San Mateo County
Physician January 2013 | Vol. 2, No. 1
A publication of the San Mateo County Medical Association
Why I Chose
Cardiology as a Career
Also In This Issue: Understanding Insomnia Cervical Cancer Awareness Month
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San Mateo County
Physician A publication of the San Mateo County Medical Association
Editor’s Introduction
January 2013 Volume 2 / No. 1
RUSS GRANICH, MD This issue of San Mateo County Physician features a new entry in our occasional series on how our members chose their specialties. This time, my Kaiser Permanente colleague Douglas Zuckermann reveals how he considered pediatrics, psychiatry, surgery, obstetrics and neurology, before finally finding himself in cardiology.
President’s Message .....................................................5 Gun-related Violence and Public Health GREGORY LUKASZEWICZ, MD Letter to the Editor .......................................................6 Doctors and Firearms STEPHEN A. WELLER, MD
Executive Report...........................................................7 SMCMA Working for You...
Another member, Mehran Farid-Moayer, has authored a clear and concise primer on the etiology and treatment of insomnia. Psychophysiologic insomnia, adjustment insomnia, paradoxical insomnia, idiopathic insomnia...this article will explain the differences and cover the most common forms of treatment. We are also sharing a contribution from the CMA Foundation on cervical cancer, a disease that disproportionally affects Hispanic and African American women. The CMA Foundation’s Cervical Cancer/HVP Project has produced a Spanish-language public service announcement to encourage regular screenings and HPV vaccinations.
SUE U. MALONE
Why I Chose Cardiology as a Career ...........................9 The average medical student changes his or her preferred field of endeavor five times before graduating. Here’s one member’s story. DOUGLAS ZUCKERMANN, MD
Understanding Insomnia ........................................... 11 A sleep physician outlines the causes and manifestations of sleeplessness, as well as common treatments. MEHRAN FARID-MOAYER, MD
CMA Foundation Launches National Cervical Cancer PSA ...................................................13 Close to 2,000 women in the U.S. develop cervical cancer every year, leading to almost 4,000 deaths. CMA FOUNDATION STAFF Membership Update, Classifeds, and Index of Advertisers ............................................14
PRESIDENT’S MESSAGE
Gun-Related Violence and Public Health GREGORY LUKASZEWICZ, MD As I write this editorial the nation continues to reel from yet another tragic mass killing, this time involving twenty school children, six teachers, the shooter’s mother and the shooter himself, about whom little is really known. Perhaps because of the extreme and particularly heinous nature of this particular incident, this event appears to be pushing our political leaders to go beyond the usual clichéd responses and to be spurring an actual discussion about gun-related violence and in particular gun control. In 2012 alone, mass shootings in the United States claimed the lives of more than 150 victims, including people at a movie theater in Colorado, a Sikh temple in Wisconsin and a shopping mall in Oregon. But while these incidents may grab headlines at least for a few weeks, we tend to overlook the fact that there are approximately 12,000 and 18,000 gun-related homicides and suicides, respectively, each year in the U.S. These victims typically do not make the front page and, if they do happen to garner the public’s attention, are usually quickly forgotten by everyone but their families, friends and communities.
While a great deal continues to be written about the shootings in Newtown, Connecticut, one comment that stood out for me was that we should not turn the debate into an issue of public health. My response was, why would we not look at it this way? Considering the problem of gun violence in this manner may be the exact approach to take as it allows us to approach the issue with a certain amount of dispassion and rational thinking. I do not agree that it somehow trivializes the problem or dehumanizes the victims. While we may look at numbers of deaths due to cancer, heart disease, AIDS or diabetes as statistics, few physicians fail to realize that these numbers represent actual patients. Only by looking at large populations rather than individual cases can we recognize the patterns behind a disease that leads to understanding and an eventual cure. Thus is the case with gun-related violence. As physicians we can bring scientific rigor to understand the cause or causes of what can only be described as a major public health challenge while remembering the humanity of the victims and their families as well.
