November 2001 • POST-ASSEMBLY EDITION
Make the case for primary care, Assembly keynoter tells FPs
BY DENNIS CONNAUGHTON
Uwe Reinhardt, Ph.D. "Managed care is dead -- killed not by lawyers, politicians or the insurance industry, but by the booming economy of the 1990s, economist Uwe Reinhardt, Ph.D., said in his keynote address at the AAFP Scientific Assembly held Oct. 3 7 in Atlanta.
Reinhardt described a vision of the future with a multi-tiered system of care, in which the uninsured have to beg for health care and the super-rich can afford to have their own physicians on call 24 hours a day.
"The Congress of the United States likes this tiered system now," he said. "If you don't like this system, you should tell Con-gress in unvarnished language, 'That's not the American way.'"
A RECESSION TOOL
Reinhardt, the James Madison Professor of Political Economy and professor of economics and public affairs at Princeton University in Princeton, N.J., said the era of managed care ran from 1992 to 1997. "The economic boom time of the '90s did it in," he said. "Managed care is basically a recession tool. Health insurance is part of the labor contract. As long as health insurance is part of a contract employers use in the labor market, employers will fight cost increases." However, in boom times, employers are not as aggressive at fighting costs.
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From 1998 to the present, health care economics has shifted into a new paradigm that presents a number of challenges, he said. The number one challenge is the renewal of an explosion in health care costs in an economy that is moving toward or in a recession.
CASE FOR PRIMARY CARE
In response to this challenge, Reinhardt urged those in the audience to make a business case for primary care: "Every one of you knows and research shows that primary care can avoid unnecessary hospitalization of patients and save costs. Why Congress doesn't get this, I don't know."
Another challenge facing health care today is a growing shortage of nonphysician health workers and a possible shortage of physicians. Under the laws of supply and demand, with shortages, health care costs will go up, he said. The aging of the U.S. population is another factor driving up the cost of health care.
The problem of 40 million or more uninsured Americans also challenges the system.
Cost to solve this problem? About $100 billion each year, said Reinhardt.
He noted that after the terrorist attacks of Sept. 11, Americans have rediscovered nationhood and the responsibility of all citizens to help one another. "Insurance coverage for the uninsured must be mandatory," Reinhardt proclaimed to the applause of attendees. He proposed a combination of public and private insurance to meet the challenge.
Health coverage for all -- it can happen, and here's how
BY JANE STOEVER
"For the $600 tax refund many of us just got, we could have made sure all Americans got covered for basic health care," says Richard Roberts, M.D., J.D. The AAFP Congress of Delegates adopted a sweeping proposal, "Assuring Health Care Coverage for All," during the delegates' meeting Oct. 1 3 in Atlanta.
The plan would build from public and private funding and would cover everyone in the United States, including undocumented aliens.
(Then) AAFP President Richard Roberts, M.D., J.D., of Madison, Wis., countered the notion that the current health care system is almost completely a private instead of public system. He said, "Over 45 percent of our health care spending now is by the government. Do you want to eliminate Medicare? Medicaid? Military coverage? Veterans' health care?"
Providing the benefits under the plan would cost an estimated $52.8 billion more than current health spending. "For the $600 tax refund many of us just got in the mail, we could have made sure all Americans got covered for basic health care," said Roberts at a town hall meeting.
"We have our nation's defense provided through taxes. Education K through 12 is assured," said (then) AAFP Board Chair Bruce Bagley, M.D., of Albany, N.Y. "Coming after all the rest of the developed countries, it's about time for this society to say all its citizens should have access to health care."
After extended debate at the town hall meeting and during the Congress, the delegates adopted the proposal 72 50.
ELEMENTS OF THE PLAN
Under the plan, all U.S. residents would receive basic benefits, some with no copay (such as maternity care and periodic evaluations) and some outpatient services with a 20 percent copay (such as office visits and ER services). The plan would protect people from extraordinary costs by capping out-of-pocket expenses.
The plan retains the current insurance market; requires a national tax, such as a sales tax, value-added tax, payroll tax, or tobacco or alcohol tax; and calls for Congress to pass a law assuring basic health care for all.
A 1999 2000 AAFP task force wrote the forerunner of the plan. Last year, delegates called for widespread dissemination of the plan to seek reactions to it. Some 1,200 responses later -- from individual FPs, chapters and other groups -- the Board revised the plan and asked for its adoption.
Delegate Daniel Derksen, M.D., of Albuquerque, N.M., said, "For a 5 percent increase in cost, you get 17 percent of the people insured," referring to the more than 40 million uninsured Americans. "All of us see patients who are uninsured. Most of us see from 10 to 20 cents on the dollar for these people. This plan might help us."
CHALLENGES AHEAD
Some delegates zeroed in on the difficulties of getting the plan into the public arena and to the U.S. Congress.
Joseph Leming, M.D., of Colonial Heights, Va., the Virginia AFP
president, said the groups the Academy would need to do battle with were the ones to make alliances with before going to the U.S. Congress: the American Hospital Association, the U.S. Chamber of Commerce, the Farm Bureau.AAFP Past President Neil Brooks, M.D., of Vernon, Conn., said he spoke for universal health care but not the proposal. "I rise with a heavy heart to oppose this plan," said Brooks. "What we propose now comes at a cost that's not affordable, and it puts us in opposition to others in medicine at a time when we're trying to promote unity."
Some delegates feared members might misunderstand the plan. "Back home, perception is reality," said Jeffrey Akerson, M.D., of Sidney, Neb. "They'll see the headlines. The plan will be interpreted by the silent majority as socialized medicine, an intervention into their practices."
Akerson and many others advocated filing the report that contains the plan and continuing to use the report and embrace its principles.
Instead, delegates adopted the plan "with reservation," urging the Board to build consensus on the document among AAFP members.
The delegates earned thanks from AAFP Past President Lanny Copeland, M.D., of Frisco, Texas, chair of the 1999 2000 task force. "As family physicians, we're rebels, standard bearers," said Copeland. "The uninsured may be poor. They may be my son. They may be your brother. They may be illegal aliens. Because you adopted this plan, we'll be stronger in this country, and we'll serve our patients the best we know how."
The Academy will communicate the plan to members and dialogue with them and other groups about the plan.
After the delegates voted, Roberts said he'd been quiet during the lengthy debate on the floor of the Congress. "I was listening," said Roberts. "That's what we on the Board will continue to do -- listen to you, listen to our members. You've given us a direction, and we will follow it."
Family physicians critical to giving 'education, reassurance and presence,' says Assembly bioterrorism lecturer
BY CINDY MCCANSE
"My children and your children, and you and I, and our families and our communities have all become potential targets for terrorists," warned Jonathan Temte, M.D., Ph.D., during a special bio-terrorism presentation at the Scientific Assembly in Atlanta.
