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Pima County Medical Society May 2012

Home Medical Society of the 17th United States Surgeon-General

More opportunity for mendacity?

‘New CPR’ means more survivors

Remembering Dr. Jim Parsons

If you feel as if your practice is under attack, you’re probably right.

With reimbursements shrinking and the integration

of electronic medical records, treating your patients effectively and running a profitable practice has never been more difficult.

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Visit Bank of Tucson or call Mike Hannley at 520-321-4500. Ask him about what Bank of Tucson is doing to help, and how you can focus on patient care without sacrificing the financial health of your practice.

without sacrificing the financial health of your practice. Mike Hannley President Bank of Tucson MEMBER It’s

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Official Publication of the Pima County Medical Society V o l . 4 5 N
Official Publication of the Pima County Medical Society V o l . 4 5 N

Official Publication of the Pima County Medical Society

Vol. 45

No. 5

Pima County Medical Neil Clements, MD Michael Connolly, DO Bruce Coull, MD (UA College of
Pima County Medical
Neil Clements, MD
Michael Connolly, DO
Bruce Coull, MD
(UA College of Medicine)
Randall Fehr, MD
Alton “Hank” Hallum, MD
Evan Kligman, MD
Melissa D. Levine, MD
Lorraine L. Mackstaller, MD
Clifford Martin, MD
Kevin Moynahan, MD
Soheila Nouri, MD
Jane M. Orient, MD
Guruprassad Raju, MD
Wayne Vose, MD
Scott Weiss, MD
Victor Sanders, MD (resident)
Cambel Berk (student)
Christopher Luckow (student)
Members at Large
Thomas Rothe, MD,
Society Officers
Kenneth Sandock, MD
Richard Dale, MD
President
Alan K. Rogers, MD
vice-president
Michael F. Hamant, MD,
secretary
Board of Mediation
At Large ArMA Board
President-Elect
Charles Katzenberg, MD
Bennet E. Davis, MD
Ana Maria Lopez, MD,
Vice-President
Timothy Marshall, MD
Thomas F. Griffin, MD
Charles L. Krone, MD
Pima Directors to ArMA
Secretary-Treasurer
John Curtiss, MD
Edward J. Schwager, MD
Eric B. Whitacre, MD
Timothy C. Fagan, MD
R. Screven Farmer, MD
Past-President
Timothy C. Fagan, MD
Arizona Medical
Delegates to AMA
Association Officers
PCMS Board of Directors
Gary Figge, MD,
past president
Diana V. Benenati, MD
R. Mark Blew, MD
William J. Mangold, MD
Thomas H. Hicks, MD
Gary Figge, MD (alternate)

Editor

Stuart Faxon

Phone:

883-0408

E-mail:

tjjackal@comcast.net

Please do not submit PDFs as editorial copy.

Advertising

Bill Fearneyhough

Phone:

795-7985

Fax:

323-9559

E-mail:

bill5199@simplybits.net

Art Director Alene Randklev, Commercial Printers, Inc. Phone: 623-4775 Fax: 622-8321 E-mail: alene@cptucson.com

Printing Commercial Printers, Inc., Andy Charles Phone: 623-4775 E-mail: andy@cptucson.com

Publisher Pima County Medical Society Steve Nash, Executive Director 5199 E. Farness Drive, Tucson, AZ 85712 Phone: (520) 795-7985 Fax: (520) 323-9559 E-MAIL: steve5199@simplybits.net Website: pimamedicalsociety.org

SOMBRERO (ISSN 0279-909X) is published monthly except bimonthly June/July and August/ September by the Pima County Medical Society, 5199 E. Farness, Tucson, Ariz. 85712. Annual sub- scription price is $30. Periodicals paid at Tucson,

Arizona. POSTMASTER: send address changes to Pima County Medical Society, 5199 E. Farness Drive, Tucson, Arizona 85712-2134. Opinions expressed are those of the individuals and do not necessarily represent the opinions or policies of the publisher or the PCMS Board of Directors, Executive Officers or the members at large, nor does any product or service advertised carry the endorsement of the society unless expressly stated. Paid advertisements are accepted subject to the approval of the Board of Directors, which retains the right to reject any advertising submitted.

Copyright © 2012, Pima County Medical Soci- ety. All rights reserved. Reproduction in whole or in part without permission is prohibited.

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CONTENTS



5
5

President’s Page

ACA overturn? What will still remain.

8
8

PCMS News

Survey examines physicians and the truth; honors for doctors Shapiro and Spark.

14
14

Behind the Lens

Our Dr. Hal Tretbar in Cochise County and photographers statewide recorded ‘A Day in the Life of Arizona’ on Statehood Day.

18
18

In Memoriam

Remembering Dr. James L. ‘Jim’ Parsons.

20
20

Cardiology

Cardiocerebral resuscitation or CCR, the UofA-developed ‘new CPR,’ keeps proving itself.

22
22

Reality Check

About some things, why do we even debate? asks Dr. Michael S. Smith.

23
23

Lifestyle Medicine

Dr. Hunter Yost on ‘dieting forever.’

24
24

Perspectives

Dr. George Makol on his sudden enviro-urge; Dr. David Ruben on unifying our political processes.

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D E P A R T M E N T S

Letters Members’ Classifieds

7

26

CORRECTION

We erred in last month’s exposition of statehood centennial history. The name of Tucson’s mayor when Arizona became a state was not Hoffman, but I.E. Huffman, M.D. He served as mayor in 1911-15, and was PCMS president in 1910 and 1931.

On the Cover

Actor Stephen Keith portrays Doc Holliday in re-inactment of the legendary O.K. Corral shootout in Tombstone. Here he chats with Deputy Marshal J.J. Norris in front of the Crystal Palace Saloon. Our Dr. Hal Tretbar was part of the Arizona Highways “A Day in the Life of Arizona” project, and recorded this and other Bisbee and Tombstone images on Statehood Day, Feb. 14.

project, and recorded this and other Bisbee and Tombstone images on Statehood Day, Feb. 14. 4

PRESiDENT’S PagE

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The ACA flipside

With the Supreme Court’s ruling on the Affordable Care Act looming next month, it might be useful to think what might be the flipside if it is overturned. The Affordable Care Act is a deeply flawed bill passed at the last minute by lawmakers who admitted they had not read it entirely. I agree with conservatives that granting the government the ability to force its citizens to buy something they may not want does seem to be a slippery slope of far reaching government power.

Conservatives gloat over the irony of constitutional-law expert Barack Obama having his centerpiece legis- lation overturned as unconstitutional. He should have known better! Presumed Republican presidential nominee Mitt Romney has stated that he plans to repeal “ObamaCare” “root and branch.” Obviously, legal complexities and partisan emotions run high on this topic, but does nasty rhetoric help us reach a workable solution? If the ACA is unconstitutional, what’s next? Here are some possible scenarios:

Maintain the status quo. Let our current system of medical in- surance companies and government programs stand as they are. The trouble is, virtually everyone agrees the status quo is not sus- tainable. The problems of booming healthcare costs and huge numbers of uninsured citizens would still exist. Consider it this way: If our current system of healthcare was proposed as a new law would anyone vote for it? No way. National single-payer system. Political experts argue that there is considerable support for a single-payer system among Americans and if Barack Obama is re-elected and has a Democratic majority in Congress, it could happen. The competition-stifling and innova- tion-killing aspects of such a plan make it an undesirable choice for us as physicians. Having just one national fee schedule that could be ratcheted up or down on political whims is a scary thought. Just look at Medicare fees and the Sustained Growth Resolution prob- lems we have dealt with as an example. Universal healthcare. Yes, I’ll come out and say it: I am in favor of mandated health coverage for all citizens of the United States. Mandatory health insurance is really the meat of the Affordable Care Act. If everyone is covered, then the cost to cover an individu- al goes down. One of the most fundamental factors making insur- ance costly is adverse selection. Without a mandate, healthy people will opt out of coverage, leaving high-cost patients in the system. Medical insurance companies are really just gambling houses. They are betting that the insurance premiums you pay are more than the pay out for your illness. If you are seen as a losing bet, insurance

companies avoid you like the plague. What we need are insurance companies motivated to improve the health of their enrollees and provide efficient and cost-effective care. Let me point out that we already have a form of universal cover- age. It’s called emergency care. Any patient without insurance, job, or money who develops a serious disease will end up getting full treatment. The ethics and morals of our profession would prohibit otherwise. Emergency care is just not efficient.

prohibit otherwise. Emergency care is just not efficient. Dr. Alan K. Rogers Uninsured people don’t go

Dr. Alan K. Rogers

Uninsured people don’t go for routine care for fear of cost. My uninsured patient who presented with widely metastatic colon can- cer had never had a colonoscopy because he could not afford it. Af- terward, his diagnosis, surgery, chemotherapy, and hospice care were provided and they cost a small fortune. He paid none of it. A $2,000 colonoscopy three years earlier would have been better. When a Chevy Suburban loaded with illegals rolls over on I-19, the occupants get full treatment at our hospitals without regard to their ability to pay. Uninsured patients in our country are treated one way or another, and we are already paying for it. What advantages might mandated universal health insurance provide? A few ideas:

Emergency rooms would make money. Hospitals have emer- gency departments now only because they are required to. EDs are big money losers. If the hospital got paid for every patient, EDs would be a profitable business. Hospitals would be incentivized to attract patients by improving service. Waiting times and over- crowding would fall. There could be competition on prices. There is a reason a Starbucks is on every corner. It’s because they make money. Preventive care would flourish. If all patients had health cover- age, they could stop using the emergency room for primary care. Ask our ED colleagues. Many ED visits could be handled much less expensively in the doctor’s office. Chronic illness would be treated as outpatient instead of as a crisis in the emergency depart- ment. If patients with diabetes all knew they had the disease and came to an office visit a few times a year, the savings to the system would be enormous. Medical costs would stay about the same. Experts say there is enough money spent yearly in this country to care for everyone if it was done efficiently. Mandating insurance puts healthy low-cost patients in the risk pool to contribute to the total funding of health insurance. People forget what insurance is. Insurance is sharing risk over a large group so those with illness can receive care without bankruptcy. Unfortunately, many think medical insurance is a ser- vice contract. If they pay $1,000 in premiums, they expect $1,000 in services. For insurance to work, the majority must pay in more than they receive. It’s like my life insurance. I’ve been paying life in- surance premiums for years but have yet to see a single nickel. Pricing would become rational. Liability, defensive medicine, expensive new technology, and burgeoning numbers of elderly are often blamed for the increasing medical costs, but the real elephant in the room is cost shifting. If someone doesn’t pay for his or her healthcare, someone else does. Hospitals must make money to stay open. What you pay reflects the uncompensated care the hospital must provide. Your in-patient Tylenol tablet does not cost eight dollars. The reason to have medical insurance is to be able to use the fee schedule your insurance company negotiated with the hos- pital. The poor slob who goes to the ED without insurance gets billed the full sticker price, probably double what it should be. Universal coverage would eliminate uncompensated care. Then prices would reflect what it really costs to deliver care. To para - phrase medical economist Uwe Reinhart, our medical care is so ex- pensive because we are overcharged for everything.

