S a n M at e o C o u n t y
February 2015
Physician
M edical E thics
in s id e
S a n M at e o C o u n t y M e d ic a l Ass o ci at i o n
Volume 4 Issue 2
Ethics and aesthetic surgery
The new genetics and reproduction
Avoiding boundary violations
There’s no debate that vaccines work
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Health Insurance Are you aware that small groups can change their health insurance at any time throughout the year? Mercer provides a wide range of health insurance options and guidance to members of the San Mateo County Medical Association. We connect you with the top group insurance carriers and help you choose the coverage that best fits your needs and budget. We offer flexibility and value so you can provide quality health, dental, life and disability plans to your employees. Small Group (2 to 50 employees) coverage is available for all business forms that include at least one non-spouse W-2 employee in addition to the owner(s). Tax form verification of your status as a small group is required. We can help you to determine whether your business structure and enrollment will qualify for small group coverage if you are not sure. Plus, members who purchase their group health insurance through Mercer, the Association’s sponsored insurance program broker and administrator, are eligible to receive Mercer Select H&B KnowHow. Developed by Mercer, a leader in human resource consulting, outsourcing and investments, Mercer Select H&B KnowHow is a tool that helps provide employers with important human resources information such as the latest health and benefit requirements for California, and it provides the forms needed for compliance. For more information, contact a Mercer Client Advisor at 800-842-3761, or visit www.CountyCMAMemberInsurance.com.
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S a n M at e o C o u n t y
Physician Editorial Committee Russ Granich, MD, Chair Uli Chettipally, MD Sharon Clark, MD Edward Morhauser, MD Gurpreet Padam, MD Sue U. Malone, Executive Director Shannon Goecke, Managing Editor
SMCMA Leadership Vincent Mason, MD, President; Michael Norris, MD, President-Elect; Russ Granich, MD; SecretaryTreasurer; Amita Saxena, MD, Immediate Past President Alexander Ding, MD; Manjul Dixit, MD; Toby Frescholtz, MD; Edward Koo, MD; Alex Lakowsky, MD; Susan Nguyen, MD; Michael O’Holleran, MD; Kristen Willison, MD; Douglas Zuckermann, MD; David Goldschmid, MD, CMA Trustee; Scott A. Morrow, MD, Health Officer, County of San Mateo; Dirk Baumann, MD, AMA Alternate Delegate
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February 2015 - Volume 4, Issue 2 Columns Executive Report: The Theranos lab tests................................................... 5 Sue U. Malone
Feature Articles Ethics and aesthetic surgery.................................................................... 7 Lorne Rosenfield, MD, FACS
The new genetics and reproduction........................................................ 9 Christo Zouves, MD
San Mateo County Physician is published ten times per year by the San Mateo County Medical Association. Opinions expressed by authors are their own and not necessarily those of the SMCMA. San Mateo County Physician reserves the right to edit contributions for clarity and length, as well as to reject any material submitted.
Avoiding boundary violations. . .............................................................. 12
Acceptance and publication of advertising does not constitute approval or endorsement by the San Mateo County Medical Association of products or services advertised.