Jonathan Temte, M.D., Ph.D.Temte, assistant professor in the family medicine department at the University of Wisconsin, Madison, and infectious disease researcher, addressed more than 1,000 people at the Oct. 6 session. Since the events of Sept. 11, he noted, "What used to be in the imagination of authors is now front-page news."
In light of this all-too-real threat, family physicians must know what to look for. (For Temte's listing of the CDC's top bioterrorism candidates, go to http://www.aafp.org/fpr/assembly/saturday/1.html.)
But even when you know what you're looking for, that doesn't guarantee you'll know when you're looking at it, Temte added, reading off the symptoms that characterize the initial clinical presentation of inhalational anthrax.
"Fever, cough, myalgia and malaise. Now how many patients do you have in your practice who present with those symptoms?" he asked. The same holds for the first signs and symptoms of smallpox, Temte went on. "In my practice, this looks like any number of rash illnesses."
From that point, however, patients with these illnesses take a rapid and drastic downturn. For patients with some of these diseases, little is available in the way of treatment.
For example, only a single investigational drug -- cidofovir -- exists to treat smallpox, said Temte. Anthrax vaccine and antibiotic therapy may be of benefit in patients exposed to Bacillus anthracis -- the bacterium that causes anthrax -- but only if administered promptly after exposure. After that, only supportive measures are available to manage the disease.
So, how to avoid these illnesses in the first place? What preventive measures are available? Again, the answers aren't always reassuring.
Given that the World Health Organization declared smallpox to have been eradicated in 1980, production of the vaccinia vaccine against it was curtailed long ago and has only recently begun again. Clinical trials on the new vaccine aren't scheduled to begin until next year, and the timing of delivery of the initial shipment ordered by the U.S. government remains uncertain. At present, only 14 million doses of the older vaccine remain frozen in storage.
Anthrax vaccine availability is also deemed inadequate to deal with a significant bioterroristic event, although release of additional doses could come as soon as next year.
The real answer, said Temte, is to encourage vigilance among physicians in the community. "Look for things out of season," he said, "influenza, for example, in July." Look, too, he said, for things out of context, out of sequence, out of range.
Another key role for FPs, according to Temte, will be establishing and maintaining contact with public health officials. "We need to know what their perspective is, and they need to know what ours is," he said. He advised family physicians to form interactive partnerships with public health agencies to enable development and easy dissemination of treatment protocols.
But perhaps most critical for family physicians is to realize that there are significant psychosocial consequences that would accompany any biological attack: "Bioterrorism response isn't entirely limited to an infectious threat," Temte said. "This is where we need to be out there giving education, reassurance and presence."
Working smarter just got easier
Sure, the latest electronic wizardry can streamline routine office tasks, but don't forget the basics, said practice redesign guru Charles Kilo, M.D., M.P.H., at Assembly.
To read more about revamping your office systems and giving your patients more bang for their buck, see "Practice 2010 Can Accelerate Change in Your Office".
O. Dan Smith, M.D., of Idaho Falls, Idaho, gets the hang of using a personal digital assistant at this year's Scientific Assembly in Atlanta.
AAFP leaders, Congress urge new roles for FPs -- both at home and abroad
There's no arguing with the obvious, said AAFP leaders during this year's Congress of Delegates Oct. 1 3 in Atlanta: It's a new world out there, and the roles of family physicians must evolve accordingly.
"The rules have all changed," said (then) President Richard Roberts, M.D., J.D., of Madison, Wis., in his opening address to the Congress. "The unimaginable can happen; adversaries can become allies. Great things are possible so long as we are not afraid to step forward into the world and invest in our future."
Following the terrorist attacks of Sept. 11, family doctors and others from around the world sent letters of condolence to the Academy. "The emotions they (the messages) express convince me that our hurt is a global hurt," said Roberts. "They reinforce my belief that we Americans must be even more engaged in the world community."
He recommended that AAFP develop a comprehensive strategy for international activities -- a proposal that received the delegates' full blessing. Accordingly, the Academy will examine the feasibility of establishing a Committee on International Programs and will coordinate and communicate to members international opportunities for clinical care, research and training.
In his opening remarks, (then) President-elect Warren Jones, M.D., of Ridgeland, Miss., considered the issue from a perspective a little closer to home. The United States is not immune to a terrorist attack with chemical or biological weapons, he said, and the nation's FPs must know how to respond.
"We can no longer exclude ourselves from this process," said Jones. "Family physicians must be involved not only in the execution of community-based, mass casualty disaster response, but in chemical and biological agent surveillance planning."
The AAFP Web site provides links to numerous resources on biochemical terrorism and disaster preparedness, including CME opportunities and a CDC health advisory. Go to http://www.aafp.org/resources/ to view that listing.
A new listserv offers Academy members an opportunity to share information and resources on bioterrorism and related issues. To sign up, go to http://www.aafp.org/members/ lyris , click on the link for the bioterrorism list, and follow the instructions.
Jones recommended a three-pronged approach, which the Congress referred to the board:
- Collaborate with other family medicine organizations to develop a core set of knowledge, skill and ability levels for FPs in casualty management, disaster response and bio-chemical exposure surveillance.
- Encourage ongoing inclusion of these elements into family practice residency curricula and CME activities.
- Work with constituent chapters and other agencies to develop roles for FPs in disaster response plans.
A key component of fostering FPs' ability to respond to bioterrorism will be CME programming to familiarize them with the likely causative agents and treatment options. Delegates called for just that by adopting a resolution that directs AAFP to "develop and dispense accurate, timely and current information to prepare family physicians for dealing with known and potential terrorist attacks."
In addition, a Board report filed by the Congress outlines both short- and long-term
strategies to bring AAFP members up to speed on bioterrorism and to give them a voice in national policy-making and planning processes:
- Connect FPs on medicine's "front lines" with agencies already addressing this issue.
- Contact the AMA to explore opportunities for information resource-sharing.
- Distribute a needs assessment survey to 1,000 randomly selected AAFP members to determine how to proceed in the long term, with results going to the Board by January 2002.
Practice 2010 can accelerate change in your office
BY TONI LAPP
Although his main-stage "Practice 2010" lecture at Assembly was subtitled "A Revolution in Office-based Care," it is revitalization -- not revolution -- that is needed, said Charles Kilo, M.D., M.P.H.
At any rate, changes are in the works. Consumers, especially baby boomers and Genera-tion Xers, are just beginning to exert their influence, and they want change, he said. "They are activated, engaged and intolerant to paternalism."
The current system's flaws run deep, to the very core, Kilo said. "We are trained to focus on the individual and not on systems. To change, we must focus on systems."
