Archives for August 2017

By Rotimi Adesina, M.D. (third year pediatric resident), and June Elcock-Messam, M.D.

The national immunization program aimed at protecting children and adolescents from vaccine preventable diseases continues to be one of the most impressive examples of preventive medicine in the United States. Organizations that collaborate over this program include the Advisory Committee on Immunization Practices (ACIP), the Committee on Infectious Diseases of the American Academy of Pediatrics (AAP), the American Academy of Family Physicians (AAFP), and the American College of Obstetricians and Gynecologists (ACOG).

As breakthroughs continue to emerge within the fields of virology, immunology, and genetics, immunization guidelines are constantly being revised to stay up to date. You may have received a letter from your child’s school nurse or heard on the news that there are some changes to the vaccine requirements for school-aged children in the state of Pennsylvania that will go into effect in August 2017. If your child is not up to date on his or her immunizations according to these guidelines, your child may be excluded from school in September 2017. Currently, the vaccines listed below are needed for attendance in all grades.

Name of Vaccine Amount of doses needed to be considered up to date:

DTaP (tetanus, diphtheria, acellular pertussis) 4 doses, including one dose on or after 4 years old
IPV (Polio)… 4 doses, 1 dose on or after 4 years old
MMR (measles, mumps, rubella)… 2 doses
Hepatitis B… 3 doses
Varicella (chickenpox)… 2 doses or proof that child had the chickenpox

In addition to the above vaccines, for attendance in 7th grade your child must have two additional vaccines by the first day of school or risk exclusion.

Tdap (tetanus, diphtheria, acellular pertussis)… 1 dose
MCV (meningococcal conjugate vaccine)… 1 dose

For attendance in 12th grade, your child must have another dose of the MCV vaccine by the first day of school or risk exclusion.
MCV (meningococcal conjugate vaccine)… 1 dose

There are four scenarios that can occur when your child’s immunization history is reviewed by the school nurse:

• If your child has received all of the above recommended doses of vaccines, you are in compliance and do not need to take any further action.
• If your school-aged child is not up to date on his/her vaccines as listed above and is able to medically receive the recommended doses within the first five days of school, he or she MUST receive the needed vaccinations or risk being excluded from school.
• If your child is not in compliance but it is too early to vaccinate him or her with the next dose in a particular series, a “medical plan” – a red and white card– must be provided to the school within five days or risk exclusion from school. This red and white card has to be signed by your medical provider and should contain a plan to bring your child up to date with the immunizations. This card can be downloaded here.
  School officials will then monitor this plan to ensure compliance in a timely manner.
• If your child has a medical exemption or if you have a religious/philosophical issue, this information should be documented and provided to school officials.

If you have further questions about these changes, please contact your doctor immediately or call 1-877-PA-HEALTH. You can also google “28 pa.code ch.23 (school immunization)” to learn more about the Pennsylvania immunization requirements for attendance in school.

Some additional reputable immunization resources include:

The Children’s Hospital of Philadelphia (CHOP) Vaccine Education Center
The Centers for Disease Control and Prevention (CDC)
The Advisory Committee on Immunization Practices (ACIP)
The American Academy of Pediatrics (AAP) immunization guidelines
The American Academy of Family Practice (AAFP) immunization guidelines
The American College of Obstetricians and Gynecologists (ACOG)

Reprinted from the Delaware County Medical Society publication, Delaware County Medicine and Health, Summer 2017 issue

Read more content at dm.hoffmannpublishing.com

By Mian A. Jan, MD, FACC, FSAI
President of the Chester County Medical Society

I was reading TIME magazine recently and came across an article about the Supreme Court of the United States. Authors analyzed Supreme Court’s oral arguments from 2004 to 2015 and created a data set of all the interruptions by justices and advocates; data revealed female judges were much more frequently interrupted. Between 2011 and 2015 female judges were interrupted three times more as compared to male judges. I am not certain if that indicates a lack of respect for female judges but inference was that it does. It started me thinking that if there is a gender bias in the most respected group in the country, are we also guilty in medicine?

I recall that when my wife Amber started her practice about two decades ago, she would complain that when she walked into a patient’s room she was often asked if she was a nurse; although nursing is a most honorable profession, the fact is, that being a female puts you in a certain category. Although things have changed and it’s rare that this happens anymore, the data I reviewed still shows bias against female doctors.

The most recent data revealed that there are 608,685 male and 313,874 female doctors in the USA. Another 749 were listed as unspecified which I am not certain what that means, but let’s say those were gender unknown. A BMJ article reviewed compensation by gender and race, and the data revealed an annual compensation to be

• white male doctors 253,042 dollars
• black male doctors 188,230 dollars
• white female doctors 163,234 dollars
• black female doctors 152,784 dollars

It appears, at least in compensation, that there is a bias against both minorities and female doctors, but more so against females.

But as you look deeper, you find that they did not separate sub-specialty doctors from general physicians, and on average specialists make more, and there are more male specialists. But then is it gender bias that pushes woman into less lucrative specialties, because of home and family obligations.