Universal healthcare should keep capitalist-style competition. An individual’s coverage could come from government insurance plan, private insurance company, or be employer-based. The indi- vidual could pay for it or get it as a job benefit. Patients could pick freely between the plans and make choices based on service, levels of coverage, availability, and provider network. Pre-existing condi- tion exclusions would not be allowed, so insurance would be porta- ble. Insurance companies would make their money by managing risk instead of avoiding it. I would propose national underwriting with an independent panel to determine the actuarial cost of insur- ing a given type of patient. Insurance companies would have to accept that rating, thus making the risk pool the entire company instead of small groups. Years ago when my office had only 20 employees, one of them developed leukemia. Because of small- group underwriting, our health insurance premium skyrocketed the next year. Are there problems with a universal healthcare scenario? Of course. What to do about people who don’t pay their premiums? Is there a penalty or a tax? How do we motivate people to adopt cost- saving, healthy lifestyles? Are there enough physicians to see all the patients who suddenly have insurance? Obviously a lot of details need to be addressed, but my belief is a workable solution is possi- ble and will be better than what we have now. If the Affordable Care Act is overturned, we as Pima County Medical Society members must participate actively in choosing a replacement. We must have a healthcare system we can live with, and which our patients can live with. Maintaining competitive in- centives for excellence and innovation are paramount. If we do not weigh in on the healthcare reform debate, we may all be forced to eat broccoli.

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reform debate, we may all be forced to eat broccoli. “WE ANSWER FOR YOU!” • Live
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lETTERS

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EMRs: Cost and compatibility

To the Editor:

I have had the same experiences as Dr. Rogers (President’s Page, April Sombrero) with EMRs and Dragon. However, whichever EMR is used or how it performs, the real issues are cost and compatibility. There are enough users and facilities in this country to question why we have no economies of scale for medicine, both in hardware and software. Combined with monthly fees for support, the bot- tom line is outrageous. We should all be Cloud-computing and owning no programs, not paying for software support. Just using dumb terminals. Pa- tients’ clinical information would be at least as secure as in the pro- fusion of free-standing locations in current use. Vendors are quick to induce practitioners to load up on debt for medical EHR systems, owned by credit companies who administer these loans. If you close your office before retiring all of these obli- gations, you quickly discover that there is no residual value in any of it. It’s just you, the indebtedness, and no equity to cash in. And, we all know these systems are awkward, time-consuming, inefficient and, as Dr. Rogers notes, generate masses of valueless pa- per. The big joke is their incompatibility between venues. What other commercial enterprise would put up with this expensive, sec- ond-rate product or allow itself to be forced to adapt its monumen- tal, outdated inefficiencies? There must be quite an effective lobby inducing government subsidy for a much-needed product which the industry shows no sign of producing.

Jonathan B. Pasternack, M.D. Tucson

Changing climate change

To the Editor:

In response to “Swimming with the orcas” (Reality Check, Dr. Michael S. Smith, March Sombrero), the oceans are not “more acid.” The oceans are alkaline, ranging variously from 7.8 to 8.3 pH. A recent “scientific” study stated that the oceans had become

slightly less alkaline by .1 pH over the past 100 years. The ability to track this variable at .1pH for all the oceans of the world over a cen- tury beggars belief when a segment of the ocean may vary by .3 pH over a short time interval. Glaciers are supposed to melt when it gets warmer. However, a recent Grace satellite-based study showed that in the high moun- tainous area of Asia including the Himalayas, Karakoram, Tian- shan, Pamir, and Tibet that snow and ice losses from 2003-2010 were insignificant. The loss of 4 +/- 20 gigatons/year corresponds to a .01mm sea level rise/year. The seas are rising, a little bit. Oceans globally rose 15cm in the

20 th century. In the first decade of the 21 st century they have been

receding. Stockholm’s Dr. Nils Axel Morner and the INQUA Commission on Sea Level Changes and Coastal Evolution, the true sea level specialists of the world, predict by the year 2100 a 5cm +/- 15cm sea level rise. This is based on actual observations around the globe, and the probability of a new solar minimum around years 2040-2050 resulting in significant atmospheric and oceanic cool- ing. There has been no net warming worldwide for 17 years, with a decreasing trend the past decade. The planet’s mean temperature

dropped .6 degree Celsius in the past two years, equal to the entire warming gained in the 20 th century. As to Southwestern rainfall, a paper published March 14 in Environmental Research Letters found over the past 346 years droughts of extended duration occurred most frequently between

1696 and 1820. Our present instrumental data based period is

amongst the wettest since at least 1665. Dr. William Happer, professor of physics at Princeton, testified before a U.S. Senate Committee that atmospheric carbon dioxide levels have averaged 1,500 parts/million for the past 350 million years. He described the present <400 ppm as being in CO2 famine.

Because of its undeniable growth effect on all plant species, a dou- bling of CO2 may be the key to increased future food production to feed our burgeoning world population. Dr. Smith based his findings and predictions on the Interna- tional Panel on Climate Change’s “95% confidence” level in their

2007 AR4 report. This report has been subsequently shown to be

35 percent composed of non peer-reviewed documents written by environmental activist groups, journalists, and students rather than the “100% peer reviewed scientific reports” espoused by the IPCC. This leads one to highly question a “95% confidence rating” of predictions based on such biased and poorly sourced data. The world’s climate is changing as it always has and will. We live in an Ice Age. The warmer periods have been good for all the earth’s inhabitants and the colder have not. Enjoy our Holocene Modern Warm Period. The bad cold days will come soon enough. Dr. Richard Switzer Tucson

Why is there debate if there is none?

To the Editor:

In the March Sombrero Dr. Michael S. Smith writes: “I believe I

have convincing evidence about the world’s climate. I believe if no- body speaks out against those who disagree, and I continue to be polite with my choice of verbs, misinformation will continue. I am calling them out; I will not be silent.”

I interpreted this to mean that he was throwing down the gaunt-

let. Dr. Richard Switzer, Dr. George Makol, and I offered to accept the challenge, and suggested a debate. Dr. Smith could present his evidence and teach us (and the audience) where we are wrong.

I was mistaken. That isn’t what he meant. He writes that “there

is no debate,” and that the issue is “beyond debate.” In fact, there generally is no debate in the sense of a public exchange between ad- vocates and dissenters, because the advocates decline to engage. This does not mean that there is not spirited disagreement. More than 31,000 Americans with university degrees in science signed a petition disagreeing with the U.N. IPCC, and their names are posted online at www.petitionproject.org. The issue of “climate disruption” is critically important, as it is being used as the rationale for draconian energy rationing propos- als. Based on the one-sided pro-IPCC coverage in most medical journals, an exception being the Journal of American Physicians and Surgeons, the press might assume, erroneously, that American phy- sicians are thoroughly informed and all but unanimously behind the theory.

Jane M. Orient, M.D. Tucson

are thoroughly informed and all but unanimously behind the theory. Jane M. Orient, M.D. Tucson SOMBRERO

PCMS NEwS

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Physicians, the truth, and the survey

Once there was a two-way relationship, you and your patient. Then with third-party payment it became three-way between you, your patient, and the payer. Now it’s a four-way relationship between you, your patient, the payer, and the truth. It would seem that oppor- tunities for mendacity have grown with the healthcare industry. At least that’s what some Massachusetts General Hospital re- searchers who did a national survey are saying. They are saying that “most physicians paint overly optimistic prognoses for their pa- tients, and that many have told lies or withheld information con- cerning their medical mistakes and financial relationships with drug companies and device manufacturers.” The survey was published in the journal Health Affairs. The story was reported recently on boston.com/Health’s Daily dose by Deborah Kotz of the Boston Globe, a New York Times Co. newspaper, in the city where MGH is often said to stand for Mankind’s Greatest Hospital. Then Fox News Channel spread the story around in April, attempting to reach a conclusion from an inconclusive, anonymous survey. “The 2009 survey of nearly 1,900 doctors … shows that many doctors don’t adhere to the standards of medical societies and ac- creditation groups, which have long required doctors to be open and honest with their patients,” the Globe reported. ‘There’s an expectation that our doctors will be truthful, and most are, but some are not,’ said study co-author Eric Campbell, director of research at the hospital’s Mongan Institute for Health Policy. “The researchers didn’t determine whether any patients were harmed because of a physician’s dishonesty. The survey found that nearly one-fifth of doctors said they hadn’t fully disclosed their mis- takes over the past year, in order to avoid a lawsuit.” ‘I was disappointed to see so many doctors not disclosing er- rors,’ said Arthur Caplan, a bioethicist at the University of Pennsyl- vania who wasn’t involved in the study. ‘They may dodge a bullet, but if it’s found out later they can really get clobbered for not tell- ing the truth—to say nothing of the patient consequences.’ “In addition, nearly 40 percent of physicians said they didn’t think it was necessary to tell patients if they had accepted speaking fees or a free vacation from the manufacturer of the drug they were prescribing or whether they owned the scanner for the imaging test they were ordering.” ‘If a reasonable person might think a financial relationship might affect what drug, procedure, or test they were prescribed, it’s better to disclose,’ Caplan said. ‘A lot of times patients will say they don’t care about the conflict,’ but they should be given the chance to ask further questions. “Efforts are underway to make potential financial conflicts more transparent: Partners HealthCare, the parent company of Brigham and Women’s Hospital and MGH, may soon start requiring doc- tors to disclose to patients any substantial monetary ties they have to medical companies. And a new federal law requires pharmaceuti- cal and medical device companies to publicly report any physician payments or gifts worth more than $10. Everything from stock op- tions, meals, and consulting fees will pop up on a searchable physi- cian database slated to appear online in September of next year. “For now, patients facing a choice between multiple procedures