So are guns themselves to blame? Are the presence and sheer number of guns the cause of the problem, or are they simply the tool by which violence is carried out? Are there other underlying issues to blame such as violence in the media, an innate flaw in our national character, an absence of social cohesion or connectedness, a problem of socioeconomic opportunity, or a lack of adequate mental health systems? Is it a combination of some or all of these factors, a perfect storm, so to speak? Do we need simply to accept that we live in a particularly violent society, or can we address the factors that have led to our current state of affairs in a systematic and holistic manner? We do know that firearm-related deaths account for roughly onehalf the suicides (the 10th most common cause of adult death) and two-thirds of the homicides (the 15th most common cause of adult death) in the United States each year. and that people do kill others and themselves without guns. In addition, the majority of gun violence is concentrated in poor communities, and in particular communities of color, among young males who are often associated with gang or other
SAN MATEO COUNTY PHYSICIAN | PAGE 5
President’s Message: Gun-Related Violence and Public Health (continued) criminal activities. However, there is also data to suggest that having a gun in the home increases the risk of homicide in that home. While the United States does not have the highest rate of gun related homicides overall, it does have the highest rate of gun-related violence compared to countries with a similar level of economic development, and also has the highest rate of gun ownership in the world. In Britain, with very strict gun laws in place and a very low rate of gun ownership, there were 44 deaths due to firearms in 2007, while Japan, with some of the strictest regulations around firearms, had eleven. In addition, states in the United States with stricter gun ownership regulations also tend to have a lower rate of gun related deaths as well.
Gun advocates are correct in that we should not allow these sensational mass shootings to drive policy. These heinous crimes are in fact only a fraction of the overall suffering that occurs in the United States due to gun-related violence, and we should remind ourselves that many communities live with the threat of violence on a constant basis. Certainly stricter gun control laws alone will not solve the problem as demonstrated by the terrible killing spree in Nor way (which has very strict gun laws in place) in 2011. But it behooves us to consider rationally, systematically and dispassionately every possible cause and solution to the problem of gun-related violence if we hope to affect a change in our society.
Letter to the Editor: Doctors and Firearms Editor: I am a gun owner: five guns locked away for safe keeping, no bullets/shells in our home. I consider irresponsible gun ownership to be a major public health issue in America. The incidence of accidental death and injury from guns in America, especially in childhood, is appalling. The use of guns for suicide and purposeful injury in domestic violence in America is appalling. In my mind, the “right” to own guns for self-protection as afforded in the Second Amendment to the Constitution will be preserved, while at the same time we must enhance public safety by advocating safe gun storage, mandating background checks for all gun purchases and taking other thoughtful, common-sense approaches for avoiding deaths and injuries from guns. Physicians have successfully promoted public health issues such as reducing tobacco use, avoiding childhood head injuries with helmet use, promoting immunizations, reducing air pollution, and countless other public health programs. Major physician groups including the American Academy of Pediatrics, the National Physician Alliance, and the American College of Physicians are on record encouraging physician leadership in promoting safe gun ownership. The paranoid, rabid response of the “powerful” and influential gun advocacy groups such as the National Rifle Association is restraining clinical research,
6 SAN MATEO COUNTY PHYSICIAN | JANUARY 2013
preventing the collection of data on risks associated with irresponsible gun ownership, and attempting to prevent patient/doctor discussions on gun safety in homes with guns and children. Preventing gun related injuries and deaths requires a science-based, pragmatic approach. Physicians should take leadership roles in preventing senseless death and injury from guns in San Mateo County, as we have for countless other public health and safety issues, despite the negative pressures brought to bear from gun advocacy groups. Gun ownership in America is a right, and also a responsibility. Please contact your elected representative. I welcome physician responses to my message. Stephen A. Weller, MD San Mateo wellers@sutterhealth.org
Editor’s Note: Legislative representatives can be found on the SMCMA website, smcma.org, under the Advocacy tab. If you would like to submit a letter to the editor, please see page 15.
EXECUTIVE REPORT
SMCMA Working for You... SUE U. MALONE I would periodically like to introduce to members individuals on SMCMA’s staff who are working to educate and serve our members and to promote public health. This month I would like to introduce Whitney Wood, our Membership, Development and Program Director. Born and raised in Salt Lake City, Whitney earned a Bachelors of Science Degree in Business Management from the University of Utah. She spent three years as Program Coordinator at the Utah Cancer Foundation, followed by three years as Director of Membership Services and Events Coordinator with the Salt Lake Home Builders Association. Whitney arrived in San Mateo two years ago with not only solid association management experience from her previous employers but enthusiasm as well. Though all aspects of Whitney’s position fill a vital role for SMCMA, we needed her passion to breathe new life into our San Mateo Hep B Free program, a service of SMCMA’s Community Service Foundation. The Hep B Free program was started in the fall of 2009 with a kick-off gala, but we had not been particularly successful in screening and testing large numbers of the Asian-Pacific Islander (API) population who are at the highest risk for contracting
Hepatitis B. We needed money, we needed volunteers, we needed to devote a lot of attention to turn this program into a positive force in San Mateo County.
