Shatz had done in normal mice — but this time, they deleted the PirB gene in the Alzheimer’s mice. By about nine months of age, these mice typically develop learning and memory problems. But that didn’t happen in the absence of PirB. Next, the researchers began thinking about how PirB might fit into the Alzheimer’s disease process, and particularly how it might interact with beta-amyloid. Dr. Kim theorized that since PirB resides on the surface of nerve cells, it might act as a binding site — or receptor — for beta-amyloid.

Indeed, he found that PirB binds tightly to beta-amyloid, especially to

tiny clumps of it that are believed to ultimately grow into plaques.

Beta-amyloid is known to weaken synapses — the connections between nerve cells. The researchers found that PirB appears to be an accomplice in this process. Without PirB, synapses in the mouse brain were resistant to the effects of beta-amyloid. Other experiments showed that binding between PirB and beta-amyloid can trigger a cascade of harmful reactions that can lead to the breakdown of synapses.

Although PirB is a mouse protein, humans have a closely related protein called LilrB2. The researchers found that this protein also binds tightly to beta-amyloid. By examining brain tissue from people with Alzheimer’s disease, they also found evidence that LilrB2 may trigger the same harmful reactions that PirB can trigger in the mouse brain.

“These are novel results, and direct interaction between beta-amyloid and PirB-related proteins opens up welcome avenues for investigating new

drug targets for Alzheimer’s disease,” said Roderick Corriveau, Ph.D., a program director at NINDS. Dr. Shatz said she hopes to interest other researchers to work on developing drugs to block PirB and LilrB2. Currently, no drugs treat the underlying causes of Alzheimer’s disease. Most of the interventions that have reached clinical testing are designed to clear away beta-amyloid.

To date, only two other beta-amyloid receptors (PrP-C and EphB2) have been found and are being pursued as drug targets.  Reference: Kim T, Vidal GS, Djurisic M, William CM, Birnbaum ME, Garcia KC, Hyman BT, and Shatz CJ. “Human LilrB2 is a beta-amyloid receptor and its murine homolog PirB regulates synaptic plasticity in an Alzheimer’s model.”

Science, September 2013. DOI: 10.1126/ science.1242077.

Source: http://www.nih.gov/news/ health/sep2013/nei-19.htm

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Medical-Grade Display Market Soars as Demand Rises in Disparate Regions

The global market for medicalgrade displays is set to rise by nearly 30 percent from 2012 to 2017, driven by positive factors including improving economic conditions, the unleashing of postponed demand and rising sales in Latin America, Europe, the Middle East and Asia.

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Medical-grade display revenue is forecast to rise to $3.2 billion in 2017, up 29 percent from $2.5 billion in 2012, according to the “Medical Displays - World – 2013� report from IHS Inc. (NYSE: IHS), a leading global source of critical information and insight.

The forecast encompasses monitors used for radiology, surgical and patient monitoring purposes. Within the patient monitoring category, the revenue figures exclusively cover monitors employed in central stations, magnetic resonance imaging (MRI)compatible equipment and midrange

to high-end multi-parameter displays.

The majority of the market revenue in the coming years will be generated by patient-monitor displays because they command the highest average selling prices of all products in the market. However, the fastest growth in the medical-grade display market will be generated by the radiology and surgical segments. Revenue for these product segments are set to expand at a compound annual growth rate (CAGR) of 7 percent from 2012 through 2017, compared to about 5 percent for the overall medical-grade display space.

“The medical-grade display market is reaping the benefits of multiple sources of demand,” said Shane Walker, senior manager for consumer & digital health research at IHS. “After years of postponing purchases, U.S. hospitals are seeing their budget constraints loosen up, resulting in rising purchases of equipment, including displays.

However, the rise in demand is actually very broad-based, with multiple developed and emerging regions around the world driving expansion of the market.”

Displays of Health Despite scrutinizing budget increases and seeking ways to limit redundancy in the displays they use, U.S. healthcare providers are upgrading their units that are at the end of their warranty periods.

Meanwhile, Latin American healthcare facilities are engaged in a long-term transition to digital technology. This will spur a continuous rise in demand for monitors from the region in the coming years.

Getting in the Eurozone As the year 2017 approaches, the recovery in Eurozone economies is expected to start to drive demand for medical-grade displays. The recovery is likely to be staggered, with some of the member countries remaining in a state of recession for the next few years.

The southern Eurozone countries, which have been the most affected by the monetary crisis, eventually will emerge as a growth opportunity.

This is because they will increase their adoption of picture archiving and communication systems (PACS) up from currently low levels, a phenomenon that will require the purchase of displays.

The Middle East is also expected to emerge as a major market growth driver in the coming years, with Saudi Arabia and neighboring countries investing in multibillion-dollar research facilities and hospital building projects.

Asian Health Craze The Asia-Pacific region, in particular, continues to exhibit strong growth, due in part to government stimulus programs that contributed to specialty monitor adoption in 2010 and 2011.

While most of the stimulus funds have now been exhausted, the initial spending helped to fuel equipment demand and industry development across the region, which has resulted in continued demand for specialty displays. The comparatively low penetration of specialty displays in Asia-Pacific is a key factor driving its high growth rate. Large segments of the Asia-Pacific market are still in the initial transition phase to higherperformance displays and increased use of digital imaging in medicine.

Display Dispatches Revenue growth in the medicalgrade display market is being boosted by stabilization in average selling prices (ASP). The ASPs, in turn, are being propped up by increasing demand for larger screen sizes and for liquid-crystal displays with newer light-emitting diode (LED) backlighting technology.

Ultrasound is projected to generate the strongest growth of the imaging modality markets during the next

‘‘

“After years of postponing purchases, U.S. hospitals are seeing their budget constraints loosen up, resulting in rising purchases of equipment, including displays. However, the rise in demand is actually very broadbased, with multiple developed and emerging regions around the world driving expansion of the market.”

five years. The relatively low-cost and increasing diversity of the application is driving greater demand for ultrasound systems, including displays.

Also, sales of very-high-resolution mammography displays are offsetting losses from the declining demand for low-resolution monochrome displays.  About IHS (www.ihs.com) IHS (NYSE: IHS) is the leading source of information, insight and analytics in critical areas that shape today’s business landscape. Businesses and governments in more than 165 countries around the globe rely on the comprehensive content, expert independent analysis and flexible delivery methods of IHS to make high-impact decisions and develop strategies with speed and confidence.

IHS has been in business since 1959 and became a publicly traded company on the New York Stock Exchange in 2005. Headquartered in Englewood, Colorado, USA, IHS is committed to sustainable, profitable growth and employs approximately 8,000 people in 31 countries around the world.

Source: http://www.pressreleasepoint. com/medical-grade-display-marketsoars-demand-rises-disparate-regions MEDMONTHLY.COM |17

practice tips

New and Satisfying Type of Medical Practice

By Barbara Hales, M.D. Do you know of a medical practice where: • All the health professionals are smiling all day?

• In a place where they WANT to be?

• Doctors really do make a difference?

• Physicians are not constantly stressed out?

Does this sound like a fantasy? Well, a place like this DOES exist!

Just ask Marion Simon, one of the founders of Volunteers in Medicine of the Berkshires, located in Great Barrington, Massachusetts. She explained, “I feel very fortunate to enjoy my health and healthcare. It was an eyeopener to know that others didn’t have the same healthcare and feel everyone should have access. I feel strongly about paying back to others for having a good life, and being there to help others in their time of need.”

VIM (Volunteers in Medicine) VIM provides a totally free, comprehensive program of primary medical care, women’s health, mental health services, nutrition, optometry, a full range of dental care and acupuncture.

In addition, assistance is given for prescriptions, laboratory services and in-hospital care. Arrangements 18 | OCTOBER 2013

with Fairview Hospital and other local care resources ensure that testing and specialty consultations are available for free. Eligible individuals are referred for enrollment in the Commonwealth Care and Mass Health programs through the Berkshire Health System Advocacy for Access program. Large pharmaceutical companies supply drugs for enrolled patients, much of which is gotten from patient assistant programs (PAP) Many physicians and health personnel are busy with their careers and family. They have not had the time or opportunity to give back in a meaningful way although it is something that is often expressed.

Some doctors, dentists and health providers have active practices elsewhere but volunteer their time at VIM as a way to get involved in the community.

Retired health professionals can keep up with their medical and dental training and feel that they still have a purpose…and make a tremendous difference.

Because VIM accepts NO insurance, NO grants or governmental aid, this healthcare model can work without getting bogged down in truckloads of forms and administrative work…cutting down on expenses and frustration.

The health center depends on volunteer support to operate on a daily basis providing healing with respect

and operating costs are covered through fund raising and charity events. Currently $600,000 is needed and raised annually for operations, over and above the approximate $400,000 supplied through volunteer services. Many committed and skilled volunteers give generously of themselves, their experience and their time.

The diverse range of services is provided in a caring way, integrating a host of problems in one location using crossdisciplinary specialties in the same visit.

Mission and Goal VIM’s mission is to “provide quality healthcare and support in a culture of caring for the working uninsured or unemployed residents”.

The goal is to educate the community to self-manage their health conditions and to transition the healthcare from that of caring for urgent or catastrophic events to that of prevention.

This services us all for improved health decreases lost work time and improves the overall health of the community. “ What raises the quality of life for one of us, raises the quality of life for all”.

VIM’s vision is “May we have eyes to see those rendered invisible and excluded, open arms and hearts to reach out and include them, healing hands to touch their lives with love, and in the process, health ourselves”.

Who Do They Serve?

Patients at VIM are our neighbors, our friends, and those who service us as part of our local community.

These deserving people are hardworking and often have two or three jobs to make ends meet. They beautify our landscaping, clean our homes, farm our produce, work in restaurants and beauty salons, do construction or have part-time jobs. Some are small business owners who bring

in profits sporadically. All are financially challenged and struggling- the unseen, neglected, and forgotten members of our community who are hurting.

When we look around and see beautiful scenery, lush greenery and mountains, lots of culture with Shakespeare Company, The Boston Symphony and many shows with famous actors congregating in the Berkshires for the summer, it is not easy to think of the “subculture” lurking in the shadows- the people in need.

Eligibility Income limits are set at 300% of Federal Poverty Guidelines, which basically means approximately $35,000 per year for a single individual and $70,000/year for a family of four.

Too, VIM fills the gap for the 6 months that people are forced to wait for healthcare after applying for MassHealth.

Many valued lives are lost or compromised each and every day, without this available care.

In these ever-changing times in healthcare when many are voicing a sense of helplessness and frustration, we can help to rid our communities of illness and strife.

Remember when caring for patients brought us a sense of pride and accomplishment? You can get it back again!

There are actually VIMS located in many regions of the country; perhaps even in your locale. Give them a call and extend your helping hand.  MEDMONTHLY.COM |19

practice tips

Your Practice’s

Phone Plan

By Karen Albright Owner/Operater BodyLase Skin Spa www.getbodylase.com

20| OCTOBER 2013

F

or those of us in aesthetic medicine, the person answering the telephone is one of the most important people in our practices. Who would have thought that this person could make the difference between our success and failure? But one of the most important people in your aesthetic medical practice is the person who answers your telephone.

Medspa owners and managers allocate significant funds to advertising campaigns that make their telephones ring. Yet, they often place little value on the importance of who is answering the telephone when it does ring.

According to one study, 94% of most marketing budgets are spent persuading a customer to call but only 6% of these budgets are spent on handling the customer’s call.

Typically, we charge our youngest and least experienced staff members with telephone duty. Yet, this is where we need to place our star players. In this article, we will explore how to create a phone plan with a customer service mindset that will convert more of your phone call inquiries into satisfied, lifelong clients.

YOUR PHONE PLAN An effective telephone staff member needs to do one of two things: 1) book a consultation, or 2) capture the lead’s information so follow-up can occur.

Four key steps will ensure your staff member’s success: 1) create rapport with the caller; 2) capture the lead’s information, 3) book the consultation, and 4) create a follow up plan. Let’s evaluate each step.

1) Create rapport with the caller Make sure the person answering your phone is happy and enthusiastic.

A smile actually comes through the telephone line and is a welcome response to a caller in our sometimes not-so-welcoming world. Your receptionist should be delighted to be

of assistance, proud of the practice, and knowledgeable about your services.

Your telephone staff member should ask the caller open-ended questions about his/her goals. For example, she might say, “Tell me a little bit about why you called us today, Mary.” This simple question can get the caller to really open up and will allow your staff member to create rapport. Your staff member should then try to “relate” to the caller - “I understand how you feel, Mary. I too had that problem and found such relief when I got “X” treatment.” (Note: don’t lie here - your staff member should have experienced all the treatments that you offer!). The rapport that is created through the telephone line can make the difference between a caller booking a consultation or not.

2) Capture the lead’s information It is important to capture the name and phone number of the person who calls your practice. I recommend asking for the caller’s name and phone number immediately. For example, “Yes, I’d be happy to answer your questions about Botox. My name is Karen, may I have your name please?

And can you give me a telephone number in case we get disconnected?”

In addition, your staff member needs to find out how the caller learned about your practice. Without this data, you are at a tremendous disadvantage. You are likely spending a good amount of money on advertising campaigns but will have no way of knowing how effective each campaign is. Moreover, if the caller has been referred by an existing client or colleague, you will certainly want to thank that person for the referral.

Practice management software programs allow for easy tracking of this data.

3) Book the consultation Your telephone staff member should understand that the goal of

every inquiry phone call is to book the consultation, not sell the actual service. The details of the service can be explained at the consultation. Your staff member should always defer to the consultation: “It is difficult to tell you the exact cost of the treatment until we actually see you, Mary. Dr. Smith will be able to give you a firm price when you come in. And, our consultations are free so you can take advantage of that and come in to meet with our physician.”

4) Create a follow-up plan If your staff member is unable to sell the consultation, she should at a minimum capture the lead’s email address. “Mary, we have wonderful email specials that we send out each month. Can I get your email address so that I can add you to our list?” When the email address is captured, it should be entered into the practice’s “drip marketing” program so that emails can be sent monthly and your practice stays top of mind. Remember, clients buy when they are ready, not when you are ready.

In addition, your staff member should ask permission to contact the caller again: “Mary, I understand that you are not ready to schedule a consultation at this time but would it be ok if I called you next week to follow up with you?” Then, your staff member needs to actually put this on her calendar and make the call the following week. Follow up is one of the most crucial aspects of lead conversion.

Conclusion The phone plan detailed above can make the difference between success and failure in an aesthetic medical practice. Invest in your telephone staff members - train them, incentivize them and spend time with them. They are the main conduit for new clients to flow into your practice. Make sure these individuals are prepared to function in this very important role.  MEDMONTHLY.COM |21

practice tips

35 year old Jennifer is pleased with the care and attention that she receives from her dentist, so she routinely refers many of her friends to the clinic. Dr. Norton goes out of his way to understand how each of his new patients found his practice, and for every patient referral, he sends out a signed thank you note to the original referrer. Needless to say, Dr. Norton’s dental clinic has no dearth of patients.

Patient-to-patient referral is one of the most effective ways to build the reputation of your medical practice. If you ignore this golden opportunity, you may be turning your back on a low-investment, high-return strategy to grow your practice. With the intimate integration of social media into our day to day lives, patient referrals have now become more complex and have gained more importance. Word of mouth publicity today is as simple as a Facebook update by one of your patients, praising the care that they received at your office.

Your marketing plan should have special emphasis on maintaining and increasing your referrals. It needs to be cultivated actively, and must meld into the DNA of your practice. Only if you understand the reasons that encourage a patient to refer others to your clinic, can you play an active role in improving this aspect of your marketing plan.

What prompts patient-to-patient referrals?

A survey by ClickFox on Consumer Tipping Points reveal that 52% of disgruntled customers share their unsavory experience with their friends and family, 32% stop dealing with the company altogether, and 60% of consumers are 22 | OCTOBER 2013

INCREASING PATIENT-TO-PATIENT REFERRALS FOR YOUR MEDICAL PRACTICE

influenced by detrimental comments aired on social media.

The fact is that when people have a negative experience, they tell up to 10 people (possibly more, considering social media), and happy customers may share details about their good experience only with 2 or 3 others. The secret behind keeping your referral rates up is to ensure that your patients are satisfied with your service, and to encourage them to talk positively about your practice to their friends and family.

Every single touch-point between the patient and the practice will influence his or her perception about the service. The initial phone call, how they were greeted, whether all their questions were answered, how easy it was to find your office, how long they had to wait for the appointment, the quality of reading material in the waiting room, the demeanor of staff, your bedside manner, and post-visit communications, all play a crucial role in how many points you score in the patient’s mind.

There is a good chance that the patient will refer others to your practice if they had a positive experience. A negative experience may not just lead to the loss of the patient, but also the possibility of all future referrals as well.

A 2012 survey by the C.S. Mott Children’s Hospital National Poll on Children’s Heath reveals that 50% of parents thought that word of mouth is very important when selecting a pediatrician. 25% thought that doctor rating websites are very important, out of which 30% selected a doctor based on good ratings. Younger people are more likely to look you up Yelp or similar services before they decide whether to visit you or not. Referrals

By Nisha Salim

from friends and online reviews, both play an important role in whether the patient decides to walk in your door or not.

Encouraging word-of-mouth referrals Perhaps one of the toughest things for a doctor and his staff to do is to ask a patient to refer others to the practice. But this can be done very naturally by delivering a short, personal message to the patient, and ending it with a request for referrals. Consider what Dr. Norton told Jennifer: “Jennifer, I am pleased to see that you are so thrilled with your smile makeover. I hope you will tell your friends and family about our practice so we may have a chance to help them get great smiles too.”