Luther Cobb, MD
For more information, contact the managing editor at (650) 312-1663 or sgoecke@smcma.org. Visit our website at smcma.org, like us at facebook.com/smcma, and follow us at twitter.com/SMCMedAssoc. © 2015 San Mateo County Medical Association
Marvin Firestone, MD, JD
There’s no debate that vaccines work. . .................................................. 13
Of Interest Member updates, classified ads, index of advertisers.........................14
Executive Report by Sue U. Malone
The Theranos lab tests At a recent SMCMA Board meeting, mention was made of Theranos, a privately held health technology and medical laboratory company, based in Palo Alto, that provides blood tests. The company’s blood testing platform uses a few drops of blood obtained via a fingerstick rather than vials of blood obtained via the traditional route. The company’s five objectives
were: (1) extract blood without syringes, (2) make a diagnosis from a few drops of blood, (3) automate the tests to minimize human error, (4) do the test and get the results more quickly, and (5) do the testing more economically. The company was founded in 2003 by Elizabeth Holmes, then a sophomore majoring in chemical engineering at Stanford, who left the university at 19 to start the company with a bridge loan from a venture capitalist. Ms. Holmes and her company are working to upend the lucrative business of blood testing. The two dominant
lab companies, Quest and Laboratory Corporation of America, generate $75 billion a year in revenue. Theranos is working to make its testing available to several hospital systems and is in discussions with the Cleveland Clinic. Recently the company opened centers in 41 Walgreens pharmacies, with plans to open thousands more. One of those Walgreens pharmacies is located at 300 University Avenue in Palo Alto. All you have to do is show the Walgreens pharmacist your ID, insurance card, and a doctor’s note, and your blood will be drawn right there. Theranos lab processes the blood draw. The cost, all less expensive than standard blood tests, are sometimes as much as 90 percent below the rates that Medicare sets. For example, the Theranos test for cholesterol at Walgreens costs $2.99! Holmes claims that between 40 and 60 percent of people who are ordered by their physician to get a blood test do not go through with it. I don’t know whether you would agree with her estimate, but even if exaggerated, it is still a large number. Theranos, which is privately held, is both a hardware company and a medical company. Holmes owns more than 50 percent of the company, and Forbes has identified her as “the youngest female billionaire in the
world.” The Theranos Board is stocked with notable members, including George Schultz, Henry Kissinger, Sam Nunn, and William Foege, former director of the CDC. Delos Cosgrove, CEO of the Cleveland Clinic, is also an avid supporter. Holmes’ former chemical engineering professor at Stanford, Channing Robertson, urged her to start her company, and initially served as the company’s technical advisor and first board member. Elizabeth Holmes states that she wants to redefine the paradigm of diagnosis, away from one in which people have to present with a symptom in order to get access to information about their bodies, to one in which everyone, no matter how much money they have or where they live, has access to actionable health information when they want it. The company believes that patients will often initiate the finger stick blood tests. Of course, unfiltered medical data isn’t a pure virtue and some observers are troubled by Theranos’s secrecy, as for many years it has operated with a stealth common to many Silicon Valley startups. The company counters that Theranos is only trying to protect itself from competitors while it tries to do something unique. The COO, Sunny Balwani, states that the Theranos platform is about automation: “We have automated the process from start to finish.” ■
February 2015 | SAN MATEO COUNTY PHYSICIAN 5
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Ethics and Aesthetic Surgery The importance of the psychological perioperative checklist in plastic surgery by Lorne Rosenfield, MD
Over the years I’ve been asked many times to participate in reality and other shows “promoting” plastic surgery. And every time I decline. I explain to the dismayed producer that my patients, my surgeries, and I would be boring. “Boring?!” they ask. “How could plastic surgery be boring?“ Simply because a good plastic surgery, on the right patient, is consistently uneventful and the result predictably satisfying— not the kind of raw material for a modern TV show! In fact, one of my favorite mantras is “bad plastic surgery is always visible…but good plastic surgery always invisible.” Have you ever noticed how you only seem to see the bad face lifts!? Well, the good ones are out there, they’re just under the radar.
marketing forces from without, patients should be given far more respect. They are not walking around like so many zombies, their decision-making skills solely controlled by the billboard on the freeway or the ad on their Facebook page. A healthy patient may be exposed to this hyperbolic information but then they properly temper it with their better internal judgment.
In general, the vast majority of plastic surgeries performed by proper, board-certified plastic surgeons, result in happy patients. What all the weekly magazines and television talk shows feature is beguilingly the opposite: predictably unhappy patients, a postoperative population that actually represents a veritable sliver statistically. The general public has been inculcated to believe that too many people are having too much plastic surgery, and that the fount is an insidious societal pressure to sacrifice one’s body image on the altar of beauty.
