December 2014 by San Francisco Marin Medical Society

SAN FRANCISCO MEDICINE J O U R NA L O F T H E S A N F R A N C I S C O M E D I CA L S O C I E T Y

CELEBRATING 150 YEARS OF UCSF UCSF and Desegregation | The First Woman Graduate The Early Days of AIDS |Stories from the UCSF Community

Save the Date: SFMS Annual Gala January 30, 2015 | Details on Page 4

VOL.87 NO.10 December 2014

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IN THIS ISSUE

SAN FRANCISCO MEDICINE

December 2014 Volume 87, Number 10

Celebrating 150 Years of UCSF FEATURE ARTICLES

MONTHLY COLUMNS

10 A Brief History: The Founding of the University of California, San Francisco Arthur E. Lyons, MD

Membership Matters

President’s Message Lawrence Cheung, MD, FAAD, FASDS

11 A Turbulent Time: Chancellor Emeritus Philip R. Lee, MD, Looks Back Steve Heilig, MPH

13 The Early Days of HIV/AIDS: UCSF’s Response to the Crisis Marcus A. Conant, MD 15 The First Female Graduate: The First Woman to Attend Medical School in the West Jeffery Chen, MS2 16 Clinician as Teacher: The Essential Role Meg McNamara, MD

17 My “Long Strange Trip”: The Role of UCSF in My Unusual Career David E. Smith, MD

18 UCSF Physicians Speak: SFMS Members in the UCSF Community Share Their Stories 21 UCSF Health: A Framework for Twenty-First-Century Physicians Bruce Wintroub, MD

Editorial and Advertising Offices: 1003 A O’Reilly Ave. San Francisco, CA 94129 Phone: (415) 561-0850 Web: www.sfms.org

Editorial Gordon Fung, MD, PhD

22 Medical Community News 26 Classified Ad 26 Upcoming Events

OF INTEREST 18 SFMS Election Results 24 Gordon Fung, MD, PhD, Wins 2014 CMA Foundation Access to Health Care and Disparities Award 25 Health Policy Perspective: Soda Tax in San Francisco: A Post Mortem—and a Rebirth? John Maa, MD, and Steve Heilig, MPH

Welcome New Members Benjamin L. Franc, MD | Nuclear Medicine Winston Louis Goh, MD | Family Medicine Zachariah Woelz Martinez, MD | Anesthesiology Elizabeth Ann Schaefer, MD | Internal Medicine

MEMBERSHIP MATTERS Activities and Actions of Interest to SFMS Members

SFMS Career Fair: Connecting Physicians with Local Employers

SFMS and CMA Lead Successful Campaign to Defeat Props 45 and 46 SFMS and CMA have successfully led the campaign to defeat two onerous measures that would have negatively impacted health care. This has truly been an example of just how much stronger we are when we speak together with one voice to ensure that our patients continue to have access to quality patient care. PROP 45 – NO: 59.3%, Yes: 40.7% PROP 46 – NO: 67.3%, Yes: 32.7% Prop 45 would have given the state insurance commissioner the power to reject health insurance rate hikes for about six million Californians who buy their own policies or who work for small businesses. Prop 46 would have dramatically altered the Medical Injury Compensation Reform Act (MICRA) by making it easier to file lawsuits against health care providers, thus increasing health care costs, reducing access to care, and ultimately generating more legal fees for lawyers. SFMS leaders participated in press conferences, lobbied at Democratic Party conventions, and granted one-on-one interviews with the local media to inform voters of the dangers of the two proposed measures. This win is proof of the importance of strong physician advocacy from organized medicine and affirms that access to quality health care is a priority for Californians. SFMS and CMA will remain vigilant in our work to ensure that physicians remain in control of medicine this year and in years to come. On behalf of the SFMS and our board of directors, we would like to thank our members and all San Franciscans for making these victories possible through your advocacy, contributions, and support through membership in organized medicine!

David Chiu Wins State Assembly Seat

San Francisco Board of Supervisors President David Chiu is headed to Sacramento after winning a seemingly tight race for Assembly District 17. David Chiu believes in and publicly advocates for the protection of MICRA. His advocacy on the matter became a critical point of contention in the campaign, transforming this race into a proxy race for Proposition 46. SFMS and CMA endorsed David Chiu for his physician-friendly position on MICRA and health care access issues. 4

The fifth annual SFMS Career Fair connected more than ninety residents and fellows with recruiters from twenty exhibiting organizations representing a variety of practice types and settings based in the San Francisco Bay Area. Participants felt this was a wonderful opportunity to become acquainted with practice position opportunities and choices locally available in their specialty, and it highlighted community clinics and small physician groups that may have been overlooked by regional or national job search events. For those who missed the career fair, SFMS will be publishing a list of available positions and recruiter contact information in our December member-only eNewsletter. SFMS would like to thank the CPMC Graduate Medical Education Department for providing the venue for this event. We would also like to recognize our participating exhibitors and staff at the graduate medical departments of CPMC, UCSF, St. Mary’s, and Kaiser Permanente for their generosity and support. Please visit http://www.sfms.org/Membership/StudentResidents. aspx for the list of the participating exhibitors.

Save the Date: SFMS Annual Gala, January 30 Join the SFMS for our Annual Gala on January 30, 2015. Come together with many of San Francisco’s most influential stakeholders in the medical community to celebrate SFMS’s 147 years of physician advocacy and camaraderie. The 2015 Annual Gala will be held at the iconic Asian Art Museum of San Francisco. Guests will be treated to an exquisite reception with elegant hors d’oeuvres, libations, and exclusive access to the museum’s second floor galleries. Roger Eng, MD, will be installed as the SFMS President. The event will kick off with a special lion dance performance by the internationally renowned Leung’s White Crane Martial Arts School. For more information, please contact Posi Lyon at (415) 561-0850 x260 or visit http://www.sfms.org/Events/annualgala.aspx.

SAN FRANCISCO MEDICINE DECEMBER 2014 WWW.SFMS.ORG

Health Net Modifying Exchange/Mirror Products Health Net will be offering an Exclusive Provider Organization (EPO) in all Bay Area counties (San Francisco, Marin, Contra Costa, San Mateo, and Santa Clara) for its individual exchange/mirror products, effective January 1, 2015. No PPO product is offered in the individual exchange/mirror market. Health Net has mailed notices to select physicians to inform them that they were automatically being opted into the provider networks for Health Net’s new products and will be paid at 100 percent of their current contracted PPO/EPO rates. Practices that did not receive the notice are encouraged to confirm their participation status with Health Net by calling Provider Services, as Health Net’s online directory had not been updated to reflect the new products at the time of publication. Physicians with questions for the EPO product and network can contact Health Net Provider Services Center at (800) 641-7761.

Anthem to Expand Medi-Cal Managed Care Network

In an effort to expand its Medi-Cal managed care provider network across the state, Anthem Blue Cross is reaching out to California physicians who are interested in joining the insurer’s network. Physicians who would like to learn more about this opportunity are asked to complete a short form at http://www.cmanet.org/survey_anthem/?p=survey_anthem. Anthem will then follow up with physicians who have expressed interest with additional details.

Covered California Open Enrollment Starts November 15

Covered California open enrollment for plans effective in 2015 will be held from November 15, 2014, to February 15, 2015. During this time, consumers may renew or change their existing Covered California plans or purchase plans for the first time. New for the 2015 plan year, Covered California will offer integrated pediatric dental services through all health plans and separate stand-alone dental plans for adults. Persons earning from 139 to 400 percent of the federal poverty level (FPL, $16,105–$46,860 per year for individuals, $26,321–$79,160 per year for a family of three) are eligible for federal subsidies to reduce their plan costs. Medi-Cal enrollment continues year-round for individuals and families earning below 138 percent of FPL. San Franciscans have the choice of plans from Anthem, Blue Cross, Chinese Community Health Plan, Health Net, and Kaiser. Visit the SFMS Covered California Provider Resource Page at http:// www.sfms.org/for-physicians/covered-california.aspx for additional information and guidelines.

SFMS Membership Expires December 31; Renew Your Membership Today

SFMS would like to thank our 1,600-plus members for their support of the local medical society this year. Because of your support and participation in organized medicine, SFMS continues to be the preeminent physician organization championing the cause of physicians and their patients as we face the many challenges of these changing times. Please take a moment to renew your support of SFMS by remitting payment for your 2015 dues today. There are three easy ways to renew your dues again this year: • Mail/fax in your completed renewal form. • Renew online at sfms.org using your credit card. • Enroll in the Easy Pay (quarterly installments) Automatic Dues Renewal Plan by contacting SFMS at (415) 561-0850 or membership@sfms.org. WWW.SFMS.ORG

December 2014 Volume 87, Number 10 Editor Gordon Fung, MD, PhD Managing Editor Amanda Denz, MA Copy Editor Mary VanClay

EDITORIAL BOARD Editor Gordon Fung, MD, PhD Obituarist Erica Goode, MD, MPH Stephen Askin, MD Erica Goode, MD, MPH Toni Brayer, MD Shieva Khayam-Bashi, MD Linda Hawes Clever, MD Arthur Lyons, MD John Maa, MD Chunbo Cai, MD Payal Bhandari, MD David Pating, MD SFMS OFFICERS President Lawrence Cheung, MD President-Elect Roger S. Eng, MD Secretary Richard A. Podolin, MD Treasurer Man-Kit Leung, MD Immediate Past President Shannon UdovicConstant, MD SFMS STAFF Executive Director and CEO Mary Lou Licwinko, JD, MHSA Associate Executive Director, Public Health and Education Steve Heilig, MPH Associate Executive Director, Membership and Marketing Jessica Kuo, MBA Director of Administration Posi Lyon Membership Coordinator Ariel Young BOARD OF DIRECTORS Term: Jan 2014-Dec 2016 William J. Black, MD Benjamin C.K. Lau, MD Ingrid T. Lim, MD Keith E. Loring, MD Ryan Padrez, MD Rachel H.C. Shu, MD Paul J. Turek, MD

Term: Jan 2013-Dec 2015 Charles E. Binkley, MD Gary L. Chan, MD Katherine E. Herz, MD David R. Pating, MD Cynthia A. Point, MD Lisa W. Tang, MD Joseph Woo, MD

Term: Jan 2012-Dec 2014 Andrew F. Calman, MD Steven H. Fugaro, MD Brian Grady, MD John Maa, MD Todd A. May, MD Kimberly L. Newell, MD William T. Prey, MD

CMA Trustee Shannon Udovic-Constant, MD AMA Delegate Robert J. Margolin, MD AMA Alternate Gordon L. Fung, MD

DECEMBER 2014 SAN FRANCISCO MEDICINE

THE SAN FRANCISCO MEDICAL SOCIETY REQUESTS

Gala THE PLEASURE OF YOUR COMPANY

SPECIAL LION DANCE PERFORMANCE BY THE INTERNATIONALLY RENOWNED LEUNG'S WHITE CRANE MARTIAL ARTS SCHOOL

Janua ry 30, 2015 • 6:30 PM - 9:00 PM Asia n Art Muse um of San Francisco Celebrate SFMS ’ 147 years of physician advocacy and camaraderie, as well as the installation of Roger Eng, MD as the 2015 SFMS President.