You may send your patients away with a promotional item like a desktop calendar to show your appreciation. To encourage online reviews, you may also specifically request them to post a review on Google Places, Yelp, or other directories where you are listed. Whenever a new patient comes in, find out who referred them. If it is one of your previous patients, make sure that you thank them.

Blogging to build referrals A blog is a powerful way to build referrals at a very low cost. It is your very own marketing channel, and gives you considerable power and flexibility to position yourself in the best possible light. You can share information about the latest advances in your specialty and answer questions posed by your readers. A blog is a great way to build

authority, and encourage people to visit you or refer your practice to others.

Social media – the new word of mouth You just cannot ignore social media, the new physician referral system. Before a patient walks in for an appointment, chances are that he has tweeted about it or updated his Facebook status. While he waits for the appointment, he has probably checked into FourSquare.

After leaving the clinic, he most likely updates his network about the experience he had. The ClickFox survey reveals that 8% of respondents were more likely to post comments on social media after a positive experience, while 16% are likely to do so after a negative experience. With the average number of 254 social media friends per person (Source: Pew Research Center), you can see how many potential patients a single person can influence.

Medical practices must establish their presence where their potential patients congregate. Set up a Facebook page to let your potential patients see how happy people are to interact with you. They are going to see how invested you are in educating them, and helping them understand things that are important to their health.

People are going to look for more and more convenient ways to select their healthcare service providers. Those who have a head-start in setting up a good online presence, including a website, blog and social media pages, will be the ones that will attract the maximum number of patients.  MEDMONTHLY.COM |23

international

Extensive Research On the Indian Medical Device Market

24| OCTOBER 2013

Bharat Book Bureau presents the new report, on ‘Indian Medical Device Market Outlook to 2017’ India is a land full of opportunities for players in the medical devices industry. The Indian hospital services generated revenue of more than US$ 45 Billion in 2012. This revenue is expected to rise at a CAGR of 20% during 20122017 generating immense possibilities for players in the market. Besides, Indian medical service consumers have become more conscious towards their healthcare upkeep. Thanks to India’s economic growth and a rise in penetration of medical insurance, the 300 Million plus middle class population of India can now afford almost any of its healthcare needs.

Such a scenario presents immense opportunities for players in the medical devices business.

The report, “Indian Medical Device Market Outlook to 2017”, provides an extensive research and in-depth analysis of the current status and future outlook of the Indian medical devices market. The market, which

stood at around US$ 5.1 Billion in 2012, is expected to grow at a rate of around 16% during 2012-2017, representing one of the fastest growing medical devices markets in the world.

Currently, import constitutes almost 70% of the Indian medical devices market. A historical trend analysis of the total import value of medical devices in India shows that despite a depreciating currency, the trend to import has remained positive. For RNCOS’ study, the company analysts have conducted a thorough trend analysis of medical device imports in the country. What medical devices are majorly imported; what are the key drivers behind their import; and what are the challenges that imports of these medical devices face; such and other factors depicting the overall scenario of medical device imports in the country are provided in the report.

Similar facts have been reported for exported and locally manufactured medical devices, providing a complete picture of the Indian medical devices industry. Research findings from the

study will help players in identifying distinct opportunities. They will get an insight on which medical devices are exported to which countries. Also, local players will get to know which medical devices are majorly imported and thus can be intelligently targeted.

In addition to the above, the study delves into the market by categorizing it on the basis of application of medical devices. The major categories covered are Medical and Diagnostic Equipments; Medical Implants; and Medical Disposables and Supplies.

Insights on the current market and future outlook to 2017 will equip companies with business intelligence that will help them align their operations when market grows and thereby maximize earnings.

For more information kindly visit : http://www.bharatbook.com/medicaldevices-market-research-reports/ indian-medical-device-marketoutlook-to-2017.html  Source: http://www.pressreleasepoint. com/extensive-research-indian-medicaldevice-market

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research & technology

26 | OCTOBER 2013

NIH Scientists Pursue New Therapies to Improve Rare Disease Drug Development

Four new pre-clinical drug development projects at the National Institutes of Health will target a form of blindness and diseases characterized by cardiac problems. The projects were selected for their potential to treat specific rare diseases and to help scientists uncover new information that can be shared with other researchers.

The studies will be funded through the Therapeutics for Rare and Neglected Diseases (TRND) program at the NIH’s National Center for Advancing Translational Sciences (NCATS). This group of projects also marks the TRND program’s first use of stem cells as well as its first collaboration with a large pharmaceutical company, Eli Lilly, to co-develop a treatment for a rare disease.

“TRND is grounded in partnerships with academic, government, pharmaceutical and patient advocacy groups. Working in collaboration,

scientists conduct pre-clinical development of new drugs and then advance them to first-in-human clinical trials,” said NCATS Director Christopher P. Austin, M.D. “Like all NCATS programs, TRND seeks to develop new technologies and more efficient paradigms for translation, in the context of important unmet medical needs.”

Two projects employ therapeutic approaches to developing a treatment for retinitis pigmentosa, a severe form of hereditary blindness. A third project focuses on a potential treatment for hypoparathyroidism, a hormonedeficiency syndrome that can lead to cardiac problems and convulsions.

The remaining project aims to develop a possible therapeutic that targets a cardiac disorder associated with LEOPARD syndrome, an extremely rare genetic disease that affects many areas of the body. About 80 percent of patients with LEOPARD syndrome have a cardiac disorder

called hypertrophic cardiomyopathy, which is a thickening of the heart muscle that forces the heart to work harder to pump blood, which can lead to early death.

A rare disease is one that affects fewer than 200,000 Americans. NIH estimates that, in total, there are more than 6,000 rare diseases. However, effective pharmacologic treatments exist for only about 200 of these illnesses.

Private companies often do not pursue new therapies for rare diseases due to the low anticipated return on investment. Through TRND, NCATS advances potential treatments for rare and neglected tropical diseases to firstin-human trials, an approach known as “de-risking.” This strategy can make possible new drugs more commercially viable and attractive to outside partners, who can invest in their further development and additional continued on page 28

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continued from page 27

clinical trials. The new projects are: Long-acting parathyroid hormone analog for the treatment of hypoparathyroidism Henry U. Bryant, Ph.D., distinguished research fellow Lilly Research Laboratories, Eli Lilly and Company, Indianapolis Use of rapamycin for the treatment of hypertrophic cardiomyopathy in patients with LEOPARD syndrome Maria I. Kontaridis, Ph.D., assistant professor of medicine Beth Israel Deaconess Medical Center, Boston Use of retinal progenitor cells for the treatment of retinitis pigmentosa Henry J. Klassen, M.D., Ph.D., director, Stem Cell and Retinal Regeneration Program University of California, Irvine School of Medicine Small molecule pharmacological chaperone for the treatment of retinitis pigmentosa William F. Brubaker, Ph.D., chief executive officer Bikam Pharmaceuticals, Inc., Cambridge, Mass.

The project descriptions are available at http://www.ncats.nih.gov/trndprojects.html.

TRND partners do not receive grants. The collaborative project teams receive in-kind support and gain access to TRND researchers with rare disease drug development capabilities, expertise, and clinical and regulatory resources. Each project has established data-driven milestones to track progress. TRND staff may choose to discontinue projects that do not achieve milestones in the established timeframe. This allows other more promising candidates to enter the program.

“We are particularly excited about this set of collaborative projects for its 28 | OCTOBER 2013

potential to produce treatments for underserved patient populations,” said John C. McKew, Ph.D., acting director of NCATS Division of Pre-Clinical Innovation and director of the TRND program.

A number of early projects fostered

by TRND have reached the stage where partners, such as pharmaceutical, biotechnology or disease groups, are being sought to move the treatments out of TRND and in the next phases of clinical development. Through the program in the last two years, TRND researchers and collaborators have advanced four projects to human clinical trials, evaluating treatments for sickle cell disease, chronic lymphocytic leukemia, hereditary inclusion body myopathy and Niemann-Pick Type C. TRND projects are applied for via a solicitation process, and NCATS currently is accepting applications until September 30, 2013. For more information, visit http://www.ncats. nih.gov/research/rare-diseases/trnd/ apply/apply.html. To read more about TRND, its projects and clinical research studies, see http://www.ncats. nih.gov/research/rare-diseases/trnd/ trnd.html.

The National Center for Advancing Translational Sciences (NCATS) is a distinctly different entity in the research ecosystem. Rather than targeting a particular disease or fundamental science, NCATS focuses on what is common across diseases and the translational process. The Center emphasizes innovation and deliverables, relying on the power of data and new technologies to develop, demonstrate and disseminate improvements in translational science that bring about tangible improvements in human health. For more information, visit http://www. ncats.nih.gov.  Source: http://www.nih.gov/news/ health/sep2013/ncats-12.htm

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research & technology

Bruker Announces the World’s First Preclinical Magnetic Particle Imaging (MPI) System At the 2013 World Molecular Imaging Congress (WMIC, wmicmeeting.org), Bruker announced the world’s first Magnetic Particle Imaging (MPI) system, an entirely new technology for preclinical imaging. The addition of MPI as a complementary preclinical imaging technique for disease studies, translational research and drug discovery, has significant potential in helping researchers gain new insights into disease processes at the organ, cellular and molecular level.

The new Bruker preclinical MPI scanner was developed in collaboration with Royal Philips (NYSE: PHG, AEX: PHIA), in a partnership that combines Bruker’s leadership in analytical magnetic resonance instruments and preclinical Magnetic Resonance Imaging (MRI) with Philips’ strengths in medical imaging. With MPI, Bruker has further expanded its fast growing preclinical imaging product portfolio that includes MRI, PET, SPECT, microCT, optical molecular imaging, X-ray, and now also MPI. MPI is a new medical imaging technology that was invented and developed by scientists at Philips and a proof of principle was first published in the Journal Nature in 2005. The MPI tomographic imaging technique relies on the detection of the magnetic properties of iron-oxide nanoparticles injected into the bloodstream to produce three-dimensional images. The potential of the technology for medical and industrial research and, ultimately, patient care, has been demonstrated in several studies, e.g. MPI technology has been used to produce real-time images that accurately capture the activity in the cardiovascular system of a mouse. Indeed, the ability to acquire high timeresolution images in a matter of milliseconds, allows for novel applications in which temporal resolution is able to 30 | OCTOBER 2013

resolve questions not addressed by many existing imaging techniques.

Dr. Michael Heidenreich, Technical Director of Bruker BioSpin MRI, stated: “We are very pleased about this breakthrough in preclinical imaging and our collaboration with Philips on this exciting technology. Magnetic Particle Imaging is a novel imaging modality that is expected to enable scientists to address an extensive range of new issues in preclinical research. MPI nicely complements Bruker’s preclinical imaging product portfolio of now nine different modalities. The highly sensitive visualization of functional characteristics in vivo at high temporal resolution offers great potential for small animal imaging, especially when combined with high spatial resolution morphological MRI.” “Magnetic Particle Imaging represents a fundamentally new imaging modality with an exceptional ability to image in vivo functional behavior,” said Homer Pien, Chief Technology Officer at Imaging Systems, Philips Healthcare.

“We are particularly excited about its potential for providing new insights into cardiovascular disease, cancer, and stem cell therapies. Going forward, I am convinced that the results from the research studies conducted with preclinical MPI systems will provide valuable guidance for our ongoing development of a whole-body clinical MPI system.”

As part of the collaboration, Bruker and Philips will comarket the new preclinical MPI scanner.

For more information on magnetic particle imaging (MPI), please visit bruker.com/MPI.  Source: http://www.newswiretoday.com/news/134023/

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research & technology

New Medical Device Treats Urinary Symptoms Related to Enlarged Prostate

T

he U.S. Food and Drug Administration authorized the marketing of the UroLift system, the first permanent implant to relieve low or blocked urine flow in men age 50 and older with an enlarged prostate.

The prostate is a walnut-sized gland, in men, that sits below the bladder.

As men age, the prostate can become enlarged, also known as benign prostatic hyperplasia (BPH). When the prostate is enlarged it can restrict or block urine flow. The UroLift system relieves the urine flow by pulling back

32 | OCTOBER 2013

the prostate tissue that is pressing on the urethra.

More than half of all men in their sixties and as many as 90 percent of men in their seventies and eighties have some symptoms of BPH such as more frequent urination with hesitant, interrupted, or weak stream and urgency and leaking. Severe BPH can lead to serious problems over time, such as strain on the bladder, urinary tract infections, bladder or kidney damage, bladder stones, and the inability to control urine (incontinence). Current treatment

options to relieve symptoms associated with BPH include drug therapy or surgical procedures including removal of the enlarged part of the prostate.

“The UroLift provides a less invasive alternative to treating BPH than surgery,” said Christy Foreman, director of the Office of Device Evaluation at the FDA’s Center for Devices and Radiological Health. “This device also may offer relief to men who cannot tolerate available drug therapies.”

The FDA’s review of the UroLift system included data from two clinical studies of men with BPH implanted with two or more UroLift sutures. The first study included 64 men between the ages of 53 and 83, and the second study included 210 men between the ages of 49 and 86. Both studies showed that physicians successfully inserted UroLift in 98 percent of participants.

The studies also measured participant urine flow and ability to empty the bladder, and throughout the study period, found a 30 percent increase in urine flow and a steady amount of residual urine in the bladder. Study participants answered validated questionnaires about their BPH-related symptoms and quality of life, reporting a decrease in symptoms and an increase in quality of life in the two years following treatment.

Minor adverse events reported included pain or burning during urination, blood in the urine, frequent or urgent need to urinate, incomplete emptying of the bladder, and decreased urine flow. Investigators did not report any serious device-related adverse events.

The FDA reviewed the UroLift system through its de novo classification process, a regulatory pathway for some novel low-tomoderate risk medical devices that are not substantially equivalent to an already legally marketed device.  Source: http://www.pressreleasepoint. com/new-medical-device-treatsurinary-symptoms-related-enlargedprostate

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legal

IRS Issues Proposed Regulations on Information Reporting Under the Affordable Care Act

By Amy M. Gordon, Susan M. Nash, and Jacob M. Mattinson McDermott Will & Emery

Recently issued guidance clarifies annual information reporting requirements for insurers and employers under the Affordable Care Act (ACA). The required reporting enables the Internal Revenue Service to determine compliance with the employer and individual mandates and individual eligibility for premium tax credits under the ACA. The Internal Revenue Service (IRS) issued proposed regulations on September 5, 2013, addressing information reporting requirements applicable to employers and insurers under Internal Revenue Code (the Code) Sections 6055 and 6056.

Reporting of Minimum Essential Coverage Beginning in 2014, individuals must generally maintain minimum essential coverage or pay an individual shared responsibility payment with their annual federal income tax return.

The IRS will use information reported under the information reporting requirements of the Affordable Care Act (ACA) to determine individual compliance with the individual shared responsibility requirements and to determine individual eligibility for premium tax credits.

Minimum essential coverage is defined in Code Section 5000A(f) (1), and includes coverage under an 34 | OCTOBER 2013

eligible employer-sponsored plan.

An eligible employer-sponsored plan includes a group health plan or group health insurance coverage offered by an employer to an employee that is a plan or coverage offered in the small or large group market within a state.

Code Section 6055, added by ACA Section 1502, imposes annual information reporting requirements on insurers, employers that self-insure group health plans and certain other providers of minimum essential health insurance coverage. Covered entities will report the required information to the IRS on Form 1095-B, or another form the IRS designates, and to covered individuals through a statement providing the policy number, contact information for the entity and information required to be reported to the IRS. Code Section 6055(a) requires entities providing minimum essential coverage to file annual returns reporting information about the entity and specific

information for each individual for whom minimum essential coverage is provided.

The information these entities are required to report on individuals includes individually identifying information for insured individuals and the months during which each employee was covered by minimum essential coverage for at least one day.

Entities may report birthdates rather than taxpayer identification numbers to identify covered individuals if the entity is unable to obtain a taxpayer identification number after reasonable effort.

Information Reporting by Applicable Large Employers on Health Insurance Coverage Offered Under Employer-Sponsored Plans Code Section 6056, added by ACA Section 1514, imposes annual information reporting requirements on applicable large employers regarding

health insurance the employer provides to its full-time employees. Applicable large employers are generally defined as employers with 50 or more fulltime employees. Code Section 6056 requires applicable large employers that are subject to the employer shared responsibility requirements of Code Section 4980H to file a return with the IRS describing health care coverage the employer provides to its full-time employees, including a list of full-time employees, the coverage offered to each full-time employee and for which months it applied. Entities will report the required information to the IRS on Form 1094-C, or another form the IRS designates, and to each of its full-time employees. The proposed regulations provide potential simplified reporting methods that would serve as alternatives to the general reporting method.

Under the proposed regulations, applicable large employers are only required to report the employee’s share of the lowest cost monthly premium for self-only coverage, because the IRS determines the affordability of employer coverage for premium tax credit eligibility based on the cost of self-only coverage, not on the cost of coverage for the employee and his or her dependents. The IRS will use information obtained under this reporting requirement to determine employer compliance with the ACA’s employer shared responsibility rules and to determine individual eligibility for premium tax credits.

As part of the proposed regulations, the IRS describes various possible administrative simplifications that are designed to reduce or streamline information reporting and cost burdens on employers. The simplifications include: • Allowing employers to report offers of minimum essential coverage on Form W-2 • Eliminating the need to determine an employee’s full-time status if

applicable coverage is offered to all potentially full-time employees • Requiring an employer to report an employee’s cost to purchase employer-sponsored health coverage only when that cost is above a threshold amount • Limiting reporting for employers offering no-cost coverage to employees and their spouses and dependents • Eliminating certain duplicative reporting requirements • Various other simplifications.

Any simplifications the IRS adopts would serve as optional alternatives to the general reporting requirements described above.

The IRS has delayed compliance with the proposed regulations for one year under IRS Notice 2013-45.