Whitney arrived in San Mateo with not only solid association management experience but enthusiasm as well.
Whitney turned the program into a well recognized and respected campaign through community and physician education, outreach, testing and vaccination. By reaching out to
pharmaceutical groups, other corporations, and healthcare districts, Whitney has been able to attract more than $100,000 in support for this springorganized our second Hep B Free Gala, which helped bring new partnerships, donors, and volunteers to this effort, not to mention the positive publicity received from the print media. The program has now screened nearly 700 at-risk individuals for hepatitis B at no cost, thanks to the generosity of our partners such as hospital labs, vaccine donations, the county Public Health Department, and numerous churches that have large congregations in the API community. Before turning to other responsibilities that Whitney assumes, I would be remiss if I did not also mention the enormous contribution made by Dirk Baumann, who has chaired the program from its inception. It was Dirk, who was challenged by thenAssemblywoman Fiona Ma, to start a program in San Mateo County. Another program launched this past fall, through SMCMA’s Community Service Foundation, is our Walk with a Doc program. The overall mission is to encourage healthy physical activity in people of all ages, and help reverse the consequences of a sedentary lifestyle in order to improve the health and well-being of citizens in San Mateo
JANUARY 2013 | SAN MATEO COUNTY PHYSICIAN 7
Executive Report: SMCMA Working for You (continued) County. The concept is to encourage people to join a physician(s) on a weekend morning to walk a mile in a community park. Walkers receive bottled water and fresh fruit thanks to in-kind contributions from the Magnolia of Millbrae retirement community. Though we took a hiatus this winter, we will be back again offering this opportunity to the community come spring with physician volunteers “leading by example,” and answering basic health related questions from the walkers. Just because I mention this last, does not mean it is of less importance. Whitney also runs membership recruitment efforts to inform physicians who are not members why they need to support organized medicine.
8 SAN MATEO COUNTY PHYSICIAN | JANUARY 2013
Whitney develops campaign materials to reach out to these individuals and provides follow-up. In this capacity she will also organize member networking events that will take place this summer, including a membership appreciation barbecue, and other social opportunities. As you can see, Whitney Wood’s job is no easy task, and yet she fulfills her responsibilities with passion and enthusiasm. SMCMA is very fortunate to have staff with such dedication. I will introduce you to other staff members from time to time in the coming months.
W H Y I C HOSE
A
C AREER
IN
C ARDIOLOGY BY
D OUGLAS Z UCKERMANN , MD
Upon graduating from college I remember reading that the average medical student changes his or her preferred field of endeavor five times during the course of medical school. At the time I thought this to be implausible. But by the time of my own graduation from Tufts University School of Medicine in 2002, I could list pediatrics, psychiatry, surgery, obstetrics and neurology among the fields I had once been drawn to. I eventually chose anesthesia and matched in the field, only to later change again to internal medicine and then cardiology. It’s not that I disliked any of the above fields. Indeed, it was quite the opposite. I often became so engrossed on a rotation that I convinced myself that I had found my match. I often dreaded the end of each month, when I would have to move onto a different rotation and abandon that which I had grown to admire. Of course, the cycle would begin anew the following month. Perhaps this apparent love for the various different aspects of medicine is what eventually drew me to cardiology. The field of cardiology was able to whet so many of my different appetites. I could have time in the outpatient clinic, in the hospital wards, in the intensive care unit. I could follow patients for years, and see the progression of their disease. I could read various studies, similar to a radiologist. Or I could perform procedures like cardiac cath with percutaneous interventions, like an interventional radiologist. I could even have the option of implanting cardiac devices, much like a surgeon would do. I felt that, as a cardiologist, I would never have a sense of lacking.