Practice 2010 was designed to accelerate the change, said Kilo, director of the Idealized Design in Clinical Office Practice program of the Institute for Healthcare Improvement. His lecture was complemented by presentations on implementing specific Practice 2010 concepts such as quality improvement and open-access appointment scheduling (see stories at http://www.aafp.org/fpr/assembly/friday/1.html#2 and http://www.aafp.org/fpr/assembly/friday/1.html#3).
The idea is that by the year 2010, family practice will look very different from the way it looks today. But given what's known now, family physicians don't have to wait, Kilo said.
"Health care today is a jumble of Band-Aids ®, and no one knows what's at the core," he said. He suggested peeling away the Band-Aids to get to the solution.
Patients are frustrated; they wait on hold to set an appointment to see their doctor but are told the doctor is booked for weeks. Physicians are feeling dejected and overly managed by managed care. And clinical outcomes are worse than they should be.
With satisfaction over health care at an all-time low, there's never been more incentive to change, said Kilo.
He advised focusing on relationships and knowledge.
Don't just know your patients by name -- know how to pronounce their names, he said, showing an electronic record with the phonetic pronunciation of a patient's name.
When it comes to knowledge, learn to manage the vast amounts of it. Too often, standards of care aren't used, he said. Treatment for conditions as simple as sore throats vary from practice to practice.
He urged participants to evaluate their own methods of applying knowledge, admonishing that "collecting data and managing knowledge are two different things." In his practice, he has organized a chronic disease registry so he can identify his patients according to their conditions. This way, he can follow their progress and evaluate his treatment methods.
Go to the Practice 2010 Web site, http://www.aafp.org/quality/, and click on "Practice 2010 Project" for new resources, such as materials on practice measurement and using e-mail with patients.
2001 - 2002 AAFP Board of Directors
President President-elect Board Chair Speaker Vice Speaker Executive Vice President
Warren jones, M.D. Ridgeland,
Miss.
James Martin, M.D.
San Antonio
Richard Roberts, M.D., J.D.
Madison, Wis.
Michael Fleming, M.D.
Shreveport, La.
Carolyn Lopez, M.D.
Chicago
Douglas Henley, M.D.
Leawood, Kan.Directors
Karla Birkholz, M.D.
Phoenix
Burton Dibble, M.D.
Exeter, N.H.
Daniel Van Durme, M.D.
Tampa, Fla.
Nancy Wilson, M.D
Loveland, Colo.
Mary Frank, M.D
Mill Valley, Calif.
Richard Wherry, M.D., M.D
Dahlonega, Ga.Directors Resident Director Student Director
Arlene Brown, M.D
Ruidoso, N.M.
Larry Fields, M.D
Ashland, Ky.
Daniel Heinemann, M.D.
Canton, S.D.
English Gonzalez, M.D., M.P.H.
Silver Springs, Md.
Jaime Hartung
Rootstown, Ohio
President-elect James Martin, M.D., tops list of election winners
The Congress of Delegates chose James Martin, M.D., of San Antonio as the Academy's new president-elect. The delegates re-elected Speaker Michael Fleming, M.D., of Shreveport, La., and Vice Speaker Carolyn Lopez, M.D., of Chicago.
The new directors for the AAFP Board are Arlene Brown, M.D., of Ruidoso, N.M.; Larry Fields, M.D., of Ashland, Ky.; and Daniel Heinemann, M.D., of Canton, S.D. The new resident Board member is English González, M.D., M.P.H., of Silver Spring, Md. Jaime Hartung of Rootstown, Ohio, is the student member of the Board.
The delegates also selected three finalists as candidates for the Academy position on the board of directors of the American Board of Family Practice: Ted Epperly, M.D., of Boise, Idaho (USAFP); Karen Mitchell, M.D., of Southfield, Mich.; and George Shannon, M.D., of Columbus, Ga. The ABFP board will elect one of the three candidates this spring.
The Congress elected these delegates from the AAFP to the AMA: Larry Anderson, M.D., of Wellington, Kan.; David Avery, M.D., of Vienna, W.Va.; Robert Bosl, M.D., of Starbuck, Minn.; Glen Johnson, M.D., of Houston; Joseph Lieberman, M.D., of Wilmington, Del.; and Dale Moquist, M.D., of Bryan, Texas. Elected as alternate delegates to the AMA were Darlene Lawrence, M.D., of Washington; Glenn Loomis, M.D., of Fishers, Ind.; and Colette Willins, M.D., of Westlake, Ohio.
Academy bestows awards
During the AAFP Annual Assembly, the following awards were presented:
- Honorary Membership -- the AAFP's highest honor -- professor Julio Ceitlin of Buenos Aires, Argentina; and professor Wesley Fabb of Melbourne, Australia
- Awards of Merit -- Roger Sherwood, executive director, Society of Teachers of Family Medicine; Ann Kane, C.A.E., executive vice president, New Mexico AFP; and Jean Larson, executive director, Missouri AFP
- Exemplary Teaching Awards -- Edward Bope, M.D., of Columbus, Ohio (full-time); Francesca Taylor, M.D., of Los Angeles (part-time); and Terry Lowe, M.D., of Hattiesburg, Miss., and Charles O'Donnell, D.O., of Wichita, Kan. (volunteers)
- Family Physician of the Year -- Cathy Baldwin-Johnson, M.D., of Wasilla, Alaska
- Humanitarian Awards -- Alain Montegut, M.D., of Portland, Maine; and Daniel Ostergaard, M.D., AAFP vice president for international and interprofessional activities
- John G. Walsh Award -- Robert Higgins, M.D., of Anacortes, Wash.
- Thomas W. Johnson Award -- William Jacott, M.D., of Minneapolis
- President's Awards -- Sanford Bloom, M.D., of Santa Barbara, Calif.; Linda Farley, M.D., of Verona, Wis.; and Cynthia Haq, M.D., of Madison, Wis.
- Public Health Award -- Louis Kazal Jr., M.D., of Chevy Chase, Md.
- Robert Graham Family Physician Executive Award -- Brig. Gen. Kenneth Farmer Jr., M.D., of Tacoma, Wash.
Delegates take action on behalf of new FPs, IMGs, nurses
The Congress of Delegates ap-proved Bylaws amendments and asked for collaboration with nursing organizations.
President-elect Warren Jones, M.D., left, congratulates delegate Ashok Kumar, M.D., of Tyler, Texas, and alternate delegate Crystal Goveia, M.D., of Toledo, Ohio, the first IMG representatives to be seated in the Congress.New family physicians. Those in practice for up to seven years won their bid for a seat on the AAFP Board of Directors. Each year, the new physicians' constituency at the National Conference of Special Constituencies will elect a candidate for the Board, and the Congress will review the person's credentials before welcoming him or her to the Board.
International medical graduates. The IMGs now have a voice in the Congress, the Academy's highest decision-making body. Delegates testifying on behalf of the Bylaws amendment on slotted seats for IMGs said that between 11 percent and 15 percent of AAFP members are IMGs.