The reporting requirements are now effective for tax years beginning in 2015, with the first report due in 2016 for 2015 coverage. The IRS, however, encourages employers to voluntarily comply with the information reporting requirements for 2014. The proposed regulations were published in the Federal Register on September 9, 2013, with written comments to reduce or streamline reporting under the proposed rules due by November 8, 2013.

Next Steps Employers sponsoring group health plans should prepare for compliance with the ACA’s information reporting requirements by reviewing internal administrative processes and systems to generate the necessary reports and determining whether any additional action is needed to bring health plans into full compliance with the ACA to avoid potential penalties.  Source: http://www.mwe.com/ IRS-Issues-Proposed-Regulations-onInformation-Reporting-under-theAffordable-Care-Act-09-11-2013/

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legal

Legal Issues in Keeping Patient’s Credit Card Information on File

By Scott F. Roberts, Esq. Dickinson Wright PLLC

36 | OCTOBER 2013

M

any physicians find credit cards to be the easiest way of accepting payment, and some will even keep their patient’s credit card information on file in case a patient fails to pay their bill. What many of these physicians do not realize, however, is that electronically storing a patient’s credit card information opens them up to a litany of legal issues. While not meant to be exhaustive, this article will briefly run through three issues physicians may face when they retain their patient’s credit card information.

Health Insurance Portability and Accountability Act of 1996 (“HIPAA”)

Credit card information is considered protected health information, or “PHI”, under HIPAA and its implementing regulations when it is stored by a healthcare provider. Specifically, the electronic storage of credit card information by a physician practice raises several legal issues under HIPAA, including issues under both the Privacy Rule and Security Rule. While there are no bright line requirements that physicians must follow to guarantee compliance with HIPAA in the storage of patient credit card information, the Security Rule emphasizes the “reasonableness” of the security measures in place while also setting forth minimum security standards that a healthcare provider must follow. Every practice should already employ HIPAA compliant security measures to protect their electronic PHI, and should make sure that it uses at least equivalent measures to protect electronically stored credit card information so that it satisfies its HIPAA obligations with respect to such information.

Payment Card Industry Data Security Standards

In addition to HIPAA, storing patient’s credit card information will likely trigger Payment Card Industry Data Security Standards (“PCI DSS”). PCI DSS consists of a minimum set of security standards necessary to protect cardholder data. These standards are not issued by a governmental entity but instead apply to businesses pursuant to their contracts with the individual card schemes (e.g. Visa, American Express, Mastercard).

The PCI DSS divides businesses into four tiers depending on the volume and type of transaction processed and imposes different standards on each tier. In addition to the tiered approach, the PCI DSS imposes minimum standards on all businesses that store and process card data electronically, including the installation of a firewall configuration to protect data and the prohibition on the use of vendor supplied default passwords, just to name a few. Businesses that do not comply with these standards can be fined by one of the various card schemes or have their contract canceled.

The Federal Trade Commission Act (“FTCA”)

Physicians who store their patients’ credit card information on file could also potentially be subject to Section 5 of FTCA and analogous state laws. While the FTCA does not explicitly prohibit physicians from storing their patients’ credit card information, Section 5(a) of the FTCA would subject them to liability if the information becomes compromised in certain circumstances. Courts have interpreted Section 5(a) to require companies “employ reasonable and appropriate security measures to protect personal information and files.” Similar to the HIPAA standard, the question of whether a set of security measures is “reasonable and appropriate” is not always clear.

In addition to the security measures requirement, Section 5 of the FTCA has been interpreted to prohibit an entity from charging an individual’s credit card without first receiving their authorization. Section 5 of the FTCA also requires businesses to disclose, or at the very least not obscure, material changes to their billing practices. Thus, physicians who previously accepted payment by credit cards but who now wish to retain a patient’s credit card information for future billings should notify the patient of the change in billing practices and be sure to obtain the patient’s authorization before billing their credit card.  Source: http://www.mintz.com/newsletter/2013/ Advisories/3317-0813-NAT-GOV/index.html

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legal

Federal District Court Orders Food and Drug Administration (FDA) to Produce Records Regarding New Drug Application Pursuant to Freedom of Information Act (FOIA)

By Kelly L. Frey and Elissa Flynn-Poppey Mintz, Levin, Cohn, Ferris, Glovsky and Popeo, P.C.

Sponsors of developmental new drugs may want to take additional steps to protect their trade secrets and confidential information in the wake of a recent federal court decision narrowly interpreting certain exemptions to the Freedom of Information Act (“FOIA”).1 On August 6, 2013, the United States District Court for the Central District of California ordered the United States Food and Drug Administration (the “FDA”) to release unredacted versions of safety and efficacy records regarding a new drug application, finding that the new drug’s sponsor faced no current or immediate threat of future competition.

The decision addressed a motion for 38 | OCTOBER 2013

summary judgment by the FDA, which argued that safety and efficacy records related to a new HIV pre-exposure prophylaxis (“PrEP”) drug should be protected from disclosure pursuant to FOIA Exemption 4, exempting disclosure of “trade secrets and commercial or financial information.”3 The court rejected the FDA’s argument and, instead, entered summary judgment sua sponte in favor of the plaintiff, ordering the FDA to produce complete and unredacted copies of the safety and efficacy records.4 In so holding, the court rejected the FDA’s argument that the drug’s sponsor faces actual competition in the “extremely competitive” market for HIV drugs. Specifically, the court

found that the sponsor “currently faces no competition in the PrEP market, because no other drug has been approved by the FDA for such use, and no such drugs are in advanced clinical trials.”5 Similarly, the court found that the FDA failed to adduce specific, admissible evidence that future competition will exist between the sponsor and other companies working to develop competitive PrEP drugs.6 The FDA did, however, produce sufficient evidence to show that actual competition existed in the broader non-PrEP HIV treatment market, of which the sponsor was a part.

Despite this showing, the court still found that FOIA Exemption 4 would not protect the sponsor’s safety and

efficacy records because the FDA failed to demonstrate that the sponsor would suffer substantial competitive harm if those records were disclosed. Specifically, the court reasoned that “the FDA has adduced no evidence explaining how disclosure of [the sponsor’s] application of statistical methods it developed to analyze specific ‘non-traditional’ datasets generated by third-party PrEP studies could be used by its competitors to its disadvantage outside the PrEP context.”7 If this decision is not overturned,8 it will be of critical importance for sponsors of developmental new drugs seeking to protect their trade secrets and confidential information. Before disclosing such information to the FDA, sponsors should carefully scrutinize the competitive landscape for their new drugs to ensure that their confidential information will be adequately protected. Failure to do so may result in sponsors’ forfeiting protection of crucial commercial information and enable competitors to use such information to obtain approval for their own competitive new drugs.  ___________ 1 Freedom of Information Act, 5 U.S.C. § 552 et seq.

2 AIDS Healthcare Foundation v. United States Food and Drug Administration, No. CV 11-07925 (C.D. Cal. Aug. 6, 2013).

3 5 U.S.C. § 552(b)(4).

4 AIDS Healthcare Foundation, No. CV 1107925, 2013 at 21.

5 Id. at 11-12.

6 Id. at 12-13.

7 Id. at 20.

8 The FDA may consider an appeal of the decision. See Alexander Gaffney, AIDS Group Wins Bid to Obtain ‘Confidential’ Data Analysis, Summaries About HIV Drug from FDA, Regulatory Focus, Aug. 8, 2013 (available athttp://www.raps.org/focusonline/news/news-article-view/article/3918/ aids-group-wins-bid-to-obtain-confidentialdata-analysis-summaries-about-hiv-dr.aspx) (last visited Aug. 21, 2013).

Source: http://www.mintz.com/ newsletter/2013/Advisories/3317-0813-NATGOV/index.html

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features

MIND OVER MECHANICS

By Deane Morrison University of Minnesota

How thoughts can control a flying robot It’s a staple of science fiction: people who can control objects with their minds.

At the University of Minnesota, a new technology is turning that fiction into reality.

In the lab of biomedical engineering professor Bin He, several young people have learned to use their thoughts to steer a flying robot around a gym, making it turn, rise, dip, and even sail through a ring.

The technology, pioneered by He, may someday allow people robbed of speech and mobility by neurodegenerative diseases to regain function by controlling artificial limbs, wheelchairs, or other devices.

And it’s completely noninvasive: Brain waves (EEG) are picked up by the electrodes of an EEG cap on the scalp, not a chip implanted in the brain.

40 | OCTOBER 2013

A report on the technology has been published in the Journal of Neural Engineering.

“My entire career is to push for noninvasive 3-D braincomputer interfaces, or BCI,” says He, a faculty member in the College of Science and Engineering. “[Researchers elsewhere] have used a chip implanted into the brain’s

‘‘

“I think the potential for BCI is very broad. Next, we want to apply the flying robot technology to help disabled patients interact with the world. It may even help patients with conditions like stroke or Alzheimer’s disease. We’re now studying some stroke patients to see if it’ll help rewire brain circuits to bypass damaged areas.”

scalp electrodes of the EEG cap report the signals (or lack of signals) they detect to a computer, which translates the pattern into an electronic command. Volunteers first learned to use thoughts to control the 1-D movement of a cursor on a screen, then 2-D cursor movements and 3-D control of a virtual helicopter.

Now it’s the real deal, controlling an actual flying robot—formally, an AR [augmented reality] drone. He’s computers interface with the WiFi controls that come with the robot; after translating EEG brain signals into a command, the computer sends the command to the robot

by WiFi. motor cortex to drive movement of a cursor [across a screen] or a robotic arm. But here we have proof that a noninvasive BCI from a scalp EEG can do as well as an invasive chip.”

Mapping the brain He’s BCI system works thanks to the geography of the motor cortex—the area of the cerebrum that governs movement. When we move, or think about a movement, neurons in the motor cortex produce tiny electric currents.

Thinking about a different movement activates a new assortment of neurons.

Sorting out these assortments laid the groundwork for the BCI, says He. “We were the first to use both functional MRI and EEG imaging to map where in the brain neurons are activated when you imagine movements,” he says. “So now we know where the signals will come from.”

The brain map showed that imagining making fists— with one hand or the other or both—produced the most easily distinguished signals.

“This knowledge about what kinds of signals are generated by what kind of motion imagination helps us optimize the design of the system to control flying objects in real time,” He explains.

Tapping the map Monitoring electrical activity from the brain, the 64

Future directions The journal article describes how five men and women learned to guide the flying robot. The first author is Karl LaFleur, who was a senior biomedical engineering student during the study.

“Working for Dr. He has been a phenomenal experience,” says LaFleur, who plans to put his knowledge to use when he enters the U’s Medical School next year.

“He has so much experience with the scientific process, and he is excellent at helping his students learn this process while allowing them room for independent work.

Being an author on a first-person journal article is a huge opportunity that most undergraduates never get.”

“I think the potential for BCI is very broad,” says He. “Next, we want to apply the flying robot technology to help disabled patients interact with the world.

“It may even help patients with conditions like stroke or Alzheimer’s disease. We’re now studying some stroke patients to see if it’ll help rewire brain circuits to bypass damaged areas.”

The YouTube Video can be viewed at either http://www. youtube.com/watch?v=6LWz4qa2XQA&feature=youtu.be or http://www.youtube.com/watch?v=rpHy-fUyXYk  Source: http://www1.umn.edu/news/features/2013/ UR_CONTENT_444147.html?utm_source=youtube&utm_ medium=uofmn&utm_campaign=social-media MEDMONTHLY.COM | 41

features

CLINICAL TRIALS AND NETWORK META-ANALYSIS (NMA): SIDE BY SIDE

By Goran Medic, Feike van der Scheer, Eline Huisman, Gert Bergman Mapi - HEOR & Strategic Market Access, The Netherlands www.mapigroup.com

42 | OCTOBER 2013

Drug development is a term used to define the process of bringing a new drug to the market when a new molecular entity has been identified through the process of drug discovery.(1,2) The drug development phase is followed by the regulatory approval phase (marketing authorization). Once the drug is on the market, market access is the fourth hurdle that it needs to overcome. Once the drug is approved and reimbursed the standard lifecycle processes like marketing, sales and pharmacovigilance (monitoring of adverse drug reactions) are implemented.

INTRODUCTION In contrast to what is commonly believed, drug development is not limited to preclinical development (in laboratories, animal experiments) and evaluation in clinical trials (human subjects). Drug development may include the process of obtaining regulatory approval to market the new compound. In order to bring a single new drug to the market, companies are screening and synthesizing between 5 and 10 thousand candidate compounds in the drug discovery process. Most of these compounds get discarded at early stages, but some get further up the ladder. In drug development, all parameters of the future drug (safety, pharmacokinetics, pharmacodynamics, mechanism of action) are assessed prior to exposure to humans in clinical trials. The most important features of a new drug are that it is effective (i.e. treats a disease) and that it is safe. On average out of 10,000 newly synthetized molecules about 250 show promise for pre-clinical research, of which only 10 qualify for tests on humans.(3) This huge number of compounds initially screened translates into high costs to only identify a possible drug candidate.

CLINICAL TRIALS AND NETWORK META-ANALYSIS (NMA) Clinical trials are sets of tests in medical research that provide data about quality, safety and efficacy of a new drug. They are intended to explore or verify the effects of one or more investigational drugs.(4) Clinical trials are actually designed for regulatory purposes, to evaluate quality, safety and efficacy of a new drug. For the purpose of market access and reimbursement different questions need to be addressed, such as: does the drug have added clinical value to the ones already on the reimbursement lists, what is the budget impact of the new drug, etc?

However, the whole drug-lifecycle, from its discovery through marketing authorization till its withdrawn from the market is not just complex and long, but extremely expensive too. A study estimated the costs of bringing a new drug to the market at approximately US$800 million.(5) Estimates in other studies ranged from US$500 million to US$5 billion depending on the disease, therapy and/or the developing company.(6,7,8) Pharmaceutical companies need to enrich their pipelines with new branded compounds, but are faced with hurdles to bring those compounds on the market, including rising costs for clinical trials and more evidence. According to a recent survey, rising costs occur across all phases of clinical trials, because of increasing competition for trial sites and clinical research organizations that can yield reliable, high quality data.(6,9) For the purpose of marketing continued on page 44 MEDMONTHLY.COM |43

continued from page 43

authorization, new innovative drugs are often compared with placebo or standard therapy, but not against all available treatment options.

In an era of evidence based medicine, where more and more data is required before a drug may enter the market and more clinical trials are needed to generate data, it may be wise to explore other possibilities to obtain data for reimbursement submissions.

What could pharmaceutical companies actually do to collect as much evidence as possible to ensure the market access of the new drug?

A good solution could be a network meta-analysis (NMA). But what is NMA exactly?

Network meta-analysis, in the context of a systematic (literature) review, is a meta-analysis in which multiple treatments (three or more) are being compared using both direct comparisons of interventions within randomized controlled trials and indirect comparisons across trials based on a common comparator (active treatments or placebo).(10) NMA therefore compares results from two or more studies that have one treatment in common. The benefit of NMA lies in the fact that the relative efficacy and/or safety of a particular drug versus its competitors can be obtained in the absence of head-to-head evidence. Using NMA enables simultaneous comparisons of virtually all drugs available on the market to treat a disease.

A simple example of a NMA would be the following: an initial trial compares drug A to drug B. A different trial studying the same patient population compares drug B to drug C (see Figure below).

We could assume that drug A is found to be superior to drug B in the first trial and drug B is found to be equivalent to drug C in a second trial. Since drug A is better than drug B, and drug B is equivalent to drug C, drug A is

44 | OCTOBER 2013

also better than drug C even though there is no clinical trial directly comparing these two drugs. On the basis of statistical inference, a NMA of these two trials would allow a researcher to conclude that treatment option A is more effective than option C, even though the two options have never been directly compared.(11) Randomized controlled trials (RCTs) are considered as the gold standard of evaluating the efficacy and safety of a new drug compared to other drugs. However, when the available clinical trials do not compare the same drugs to each other, it is possible to develop a network of RCTs where all trials have at least one drug in common with another one. Such a network allows for indirect comparisons of drugs not studied in a head-to-head fashion.(12) In that aspect, NMA is different from classical pairwise meta-analysis in the sense that there is not only one type of treatment comparison (drug A versus B), but multiple treatment comparisons (drug A versus B, B versus C and A versus C). Since NMA allows for using a larger evidence base in the analysis, the drug can be evaluated in a broader spectrum than is possible with a single pairwise meta-analysis, which often offers a fragmented picture of the drug’s performance.(13) A NMA combines multiple studies and makes statistical comparisons in a similar manner as done within a RCT. NMA results are more likely to be valid when analyzing studies with a similar study design and similar patient populations. Indirect estimates obtained with a NMA might be preferable to the estimates obtained by pairwise meta-analyses since the analysis is based on a broader evidence base.(14,15) However, the broader evidence base is also counterbalanced with a risk of introducing bias.

The purpose of NMA is not to reduce costs of RCTs or to diminish the value of clinical trials, but to make a larger evidence base for everybody (clinicians, pharmacists, regulatory agencies like FDA) to make informative decisions.

NMA simply informs decision problems and it might provide insight why some treatments are better than the others. These insights might trigger further research and development programs and even better care for patients. One example of the insights are treatment gaps that include complex relationships among culture, environment, population genetics, drug metabolism, and drug response which could be missed/ overlooked in one single clinical trial, but in a NMA these issues would become apparent. Increased awareness of coexisting conditions and a better use of knowledge regarding patient

response factors that impact the effectiveness and safety of drug therapy are just some examples of treatment gaps.

CONCLUSION Clinical trials are certainly the gold standard to assess the efficacy and safety of a treatment compared to other treatments.(13) NMA allows for simultaneous indirect comparison of all available treatments, incorporating more data in the analysis ensuring optimal use of all available evidence. Comparisons of all available treatment options would be very useful to pharmaceutical companies as much as to clinicians to make informative decisions about the treatment of patients. The final costs for drug development and clinical drug evaluations are extremely high and cost reductions would be beneficial to all stakeholders.