Once I began focusing on the field of cardiology, my motivation strengthened. I discovered that cardiology was a field with intense research that yielded evidence-based guidelines for care. I enjoyed knowing that the therapies delivered were justified by a plethora of scientific evidence. I was encouraged by the rapid progression in therapies as well. New medications and interventions were constantly on the horizon. Finally, while I was in residency, it was announced that cardiovascular disease was no longer the leading cause of death in the United States. Surely this dedication to research and improvement in therapies must have contributed to this result. I am now entering my fifth year in practice as a cardiologist. I can honestly say that my choice has not led to any disappointment. I come to work each day not having any idea what the day will bring. My work is always quite varied, and I am constantly facing clinical and non-clinical challenges. I am never given an opportunity for boredom.
JANUARY 2013 | SAN MATEO COUNTY PHYSICIAN 9
Why I Chose a Career in Cardiology (continued) I think back to a patient I first met in my first year of practice. She was a vibrant lady in her 80s who was suffering from increasing dyspnea on exertion. I performed a transthoracic echocardiogram and later a transesophageal echocardiogram that revealed agerelated aortic valve stenosis. After coronary angiography she under went an aortic valve replacement. Shortly after surgery she developed heart block, for which I implanted a permanent pacemaker. She did well thereafter and I enjoyed seeing her for her routine appointments and hearing about her various exploits. She was writing a book, did a lot of traveling and had a large, interesting family. Unfortunately, over the course of the next several years she developed progressive dementia. Last year it was discovered that she had a lung mass that was found to be malignant. Because of my relationship with both her and her family, we were able to transition her to a palliative care program, and she died peacefully with her family at home a few months ago.
10 SAN MATEO COUNTY PHYSICIAN | JANUARY 2013
I can think of few other professions in which I could serve so many different roles for my patient. I truly feel lucky to have a profession in which I can give, and receive, so much on a consistent basis.
Douglas Zuckermann, MD, is a cardiologist at Kaiser Permanente in South San Francisco. A graduate of Tufts University School of Medicine, he is certified by the American Board of Internal Medicine in cardiovascular disease and internal medicine.
Understanding
insomnia
By Mehran Farid-Moayer, M.D. Taking more than 30 minutes to fall asleep after the lights and TV are off, or taking more than 30 minutes to fall back to sleep after a nocturnal awakening are the main features of insomnia. Insomnia is a common condition that could interfere with quality of life and may be associated with certain morbidities. Etiology
Simple ways to differentiate
Insomnia could be a symptom of another disorder, or be a diagnosis by itself. Psychophysiologic insomnia, adjustment insomnia, paradoxical insomnia, and less commonly, idiopathic insomnia are among the types of insomnia categorized as diagnostic entities.
A patient who cannot easily fall asleep, gets frustrated with their inability to fall asleep, wakes up at night, and feels tired during the daytime may have chronic insomnia/psychophysiologic insomnia. This patient is not able to take naps and is not able to sleep during the daytime.
Insomnia could be a symptom of many other ailments, including depression, anxiety disorders, bipolar disorder, endocrine disorders, neurologic disorders, or chronic pain. Other sleep disorders, including narcolepsy, certain forms of sleep apnea, and Restless Legs Syndrome (RLS) may be associated with insomnia. Insomnia could also be a side effect of certain medication or substances.
Presentation Typically, there are three presentations, including sleep-onset insomnia, sleep-maintenance insomnia, or early morning awakenings. These three presentations may provide further diagnostic clues.
Diagnosis of insomnia Typically people with insomnia express frustration with their inability to fall asleep. They cannot take daytime naps, and due to poor sleep, have deficits in daytime function, including tiredness, and may have impairments in memory and cognition.
A patient with symptoms similar to the above, who feels sleepy and takes daily naps, may have another sleep disorder. Most likely his or her insomnia is a symptom of another sleep disorder. A patient who has no problem falling asleep or falling back to sleep, but wakes up frequently and feels sleepy during the day, most likely has sleep-maintenance insomnia as a symptom of another sleep disorder such as sleep apnea. A patient who has significant difficulty falling asleep, but whose sleep is solid for seven or more uninterrupted hours, without nocturnal awakenings, may have a delayed sleep-phase syndrome, which is a circadian sleep disorder. A patient whose only complaint is early morning awakenings with no difficulty falling asleep or maintaining sleep may have an advanced sleep-phase disorder, depression, or sleep apnea.