The strange thing is, that despite perception that males make better doctors, the data does not support that. One of the largest studies published in JAMA which looked at 1.5 million Medicare hospital admissions over four years revealed that if your admitting physician was female, you were .4% less likely to die, and that would save 32,000 lives a year. The FDA has approved many therapies that cost more and save less lives. Although there were some issues with the study [they used the admitting doctor as owner of data but the majority of patients were taken care of by multiple doctors, both male and female], data does support that female doctors tend to follow guidelines more closely.

I believe that with the new generation, all kinds of biase, both gender and race, are disappearing. Hopefully, every physician, more importantly, will be looked at and respected on his or her own merit rather than his or her sex or skin color.

Mian A. Jan, M.D., is a practicing Cardiologist and President of Chester County Medical Society.
Contact Dr. Jan at 610-827-1543.

Reprinted from the Chester County Medical Society publication, Chester County Medicine, Summer 2017 issue.

For more content visit cm.hoffmannpublishing.com

Lyme disease is a bacterial infection primarily transmitted by Ixodes ticks, also known as deer ticks, and on the West Coast, black-legged ticks. These tiny arachnids are typically found in wooded and grassy areas. The Centers for Disease Control and Prevention estimate that 300,000 people are diagnosed with Lyme disease in the United States every year. However, because diagnosing Lyme can be difficult, many people who actually have Lyme may be misdiagnosed with other conditions. Many experts
believe the true number of cases is much higher.

Warmer Winters May Increase Number of Cases

In 2015, there were 9,427 confirmed cases of Lyme disease reported in Pennsylvania, of which 396 of these confirmed cases were in Montgomery County. Due to back-to-back warmer winters, health officials are predicting that we may observe a bad tick season and therefore we could potentially see an increase in the number of cases of tick-borne illnesses. It is important to know that ticks infect most people when they are in the nymph stage (an immature stage) of development, because they are very small and difficult to see. The infected ticks can attach to any part of the human body but are often found in hard-to-see areas such as the groin, armpits, and
scalp (CDC, 2017). In most cases, the tick must be attached for 24 to 36 hours before the Lyme disease bacterium can be transmitted. Symptoms usually begin to appear within 3-30 days after a tick bite.

The most common symptom in most cases of Lyme disease is the Erythema Migrans (EM) rash, also called the “Bull’s Eye” rash that occurs around the bite area; however, this symptom varies widely, ranging between 30-80%.

Fatigue, fever, chills, muscle and joint pain are also common symptoms with Lyme disease. A blood test can help determine if someone is infected. Lyme disease can be treated by several weeks of antibiotics. If left untreated Lyme disease can affect the nervous system, joints and heart.

Take the Montgomery County Trail Challenge

Ticks should not prevent the community from continuing to be active. This summer, Montgomery County is promoting their Montgomery County Trail Challenge from May 6-December 3, 2017. The Trail Challenge allows for a family-friendly experience of exploring your community and benefiting your health by getting out on the trails. In support of this wonderful public health activity, Montgomery County Health Department (MCHD) has created a Lyme Disease Awareness Flyer to post on the trails and in the parks to keep the community informed of their risk and how to prevent disease.

Do not let a tick make you sick!
• Use repellent that contains at least 20 percent DEET on exposed skin and use products that contain 0.5% permethrin on clothing.
• Check for ticks daily. Be sure to check places like behind your knees, hair, and the ears. Thoroughly check your children, pets, clothing, and gear as well.
• Shower soon after being outdoors.
• Remove ticks found on body with fine tipped tweezers.
• Walk in the center of trails and avoid areas with high grass and leaf litter.
• Wear light-colored clothing, which will make it easier to see crawling ticks.
• Call your doctor if you get a fever or rash.

For more information on Lyme disease, please visit:
MCHD’s Lyme Disease web page, www.montcopa.org
CDC’s Lyme Disease web page , www.cdc.gov

WRITTEN BY LEONARD OLU-WILLIAMS, MPH, CHES
PUBLIC HEALTH INFO ANALYST, MONTGOMERY COUNTY HEALTH DEPARTMENT

Reprinted from the Montgomery County Medical Society publication, MCMS Physician, Summer 2017 issue.
Read more at mp.hoffmannpublishing.com

How a Citizens Commission Can End Gerrymandering, Return Sanity to our Political Process and Even Improve Our Economy

It has famously been described as Goofy kicking Donald Duck. Is it a cartoon drawing? A Rorschach inkblot test? No, it’s Pennsylvania’s 7th Congressional District, one of the most gerrymandered congressional districts in the country. It stretches, dips, cuts, and curves in a highly contorted fashion over five separate counties, lumping together Pennsylvania voters from the Maryland border with voters north of Reading and those living east of Blue Bell.