or medications might want to ask doctors about any financial inter- ests that could bias them in favor of one treatment over another, said Dr. Michael Barry, president of the Foundation for Informed Medical Decision Making, a Boston-based patient advocacy group. “Barry added that he was ‘gratified’ to see that nearly 90 percent of doctors reported that patients should be fully informed about the benefits and risks of a procedure or drug. He did, though, wonder whether they actually practiced what they preached.” ‘It contrasts with what we found from patients who tell us their doctors tend to present more benefits than risks when it comes to treatments,’ he said. “While the survey was anonymous, doctors may have veered a bit toward reporting behaviors that they deemed to be acceptable to their colleagues rather than what they truthfully did in practice, Campbell said. ‘Only 11 percent of physicians reported saying something un- true to patients over the past year,’ he said, ‘which I suspect is much higher.’ “The doctors were not asked what they lied about. “Some of the communication lapses reported in the survey may simply be signs that doctors are human. Nearly 45 percent of doc- tors said they’ve given patients prognoses that are rosier than reality in the past year, which Caplan said reveals their compassionate side.” ‘It’s a human impulse to fine tune how you present bad news or a grim prognosis,’ he said. ‘It’s important to get to the truth, but it’s a process to tell someone they will be dead in six months.’ “That’s something doctors are loathe to do, especially when they have a strong relationship with a patient. A study published recent- ly in Annals of Internal Medicine found that most patients with in- curable lung or colon cancer don’t discuss their end-of-life care op- tions with their doctors until a few weeks before they die. More than three-quarters had these discussions with physicians they didn’t know during an emergency hospital visit, rather than with their regular oncologist.” ‘I understand why this happens,’ said study author Dr. Jennifer Mack, a pediatric oncologist at Dana-Farbaer Cancer Institute. ‘I have this instinct, too, to not want to cause harm and pain to peo- ple by bringing up topics’ such as death and how it should be man- aged. ‘But I also feel obligated to do it.’ “And patients may be grateful for doctors who convey that last bit of hope. “While medical association guidelines recommend that doctors discuss end-of-life care with all cancer patients who have a life expec- tancy of less than one year, the timing of those discussions are left to the doctor and patient. ‘We’re still learning about the right time to have these conversations,,’ Mack said. ‘What’s right for one family may not be right for another, and I ask what’s important for you to know right now? Would it be helpful to talk about your prognosis?’”

EHRs, liability workshop May 24

Do EHRs increase liability? That’s the question to be answered at a free workshop at PCMS, 5199 E. Farness Drive, May 24, 12- 1:30 pm. Karen Connell and Ken Adler, M.D. will speak. PCMS planned the workshop along with Maricopa County Medical Society, ArMA, Arizona Osteopathic Medical Association, MICA, and the Arizona Regional Extension Center. To register, go to http://www.arizonarec.org/events and click on “Do EHRs Increase Liability.” If you have trouble, call Steve, 795.7985.

Dr. Shapiro to be honored May 20

Former PCMS President Eve C. Shapiro, M.D., M.P.H., will be honored with the Martha K. Rothman Lifetime Achievement Award from Child & Family Re- sources at an event May 20. Tickets are $85. Please call Mi- chelle Fuentes, 321.3394, for more information. Dr. Shapiro’s lifetime of work as a teacher, volunteer, and pedi- atrician will be recalled, but her work chairing the successful citi- zen initiative to raise AHCCCS eligibility to 100 percent of the federal poverty level—and her subsequent efforts to stop legislative efforts to weaken the law— will be specially highlighted.

Award named for Dr. Spark

The University of Arizona College of Medicine Department of Pathology has established an Annual Distinguished Service Award in the name of Dr. Ron- ald P. Spark. “I’m still trying to believe that I’m receiving this honor,” Dr. Spark said in his acceptance speech April 14. “I’m reminded of what Einstein said—Reality is an illusion. But it is a persistent one.” He noted that his 45 years as a pathologist has been a time of “focused, attempted engage- ment, applying continuous learning to match the viscitudes and vagaries of human disease: a most humbling experience. But, look- ing back, this practice we call pathology, has nearly always been ful- filling, In fact, I can honestly say, most days, I still can’t believe I also got paid for doing this!” Dr. Spark has been a member of the Arizona Society of Patholo- gists since 1974 and has served as one of its executive officers for eight years and as editor of The ASP for 18. “Each role gave me a deep satisfaction, rising from the sense of belonging and actively participating in this valued, unique craft guild of ours. I have trea- sured the many lasting, professional and personal relationships the Society has afforded me. I salute you, members of the Arizona Soci- ety of Pathologists for your vision and solidarity!” Dr. Spark has been a member of UofA CofM Department of Pa- thology since 1975. “But only in the recent decade have I had the opportunity to teach and mentor. This has been a profoundly mov- ing and motivating experience: truly one of my life’s highlights.” He said that as a “young, naive pathologist, I assured myself I could do it all. But, reality quickly set in. The intensity and com-

it all. But, reality quickly set in. The intensity and com- plexity of our practice promptly
it all. But, reality quickly set in. The intensity and com- plexity of our practice promptly

plexity of our practice promptly disabused me of that notion. That initial period was indeed sobering, if not deflating. What I really learned soon enough is that what we really accomplish in our prac- tice of pathology is the end result of a team effort by committed professionals.” Awards are often made posthumously, Dr. Spark noted. “So, I am most delighted and honored to receive this recognition, espe- cially, while still being very much alive. Thank you!”

Alliance brunch May 10

The Pima County Medical Society Alliance will have a no-host (not at a member’s home) brunch on Thursday, May 10 at Schlomo & Vito New York Delicatessen, 2870 E. Skyline Drive in Tucson. The business meeting is 9:30-10 a.m., and brunch 10-11:30. Please RSVP Kay Dean at 520.232.0240 or kmcdean@yahoo.com, or Anastasha Lynn at 520.219.9800 or msdesertprincess@gmail.com Reminder: Dues are due! If you have not paid your PCMSA dues for the 2012 calendar year, please make checks payable to PCMSA or Pima County Medical Society Alliance, and submit to:

Kay Dean—Treasurer, 6433 N. Placita del Zopitote, Tucson 85750. Dues are $50; $25 for retirees and housestaff.

New date for ‘Stars’

PCMS’s Stars on the Avenue is moving dates under the leader- ship of a new committee, but will still offer the same great time. The new date is April 2013, to avoid conflicts with UofA foot- ball and to garner more institutional support. The object will still be to have physicians gather and mingle in an informal setting with great food and drink while listening to terrific music. Watch for details in these pages as they develop.

AMA promotes Medicare ‘empowerment’ bill

The AMA has launched a grassroots initiative to generate public support for Congressional passage of H.R. 1700 and S.1042, the Medicare Patient Empowerment Act, introduced by Rep. Tom Price (R-Ga.) and Sen. Lisa Murkowski (R-Alaska), respectively. This legislation, based on policy developed by the AMA House of Delegates, will create a new Medicare option to allow patients and physicians to enter into private contract arrangements without penalties for either party. The focus now is on securing House and Senate co-sponsors for this important legislation. A patient brochure is available for distribution in physician of- fices. The brochures are available free of charge, in batches of 50, for physicians who order them through the website http://mymedi- care-mychoice.org/. The My Medicare-MyChoice website also features an online pe- tition that physicians and patients can sign. So far, 198 physicians and 167 patients have signed the petition, with the largest number (30 percent of the total) coming from Georgia. Web stickers can be downloaded from the site and affixed to your own website to help direct traffic to the petition—please visit http://mymedicare-my- choice.org/ and download your web stickers today. On the AMA’s own website, at http://www.ama-assn.org/go/pri-

vatecontracting, a range of resource material to support this work is available, including:

3 An educational slide deck, with script, for physician audienc-

es that can be personalized by the presenter.

3

A physician-focused Frequently Asked Questions document.

3

An educational slide deck, with script, for patient audiences

that can be personalized by the presenter.

3

A patient-focused Frequently Asked Questions document.

3

A short educational video for patients.

3

A downloadable patient flyer for physician offices.

Gaining on primary care

The UofA reports from Match Day for the College of Medicine Class of 2012 that 69 graduates will pursue primary care, the most critical shortage Arizona faces. “Nearly half of Arizona medical school graduates practice in- state, while nationally, fewer than 39 percent of physicians practice in the state where they went to medical school, according to the As- sociation of American Medical Colleges,” they reported. “This year on March 16 at 10 a.m., students received traditional Match Day sealed envelopes containing letters showing where they will go for their residency training, in programs varying in length from three years for general medicine/family practice specialties to eight years for the most specialized of surgeons. Nationwide, there were 38,377 medical students eligible to match for a total of 26,772 training positions, according to the NRMP. “The UA College of Medicine—Tucson had its 31 st Match Day ceremony in DuVal Auditorium at The University of Arizona Medi- cal Center—University Campus. An overflow crowd of medical stu- dents, their parents, siblings, spouses and children—many dressed in keeping with the event’s theme, ‘Game Night: Match 2012’— gathered for the event, which kicked off with a board-game themed skit about the college’s departments written and performed by the medical students. After the skit, students’ names were called ran- domly to receive their match envelope, which they opened to loud cheers from fellow students and family members. Video of the event is archived on the Internet at http://streaming.biocom.arizona.edu “At the UA College of Medicine—Phoenix, a ‘mini-airport’ was created in the middle of Virginia G. Piper Auditorium on the downtown Phoenix campus for its second Match Day ceremony. Signs dangled over 43 suitcases, each with a match envelope at- tached, arranged like a baggage claim area and cordoned off with a red ribbon. At 10 a.m., Dean Stuart D. Flynn, M.D., cut the rib- bon and the restlessly waiting medical students dashed to find the suitcase with his or her envelope. Stepping to the podium onstage, each student announced his or her location and placed a pin to mark it on a map of the United States. Video of the event is ar- chived on the Internet at http://vimeo.com/38946351 “The UA College of Medicine Class of 2012 totals 149 students on the Tucson and Phoenix campuses who will graduate this month: 85 women, 64 men, 14 Hispanic students, and one Native American student. Forty-three percent will remain in Arizona for their residency training. Several graduates earned places in presti- gious residency programs nationwide. “Sixty-nine graduates will go into primary care: 25 in family med- icine, 21 in internal medicine, and 23 in pediatrics. Twenty-five grad- uates will pursue residency training in Phoenix, 22 will begin their residencies in Tucson, and three will spend a preliminary year train- ing elsewhere then return to Arizona to complete their residencies.