JANUARY 2013 | SAN MATEO COUNTY PHYSICIAN 11
Understanding Insomnia (continued) Patients with psychophysiologic insomnia may fall asleep easier in places other than their own bedroom, including hotel rooms, the sofa, and so on. These patients have become conditioned to stay awake while in their beds. Treatment 1.
Medications are the most common options. Pharmacotherapy of insomnia include benzodiazepines, non-benzo hypnotic agents, certain antidepressants, and melatonin agonists. A new class of medications, called orexin receptor antagonists (suvorexant) is under clinical trials.
2.
Behavioral and cognitive treatment options are effective and should be utilized when available. They are typically implemented by a “Behavioral Sleep Medicine� psychologist or sleep physician.
3.
Innovative medical devices are being evaluated and may prove to be helpful in the future.
General recommendations For insomnia as a symptom of another disorder, the underlying cause should be detected and treated. Including psychiatric illness, depression, anxiety, pain, certain form of sleep apnea, narcolepsy, and thyroid disorders.
A new class of medications, orexin receptor antagonists (suvorexant) is under clinical trials. Suvorexant works by turning off wakefulness rather than by inducing sleep. Types, doses, and timing of medications should be reviewed and adjusted to reduce their effect on sleep. Other substances may affect sleep and should be reviewed. Alcohol may induce sleep-maintenance insomnia and could deteriorate the restorative quality of sleep. Pharmacotherapy is a good option for transient insomnia, including adjustment
12 SAN MATEO COUNTY PHYSICIAN | JANUARY 2013
insomnia or when insomnia is a symptom of another medical problem. Cognitive behavioral therapy is the best longterm option for treatment of chronic insomnia and psychophysiologic insomnia. Sleep medicine physicians can help in detecting the etiology and choose the best treatment options.
Mehran Farid-Moayer, MD, is a pulmonary disease specialist, sleep medicine specialist, and sleep medicine pediatrician practicing in Burlingame.
CMA Foundation Launches National Cer vical Cancer PSA January is cervical health awareness month. Close to 12,000 women in the United States develop cervical cancer every year, leading to almost 4,000 deaths. The disease disproportionately affects Hispanic and African American women. Unfortunately, many people don’t know that cervical cancer is a preventable disease through regular screenings and HPV vaccinations. To educate the Latinas about the importance of regular screenings and vaccinations, the CMA Foundation’s Cervical Cancer/HPV Project will be releasing a national television public service announcement (PSA). The Spanishlanguage PSA will be aired on Univsion in early 2013.
MD, MPH, assistant professor of obstetrics and gynecology at the University of Southern California Keck School of Medicine and CMA Foundation board member. “It is imperative that all women get regular pap tests and also schedule appointments for their adolescents to receive the series of HPV vaccine shots.”
The CMA Foundation has joined forces with the Cervical Cancer-Free Campaign, and is engaged in efforts to reduce the prevalence of cervical The CMA Foundation’s cancer through increased Cervical Cancer / screening and vaccination. HPV Project strives We have developed a to educate both The Spanish-language PSA will be aired comprehensive array of patients and clinicians on Univsion in early 2013. It can also be resources for physicians, about the connection viewed at www.cal.md/hpv-psa-spanish. other health care between cervical providers and consumers, cancer and the including online clinical human papillomavirus education resources (HPV). Through our and multilingual patient education materials. collaborations with provider organizations, health Please visit www.thecmafoundation.org for more plans, public health agencies and key consumer information. organizations, the Foundation is working to address the health disparities associated with For more details on the Foundation’s cervical cervical cancer and HPV. cancer awareness activities, please contact Leslie Barron at lbarron@thecmafoundation.org. “No woman should ever die from this easily preventable disease,” says Diana Ramos,
JANUARY 2013 | SAN MATEO COUNTY PHYSICIAN 13
San Mateo County
Physician
2012-2013 Officers & Board of Directors
Editorial Committee
Gregory C. Lukaszewicz, M.D. ............................. President Amita Saxena, M.D. ..................................... President-Elect Vincent Mason, M.D............................. Secretary-Treasurer John D. Hoff, M.D ...................... .Immediate Past President
Russ Granich, M.D., Chair Sharon Clark, M.D. Edward G. Morhauser, M.D
Raymond Gaeta, M.D. Russ Granich, M.D. Edward Koo, M.D. C.J. Kunnappilly, M.D. Michael Norris, M.D.
Michael O’Holleran, M.D. Irwin Shelub, M.D. Chris Threatt, M.D. Kristen Willison, M.D.