I do not deny that there are patients who are requesting, and surgeons who are delivering, too much plastic surgery. However, in such instances these same patients should have been properly evaluated by a specialist surgeon and ethically denied care in the first place. In fact, plastic surgery remains unique amongst medical disciplines in which denial of care can be a sign of good care.
Well, with a surgical practice of 27 years that has delivered care to thousands of happy patients, and a medical library shelf sagging under the weight of supporting studies, I can say with assurance that the majority of patients are sensible people, like you and I, who have undergone a thoughtful cosmetic surgery and are now happier and more selfconfident. And this modern “urge” is not a new phenomenon: since man and woman first saw their faces reflected in a pool of water, body image has been an integral, inexorable element within the psyche of humankind. And as for the inescapable
With any kind of surgery, a perioperative checklist is a must. It integrates mindful “pauses” in the workflow to insure the prevention of medical and surgical errors of both omission and commission. I published one of the first surgical checklists1, and the first within the plastic surgical literature (now the recognized standard checklist for the American Aesthetic Society and adopted by the European Union). There is a lacuna in our oeuvre, however, when it comes to a similarly designed checklist for preoperative psychological clearance. As stated by Dr. Wildgoose in his article “Psychological Screen Measures for Cosmetic Plastic Surgery Patient: A Systematic Review, “research suggests that many February 2015 | SAN MATEO COUNTY PHYSICIAN 7
patients who seek consultation for a cosmetic procedure meet the criteria for a psychiatric disorder such as body dysmorphic disorder, narcissistic personality disorder or histrionic personality disorder.”2 PREOPERATIVE PATIENT ASSESSMENT Name: Date: Planned Surgery: 1. Satisfactory Concerns: Extent of problem > Extent of concern 2. Satisfactory Motivations: Internal motivation > External motivation 3. Satisfactory Expectations: Surgical outcomes > Patient expectations 4. Satisfactory State of Mind: Psychological health > Physical status 5. Satisfactory Support System: Family support > Personal stability Candidate for surgery: Yes No Signed:
Thus, a more deliberate evaluation of the patient’s psychiatric state should be an integral part of the consultation. Although many preoperative psychiatric questionnaires have been described, they have been inconsistently adopted by plastic surgeons3. The answers to these dense screenings are entirely patient-generated: a process that can be both offputting to the patient and time-consuming for the surgeon. Additionally, these analyses can be easily manipulated by the very patients whom the doctor is seeking to unmask: i.e., they can be “gamed.” And the physician generated acronymal tags, such as SIMON (single, immature, male, over-expectant, narcissistic), SYLVIA (secure, young, listens, verbal, intelligent, attractive) and SLAP (still lives at parents’) are too conveniently simplistic and as such may overlook many other signs of trouble. In the final “analysis,” the psychological evaluation most often defaults to our own experientially honed powers of intuition. And considering our relatively successful cumulative track record, we have indeed been both trained well and been diligent students of this art. At the same time, one could argue that we are perhaps still “winging it”
8 San Mateo county physician | February 2015
more than we should be: without prescribed, premeditated criteria, the surgeon’s evaluation and documentation may not always be as accurate and complete as it could be.