“Twenty-two students matched with the UA College of Medi- cine Graduate Medical Education Program (www.gme.medicine.ar- izona.edu), which oversees 42 ACGME (Accreditation Council for Graduate Medical Education)-accredited residency programs in all major specialties and subspecialties. The students will pursue resi- dencies in anesthesiology, dermatology, emergency medicine, family medicine, internal medicine, neurology, orthopaedic surgery, pa- thology, pediatrics, radiation oncology, diagnostic radiology, surgery and urology. More than 500 residents and fellows are trained at The University of Arizona Medical Center—University Campus, the primary teaching hospital for the UA College of Medicine—Tuc- son, and 14 other major participating institutions in Tucson. “Three graduates matched with two of the six new ACGME-ac- credited residency programs created by the University of Arizona College of Medicine at South Campus (www.uph.org/gme) (formerly the University of Arizona/UPHK Graduate Medical Education Con- sortium): one in emergency medicine and two in family medicine. The programs are based primarily at The University of Arizona Med- ical Center – South Campus with rotations throughout the state, in- cluding the Southern Arizona VA Health Care System and the Indian Health Service. Approximately 100 residents are participating in the new programs, which focus on providing health care in rural and un- derserved areas of Arizona to help reduce the Arizona physician shortage and improve access to health care throughout the state. “Thirty-three UA College of Medicine—Tucson graduates will begin residencies in Arizona: 16 will remain in Tucson, 15 will go to Phoenix (two to Phoenix Children’s Hospital, the college’s pri- mary pediatric affiliate in Phoenix), one will spend a year training in Arizona before embarking on specialty training and two will spend a preliminary year training elsewhere before returning to Ari- zona to complete their residencies. Forty-eight graduates will go into primary care: 19 in family medicine, 16 in internal medicine and 13 in pediatrics.”

‘Child Life Event’ beats goal

Dr. Chris Maloney reports that March 23 at Tucson Country Club, at the “Child Life Event” to raise funds for the Child Life Specialist Program at Diamond Children’s medical center, they raised more than $44,000, exceeding their goal “Child life specialists are vital in the overall well-being of a child who has been diagnosed with a disease or must undergo a procedure that might be frightening or painful,” said Dr. Maloney, UofA clini- cal associate professor and owner of Maloney Plastic Surgery. Dr. Maloney organized the event when his friends Jeff and Tiana Ronstadt’s seven-year-old son, Larry, was diagnosed with acute lymphoblastic leukemia (ALL) last December. Soon after the diag- nosis, friends and family of the Ronstadts asked how they could help. Jeff, Tiana and Larry came up with the idea to raise funds for the Child Life Specialist Program at Diamond Children’s, because they saw how much the child life specialists helped and encouraged Larry.“The child life specialists at Diamond Children’s are great,” says Tiana. “They eased Larry’s anxiety about being hospitalized and helped him understand his illness.” On any given day at Diamond Children’s, each child life special- ist may provide support and assistance for as many as 40 children throughout the hospital, the emergency department and the outpa- tient clinics—21 areas in all.

Poison center re-certified

The Arizona Poison and Drug Information Center reports that it has earned re-certification for the next five years from the American Association of Poison Control Centers. The Arizona Poison and Drug Information Center at the Uni- versity of Arizona College of Pharmacy provides free and confi- dential poison control and medication information to the public and healthcare professionals. The hotline operates 24 hours a day, seven days a week. One of 57 centers that make up the American Association of Poison Control Centers, the Tucson center serves all of Arizona except Maricopa County. Call 1800.222.1222 from any location to reach the poison center nearest you. “Certification on is designed to ensure that every poison cen- ter in the nation adheres to the same high standards,” they said. “For example, it determines if the center is reaching the commu- nity it is supposed to serve, if qualified employees answer the phones, if the center is open 24 hours per day, as required, if staff members receive continuing education and whether the medical direction of the center is appropriate.” “Recertification is vital to us,” said Keith Boesen, PharmD, CSPI, director of the center. “Our center answers more than 150 calls per day from citizens and healthcare professionals seeking advice from our experts about poisons, drugs and venomous creatures. Our certi- fication ensures our callers get the high level of care they deserve.” The poison center started more than 50 years ago as a vol- unteer service provide by UofA College of Pharmacy faculty. It officially was established by the Arizona Legislature as a state pub- lic health service in 1980 and has continuously been accredited since 1981.

Book on dying gets good review

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Ira Byock, M.D., who will be in Tucson in November, had his book positively reviewed in The Wall Street Journal April 10. In the book, The Best Care Possible, Byock says, “Americans are scared to death of dying. And with good reason. We make dying a lot harder than it has to be.” Yet we have the tools already to make dying easier, and not by calling the late Dr. Kevorkian. He calls end-of-life care dysfunctional and neglectful, and cites studies that show people with advanced cancer live 8.5 months with standard oncology care, while they live 14 months if they re- ceive basic palliative care. PCMS has a copy of Dr. Byock’s book and is willing to share. If you are interested, call 795.7985, and ask Steve about borrow- ing it. Dr. Byock will be in Tucson for several events in November, including a dinner lecture for physicians at the Arizona Inn. When Sombrero has details, we will publish them.

PCMS 2012 meetings

The ArMA Annual Meeting (delegates only) is June 1-2. Our coming Regular Membership Meetings are Tuesday Nov. 8, 7 p.m. including reading of the nominees slate, and Tues- day Dec. 11 after the Board of Directors meets, for ballot count and declaration of election winners.

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Coming PCMS Board of Directors and Executive Committee (officers only) meetings are:

BOARD:

Tues. May 22, 6:30 p.m. (Memorial Day May 30) Tues. Aug. 28, 6:30 p.m. Mon. Sept. 24, 6:30 p.m. (Yom Kippur starts Sept. 25) Tues. Oct. 23, 6:30 p.m.

Tues. Dec. 11, 6:30 p.m.

EXECS:

Tues. May 22 5:30 pm Tues. June 26, 5:30 p.m. Tues. Aug. 28, 5:30 p.m. Mon. Sept. 24, 5:30 p.m.

Tues. Oct. 23, 5:30 p.m. Tues. Nov. 13, 5:30 p.m. Tues. Dec. 11, 5:30 p.m.

Pima County Medical Foundation Evening Speaker Series

Pima County Medical Foundation’s Evening Speaker Series is on the second Tuesdays in May, June, September, October, and No- vember, often including CME. Dinner is at 6:05 p.m., meeting be- gins at 6:45, speaker’s presentation at 7:15. Coming topics include:

May 8: Cocci specialist Dr. John Galgiani with an update. May 8 will also be presentation of the Foundation Awards, hon- oring physicians who have made exemplary efforts in furthering medical education. Recipients are Dr. James Corrigan, first pedi- atric hematolgist at the University of Arizona College of Medicine, former dean at Tulane University School of Medicine, and 1988 PCMS president; Dr. Brendan Phibbs, professor of clinical medi- cine at the UofA College of Medicine and for more than 30 years cardiology chief at Kino Community Hospital, now University of Arizona Medical Center—South Campus; and Dr. Vincent Fulg- initi, founding chairman of the Department of Pediatrics at the UofA College of Medicine, who preceded Dr. Corrigan as dean at Tulane, and was later vice-president for health sciences at the Uni- versity of Colorado. June 12: Medical liability and tort reform, speaker to be an- nounced.

March monthly report

Referrals to physicians: 115 Meeting rooms occupied: 26.9 percent (8 a.m.-10 p.m., seven days per week) Executive Committee: PCMS President Alan Rogers MD pre- sided March 27, 5:40-6:23 p.m. Plans for the April board meeting were examined and the night’s board agenda was studied for additions and considerations. A plan from a member to have the medical society act as consul- tant in regulatory, hospital, and legal disputes will be researched. Board of Directors: PCMS President Alan Rogers presided March 27, 6:35-8:13 p.m. Wayne Vose MD and Randall Fehr MD were appointed to the board and took their seats. The board ratified Bennet Davis MD as the liaison to the board of directors of the Arizona Business Coalition on health and asked that the alternate be drawn from the ad hoc committee on business/medicine.

Letters will be sent to Carondelet asking it to be straightforward

with the staff at the heart hospital as to whether it will close or not, and to NextCare regarding communication with community physicians.

A resolution about exercise was considered and delegates elected

for the ArMA Annual Meeting. Reports from ArMA and Medicare were heard.

Dr. Marc Leib, chief medical officer at AHCCCS, said a fee in- crease is in the governor’s budget that would begin Oct. 1.

A special issue of Sombrero will be published in the summer and

will be a voter’s guide for PCMS members. The Board of Mediation, Chairman Edward Schwager MD, did not meet in March. Public Health Committee: Chairman Jane Orient MD presid- ed March 5, 12:23 -1:19 p.m. Flu season is off to its latest start in 29 years, with the numbers edging up in February. RSV also climbed, but still within normal

limits for this time of year, and a few pertussis cases were confirmed. The county health department is studying opiate deaths in Pima County and will examine heat-related deaths. Statistics on physician mortality were examined and will be studied by the committee for trends that bear watching.

A bill, now dead at the legislature, was examined. It would have

allowed bicyclists to treat stop signs as yield signs—provided the rider is over 16.