$90 per person with Early Bird registration (RSVP by 12/31/2014) $100 per person regular admission

Guests are treated to an exquisite reception with elegant hors d ’oeuvres, libations, and exclusive access to the Asian Art Museum’s second floor galleries.

200 Larkin St, San Francisco, CA 94102

For more information, go to www.sfms.org/Events/AnnualGala.aspx or contact SFMS at (415) 561-0850 x260

PRESIDENT’S MESSAGE Lawrence Cheung, MD, FAAD, FASDS

The Worst of Times, the Best of Times As the end of the year approaches, so does my term as President of the San Francisco Medical Society. Looking

back, this year started out as the worst of times and we ended it as the best of times. Our profession was under a frontal attack as we fought improve the health of our community with a sugar sweetened beverage tax (see page 25 for more on that). In the end, after a hard fought battle, organized medicine has risen to the challenge and triumphed over special interest. The Society’s efforts to decrease the rate of sugar sweetened beverage (SSB) consumption began with Immediate Past President Shannon Udovic-Constant’s ground breaking resolution to the CMA in 2011, which was successfully adopted by the CMA House of Delegates and thereby making it official CMA policy. The Society was then approached by Supervisors Scott Wiener and Eric Mar in late 2013 for collaborative efforts in sponsoring a $0.02 per ounce tax on SSB. Throughout this year, Dr. Udovic-Constant, Dr. John Maa, and I worked tirelessly to educate our community about the dangers of the consumption of SSB and we discussed the benefit that a tax would have on improving the health of our community. This special tax required a two-thirds majority because it mandated that the tax revenues be directed towards programs specifically intended to improve the health of our community. In the end, the special interest group, American Beverage Association, spent over $8 million on their campaign. They hired people ($14 per hour) to picket signs on every street corner but we were still able to garner a majority of the votes (55%) even though we failed to reach the two-thirds majority necessary to establish this tax on SSB. I am buoyed by the fact that our neighbor in Berkeley was successful in becoming the first city in the country to impose a tax on SSB. I believe that, like tobacco, the dangers of consuming SSB will be apparent over time and that we have succeeded in moving the dial in a national conversation on SSB. More importantly, our close collaboration with the Supervisors this year has cemented our role as the voice of public health and of all San Francisco

physicians. It is my hope that we, as the Society, will continue to work on public health policy relevant to the health of San Francisco. While we were busy working to improve the health of San Franciscans, our profession was assaulted by the special interest group, Consumer Watchdog, in the forms of Proposition 45 and 46. This special interest group wanted to increase the cap on MICRA, mandate random drug testing on physicians, and require the use of the CURES prescription database without funding it adequately. Our Society, with the help of the California Medical Association and a broad coalition of partners, were able to hand both propositions a resounding defeat. For those of you who helped with time or monetary resources, I want to extend a deep thank you because this was a team effort and it showcases the best of what organized medicine can achieve. For those of you who are members of SFMS and CMA, I want to thank you for your support because you have added your voice to our ongoing fight. For those of you who are deciding to become members, I hope that this year’s fight has demonstrated to you that we can only preserve our profession when we speak collectively with one voice. Like our efforts in SSB, the special interest group Consumer Watchdog has also moved the dial in the debate on liability reform and physician drug testing. We anticipate that this is not the end of the battle and that we must bring the fight to the special interest group by pre-empting their efforts. Our Society has already crafted resolutions that will address some of these issues and we hope that the CMA will make them their policy. With this ongoing fight, I hope that our Society members will consider to donate to our Political Action Committee (PAC) so that we can further engage in our legislative process. This has been a tremendous year for organized medicine. I think that the work we have done this year has demonstrated the relevance of our Society and that of organized medicine for years to come. It has been truly both an honor and a privilege to have served as your President.

The SFMS Would Like to Thank the Following Contributors to the SFMS Political Action Committee Douglas B. Anderson, MD Michael W. Bigelow, MD Nancy J. Bohannon, MD Richard A. Bohannon, MD Richard L. Caplin, MD Paul B. Carlat, MD Andrew F. Calman, MD Gary L. Chan, MD Kenneth D. Chan, MD Randolph H. Chase, MD Lawrence Cheung, MD, FAAD, FASDS Edward A. Chow, MD Lucy S. Crain, MD Richard G. Dedo, MD Roger S. Eng, MD, MPH, FACR Anthony J. Errichetti, Jr., MD Mei-Ling Fong, MD WWW.SFMS.ORG

George A. Fouras, MD Steven H. Fugaro, MD Gordon L. Fung, MD, PhD, FACC, FACP Erica T. Goode, MD William H. Goodson III, MD Shawna K. Hedley, MD Katherine E. Herz, MD Thomas M. Jackson, MD Donald C. Kitt, MD Howard B. Kleckner, MD M. Margaret Knudson, MD Man-Kit Leung, MD Elizabeth M. Lewis, MD Ronel L. Lewis, MD Raymond K. Li, MD Martin S. Liberman, MD Ingrid T. Lim, MD

Randall Low, MD Michael C. Schrader, MD, PhD John Maa, MD Rachel H. Shu, MD Helen S. Manber, MD Judy L. Silverman, MD Robert J. Margolin, MD James E. Storm, MD James G. Moore, MD Peter W. Sullivan, MD Kimberly L. Newell, MD Lisa W. Tang, MD Stuart M. Pickel, MD Edmund K. Tsoi, MD John W. Pierce, MD Paul J. Turek, MD Stephen J. Pinney, MD Shannon Udovic-Constant, MD Todd C. Pope, MD John I. Umekubo, MD Winchell W. Quock, MD Eric C. Wang, MD Joel W. Renbaum, MD David Werdegar, MD Vivian M. Reyes, MD Charles J. Wibbelsman, MD Dean L. Rider, MD Larry E. Williams, MD Rodman S. Rogers, MD Joseph W. Woo, MD Michael H. Rokeach, MD Roger M. Wu, MD Kevin Saitowitz, MD DECEMBER 2014 SAN FRANCISCO MEDICINE 7

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EDITORIAL Gordon Fung, MD, PhD

Celebrating 150 Years UCSF. I can’t remember a time in my life that UCSF wasn’t a part of it. Looking back at the history of the in-

UCSF is home and family to me. I am still incredulous that I was able to attend and now work at this outstanding institution that is ranked among the world’s best medical, pharmacy, stitution, I recognize that when it formally became associated nursing, and dental schools, among the world’s best medical with U.C. in 1864, my family was landing in San Francisco. My centers, and the world’s leading science and global health refather was first in his family to go to college (U.C. Berkeley) search facility. And it’s right in my own backyard. Every day and was one of only two Chinese men in his medical school I learn something new about UCSF in the breakthroughs or class at UCSF School of Medicine. innovations that make me more proud to be a member of its Later my oldest sister Linda was one of the first students family. At the same time, I am in awe of the sheer brainpower to graduate from the UCSF School of Pharmacy with a PharmD and creativity and leadership of the people I meet and work degree. My next-older sister, Lynette, worked at the UCSF Liwith. I am also amazed at how friendly and supportive they brary; and the next three children of the Fung family, Lenora, are when I am faced with a challenging case or need some Gregory, and I, went to UCSF School of Medicine. Lenora comguidance on braving the bureaucracy of this giant organizapleted her internal medicine residency and then radiology tion. So you can tell that I am a little biased when it comes to all at UCSF before entering private practice in San Francisco. writing an editorial about my home and my workplace that I My brother Greg completed his internal medicine residency am so proud of. at UCSF and pursued a subspecialty in gastroenterology at In this edition, you will learn more of the history of UCSF the Veterans Administration Medical Center in Martinez. He from one of SFMS’s past presidents and historians, Dr. Arthur then returned to San Francisco to start private practice; he Lyons. UCSF has had to struggle to achieve its recognition and also joined the Volunteer Clinical Faculty for the UCSF School reputation. Many if not all the challenges of becoming a topof Nursing to establish the Glide Memorial Medical Clinic for level health care and research institution fell on the chancelthe advanced-practice nurses’ training program and then the lor to provide guidance and direction. Chancellor Emeritus Medical Clinic at the Delancey Street Foundation. Philip Lee is interviewed by Steve Heilig and recounts some I spent two years in the School of Pharmacy and then turbulent times in UCSF’s development. There were also many transferred into the School of Medicine. I initially started out firsts at UCSF. Marc Conant writes about the early days of HIV/ in private community practice as a volunteer clinical faculty AIDS and how the institution responded to the crisis. Jeffrey member in cardiology and then was recruited to the full-time Chen provides the history of the first woman to attend medifaculty of UCSF in 2000. My youngest brother Tim received cal school in the West, at UCSF. some of his specialized care at UCSF. Now my daughter Kelly Meg McNamara discusses the role of the clinician as is completing her internal medicine residency training at the teacher, significant because UCSF has the largest clinical facUCSF Primary Care Medicine program. Many of my cousins, ulty of the nation’s health care schools. Dr. David Smith renieces, and nephews received their training and continue to counts his life journey in medicine and how it was closely inwork at UCSF. tertwined with UCSF. Many SFMS members have ties with UCSF, and some of them tell their stoUCSF Cable Car, circa 1900 ries as well. And finally, our current dean of the School of Medicine, Dr. Bruce Wintroub, offers a look toward the future of UCSF and how it will impact medicine in San Francisco. Dr. Wintroub has been a medical leader in the school for many years and recently was appointed interim dean. His 30,000-foot perspective of the initiatives of the medical center as it plays an integral part of a health care network and system speaks to the leadership direction that UCSF is taking in the arena of health care delivery. As this is the final edition of the calendar year, have a happy holiday season and a healthy and fulfilling New Year! See you soon in our next edition, in January 2015. WWW.SFMS.ORG

DECEMBER 2014 SAN FRANCISCO MEDICINE

Celebrating 150 Years of UCSF

A BRIEF HISTORY The Founding of the University of California, San Francisco Arthur E. Lyons, MD In what is now the oldest part of the building complex that makes up the University of California, San Francisco, campus, a structure

erected in 1917 and now used for professional offices, is an auditorium decorated by a lively mural depicting a history of California medicine. In the lobby of the much newer School of Medicine building nearby is a large, heroic bronze bust of the man after whom the auditorium is named: Hugh Huger Toland.