Nursing shortage. The AAFP Board will offer assistance to national nursing organizations in addressing the nursing shortage crisis.
Dale Moquist, M.D., of Bryan, Texas, vice chair of the AAFP delegation to the AMA, told delegates this sign of the times: At one hospital in Moquist's area, the director of nursing -- unable to find staff in this country -- went to the Philippines to recruit about 20 nurses.
Pronouncement of death by nurses. The Academy will work with the American Nurses' Association to establish model state legislation to permit a registered nurse to collaborate with a physician to pronounce a patient dead if the physician is not present.
The vote on this measure was 100 21, following heated debate. "When we're fighting scope of practice issues all over the country, we need to keep this responsibility with family physicians," said delegate George Shannon, M.D., of Columbus, Ga.
"Pennsylvania has this legislation," said alternate delegate Tom Weida, M.D., of Hershey, Pa. "The nurse pronounces the patient dead, and the doctor certifies the cause of death. The process works especially well when hospice is involved."
AAFP should act to avoid flu vaccine problem, says Congress
BY JANE STOEVER & TONI LAPP
L ate supplies, rising costs, uneven distribution problems: That's just the short list of flu vaccine issues the Congress of Delegates addressed Oct. 1 3 in Atlanta.
Dennis Saver, M.D., discusses his concerns about this year's flu vaccine supply with Barbara Paul, M.D., of the Centers for Medicare and Medicaid Services. "I'm a solo rural family physician, and after last year's debacle (with vaccines coming late to many physicians' offices), I got stuck with a lot of extra immunizations that I had to eat the cost of," said alternate delegate Maggie Blackburn, M.D., of Harpersfield, N.Y. Many of her patients were immunized at local stores before she could offer them the vaccine.
"This year, the companies are charging much, much more, and I have told my patients to go to Eckerd's, go to Kmart, go to Price Chopper, because I can't afford to be in this business," said Blackburn.
Vaccine wholesale prices went up by as much as 67 percent from last year to this year. In early September, the Centers for Medicare and Medicaid Services said it would reimburse $4.26 for each dose of the vaccine. By now, CMS has hiked the payment.
"The Medicare carriers in all but three states will be paying $7.12 or $7.13 per dose," Barbara Paul, M.D., medical adviser to CMS, said in reference committee testimony. "The agency has been working very closely with the CDC and the AMA and other physician associations on this issue, and we're very concerned about it. But we have updated the prices, and you should see that reflected in your payments."
Dennis Saver, M.D., of Vero Beach, Fla., the AAFP 2001 Family Physician of the Year, told delegates, "The circumstances of this price increase look very suspicious. There are now only two U.S. manufacturers. They have a vise grip on the supply, there is not a projected shortage, and the price is up. I think it needs to be investigated through legal mechanisms that have to do with anti-competitive practices and monopolistic practices."
Delegates urged the AAFP to:
- deliver the message to manufacturers and the public that mass immunization programs should be held only after physicians and health care facilities have been able to immunize patients at high risk;
- educate members about distribution and pricing variations so they can avoid taking a financial loss while providing a key clinical preventive service;
- work with AAFP chapters, AMA, state medical societies, CDC and local public health officials to develop coordinated community plans for distribution in the coming years;
- protest and challenge the unjustifiable price increases and the public health crisis they create; and
- investigate the causes of shortages of tetanus, flu and other vaccines and recommend ways to prevent future vaccine shortages.
Because of concerns over the delay of the flu vaccine this year, the Academy has approved a prioritization policy to ensure that high-risk patients are immunized first. The prioritization policy can be viewed at http://www.aafp.org/policy/camp/27.html.
Members put sites on Web
During last month's Assembly in Atlanta, 19 family physicians created new connections to their patients and to each other through personalized Web sites.
And, for the first time, they were offered the opportunity to add their sites' links to the physician Web directory at http://familydoctor.org, the Academy's consumer health information site.
These FPs were able to use the latest software and page designs AAFP offers to create their customized sites -- and you can, too.
AAFP members can create a site or directory listing by going to http://www.aafp.org and clicking on "My Academy" in the upper right-hand corner of the page.
AAFP Assembly, Atlanta-style!
Whether auctioneering or adjusting, excavating or exhibiting, joining hands or flinging them high in the air
-- there was no shortage of "goings-on" at the 53rd Annual Assembly in Atlanta.
Children participating in the "Youth Program" on Oct. 4 become "archeologists for a day" at an educational session at Atlanta's Michael C. Carlos Museum.
Outgoing President Richard Roberts, M.D., J.D., left, and incoming President Warren Jones, M.D., share a warm embrace as the Academy torch is passed.
A run through the Georgia Scorcher, a twisting roller coaster at Six Flags® Over Georgia, leaves riders with hands held high and broad smiles during this years Assembly Celebration.
"Do I hear $800? asks auctioneer and past AAFP President Neil Brooks, M.D., center, hawking an item at the AAFP Foundation Auction Oct. 6. "There's the bid! says Ross Black, M.D., right as Jerry Rogers, M.D., peers into the crowd of thousands. Black of Cuyahoga Falls, Ohio, and Rogers, of Moorhead, Minn., AAFP past directors, helped boost the night's tally to $46,000.
Canadian physician Bryant Litchfield, M.D., of Edmonton, Alberta, concentrates as he works on Karen Bruce, M.D., of Topeka, Kan., during a clinical procedures workshop on manipulative treatment.
Tar Wars® proponent and NASCAR driver John Baumgartner is a big hit at the exposition hall in the Georgia World Congress Center.
Slow Alzheimer's progress with new drugs
BY SHERI PORTER
Once you've made the diagnosis of Alzheimer's disease, it's time to get your patients started on new medications that can delay progression of their condition, advised Thomas Rosenthal, M.D., of Buffalo, N.Y., during an Oct. 3 Scientific Assembly clinical seminar.
The new medications all fall in the acetylcholinesterase inhibitor class of medicines. During the two-hour session, Rosenthal responded to questions about when to start these medications and when to stop them. He discussed side effects and cost. And Rosenthal readily acknowledged the shortcomings of the drugs.
The drugs are expensive and, at best, only temporarily delay the progression of the disease, said Rosenthal, who serves as professor and chair of the family practice department at the University of Buffalo. One potential adverse effect observed is reversion by the patient to a more agitated state.
Even so, these drugs may have a place in treatment."Death is a normal part of Alzheimer's disease," Rosenthal said. "But if you can delay institutionalization for six months, it (the drug) is probably cost-effective."
But physicians are balking at prescribing a costly medication -- $130 to $140 a month -- that offers so little benefit. "Should I be pushing these drugs harder?" asked a physician from the audience. "Maybe I don't know because I'm not convinced myself."