However, expanding the evidence base is crucial. In the absence of RCTs of all available treatments, or combined with RCTs, NMA would provide useful evidence for selecting the best choice of treatment and should therefore be used more often to inform decision making. NMA cannot replace clinical trials, but can complement them and can help in generalizability of the findings from the RCTs (efficacy to effectiveness). 

10. Li T, Puhan MA, Vedula SS, Singh S, Dickersin K; Ad Hoc Network Meta-analysis Methods Meeting Working Group. Network meta-analysis-highly attractive but more methodological research is needed.BMC Med. 2011 Jun 27; 9:79.

11. http://www.mapigroup.com/Services/EvidenceSynthesis/Indirect-Treatment-Comparison-NetworkMeta-analysis 12. Caldwell DM, Ades AE, Higgins JPT: Simultaneous comparison of multiple treatments: combining direct and indirect evidence. BMJ 2005, 331:897-900 13. Jansen JP, Naci H.Is network meta-analysis as valid as standard pairwise meta-analysis? It all depends on the distribution of effect modifiers. BMC Med. 2013 Jul 4; 11:159.

14. Lu G, Ades AE: Assessing evidence inconsistency in mixed treatment comparisons. J Am Stat Assoc 2006, 101:447-459.

15. Higgins JPT, Jackson D, Barrett JK, Lu G, Ades AE, White IR: Consistency and inconsistency in network meta-analysis: concepts and models for multi-arm studies. Res Synth Methods 2012, 3:98-110.

Corresponding author: Goran Medic, gmedic@mapigroup.com

REFERENCES

1. Clinical Trials Handbook. Shayne Cox Gad (2009).

John Wiley and Sons. p.118. ISBN 0-471-21388-8 2. Curtis L. Meinert, Susan Tonascia (1986). Clinical trials: design, conduct, and analysis. Oxford University Press, USA. p. 3. ISBN 978-0-19-503568-1.

3. Stratmann, Dr. H.G. (September 2010). “Bad Medicine: When Medical Research Goes Wrong”. Analog Science Fiction and FactCXXX (9): 20.

4. Clinical Trials in Humans -http://www. ema.europa.eu/ema/index.jsp?curl=pages/ special_topics/general/general_content_000489. jsp&mid=WC0b01ac058060676f 5. DiMasi, Joseph A.; Hansen, Ronald W.; Grabowski, Henry G. (March 2003). “The price of innovation: new estimates of drug development costs”. Journal of Health Economics 22 (2): 151–185.

6. Adams C, Brantner V (2006). “Estimating the cost of new drug development: is it really 802 million dollars?”.

Health Aff (Millwood) 25 (2): 420–8.

7. Adams, Christopher Paul; Brantner, Van Vu (February 2010). “Spending on new drug development”. Health Economics 19 (2): 130–141.

8. Pharma & Healthcare. 8/11/2013. The Cost of Creating A New Drug Now $5 Billion, Pushing Big Pharma To Change 9. Silverman E (2011), “Clinical Trial Costs Are Rising Rapidly” Pharmalot http://www.pharmalive.com/ clinical-trial-costs-are-rising-rapidly.

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features

Reality:

Mind-controlled Limbs

They’re Here!

By Laura Maaske Med Monthly Staff Illustrator, Writer and Journalist

An early September morning, apples ripe out my window. I was speaking with Dr. Albert Chi, a pioneering surgeon for advanced prosthetics procedures at the Trauma Motor Control Research Division of Trauma and Critical Care, Johns Hopkins. Dr. Chi has been perfecting a surgical technique, called TMR, Targeted Muscle Reinnervation, for patients who have lost most of their upper limbs. Patients include those who have lost their arms to amputation above the level of the elbow, and also patients who have experienced shoulder disarticulation. Historically, for those people with injuries above the elbow, recovering function has been a greater challenge than for those with injuries below the elbow. This is because the nerve signals traveling to the missing limb after amputation cannot even be detected by conventional myoelectrical devices.

The new surgical procedure Hopkins offers, and its accompanying prosthetic technology, has become a reality more rapidly than it was imagined even a year or two ago. It was projected for perhaps 2016. Back in 2006, The Defense Advanced Research Projects Agency, DARPA, launched the Revolutionizing Prosthetics program with two objectives to improve upper limb prosthetics. Until this point lower limb prosthetics were advancing well. But upper limb prosthetics required a more technologically sophisticated approach, less mechanical and more capable of accessing cortical signals. DARPA suggested two challenged to be solved. One strategy for patients with high level nerve damage offering direct brain control.

And another option for those with above the elbow amputees for surface control by targeting motor signals.

The engineers and surgeons at the Johns Hopkins Applied Physics Laboratories took up this challenge and made both strategies real.

46 | OCTOBER 2013

Targeted Motor Signals My call to Dr. Chi was to understand this second strategy: accessing motor signals. With this strategy it is now possible for patients to control an artificial limb with their own thoughts: thoughts originating in the cerebral cortex. And while the areas supplying motor impulses from the cerebral cortex are often highly degraded in the months following injury, the Johns Hopkins experts are finding that these cortical areas are remarkably plastic and offer great potential for rebuilding those neural signals.

Cortical signals passed through peripheral motor nerves, they are adjusted with surgery, and they are targeted so their impulses are picked up by EMG electrodes outside the body, in the socket of the prosthesis.

Speaking with Dr. Chi, and later, Dr. Francesco V. Tenore, Project Manager at Biological Sciences and Engineering Group, Johns Hopkins Applied Physics Laboratory, I was curious to learn how the signals from the brain actually translate to a movement in this futuristiclooking robotic limb I’d seen in photo images.

Popular Mechanics prediction, made in 2012

Step 1: Channeling the Whole Signal Targeted muscle reinnervation surgery is where the revolutionary solution begins. Dr. Todd Kuiken first proposed the idea of the surgery, working at the Rehabilitation Institute of Chicago, Center for Bionic Medicine. Now Dr. Chi is one of a few surgeons in the country performing this technique. Targeted muscle reinnervation is a procedure which reassigns nerves to residual muscles that are still intact. Dr. Chi finds and tests for viability of the available nerve endings that remain in amputated muscle tissue. Then he does a coaptation of the neural wiring which will allow the nerve signals to rerouted. If necessary, larger nerve trunks are cut and reassigned to underutilized muscles which will be better able to transmit this neural signal at skin sites around the amputation. The larger the signaling from the originating tissue, the more viable and rich the output signal will be available. After the surgery and with the fitting of the prosthetic, these signals will then be detected at the input region of the modular prosthesis and translated to output EMG electrodes.

There are no electrodes placed in the tissues of the body or under the skin. There are no foreign materials placed in the body at all during Dr. Chi’s procedure. All the electrical and processing components have been fitted to the modular prosthetic itself. What he’s creating offers a noninvasive method for advanced control of myoelectric devices: the robotic arm.

Photo Courtesy of Albert Chi

Step 2: Amplifying the Nerve Impulse The sensory nerves in the skin of a patient who has experienced amputation will retain their “knowledge” or “awareness” of the region they originally offered sensory information through. Let’s say you touch a particular and consistent place on the amputated trunk of a person who has lost their limb. When you touch there, the patient

Targeted Muscle Re-innervation: a reassigning of the nerves to residual muscles that are still present. will perceive that touch as occurring in the region that the nerve originally targeted, such as the tip of the pinky finger, or, the palm-side of the lower thumb. Peripheral nerve awareness by these higher-level nerves create a map of the missing limb. This mapping is felt by the patient and often referred to as a phantom limb. As Dr. Chi says, “Our patient can perceive up to 90% of the sensory awareness being returned to his skin via the prosthetic.” That’s an remarkable retention of the distal awareness a nerve can carry. It means that sensors in the prosthetic can send signals to vibratory tactors in the socket of the prosthesis, so that patients will actually perceive their fingers, their artificial fingers, as feeling touch. This capability is still in its early stages. Stimulation is being offered from the thumb and the pinkly of the prosthetic. And two kinds of touch can be picked up: hard and soft objects. In total, then there are four sensory inputs available to patients presently, in this early stage of the technology. As the surgery advances, there is every reason to believe that more inputs will become possible.

Researchers like Dr. Francesco V. Tenore, current Project Manager at the Biological Sciences and Engineering Group, use this sensory awareness to enhance the digital algorithms. Signals are detected by EMG electrodes from the muscles on the surface of the skin around those muscles. The nerve signals are collected by electrodes in the socket of the modular prosthetic. Algorithms, designed and refined by engineers, are integrated with the processor. The processor, nested in the palm of the prosthetic hand, integrates these algorithms, decodes the nerve signals emerging from the muscle to the skin, and produces a control signal to actuate the appropriate region of the prosthetic hand. The signal being produced here is adjusted, continually as necessary, based on each patient’s functional needs. That output signal is refined based on how that patient’s cortex and muscles are learning to respond and feed signals to and from the prosthetic.

As Dr. Chi stated, “Just 15 years ago algorithms for this amplification would need to run the code for 24 hours.”

That’s how long it would take the signal to process input and send it to the computing device. So much has changed since then. continued on page 48 MEDMONTHLY.COM | 47

continued from page 47

Capability this sophisticated is made possible by many contributors over time. Dr. Chi offered credit to many researchers who came before him. One is Colonel Geoffrey Ling, Defense Advanced Research Projects Agency (DARPA), who led the project for Revolutionizing Prosthesis (RP) at Johns Hopkins. He was the first to bridge the gap between the viable tissue in a patient’s arm and the modular prosthetic limb. He conceived and developed a device that can be replaced to every level, with sensors feedback pressure and temperature.

Step 3: Processing of the Signal to the Myoelectrical Device Signals sent to the socket of a modular prosthetic are collected by at least 8 electromyography (EMG) electrodes and then relayed to a processor in the palm of the hand of the modular prosthetic device. Processing is handled by algorithms available in a commercially available and customizable processor. The patterns and algorithms are established and modified by computer input, and adjusted with time for each individual patient’s changing needs.

Signals generated are not only different between people, but may be different in different sessions with the same patient.

What’s even more amazing is that with greater practice and customized modulation of the signal impulses, patients and the modular prosthetic “learn” to work well together. Input loops and feedback loops work together.

The algorithms are studied by scientists at Hopkins, so that Dr. Albert Chi delicate signals from the viable muscle in patients can be transferred to an accurate reading of the user’s thoughts. When this nerve ending stimulates the innervated muscle and the muscle signal is collected by the EMG electrode, then the algorithm decodes the patient’s intent by executing the desired action through the modular prosthesis. And, as Dr. Chi says, “Because of increasingly sophisticated computer-generated algorithms, we’ve had constant modification and upgrading of these algorithms.”

As physical therapy accelerates the recovery of a patient’s mobility, feedback from therapists provides guidance for the continued adjustment of the algorithms that allow a patient to more effectively utilize their prosthetic.

48 | OCTOBER 2013

What Next?

Tremendous collaboration among experts in the medical, scientific, and engineering community led to these cutting-edge technologies now available for brain and muscle control of the modular prosthetic. Dr. Chi expects that in the future he will be conducting smaller and smaller nerve branch divisions, to be divided from large bundles. He expects a greater capability to route and reroute surrogate sensory areas. This will offer more sophisticated targeting of those nerve ends. Naturally, he expects the algorithms to become more sophisticated with feedforward and feedback loops. He expects more isolated and sensory feedback to be harnessed. Dr. Chi hopes for improvements that will prevent neuromas and to regenerate the nerves themselves. “We still don’t have great methods for regenerating nerves that are already damaged,” Dr. Chi reminds.

Patients will actually perceive their artificial fingers as feeling touch, as their natural fingers had felt prior to injury

A Note to Every Physician Dr. Chi emphasizes that no patient should now be overlooked. No matter how high the level of amputation above the elbow, and no matter what the cause of the limited limb function, no patient should be excluded from the possibility of a functioning modular prosthetic. Physicians who are aware of potential candidate patients can contact the Johns Hopkins research center.

Albert Chi, MD, Assistant Professor of Surgery Phone: 443-287-0618 l Email: achi3@jhmi.edu  Author information: Laura Maaske, Medimagery Medical Illustration & Design info@medimagery.com http://www.medimagery.com/ http://www.linkedin.com/in/lauramaaske http://twitter.com/#!/Medimagery http://www.facebook.com/Medimagery http://www.facebook.com/laura.maaske MEDMONTHLY.COM | 49

the arts

Scull on the Delaware

20” X 24” oil on linen

Painting With Feeling

By Thomas Hibbard, Creative Director, Med Monthly

“My life is an open book” states Jan Lipes and one has only to view his paintings to observe that the artist puts a little of himself in each of his pieces.

Lipes was an emergency physician at Doylestown Hospital. After being diagnosed with multiple sclerosis in 1983, he continued, even from his wheelchair, to work as an ER physician until 1993.

He had always had an interest in art. While in pre-med, he had minored in Art History and had attended a summer workshop at the Art Students League in Woodstock. In 1991 Jan began painting as a Sunday painter, and by 1993, was painting full time.

Jan Lipes is a self-taught painter who has faced many 50 | OCTOBER 2013

obstacles in the pursuit of his art. Multiple sclerosis had confined him to a wheelchair and had denied him the use of his right side. He is right handed and had to train himself to use his non-dominant left hand to hold the brush, from the very beginning of his painting career in 1991. He studied color and brush techniques, then plunged wholeheartedly into his work using his rich knowledge of art. He started as a plein air painter, setting up his paints outdoors on location with the assistance of his wife, Janet, to paint his colorful landscapes. In recent years he has begun more studio painting because of the different subject matter, materials, and techniques. His subject matter includes still lifes, figures and abstract paintings.

Brantome

20” X 20” oil on board

Jan’s works focus on the Bucks County area of Pennsylvania and in Hunterdon County, New Jersey, particularly scenes along the Delaware River. And annually he travels to France to do some plein air painting.

He painted mainly in oil until about two years ago when he started to paint in acrylic. Acrylic dries more rapidly than oil and he likes the way it increases his tempo. Jan is eclectic in his approach, sometimes painting in washes and other times using a heavier coverage like a traditional oil painting, depending on the subject and what it is dictating to him. As he has matured, Lipes now approaches his paintings using more intuition and a little less intellect. Logic still plays its part in composition, but is now less important in the final work, allowing him more freedom to express himself. Jan does not consider himself from any particular school of painting or style. His paintings are sometimes impressionistic, sometimes realistic, and sometimes abstract. He paints what he has interpreted in his mind

‘‘

“Painting is a continuous epiphany. It’s my language.

It’s what I do and why I’m here.”

Orange 18” X 24” acrylic on canvas

of his subject matter, then incorporates what he is feeling at the time, making each of his pieces unique and heart-felt.

Lipes says, “Painting is a continuous epiphany. It’s my language. It’s what I do and why I’m here.”

Jan has had numerous exhibitions, has 10 awards for his work, and 11 one-man shows. This includes a one-man show at the Gallery & Conservation Studio in Doylestown PA annually, the Sienkiewicz Award for Traditional Painting in the Style of the New Hope School from The Phillips Mill 79nd Annual Juried Exhibition and the New Hope Art and the River award from the Michener Art Museum. To see more of his work, please visit his web site at http://www.janlipes.com. Also view a video of Jan’s story at http://www.youtube.com/watch?v=zdI6xd0XzCU.  MEDMONTHLY.COM |51

healthy living

Ingredients: 1 cup natural creamy peanut butter (preferably organic) 1/3 cup honey or agave 4 egg whites 1/4 teaspoon sea salt (*if using unsalted peanut butter) 1/2 teaspoon baking soda 1/2 cup dark chocolate chips

Flour-less Peanut Butter Chocolate Chip Blondies

By Ashley Acornley, MS, RD, LDN

Preparation: 1. Preheat oven to 350F and grease an 8� square pan with butter or coconut oil.

2. In a small bowl, mix the peanut butter, honey, egg, salt and baking soda until well combined, then fold in the chocolate chips.

3. Pour the batter into the greased pan, and use a spatula to smooth the top.

4. Bake at 350F for 20-25 minutes, or until the top is a light golden brown. (it only took 20 minutes in my oven)

Let cool, then cut into squares and serve!

52 | OCTOBER 2013

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healthy living

CIDER BRINED AND SMOKED GAME HENS

By John Ash This brine works equally well with chicken or turkey. Brining is sort of a magical process that adds both flavor and moistness to the meat.

In this recipe I’m using a covered barbecue to both cook and smoke the birds. You want to make sure to use the indirect heat method (described below) in the barbecue and monitor both temperature of the barbecue and the birds with a thermometer.

The objective is to cook the birds slowly enough so that they can pick up a rich smoky flavor and you also want to be sure that they are cooked through before removing them.

Woods Chips for Smoking

Ingredients For the Brine:

1 quart apple cider 1/2 cup sodium reduced soy sauce 1 cup brown sugar 3/4 cup kosher salt 6 cups water 2 medium oranges, sliced 1/2 cup coarsely chopped ginger 1 or 2 whole star anise 2 tablespoons chopped garlic 3 whole bay leaves 6 whole game hens, split with backbones removed Olive oil

Add the apple juice, soy sauce, sugar, salt and water to a saucepan and bring to a simmer stirring all the time to dissolve the sugar and salt. Add the oranges, ginger, star anise, garlic and bay leaves and simmer for a minute or two then remove from heat and cool. Using a large zip lock bag or two, squeeze out as much air as you can before zipping closed. Refrigerate for at least 4 hours and up to 12, turning occasionally.

Prepare the grill using the indirect heat method below and also the smoking wood of choice.