A report from the ArMA Public Health Committee was dis-

cussed. It suggests that all Asian Americans be screened for hepati- tis B because two out of three Asian Americans are foreign-born in areas were HBV is endemic. Bioethics Committee: Chairman David Jaskar MD presided March 20, 12:38-1:34 p.m. An article about brain death criteria in The Wall Street Journal has caused quite a stir. The story will be checked for accuracy and a response given if necessary. Disaster scenarios do not lend themselves to a good case that will resonate with PCMS members, so another case was discussed and will most likely be used as a future case in Sombrero. The Arizona Bioethics Network is holding a webinar in late March and the committee will tune in. History Committee: Chairman James Klein MD presided March 13, beginning at 5:30 p.m. No more details were available at press time. Pima County Medical Foundation, Inc.: President James Klein MD presided March 19. The foundation presented the Evening Speaker Series March 13, featuring an update on compression-only CPR. The next Regular Membership Meeting is Nov. 13. Odds & Ends: Melissa Levine MD led PCMS’s Walk with a Doc session March 10. Afterward, many attended the Exercise is Medicine CME conference at the DoubleTree Hotel. There were 165 attendees at the conference which PCMS helped plan. PCMS participated with Paula Maas DO and her USHIN project. The ad hoc committee looking at a dialogue with local business leaders about genuine health reform met twice in March under the leadership of Bennet Davis MD. The PCMS Long Range Planning Committee completed a SWOT analysis and will meet in depth this April to plan out its agenda for the year.

a SWOT analysis and will meet in depth this April to plan out its agenda for
Get to know the BUSINESS SIDE OF COX. An EMR system is only as powerful

Get to know the

Get to know the BUSINESS SIDE OF COX. An EMR system is only as powerful as
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bEhiND ThE lENS

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A Day in the Life of Arizona

A Day in the Life of Arizona Dr. Hal Tretbar As part of Arizona’s Centen- nial

Dr. Hal Tretbar

As part of Arizona’s Centen- nial celebration, Arizona High- ways, the state tourism maga- zine, is in process of gathering material for a book that will rep- resent “A Day in the Life of Ari- zona.” All of the photographs to be included had to be taken on Feb. 14, the day Arizona became a state 100 years ago. The Arizona Professional Pho- tographers Association, with the Phoenix and Tucson Chapters of American Society of Media Pho- tographers, are sponsors and con-

tributors. Notices were placed in Tucson and Phoenix newspapers inviting the general public to submit images that reflected what was happening on that day. All images were uploaded to a site on the Arizona Highways website. To see them, log onto www.arizonahighways.com and click on the appropriate box. I am part of Arizona Highways Photo Workshops and serve as a voluntary organizer and trip leader. We also participated in record-

organizer and trip leader. We also participated in record- Bisbee’s Copper Queen Hotel opened in 1902

Bisbee’s Copper Queen Hotel opened in 1902 to accommodate mining company executives and potential investors.

ing what was happening on Valentine’s Day, our state birthday. I decided to record the activities of Southern Cochise County in Bis- bee and Tombstone. Dorothy and I made an exploratory trip the week before to check out locations and make contacts. We wanted to start with the Copper Queen Hotel in Bisbee, the icon of this famous mining community.

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Phelps Dodge Mining Company began construction of the hotel in 1898. It was fin- ished in 1902 to house dignitaries and poten-

The ghost of Julia Lowell may still be encountered in the halls of the Copper

The ghost of Julia Lowell may still be encountered in the halls of the Copper Queen Hotel.

still be encountered in the halls of the Copper Queen Hotel. Sonny Tovar was an underground

Sonny Tovar was an underground miner for 15 years. Now he takes people on tours of the Bisbee’s Copper Queen mine.

takes people on tours of the Bisbee’s Copper Queen mine. Fireman Mark Perez kills time in

Fireman Mark Perez kills time in front of Bisbee’s historic Fire Station No. 2 shortly after midnight.

historic Fire Station No. 2 shortly after midnight. Bisbee’s St. Elmo bar is 110 years old.

Bisbee’s St. Elmo bar is 110 years old. Bartender Walter Carbajol tends to the day’s first customers.

Walter Carbajol tends to the day’s first customers. Bruce Munn and Katy Thompson are competitive pistol

Bruce Munn and Katy Thompson are competitive pistol shooters. They trailer their four horses from Michigan to the Phoenix area every year. They have just enjoyed lunch at Tombstone’s Big Nose Kate’s Saloon.

area every year. They have just enjoyed lunch at Tombstone’s Big Nose Kate’s Saloon. SOMBRERO –
The Mimosa Market in Bisbee has been a mom-and- pop operation since it opened 1904.

The Mimosa Market in Bisbee has been a mom-and- pop operation since it opened 1904. Barbara Johnson is one of the current owners.

opened 1904. Barbara Johnson is one of the current owners. Richard Wilson, owner of Tombstone’s Smoke

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Tombstone’s Crystal Palace Saloon remains the same as it was in the 1880s when it

Tombstone’s Crystal Palace Saloon remains the same as it was in the 1880s when it was noted for fine whiskey and gambling. Ashlinn Nixon serves fine drinks from the original bar.

Ashlinn Nixon serves fine drinks from the original bar. Actors portraying Doc Holliday and the Earp

Actors portraying Doc Holliday and the Earp brothers walk down Tombstone’s Allen Street on the way to the O.K. Corral for the now-daily gunfight.

tial investors. The Copper Queen Hotel has been in continuous operation and is presently owned by Dan and Connie Finck. Con- nie told me, “It was in excellent condition when it was offered for sale at $1 when the mines closed in 1975.” The Fincks bought it in 2005, and with the resurgence of Bisbee as a travel destination, they say the Copper Queen is now worth several million dollars. The hotel is noted for its three ghosts. There is the hint of an old- er man who keeps to the dark shadows. The spirit of a young boy who drowned in the San Pedro River is said to sometimes appear. Then there is the story of Julia Lowell. She was a lady of the night who frequented the hotel. She is said to have done herself in when she was jilted by a paramour. Her apparition is sometimes seen danc- ing down the third floor hallway close to her room by the back door. Of course I wanted to try to record a ghost image, so we stayed overnight on Feb. 13 and enlisted the help of desk clerk Angie Bau- er. I had planned on Angie wearing a white dress so she would ap- pear to drift down a darkened hallway, but she arranged to have an authentic dark gown for the shoot. We ended up having a darker ghost dancing down the hall that is just as effective! I scheduled a series of location shoots for Bisbee in the morning and Tombstone in the afternoon. In Bisbee I concentrated on daily activities. In Tombstone I tried to show how tourism is the lifeline of the community. I started with a historic Bisbee fire station a few minutes after midnight and ended with Tombstone’s Crystal Palace Saloon long after sunset. Here are some of the images from Arizona’s 100 th birthday, Feb.14, 2012.

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iN MEMORiaM

By Stuart Faxon



Dr. James L. Parsons, 1929-2012

Dr. James L. “Jim” Parsons, rheumatologist and IM physician who joined PCMS in 1961 and served as president in 1975, died April 5 in Tucson. Retired since 1995 from a 35-year medical ca- reer, he was 83. James Lewis Parsons was born Jan. 30, 1929 in Gunnison, Colo., where he earned his bachelor’s degree at Western State Col- lege. He earned his M.D. in 1955 at University of Colorado School of Medicine. He interned at Hurley Hospital in Flint, Mich., and did IM residencies at Hurley and the Veterans Administration Hos- pital in Denver. In between he served two years in the U.S. Navy as a lieutenant commander. Dr. Parsons and his wife, Carolyn, moved to Tucson in 1961 to raise their family. He began his practice in Tucson that year, work- ing with J. Steven Strong, M.D. and Edward W. Dick, M.D. in Desert Medical Group, Ltd. on East Hampton Street. In 1989 they associated with David W. Sundheimer, M.D., Ph.D. and moved to North Rosemont Boulevard. When the first PCMS Physician of the Year award was made in 1992 (for 1991), Dr. Parsons’ colleagues chose him. “Arthritis is an extremely frustrating and debilitating disease for patients,” PCMS President Jack Dunn. M.D. said. “Dr. Parsons follows these pa- tients for many, many years, and uses all his skill and care to help them through the frustrations.”

He was a member of ArMA, AMA, American Col- lege of Physicians, American College of Rheumatology, Ar- thritis Foundation Southwest Chapter, National Society of Clinical Rheumatology, American Rheumatism Asso- ciation, National Society of Nuclear Medicine, Multiple Sclerosis Society, Southern Arizona Chapter American Heart Association, Arizona Training Center for the Hand- icapped, Medical Society of the United States and Mexico, Southwestern Clinic and Re- search Institute, of which he was president for many years. He was on the steering committee for the Stroke Home Care Project, and

served as a consultant to Children’s Rehabilitative Services. He was also a UofA visiting professor, first in agricultural re-

also a UofA visiting professor, first in agricultural re- Dr. James L. Parsons in 1992 when

Dr. James L. Parsons in 1992 when he was named first PCMS Physician of the Year recipient.

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search, and then in microbiology. He published frequently on rheumatological topics and partici- pated in many symposia and seminars. Dr. Parsons was always ready to help at PCMS. He served on the sports medicine, re- habilitation, and legislative committees, and chaired the Board of Mediation. He also served as a Southern District Director for ArMA, and on our board of directors. In addition, he was an outdoors lover—an avid hiker, camper, fisherman and hunter, and a talented landscape watercolorist. “He had a real thirst for knowledge,” Carolyn told the Ar- izona Daily Star. “He was an avid reader, and he loved to travel and explore different cul- tures.” As a watercolorist, he loved to capture the beauty of the Southwest that he so loved, she said. His parents, and his daughter Julie Ann Parsons predeceased him. Carolyn, his wife of 56 years; sister Cara Harwell; son Jim; grand- daughter Jessica Laos; four nieces and six nephews; and great-grandson Trent Chollar survive him. Memorial services were on May 5 at Luther- an Church of the Foothills in Tucson. Contri- butions in Dr. Parsons’ memory may be made to Lutheran Church of the Foothills’ Memorial Garden Project, 5102 N. Craycroft Rd., Tuc- son 85718-6343.