The name Toland means very little to the hundreds of people who pass through the doors of UCSF everyday, but it should. Toland started the school. Hugh Toland (1806–1880) was a native of South Carolina at a time when virtually anyone could call himself a doctor—anyone could purport to practice medicine, irrespective of education or experience. Toland, however, obtained the finest medical education available at the first medical school established west of the Alleghenies: the Transylvania Medical College in Lexington, Kentucky. After graduating in 1827, he established a highly successful practice on returning to South Carolina. Two years later he went to Paris, then the world center of medicine, for postgraduate study. After another twelve years of practice in Columbia, he joined a wagon train of Argonauts to California in 1852, planning to operate a quartz mill that he had purchased and shipped by sea to San Francisco. With his fortune saved from his practice, he bought a gold mine near Mokelumne Hill, where he installed his quartz mill. The venture, however, was unsuccessful and he gave it up to resume what became a highly successful medical and surgical practice in San Francisco. Mary Toland, Hugh Toland’s adored wife, unfortunately died of cholera only a few miles from their destination, and Toland, after having her body embalmed, refused to have it buried. Remarkably, he kept it in a glass-covered coffin in his San Francisco office. Toland established his office at Montgomery and Merchant Streets. Within two years he was seeing as many as one hundred patients a day, making $20,000 annually, which soon rose to an immense $40,000. It is said he kept two barrels of medicine: 10

“anti-scrof” and “anti-syph,” from which he filled medicine bottles from his own adjoining pharmacy. In fifteen years he filled some 581,000 prescriptions! He filled them on request at $5 each, mailing them to the miners in the diggings, depending on their described symptoms. In 1864, 150 years ago, Toland started his own medical school, named after himself, building it of stone and brick on Stockton near Chestnut Street. It was next door to the City and County Hospital. Toland lectured on surgery while local physicians filled the other chairs. The Toland Medical College was in competition with the several other medical schools in the city, notably the Cooper Medical College. This ultimately became the Stanford School of Medicine in 1907. The competition was often hostile, and periodically the faculty of one school would resign and take up with the other. The relation between Levi Cooper Lane and Toland was also very frosty. Toland and his dean Beverly Cole (1829–1901) were early supporters of the fledgling American Medical Association, while Lane ignored it. Cole, whose name is perpetuated by the street named for him near the Parnassus campus, ultimately became AMA president. At one point, apparently exasperated by his faculty, Toland offered his school to the Regents of the University of California on the condition that he be named Professor of Surgery. This was readily agreed to and in 1873 U.C., which had been established in Berkeley since 1867, expanded to San Francisco. Toland published his surgical lectures in 1877 and died following a fall in 1880, ending a distinguished career.

The early U.C. medical school had no hospital of its own in which its students could gain experience but used the San Francisco City and County Hospital on Potrero Avenue. The schools of nursing and dentistry and medicine, the Affiliated Colleges of U.C., were established on Parnassus Heights in 1897, on land donated for the purpose by Adolph Sutro in 1893. It was to the Affiliated Colleges that anthropologist Alfred Kroeber brought Ishi, the last survivor of the Yahi Indian tribe, who then lived at the

Continued on page 12 . . .

SAN FRANCISCO MEDICINE DECEMBER 2014 WWW.SFMS.ORG

Celebrating 150 Years of UCSF

A TURBULENT TIME Chancellor Emeritus Philip R. Lee, MD, Looks Back Steve Heilig, MPH

“There was once gunfire into my office at UCSF . . . I moved my desk away from the window.” South, but it did need more integration. Some people referred to UCSF as “the plantation,” as the black workers had no possibility of any advancement and had to go from the top floor to the basement to find a bathroom they were allowed to use. It was controversial, because we had to do things that were new, and the medical school, although already a leading institution, was not a leader in this regard yet. But eventually black workers rose much higher. And of course we also started efforts to get many more minority students in all the schools.

I’ve heard your efforts were not appreciated by thenGovernor Ronald Reagan.

Dr. Phil Lee was UCSF chancellor from 1969 to 1972. Trained at Stanford Medical School, he has held numerous leadership positions in medicine, public health, and government. As noted on UCSF’s website, “In February 1969 he agreed to become the third chancellor of UCSF, in the midst of national and local political turbulence over civil rights and the Vietnam War.”

That was true. I later learned I was approved as chancellor by only one vote by the U.C. Regents, as they were very conservative and I was not. I probably wouldn’t have even taken the job if I had known that going in. Anyway, once I was there, Reagan would block funds and grants and such that were supposed to be coming to UCSF, and it was a serious problem as it became clear that this would continue as long as I was there. Then I had a bowel obstruction and surgery and that pushed my decision to resign sooner than I might have otherwise. I recommended they appoint Frank Sooy, who was much more conservative than I was and thus worked better with Reagan’s people. But he and I had agreed he would continue what I was doing anyway!

How did you arrive as chancellor at UCSF?

There was much ferment in the air in San Francisco in that era.

I was assistant secretary of health for President Johnson; I had been at the Palo Alto clinic and was planning to return to practice there but was asked if I’d go to Washington for a year to help implement the new Medicare program.

Well, there was once gunfire into my office at UCSF, I think by Hispanic activists who were upset that we were focusing on blacks and thought that was all we were doing. I moved my desk away from the window.

Well, I’d say cost issues—so some things don’t change. We were told we had to make cuts, and some of those were painful.

Yes, David Smith was a recent UCSF graduate and clearly had some wonderful ideas and energy, even though some of them were controversial too. So I helped him start the Clinic, which continues to this day and has served as a model around the nation.

What were the biggest issues facing you and UCSF then?

In Washington, you were very involved in desegregation of health facilities.

Yes, we desegregated more than 1,000 hospitals. When I got to UCSF, it wasn’t a truly segregated institution like in the WWW.SFMS.ORG

The famed Haight Ashbury Free Clinic was started nearby while you were there, and you were supportive?

Continued on the following page . . .

DECEMBER 2014 SAN FRANCISCO MEDICINE

A Turbulent Time Continued from the previous page . . .

A Brief History Continued from page 10 . . .

What were issues in medical education then?

Anthropology Museum there. (It was Ishi who taught Dr. Saxton Pope the art of bow hunting; Saxton became known as the father of the sport in America.) There was no hospital at the site, but a small number of patients were treated at there after the destruction of San Francisco hospitals in the1906 earthquake and fire. The first U.C. hospital buildings were then built and opened there in 1917 and were used for teaching purposes, along with S.F. General, until the Moffitt and Long Hospitals were built in the 1950s and ’60s. Medical students continued to obtain their preclinical education—anatomy, biochemistry, and so on—on the Berkeley campus until the 1950s, when preclinical faculty was finally established at Parnassus in new buildings along with the School of Nursing. The original structures on Parnassus have been demolished as further structures were put up. The Hooper Foundation, the first research institute within a medical school, was established in 1913. The Langley Porter Psychiatric Institute was created in 1941. In recent years there has been a modern medical office building and the advanced Klamonovitz Medical Library. The latest U.C. structures, research and clinical, have been going up as the additions to the campus in Mission Bay. Mt. Zion Hospital in San Francisco was absorbed in 2002 and Oakland’s Children’s Hospital in 2014. Intimate affiliations remain with the San Francisco Veterans Center and with SF General. An attempt to improve efficiency in combining clinical activities with Stanford in 2005 was not successful. The modern U.C. Medical Center is the result of the efforts of many foresighted individuals over the years. U.C. has expanded to broaden its reach and capacity well beyond Toland’s fondest dreams. Two examples are: neurosurgeon Howard Naffziger, as chief of surgery and later regent, first established the medical specialty board system and the first formal surgical residency program in the West. Julius Comroe was appointed chairman of the newly created Cardiovascular Research Institute in 1957. The famous historian and dean John B. De C. M. Saunders was promoted as Comroe reoriented U.C. into a major medical research center and literally transformed it, giving it international stature. U.C. is unique among medical schools. The institution is primarily supported by income and grants from its research and its nonclinical activities rather than from income from patient care. The emphasis on research at UCSF has led to many important medical discoveries. They include vitamin E and pituitary growth hormone by Dr. Herbert Evans; Nobel Prizes awarded for the discoveries of oncogenes in 1989 by Drs. Michael Bishop and Harold Varmis; prions, 1997, by Dr. Stanley Prusiner; and telomerase, 2009, by Professor Elizabeth Blackburn. The AIDS virus was codiscovered by Jay Levy in 1983. Over the years UCSF thus has become transformed, and it probably will continue to reinvent itself. After 150 years of a fascinating and distinguished history, UCSF has a great and important tradition in advancing medical knowledge. It has maintained a remarkable faculty and staff and it trains unusually talented men and women. It is the noble heir of Toland’s legacy. Its future is assured.

I recruited Julius Krevans, MD, from Johns Hopkins to be dean of the Medical School, not only because he was great but again as he was more conservative than I was, and that was needed to get support of both the Regents and faculty. Julie, I would say, modernized medical education there, along with Holly Smith as chair of medicine and Mel Grumbach as chief of pediatrics, and some others—first-class leadership there. We pushed for needed change in the pharmacy, nursing, and dental schools too, and all of them were soon among the very best in the nation due in some part to new leaders coming in.

And you started the UCSF health policy institute as well, which is now the Philip Lee Institute.

Right, as there had been virtually no focus on policy issues before, and health is a complicated arena that is not just clinical, obviously.

After your UCSF years, you returned to Stanford, and then even to Washington to be assistant secretary again, but this time under President Clinton. And you keep tabs on health policy issues now, judging from your recent letter in The New York Times regarding lack of resources for a solid Ebola response. Do trends today otherwise give you any sense of optimism?

It’s a mixed bag, in terms of public health and reform. Unfortunately, real progress seems to depend too much on which political party is in power.