David Goldschmid, M.D. .................................. CMA Trustee Scott A. Morrow ........ Health Officer, County of San Mateo Dirk Baumann, M.D ...................... AMA Alternate Delegate
Gurpreet K. Padam, M.D. Michael Stevens, M.D
Sue U. Malone ......................................... Executive Director Shannon Goecke......................................... Managing Editor
Editorial and Advertising Offices 777 Mariners Island Boulevard, Suite 100 San Mateo, California 94404 Tel (650) 312-1663 | Fax (650) 312-1664 smcma@smcma.org | www.smcma.org
Article Submission
NEW SMCMA MEMBERS Sashibindu Amara/*IM Burlingame
George Chang/FM San Mateo
Members are always encouraged to submit articles, commentary and Letters to the Editor. Email your submission to the SMCMA Editorial Committee at smcma@smcma.org for consideration for publication in San Mateo County Physician.
Advertising Opportunities Advertising in San Mateo County Physician is a great way to reach out to the San Mateo County medical community. We offer a variety of display ads, in black & white and full color. Design assistance is also available. Classified ads begin at $40 (for up to five lines) for members and $75 for non-members.
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Index of Advertisers American Medical Association..................................... 10 The Magnolia of Millbrae. .............................................. 4 Marsh. ................................................ Inside Front Cover NORCAL Mutal Insurance ................Outside Back Cover Office Space for Rent: Redwood City 1-2 days/week .. 14 Tracy Zweig Associates. .............................................. 12
14 SAN MATEO COUNTY PHYSICIAN | JANUARY 2013
Please contact Shannon Goecke, Managing Editor, at (650) 312-1663 or sgoecke@smcma.org to get started.
Legal Information 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. Acceptance and publication of advertising in San Mateo County Physician does not constitute approval or endorsement by the San Mateo County Medical Association of products or services advertised. SMCMA reserves the right to reject any advertising. Š Copyright 2013 San Mateo County Medical Association
HIPAA & MEANINGFUL USE :
SMCMA
What you need to know for a successful attestation
BONUS: This webinar will also include information about recent changes to HIPAA and HITECH brought about by the January 17, 2013 release of the HIPAA Omnibus Rule, which will implement tougher privacy and security provisions. The Rule was published in the Federal Register on January 25, 2013. Presenter David Ginsberg is co-founder and president of PrivaPlan Associates, Inc., which offers a wide array of products and services including guidance on HIPAA Privacy and HIPAA Security, HIPAA Training, Meaningful Use Consultation, and Security Risk Assessments.
W EBINAR
Wednesday, February 13, 2013 12:00 12:0 0 0 - 1: 1:30 3 P.M. 30
U
Meaningful Use attestation requires completion or review of a HIPAA Security Risk Analysis and appropriate updates or correction of deficiencies. Failure to adequately complete this step can create HIPAA Compliance issues AND expose a medical practice to Medicare false claims penalties. This webinar will teach you how to reach meaningful use as well as comply with HIPAA.
H I PA A For registration or more information, please contact Shannon Goecke at (650) 312-1663 or sgoecke@smcma.org.
People of Asian/Pacific Islander(API) descent have the highest prevalence of chronic hepatitis B (CHB) in the United States. In fact, CHB is 100 times more common in Asian Americans than in non-Asian Americans. And a majority of them most likely acquired the hepatitis B virus (HBV) during childhood, currently show no symptoms, and are unaware of their infection. This is alarming because chronic carriers of HBV have a risk of liver cancer 100 times higher than the general population. Please join San Mateo Hep B Free (smhepbfree.org) in their local effort to raise awareness of CHB risk and initiate screening among our API patients. CHB can be reliably diagnosed with a simple and inexpensive blood test (for HBsAg and Anti-HBs markers), which will detect an active infection and assess immune status. Subsequent vaccination of appropriate patients who have not been exposed to HBV is >95% effective at preventing HBV Infection. And for those who need it, effective treatment is available, which might help improve the condition of the liver. As physicians who serve patients of Asian descent, we are in a position to reduce the impact of CHB on their lives. Your help, along with that of your office staff, is crucial to this effort. Please contact Whitney Wood at wwood@smcma.org to find out how you can get involved. Together, we can help reduce the impact of CHB in our community. Thank you for your help.
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