Concept Just as the patient’s medical and surgical care can be transformed by a perioperative checklist, this proposed “audit” aims to equally streamline and standardize the process of patient psychological screening for plastic surgery. This critical assessment is distinct from those currently in use because it is a result of the objective assessment by the surgeon rather than the self-evaluation by a patient. Another notable feature of this deceptively simple assessment is its inclusion of the primary concerns relative to patient operative suitability. With this concrete psychological checklist, the physician can more consistently and comprehensively vet the preoperative patient. By design, the dynamic questions enumerated in the checklist should already be embedded within the routine preoperative dialogue between patient and physician. As such, the criteria on this form should be perceived as neither threatening nor discourteous. In fact, this checklist can and should be made part of the patient medical record as clear documentation of the surgeon’s deliberate effort to properly screen a patient. To create this checklist, a literature survey was initially conducted to identify the key psychological “red flags” and then extract the essence from each. A line item represents a deliberately shorthand version, a more pragmatic distillation of these otherwise opaque emotional patient dynamics. The common thread within the criteria is balance: a kind of yin and yang between patient dynamics such as “concerns,” “motivations” and “expectations.” For the sake of review, each of these will be elucidated: 1. Extent of the problem vs. extent of the concern We are all well aware of this simple but effective evaluation, which was originally graphically elucidated by the Gorney Gram4, a plot of the patient’s concern for his deformity against the surgeon’s perception of the same deformity. The clinical expression of this “marker” runs the gamut from a sensible concern to a paralysing obsession. This latter end of the presentation falls within the realm of the body dysmorphic syndrome, the “red flag” of all flags in our critical evaluation quiver.5
Continued on page 10
The new genetics and reproduction by Christo Zouves, MD Advances in medicine sometimes occur serendipitously, like the discovery of a mold that became penicillin in the laboratory of Alexander Fleming (left) in London in 1928. This led to the mass production of penicillin by Howard Flory and Ernst Chain at the Radcliffe Infirmary in Oxford shortly after the bombing of Pearl Harbor. By D-Day in 1944, they had produced enough penicillin to treat all of the wounded in the allied forces. These three men shared the Nobel Prize in Physiology and Medicine in 1945. Other advances in medicine come after massive efforts on the part of hundreds or thousands, and this is the case in the mapping of the human genome. First advocated by the U.S. government in 1984, the Human Genome Project officially began in 1990 under the auspices of the National Institutes of Health. Private companies like Celera started parallel projects in 1998. Valuable work was also done in France and Japan, culminating in the announcement in 2003 that the human genome had essentially been mapped. As the gene sequence of individual genes causing inherited disease became known, it became possible to identify this gene in the blood of individuals who were carrying the gene, and by extension we became able to test embryos before implanting them back into the uterus through assisted reproduction. Comprehensive Chromosomal Screening (CCS) is the term used to describe the process of analyzing the 23 pairs of chromosomes (22 autosomes, X and Y) of a human embryo. As it relates to assisted reproduction and patients undergoing In-Vitro Fertilization (IVF), we know that 60% of early miscarriages are associated with chromosomal abnormalities. Because chromosomally normal embryos cannot be identified by standard microscopic observation, the development of CCS is arguably one of the most useful breakthroughs in assisted reproductive technology.
The original platform allowing us to do CCS was comparative genomic hybridization (CGH), where the DNA, after amplification, is added to a micro-array chip, which is then analyzed in a special scanner. Testing for abnormalities of chromosome number, as well as single gene disorders and translocations, can all be performed on the same sample of cells removed from the embryo at the blastocyst stage of development. The method of performing CCS is changing rapidly. The recent introduction of instruments capable of producing millions of DNA sequencing reads in a single run is rapidly changing the landscape of genetics, providing the ability to test for chromosome anomalies or genetic disease with unimaginable speed. Next-Generation Sequencing (NGS) is the most powerful methodology available today. NGS provides direct sequencing of an embryo’s DNA. When applied to embryo aneuploidy screening, the thousands of DNA sequencing reads per chromosome it produces can provide insight into partial chromosome gains and losses, as well as mosaicism, which may have gone undetected by previous methods. In addition, single gene disorders and translocations can also be tested on this platform. This enhanced genetic information allows for the selection of embryos for transfer with the highest possibility of implantation, resulting in a healthier pregnancy and delivery.
NGS provides DNA coverage, sensitivity and precision superior to any existing technology. The ready availability of NextGeneration Sequencing has also brought about a revolution in the evaluation of early pregnancy. NonInvasive Prenatal Testing (NIPT) by Next Generation Sequencing has brought about a reduction in the number of CCS and amniocentesis procedures being performed. A peripheral blood draw on a woman at 10 weeks of pregnancy allows access to the baby’s cell-free DNA circulating in the maternal blood, which can be sequenced and reassembled giving information on the fetal karyotype for chromosomes X and Y as well as 21, 18 and 13. Zouves Fertility Center, located in Foster City, is now offering in house comprehensive chromosomal screening by NGS to all its patients undergoing IVF treatment. Understanding the complexity of this issue from a scientific, psychological and social standpoint, Zouves Fertility Center provides an experienced genetic counselor to conduct a genetic risk assessment and assist patients considering genetic testing. All patients undergoing treatment at Zouves Fertility Center are required to talk with the in-house genetic counselor to explore their family’s genetic history and determine the scope of any genetic screening that may be indicated.