Is there a reason anyone should care? Haven’t politicians been engaging in gerrymandering since Eldridge Gerry, its namesake, approved a salamander shaped district in Massachusetts back in 1812? Whether you are a Republican, a Democrat or an Independent, there is plenty of reason to care.

Competitive Elections Create Robust Representation

With the advent of mapping technologies and voter sorting software, partisan legislators now use very precise tools to draw the district lines around the voters that they want, creating exceptionally safe seats. When legislators are in safe seats, they have no incentive to work with their colleagues across the aisle or even to address the concerns of constituents. Elections are not competitive and are usually decided in the low-voter-turnout primaries. In 2016, in a shocking 57% of Pennsylvania state house general election races, there was just one person on the ballot. The opposition party did not even field a candidate. Over 91% of races had an incumbent running for reelection and 86% of races had no primary opponent. Pennsylvania voters feel disenfranchised, and rightly so.

Pennsylvania is one of the most gerrymandered states in the country — and there are numbers to prove it. The Brennan Center for Justice, a nonpartisan law and policy institute dedicated to improving our democracy, analyzed the 2012, 2014 and 2016 congressional elections using three separate quantitative measures of partisan bias.1That quantitative analysis found Pennsylvania to be one of three states with consistently extreme levels of partisan bias.2 The Brennan Center considers this level of gerry-mandering to be an alarming threat to democracy.3

Without competitive elections, legislators pander to their extreme base to stay in office. Compromise becomes impossible, the important business of governing is mired in gridlock, and our infrastructure, educational system, economy, and prosperity suffer. A September 2016 report of Harvard Business School’s U.S. Competitiveness Project includes this key finding: “The U.S. political system was once the envy of many nations… Today, we believe that our political system is now the major obstacle to progress on the economy…”4 How to fix that broken political 2017system? Harvard Business School alumni believe that gerrymandering reform is the top priority.

How to Solve the Gerrymandering Problem

As lawyers, we are trained to look for and to avoid conflicts of interest. Shouldn’t legislators do the same? Drawing the boundaries of their own districts, choosing the people they want to vote for them, is a clear conflict of interest. Voters should choose their legislators, not the other way around. The good news is that there is something we can do about this problem.

The Pennsylvania Constitution currently provides for state house and senate redistricting to be accomplished by a reapportionment commission consisting of five legislators, two each from the majority and the minority party with the fifth member, the chairperson, to be selected by the four members.6 If the four are unable to agree on the fifth member, which has historically been the case, a majority of the Pennsylvania Supreme Court appoints the fifth member. The fifth member tilts the balance in favor of one party or the other, and the gerrymandering begins.A bipartisan group of Pennsylvania legislators is seeking to reform this broken system. Senate Bill 22, introduced by Senators Lisa Boscola (D) and Mario Scavello (R) and co-sponsored by 10 other senators, and House Bill 722, introduced by Steve Samuelson (D) and Eric Roe (R) and cosponsored by 90 other representatives, would put redistricting into the hands of an independent citizens commission that would redraw the district lines in an open and fair manner. The commission would be composed of 11 willing citizens randomly chosen from a vetted pool of registered voters, four of whom are registered with the largest political party, four of whom are registered with the second-largest party, and three of whom are unaffil-iated with either of the largest political parties.

The process for redistricting would be transparent, with opportunity for public input, and the commission would not be permitted to consider prior election results, the party affiliations of voters or the addresses of any individual.

Time is Critical

To accomplish these common-sense reforms, the Pennsyl-vania Constitution must be amended. In order to do so, a bill establishing the citizens commission must pass both the Pennsylvania House and the Senate in two consecutive legislative sessions and then be approved by voters. Both SB22 and HB722 have been introduced and referred to committee. Each is waiting to be scheduled for action by the committees’ chairs. Time is of the essence as the decennial census, and hence redistricting, is only a few short years away.As lawyers, we are well-positioned to advocate for passage of redistricting reform by getting involved in the process, making our views known to our legislators and spreading the word about this crucial issue. Tired of partisan extremism and bickering? Don’t just complain, get involved! Redistricting reform, a bipartisan cause, is a vitally important first step to ending the fanatical partisanship that has gripped our state and country and created virtual gridlock in our legislatures. Our democratic system deserves better. It is time to return the power to the people of the Commonwealth and to make our political system, once again, the envy of the world.

1 Brennan Center for Justice, Extreme Maps, published May 2017 (Efficiency Gap Analysis, Seats-to-Votes Curve Analysis and Means-Median Difference Analysis).
2 Id. at page 15.
3 Id. at page 1.
4 https://www.hbs.edu/competitiveness/Documents/problems-unsolved-and-a-nation-divided.pdf, page 48.
5 https://www.hbs.edu/competitiveness/Documents/problems-unsolved-and-a-nation-divided.pdf, page 55.
6 Section 17 of Article II of the Constitution of Pennsylvania.

Reprinted with permission from Bucks Writs, Summer 2017 Issue, bw.hoffmannpublishing.com, written by Theresa Martin Golding, Esq. Golding Heefner