Remove the hens from the brine and pat dry. Brush hens liberally with olive oil, place on grill and cook/ smoke until done. Birds should reach an internal temperature of 160 degrees in the thickest part of the meat. Depending on heat of barbecue it should take approximately 40 minutes. Let birds rest loosely covered in foil for at least 5 minutes before carving.

The Indirect Heat Method With this method you want to cook the food with the heat source off to the side. It’s essential that you have a grill with a good tight fitting lid so that the heat, as it rises, can bounce off the lid and the inside surfaces of the grill to slowly cook the food evenly on all sides. It’s the preferred method for cooking large cuts of meat and whole birds. The method is simple. You first put a drip pan in the center of the charcoal bed and then arrange hot coals on either side. The cooking grate goes over and then you arrange the food (in this case the hens) over the drip pan. This method prevents flareups and the drip pan allows you to capture juices to make a sauce or gravy.

Serves 6 generously 54 | OCTOBER 2013

U.S. OPTICAL BOARDS Alaska P.O. Box 110806 Juneau, AK 99811 (907)465-5470 http://www.dced.state.ak.us/occ/pdop.htm

Idaho 450 W. State St., 10th Floor Boise , ID 83720 (208)334-5500 www2.state.id.us/dhw

Oregon 3218 Pringle Rd. SE Ste. 270 Salem, OR 97302 (503)373-7721 www.obo.state.or.us

Arizona 1400 W. Washington, Rm. 230 Phoenix, AZ 85007 (602)542-3095 http://www.do.az.gov

Kentucky P.O. Box 1360 Frankfurt, KY 40602 (502)564-3296 http://bod.ky.gov

Arkansas P.O. Box 627 Helena, AR 72342 (870)572-2847

Massachusetts 239 Causeway St. Boston, MA 02114 (617)727-5339 http://1.usa.gov/zbJVt7

Rhode Island 3 Capitol Hill, Rm 104 Providence, RI 02908 (401)222-7883 http://sos.ri.gov/govdirectory/index.php? page=DetailDeptAgency&eid=260

California 2005 Evergreen St., Ste. 1200 Sacramento, CA 95815 (916)263-2382 www.medbd.ca.gov Colorado 1560 Broadway St. #1310 Denver, CO 80202 (303)894-7750 http://www.dora.state.co.us/optometry/ Connecticut 410 Capitol Ave., MS #12APP P.O. Box 340308 Hartford, CT 06134 (860)509-7603 ext. 4 http://www.dph.state.ct.us/ Florida 4052 Bald Cypress Way, Bin C08 Tallahassee, FL 32399 (850)245-4474 doh.state.fl.us Georgia 237 Coliseum Dr. Macon, GA 31217 (478)207-1671 www.sos.state.ga.us Hawaii P.O. Box 3469 Honolulu, HI 96801 (808)586-2704 optician@dcca.hawaii.gov

Nevada P.O. Box 70503 Reno, NV 89570 (775)853-1421 http://nvbdo.state.nv.us/ New Hampshire 129 Pleasant St. Concord, NH 03301 (603)271-5590 www.state.nh.us New Jersey P.O. Box 45011 Newark, NJ 07101 (973)504-6435 http://www.njconsumeraffairs.gov/ ophth/ New York 89 Washington Ave., 2nd Floor W. Albany, NY 12234 (518)402-5944 http://www.op.nysed.gov/prof/od/ North Carolina P.O. Box 25336 Raleigh, NC 27611 (919)733-9321 http://www.ncoptometry.org/ Ohio 77 S. High St. Columbus, OH 43266 (614)466-9707 http://optical.ohio.gov/

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4665 www.llr.state.sc.us Tennessee Heritage Place Metro Center 227 French Landing, Ste. 300 Nashville, TN 37243 (615)253-6061 http://health.state.tn.us/boards/do/ Texas P.O. Box 149347 Austin, TX 78714 (512)834-6661 www.roatx.org Vermont National Life Bldg N FL. 2 Montpelier, VT 05620 (802)828-2191 http://vtprofessionals.org/opr1/ opticians/ Virginia 3600 W. Broad St. Richmond, VA 23230 (804)367-8500 www.state.va.us/licenses Washington 300 SE Quince P.O. Box 47870 Olympia, WA 98504 (360)236-4947 http://www.doh.wa.gov/LicensesPermitsandCertificates/MedicalCommission. aspx

MEDMONTHLY.COM |55

U.S. DENTAL BOARDS Alabama Alabama Board of Dental Examiners 5346 Stadium Trace Pkwy., Ste. 112 Hoover, AL 35244 (205) 985-7267 http://www.dentalboard.org/ Alaska P.O. Box 110806 Juneau, AK 99811-0806 (907)465-2542 http://bit.ly/uaqEO8 Arizona 4205 N. 7th Ave. Suite 300 Phoenix, AZ 85103 (602)242-1492 http://azdentalboard.us/ Arkansas 101 E. Capitol Ave., Suite 111 Little Rock, AR 72201 (501)682-2085 http://www.asbde.org/ California 2005 Evergreen Street, Suite 1550Â Sacramento, CA 95815 877-729-7789 http://www.dbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7800 http://www.dora.state.co.us/dental/ Connecticut 410 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Cannon Building, Suite 203 861 Solver Lake Blvd.

Dover, DE 19904 (302)744-4500 http://1.usa.gov/t0mbWZ Florida 4052 Bald Cypress Way Bin C-08 Tallahassee, FL 32399 (850)245-4474 http://bit.ly/w1m4MI 56 | OCTOBER 2013

Georgia 237 Coliseum Drive Macon, GA 31217 (478)207-2440 http://sos.georgia.gov/plb/dentistry/ Hawaii DCCA-PVL Att: Dental P.O. Box 3469 Honolulu, HI 96801 (808)586-3000 http://1.usa.gov/s5Ry9i Idaho P.O. Box 83720 Boise, ID 83720 (208)334-2369 http://isbd.idaho.gov/ Illinois 320 W. Washington St. Springfield, IL 62786 (217)785-0820 http://bit.ly/svi6Od Indiana 402 W. Washington St., Room W072 Indianapolis, IN 46204 (317)232-2980 http://www.in.gov/pla/dental.htm Iowa 400 SW 8th St. Suite D Des Moines, IA 50309 (515)281-5157 http://www.state.ia.us/dentalboard/ Kansas 900 SW Jackson Room 564-S Topeka, KS 66612 (785)296-6400 http://www.accesskansas.org/kdb/ Kentucky 312 Whittington Parkway, Suite 101 Louisville, KY 40222 (502)429-7280 http://dentistry.ky.gov/ Louisiana 365 Canal St., Suite 2680 New Orleans, LA 70130 (504)568-8574 http://www.lsbd.org/

Maine 143 State House Station 161 Capitol St. Augusta, ME 04333 (207)287-3333 http://www.mainedental.org/ Maryland 55 Wade Ave. Catonsville, Maryland 21228 (410)402-8500 http://dhmh.state.md.us/dental/ Massachusetts 1000 Washington St., Suite 710 Boston, MA 02118 (617)727-1944 http://www.mass.gov/eohhs/gov/departments/dph/programs/hcq/dhpl/ dentist/ Michigan P.O. Box 30664 Lansing, MI 48909 (517)241-2650 http://www.michigan.gov/lara/0,4601,7154-35299_28150_27529_27533---,00. html Minnesota 2829 University Ave., SE. Suite 450 Minneapolis, MN 55414 (612)617-2250 http://www.dentalboard.state.mn.us/ Mississippi 600 E. Amite St., Suite 100 Jackson, MS 39201 (601)944-9622 http://bit.ly/uuXKxl Missouri 3605 Missouri Blvd.

P.O. Box 1367 Jefferson City, MO 65102 (573)751-0040 http://pr.mo.gov/dental.asp Montana P.O. Box 200113 Helena, MT 59620 (406)444-2511 http://bsd.dli.mt.gov/license/bsd_ boards/den_board/board_page.asp

Nebraska 301 Centennial Mall South Lincoln, NE 68509 (402)471-3121 http://dhhs.ne.gov/publichealth/Pages/ crl_medical_dent_hygiene_board.aspx

Ohio Riffe Center 77 S. High St.,17th Floor Columbus, OH 43215 (614)466-2580 http://www.dental.ohio.gov/

Nevada 6010 S. Rainbow Blvd. Suite A-1 Las Vegas, NV 89118 (702)486-7044 http://www.nvdentalboard.nv.gov/

Oklahoma 201 N.E. 38th Terr., #2 Oklahoma City, OK 73105 (405)524-9037 http://www.dentist.state.ok.us/

New Hampshire 2 Industrial Park Dr. Concord, NH 03301 (603)271-4561 http://www.nh.gov/dental/

Oregon 1600 SW 4th Ave. Suite 770 Portland, OR 97201 (971)673-3200 http://www.oregon.gov/Dentistry/

New Jersey P.O Box 45005 Newark, NJ 07101 (973)504-6405 http://bit.ly/uO2tLg

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)783-7162 http://bit.ly/s5oYiS

New Mexico Toney Anaya Building 2550 Cerrillos Rd. Santa Fe, NM 87505 (505)476-4680 http://www.rld.state.nm.us/boards/Dental_Health_Care.aspx

Rhode Island Dept. of Health Three Capitol Hill, Room 104 Providence, RI 02908 (401)222-2828 http://1.usa.gov/u66MaB

New York 89 Washington Ave. Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/prof/dent/

South Carolina P.O. Box 11329 Columbia, SC 29211 (803)896-4599 http://www.llr.state.sc.us/POL/Dentistry/

North Carolina 507 Airport Blvd., Suite 105 Morrisville, NC 27560 (919)678-8223 http://www.ncdentalboard.org/

South Dakota P.O. Box 1079 105. S. Euclid Ave. Suite C Pierre, SC 57501 (605)224-1282 https://www.sdboardofdentistry.com/

North Dakota P.O. Box 7246 Bismark, ND 58507 (701)258-8600 http://www.nddentalboard.org/

Tennessee 227 French Landing, Suite 300 Nashville, TN 37243 (615)532-3202 http://health.state.tn.us/boards/dentistry/

Texas 333 Guadeloupe St. Suite 3-800 Austin, TX 78701 (512)463-6400 http://www.tsbde.state.tx.us/ Utah 160 E. 300 South Salt Lake City, UT 84111 (801)530-6628 http://1.usa.gov/xMVXWm Vermont National Life Building North FL2 Montpelier, VT 05620 (802)828-1505 http://bit.ly/zSHgpa Virginia Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4538 http://www.dhp.virginia.gov/dentistry Washington 310 Israel Rd. SE P.O. Box 47865 Olympia, WA 98504 (360)236-4700 http://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist.aspx West Virginia 1319 Robert C. Byrd Dr. P.O. Box 1447 Crab Orchard, WV 25827 1-877-914-8266 http://www.wvdentalboard.org/ Wisconsin P.O. Box 8935 Madison, WI 53708 1(877)617-1565 http://dsps.wi.gov/Default. aspx?Page=90c5523f-bab0-4a45-ab943d9f699d4eb5 Wyoming 1800 Carey Ave., 4th Floor Cheyenne, WY 82002 (307)777-6529 http://plboards.state.wy.us/dental/index.asp MEDMONTHLY.COM |57

U.S. MEDICAL BOARDS Alabama P.O. Box 946 Montgomery, AL 36101 (334)242-4116 http://www.albme.org/ Alaska 550 West 7th Ave., Suite 1500 Anchorage, AK 99501 (907)269-8163 http://bit.ly/zZ455T Arizona 9545 E. Doubletree Ranch Rd. Scottsdale, AZ 85258 (480)551-2700 http://www.azmd.gov Arkansas 1401 West Capitol Ave., Suite 340 Little Rock, AR 72201 (501)296-1802 http://www.armedicalboard.org/ California 2005 Evergreen St., Suite 1200 Sacramento, CA 95815 (916)263-2382 http://www.mbc.ca.gov/ Colorado 1560 Broadway, Suite 1350 Denver, CO 80202 (303)894-7690 http://www.dora.state.co.us/medical/ Connecticut 401 Capitol Ave. Hartford, CT 06134 (860)509-8000 http://www.ct.gov/dph/site/default.asp Delaware Division of Professional Regulation Cannon Building 861 Silver Lake Blvd., Suite 203 Dover, DE 19904 (302)744-4500 http://dpr.delaware.gov/ District of Columbia 899 North Capitol St., NE Washington, DC 20002 (202)442-5955 http://www.dchealth.dc.gov/doh 58 | OCTOBER 2013

Florida 2585 Merchants Row Blvd.

Tallahassee, FL 32399 (850)245-4444 http://www.stateofflorida.com/Portal/ DesktopDefault.aspx?tabid=115

Louisiana LSBME P.O. Box 30250 New Orleans, LA 70190 (504)568-6820 http://www.lsbme.la.gov/

Georgia 2 Peachtree Street NW, 36th Floor Atlanta, GA 30303 (404)656-3913 http://bit.ly/vPJQyG

Maine 161 Capitol Street 137 State House Station Augusta, ME 04333 (207)287-3601 http://bit.ly/hnrzp

Hawaii DCCA-PVL P.O. Box 3469 Honolulu, HI 96801 (808)587-3295 http://hawaii.gov/dcca/pvl/boards/medical/

Maryland 4201 Patterson Ave. Baltimore, MD 21215 (410)764-4777 http://www.mbp.state.md.us/

Idaho Idaho Board of Medicine P.O. Box 83720 Boise, Idaho 83720 (208)327-7000 http://bit.ly/orPmFU

Massachusetts 200 Harvard Mill Sq., Suite 330 Wakefield, MA 01880 (781)876-8200 http://www.mass.gov/eohhs/gov/departments/borim/

Illinois 320 West Washington St. Springfield, IL 62786 (217)785 -0820 http://www.idfpr.com/profs/info/Physicians.asp

Michigan Bureau of Health Professions P.O. Box 30670 Lansing, MI 48909 (517)335-0918 http://www.michigan.gov/lara/0,4601,7154-35299_28150_27529_27541-58914-,00.html

Indiana 402 W. Washington St. #W072 Indianapolis, IN 46204 (317)233-0800 http://www.in.gov/pla/ Iowa 400 SW 8th St., Suite C Des Moines, IA 50309 (515)281-6641 http://medicalboard.iowa.gov/ Kansas 800 SW Jackson, Lower Level, Suite A Topeka, KS 66612 (785)296-7413 http://www.ksbha.org/ Kentucky 310 Whittington Pkwy., Suite 1B Louisville, KY 40222 (502)429-7150 http://kbml.ky.gov/default.htm

Minnesota University Park Plaza 2829 University Ave. SE, Suite 500 Minneapolis, MN 55414 (612)617-2130 http://bit.ly/pAFXGq Mississippi 1867 Crane Ridge Drive, Suite 200-B Jackson, MS 39216 (601)987-3079 http://www.msbml.state.ms.us/ Missouri Missouri Division of Professional Registration 3605 Missouri Blvd.

P.O. Box 1335 Jefferson City, MO 65102 (573)751-0293 http://pr.mo.gov/healingarts.asp

Montana 301 S. Park Ave. #430 Helena, MT 59601 (406)841-2300 http://bsd.dli.mt.gov/license/bsd_ boards/med_board/board_page.asp Nebraska Nebraska Department of Health and Human Services P.O. Box 95026 Lincoln, NE 68509 (402)471-3121 http://www.mdpreferredservices.com/ state-licensing-boards/nebraska-boardof-medicine-and-surgery Nevada Board of Medical Examiners P.O. Box 7238 Reno, NV 89510 (775)688-2559 http://www.medboard.nv.gov/ New Hampshire New Hampshire State Board of Medicine 2 Industrial Park Dr. #8 Concord, NH 03301 (603)271-1203 http://www.nh.gov/medicine/ New Jersey P. O. Box 360 Trenton, NJ 08625 (609)292-7837 http://bit.ly/w5rc8J New Mexico 2055 S. Pacheco St. Building 400 Santa Fe, NM 87505 (505)476-7220 http://www.nmmb.state.nm.us/ New York Office of the Professions State Education Building, 2nd Floor Albany, NY 12234 (518)474-3817 http://www.op.nysed.gov/ North Carolina P.O. Box 20007 Raleigh, NC 27619 (919)326-1100 http://www.ncmedboard.org/

North Dakota 418 E. Broadway Ave., Suite 12 Bismarck, ND 58501 (701)328-6500 http://www.ndbomex.com/

Texas P.O. Box 2018 Austin, TX 78768 (512)305-7010 http://bit.ly/rFyCEW

Ohio 30 E. Broad St., 3rd Floor Columbus, OH 43215 (614)466-3934 http://med.ohio.gov/

Utah P.O. Box 146741 Salt Lake City, UT 84114 (801)530-6628 http://www.dopl.utah.gov/

Oklahoma P.O. Box 18256 Oklahoma City, OK 73154 (405)962-1400 http://www.okmedicalboard.org/

Vermont P.O. Box 70 Burlington, VT 05402 (802)657-4220 http://1.usa.gov/wMdnxh

Oregon 1500 SW 1st Ave., Suite 620 Portland, OR 97201 (971)673-2700 http://www.oregon.gov/OMB/

Virginia Virginia Dept. of Health Professions Perimeter Center 9960 Maryland Dr., Suite 300 Henrico, VA 23233 (804)367-4400 http://1.usa.gov/xjfJXK

Pennsylvania P.O. Box 2649 Harrisburg, PA 17105 (717)787-8503 http://www.dos.state.pa.us/portal/server. pt/community/state_board_of_medicine/12512 Rhode Island 3 Capitol Hill Providence, RI 02908 (401)222-5960 http://1.usa.gov/xgocXV South Carolina P.O. Box 11289 Columbia, SC 29211 (803)896-4500 http://www.llr.state.sc.us/pol/medical/ South Dakota 101 N. Main Ave. Suite 301 Sioux Falls, SD 57104 (605)367-7781 http://www.sdbmoe.gov/ Tennessee 425 5th Ave. North Cordell Hull Bldg. 3rd Floor Nashville, TN 37243 (615)741-3111 http://health.state.tn.us/boards/me/