Church of the Foothills’ Memorial Garden Project, 5102 N. Craycroft Rd., Tuc- son 85718-6343. 18 SOMBRERO

SOMBRERO – May 2012

19

CaRDiOlOgy

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Cardiocerebral Resuscitation

The alternative approach to CPR By Stuart Faxon

Editor’s note: This report follows a presentation by Dr. Karl B. Kern at PCMS March 13 at Pima County Medical Foundation’s Evening Speaker Series. Dr. Kern is professor of medicine at the University of Arizona, chief of the Section of Cardiology at Sarver

Heart Center, and director of Cardiac Catheterization Laborato- ries and the Interventional Cardiology Fellowship in Tucson. By now physicians have heard of the UofA-developed “new CPR,” but they don’t have all the details—such as the far larger survival rates—and the public still needs to understand this huge change

in methodology, despite a kickoff initia- tive back in 2003. Consequently in February, the Be a Lifesaver Tucson Campaign kicked off with a news conference including Tucson Mayor Jonathan Rothschild, Councilman Steve Kozachik, Dr. Kern, Claudine Mess- ing, Steven M. Gootter Foundation, and Ann and Rob Charles (Rob is a sudden cardiac arrest survivor and Ann is vice- president of the Kaimas Foundation.) Everyone was just outside McKale Memorial Center because the official launch was at the UofA vs. USC basket- ball game. The campaign continued through February and concluded March 25 at the Gootter Grand Slam charity tennis event at Jim Reffkin Tennis Center, Randolph Park. The goal of the month-long initiative was to train more than 500,000 Tucsonans in the new chest-compression-only method of cardiopulmonary resuscitation. Devel- oped in Tucson by the Sarver Heart Center Resuscitation Research Group, this meth- od significantly increases survival rates for victims of sudden cardiac arrest, which remains a major U.S. health issue. Studies have shown that many people

can be effectively trained by watching a short demonstration video. In order to reach as many people as possible, the Be A Lifesaver Tucson team made a two-minute demon- stration video for circulation throughout the community via emails, PSAs and word of mouth, directing those interested to

http://bealifesavertucson.org/learn-cpr-

steve-kerr to watch the video. Additionally, for those who prefer to learn in person, training sessions were of-

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fered throughout the month at various times and locations. “Be

a Lifesaver” is the name for the monthly community training

classes in which the public can learn chest-compression-only CPR, sponsored by UofA Sarver Heart Center, Tucson Fire De- partment, and University Medical Center. See dates at www. heart.arizona.edu or call 626.4083. Surviving cardiac arrest is a matter of “location, location, location,” Dr. Kern and Dr. Arthur B. Sanders said in an edi- torial in JAMA 2008;300:1462—3. “Wide variability in out- come emphasizes the need for each community to ‘know its numbers,’ then concentrate on improvement by focusing on

locally identified problem areas within the Chain of Survival.” What Dr. Kern called the “three pillars” of CCR are:

3 Chest-compression-only BLS for witnessed unexpect-

ed collapse in adults.

3 New cardiocerebral resuscitation ACLS algorithm for

dispatchers and EMS personnel.

3 Post-resuscitation care to include use of mild hypother-

mia and aggressive reperfusion.

The first is for lay rescuers, Dr. Kern said. “The rationale

is that circulation is more important than ventilation in early

VF cardiac arrest.” In 2000 a video of lay individuals taught CPR showed that it took 15-16 seconds each time to deliver the two mouth-to-mouth breaths, he said. “The ‘ideal CPR’ has four-second pauses for ventilations. ‘Realistic CPR’ has 16-second pauses for ventilations! So what happens if we eliminate mouth-to-mouth rescue breathing? What about oxygenation?” In VFCA, the lungs and arterial circulation are full of oxygen. “The key is circulating the oxygen already there. Experimental work has shown that arterial saturations re- main acceptable for five to 10 minutes of CPR. Respiratory

arrest is different! Ventilation is crucial to replace oxygen. The price for interrupting chest compressions is compromise in hemodynamic support, and decrease in survival.” Total incidence of bystander CPR in Arizona in 2005- 2009 shows a 36 percent increase, according to one of Dr. Kern’s citations. “But does the increase in bystander per- formance of compression-only make any difference in the outcomes?” he asked. In a word, yes. He cited percentages of survival to hospital discharge for all-rhythm CA in Arizona at 5 percent for no-bystander CPR; 6 percent for with a bystander; and 13 percent with a com- pression-only bystander. For witnessed VF in Arizona, surviv-

al rates were 17 percent for no bystander CPR; 19 percent for

bystander; and 32 percent for compression-only bystander. In an observational study of cardiopulmonary resuscita- tion by bystanders with chest-compression only, by the SOS—Kanto Study Group and published in The Lancet in 2007, 9,592 cardiac arrests in 58 communities were studied, using the primary endpoint of 30-day survival with a favor- able neurological outcome. In the study, for bystander CPR for witnessed arrest with a shockable rhythm (VF/VT), 30-day neurologically normal survival was 11.2 percent with

How to do it

How to do it? You won’t know when or where, but here’s how: Call or ask someone to call 911. Leave the phone on. Put the victim on his or her back on the floor. Put one hand on top of the other, and then put the heel of the bot- tom hand on the center of the victim’s chest. Lock your el- bow straight and use your body weight to begin forceful chest compressions at the rate of 100 per minute. After each 50 compressions, rest very briefly and begin again, until help arrives. If an AED is available, such as in airports, attach it to the victim and follow the machine’s instructions. You and your patients can learn chest-compression-only CPR in free monthly UofA events using hands-on training with lifelike mannequins. Specially trained med students walk attendees through the steps and answer questions. This month’s event is Wednesday May 9, 5:30-6:30 p.m. at Kiewit Auditorium, Arizona Cancer Center.

chest compression plus mouth-to-mouth, and 19.4 percent with compression alone. As published in the New England Journal of Medicine, a summary of 2010 randomized data for dispatcher-instructed resuscitation in all cardiac arrests showed survival to discharge of 30 days at 9.4 percent for compression plus ventilation, and 12.4 percent for compression alone. Among the largest contrasts in figures comparing the old and new, also cited in JAMA in 2008, percentages of survival to hospital discharge from out-of-hospital cardiac arrest pre-CCR (CPR) training and post-CCR, in two suburban communities, using 174 witnessed VF arrests, were 5 percent before the training, and 18 percent after. In survival from out-of-hospital cardiac arrest post-CCR vs. pre-CCR (CPR) training in a State of Arizona pro- tocol compliance analysis, witnessed VF arrests by 62 fire departments showed a 12 percent survival rate for those given no CCR, and a 28 percent survival rate for those who received it. “Does this new approach to advanced cardiac life support make any difference in other communities’ cardiac arrest outcomes?” Dr. Kern asked. With CPR vs. CCR showing 15 percent vs. 48 percent survival in a rural Wisconsin study, and a near doubling of similar percentages in Kansas City, Mo., the answer is yes. Further, if chest-compression-only for witnessed unex- pected collapse in adults is combined with new CCR ACLS algorithms for dispatchers and EMS personnel, the two-step approach in Tucson meant rates of survival to hospital dis- charge rose from 9 to 25 percent. “Cardiocerebral resuscitation really does save more lives,” Dr. Kern said.

9 to 25 percent. “Cardiocerebral resuscitation really does save more lives,” Dr. Kern said. SOMBRERO –

REaliTy ChECK



Must we debate every thing?

1953: I am not allowed to play out- side in the summer because of fear of po- lio. I was among the first to be given both the Salk and Sabin vaccines. Polio today is a rarity in the U.S.; neurologists miss the diagnosis in CPCs. One of my brothers had polio, another had mumps meningitis; my mother had pertussis and almost died. Twenty years later, Crow Indians still had diphtheria. Measles also devastated Native Americans, and con- genital rubella syndrome was something

we saw in med school. Today, a signifi- cant number of Americans think vaccines are harmful, and nothing I say will likely convince them otherwise. 1983: I am in court testifying that a woman post-cardiac arrest is irreversibly brain damaged. Her husband wants to discontinue support; her sisters sued to keep her on the ventilator. Nothing I said in the hospital had changed the sisters’ minds. I knew the sci- ence and the outcomes of persistent vegetative states after cardiac arrest, and I agreed with the husband. Eventually, he prevailed. February 1988: I show a nurse the conjunction of Saturn and Uranus in the morning sky. She said they were in Capricorn (the proper name is Capricornus), but the two planets were visibly in Sag- ittarius. I argued with her for five minutes before realizing nothing I said would change her mind. Their next conjunction is in 2032. Later, a man got a great deal of publicity for supposedly having discovered a new planet near Neptune. I got a call at home from the man, who told me the planet was moving rapidly. I stated that at Neptune’s distance from the sun, the planet would move about a fin- gerbreadth at arm’s length every year among the stars. No matter. The man was convinced. Nothing I could say would change his mind. A physical therapist took me to lunch and told me that manipu- lation of the bones in the skull got rid of headaches. I told him that skull bones were fused in adults. No matter. “It works!” he said; nothing I could say would convince him otherwise. 1984-1994: I said that the science underlying asymptomatic ca- rotid artery stenosis meant that operations should be done only if the surgeon had a complication rate of less than 0.5%. No matter. Many were done at the hospitals I practiced; the major complica- tion rate was 14%. I got screamed at and threatened a few times; intimidation, repetition, and reputation often trump facts. I did not prevail. 2005: Terri Schiavo. Sen. Bill Frist, a physician, said she had cognition, despite clear evidence she was vegetative (smiling is part of the vegetative state). Congress intervened briefly, an example of government dictating medical care if ever there was one. Fortu- nately, science (amicus curiae brief by the American Academy of Neurology) and the court prevailed; indeed, the 600 gm brain with large ex vacuo hydrocephalus at autopsy confirmed what we neurolo- gists knew. March 2012: I am in Tower Blind at Nebraska’s Rowe Sanctu- ary, guiding people to a suitable place to see the Lesser Sandhill

people to a suitable place to see the Lesser Sandhill Dr. Michael S. Smith crane migration,

Dr. Michael S. Smith

crane migration, one of Jane Goodall’s top 10 sights in nature and one of my top three. As we waited for the cranes to land, my co- guide, an elderly woman, told me how she saw an egg stand up- right on the recent equinox. I said that can happen any day of the year. The equinox is an instantaneous point in time, like the tan- gent to a function, with no influence on egg behavior. No matter. She was convinced. Nothing I could say would change her mind. More people believe in astrology than know why we have sea- sons. Many believe we didn’t land on the moon, that strange lights in the sky are aliens, who may abduct us. A woman doing the luge at the Olympics held her neck in a certain way to “increase verte- bral artery blood flow to the brain”; holding her breath would have been better. Each of us has heard some remarkably odd ideas from people, totally convinced, totally wrong, about how the body func- tions. Laetrile and colonic cleansing come to mind. Our sun is at least a second-generation star, for elements heavier than iron must form in supernovae. I believe in evolution and that

vaccines are several orders of magnitude more helpful than harmful.