Rosenthal asked for a show of hands: How many in the room, he asked, have prescribed a cholinesterase inhibitor at least 20 times? Only six hands went up. "That's up from one or two hands that went up a year ago," said Rosenthal. "We're taking a measured approach to using these medications. We're learning they're not a cure-all."
Once you make the decision to prescribe a cholinesterase inhibitor, "you want to move slowly on these meds," said Rosenthal. He suggested that physicians increase the patient's dose every four to six weeks.
"With all of these medications, you want to start on a low dose and build up to get around the gastrointestinal problems," said Rosenthal.
He also suggested the medications be prescribed for nighttime usage since sleeping patients won't notice nausea, a common side effect.
Physicians should carefully monitor the patient's progress as the dosage is increased. "I go until the response is satisfactory to the family, and then I hold," said Rosenthal.
And when should treatment stop? Studies show that after nine to 15 months on a cholinesterase inhibitor, people with Alzheimer's disease begin to show a decline, said Rosenthal. He suggested using the patient's Folstein Mini-Mental State Examination score as a guide, continuing the medication until the patient scores lower than 12 points out of a possible 30 on the mental test.
Even as Rosenthal advises colleagues on the use of cholinesterase inhibitors, he's looking forward to better treatments for patients with Alzheimer's disease. "These drugs are not where we're going," he said. "I think in five years, we'll be looking at a different class of drugs."
"The future is in prevention," concluded Rosenthal. "In five years, we'll see pharmacological treatments that will block amyloid deposition. The challenge will then be to identify patients who are laying down amyloid deposits."
Which way family practice?
With the Future of Family Medicine project up for discussion, B. Toloria Braswell, M.D., of Suitland, Md., was among many participants who lined up to comment. Academy leaders held the meeting Oct. 3 to receive members' input on direction for the specialty.
Do total body scans have clinical value?
One ad reads, "What you don't know may be killing you." Another says, "It's easy, fast and painless. It's really fun."
These are not ads for a health lecture or an aerobic exercise program. Instead, they're campaigns promoting total body computed tomography scanning as a screening tool for disease.
"Are media hype and the profit motive getting ahead of the curve of what we know about the science of screening?" asked family physician Mark Needham, M.D., in his Oct. 5 lecture on total body scans at the Scientific Assembly. Needham, in private practice with the Santa Monica Bay Physicians in Santa Monica, Calif., talked about the proliferation of commercial centers dedicated to total body scans. He has a special interest in radiology and has been teaching family practice residents and family physicians about advanced imaging for several years.
The scanning centers, called "stores" in the industry, are slowly becoming popular additions to malls across the country because there's a lot of money to be made from them. Aging baby boomers are increasingly concerned about their health, and most Americans just love technology, Needham said.
But is there any clinical value to body scanning? Controlled, randomized trials are needed to answer that question definitively -- and some are now under way for various human organ systems. The currently available scientific evidence, however, shows mixed results.
Needham described what is known about the clinical value of electron-beam CT and spiral CT scanning in various organs and body areas.
- Brain. "There is no clinical benefit in asymptomatic people," he said. Magnetic resonance imaging and magnetic resonance angiography are better methods to detect potential problems in those patients, according to Needham.
- Lungs. Body scanning is a promising technique in lung cancer screening, Needham said, but it results in many false positives that require long-term follow-up studies. One of the major criticisms of total body scanning is that it generates additional studies for false positives that drive up the cost of health care, he added. Also, more invasive testing may create unnecessary risks for patients.
- Heart. CT scanning is useful in detecting coronary artery calcification, the hardened plaque that often underlies coronary artery disease. "I think CT body scanning has its greatest clinical utility in assessing the risk of coronary artery disease," Needham said. One drawback, however, is that it does not detect soft plaque, which can also cause coronary events, such as heart attacks, as it builds up in the arteries. Manufacturers are currently developing scanners that will detect soft plaque as well, he said.
- Bone.CT scanning is useful in determining bone density in the spine, Needham said, but there are better alternatives available, such as the dual energy X-ray absorptiometry test.
- Abdomen and pelvis. Body scans are not indicated in screening for disease in the abdomen and pelvis because they have a low yield and produce many false positives, Needham noted.
- Colon. Finally, Needham said, virtual CT colonoscopy is a promising technique, compared with conventional colonoscopy, in detecting larger polyps. "In fact, conventional colonoscopy fails to reach the cecum 5 percent of the time, so virtual colonoscopy may actually be superior," he said.
Delegates take up patient care issues
Delegates and others attending the Congress of Delegates voiced their opinions on several resolutions dealing with aspects of patient care. Here's a sampling of what was decided:
Medicare regulations and teaching. Delegates stopped just shy of taking the U.S. Congress to task over legislative restrictions involving residents' and medical students' interaction with Medicare patients. At issue was the question of reimbursement for medical preceptors supervising delivery of care by residents and students. Discussion participants cited concerns that, if pressed too hard on the issue, Congress would rescind the primary care training supervision exception now included in Medicare regulations.
The delegates did, however, charge AAFP with studying the effects of those regulations on residents, students and their preceptors.
As the system stands now, said Student Member Constituency alternate delegate Marc Carey of Portland, Ore., "I'm actually a hindrance to my preceptors."
The Academy will also offer advice and consultation to federal agencies on matters affecting the teaching of residents and students in family medicine.
Colonoscopy privileges. Not surprisingly, the issue of privileging drew extensive and impassioned testimony during reference committee hearings. Bypassing the quagmire of setting what many participants termed arbitrary numeric determinants of privileging eligibility, delegates directed AAFP to develop a strategy to ensure that "family physicians with training, experience and competency obtain privileges in colonoscopy and colonoscopic polypectomies."
Cultural and linguistic proficiency. Cultural competency proved to be a less contentious issue, with delegates directing the Academy to support implementation of cultural proficiency training in family medicine residency curricula.
Physician gifts draw HHS scrutiny
Tucked in amidst other action items in the HHS Office of Inspector General's work plan for fiscal year 2002 is an innocuous-appearing item announcing that OIG officials intend to "evaluate the extent of gifts and payments to physicians from pharmaceutical companies."
"We just wanted to get a sense of what's going on right now," said HHS/OIG spokesperson Katherine Harris.
Citing the nearly $12 billion spent annually on pharmaceutical marketing to physicians, the HHS document notes, "Some of these gifts may present an inherent conflict of interest between the legitimate business goals of manufacturers and the ethical obligation of providers to prescribe drugs in the most rational way."
AAFP has already taken decisive steps to address this and related issues through its creation of the "Principles for Cooperation" initiative, a voluntary agreement between the Academy and 16 pharmaceutical firms in which all parties pledge to honor the AMA Council on Ethical and Judicial Affairs guidelines on gifts to physicians from industry.