Arthur E. Lyons, MD, is a retired neurosurgeon, longtime member and past president of the SFMS, member of the San Francisco Medicine editorial board, and local medical history buff.

SAN FRANCISCO MEDICINE DECEMBER 2014 WWW.SFMS.ORG

Celebrating 150 Years of UCSF

THE EARLY DAYS OF HIV/AIDS UCSF’s Response to the Crisis Marcus A. Conant, MD When AIDS appeared in 1981, its primary manifestation was the explosive appearance of Kaposi’s sarcoma in young gay men. Often these patients then de-

veloped life-threatening opportunistic infections, such as pneumocystis pneumonia. Dermatologists and oncologists at UCSF created the first multidisciplinary HIV/AIDS clinic in America to evaluate and treat patients with this new disease. Funding for this clinic was provided by the chairman of dermatology, Dr. William Epstein. Numerous physicians, dentists, nurses, bench scientists, and hospital administrators met regularly to present cases and discuss new findings that surfaced weekly. Many of these early AIDS pioneers went on to illustrious careers in caring for HIV patients and in research and advocacy. The first group included Drs. Paul Volberding, Donald Abrams, John Ziegler, Paul Dague, Jay Levy, John Greenspan, Arthur Ammann, Stephen Follansbee, and many others. With the support of UCSF, the members of the aforementioned clinic sponsored the first national meeting on HIV/AIDS in Toland Hall in 1982. The meeting was attended by officials and physicians from the CDC in New York and Los Angeles. At this meeting, Dr. Hal Jaffe from the CDC met with Dr. Art Ammann and identified the first case of transfusion-associated AIDS. This finding led to increased urgency to develop a reliable Eliza test to identify HIV-infected blood. The commercial test became available two-and-a-half years later in March 1985. While all this was going on, the number of AIDS cases had been increasing exponentially.

The exact number of young gay men infected with HIV in those early days is unknown; many of us estimate that somewhere in the range of 17 men were infected each night.

The number ultimately infected in San Francisco was over 35,000. (While we have come a long way, we still have one infection a night occurring in a city of fewer than 800,000 people). Money for research was desperately needed. Working with Assembly Speaker Willie Brown and State Assemblyman John Vasconcellos, U.C. physicians met in Sacramento and proposed a budget of $3 million for HIV/AIDS research, which was approved by the California legislature. Using some of this money, UCSF’s Dr. Jay Levy was the first physician in the world to both isolate and culture the HIV virus. Previously the virus had been isolated in France and cultured by a separate group in the United States. WWW.SFMS.ORG

Back in San Francisco’s clinics and private offices, the alarming infection rate was leading to an increasing number of patients presenting to internists, family physicians, pediatricians, oncologists, gastroenterologists, and dermatologists. While the initial presentation was usually Kaposi’s sarcoma or some other cutaneous finding, more than 90 percent of these patients developed some life-threatening opportunistic infection such as pneumocystis, toxoplasmosis, or systemic candidiasis. It soon became apparent that we needed a dedicated ward to treat patients who were critically ill. Many of us wanted to see that clinic established at UCSF, but it was argued that the gay patient population had no money (not true), their presence would deter other physicians from sending their patients to UCSF (probably true), and that their presence would dilute the learning experience of young interns and residents. Fortunately UCSF is partnered with San Francisco General Hospital, whose chief of medicine at the time was Dr. Merle Sande. Working with Dr. Volberding, Sande opened Ward 86, which became an international model for providing compassionate care to patients who were otherwise shunned by society. The physicians and nurses at San Francisco General taught all of us how to provide care for HIV/AIDS patients, prevent transmission to health care workers, and reassure society that this was a medical condition that could be treated and not feared. Dr. Sande also convened a large group of UCSF physicians and HIV activists and produced a document that was published in the New England Journal of Medicine, which established recommendations for appropriate infection control for health care providers caring for AIDS patients. UCSF can be justly proud of the role it played in the early days of the AIDS epidemic. The scientific and academic contributions are impressive, but even more important is that UCSF taught the world how to provide compassionate care for feared and disenfranchised patients. Marcus Conant, MD, diagnosed and treated his first HIV-positive patient in February 1981. He is clinical professor of dermatology emeritus at UCSF, where he completed his residency, and he still cares for HIV-positive patients. He was chair of the California state committee on AIDS, cochaired San Francisco Mayor Willie Brown’s AIDS Summit, was a founder of the San Francisco AIDS Foundation, and was awarded the UCSF Chancellor’s Award for Outstanding Public Service.

DECEMBER 2014 SAN FRANCISCO MEDICINE

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Celebrating 150 Years of UCSF

THE FIRST FEMALE GRADUATE The First Woman to Attend Medical School in the West Jeffrey Chen, MS2 In 1876, Lucy Maria Field Wanzer became the first woman to graduate from the UCSF School of Medicine (then known as the Medical Depart-

ment of the University of California). When Lucy Wanzer applied to the Medical Department of the University of California in 1873, she was rejected. Throughout the nation, female medical students were few and far between, and no medical school west of the Rocky Mountains had ever admitted a woman. But, committed to her childhood dreams of becoming a doctor, Wanzer appealed the decision. After a four-monthlong process, the Regents of the brand-new University of California finally let her in, passing a resolution that “women offering themselves for admission and passing the required examination must be received to all the privileges of the Medical Department.” This resolution would set a precedent for generations to come of female medical applicants to U.C. medical schools. “Dr. Wanzer’s contributions to UCSF and American culture vis-à-vis women’s rights cannot be overstated,” said Dr. Robert Sherins, a member of the UCSF School of Medicine Class of 1963. “Her life was so inspiring to me that I decided to publish an updated iteration of her biography.” This iteration appears in the Fiftieth Reunion Memory Book that Dr. Sherins recently compiled for his class reunion in April. With nearly twenty years of experience doing family genealogical research, Dr. Sherins set out to write a historically accurate biography of Dr. Wanzer. The final product was a full chapter of material that Dr. Sherins obtained from civil archives, newspaper and academic journal articles, and UCSF archival images. The Reunion Book is available in Archives & Special Collections at the UCSF Library. Dr. Sherins’ research reveals that Wanzer’s first few days in medical school were not so easy. At the start of the year, the dean of the school had encouraged her male classmates to haze her. Many of her twenty-six classmates complied, playing pranks on her and trying to scare her during anatomy dissections. Unfazed, Wanzer continued going to class, where she faced discrimination by her professors. One instructor told her that a woman had no business studying medicine, and that if one did, she ought to have her ovaries removed. To this, Wanzer allegedly replied, “Then men students ought to have their testicles removed.” In the obstetrics clinic, Dr. R. Beverly Cole warned WWW.SFMS.ORG

her that the material he was about to teach would be embarrassing to her and suggested that she excuse herself. When she insisted on staying, an impressed Dr. Cole took her on as his mentee. Eventually, Wanzer also won over her male classmates when she refused to rat them out to the administration for a prank they’d pulled on a fellow student. Over the next few years in school, her classmates and teachers treated her with respect and consideration as an equal in education. Lucy Maria Field Wanzer graduated in 1876 with the first official class of the Medical Department of the University of California (today’s UCSF School of Medicine). However, her problems as a pioneer for women in medicine were far from over. Upon graduation, Dr. Wanzer had to fight for admission to the San Francisco County Medical Society. This time, however, she was backed by her UCSF mentor Dr. Cole, and she soon became the first woman to be elected to the Society. She went on to open a private clinic on Geary Street, specializing in obstetrics and gynecology as well as pediatrics. She was elected the vice president of the UCSF Alumni Association in 1885 and eventually served as an attending at the Children’s Hospital of San Francisco. Many women would follow the precedent set by Dr. Wanzer. In 1919 (43 years after Dr. Wanzer’s graduation), when women won the right to vote, about 10 percent of each UCSF graduating class was female, far ahead of the national average of 4 percent. Moreover, it would take many medical schools well into the midtwentieth century to start accepting women. Today, women actually outnumber men at the UCSF School of Medicine; women made up 56 percent of graduates this year, compared to a national average of 47 percent. In his article, Dr. Sherins included a detailed analysis of female graduates of the UCSF School of Medicine through the years since its founding. “The trends of the past decades show pretty clearly that the UCSF administration and faculty have a very certain view of their responsibilities vis-à-vis gender equality,” he suggested. And it all started with the first female medical graduate in 1876. “Dr. Lucy Wanzer contributed to the local and national awareness of women’s rights by successfully doing what she knew best, taking good care of her patients and being recognized for her many efforts.” Jeffrey Chen is a second-year medical student at UCSF.

DECEMBER 2014 SAN FRANCISCO MEDICINE

Celebrating 150 Years of UCSF

CLINICIAN AS TEACHER The Essential Role Meg McNamara, MD When I came to UCSF for residency in the early 1990s, I had no inkling that I would be here two decades later or that education would be such a large part of my medical career. It is inspiring and gratifying to teach the

next generation of physicians, and a perfect complement to the immense privilege it is to care for patients. Many aspects of medicine have changed profoundly over the past two decades since my residency training, but the essential role of teachers to pass on their clinical wisdom and to foster the young physician’s professionalidentity development remains constant. We are living and working through a massive cultural change within the field of health care, where the growth of medical knowledge and technologies as well as the information systems to manage them are rapidly evolving, outstripping the pace with which most people can realistically keep up on everything. Even with this dizzying pace of development and change, the key qualities of compassionate, conscientious, and competent care remain the core of what we value in clinical medicine. It is critical that we maintain these fundamental elements while educating the physician of the twenty-first century, who will also need to navigate the complex and emerging systems of information and health care delivery. Medical education is accordingly undergoing substantial transformation. The UCSF School of Medicine, along with the American Association of Medical Colleges (AAMC), adopted a framework of key “competencies” that students are required to master prior to graduation, under the domains of patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. Students are expected to progress through designated “milestones” on their way to achieving specific competency goals that certify their readiness for graduate medical education (GME) residency training. The emphasis within medical education at UCSF has shifted in recent years to focus heavily on the development of competence through “active learning,” critical reflection, and independent learning plans. In addition, professionalism and systemsbased practice are now explicitly highlighted and considered as essential to the formation of the medical student as passing the board exams or performing the H&P. Students learn and master much of the material through small-group seminars or problembased learning cases, team-based learning, skills-development workshops, laboratory sessions, instructional videos, and simulations involving “standardized patients” played by paid actors or via high-tech equipment such a mannequins or online scenarios. UCSF’s integrated curriculum is highly engaging, but there is still no substitution for students stepping into the “real world” of clinical medicine, and this is where the clinical preceptor’s role remains paramount. One of my roles within UCSF’s Office of Medical Education is to oversee all the clinical preceptorships for the pre16

clerkship students, and I hear from the students about how deeply they value and appreciate these experiences. The clinical preceptorships are consistently highly rated because they introduce students to the special relationship between physician and patient and also provide opportunities to practice the skills they learn in on-campus sessions. Most of us recall a teacher who took a shine to us or illuminated something in a way that made it memorable. For any of you who would like the opportunity to pass the torch, I hope you will consider becoming a preceptor for this new generation of physicians. The effort involved in teaching—even in a busy and demanding practice—is richly rewarded and well worthwhile. If you have questions or interest in serving as a clinical preceptor, please contact us in the UCSF Clinical Learning Unit through Ivan Mendez (mendezi@medsch.ucf.edu). Meg McNamara, MD, is a professor of pediatrics at UCSF, co-director of the Foundations of Patient Care and Preceptorships, and director of preceptor outreach at the UCSF Office of Medical Education.