Washington Public Health Systems Development Washington State Department of Health 101 Israel Rd. SE, MS 47890 Tumwater, WA 98501 (360)236-4085 http://www.medlicense.com/washingtonmedicallicense.html West Virginia 101 Dee Dr., Suite 103 Charleston, WV 25311 (304)558-2921 http://www.wvbom.wv.gov/ Wisconsin P.O. Box 8935 Madison, WI 53708 (877)617-1565 http://drl.wi.gov/board_detail. asp?boardid=35&locid=0 Wyoming 320 W. 25th St., Suite 200 Cheyenne, WY 82002 (307)778-7053 http://wyomedboard.state.wy.us/

MEDMONTHLY.COM | 59

medical resource guide ACCOUNTING

Ajishra Technology Support

Boyle CPA, PLLC 3716 National Drive, Suite 206 Raleigh, NC 27612 (919) 720-4970 www.boyle-cpa.com

ADVERTISING

PO Box 15130 Scottsdale, AZ 85267 (602)370-0303 www.findurgentcare.com

MedMedia9

www.medmedia9.com

Ring Ring LLC

6881 Maple Creek Blvd, Suite 100 West Bloomfield, MI 48322-4559 (248)819-6838 www.ringringllc.com

ANSWERING SERVICES Corridor Medical Answering Service

3088 Route 27, Suite 7 Kendall Park, NJ 08824 (866)447-5154 www.corridoranswering.net

Docs on Hold

14849 West 95th St. Lenexa, KS 66285 (913)559-3666 www.soundproductsinc.com

BILLING & COLLECTION Advanced Physician Billing, LLC

PO Box 730 Fishers, IN 46038 (866)459-4579 www.advancedphysicianbillingllc.com

60 | OCTOBER 2013

Applied Medical Services 4220 NC Hwy 55, Suite 130B Durham, NC 27713 (919)477-5152 www.ams-nc.com

Sweans Technologies 501 Silverside Rd. Wilmington, DE 19809 (302)351-3690 www.medisweans.com

VIP Billing

PO Box 1350 Forney, TX 75126 (214)499-3440 www.vipbilling.com

Axiom Business Solutions

Find Urgent Care

PO Box 98313 Raleigh, NC 27624 (919)747-9031

3562 Habersham at Northlake, Bldg J Tucker, GA 30084 (866)473-0011 www.ajishra.com

4704 E. Trindle Rd. Mechanicsburg, PA 17050 (866)517-0466 www.axiom-biz.com

Frost Arnett 480 James Robertson Parkway Nashville, TN 37219 (800)264-7156 www.frostarnett.com

CAREER CONSULTING Doctor’s Crossing 4107 Medical Parkway, Suite 104 Austin, Texas 78756 (512)517-8545 http://doctorscrossing.com/

Gold Key Credit, Inc. PO Box 15670 Brooksville, FL 34604 888-717-9615 www.goldkeycreditinc.com

Horizon Billing Specialists 4635 44th St., Suite C150 Kentwood, MI 49512 (800)378-9991 www.horizonbilling.com

CODING SPECIALISTS The Coding Institute LLC 2222 Sedwick Drive Durham, NC 27713 (800)508-2582 http://www.codinginstitute.com/

Management Services On-Call 200 Timber Hill Place, Suite 221 Chapel Hill, NC 27514 (866)347-0001 www.msocgroup.com

Marina Medical Billing Service 18000 Studebaker Road 4th Floor Cerritos, CA 90703 (800)287-8166 www.marinabilling.com

Mediserv 6451 Brentwood Stair Rd. Ft. Worth, TX 76112 (800)378-4134 www.mediservltd.com

Practice Velocity 1673 Belvidere Road Belvidere, IL 61008 (888)357-4209 www.practicevelocity.com

COMPUTER, SOFTWARE American Medical Software

1180 Illinois 157 Edwardsville, IL 62025 (618) 692-1300 www.americanmedical.com

CDWG

300 N. Milwaukee Ave Vernon Hills, IL 60061 (866)782-4239 www.cdwg.com/

Instant Medical History

4840 Forest Drive #349 Columbia, SC 29206 (803)796-7980 www.medicalhistory.com

medical resource guide CONSULTING SERVICES, PRACTICE MANAGEMENT

Dental Management Club

4924 Balboa Blvd #460 Encino, CA 91316 www.dentalmanagementclub.com

The Dental Box Company, Inc.

Medical Credentialing

(800) 4-THRIVE www.medicalcredentialing.org

PO Box 101430 Pittsburgh, PA 15237 (412)364-8712

www.thedentalbox.com

Medical Practice Listings

8317 Six Forks Rd. Suite #205 Raleigh, NC 27624 (919)848-4202 www.medicalpracticelistings.com

DIETICIAN

Brumbaugh Appraisals 8601 Six Forks Road, Suite 400, Raleigh, NC 27615 (919) 870-8258 www.brumbaughappraisals.com

FINANCIAL CONSULTANTS

Triangle Nutrition Therapy

myEMRchoice.com

24 Cherry Lane Doylestown, PA 18901 (888)348-1170 www.myemrchoice.com

6200 Falls of Neuse Road, Suite 200 Raleigh, NC 27609 (919)876-9779 http://trianglediet.com/

Physician Wellness Services 5000 West 36th Street, Suite 240 Minneapolis, MN 55416 888.892.3861 www.physicianwellnessservices.com

Synapse Medical Management

18436 Hawthorne Blvd. #201 Torrance, CA 90504 (310)895-7143 www.synapsemgmt.com

Urgent Care America

17595 S. Tamiami Trail Fort Meyers, FL 33908 (239)415-3222 www.urgentcareamerica.com

Urgent Care & Occupational Medicine Consultant Lawrence Earl, MD COO/CMO ASAP Urgentcare Medical Director, NADME.org 908-635-4775 (m) 866-405-4770 (f ) ASAP-Urgentcare.com UrgentCareMentor.com

Utilization Solutions service@pushpa.biz (919) 289-9126

www.pushpa.biz

DENTAL Biomet 3i

EQUIPMENT APPRAISER

4555 Riverside Dr. Palm Beach Gardens, FL 33410 (800)342-5454 www.biomet3i.com

ELECTRONIC MED. RECORDS ABELSoft 1207 Delaware Ave. #433 Buffalo, NY 14209 (800)267-2235 www.abelmedicalsoftware.com

Sigmon Daknis Wealth Management 701 Town Center Dr. , Ste. #104 Newport News, VA 23606 (757)223-5902 www.sigmondaknis.com

Sigmon & Daknis Williamsburg, VA Office 325 McLaws Circle, Suite 2 Williamsburg, VA 23185 (757)258-1063 http://www.sigmondaknis.com/

INSURANCE, MED. LIABILITY

Acentec, Inc 17815 Sky Park Circle , Suite J Irvine, CA 92614 (949)474-7774 www.acentec.com

AdvancedMD 10011 S. Centennial Pkwy Sandy, UT 84070 (800) 825-0224 www.advancedmd.com

CollaborateMD 201 E. Pine St. #1310 Orlando, FL 32801 (888)348-8457 www.collaboratemd.com

DocuTAP 4701 W. Research Dr. #102 Sioux Falls, SD 57107-1312 (877)697-4696 www.docutap.com

Aquesta Insurance Services, Inc.

Michael W. Robertson 3807 Peachtree Avenue, #103 Wilmington, NC 28403 Work: (910) 794-6103 Cell: (910) 777-8918 www.aquestainsurance.com

Jones Insurance 820 Benson Rd. Garner, North Carolina 27529 (919) 772-0233 www.Jones-insurance.com

Medical Protective

5814 Reed Rd. Fort Wayne, In 46835 (800)463-3776 http://www.medpro.com/ medical-protective

MGIS, Inc.

1849 W. North Temple Salt Lake City, UT 84116 (800)969-6447

Integritas, Inc. 2600 Garden Rd. #112 Monterey, CA 93940 (800)458-2486

www.mgis.com www.integritas.com MEDMONTHLY.COM | 61

medical resource guide INSURANCE, MED. LIABILITY

Nicholas Down http://bit.ly/yHwxb0

Martin Fried

www.martindfried.com

Professional Medical Insurance Services

16800 Greenspoint Park Drive Houston, TX 77060 (877)583-5510 www.promedins.com

Wood Insurance Group

4835 East Cactus Rd., #440 Scottsdale, AZ 85254-3544 (602)230-8200 www.woodinsurancegroup.com

LOCUM TENENS Physician Solutions

PO Box 98313 Raleigh, NC 27624 (919)845-0054 www.physiciansolutions.com

Bank of America

Barry Hanshaw 18 Bay Path Drive Boylston MA 01505 508 - 869 - 6038 JHans76271@aol.com www.barryhanshaw.com

MMA Medical Architects

520 Sutter Street San Francisco, CA 94115 (415) 346-9990 http://www.mmamedarc.com

Laura Maaske 262-308-1300 Laura@medimagery.com

medimagery.com

Marianne Mitchell (215)704-3188 http://www.mariannemitchell.com http://www.colordrop.blogspot.com

MEDICAL EQUIPMENT

1295 Walt Whitman Road Melville, NY 11747 (888)862-4050 www.allproimaging.com

Biosite, Inc

9975 Summers Ridge Road San Diego, CA 92121 (858)805-8378

www.artisanprinter.com

Deborah Brenner

877 Island Ave #315 San Diego, CA 92101 (619)818-4714 www.deborahbrenner.com

800 Shoreline, #900 Corpus Christi, TX 78401 (888)246-3928

www.cryopen.com

Pia De Girolamo

62 | OCTOBER 2013

www.piadegirolamo.com

391 Technology Way Winston Salem, NC 27101 (336)722-8910 www.carolinachemistries.com

Robert Sayre Marketing Adviser/Business Coach http://www.linkedin.com/pub/robsayre/2/977/355/

MedMedia9

PO Box 98313 Raleigh, NC 27624 (919)747-9031 www.medmedia9.com

WhiteCoat Designs

Web, Print & Marketing Solutions for Doctors (919)714-9885 www.whitecoat-designs.com

www.dicomsolutions.com

Tarheel Physicians Supply 1934 Colwell Ave. Wilmington, NC 28403 (800)672-0441

Medical Practice Listings

8317 Six Forks Rd. Ste #205 Raleigh, NC 27624 (919)848-4202 www.medicalpracticelistings.com

MEDICAL PRACTICE VALUATIONS

Dicom Solutions 548 Wald Irvine, CA 92618 (800)377-2617

High Performance Network

MEDICAL PRACTICE SALES

Carolina Liquid Chemistries, Inc. Brian Allen

MEDICAL MARKETING

www.biosite.com

Cryopen

MEDICAL ART

Mark MacKinnon, Regional Sales Manager 3801 Columbine Circle Charlotte, NC 28211 (704)995-9193 mark.mackinnon@bankofamerica.com www.bankofamerica.com/practicesolutions

MedImagery

ALLPRO Imaging

MEDICAL ARCHITECTS

MEDICAL EQUIPMENT FINANCING

www.thetps.com

BizScore

PO Box 99488 Raleigh, NC 27624 (919)846-4747 www.bizscorevaluation.com

medical resource guide

MEDICAL PUBLISHING

PRACTICE FINANCING Bank of America

Greenbranch Publishing

info@greenbranch.com 800-933-3711 www.greenbranch.com

MEDICAL RESEARCH

Mark MacKinnon, Regional Sales Manager 3801 Columbine Circle Charlotte, NC 28211 (704)995-9193 mark.mackinnon@bankofamerica.com www.bankofamerica.com/practicesolutions

CNF Medical 1100 Patterson Avenue Winston Salem, NC 27101 (877)631-3077 www.cnfmedical.com

Dermabond

Ethicon, Route 22 West Somerville, NJ 08876 (877)984-4266 www.dermabond.com

DJO

1430 Decision St. Vista, CA 92081 (760)727-1280

REAL ESTATE

www.djoglobal.com

Arup Laboratories

500 Chipeta Way Salt Lake City, UT 84108 (800)242-2787

www.aruplab.com

Chimerix, Inc. 2505 Meridian Parkway, Suite 340 Durham, NC 27713 (919) 806-1074 www.chimerix.com Clinical Reference Laboratory 8433 Quivira Rd. Lenexa, KS 66215 (800)445-6917

www.crlcorp.com

Sanofi US

55 Corporate Drive Bridgewater, NJ 08807 (800) 981-2491

Scynexis, Inc.

ExpertMed

York Properties, Inc.

www.sanofi.us

Headquarters & Property Management 1900 Cameron Street Raleigh, NC 27605 (919) 821-1350 Commercial Sales & Leasing (919) 821-7177 www.yorkproperties.com

STAFFING COMPANIES Additional Staffing Group, Inc. 8319 Six Forks Rd, Suite 103 Raleigh, NC 27615 (919) 844-6601 Astaffinggroup.com

31778 Enterprise Dr. Livonia, MI 48150 (800)447-5050

www.expertmed.com

Gebauer Company

4444 East 153rd St. Cleveland, OH 44128-2955 (216)581-3030 www.gebauerspainease.com

Scarguard

15 Barstow Rd. Great Neck, NY 11021 (877)566-5935 www.scarguard.com

WEBSITE DESIGN

SUPPLIES, GENERAL

3501 C Tricenter Blvd.

Durham, NC 27713 (919) 933-4990

MedMedia9 www.scynexis.com

BSN Medical 5825 Carnegie Boulevard Charlotte, NC 28209 (800)552-1157 www.bsnmedical.us

PO Box 98313 Raleigh, NC 27624 (919)747-9031 www.medmedia9.com

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classified listings

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina GP Needed Immediately On-Going 3 Days Per Week at Occupational Clinic . General Practictioner needed on-going 3 days per week at occupational clinic in Greensboro, NC. Numerous available shifts for October.

Averages 25 patients per day with no call and shift hours from 8:30 am to 5:30 pm. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com 3-5 days per week in Durham, NC . Geriatric physician needed immediately 3-5 days per week, on-going at nursing home in Durham. Nursing home focuses on therapy and nursing after patients are released from the hospital. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com GP Needed Immediately On-Going 1-3 Days Per Week at Addictive Diease Clinics located in Charlotte, Hickory, Concord & Marion North Carolina. General Practitioner with a knowledge or interest in addictive disease.

Needed in October on-going 1-3 times per week. This clinic requires training so respond to post before October 1st. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Primary Care Physician in Northwest NC (multiple locations). Primary care physician needed immediately for ongoing coverage at one of the largest substance abuse treatment facilities in NC. Doctor will be responsible for new patient evaluations and supportive aftercare. Counseling and therapy are combined with physician’s medical assessment and care for the treatment of adults, adolescents and families. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Pediatrician or Family Medicine Doctor in Fayetteville Comfortable with seeing children. Need is immediate - Full time ongoing for maternity leave. 8 am - 5 pm.

Outpatient only. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com

64| OCTOBER 2013

Immediate need for full time GP/FP for urgent cares in eastern NC. Urgent care centers from Raleigh to the eastern coast of NC seek immediate primary care physician. Full time opportunity with possibility for permanent placement. Physician Solutions, PH: (919) 845-0054, email: physiciansolutions@gmail.com General Practitioner Needed in Greensboro. Occupational health care clinic seeks general practitioner for disability physicals ongoing 1-3 days a week. Adults only. 8 am-5 pm. No call required. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

Pediatrician or Family Physician Needed Immediately at clinic in Roanoke Rapids, NC. Pediatric clinic in Roanoke Rapids, NC seeks Peds physician or FP comfortable with children for 2-3 months/on-going/full-time.

The chosen physician will need to be credentialed through the hospital, please email your CV, medical license and DEA so we can fill this position immediately. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com County Health Department in Fayetteville, NC seeks GP/IM/FP Full-Time, On-Going Shifts. GP/IM/FP Needed Immediately at County Health Department in Fayetteville, NC. Approximately 20 patients per day with hours from 8 am -5 pm. Call or email for more information. 919-845-0054 physiciansolutions@gmail.com Occupational Clinic in Greensboro, NC seeks FP/GP for On-Going Shifts. Locum tenens position (4-5 days a week) available for an occupational, urgent care and walk in clinic. The practice is located in Greensboro NC. Hours are 8 am-5 pm. Approximately 20 patients/ day. Excellent staff. Outpatient only. physiciansolutions@gmail.com Diabetic Clinic 1 hour from Charlotte seeks FP/GP/ IM for On-Going Shifts.Primary care physician needed immediately for outpatient diabetic clinic one hour outside Charlotte, NC On-going. Hours are 8 am -5 pm with no call. Approximately 15-20 patients a day. Call or email for more information. 919-845-0054 physiciansolutions@gmail.com Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing. A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call. email: physiciansolutions@gmail.com

Classified To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Addictive Disease Clinic in Charlotte, NC and surrounding cities seeks GP/FP/IM for on-going shifts An addictive disease clinic with locations with locations in Charlotte, NC and surrounding cities seeks a GP with an interest in addictive medicine for on-going shifts. This clinic has 15-25 open shifts every month and we are looking to bring on a new doctor for consistent coverage. The average daily patient load is between 20 and 25 with shifts from 8 am - 5 pm and 6 am - 2 pm. If you are interested in this position please send us your CV and feel free to contact us via email or phone with questions or to learn about other positions.