Further information about this initiative can be found at http://www.aafp.org/cooperation on AAFP's Web site.
The OIG work plan notes, "Gifts may also violate the Federal anti-kickback statute if they are intended to induce referrals," a reference to the AMA guidelines stipulation that there must be "no strings attached" to gifts given to physicians.
"We want to see how well those sort of regulations and guidelines are being followed," Harris said. "The system has made a lot of people upset. We believe there are a lot of people who want to talk about this."
Although work on the OIG investigations has not yet begun, it could soon, given that the federal fiscal year runs from Oct. 1 through Sept. 30.
Past investigations, Harris noted, have included activities ranging from visits to physicians' offices to reviews of financial records, although she could not speculate about precisely what tack would be taken in this series of investigations.
Once the investigations are completed, results will be posted on the HHS/OIG Web site at http://www.os.dhhs.gov/oig/.
Family Physicians must protect abused chilgren, says 2002 FP of the Year
BY JODY McAULAY GLOOR
Family physicians have the power to protect abused children from the terror in their own homes, said AAFP's 2002 Family Physician of the Year, Cathy Baldwin-Johnson, M.D., at the Annual Assembly in Atlanta.
In her impassioned Oct. 1 acceptance speech before the Academy's Congress of Delegates, the Wasilla, Alaska, FP urged her colleagues to begin the fight against child abuse with "one child, one family at a time."
"Child maltreatment may be a vast and multi-layered problem, but this group has incredible power to make change," she said, because FPs see what's going on in the entire family. "We start with education. We can learn to make the diagnosis. We can learn how to intervene. And we should always be working toward prevention."
Baldwin-Johnson's commitment to end child abuse was sparked in 1994 when she volunteered to train for and perform sexual and physical abuse exams in her growing Alaskan community.
She headed to the "Lower 48" for training with the idea that "I'd just be doing a little of this," she said. But when she came home, "the floodgates opened."
Cathy Baldwin-Johnson, M.D., examines the ankle of Weston Patrick in her Wasilla, Alaska, office. Patient Lauren Patrick says "Aaah" during a routine visit. Baldwin-Johnson checks over one of her newest patients, Blake Pfifer. Word spread about her training, and Baldwin-Johnson said she quickly was labeled the region's "expert" in child and adult sexual abuse assessment. Her phone began ringing off the wall with requests for help from area police departments, other physicians, social services agencies and hospital emergency rooms.
So she helped form a Sexual Assault Response Team for the Matanuska Susitna Borough in which she lives and practices family medicine. Yet it soon became clear that the team was being called on to deal mostly with adult victims. Baldwin-Johnson became concerned that children might be ill-served by a response process geared toward adults. That's because trips to the emergency room, law enforcement center and counseling center can create enormous stress for children, Baldwin-Johnson said.
Then she heard about the Children's Advocacy Center model in which abuse cases are processed using a child-focused approach. The model hinges on ensuring that young victims are not "revictimized" by the legal and medical processes designed to protect them. "They let the child stay in one place and not go through locked doors, a jail or interrogation rooms," Baldwin-Johnson said. Instead, legal and medical professionals come to the child.
Excited about the possibility of starting Alaska's second such center, Baldwin-Johnson spent countless hours recruiting supporters and volunteers. A little more than two years later, The Children's Place opened its doors. "It definitely was a community effort," said Baldwin-Johnson.
The center is now in its third year. Health care providers at The Children's Place videotape or photograph every victim interview and exam so a team of professionals can monitor the process. Most often the children are referred for mental health services, but the center also looks at their families' needs, such as insurance assistance, counseling, shelters or substance abuse centers.
Baldwin-Johnson spends at least half a day per week, some evenings and many weekends at the center performing medical exams, reviewing cases and consulting on other cases within Alaska. Also, she oversees projects and writes grant proposals. Yet she still runs a full-time family practice.
"Sometimes it's hard because I have to juggle so many things," she said. "But my husband and children are so supportive, and that helps."
Her husband, Rick Johnson, markets insurance to small businesses, which gives him "a lot of flexibility" to help care for their children Travis, 17, and Kristin, 14.
Baldwin-Johnson's dedication in starting The Children's Place "makes her extraordinary," said Karen Perdue, commissioner of the Alaska Department of Health and Social Services. That commitment also earned Baldwin-Johnson the Alaska First Lady's Volunteer of the Year Award in 1999 and the 2000 Family Physician of the Year award from the Alaska AFP.
Needless to say, Perdue added, "We do not hesitate to call on her for expert consultation."
ACF 2002: Cancer launches to much fanfare
Tamily physicians are once again out in front of the medical community -- this time working to improve care for what a representative from the American Cancer Society termed "the most feared disease" in the United States.
AAFP kicked off Annual Clinical Focus 2002: Cancer during this year's Scientific Assembly in Atlanta.
"Family physicians provide more care to patients with cancer than any other physicians," said (then) President Richard Roberts, M.D., J.D., of Madison, Wis., at a press conference Oct. 4.
Roberts was joined by ACF medical director Stephen Spann, M.D., of Houston, who explained that AAFP members would receive information throughout 2002 on all aspects of cancer care. An American Family Physician monograph, a Video CME program, patient education handouts and numerous CME activities -- including several presented at the Assembly -- are just part of the 2002 ACF fare.
The need for this type of initiative is great, said American Cancer Society senior medical consultant Lamar McGinnis, M.D. "We continually poll the American people, and we learn that cancer is the most feared disease," he noted during the press conference.
Also on hand at the official kickoff was Charmaine Cummings, Ph.D., R.N., acting director of the National Cancer Institute's Office of Education and Special Initiatives.
"Family physicians are really on the front line and have the best relationship with their patients," said Cummings. "They also are able to deal with the family issues."
Partnering with the AAFP to develop the 2002 ACF materials are the ACS, NCI, American Society of Clinical Oncology and National Human Genome Research Institute.
ACF 2002: Cancer is made possible through educational grants from Bristol-Myers Squibb Company, Pharmacia Corpora-tion and Novartis Pharmaceuti-cals Corporation.
Deadline nears for teaching award, grant proposal
Applications are now available for the 2002 Pfizer Teacher Development Awards, formerly called the Parke-Davis Teacher Development Awards. Application deadline for the awards, which recognize excellence in part-time teaching, is Jan. 15. For more information and an application form, contact Susie Morantz at smorantz@aafp.org or by calling (800)
274-2237, Ext. 4470.The Joint Grant Awards Program is accepting proposals for support of research in family practice/family medicine. Applications for the first review cycle of 2002 must be postmarked by Dec. 1. For more information and an application form, contact Morantz at the phone number or e-mail address shown above.