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SAN FRANCISCO MEDICINE DECEMBER 2014 WWW.SFMS.ORG

Celebrating 150 Years of UCSF

MY “LONG STRANGE TRIP” The Role of UCSF in my Unusual Career David E. Smith, MD My life at UCSF began in 1960 after graduating from U.C. Berkeley with a B.S. in zoology. I’d come to the Bay Area

from California’s Central Valley, where I planned to eventually return as a physician. It was a difficult year for me, as my father had just passed away at the old Southern Pacific Hospital on Fell Street in the Haight-Ashbury district. My mother, who was a nurse and motivated me to go into medicine, had passed away four years earlier during my senior year in high school. As I had no siblings, I was basically an orphan; UCSF in effect become my family, and I stayed around during all holidays at my apartment on Frederick Street (where I watched 49ers games at Kezar Stadium from my roof). While in medical school I became very interested in psychopharmacology because of excellent professors such as Dr. Fred Meyers. At the same time, the civil rights movement in San Francisco was exploding and another professor, Dr. Nat Burbridge, was deeply involved in bringing social issues into our academic environment. I enrolled in both medical school and graduate school in pharmacology, receiving an MD and an MA in 1964. After my training in clinical toxicology, I took over the alcohol and drug abuse screening unit at San Francisco General Hospital and joined the clinical faculty at UCSF. However, the “counterculture” revolution and the “Summer of Love” of 1967 erupted in the Haight-Ashbury and my life underwent a dramatic change. For a variety of complex reasons that I am still trying to understand, I rented a vacant dental office at Haight and Clayton streets and opened the Haight-Ashbury Free Clinic as “David E. Smith, MD, and Associates.” We practiced primarily with UCSF faculty including Dr. David Breithaupt and many others, such as past SFMS president Steve Walsh, MD. Many UCSF students and volunteer community physicians spent time with us in those early years, providing care for the hundreds of thousands of so-called “hippies” who flooded the area and were not welcome elsewhere. We pioneered not only care for this population but developed hippie “talk-down” guides for bad LSD trips. Our financial support was from rock concerts organized by the legendary Bill Graham of the Fillmore Auditorium, who helped us receive proceeds from shows by the likes of Janis Joplin, Carlos Santana, the Grateful Dead, George Harrison, and Creedence Clearwater Revival. The relationship with Graham eventually evolved into our Rock Medicine program, which delivers medical service to 1,000 concerts a year—again, joined by many staff from UCSF. Our founding slogan was “Health care is a right, not a privilege.” “Love needs care” was the title of our first clinic history, coauthored with noted journalist John Luce, who also wrote the first national article on the clinic for Look magazine in 1967. John went on to a distinguished medical career at UCSF and became chief of staff at SFGH. UCSF leaders helped in establishing addiction medicine as a legitimate medical specialty, which was unheard of when we started out. WWW.SFMS.ORG

“I was fortunate enough to come of age during the golden era of public education in our state. . . . My grandparents had been farm workers and it was a very long way from there to studying medicine at one of the best schools in the world.” With the advent of heroin addiction in returning Vietnam veterans, we received federal grants to expand our drug detoxification services under the direction of Dr. Darryl Inaba, a graduate of the UCSF School of Pharmacy. We instituted a pharmacy training program at the school—in fact over, the years all UCSF schools and departments have volunteered or trained at the Haight Clinics. The chancellors have been supportive, particularly in tough times, from Phil Lee to Julius Krevans to Sam Hawgood, who recently gave me a UCSF tie at our fiftieth-year class reunion after I received the Peter Haas U.C. public service award. I was fortunate to come of age during the golden era of public education in our state, when the greatest public system in the nation, the University of California, was both accessible and affordable. Even though, after I opened the free clinic, one of my medical school professors lamented, “David, you were such a promising young student—where did you go wrong?” my education and association with UCSF has been a crucial part of so much of what I have done. As the Grateful Dead sang, my life has indeed been a “long, strange trip.” But I remain a grateful member of the UCSF family to this day. Below: Dr. Smith and longtime colleagues at a recent lecture

DECEMBER 2014 SAN FRANCISCO MEDICINE

Celebrating 150 Years of UCSF

UCSF PHYSICIANS SPEAK SFMS Members in the UCSF Community Share Their Stories Recurrent Educational Adventures at UCSF

Mental Illness Among Us

Over the past forty years, I have benefited from and contributed to a wide variety of learning programs at UCSF, including two months as a medical resident on the (gone but not forgotten) Women’s Ward at SFGH; teaching epidemiology to medical students; attending on the general medicine service at SFGH; annual review of internal medicine; midcareer fellowship in health services research and policy; currently, interprofessional career development in geriatrics; facilitation of team development for incoming health science students; and varied programs through the Entrepreneur Center. Collaborations with faculty and graduate students have led to successful studies and projects, numerous publications, and ongoing SFMS initiatives for POLST and Advance Care Planning. My advice for SF and Bay Area physicians is to explore and consider participation in the incomparable CME, career development, teaching, community program, and research opportunities offered by UCSF. Jeff Newman MD, MPH Adjunct Professor, Institute for Health & Aging, UCSF Proud member (formerly on the Board) of SFMS

UCSF has a history of advocating for marginalized, stigmatized populations. Although I was aware of the historical events before becoming a student, I did not fully comprehend the culture within the UCSF community that has allowed it to continually lead these dramatic shifts in societal perception. My first year of medical school has been a year of science and discovery but, not only that, it has been a year of learning about this community. In May of this year, a week was dedicated to highlighting mental illness among medical students. The week of activities was entirely organized and led by medical students. I woke up each morning to anonymous, personal stories about mental illness from my classmates—brief windows into their pasts and presents. The week concluded with a powerful session where I watched one brave colleague after another stand up and share their struggles with disease. I felt humbled by their stories, honored to be trusted in their intimacy, and proud to be a part of this community. It made me realize that the stigma of mental illness does not just afflict our patients but personally touches all of us. UCSF, as a community, leads not only through scientific breakthrough but also through the dismantling of barriers. It leads through humility, through recognizing our own vulnerabilities as health providers, through breaking down the walls between “us” and “them.” We are not just health providers—we have all once been and will one day be patients. That recognition of the illnesses among us is what helps us become the best physicians we can be. Rowen Jin SFMS Medical Student Leader

A Great Training Ground It was during my third year of medical school that I found my love for plastic and reconstructive surgery. The ability to establish form and function, solve complicated surgical problems, and interact with a variety of different patients intrigued me. In my reading and research in the field during this time, I would frequently come across literature by Dr. Stephen Mathes, chairman of plastic surgery at UCSF. I was honored to be invited to interview at this program and meet him in person. During the interview I learned about the department’s rich history and illustrious list of contributions to medicine and surgery. I interacted with residents and attendings who were intelligent, down to earth, happy, and clearly excited to be a part of this institution. I was fortunate to match in the combined plastic surgery/general surgery residency at UCSF. The program has taught me not only the skills and techniques of surgery but clinical decision making, creative problem solving, determination, and persistence. I was privileged to have great mentors who have helped set the foundation on which I can further build my career as an aesthetic and reconstructive plastic surgeon. I am passionate about the field and am thankful for my years at UCSF for instilling in me the training necessary to accomplish my professional goals. Looking back, even the smallest cases in my residency will always have a special place in my surgical repertoire. Lynn Chung, MD Plastic Surgeon at Laurel Heights Plastic Surgery 18

Team UCSF I am a proud member of Team UCSF. Since my medical school interview, the compassion and ingenuity championed by the UCSF community inspired me, and I wanted to be part of it. Several years later, now a senior pediatric resident, I found myself entrenched in a challenging case that taught me what Team UCSF is all about. I received a page to the SFGH Emergency Room. A sickly, jaundiced, three-day-old infant, breathing shallowly, lay lethargic in his mother’s lap. He was passing bloody stools. I didn’t know what was wrong, but he needed help fast. I transferred the infant to the intensive care nursery, where two of my resident colleagues and our superb nurses stood ready. Together, we placed monitors, inserted IVs and a reploggle, drew labs, obtained X-rays, initiated empiric antibiotics, and called in our chief and attending. All accomplished within an hour. We were eight UCSF clinicians working smoothly and efficiently together, everyone with a role to play, to help our little patient. He subsequently underwent emergency surgery for malrotation with volvulus. Amazingly, due to our combined effort and efficiency, the infant’s bowels were entirely preserved. He lost nothing. It was truly an honor to be a part of that team. The truth is, these stories happen

SAN FRANCISCO MEDICINE DECEMBER 2014 WWW.SFMS.ORG

Celebrating 150 Years of UCSF

SFMS ELECTION RESULTS

every day at UCSF, where students, residents, nurses, and attendings unite to care for patients, excelling at what they do best, together. Meghan Gould, MD UCSF School of Medicine, UCSF Pediatric Residency Pediatrician at Golden Gate Pediatrics and SFGH