February 2015 | SAN MATEO COUNTY PHYSICIAN 9
Ethics and Aesthetic Surgery - Continued from page 8 2. Internal motivation vs. external motivation Ideally the incentive for undergoing a surgery should emanate from within the patient rather than from without. A patient submitting to a surgery to please a spouse, parent or significant raises another flag that should give the surgeon pause. 3. Surgical outcomes vs. patient expectations Equally so, there should be a reasonable synchrony between what the patient expects the outcome to be and what the surgeon truly can deliver. An imbalance here is yet another red flag. 4. Psychological health vs. physical status Clearly, just as physical health must be assured preoperatively, the patient should not exhibit proper signs of depression, anxiety, or other psychological afflictions. 5. Family support vs. personal stability In addition to his or her own competency, the patient’s preparation for surgery and arc of recovery are both clearly enhanced by a solid support system of family and/or friends. Before the particulars of a surgery are even uttered, these sundry criteria are deliberately “weighed” to help confirm the wisdom of the desired surgical correction. For most patients, this will be an easy decision. Instead, this checklist is for the small but critical subset of patients whose candidacy for surgery should be either seriously reevaluated or outright denied. And this checklist should not be viewed as simply a one-time pre-operative “biopsy”; rather, it should be filed with the rest of the patient’s documentation to be potentially recalibrated both at a late postoperative visit and before any future surgery.
Conclusion Sheer patient experience undoubtedly hones our inherent wariness regarding patients and their candidacy for surgery. This checklist is meant to both shorten the otherwise painful learning curve for new surgeons and standardize the process for the rest. It is not meant to supplant the surgeon’s intuition, but rather to augment it. Only then can we honor our perpetual pursuit of the most accurate and comprehensive evaluation of our patients. ■
References 1.
Rosenfield, L.K., and Chang, D.., The Error of Omission: A Simple Checklist Approach for Improving Operating Room Safety. American Society of Plastic Surgeons. 2008; 123: 399-401.
2.
Wildgoose, P., Scott, A., Pusic, A.L., et al, Psychological Screening Measures for Cosmetic Plastic Surgery Patients: A Systematic Review. Aesthetic Surgery Journal. 2013; 33: 152-159.
3.
J.R. Thomas, A.P. Sclafani, M. Hamilton, E. McDonough. Preoperative Identification of Psychiatric Illness in Aesthetic Facial Surgery Patients. Aesthet Plast Surgery, 2001;25:64-67
4.
Gorney M, and Martello J. Patient selection criteria. Clin Plast Surg. 1999; 26:37-40.
5.
Phillips, KA, Understanding Body Dysmorphic Disorder. New York City: Oxford University Press, 2009.
The New Genetics and ReproductionContinued from page 11 Now that we are able to identify a good quality embryo, with 23 pairs of chromosomes, the transfer of this single normal embryo back into the uterus during an ovulatory cycle yields a 70% chance of a birth. In 2005, three independent research groups showed that bacteria could develop adaptive immunity by incorporating DNA from an attacking virus into its own DNA through a system called CRISPR (clustered regularly interspaced short palindromic repeats). In 2013, work at MIT as well as in Shanghai, using the CRISPR-Cas9 system, provided proof of principle for use of the CRISPR-Cas9 system in genome editing for the correction of human genetic diseases. This technology can be applied to an embryo and hopefully also to an affected individual with a promise of treating inherited diseases that up to now have been untreatable with fated consequences. Technology always runs ahead of the ethical evaluation of its effects and this new genetics raises ethical issues of cost and access to treatment, and privacy of genetic information. This may be predictive of performance or longevity as well as nonmedical applications geared toward the creation of characteristics that may be either desirable or not, depending on the perspective. Perhaps one day reproduction will happen through IVF, and sex will be merely for recreation. ■
About the author
About the author
Lorne K. Rosenfield, MD, FACS, is a plastic cosmetic surgeon at Peninsula Plastic Surgery Medical Group in Burlingame. He is also an active clinical professor of plastic surgery at UCSF Stanford University Medical Centers.