Childhood screenings keep pace with increasing patient diversity
BY JODY McAULAY GLOOR
When it comes to childhood growth and development screening, pick the screening program that best fits your practice and -- more important -- your patients, Jeffrey Quinlan, M.D., said Oct. 3 during a clinical seminar at the Scientific Assembly.
Those young patients are becoming increasingly diverse, he said. The result? The latest screening information is likely to be outdated soon, and much of the information you learned in medical school and residency is probably obsolete. In fact, Quinlan, associate director of the family practice residency at the Naval Hospital in Jacksonville, Fla., said he decided to teach this course in order to re-educate himself on the topic.
His research turned up many answers, plus new and revised growth charts and developmental screening tools for today's family physician.
Older growth charts focused on weight for age, height for age, head circumference for age and weight for height.
However, the CDC last year introduced the first major overhaul of growth charts in more than 20 years. Weight-for-age, height-for-age and head-circumference-for-age charts were revised. But the weight-for-height chart was tossed out and replaced with one indicating body mass index for age.
Even more helpful, Quinlan said, are new charts created by other organizations for genetically diverse populations. These new tools in-clude ethnicity-specific charts and syndrome- or disease-specific charts.
"Because I see military families in my practice, many of my patients are Filipino," he said. "And you can't use classic American growth charts for children who naturally may be shorter or weigh less."
What's more, technology has greatly increased access to these charts as well as curbed costs for them. In fact, many can be downloaded free from Web sites. (See box below for more information.)
When choosing a child's screening tool, always consider its reliability, validity, application and appropriateness, Quinlan said. Most often in family practice, he said, "that means it's got to be quick and easy to perform. But it also needs to be relatively inexpensive." This is especially true for comprehensive screening programs.
Some tests, such as the Denver Developmental II, take at least 30 minutes to administer, yet the Denver Prescreening Questionnaire (a shorter version of DDII) takes only 5 10 minutes to complete. Ages and Stages screenings take about 15 minutes to administer, he said, but now they are available in many languages such as Spanish, French, Mandarin Chinese, Russian and Arabic -- making them invaluable to family physicians who care for ethnically diverse patient populations.
Several comprehensive screens require physicians to buy expensive kits with dozens of parts, while others require only pencils, crayons and/or blocks. A little more than a year ago, Quinlan said, he was introduced to Bright Futures, a comprehensive program for children's health and development that was created with input from several organizations, including the AAFP.
"I've seen little knowledge of (Bright Futures) in the medical community so far, but I highly recommend it," Quinlan said. Information can be downloaded free from the program's Web site, offering a new, affordable way to get the tools to properly screen and diagnose young patients, he said. Go to http://www.brightfutures.org for more information.
Financial Summary
This financial summary has been prepared to present an overall picture of
AAFP's financial condition and operatons.
CONSOLIDATED STATEMENTS OF FINANCIAL POSITION May 31, 2001 May 31, 2000 Assets Cash and cash equivalents $3,946,507 $77,477,10 Receivables (net) 6,849,057 8,514,261 Income tax refund receivable 6,697,900 2,275,000 Interest receivable on income tax refund 6,848,661 -- Inventory of publication materials 81,039 109,266 Prepaid expenses and other assets 2,410,217 3,270,410 Marketable securities at fair value 38,762,996 38,840,809 Deferred tax asset 345,487 -- Property and equipment Land 5,781,848 5,781,848 Office buildings 30,609,715 29,785,415 Office equipment, furniture and fixtures 9,725,298 9,128,013 44,116,861 44,695,276 Less allowances for depreciation (6,664,997) (4,951,591) 39,451,864 39,743,685 Investments in deferred compensation plan at fair value 1,689,294 1,969,523 Total assets 107,083,022 102,470,664 Liabilities and Net Assets Liabilities and unearned revenues: Accounts payable $3,883,160 4,370,383 Accrued expenses and other liabilities 4,488,837 4662479 Unearned revenue 19,260,888 18,138,878 Mortgage note payable 22,554,192 23487400 Liability for deferred compensation plan 1,689,294 1,969,523 Income taxes payable 2,363,402 2,234,257 54,239,773 54,862,920 Net assets: Unrestricted 52,843,249 47,607,744 Total libilities and net assets $107,083,022 $102,470,664 CONSOLIDATED STATEMENTS OF ACTIVITIES Revenue Membership dues and fees $14,571,271 $14,074,193 Publications 1,891,763 21,379,880 Programs and miscellaneous 25,488,855 23,922,925 Investment income 1,312,188 4,753,091 60,344,077 64,130,089 Expenses Membership services and programs 37805864 33,069,641 Publications 12,516,731 12,880,494 General and administrative 16,075,999 14,885,357 Income taxes 953,658 1,440,186 60,344,077 62,275,678 Other income (Expense): Income tax refunds 4,426,593 28,029 Interest on income tax refunds 6,848,661 -- Net unrealized gains (losses) on marketable securities 968,426 (3,869,126) 12,243,680 (3,841,097) Change in net assets 5,235,505 (1,986,686) Net assets, beginning of year 47,607,744 49,594,430 Net assets, end of year $52,843,249 $47,607,744 The above data are only part of the complete financial statements examined by
PricewaterhouseCoopers LLP, certified public accountants.
New agents, therapies offer arthritis patients new hope
For decades, patients with "regular, garden-variety arthritis" believed their family physician could do nothing for them, and about 40 percent of them still believe their aches and pains can't be treated.
But today's increased understanding of this disease, paired with the introduction of new agents and therapies at a rapid rate, can provide many patients with renewed hope, said FP Cheryl Lambing, M.D., of Ventura, Calif.
Lambing presented "New Treatment Options for Arthritis" Oct. 3 as a Scientific Assembly mini-course. She is assistant clinical professor in the University of California at Los Angeles Department of Family Medicine, a faculty member of the family practice residency at Ventura County Medical Center and co-director of the rheumatology teaching clinic there.
Lambing believes there's never been a more important or exciting time to learn about arthritis. "As family physicians," she said, "we all need to be knowledgeable about the condition and the treatments -- including new and emerging agents."
Some of the more significant treatment advances address the needs of patients suffering from rheumatoid arthritis, the most prevalent type of arthritis, which affects more than 2 million people nationwide, Lambing said.
The old approach to treating RA would begin with extensive lab tests and X-rays. After the diagnosis, the physician would slowly introduce different agents and await results, concentrating on pain management. Today, Lambing said, "We've seen a huge therapeutic shift for most of these patients."
The traditional "pyramid approach" has been reversed to provide aggressive early intervention, thus slowing the disease and managing patients' pain, she says. "Now we know you can start an agent today. And we have lots of choices. In fact, combination therapy (using new and standard medications) has become the norm."