Physician Solutions, PH: (919) 845-0054, email: physiciansolutions@gmail.com Child Health Clinic in Statesville, NC seeks pediatrician or Family Physician comfortable with peds for on-going, full-time shifts. Physician will work M-F 8 am - 5 pm, ongoing. Qualified physician will know EMR or Allscripts software. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Peds Clinic near Raleigh seeks Mid-Level Provider for on-going coverage 4x/wk. Health Department pediatrics clinic 45 min from Raleigh needs coverage 4 days a week from January through June. Provider will see about 20 patients daily, hours are 8am-5pm with an hour for lunch. Please contact Physician Solutions at 919-8450054 or emailphysiciansolutions@gmail.com.

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Health Department 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in January. Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch. Call or email for more information. 919-845-0054 physiciansolutions@gmail.com FT Mid-Level Provider needed for Wilmington practice immediately. Small private practice 45 minutes outside Wilmington seeks mid-level provider starting January.

M-F 8:00-5:00, PT or FT. This practice also is looking for a PA permanently in April. Accommodations, PLI, and mileage provided. Please contact Physician Solutions at 919-845-0054 or emailphysiciansolutions@gmail.com.

Employee Health Clinic seeks Mid-Level Provider for FT on-going coverage near Charlotte. Health Department 45 minutes from Charlotte seeks on-going coverage for employee health clinic beginning in March.

Provider will see about 20-24 patients daily, hours are 8am-5pm with an hour for lunch. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

FT/PT Mid-Level Provider needed for Wilmington practice immediately. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-level provider starting immediately. FT/PT. M-F 8:00-5:00.

Possible permanent placement. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

Western North Carolina Health Department needs continuing physician coverage. County Health Department seeks coverage for their walk in clinic which sees all ages. Ongoing, 8am-5pm, no call. 35-40 patients a day. Well established clinic located in a beautiful area. Please contact Physician Solutions at 919-845-0054 or emailphysiciansolutions@gmail.com.

Asheboro Family Practice and Urgent Care seeks GP for intermittent coverage. Family Practice and Urgent Care seeks general practitioner for intermittent days beginning in March from 8a-8p. Provider will see about 35 patients with no call. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

Greensboro occupational health care clinic seeksgeneral practitioner for intermittent shifts. Primary care physicians needed for occupational medicine. Adults only. Hours are 8am-5pm. Large corporation, no call required. Please contact Physician Solutions at 919-8450054 or emailphysiciansolutions@gmail.com.

IM/FP needed in Fayetteville health department immediately. Fayetteville health department needs coverage March through June full or part time. Clinics are adult health and women’s health. Adults only. No call 8a-5p. Please contact Physician Solutions at 919845-0054 or emailphysiciansolutions@gmail.com.

continued on page 67 MEDMONTHLY.COM |65

classified listings

Classified

continued from page 65

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Geriatric physician needed immediately 2 to 5 days per week, on-going eastern NC. Nursing homes in Durham, Fayetteville and Rocky Mount seek GP/IM/ FP with geriatric experience to work full or part time.

Nursing home focuses on therapy and nursing after patients are released from the hospital. 8a-5p, no call.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Nursing home in Durham seeks PT/FT NP/PA for immediate ongoing scheduling. Durham nursing home seeks part time or full time mid-level for ongoing locums.

Must have geriatric experience. 8-5p. Other facilities in Fayetteville and Rocky Mount. Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

COLUMBUS IM FT/PT Mid-Level Provider needed for practice near Wilmington. Small internal medicine private practice 45 minutes outside Wilmington seeks mid-level provider starting immediately. FT/PT. M-F 8-5p. Possible permanent placement. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Fayetteville occupational health care clinic seeks GP for May 5-9. Primary care physicians needed for occupational medicine. Adults only. 8-5p. Large corporation, no call required. Intermittent dates in the future and second office in Greensboro with ongoing scheduling. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Health Dept 45 min NE of Raleigh seeks MD coverage Tues/Thurs ongoing May 14. GP/FP/IM/Peds doctor needed for the following clinics in Louisburg: Adult, Family Planning, Peds, STD for ongoing scheduling or intermittent shifts. 8-5p.Please contact Physician Solutions at 919-845-0054 or email us at physiciansolutions@gmail.com.

Community Health Dept in Washington, NC (1 h 45 min E of Raleigh) seeks FP for coverage June 15 FT/PT ongoing. Family practitioner sought for eastern Carolina community health center in Washington, NC. Must see all ages, 8-5p. Start June 15 ongoing. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Nursing home in Durham seeks PT/FT Geriatrics doctor for immediate ongoing scheduling. Durham nursing home seeks part time or full time MD for ongoing locums. Must have geriatric experience. 8-5p. Other facilities in Fayetteville and Rocky Mount. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Practice 1 h SE of Raleigh seeks July 6-7 coverage. Goldsboro FP seeks MD for July 6-7 and intermittent shifts. 8-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Pediatric clinic near Greensboro needs 10 weeks of 3 day a week coverage beginning June 1. Burlington pediatric clinic seeks coverage June 1 3 days a week for 10 weeks. 8-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Greenville Clinic seeks GP May 20-22. GP/IM needed for May 20-22 and intermittent shifts. Must have experience or be willing to do pain management and trigger point injections. 8-5p. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Raleigh practice seeks BC FP for permanent placement in new facility summer 2013. Board Certified Family Practitioner sought for FT permanent placement in new clinic in Raleigh to start summer of 2013.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Clinic between Fayetteville and Wilmington seeks FP/ GP/IM Mar 22 FT ongoing . A small hospital’s outpatient clinic located within an hour of both Fayetteville and Wilmington seeks PA to work FT ongoing beginning March 22. Shifts can be either 8 or 12 hours. No call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Western North Carolina Health Department needs continuing physician coverage. County Health Department seeks coverage for their walk in clinic which sees all ages. Ongoing, 8am-5pm, no call. 35-40 patients a day. Well established clinic located in a beautiful area. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

continued on page 68 MEDMONTHLY.COM | 67

classified listings

Classified

continued from page 67

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

IM/FP/Peds needed in Fayetteville health department immediately. Fayetteville health department needs immediate coverage for the following clinics: adult health, women’s health and STD. No call 8a-5p.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Pediatrician Needed MD June-Aug, Burlington NC 3x week for 10 wks starting June 1st, 8-5 Mon-Fri Burlington, NC: located 1 hour west of Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Pediatrician, IM & FP needed, Fayetteville NC Urgent Need for immediate MDs - Pediatrics, Family Practice or Internal Medicine - PT/FT, 8-5 Mon-Fri. Ongoing. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Locum & Permanent MD Needed , Kinston NC Urgent Need for immediate MD placement, 8-5 MonFri. Must be able to do family planning & light maternity, Kinston, NC: 1.5 hours outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

PT MD needed for Occupational practice, Greensboro NC. Urgent need for PT MD to do disability physicals 2-3 days weekly, 8-5, on-going scheduling.

Greensboro, NC. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Permanent Family Practice doctor needed for Summer 2013, Raleigh, NC Need FP/BC MD for June-Sept MonFri , 8-5, New Facility in downtown Raleigh, NC. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Permanent PA or MD needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5, Goldsboro, NC: 1 hour 10 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Practice MD needed 2-3x/w in July, Goldsboro July 6 & 7 and intermittent dates, 8-5p,Goldsboro, NC 1h SE of Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

68| OCTOBER 2013

FULL TIME MD needed for Family Practice in Washington, N.C. Family Practitioner needed for FT MD June 15-Sept 1 on-going Mon- Fri 8-5, Washington, NC, 1 hour 45 minutes outside Raleigh. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Geriatric Experienced Mid Level or MD, Durham NC Must have geriatric experience, PT/FT, Locations in Durham, Rocky Mount & Fayetteville, NC. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

MD needed for June 6 & intermittent dates, Charlotte N.C. June 6 & Intermittent weekdays, 8-5 in Charlotte, NC. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Practitioner opportunity available one hour east of Charlotte Monday through Friday. The hours will be 8:00am until 5:00pm either full time or part time.

The start date is October 1st and will be ongoing for at least 6 months. You will be seeing 15-20 new patients a day. Please contact Physician Solutions at 919-8450054 or email physiciansolutions@gmail.com.

Immediate opportunity for a Primary Care Physician at a large practice located one hour south of Raleigh. The hours are from 8:00am until 5:00pm You will be treating generally 20-25 patients per day. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family MD opportunity at an Urgent Care facility that sees all ages in the Jacksonville, NC area. This will be an ongoing schedule from 8:00am until 6:00pm 1-2 days a week, including weekend dates. You will treating generally 30-35 patients a day. There is potential for permanent placement. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Primary care physician opportunity for busy occupational medicine practices near Greensboro/Fayetteville, NC. There are two locations with positions available within 15 minutes of Greensboro and Fayettteville. Your schedule will be from 8:00am until 5:00 pm either full time or part time, no call necessary. Patient treatment will consist of adults only in both facilities. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

continued on page 70

Primary Care Specializing in Women’s Health

Located on NC’s Beautiful Coast, Morehead City

Practice established in 2005, averaging over $540,000 the past 3 years. Free standing practice building for sale or lease. This practice has 5 well equipped exam rooms.

919.848.4202 medlisting@gmail.com medicalpracticelistings.com

Woman’s Practice in Raleigh, North Carolina.

NC OPPORTUNITIES LOCUMS OR PERMANENT

We have a established woman’s practice in the Raleigh North Carolina area that is available for purchase. Grossing a consistent $800,000.00 per year, the retained earnings are impressive to say the least. This is a two provider practice that see patients Monday through Friday from 8 till 6. This free standing practice is very visible and located in the heart of medical community. There are 7 well appointed exam rooms, recently upgraded computer (EMR), the carpet and paint have always been maintained. The all brick building can be leased or purchased.

Contact Cara or Philip for details regarding this very successful practice.

Medical Practice Listings; 919-848-4202

Physician Solutions has immediate opportunities for psychiatrists throughout NC. Top wages, professional liability insurance and accommodations provided.

Call us today if you are available for a few days a month, on-going or for permanent placement.

Please contact Physican Solutions at 919-845-0054 or physiciansolutions@gmail.com For more information about Physician Solutions or to see all of our locums and permanent listings, please visit physiciansolutions.com

classified listings

Classified

continued from page 68

To place a classified ad, call 919.747.9031

Physicians needed North Carolina (cont.)

Family Physician opportunity for a leading medical practice in the Raleigh area. Must be able to start immediately and be comfortable with seeing all ages.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

General Practitioner/ Internal Medicine/ Family Physician opportunity available at a large substance abuse treatment facilitiy in Western NC. Doctor will be responsible for new patient evaluations and supportive aftercare. Counseling and therapy are combined with physician’s medical assessment and care for the treatment of adults, adolescents and families. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Primary Care Physician opportunity for a leading women’s practice in the Lenoir, NC area. Treating Physician must be comfortable with light OB and well women’s exams. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

General Practitioner/Internal Medicine Physician opportunity for intermittent shifts at a prominent practice in the Greenville, NC area. Treament schedule will be from 8:00am until 5:00pm. The practicing physician must have experience or be willing to perform pain management and trigger point injections. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Exceptional Family Physician opportunity at a practice in the Raleigh, NC area. Schedule will be ongoing Monday through Friday from 8:00am until 5:00pm. Must be comfortable with treating all ages. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Immediate Pediatrician opportunity at a small outpatient hospital. Located between Fayetteville and Wilmington, this facility requires someone for intermittent shifts. Please contact Physician Solutions at 919845-0054 or email physiciansolutions@gmail.com.

70| OCTOBER 2013

Pediatrics Opportunity - Roanoke Rapids Area Northeastern North Carolina Pediatric Practice seeks on-going physician for full time coverage beginning mid-October through the end of the year. Practice sees about 16-25 patients a day, hours are 8:00-5:00 with negotiable call. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Practitioner Opportunity - Greenville area Immediate opportunity for a family practitioner for a practice about 20 miles east of Greenville. The hours will be 8:00am until 5:00pm. Must see all ages. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Primary Care Physician - Washington area Seeking a physician for a general primary care practice.

Treatment will include seeing 3-4 pediatric and about 10 adult patients per day. The hours are 8:00- 5:00pm M-F. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Family Physician –Williamston area Immediate opportunity at a developing family practice in the Williamston area. You will be treating 8-16 patients per day from 8:00-5:00 pm. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

County Health Department near Charlotte seeks FT Family Practitioner October 1- ongoing. FP needed Monday- Friday (or part- time) 8-5pm at a county health department one hour east of Charlotte. Start date is October 1st ongoing for at least 6 months. 15-20 new patients a day. Basic Primary Care. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Physicians needed South Carolina A family and urgent care in Little River, SC seeks an FP/EM physician for 1 to 2 days per week, on-going shifts. The practice is a one-physician facility and is looking for a physician to come in regularly. The practice is small and does not have a large patient load.

The qualified physician will have experience in Family or Emergency medicine. If you have any availability and a SC medical license contact us today and we will do our best to work around your schedule. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com continued on page 72

Woman's Practice A vailable for Sale Available for purchase is a beautiful boutique women’s Internal Medicine and Primary Care practice located in the Raleigh area of North Carolina.

The physician owner has truly found a niche specializing in women’s care. Enhanced with female-related outpatient procedures, the average patient per day is 40+. The owner of the practice is an Internal Medicine MD with a Nurse Practitioner working in the practice full time. Modern exam tables, instruments and medical furniture.

Gross Yearly Income: $585,000 | List Price: $365,000

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com

Adult & pediAtric integrAtive medicine prActice for sAle This Adult and Pediatric Integrative Medicine practice, located in Cary, NC, incorporates the latest conventional and natural therapies for the treatment and prevention of health problems not requiring surgical intervention. It currently provides the following therapeutic modalities: • • • • •

Conventional Medicine Natural and Holistic Medicine Natural Hormone Replacement Therapy Functional Medicine Nutritional Therapy

• • • • • •

Mind-Body Medicine Detoxification Supplements Optimal Weigh Program Preventive Care Wellness Program Diagnostic Testing

There is a Compounding Pharmacy located in the same suites with a consulting pharmacist working with this Integrative practice. Average Patients per Day: 12-20

Primary Care Practice for Sale Hickory, North Carolina Established primary care practice in the beautiful foothills of North Carolina The owning physician is retiring, creating an excellent opportunity for a progressive buyer.

There are two full-time physician assistants that see the majority of the patients which averages between 45 to 65 per day.

There is lots of room to grow this already solid practice that has a yearly gross of $1,500,00.

You will be impressed with this modern and highly visible practice.

Call for pricing and details.

Gross Yearly Income: $335,000+ | List Price: $125,000

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com

Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings vist www.medicalpracticelistings.com

classified listings

Classified

continued from page 70

To place a classified ad, call 919.747.9031

Physicians needed Virginia (cont.)

Pediatric Locums Physician needed in Harrisonburg, Danville and Lynchburg, VA. These locum positions require 30 to 40 hours per week, on-going. If you are seeking a beautiful climate and flexibility with your schedule, please consider one of these opportunities. Send copies of your CV, VA. medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, email: physiciansolutions@gmail.com Urgent Care opportunities throughout Virginia. We have contracts with numerous facilities and eight to 14-hour shifts are available. If you have experience treating patients from pediatrics to geriatrics, we welcome your inquires. Send copies of your CV, VA medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624, and PH: (919) 845-0054, E-mail: physiciansolutions@gmail.com

Charlotte Occupational clinic seeks NP in March for ongoing coverage. Nurse practitioner needed in employee health clinic for large corporation in Charlotte.

8a-5p ongoing full time or part time. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Practice wanted North Carolina Pediatric Practice Wanted in Raleigh, NC Medical Practice Listings has a qualified buyer for a pediatric practice in Raleigh, Cary or surrounding area. If you are retiring, relocating or considering your options as a pediatric practice owner, contact us and review your options. Medical Practice Listings is the leading seller of practices in the US. When you list with us, your practice receives exceptional national, regional and local exposure.

Contact us today at (919) 848-4202.

Virginia practice outside of Washington DC seeks IM doctor FT/PT now – June 1. IM physician needed immediately FT/PT for Virginia clinic near Washington DC. 8-5p Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Practice for sale

Nurse Practitioners needed

Primary Care Practice Only Minutes East of Raleigh North Carolina. The retiring physician maintains a 5 day work week and has a solid base of patients that can easily be expanded. There are 6 fully equipped exam rooms, a large private doctor’s office, spacious business office, and patient friendly check in and out while the patient waiting room is generous overlooking manicured flowered grounds. This family practice is open Monday through Friday and treats 8 to a dozen patients per day. The Gross revenue is about $235,000 yearly. Contact Cara or Philip at 919 848 4202 or email: medlistings@gmail.com to receive details.

North Carolina Permanent NP needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5 Goldsboro, NC: 1hour 10 minutes outside Raleigh.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Charlotte Occupational clinic seeks NP in March for ongoing coverage. Nurse practitioner needed in employee health clinic for large corporation in Charlotte.

8a-5p ongoing full time or part time. Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

Permanent NP needed in Goldsboro, NC On-going permanent position Mon- Fri 8-5 Goldsboro, NC: 1hour 10 minutes outside Raleigh.

Please contact Physician Solutions at 919-845-0054 or email physiciansolutions@gmail.com.

72 | OCTOBER 2013

North Carolina

Family Practice located in Hickory, NC. Well-established and a solid 40 to 55 patients split between an MD and physician assistant. Experienced staff and outstanding medical equipment. Gross revenues average $1,500,000 with strong profits. Monthly practice rent is only $3,000 and the utilities are very reasonable. The practice with all equipment, charts and good will are priced at $625,000.

Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com

Classified To place a classified ad, call 919.747.9031

Practice for sale North Carolina (cont.)