Christo Zouves, MD, is medical director of Zouves Fertility Center in Foster City, founded in 1999. Previously, he was the medical director of Pacific Fertility Center in San Francisco for seven years.
10 San Mateo county physician | February 2015
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February 2015 | SAN MATEO COUNTY PHYSICIAN 11
avoiding boundary violations by Marvin Firestone, MD, JD
A boundary violation can be a high-risk issue for a physician. Behaviors that can constitute boundary violations include: (1) touching a patient inappropriately; (2) making inappropriate comments to the patient (e.g., “I would sure enjoy spending an evening with you/going to a concert with you”); (3) scheduling a patient for the last session of the day and extending the length of the visit at no extra charge; (4) meeting a patient outside of the office in a different location (e.g., Starbucks); and (5) engaging in sexual behaviors or innuendos by the physician. The detrimental effects of boundary violations to the patient include loss of trust in the clinician, fear of seeing other clinicians, depression during or after termination of the relationship, feelings of guilt and anger, sexual dysfunction, marital disruption, and even psychotic reactions.
Legal consequences Boundary violations have legal consequences. Medical Board accusations may arise, which are very difficult to defend because the Medical Board usually adopts the patient’s position. A lawsuit based on an intentional tort of sexual battery can lead to punitive damages that are not covered by malpractice insurance. The physician can be found liable in a lawsuit for medical negligence and/or intentional infliction of mental distress or outrageous conduct. Criminal prosecution for sexual assault can even occur. The physician may lose hospital privileges may be lost, face medical society sanctions, and find their medical license restricted or even revoked.
Patient risk factors Patient risk factors for a boundary violation include patients who are seductive (not uncommon in patients with borderline personality disorder); patients undergoing a bipolar hypomanic episode; and patients going through relationship discord or breakup. Patients who have delusions or fantasies involving seduction of the physician, and patients who have a history of sexual abuse or prior sexual relationship with an authority figure, are also high risk for allegations of boundary violations. Beware of the patient who says, “I will pay you extra and we can meet somewhere else or at my home (unless the patient has some ambulatory impairment). Some ways that the physician can prevent a boundary violation include discussing appropriate boundaries with the patient and providing strict instructions about boundaries if the patient or the situation is high-risk. This discussion is best had soon after any seductive behavior occurs or risk becomes apparent. Referral for consultation with a mental health specialist may be indicated, and outright referral to another physician for further treatment, if the issue cannot be resolved, should be considered. The physician should discuss concerns about observed patient behaviors, including the physician’s personal reactions to patient behaviors, with colleagues and a psychiatric consultant to learn techniques for managing such seductive behaviors. If the physician is unable to manage such risks, or uncomfortable about speaking up, counseling can help in developing these skills.