Methotrexate has been a standard pharmacologic treatment for RA patients for 20 years, she said, because 80 percent of patients using it for five years get good results when compared with patients who used earlier remedies such as gold salts. In fact, "every other agent is compared to methotrexate, because we have 20 years of experience with it," she said.
Generally, methotrexate is well tolerated. Originally a chemotherapy drug, it slows progression of the disease with only minor toxicity concerns, improving long-term outcomes, Lambing said.
Adding new nonsteroidal anti-inflammatory drugs, such as celecoxib and rofecoxib, and disease-modifying antirheumatic drugs, such as leflunomide, etanercept and infliximab, often brings quicker relief. For example, Lambing told of how she prescribed etanercept for a walker-dependent patient, and, two weeks later, the patient walked into her office without aid. "It's the only agent in 10 years that I've seen work that quickly," she said.
However, using these agents requires increased lab testing during treatment, Lambing added, to monitor for multiple toxicities and gastrointestinal problems. In addition, pain relief may plateau in some patients. "So you have to monitor the dosage and modify combinations," she said.
Remember that no long-term trial data are available for these newer drugs, Lambing said. And because of their popularity, production is backed up, so patients may have to wait weeks for their prescription.
Another key drawback is cost. Etanercept currently costs about $12,000 per year for the average dose, and infliximab, which is given intravenously, costs $9,000 per year for six infusions.
Granted, these new aggressive treatment options require increased patient assessments and diligent monitoring by the physician, Lambing said, but that very process "is always good for the patient."
Osteoarthritis landscape changes as well
Treatments for osteoarthritis have changed dramatically with the introduction of topical therapies and intra-articular injections that can manage a patient's pain quickly, said FP Cheryl Lambing, M.D., of Ventura, Calif. Lambing presented a Scientific Assembly mini-course on the topic (see above story).
For decades, she said, the American College of Rheumatology, Arthritis and Rheumatism recommended that osteoarthritis patients first concentrate on weight loss, physical and occupational therapy, aerobic exercise and walking aids. Pharmacologic treatment began with acetaminophen, followed by low-dose ibuprofen if needed. If the patient's response was still inadequate, alternative or higher-dose nonsteroidal anti-inflammatory drugs were tried.
Now, topical solutions, some including NSAIDs, offer quick relief. And injections deliver corticosteroids directly into the affected joint, Lambing said. However, corticosteroids may not be effective for at least four weeks, and "that's where viscosupplementation comes in," she said.
Viscosupplementation, which uses newer hyaluronic acid preparations, has been around since 1998 but still is not performed often by family physicians. One reason, said Lambing, is that currently it is approved only for one series of injections, in one joint, in one disease process. It can also be difficult to find training in the procedure.
Two viscosupplementation agents, hylan G-F 20 and sodium hyaluronate, are currently available. Treatment consists of injection of one of these drugs into the affected joint to replace the pathologic fluid. Often, patients report a chemical irritation in the joint, but it dissipates quickly, Lambing said.
All in all, said Lambing,"You should always consider it. The patient can feel relief two to three weeks after the injections, compared with four or more weeks with corticosteroids."
These Vietnamese children were beneficiaries of humanitarian aid delivered in February 2001 by a Physicians With Heart delegation. Ten Physicians With Heart airlifts since 1993 have provided products valued at more than $52.25 million wholesale to former Soviet republics and Vietnam.
Travel uncertainties force modification of Moldova airlift
The Physicians With Heart humanitarian airlift scheduled to depart for the Republic of Moldova on Oct. 11 was modified just days before the departure date, in light of (then) anticipated U.S. military action in Afghanistan.
"Instead of canceling the project, we have divided the product delivery and delegation/education components," said Daniel Ostergaard, M.D., AAFP vice president for international and interprofessional activities and a member of the Physicians With Heart executive committee.
All donated medicines will be delivered as scheduled by the U.S. State Department, said Ostergaard. Humanitarian items, including clothing, bedding, toiletries and school supplies collected for 140 orphans in the Sarrata Galbena Orphanage, will also be delivered as promised.
Staff members from Heart to Heart International will be in Moldova to oversee the distribution of products. The initial load valued at $7.7 million wholesale will arrive in October, and another shipment valued at $5.8 million wholesale may be delivered in late November. The previously arranged logistical system of transportation and delivery will be maintained.
"Depending on the world situation, we are looking at rescheduling the delegation's travel in February 2002," said Ostergaard. Medical education symposia, documentation of deliveries, and visits to health care sites and the orphanage will be conducted at that time. Ostergaard touted the upside to the modified Moldova schedule. "We will have a positive impact in Moldova twice," he said.
The Academy, the AAFP Foundation and Heart to Heart International, a humanitarian aid organization based in Olathe, Kan., are founding partners of Physicians With Heart.
Assembly participants generous at AAFP charity events
Maybe it was the effect of all that Southern hospitality in Atlanta. Or maybe it was the goodwill most people are feeling toward one another as the nation strives to recover from the Sept. 11 tragedies. Whatever the reason, Assembly-goers dug down deep to contribute to the Academy's philanthropic efforts.
The biggest surprise may have been the AAFP Foundation Auction on Oct. 6.
The event surpassed everyone's expectations, says Foundation Executive Vice President Sandra Panther. Attendance was excellent, far exceeding the original estimate of 3,000 guests.
Preliminary numbers indicate the event raised $46,000 from individual donations. This does not include a corporate donation from Aventis Pharmaceuticals that supported the auction. The final reconciliation will bring that figure much higher, said Panther.
The Foundation earmarked $5,000 from auction proceeds to go to the Disaster Relief Fund to help victims of the Sept. 11 attacks and their families. In addition, jars placed around the Georgia World Congress Center for the relief fund collected nearly $500.
Other groups at Assembly made efforts to help victims of the attacks. The Pfizer Medical Humanities Initiative gave away copies of the book The Best Medicine by Mike Magee, M.D., and Michael D'Antonio; a card was enclosed suggesting donations be made to the Disaster Relief Fund.
Twenty-nine exhibiting companies contributed to the Feed the Need effort, chipping in $7,250 in monetary donations as well as products such as baby food, infant formula, diapers, stuffed animals and children's books for the Atlanta Children's Shelter.
In addition, the Academy donated $2,000 to the Atlanta Children's Shelter. Sales from the FTN pins and T-shirts will be tallied soon and disbursed to both the Resident Repayment Program and the shelter.
But the giving didn't end there. Two signature walls in the exposition hall -- provided by Pharmacia Corporation and Novo Nordisk -- offered a dollar amount per signature, bringing in $15,000 for Foundation programs.
Finally, two charity golf tournaments were held at which about 80 golfers paid $150 to tee up. Proceeds of these events will benefit the AAFP Foundation and the Georgia AFP Foundation.
FP Report is published by the AAFP News Department.
Copyright © 2001 by American Academy of Family Physicians.
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