2015 Officers

My Road to Clinical Practice I began my internship and residency in obstetrics and gynecology at UCSF in 1985. Robert Jaffe had made it one of the top programs in the country. After eight years in Boston (at Harvard and Tufts), I was ready for a change of venue. The departments had just been rejuvenated with faculty from other programs. Robert Creasy and Bill Parer were involved with their research in preterm birth prevention and fetal heart rate monitoring. Ed Hill and Caroline Braga were introducing innovative treatments in GYN oncology. Bob Jaffe and Bob Nachtigall were pioneering research in reproductive endocrinology. There was a collegial approach among the specialties, including neonatology, radiology, anesthesia, and pediatric surgery. I witnessed some of the first cases of fetal surgery and in-vitro fertilization. It was truly a very exciting time. The UCSF program also provided superb clinical exposure and training. The OB service at Moffit supported a busy referral service for tertiary and quaternary maternal/fetal/neonatal care. Russ Laros served as an excellent mentor and role model for me. The San Francisco General Hospital (county) experience was supervised by Richard Sweet, Jim Green, and Phil Darney. This time spent “in the trenches” ensured that I did not become an “ivory tower” doctor. The third leg of our experience was at Children’s Hospital, San Francisco (now CPMC). Led by the indomitable Gilbert Webb, I was taught the valuable skills of vaginal surgery, forceps, and breech delivery. I was encouraged to pursue research and I worked in Jim Robert’s laboratory. I was also mentored by Michael Katz. This early research was rewarded by two consecutive first-prize paper awards from the American College of Obstetricians and Gynecologists. In 1985, I joined the Webb Group at Children’s Hospital . . . I found that clinical practice was most fulfilling. I continued to serve on the UCSF clinical faculty and was site director for eighteen years. I am currently a clinical professor and continue to teach UCSF residents and medical students. I have also continued to be active in clinical research and have authored more than a dozen papers and textbook chapters. After thirty years in practice, I look fondly at my UCSF experience. It provided me the tools and experience to weather the many academic and clinical challenges that I have encountered. Above all, it exposed me to a cadre of physicians and nurses who continue to provide me both professional and personal support. Fung Lam, MD OBGYN at Golden Gate Obstetrics and Gynecology

One-year term President-Elect: Richard A. Podolin, MD, FACC Secretary: Kimberly L. Newell, MD Treasurer: Man-Kit Leung, MD Editor: Gordon L. Fung, MD, PhD, FACC, FACP

2014 President-Elect Roger S. Eng, MD, MPH, FACR, will automatically succeed to the office of President. 2014 President, Lawrence Cheung, MD, FAAD, FASDS, will automatically succeed to the office of Immediate Past President.

Board of Directors Seven elected for three-year term 2015–2017 Steven H. Fugaro, MD Brian Grady, MD John Maa, MD Todd A. May, MD Stephanie Oltmann, MD William T. Prey, MD Michael C. Schrader, MD, PhD, FACP

Nominations Committee

Four elected for two-year term 2015–2016 Konstantin Bukov, MD Meghan D. Gould, MD Ingrid T. Lim, MD, FACEP, FAAEM Ray Oshtory, MD, MBA

Solo/Small Group Practice Forum (SSGPF) Delegate and Alternate One each elected for two-year term 2015–2016 As the candidate receiving the highest number of votes, Eric Tabas, MD, will be recommended to the California Medical Association (CMA) as the SSGPF Delegate. As the candidate with the next-highest number of votes, Payal N. Bhandari, MD, will be recommended to CMA as the SSGPF Alternate Delegate.

Young Physicians Section Alternate Two-year term 2014-2015 Shoshana R. Ungerleider, MD

District VIII CMA Trustee Three-year term October 2015 to October 2018 Shannon Udovic-Constant, MD, FAAP

Delegation to the CMA House of Delegates Two-year term 2015–2016 Delegates Lawrence Cheung, MD, FAAD, FASDS Mihal L. Emberton, MD, MPH, MS Gordon L. Fung, MD, PhD, FACC, FACP Richard A. Podolin, MD, FACC (as President-Elect, serves automatically) Andrea M. Wagner, MD Alternates Steven H. Fugaro, MD Pratima Gupta, MD Jerry Y. Jew, MD, MBA Robert J. Margolin, MD Amy E. Whittle, MD

WWW.SFMS.ORG

DECEMBER 2014 SAN FRANCISCO MEDICINE

Working together, the San Francisco Medical

TOP

REASONS

To Join SFMS and CMA

PRACTICE MARKETING ASSISTANCE

Society and the California Medical Association are strong advocates for all physicians and for the profession of medicine. Of the many reasons for joining SFMS and CMA, 10 stand out.

MEMBER-ONLY ACCESS Gain full access to the SFMS website for guidelines, reports, and a variety of tools and resources to help you navigate the ever-changing health care environment. Members also receive exclusive admission to our private networking socials and the Annual Gala.

Promote your practice through our customizable physician member page on SFMS’ website, printed Member Directory, and networking mixers.

LEGISLATIVE ADVOCACY: Ensure physicians have a voice and remain in control of medicine this year and in years to come. By speaking as a united voice, SFMS/CMA exert a powerful influence on health policy and public health issues at the local, state, and national levels.

IMPROVING COMMUNITY HEALTH Spearhead community health issues in San Francisco including Hep B Free, anti-tobacco legislation and education, formation and continuation of the Healthy San Francisco program, advocacy on reproductive and end-of-life issues, and much more.

EXPAND YOUR NETWORK Grow your professional network and referral list by networking with peers, established physicians, and health care leaders across the state at SFMS events and online communities.

PROTECTING MICRA SFMS and CMA work diligently to protect the Medical Injury Compensation Reform Act (MICRA), spearheading a successful campaign to defeat Prop 46 in the 2014 Election. Prop 46 would have dramatically altered MICRA by making it easier to file lawsuits against health care providers, increasing health care costs, reducing access to care and ultimately generating more legal fees for lawyers.

CAREER CENTER Discover new employment opportunities through the annual SFMS Career Fair. This member-only event connect SFMS physicians with recruiters from San Francisco Bay Area hospitals, medical groups, and community clinics.

STAY CONNECTED Stay up to date on vital health care issues that affect San Francisco physicians with online and print media – San Francisco Medicine journal, SFMS News e-Newsletter, and SFMS blog.

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PRACTICE MANAGEMENT ASSISTANCE Resolve contracting, billing, and payment problems with one-on-one assistance from CMA’s team of practice management experts.

Your support of the SFMS and CMA through membership affirms your commitment to the medical profession and ensures physicians remain in control of medicine this year and in years to come.

PLEASE JOIN OR RENEW YOUR MEMBERSHIP TODAY JOIN ONLINE AT www.sfms.org/Membership/JoinNow/MembershipJoin

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Celebrating 150 Years of UCSF

UCSF HEALTH A Framework for Twenty-First-Century Physicians

Health care is changing fundamentally. Academic medical centers, charged with train-

ing the next generation of health care providers, are uniquely positioned to rise to the forefront of this change. As the interim dean of the UCSF School of Medicine, I know that education, patient care, the development of new knowledge, and a deep commitment to public service are the four pillars of our mission. To effectively educate physicians at all levels, from medical school through residency, fellowship, and into lifelong learning, we must teach inside the framework of a twenty-first-century health care system. The complexity of being an academic health center with a fourfold mission makes transformation particularly challenging and especially necessary. Though we are first and foremost a university, our clinical activities depend on the interface with the health care marketplace. To create a structure for a successful transition in a changing market, the UCSF’s “clinical enterprise” is evolving into a fully integrated health system called “UCSF Health.”

UCSF Health

Our goal is to create an environment in which everyone connected with UCSF Health—our faculty as well as community physicians and teachers, nurses and medical staff, researchers and educators, trainees, and patients and their families—all have an integrated role in the spectrum of delivering seamless health care. This will provide the best possible training ground for clinicians and a fertile environment for the full continuum of scientific research. At its core, UCSF Health is a system containing UCSF School of Medicine clinicians, UCSF-related community physicians, UCSF Medical Center, UCSF Benioff Children’s Hospital San Francisco and UCSF Benioff Children’s Hospital Oakland, Langley Porter Psychiatric Hospital, Helen Diller Family Comprehensive Cancer Center, Osher Center for Integrative Medicine, and BayChildren’s Physicians. UCSF Health also works closely with community partners, through affiliations such as with Washington Healthcare System, and through strong relationships such as with John Muir Health.

Better Care for Patients, Better Access for Community

Specific goals for UCSF Health include consistent access to care and more seamless transitions for patients, better coordination WWW.SFMS.ORG

Bruce Wintroub, MD

and communication with community and referring physicians, opportunities for independent community physicians to be integrated in our network, and opportunities for community physicians to be part of the new curriculum that integrates team and interprofessional training as well as advanced teaching technology.

A Culture of Continuous Process Improvement

UCSF Health is collectively committed to patient-centered care, coordination of services, and streamlining of operations to eliminate waste that does not add value to patients’ experiences. We are using investments in the latest information technology to better communicate with patients and to connect and support our clinicians. We also train employees and faculty so as to engage everyone in a culture of continuous process improvement in the service of our shared goal, to provide the best care possible to our patients.

Encompassing Both Specialty and Primary Care

UCSF Health continues to be the nexus for tertiary and quaternary care in the Bay Area, offering patients access to the latest in technology, treatments, and clinical trials. We are focused on the strategic development of established and emerging adult and pediatric destination programs. This includes coordination of our outreach strategies, establishing magnet services for our destination programs with regional partners, and piloting new payment models. By expanding our continuum of services into a fully integrated affordable care network through partnerships with other leading health care organizations in the San Francisco Bay Area, UCSF Health will create a high-value, regional system of care that provides a home and a welcoming structure to referring and community physicians. Change is often difficult, but change is also an opportunity to advance our fourfold mission and better serve our patients. I am committed to the UCSF School of Medicine’s leadership role during this period of health care transition. Dr. Wintroub was named interim dean of the School of Medicine in September 2014 and has served UCSF for more than thirtytwo years, including as vice dean of the School of Medicine for ten years. Dr. Wintroub is also a professor and has been chair of the Department of Dermatology since 1985. In addition to his work for UCSF, he is chair of the Dermatology Foundation, a nonprofit organization that provides research support for emerging teachers and researchers in dermatology. Dr. Wintroub has helped raise more than $60 million for the organization. He received his degree from Washington University in St. Louis and completed residencies and fellowships at Harvard Medical School and Brigham Hospital. DECEMBER 2014 SAN FRANCISCO MEDICINE