Record keeping Record keeping must show appropriate reason for any action that might otherwise be seen as a boundary violation (e.g., going to patient’s home to provide treatment of a patient with agoraphobia). The physician may want to consider tape recording sessions (with the patient’s knowledge) if the patient is acting seductively or there are other high-risk factors for boundary violation. These tape recordings also may assist the physician in discussions with a peer or supervisor. If a physician cannot deal with the patient’s inappropriate seductive behaviors, or if the patient continues the appropriate behavior after being confronted about it, the physician should consider termination of treatment of the patient. If a boundary violation does occur, the physician would be wise to seek immediate legal consultation, as well as therapy. ■
About the author Marvin Firestone, MD, JD, holds a medical degree from Temple University and a law degree from the University of Colorado. A certified specialist in Legal Medicine/Medical Jurisprudence by the American Board of Law in Medicine, Dr. Firestone provides medical-legal consultation and practices medical law across the State of California. 12 San Mateo county physician | February 2015
There’s no debate that vaccines work by Luther Cobb, MD It’s time we stop debating and politicizing what is one of the greatest medical advancements ever. The advent of vaccines that reliably prevent communicable illnesses was an important step in public health. It has led to a host of vaccines now available and recommended that have greatly decreased deaths and disease. In fact, the discovery and application of vaccines constitutes probably the greatest contribution to life expectancy in medical history. Following the outbreak at Disneyland, measles is the current topic of discussion, but it shouldn’t stop there. Just a few years ago, California had some of the lowest pneumonia vaccination rates in the country. Bacterial pneumococcal
For years, the rates of unvaccinated children have been slowly rising due to Internet rumor-mongering and debunked “scientific” studies. In 2014, however, for the first time in a decade, the number of parents who filed personal belief exemption forms to exempt their kindergarteners from vaccinations has declined. And, we’re starting to see headway with legislation that passed recently in California. Assembly Bill 2109—which was sponsored by the California Medical Association and authored by then-Assemblyman Richard Pan, a Sacramento pediatrician—requires a parent or guardian seeking a personal belief exemption to first obtain a document signed by a licensed health care practitioner. In the form, the practitioner is asked to verify that the parent or guardian has been informed of the benefits and risks of immunization, as well as the health risks of the diseases a child could contract if left unvaccinated. AB 2109 was born out of a rising concern about the increased personal belief exemptions in California and what that could mean for outbreaks of diseases such as measles, mumps and whooping cough. Exposure to these diseases not only puts individual children at risk, but the community as a whole, including infants too young to be immunized. Fewer personal belief exemptions leads to decreased numbers of preventable outbreaks, and it is imperative for the health of our state that we continue in this direction. My parents saw the days of children in iron lungs and leg braces from the destructive effects of diseases like polio. I, myself, grew up in a day when the results of measles were seen regularly. Unfortunately, in these days of good public health, many of these memories have faded.
infections are a leading cause of death for seniors who contract the flu because so many are not immunized. The fact is, the Centers for Disease Control and Prevention recommends pneumococcal vaccines for all people 65 years of age and older and for those 2 to 64 with certain high-risk conditions. And, just last year, the California Department of Public Health reported an increase in cases of whooping cough (pertussis). There were 10,831 cases in 2014, with more than 800 new cases reported in April alone—the highest monthly count since the 2010 epidemic. Pertussis is especially dangerous to infants, yet it is preventable with proper immunizations.
Now that these illnesses are uncommon, we shouldn’t have to resurrect their awful effects to remind people of the catastrophe, debilitation and, in some cases, death that comes along with them. This controversy will persist as long as these unnecessary epidemics occur and recur. The debate should end. Why do we need an outbreak of preventable disease to remind us that vaccines are safe, effective and lifesaving? Abouth the Author Luther Cobb, MD, president of the California Medical Association (CMA), is a board-certified, self-employed physician practicing in general, thoracic and vascular surgery in Arcata and Eureka.
February 2015 | SAN MATEO COUNTY PHYSICIAN 13
NEW SMCMA MEMB E R S Laura McMullen, MD
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Tracy Zweig Associates retirements The following SMCMA members have recently retired from practice: Thomas Bowstead, MD James Missett, MD J. Joseph Prendergast, MD Mark Rosenberg, MD
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Our heart beats in California ‌ and has for almost 4 decades. Since 1975 NORCAL Mutual has served healthcare professionals throughout the Golden State. Strength, stability and innovative products are just a few reasons why physicians continue to look to us for their medical professional liability insurance. We provide you: Industry-leading claims and risk solutions support 24/7 Full access to our interactive risk management library Flexible coverage options tailored to your needs California is important to us. So is your peace of mind. See how homegrown strength can help protect your practice.
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