I wish in the above instances I’d asked a simple question: “Is there

anything that you could learn that would convince you that you are incorrect?” If the answer is “nothing,” I am wasting my time. We should change our beliefs when sound science shows that our beliefs are wrong. When I learned that anti-coagulation did not help vertebrobasilar insufficiency, I stopped using it. When physi- cians at the University of Western Ontario discovered EC-IC by- pass didn’t improve outcomes, they discontinued the operation. They discharged four patients that very day. There are many issues in medicine that we should study, in order to do the best for our patients; after all, each of us will be a patient. We should discuss, not debate, the way we need to change American medicine, because I believe few are happy with the current situation. We need to listen to and understand other points of view. We must be willing to try new approaches, in order to learn from and modify them. We need leaders able to convince people they can do great things that they never thought possible. We need to use the best science available, even if it shows that our beliefs are wrong. Children are born curious; alas, too many have it drummed

out of them. Perhaps if more were curious, we would look for an- swers, discover what we thought was true wasn’t. That to me is moving forward. Could I be wrong on climate change? Yes. I don’t think I am, but yes, sound science could change my mind. But I would rather discuss how we are going to fix medicine, locally and nationally. My error reporting system has languished, unused, for 11 years. I hope I am wrong about human-caused climate change; if I am,

I will admit it. Promise.

Sombrero columnist Dr. Mike Smith’s blog is http://michaelspinnersmith. com, where there are previous Reality Check columns, outdoor writing, descriptions and pictures of National Parks, Alaska hikes, eclipse-chasing, mental arithmetic, op-eds, and two non-technical neurology articles that physicians might enjoy.

arithmetic, op-eds, and two non-technical neurology articles that physicians might enjoy. 22 SOMBRERO – May 2012

lifESTylE MEDiCiNE

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Ten thousand say they can diet forever

By Hunter Yost, M.D.

Recently a local bariatric surgeon was quoted on the front page of the Arizona Daily Star saying, “No one can diet forever.” Later in the article he said his patients would be on a post-surgical diet (pre- sumably forever). Aside from this apparent contradiction, medical research does

•  80 percent of persons in the registry are women and 20 per-

power of social influences. Only five percent of the women lost weight because of a program, and none of the men did. It Gets Easier In a 2000 study, members who had maintained weight losses for both shorter and longer periods of time derived equal amounts of

not support his first statement. This is exemplified by the 10,000 members of the National Weight Control Registry, each of whom lost at least 30 lbs and kept it off for one year to qualify for mem-

pleasure from exercise, low-fat eating, and maintaining their weight losses. Thus, as duration of maintenance increases, the effort re- quired to maintain seems to decrease. This shift may make it easier

bership. The average member has lost 65 lbs and kept it off for five- and-a-half years. The registry was started in 1994 by Rena Wing, Ph.D., a profes- sor of psychiatry and human behavior at Brown University Medical

continue maintaining the weight loss. Staying Consistent Dieting consistency appears to be a behavioral strategy that pre- dicts subsequent long-term weight loss maintenance. There was a

to

School and director of the Weight Control & Diabetes Research Center at The Miriam Hospital, and James O. Hill, Ph.D., profes- sor of pediatrics and medicine at University of Colorado Health Sci- ences Center in Denver. It is the largest prospective investigation of long-term successful weight loss maintenance in the country. The NWCR was developed to identify and investigate the characteristics

linear relationship between scores on the dieting consistency ques- tions and weight change over the one-year period, with smaller weight gains in those who reported more consistency. Participants who reported a consistent diet across the week were 1.5 times more likely to maintain their weight within five pounds over the subse- quent year than participants who dieted more strictly on weekdays.

of individuals who have succeeded at long-term weight loss.

A

similar relationship emerged between dieting consistency across

Over the succeeding years, 31 peer-reviewed articles have been published in medical journals with findings from the participants de- scribing the eating and exercise habits of successful weight losers, the behavioral strategies they use to maintain their weight, and the effect of successful weight loss maintenance on other areas of their lives. Some Facts:

cent are men. •  The “average” woman is 45 years of age and currently weighs 

the year and subsequent weight regain. Lower Dietary Variety In contrast to the investigators’ expectations that successful long-term dieters would be consuming a greater variety of low-fat

than high-fat foods, that they found that registry participants con- sumed less variety from low-fat-dense food groups than did recent weight losers suggests that reducing the total diet variety may be an important strategy for long-term weight loss maintenance. They found that variety consumed in all food groups was positively relat-

145 pounds, while the “average” man is 49 years of age and cur- rently weighs 190 pounds.

ed

to total energy intake in registry members. The finding that total dietary variety is related to energy intake

•  Weight losses have ranged from 30 to 300 pounds. 

is

also consistent with experimental animal research and cross-sec-

•  Duration of successful weight loss has ranged from one to 66  years. •  Some  have  lost  the  weight  rapidly,  while  others  have  lost  weight very slowly—over as many as 14 years. While no research has yet been done regarding any genetic markers of obesity in this sample, it is safe to assume that in a

tional investigations with humans. This study suggests that reduc- ing total dietary variety of both low- fat and high-fat foods may help maintain lower levels of energy intake, thereby aiding in long- term weight loss maintenance. Creating Good Habits Here is what they do:

group this large there will be markers of high- and low-risk distrib- uted across the popula So this means that something else “runs in the family” and it’s not necessarily obesity genes. This could be family cooking and activity habits. It all started when… How did these weight losers do it, and just as important, how do they keep doing it? Digging into the research, nearly 77 percent of the people in one study of group members reported that a triggering event had preceded their successful weight loss. For many women, it was usually some type of emotional trigger such as a relationship is- sue, a lifestyle event such as an anniversary, or seeing themselves in a mirror or photograph. For men it was more likely a specific medical

•  78 percent eat breakfast every day.  •  75 percent weigh themselves at least once a week.  •  62 percent watch less than 10 hours of TV per week.  •  90 percent exercise, on average, about one hour per day.  The original purpose of the NWCR was to dispel the prevailing thinking among medical professionals that long-term weight loss and maintenance was unachievable. These 10,000 women and men are using low-tech lifestyle habits to control their weight. It’s hoped, now after nearly 18 years of research, medical providers can begin to believe that it is possible for their patients to achieve and maintain weight loss and they can convey a positive message about this issue.

issue or symptom or “they just decided to do it” (men like to think of themselves as deciders). An equal percentage of both sexes report- ed receiving “impetus of inspiration from another” indicating the

Hunter Yost, M.D practices Functional and Nutritional Medicine and conducts a therapeutic lifestyle program at his office for weight-related health conditions.

and Nutritional Medicine and conducts a therapeutic lifestyle program at his office for weight-related health conditions.

PERSPECTivES

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The feeling of saving Earth

By Dr. George J. Makol

wi-fi, as it is not secure, and I Googled, “I want to buy an electric car.” The first thing that came up was “Why?” I ignored this and pressed on. The first car I found was the Fisker Karma, selling for $107,850.

It has a 50-mile electric range, but goes further on gas (so does my

car). Fisker has a $600 million line of credit with the government and has spent $200 million already, but I found that they just laid off a good share of their workers, are essentially out of money, and are re-negotiating their loan with the government. Kind of like bankrupt Solyndra, green energy firm Beacon Energy, and battery maker Enerl—all darlings of the current administration making bil-

lions of my dollars disappear for no good reason. Fisker actually had an earlier car, the Tramanto, costing nearly $300,000, but it turned out to be an expensive dud also. The next Google entry was from Consumer Reports, noting that the Karma they bought for evaluation broke down before testing could even begin. Let me see, at $8-per-gallon gas, it will take me until I am 137 years old to start saving by buying one of the above cars. I picked $8 because when our current president took office, gas was $1.86 per gallon, and it has more than doubled to about $4. I figure if he

is re-elected gas will double again to about $8 per gallon, and this is

a conservative estimate. Actually this is a convenient age, as Social

Security the other day informed me that I have paid in $500,000 thus far, so if I wait until age 70 to get the maximum payout, I will get my money back with no interest by age 137, too. Except you

and I know we will never see a dime of this “savings plan.” I will be means-tested and my money will go to people who do not work but already collect from the government around 40 percent of my earnings. This is only “fair,” is it not? I was always a Chevy guy, so I next examined the Chevy Volt. The Volt can go about 25-50 miles on electricity from its battery pack, and then another 344 miles as the 63-horsepower gasoline en- gine kicks in to charge the batteries. You can get 95 mpg on electric power, but once the gas engine fires up, you get 37 mpg on expensive premium fuel. It costs more than $40,000, but the government (you and me) pay part of this. But wait, the Chevy Cruze costs $20,000 less and gets 28-mpg city and 42 highway on regular fuel. To run the Volt on electric -

ity for a year boosts your home electric bill by about $700 also. If you plug in an electric car, the energy to recharge it does not come from outer space. It comes from mainly coal-fired plants, the ones that are rapidly being phased out by the Obama Admin- istration’s stringent new EPA mandates. Their 54- mpg requirement by 2025 will force production of

I was cruising down Speedway the other day in my 355-horse-

power, twin-turbo-equipped automobile, with the 700-watt Sony stereo blaring Winton Marsalis jamming live with Eric Clapton

when I suddenly came upon the realization: I need to conserve en- ergy! I need to save the planet!

I quickly hit the brakes and skidded to a near-halt, which did

not really help, as I do not have regenerative braking. I’m not really sure what regenerative braking is, but I am certainly in favor of it. Thankfully I found myself in front of a coffee purveyor so I parked and turned off my car’s powerful engine, and I immediately felt I was doing something good. But was it enough? No, I an- swered, thinking to myself (which is considered introspection, as opposed to talking to yourself which is considered mental illness), I will take a giant leap forward and buy an electric car.

I walked into the Starbucks—you know, the coffee place where

you pay $5.50 for a $1.50 cup of coffee with no refills, but then you

get to sit around for 45 minutes and try to figure why you did this. I approached the “barista”—someone who did not have a job six months ago but now is an expert on making espresso and piling on sugar and cream to create fat-filled libations with exotic names—and said, “I would like a really big mocha latte with whipped cream.” She scowled at me and said, “Venti”? Now to me, “venti” is the number that comes after 19, and I am confused as to why an American coffee shop serving Colombian coffee lists their cup sizes in Italian. Why not Czech? Anyway, I said, “the biggest you serve” and I received a Leona Helmsley “little people” look, but eventually got my coffee.

I fired up my 4G Galaxy pad, not bothering to connect to their “free”

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electric cars just when the juice is being turned off.

If President George W. Bush were to do this, people

would label him an idiot; but compared to the to- tally inept smooth talker we have as our current leader, Dubya looks like a Rhodes scholar. (I know some of you are saying, “What about natural gas generating future electricity?” Well, the same greenies blocking the Keystone pipeline will stop exploration for natural gas too if they are able!)