MEDICAL COMMUNITY NEWS Saint Francis Robert Harvey, MD

At our award-winning Total Joint Center, Saint Francis is proud to offer our patients an anterior approach to hip replacement surgery—a revolutionary procedure that minimizes the time from replacement to recovery. Nearly all traditional approaches to hip replacement surgery require the gluteal muscles to be cut. But with the anterior approach, the hip is accessed from the front of the hip, using an existing interval between muscles, which allows for an accelerated recovery time. In addition, dislocation is a common concern for patients and orthopedic surgeons alike using traditional techniques. In fact, commonly reported dislocation rates range from 2 to 4 percent. With the anterior approach, however, the risk is reduced to less than 0.5 percent. Additional benefits to the patient include a small incision, shorter rehabilitation, and improved accuracy of limb length and implant position. The anterior approach has been used for more than sixty years in Paris but until recently was rarely used by surgeons in the United States. With improving technology, design, and materials, this technique is growing worldwide. Nicholas Mast, MD, has led the movement to bring the anterior approach to patients at Saint Francis. After hearing stories of anterior-approach patients returning to golf or tennis in the time it took traditional-technique patients to no longer rely on crutches, Dr. Mast decided to spend a year as a fellow studying under Joel Matta, MD, a Los Angeles-based orthopedic surgeon who specializes in hip and pelvic reconstruction and had seen great success with the anterior approach. Since August 2012, 375 anterior approach hip replacements have been performed at The Saint Francis Total Joint Center. We recently announced that Saint Francis received a five-star rating from Healthgrades for our total hip replacement procedure due to positive outcomes—a testament to our talented surgeons and staff at the Total Joint Center who are committed to providing exceptional, innovative care for our patients. 22

St. Mary’s

Robert Weber, MD

In keeping with our long-standing practice and commitment to “leading the way” in spine care and treatment, I’m pleased to announce that St. Mary’s has added the Mazor Robotics Renaissance™ guidance system to our multidisciplinary Spine Center, the longest-standing continually operating spine center in the western United States. We are the only hospital in the Bay Area to offer this state-of-the-art technology for spine surgery. Renaissance™ is used to create a preoperative blueprint of the ideal surgery in a virtual 3D environment. This plan is then used to actively guide the surgeon during the procedure to precisely implement the predefined plan within 1.5 mm accuracy. The Renaissance™ system is used to treat patients suffering from debilitating back pain or limited range of motion caused by spinal deformities and degenerative conditions such as slipped vertebrae, scoliosis, and spinal nerve impingement. In a recent multicenter study published in Spine journal, investigators stated that Mazor Robotics technology “offers enhanced performance in spinal surgery when compared to freehand surgeries, by increasing placement accuracy and reducing neurologic risks.” By using the Renaissance™ system, our patients will experience fewer complications and revisions, as well as faster recovery time. This kind of innovation and leadership is nothing new for the surgeons at the St. Mary’s Spine Center. Our surgeons developed the X-Stop implant, a minimally invasive outpatient procedure that provides relief to patients with spinal stenosis, and the Pro-Disc artificial disc replacement procedure, both of which have been profiled nationally. In addition, the Spine Center offers other innovative procedures, including motion preservation devices that stabilize a diseased section of the spine without fusion. Our Spine Center offers a full spectrum of treatments, including noninvasive and minimally invasive surgical techniques. I’d like offer my thanks to our team of physicians, physical therapists, and nurses who work together closely to provide continuity of care and education to each patient.

CPMC

Edward Eisler, MD

CPMC CEO Dr. Warren Browner recently signed a Memorandum of Understanding with Nanfang Hospital, the major teaching affiliate of China’s Southern Medical University, to formally pursue a “Sister Hospital” relationship. CPMC is among the first hospitals in the United States to seek a health care relationship with a medical center in China. San Francisco Mayor Edwin Lee attended the signing ceremony at City Hall, along with Dr. Browner and Dr. Wenyuan Li, president of Nanfang Hospital, which is located in the city of Guangzhou. The Institute for Health & Healing’s “Celebrating Science and Soul” was held last month at the Terra Gallery in San Francisco, where it raised $300,000. More than 200 guests were in attendance to honor Dr. Abraham Verghese, professor of medicine at Stanford University, with the IHH’s Deep Medicine Award. Also honored was Dr. Walter (Buzz) Stewart, vice president and chief research and development officer at Sutter Health’s Research Development & Dissemination Division, which received the Pioneers in Integrative Medicine Award. CPMC has been recognized as a “Leader in LGBT Healthcare Equality” by the Human Rights Campaign Foundation, the educational arm of the country’s largest lesbian, gay, bisexual, and transgender (LGBT) organization. CPMC earned top marks for its commitment to equitable, inclusive care for LGBT patients and their families, who can face significant challenges in securing adequate health care. Dr. Warren Browner was joined by San Francisco Mayor Edwin M. Lee and several members of the Board of Supervisors at a groundbreaking ceremony to celebrate construction of the new state-of-the-art hospital at the St. Luke’s campus. The construction, which began in October, will mark the second of two new CPMC hospitals being built in San Francisco. The new hospital at St. Luke’s is scheduled to open in 2019 and will have 120 beds, which include eightyeight medical beds, ten intensive care unit beds, and twenty-two labor/delivery beds.

SAN FRANCISCO MEDICINE DECEMBER 2014 WWW.SFMS.ORG

UCSF

Wade Smith, MD

Hugh Toland joined a California-bound wagon train in 1852 with visions of striking it rich in the Gold Rush. It only took a few months before the South Carolina surgeon abandoned prospecting, seeing a better opportunity in providing health care to a raucous and booming San Francisco. By 1864, Toland Medical College was born, and less than a decade later, it became the “medical department” of a fledgling University of California. Since its affiliation with the University, U.C. San Francisco has blossomed, now encompassing more than 20 locations in San Francisco alone with affiliates and partners across the Bay and around the world. Today, UCSF is the leading university exclusively focused on health. UCSF is driven by the idea that when the best research, the best education, and the best patient care converge, great breakthroughs are achieved. Dean Emeritus of the UCSF School of Pharmacy, Mary Anne Koda Kimble, PharmD, who chairs the 150th Celebration Committee, summed it up well recently when she noted that, while anniversaries are a time to look back at accomplishments, the goal of this celebration also will be to recognize that UCSF has always been focused on the future. She added, “The culture of this place is about excellence, moving forward and seeking new frontiers.” Indeed, a major theme of the celebrations also will be looking ahead to new UCSF milestones over the next year, including the opening of the Mission Bay hospitals, and UCSF’s promise for decades to come. “In my 32 years at UCSF, I’ve witnessed remarkable growth and innovation that has brought us to the leading edge of health care, research and education,” said UCSF Chancellor Sam Hawgood, MBBS. “I can’t foresee what UCSF is going to look like 32 years from now—much less in another 150 years—but I do know that our past has prepared us well to lead the next revolutions in health.” WWW.SFMS.ORG

SFVAMC

SPMF

Bill Black, MD, PhD

I am mostly a local product, having studied medicine at Stanford and trained in internal medicine at the University of California, San Francisco (UCSF). Prior to medical school, I had been out in the workforce in academia so medical school, internship, and residency were mostly a joy and delight for me - an opportunity to focus on my passion for clinical medicine and hone my knowledge base and skills at what I learned I was born to do, be a doctor. Being a house officer at UCSF and its affiliated institutions was a gift.I got to apprentice in the elite halls and history of the Parnassus campus, care for the underserved on the front lines at San Francisco General Hospital (SFGH), and learn to appreciate my father’s generation at the Fort Miley Veterans Affairs Hospital (FMVAH). Cardiologists like Dr. Kanu Chattergee routinely amazed and astounded us as we learned the subtleties of cardiac physical diagnosis. I watched HIV care being invented and refined at SFGH. And I came to understand the sacrifices that our veterans have made for the United States and the world at FMVAH. While many remember the challenges of sleepless on-call nights during internship and residency, ironically I often found my UCSF on-call nights more restful.My wife and I had just had our twins the year before, and as first-time parents we had a tough time training ourselves to sleep through the night when one of the kids raised a cry. So often I would find on-call nights in the hospital more restful than at home. UCSF is a unique and special place for all of us in San Francisco. For many, it conjures up the fond memories of their training. For others, it is the world- class institution to which they now refer their toughest cases. I wish it a very happy 150th birthday.

Diana Nicoll, MD, PhD, MPA

The notion that animals can be agents of healing has been around for a long time and animals are currently widely used to assist people with disabilities. Under the Americans with Disabilities Act, a service animal is defined as any dog that is individually trained to do work or perform tasks for the benefit of an individual with a physical, sensory, psychiatric, intellectual, or other mental disability. The owner may be questioned as to whether the dog is required because of a disability and about tasks the dog has been trained to perform. However, the owner may not be queried about the nature of the disability, be requested to have the dog perform the tasks, or be asked for official certification. Animals whose companionship is for emotional support only do not qualify as service animals. Recognizing their value, the VA pays for training and veterinary care for service dogs deemed medically necessary by a VA provider for Veterans with permanent hearing, vision and mobility impairments. VA research is underway to establish whether dogs can provide a disability service for patients with post traumatic stress. Animals are permitted to visit and live in VA nursing homes, a reflection of the increasing use of animal-assisted interventions in clinical settings. The Center for Disease Control has endorsed the concept that pets can decrease stress, blood pressure and feelings of loneliness. They may also increase opportunities for exercise and outdoor activities and hence increase fitness and socialization. The Human Animal Bond Research Initiative Foundation is researching interactions with animals to help in the treatment of depression, childhood autism, infant allergies, cardiovascular disease risk and Alzheimer’s disease. As further research studies are conducted, the specific physical and psychological effects of animals may be clarified.