Impressive Internal Medicine Practice in Durham, NC: The City of Medicine. Over 20 years serving the community, this practice is now listed for sale. There are four wellequipped exam rooms, new computer equipment and a solid patient following. The owner is retiring and willing to continue with the new owner for a few months to assist with a smooth transition. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at: www.medicalpracticelistings.com Primary Care Practice specializing in women’s care. The owning female physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however that could double with a second provider.

Exceptional cash flow and profitable practice that will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several wellappointed exam rooms throughout. New computers and medical management software add to this modern front desk environment. This practice is being offered for $435,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or send an email to medlistings@gmail.com Internal Medicine Practice located just outside Fayetteville, NC is now being offered. The owning physician is retiring and is willing to continue working for the new owner for a month or two assisting with a smooth transaction. The practice treats patients four and a half days per week with no call or hospital rounds. The schedule accommodates 35 patients per day. You will be hard pressed to find a more beautiful practice that is modern, tastefully decorated and well appointed with vibrant art work. The practice, patient charts, equipment and good will is being offered for $415,000 while the free standing building is being offered for $635,000. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com

Modern Vein Care Practice located in the mountains of NC. Booking seven to 10 procedures per day, you will find this impressive vein practice attractive in many ways.

Housed in the same practice building with an internal medicine, you will enjoy the referrals from this as well as other primary care and specialties in the community. We have this practice listed for $295,000 which includes charts, equipment and good will. Contact Medical Practice Listings at (919) 848-4202 for more information. View additional listings at www.medicalpracticelistings.com

South Carolina Lucrative ENT Practice with room for growth, located three miles from the beach. Physician’s assistant, audiologist, esthetician and well-trained staff. Electronic medical records, mirror imaging system, established patient and referral base, hearing aids and balance testing, esthetic services and Candela laser. All aspects of otolaryngology, busy skin cancer practice, established referral base for reconstructive eyelid surgery, Botox and facial fillers. All new surgical equipment, image-guidance sinus surgery, balloon sinuplasty, nerve monitor for ear/parotid/thyroid surgery. Room for establishing allergy, cosmetics, laryngology and trans-nasal esophagoscopy. All the organization is done; walk into a ready-made practice as your own boss and make the changes you want, when you want. Physician will to stay on for a smooth transition. Hospital support is also an option for up to a year. The listing price is $395,000 for the practice, charts, equipment and good will. Contact Medical Practice Listings for additional information. Medical Practice Listings, P.O. Box 99488, Raleigh, NC 27624. PH: (919) 848-4202 or email: medlistings@gmail.com

Washington Family Practice located in Bainbridge Island, WA has recently been listed. Solid patient following and cash flow makes this 17-year-old practice very attractive. Contact Medical Practice Listings for more details. email: medlistings@gmail.com or (919) 848-4202. 

MEDMONTHLY.COM | 73

Hospice Practice Wanted Hospice Practice wanted in Raleigh/ Durham area of North Carolina.

Practice for Sale in South Denver

Medical Practice Listings has a qualified physician buyer that is ready to purchase. If you are considering your hospice practice options, contact us for a confidential discussion regarding your practice.

Neurofeedback and Psychological Practice Located in South Denver, Colorado, this practice features high patient volume and high visibility on the internet. Established referral sources, owner (psychologist) has excellent reputation based on 30 years experience in Denver. Private pay and insurances, high-density traffic, beautifully decorated and furnished offices, 378 active and inactive clients, corporate clients, $14,000 physical assets, good parking, near bus and rapid transit housed in a well-maintained medical building.

Live and work in one of the most healthy cities in the U.S. List Price: $150,000 | Established: 2007 | Location: Colorado

To find out more information call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

For more information contact Dr. Jack McInroy at 303-929-2598 or Shrink1324@gmail.com

FAMILY PRACTICE FOR SALE A beautiful practice located in Seattle, Washington This upscale primary care practice has a boutique look and feel while realizing consistent revenues and patient flow. You will be impressed with the well appointed layout, functionality as well as the organization of this true gem of a practice. Currently accepting over 20 insurance carriers including Aetna, Blue Cross and Blue Shield, Cigna, City of Seattle, Great West and United Healthcare. The astute physician considering this practice will be impressed with the comprehensive collection of computers, office furniture and medical equipment such as Welch Allyn Otoscope, Ritter Autoclave, Spirometer and Moore Medical Exam table.

Physician compensation is consistently in the $200,000 range with upside as you wish. Do not procrastinate; this practice will not be available for long.

List price: $255,000 | Year Established: 2007 | Gross Yearly Income: $380,000

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919.848.4202

PEDIATRICIAN

or family medicine doctor needed in

FAYETTEVILLE, NC

Comfortable seeing children. Needed immediately.

Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com

Primary Care Practice For Sale Wilmington, NC

NC MedSpa For Sale MedSpa Located in North Carolina We have recently listed a MedSpa in NC

Established primary care on the coast of North Carolina’s beautiful beaches.

Fully staffed with MD’s and PA’s to treat both appointment and walk-in patients.

Excellent exam room layout, equipment and visibility.

This established practice has staff MDs, PAs and nurses to assist patients. Some of the procedures performed include: Botox, Dysport, Restylane, Perian, Juvederm, Radiesse, IPL Photoreju Venation, fractional laser resurfacing as well as customized facials. There are too many procedures to mention in this very upscale practice. The qualified buyer will be impressed with the $900,000 gross revenue. This is a new listing, and we are in the valuation process.

Contact Medical Practice Listings for more information.

Contact Medical Practice Listings today to discuss the practice details.

Medical Practice Listings 919.848.4202 | medlistings@gmail.com www.medicalpracticelistings.com

For more information call Medical Practice Listings at 919-848-4202 or e-mail medlistings@gmail.com

www.medicalpracticelistings.com

ADVERTISE YOUR PRACTICE BUILDING IN MED MONTHLY By placing a professional ad in Med Monthly, you're spending smart money and directing your marketing efforts toward qualified clients.

Contact one of our advertising agents and find out how inexpensive yet powerful your ad in Med Monthly can be.

medmonthly.com | 919.747.9031

Comprehensive Ophthalmic and Neuro-Ophthalmic Neuro-Ophthalmic Practice Raleigh North Carolina This is a great opportunity to purchase an established ophthalmic practice in the heart of Raleigh. Locate on a major road with established clients and plenty of room for growth; you will appreciate the upside this practice offers.

This practice performs comprehensive ophthalmic and neuro-ophthalmic exams with diagnosis and treatment of eye disease of all ages.

Surgical procedures include no stitch cataract surgery, laser treatment for glaucoma and diabetic eye disease. This practice offers state-of-the-art equipment and offer you the finest quality optical products with contact lens fitting and follow-up care & frames for all ages.

PRACTICE FOR SALE

OCCUPATIONAL HEALTH CARE PRACTICE FOR SALE Greensboro, North Carolina Well-established practice serving the Greensboro and High Point areas for over 15 years. Five exam rooms that are fully equipped, plus digital X-Ray. Extensive corporate accounts as well as walk-in traffic. Lab equipment includes CBC. The owning MD is retiring, creating an excellent opportunity for a MD to take over an existing patient base and treat 25 plus patients per day from day one. The practice space is 2,375 sq. feet. This is an exceptionally opportunity. Leased equipment includes: X-Ray $835 per month, copier $127 per month, and CBC $200 per month. Call Medical Practice Listings at (919) 848-4202 for more information.

Asking price: $385,000

To view more listings visit us online at medicalpracticelistings.com

Wanted: Urgent Care Practice Urgent care practice wanted in North Carolina.

Qualified physician is seeking to purchase an established urgent care within 100 miles of Raleigh, North Carolina.

If you are considering retiring, relocations or closing your practice for personal reasons, contact us for a confidential discussion regarding your urgent care. You will receive cash at closing and not be required to carry a note.

List Price: $75,000 | Gross Yearly Income: $310,000

Medical Practice Listings Buying and selling made easy

Contact Cara or Philip 919-848-4202 for more information or visit MedicalPracticeListings.com

Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

PHYSICIANS NEEDED: Mental health facility in Eastern North Carolina seeks: PA/FT ongoing, start immediately Physician Assistant needed to work with physicians to provide primary care for resident patients. FT ongoing 8a-5p. Limited inpatient call is required. The position is responsible for performing history and physicals of patients on admission, annual physicals, dictate discharge summaries, sick call on unit assigned, suture minor lacerations, prescribe medications and order lab work. Works 8 hour shifts Monday through Friday with some extended work on rotating basis required. It is a 24 hour in-patient facility that serves adolescent, adult and geriatric patients.

FT ongoing Medical Director, start immediately The Director of Medical Services is responsible for ensuring all patients receive quality medical care. The director supervises medical physicians and physician extenders. The Director of Medical Services also provides guidance to the following service areas: Dental Clinic, X-Ray Department, Laboratory Services, Infection Control, Speech/Language Services, Employee Health,

Pharmacy Department, Physical Therapy and Telemedicine. The Medical Director reports directly to the Clinical Director. The position will manage and participate in direct patient care as required; maintain and participate in an on-call schedule ensuring that a physician is always available to hospitalized patients; and maintain privileges of medical staff.

Permanent Psychiatrist needed FT, start immediately An accredited State Psychiatric Hospital serving the eastern region of North Carolina, is recruiting for permanent full-time Psychiatrist. The 24 hour in-patient facility serves adolescent, adult and geriatric patients. The psychiatrist will serve as a team leader for multi-disciplinary team to ensure quality patient care/treatment. Responsibilities include:

evaluation of patient on admission and development of a comprehensive treatment plan, serve on medical staff committees, complete court papers, documentation of patient progress in medical record, education of patients/families, provision of educational groups for patients.

Send copies of your CV, NC medical license, DEA certificate and NPI certificate with number to Physician Solutions for immediate consideration. Physician Solutions, P.O. Box 98313, Raleigh, NC 27624 PH: (919) 845-0054 | email: physiciansolutions@gmail.com

PEDIATRICIAN

OR FAMILY MEDICINE DOCTOR NEEDED IN

ROANOKE RAPIDS, NC In mid December, a pediatrician or family medicine doctor comfortable with seeing children is needed full time in Roanoke Rapids (1 hour north of Raleigh, NC) until a permanent doctor can be found.

Credentialing at the hospital is necessary.

CALLING ALL WRITERS

Are you educated in the medical and health care field and looking to showcase your exceptional writing skills?

To become a contributing writer in Med Monthly magazine, contact MedMedia9 at medmedia9@gmail.com Call 919- 845-0054 or email: physiciansolutions@gmail.com www.physiciansolutions.com

Med Monthly

Contact us:

919.747.9031 medmedia9@gmail.com medmonthly.com

Editorial Calendar: Nov. 2013 - County Health Departments l Dec. 2013 - Selling Your Practice MEDMONTHLY.COM | 77

PRIMARY CARE PRACTICE - Hickory, North Carolina This is an outstanding opportunity to acquire one of the most organized and profitable primary care practices in the area. Grossing a million and a half yearly, the principal physician enjoys ordinary practice income of over $300,000 annually.

Hickory is located in the foot-hills of North Carolina and is surrounded by picturesque mountains, lakes, upscale shopping malls and the school systems are excellent. If you are looking for an established practice that runs like a well oiled machine, request more information.

The free standing building that houses this practice is available to purchase or rent with an option. There are 4 exam rooms with a well appointed procedure room. The owning physician works 4 to 5 days per week and there is a full time physician assistant staffed as well.

For the well qualified purchasing physician, the owner may consider some owner-financing. Call us today.

List price: $425,000 | Year Established: 2007 | Gross Yearly Income: $1,500,000

Medical Practice Listings Selling and buying made easy

MedicalPracticeListings.com | medlisting@gmail.com | 919-848-4202

MD STAFFING AGENCY FOR SALE IN NORTH CAROLINA The perfect opportunity for anyone who wants to purchase an established business. l One

of the oldest Locums companies l Large client list l Dozens of MDs under contract l Executive office setting l Modern computers and equipment l Revenue over a million per year l Retiring owner

Please direct all correspondence to driverphilip@gmail.com.

Only serious, qualified inquirers.

Practice for Sale in Raleigh, NC Primary care practice specializing in women’s care Raleigh, North Carolina The owning physician is willing to continue with the practice for a reasonable time to assist with smooth ownership transfer. The patient load is 35 to 40 patients per day, however, that could double with a second provider. Exceptional cash flow and profit will surprise even the most optimistic practice seeker. This is a remarkable opportunity to purchase a well-established woman’s practice. Spacious practice with several well-appointed exam rooms and beautifully decorated throughout. New computers and medical management software add to this modern front desk environment.

List price: $435,000

Call Medical Practice Listings at (919) 848-4202 for details and to view our other listings visit www.medicalpracticelistings.com

Internal Medicine Practice for Sale

Pediatrics Practice Wanted Pediatrics practice wanted in NC

Located in the heart of the medical community in Cary, North Carolina, this Internal Medicine practice is accepting most private and government insurance payments.

Considering your options regarding your pediatric practice? We can help.

Medical Practice Listings has a well qualified buyer for a pediatric practice anywhere in central North Carolina.

The average patients per day is 20-25+, and the gross yearly income is $555,000.

Listing Price: $430,000

Contact us today to discuss your options confidentially.

Medical Practice Listings Call 919-848-4202 or e-mail medlistings@gmail.com www.medicalpracticelistings.com

Call 919-848-4202 or email medlistings@gmail.com www.medicalpracticelistings.com

Unfortunately, its motor is inside playing video games.

Kids spend several hours a day playing video games and less than 15 minutes in P.E. Most can’t do two push-ups.

Many are obese, and nearly half exhibit risk factors of heart disease. The American Council on Exercise and major medical organizations consider this situation a national health risk. Continuing budget cutbacks have forced many schools to drop P.E.—in fact, 49 states no longer even require it daily.

You can help. Dust off that bike. Get out the skates.

Swim with your kids. Play catch. Show them exercise is fun and promotes a long, healthy life. And call ACE. Find out more on how you can get these young engines fired up. Then maybe the video games will get dusty.

A Public Service Message brought to you by the American Council on Exercise, a not-for-profit organization committed to the promotion of safe and effective exercise

American Council on Exercise

®

ACE Certified: The Mark of Quality Look for the ACE symbol of excellence in fitness training and education.

For more information, visit our website: www.ACEfitness.org

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A M E R I C A’ S A U T H O R I T Y O N F I T N E S S

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the top Here is just a small sampling of recent medical research breakthroughs. We’ve limited it to the top 9, but there are many more because of hugh advances in medical research.

1

DNA, “GENETIC MASTERMINDS”

It’s been determined that DNA are the true genetic masterminds, or metabolic switches that regulate how and when genes function, as well as how prolifically genes churn out their respective proteins. Scientists are already exploiting the newly discovered collection of biological information and pursuing new ways of controlling, and possibly even curing, diseases with the flick of a genetic switch.

2

LAB-GROWN BODY PARTS

Researchers at the Karolinska Institute fashioned a man-made trachea using synthetic microfibers and a bath of stem cells removed from the bone marrow of a patient whose own trachea was destroyed by cancer. Such techniques represent the future of regenerative medicine, in which stem cells of all kinds, including those made from patients’ own skin cells, can serve as the basis for generating any type of cell or tissue that needs to be replaced or repaired.

80

| OCTOBER 2013

BREAST CANCER

3

The Cancer Genome Atlas, a government project that is sequencing the genomes of dozens of cancers, found more than 30,000 mutations in 510 samples of breast tumors, but these fell into four major subtypes. One showed close ties to ovarian cancer, opening up the possibility that treatments for that cancer can also help breastcancer patients, while another helps explain why some have better outcomes than others among women with HER-2 receptor tumors that are supposed to respond to drugs like Herceptin.

Medical Research Breakthroughs

4

MICROBES

Most microbes, including bacteria, that live in, on and around us, are actually our friends, working hard to ensure that we digest our food and build up strong immune systems. As scientists learn more about the bugs that live within us, they are recognizing that they may play an important role in a number of chronic diseases and conditions, including inflammation and obesity.

5 6

DECODING CHILDHOOD TUMORS

Doctors hope that the Pediatric Cancer Genome Project will become a rich source of new targets for therapies. Understanding the genetic drivers of cancers can hopefully reveal common pathways among different types of cancers, allowing doctors to borrow treatments effective against one type of tumor to treat another or to generate entirely new drugs for thwarting cells that grow abnormally.

DO-IT-ALL HIV DRUG

7

REVERSING AUTISM

Researchers say early behavior therapy can help normalize brain patterns responsible for the symptoms of Autism.

It’s a hopeful sign that it’s possible to halt some of the brain changes linked to autism and possibly even reverse them, but the key to the program’s success involves early and intensive intervention with properly trained counselors who actively engage the toddlers in several hours of therapy a week.

8

MAN-MADE MOUSE EGGS

Scientists in Japan used two kinds of stem cells from mice — those taken from daysold embryos and those reprogrammed from adult mouse skin cells — and created viable egg cells that they then successfully fertilized to generate the first ever pups born from stem-cell-derived eggs. This breakthrough could potentially lead to new treatments for infertility in human couples.

9

Truvada, a combination of two antiviral medications, is now the first drug-based way to prevent infection against the virus among healthy people. After groundbreaking trials showed that uninfected individuals using the medication could lower their risk of acquiring HIV, the FDA expanded Truvada’s approval to include healthy people at high risk of becoming infected with HIV, but still warn about not participating in unprotected sex.

DNA-BASED DIAGNOSIS FOR NEWBORNS Fast genomic analysis (fifty hours) is possible thanks to advances in sequencing technology as well as innovative software that links the 3,500 known genetic defects to their childhood diseases, allowing doctors to quickly decide on the right treatment that could save a baby’s life. About 30% of babies admitted to the neonatal intensive care unit each year have inherited a genetic disease, and sequencing their genomes may become a critical part of improving their care in coming years.

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