After reviewing my preliminary research, I was at

a loss as to what a concerned environmentalist like me could do. Then I remembered the “Electric Car

Czar.” It is a bit of a story, but after attending the American College of Allergy Meeting in Boston, I visited my cousin living in Connecticut, near Springfield, Mass. Where I was born. Now he lives in a beautiful custom house on three acres of expensive Connecticut land with two lakes, so I consider him rich. I am a doctor so he considers me rich. So he said, “I have to dog-sit for my neighbor, and I would like you to meet him because he is really rich, and an interesting person.”

I asked how he became so rich, and my cousin asked if I noticed

the electric pole and outlet protruding above the ground at the res- taurant where we had just eaten. I said yes, I did, and I also noticed lots of them at businesses around town, all sitting completely un- used. Well, this guy, he told me, installs them all over town, and both he and the business owners receive federal subsidies that make it profitable for both parties. Anyway, we pulled up at his 12,000-square-foot house sitting on 60 acres with its own forest and horse trails, and were greeted at the door by this charming sixtyish fellow, and ushered us into his den. The den was done, ceiling and all, in expensive cherrywood, and his den was larger than my five-bedroom, four-bath house. He took us out to his “carriage house” to see his electric car collection, all plugged in with his invented device, which is essentially a plug in a metal housing that comes down from above, rather than below. He pointed to one odd looking electric vehicle, and said he just returned from a nearby town where it was shown off to the local press. As the town was 25 miles away, he noted he had “range anxi- ety” upon his return trip as he intended to plug it in during the demonstration to recharge the batteries, but the press kept unplug- ging it to get better pictures. I asked what happens if the batteries run out, and he replied, “Simple, I just get one of the gasoline-pow- ered tow trucks in my workplace to come and tow me back.” “What if,” I asked, “I buy such a car and do not have a fleet of tow trucks at my disposal?” He looked at me with that Leona Helmsley little-peo- ple look, and that was the second time in one month for me. On the way out he asked my cousin if he wanted to attend a $10,000-a-plate dinner for the local Democratic congresswoman who was running for re-election. In the car my cousin explained that this congresswoman voted for every green issue regardless of how silly it was, and by giving a few thousand dollars to her, and tens of thousands to our President’s reelection campaign, this gen- tleman would remain ridiculously rich, providing services that no one would ever use without government fiats. Let’s see, Bush favored the big oil companies, so I and any regu- lar citizen with a 401-k could buy oil stocks and retire well off. Obama favors green companies whose stocks are rapidly becoming totally worthless as they each enter bankruptcy, so if you buy in you will be broke. But I could always go on government assistance as 68.5 million Americans are receiving now, and benefit that way.

Nope, my Lebanese grandfather would turn over in his grave. So I will just continue driving my Ford Flex, made by a compa- ny that did not take a government bailout, and a car that gets 25 mpg on the highway while loaded with seven people and their bag- gage, and that an F150 truck would bounce off upon running into me in an accident. It goes like a bat out of hell, and will stop on a dime and give you nine cents change. Give the Ford engineers time and keep the government off their backs, and they will build a 355 hp car that will get more than 30 mpg, or more; that’s American ingenuity. I looked longingly up from my coffee and across the street to where a customer in Dunkin Doughnuts was getting his third free coffee refill.

I got up and left, saying, “Bon giorno” to the perplexed barista.

Partisan dysfunction and tools for change

By Dr. David Ruben

Our legal and legislative processes are designed for adversarial combat, to respectively find justice and solve problems. Neither works very well. An attorney friend of mine, who has more than 50 years’ experi- ence as a prosecutor, judge and plaintiff’s advocate, estimates that about 30 out of his last 100 cases had a “just” outcome. He says that years ago, when judges were elected rather than appointed, about 70 out of 100 received a fair shake. He believes that at least in workman’s compensation, the insurance industry biases the pro- cess to its benefit. Accountability is part of the issue. Other factors that affect legal outcomes include lack of compe- tent and interested jury members, most of them being very young or very old. The most productive members of society seem to have little interest and find a way out of serving. Training and ethos of attorneys is also an issue. Law students are taught to fight to win, no matter the cost. Truth, fairness, and jus- tice are often secondary in courtroom combat. A judge, who also had worked as a defense attorney, said he stopped being a prosecu- tor when he realized his bosses expected him to win all his cases or he would lose his job. The cause of being the victor has also overtaken the process of reaching effective and workable political solutions. Being right has become more important than working together for the best out- come. Democrats and Republicans are like parents fighting over how to raise the kids, and the kids are miserable. Like the dysfunc- tional family, the country is suffering. Productive approaches in these any of these areas may give us clues as to what to do in others. At least in theory, solutions are un- der control of the people they affect. Some of us join up as soldiers on one side or the other; some of the rest of us throw up our hands in despair over situations we see as too corrupt or out of our power to enable us to affect change. Although some say we have the “best” of the “worst” legal system in the world, we might consider how other countries do things in seeking ideas that might work here. We might ask questions like, “Why do insurance/financial interests dominate what happens in my friend’s cases?” We might ask about the influence of private capital and open the marketplace in our society and lives. The Occupy Wall Street movement informs us that at least some people feel that some- thing is wrong. It asks, “Does the evolution of our economy set up inequities that dictate that few of us will be able to get a fair shake?” Though we might also consider that our government is the “best” mankind has ever wrought, we might look to other countries for examples of processes we might add to our own. We might question whether an adversarial two-party system is the best way to govern, even while worrying that we might be called “communists” or worse for just mulling the idea over. We might ask if we want the leadership of legislative committees based on experience and com- petence, or on how much money they can raise for their party? Also, do we really want to gauge how a candidate is doing based on media’s daily reports of how many millions have been raised? If we want to address these and other concerns, the bottom line ques- tions are, do we have the interest and will to make changes through our democratic processes and principles? I was dismayed at the Arizona Democratic Party’s recent conven- tion. It was like a high school pep rally. “First and Ten, Do it Again.” If we make more touchdowns, so what? Is so much animosity built up

with the other side that little can be accomplished? The Roman Colise- um is the model for the modern NFL stadium. Everyone in Rome had a seat, slaves included. There was a reason for that; bloodshed was seen as a necessary factor for crowd control. The emperors promoted the crowd’s distraction from thoughts and actions that would improve their lot, including making the changes that the rulers might oppose.

including making the changes that the rulers might oppose. Is the Coliseum now the electoral process

Is the Coliseum now the electoral process in providing the blood and gore that will remove our attention from what we know is not working? What would happen if there were a prolonged NFL strike and at the same time billions were not spent on our political candi- dates attacking one another for our viewing pleasure? Finding some- one to fight or flee from; hoping that someone will come and save the day, or being lost in our own or another’s drama are some of the ways we avoid a rational analysis of our problems and possible solu- tions. Is the current disrespect in the legislature a smokescreen to distract us from doing the talking, contemplating, and acting on what we need to do to address important issues in our lives? One man asked me, “How do you propose to get legislators to

man asked me, “How do you propose to get legislators to work together?” I said we

work together?” I said we could include voters in every bipartisan discussion. Making it more public may help elected leaders act more responsibly. This might be effective if:

Our public involvement is less for entertainment than for seeing good ideas tried out and evaluated. If we were there to achieve common goals. And if we realize that we are all in this together, and that not finding solutions will have serious consequences.

A family and organizational intervention would proceed this

way. First, include as many interested stakeholders as possible, and define and establish the setting: who is to be there and how the meeting is to be conducted. Second, come to an agreement that ev- eryone is part of the problem and would participate in the solution. Third, create models of what to do, try them out, evaluate the out- come, and continue them or do something else if they are not working. There are not any winners or losers. Everyone is in it to- gether. The win is when things work out better for everyone. The family is a proud bunch. They usually solve their problems without outside help. It is only when things are bad enough that they can be dragged in. Things are bad enough. Our defenses, ra- tionalizations, and traditions of tribal warfare and loyalty pale against the problems we face. Mankind has always had winners and losers. It is part of our psy- chology and nature. It has been apparent for some time that if our species does not figure out new ways to solve problems rather than one group or country dominating another, we will not climb much higher on our family tree. The problems of environment, warfare, and class inequities are going to get us. We have learned that we

cannot change others. The first area that we can change is ourselves.

If we think the other side is “nuts” and tell them so, it does not

go far to getting them to work with us for solutions that we can all live with. Ideology and believing one is right are just as useless as seeing others as wrong. In those cases, if you win, you lose. We have learned from being with our spouses that many people think differ- ently and will never agree, but can both get along and do productive work together. My spouse often reminds me, “Do you want to be right, or happy?” How it is in our personal lives may tell us some- thing about how it needs to be in our political and legal lives as well. My lawyer friends now say that things are so unfair in court that they never go, and always settle the case. Maybe that is another clue we need. We have seen the lawyers argue in courtroom, and then have an amiable lunch together at the break. Relationships must again become more important than who is right. Getting along and finding common ground, fairness, and just solutions must become more important than collecting more votes.

We’re the ones who have control over that. Dr. David Ruben is a psychiatrist and pain and addiction specialist. He is running for U.S. Senate in the Democratic Party primary election. See drrubenforussenate.com. E-mail: meds2016@aol.com.

See drrubenforussenate.com. E-mail: meds2016@aol.com. MEMbERS’ ClaSSifiEDS

MEMbERS’ ClaSSifiEDS

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To advertise in Sombrero classifieds, call Bill Fearneyhough, 795-7985.

OFFICE TO SHARE: We are currently looking for a fourth office mate in a furnished 4 office building. Each practitioner is independent - this is not a group. Drs. Marla Reckart and Lawrence Cronin are psychiatrists with psychologist Mike Vickroy PhD in the Santa Cruz Medical Offices building, 7333 Tanque Verde across from Udall Park behind Zona 78. Rent is $1150 per month and includes virtually everything - janitor, rental taxes, utilities, waiting room (furnished), kitchen, alarm, parking, copier and phones. Staffing is negotiable and not even necessary for many styles of practice. We can refer a substantial number of people continuously due simply to convenience. We can supply some or all reception services for additional money and we have an exceptional billing company affiliated with us for ten years, but this does not need to be part of the arrangement. There is room to bring your own receptionist. We can also fully furnish the individual office for no additional cost. The office is easily found and accessed. The building is only 2 years old and all the “new building bugs” are worked out. It’s solar powered! Parking is plentiful. Staff is excellent. Collections are superb. This does not have to be a mental health clinician, but is ideal for one. Interested parties contact Dr. Larry Cronin at 975 8520. (5-12)

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