DECEMBER 2014 SAN FRANCISCO MEDICINE

GORDON FUNG, MD, PHD, WINS 2014 CMA FOUNDATION ACCESS TO HEALTH CARE AND DISPARITIES AWARD UCSF Cardiologist Recognized for Commitment to Improving Health Care Access for San Francisco’s Asian Community Gordon Fung, MD, PhD, a cardiologist and current Editor of San Francisco Medicine, was selected as the

recipient of the 2014 Adarsh S. Mahal, MD Access to Health Care and Disparities Award from the California Medical Association Foundation. Dr. Fung was recognized for his role in establishing the first Asian heart and vascular center in the nation and his ongoing commitment to improve health care access for the Asian community. The Mahal Award acknowledges “an individual or organization that has demonstrated extraordinary interest and efforts toward improving access to health care or reducing health care disparities in California.” Dr. Fung has dedicated more than twenty-five years of his cardiology career to addressing disparities in health care. He co-founded the Asian Heart and Vascular Center (AHVC) at the University of California—San Francisco in 2006, after noting Asian patients often do not seek care or delay care for heart attacks and strokes—the two leading causes of death for Asian Americans—due to language barrier and cultural differences. AHVC was the first center in the county to serve the specific cardiovascular care needs of Asian Pacific Islanders. Dr. Fung’s leadership in research, education, and community advocacy bridged the cultural and language gaps that often prevent Asian patients from getting the appropriate and necessary cardiovascular care and helped reduce health disparities in the San Francisco and California Asian community. Under his guidance, the center developed prevention and treatment programs that cater to Asians culturally, linguistically, and medically. It enabled Asian patients to learn in their own language and culture about disease processes, treatment options, and symptom recognition of cardiovascular diseases. Additionally, the center was seen as the leading institution to coordinate clinical research efforts and support program activities with community partners to decrease health disparities in the Asian community. Recognizing the importance of community education, Dr. Fung spearheaded AHVC’s educational outreach efforts to the public with monthly outreach community meetings and seminars. He also volunteered with the American Heart Association as well as the Chinese Community Health Care Association to engage San Francisco’s Chinese community in heart disease prevention and treatment. Awareness about heart disease risk factors and prevention tips significantly increased from 10 percent to 80 percent in the Chinese community in a five year span as a direct result of Dr. Fung’s community talks and AHVC seminars. Dr. Fung was appointed by Mayor Gavin Newsom as a member of the Healthy San Francisco Advisory Oversight Committee to represent the San Francisco Medical Society and

physicians in implementing Healthy San Francisco, a program designed to provide universal healthcare access for citizens of San Francisco. He was also appointed by Governor Arnold Schwarzenegger as Chairman of the Council of Multicultural Health, which was designed to develop programs and monitor statewide health activities to decrease ethnic disparities. In addition to an active clinical practice in consultative general clinical cardiology, Dr. Fung serves as a clinical professor at the UCSF School of Medicine, and represents the San Francisco Medical Society on the Healthy San Francisco Advisory Oversight Committee, a program to provide universal health care access for all San Franciscans. He is a founding board member of the National Council of Asian Pacific Islander Physicians, and Asian American Research Center on Health, a leading organization in Asian American health research to promote health and health equity. Dr. Fung earned a master’s degree in public health at the University of California, Berkeley and a medical degree at the University of California, San Francisco.

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SAN FRANCISCO MEDICINE DECEMBER 2014 WWW.SFMS.ORG

HEALTH POLICY PERSPECTIVE John Maa, MD, and Steve Heilig, MPH

Soda Tax in San Francisco: A Postmortem—And a Rebirth? “Sugar, rum, and tobacco are commodities which are nowhere necessaries of life, which are become objects of almost universal consumption, and which are therefore extremely proper subjects of taxation.” —Adam Smith, founding figure of modern economic market theory, The Wealth of Nations, 1776

In 2009, the San Francisco Medical Society succeeded in having the California Medical Association “support

increased taxes on sodas and other relevant sugar-sweetened beverages, with the revenues to be utilized for public health education efforts.” This policy statement arose from growing evidence and concern about obesity, diabetes, and a host of other health impacts linked to ever-increasing sugar consumption. Sugar looked to be the next tobacco, in terms of adverse health outcomes and economic costs. Alas, the tobacco parallel has become more relevant with time, as any proposal to decrease consumption of the unhealthy products triggers a vigorous, well-funded opposition from those who profit from it. The concept of a San Francisco tax on sugar—a penny per soda—was first proposed in 2011, but soon vanished under an onslaught of soda industry lobbying. Likewise, a 2012 proposal in Richmond was defeated by massive industry-funded opposition. Over thirty other proposals around the nation met a similar fate. However Mexico, recognizing a looming obesity crisis, imposed a one-cent-per-ounce tax on sugary beverages in 2013. In 2014, soda taxes were voted upon in Berkeley and San Francisco. Berkeley’s Measure D was approved by 75 percent of voters to impose a 1-cent-per-ounce general tax on sugar-sweetened beverages and sweeteners used to flavor drinks. In San Francisco, Proposition E proposed a 2-cents-per-ounce tax on sugarsweetened beverages, with the funds earmarked for anti-obesity efforts by the San Francisco Unified School District, Department of Public Health, and Recreation and Parks Department. It required a two-thirds margin for approval; though a majority of 55 percent voted for it, it did not pass. There has been much debate about what these votes portend for the future. The beverage industry—now widely known as “Big Soda” (another tobacco analogy)—spent many millions against both proposals. But the implications for other areas remain unclear. In any event, as evidence accumulates that such taxes could reduce consumption of sugar, improve health, and shift some health care costs to producers and consumers instead of the general public, here are some reflections for future efforts. 1) Berkeley’s mayor endorsed Prop D, as did the entire Berkeley City Council. San Francisco’s Mayor stayed neutral, and four supervisors voted not to place Prop E onto the ballot. This lack of unified support, along with the two-thirds vote requirement, may have impacted the decision by New York Mayor Bloomberg (who has since pledged to consider supporting any city proposing a “viable” soda tax) to support Prop D, but not Prop E. WWW.SFMS.ORG

2) Raise the funds for the campaign (or at least obtain commitments) before placing the measure on the ballot. Despite a strong coalition of groups and leading individuals, Prop E was vastly outspent and could not adequately counter the misinformation spread by Big Soda. 3) Use a twin-city approach where possible. The battle against Big Soda was waged on two fronts, and the campaign for Prop E in San Francisco was tenacious until the very end, thus preventing Big Soda from shifting resources to Berkeley. As both cities were in the same media market, earned media carried a double impact, and paid media reached voters in both cities. 4) The obesity epidemic is a key reason for sugar taxes, and a primary focus on diabetes, while certainly justified, can be less dramatic than highlighting obesity as the more visible and damaging impact of soda consumption. The television campaign by Bloomberg featured the role of soda in the incidence of both obesity and diabetes. The campaign in SF focused primarily upon diabetes, and did not highlight that an estimated 75 percent of all cases of diabetes result from being overweight/obese. 5) Tooth decay is another key consequence of sugar consumption, and dentists can play a key role as spokespersons. Dental hygienists spoke in strong support of Prop D. The American Dental Association did fund a polling effort in SF, but were less visible in the Prop E campaign. 6) Follow—and highlight the money. Voters dislike being manipulated and fooled by big spending interests. As with tobacco, it is important to expose the misleading industry practices such as using paid campaigners who often did not even know or care about the issues, listing businesses that had closed as supporters, and incorrectly displaying beverages that would not be included in the tax. 7) A success in San Francisco was securing the endorsement of the San Francisco Chronicle editorial board, who had opposed the Richmond soda tax. Editors and journalists also tend to distrust big-money campaigns and are open to evidence. 8) The technical designation of a special tax with funds directed to nutrition, physical education, and programs for children, rather than into the general fund, is a key issue. Voters tend to distrust taxes that might “vanish” into general funds. Targeted proposals such as Prop E thus represent a tradeoff, but we believe that future efforts should retain specifics on how funds will be used. However, one possibility may be to lower the threshold for passing a special tax from two-thirds to 55 percent, as is seen with bond measures in some California counties. We anticipate that the recent election will signal the start of a movement to adopt healthy and economically viable increased taxes on sugar—and that one day, Americans will look back and, as with the tobacco battles, wonder, “What took so long?” DECEMBER 2014 SAN FRANCISCO MEDICINE

CLASSIFIED AD Office Sublet 2100 Webster 5th floor – Premier floor adjacent to hospital passageway in well-known medical office building with indoor pt. parking. Janitorial, utilities included. Office share with one physician. MD parking available. Two exam rooms, one physician office and ability to share staff if needed. All equipped, professionally decorated. 1,580 sq. ft./790 per MD. $3,759 per month. Confidential, Contact Debra Phairas: (415) 764-4800 or dphairas@practiceconsultants.net.

UPCOMING EVENTS 1/30: SFMS Annual Gala | 6:30 p.m.–9:00 p.m., Asian Art Museum | Celebrate SFMS’s 147 years of physician advocacy and camaraderie with many of San Francisco’s most influential stakeholders in the medical community! The 2015 Annual Gala will be held at the iconic Asian Art Museum of San Francisco. Guests will be treated to an exquisite reception with elegant hors d’oeuvres, libations, and live music. Roger Eng, MD, will be installed as the SFMS President. Network with colleagues, meet SFMS leaders, and enjoy a private viewing of the Asian Art Museum’s collection galleries. Please note that this is a member-only event. Gala tickets are available at http://www.sfms.org/events/annual-gala.aspx. 3/5–3/6: Developmental Disabilities—Update for Health Professionals | UCSF Laurel Heights Confer-

ence Center | This annual interdisciplinary conference offers a unique, practical update for primary care and subspecialty health care professionals who care for children, youth, and adults with developmental disabilities and complex health care needs. The 2015 conference continues to cover topics across the lifespan on a broad range of developmental disabilities as well as focus on the self-advocacy movement, with presentations highlighting the twenty-fifth anniversary of the Americans with Disabilities Act. Visit http://www.ucsfcme.com/2015/MOC15001/info.html for course outline and registration information.

4/14: SFMS Lobby Day/Legislative Leadership Conference | 9:00 p.m. to 4:00 p.m. Sheraton Grand

Sacramento | Join SFMS for the annual CMA Legislative Leadership Conference at the State Capitol. The SFMS/CMA Legislative Leadership Conference is an excellent opportunity to learn about legislative issues affecting medicine, foster relationships with state legislators, and gain hands-on experience in the practical aspects of physician advocacy. This one-day event includes education sessions on effective advocacy and lobbying techniques, briefings on legislative issues currently before Congress from CMA’s Government Relations team, and afternoon meetings at the Capitol with legislators and their staffs. More than 400 physicians, medical students, and CMA Alliance members participated at the 2014 event. Additional details for the 2015 event will be available in February 2015. 26

SAN FRANCISCO MEDICINE DECEMBER 2014 WWW.SFMS.ORG

Member Benefit News: Open enrollment for the San Francisco Medical Societysponsored dental plan has started! You and your family are eligible to enroll in the SFMS-sponsored dental plan only during open enrollment periods. Apply by December 31, 2014! To be eligible for coverage, applications must be received during the special open enrollment period ending on December 31, 2014.

For more information... Call a Client Advisor at 800-842-3761 for more information. Or visit www.CountyCMAMemberInsurance.com to download a brochure and application.