I am an equal opportunity doubter.I doubt the teachings of my own conventional medicine, knowing how readily we succumb to the transgression of close-mindedness, welcoming only news ensconced within the confines of our native comforts and conventions.I doubt the teachings of so-called Complementary and Integrative Medicine (CIM) as well, having seen them wander into the realm known pejoratively as woo, and perpetrate the opposing transgression: a mind so open that brains flop out.

We should be on guard against both.The idea, though, that there can be no legitimate ideas expressed in a language we happen not to speak- is utter nonsense.In the biomedical world, it is commonly espoused nonsense.

As I reflect on my recent commencement addresses for Bastyr University, which confers, along with various bachelors and masters degrees in quite conventional disciplines and doctoral degrees in naturopathic medicine, degrees in Acupuncture & East Asian Medicine, and Ayurvedic Sciences- my thoughts keep turning to the confluence of medicine, and metaphor.A metaphor, then, seems best suited to introduce my meaning: everything said in Japanese is not diminished for want of expression in English, or Chinese, or French.Japanese, or Russian, or Latin for that matter, can address all of the same concepts- but will only ever do so with their entirely distinct lexicons.

We should note that every lexicon can be used well or badly, in the service of eloquence or gibberish.Just so, every approach to medicine and alleviating the bruises, abrasions, and lacerations induced by the slings and arrows of outrageous fortune.

Staunch medical conventionalists are apt to oppose alternatives on principle, noting their deviation from science.But it seems to me that argument is overlooking something quite fundamental.Traditional systems of medicine are less about enumerating pathways and specifying mechanisms than they are about pattern recognition and the application of metaphor.They can be entirely consistent with science, without using its language.To use another metaphor: there is more than one way to mishandle the combination of baby and bathwater, and we seem collectively committed to exploring them all.

Acupuncture provides a convenient and widely familiar example.Modern, randomized trials suggest the value of acupuncture for select conditions.But the placement of needles did not originate with randomized trials, or modern approaches to biomedical science.It is, presumably, a product of trial, error, and observation over a considerable expanse of time.Traditional Chinese Medicine is called traditional for good reason.

Descriptions of acupuncture in its native lexicon are unscientific.There is reference not to neurons, action potentials, or dermatomes- but to qi (energy, or life force) and meridians (the channels through which qi flows).

Such language is unsettling to science, because it is perceived as an alternative to it.But it need be no such thing, any more than the sun was an alternative to Juliet.Metaphor does not undo what it describes any more than a prism unmakes the sunlight it refracts into an arcade of colors; it translates it.It re-expresses it.It tells the same tale, but in another language.

Juliet, clearly, was not the sun- but we understood the connotations of Romeos impassioned verse just the same.Similarly, the movement of ions across the cell membranes of neurons and of neurotransmitters across synapses need not be qi for qi to be a traditional, observation-based description of just such phenomena.There need be no meridians in neuroanatomy, or connecting the ankle bone to the shin bone, for the descriptive language of meridians to reflect something genuine about anatomical and physiological linkages.

Two quite disparate authorities suggest the relevance of metaphor to medicine: Richard Dawkins, and Aristotle.

Dawkins, long the Simonyi Professor for the Public Understanding of Science at Oxford University, elevated metaphor to a scientific art form.In cases like The Blind Watchmaker, he has written entire books predicated on a unifying metaphor to propagate understanding of the subtleties of evolutionary biology.He has, rightly, opposed the potential for quackery and woo in unsubstantiated medical practice, but is no more qualified to dismiss the results of RCTs than any of us.Just as not all that glitters is gold, not all that is expressed in unscientific language is ineffective when put to the tests of science.

In his Poetics, Aristotle refers to the genius of poets as an eye for resemblances, the capacity to see similarities in dissimilars.I will defer to him and others on the genius of poets, but drawing on my 25-or-so years of patient care, invoke the same claim on behalf of clinicians.

No clinician has a crystal ball to know in advance what a given treatment will do to, or for, a given patient.What we have, at best, is an eye for resemblances- a capacity to see prior patients and populations for whom outcomes are known in the guise of the new patient before us.The more adroitly we manage to narrow the gap between the one for whom the future is uncertain, and the many for whom certain outcomes are historical- the more reliably we choose our remedies, and the better the outcomes they produce.The best clinicians have an eye for resemblances, too, and this is among the arts ineluctably conjoined to the science of medicine.

There are no alternative facts; there are only alternatives to facts.There is no place in enlightened understanding for faith in things refuted by science.The earth revolves around the sun, not vice versa. The Earth is over 4 billion years old, not less than 4 thousand.We are here through the agency of evolution and natural selection, not clay and prestidigitation.Vaccines count among the greatest of advances in the history of public health and are not causally implicated in autism.

But Juliet was the sun.Our most reliable friends are our rocks, and our shoulders on which to lean or cry.No man is an island.We are captains of our fate.The road less traveled makes all the difference.

The person with pain unattenuated by gabapentin is sure to be unimpressed by the putative mechanisms of action.The person with pain resolved thoroughly by acupuncture is as sure to be unconcerned about them.If a mind too open is Scylla, then a mind too closed is Charybdis.The best prospects for the best outcomes for the most people lie along the route that avoids them both.

There are, in other words, other ways of describing things.Ultimately, the metaphors of medicine must align with the science of it or they should be rejected; but they need not sound the same.There could be room in heaven and earth, and the diverse philosophies residing therein, for both qi and saltatory conduction. After all, a rose by any other word- in English, or in Japanese, or French, or Hindi- would presumably smell as sweet.

What we've got here dividing us is, often, that famous failure to communicate.

Senior Medical Advisor, Verywell.com

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Medicine And Metaphor - HuffPost

HEALING CHILDREN A Surgeons Stories From the Frontiers of Pediatric Medicine By Kurt Newman 262 pp. Viking, $27.

Newman, a pediatric surgeon, argues that seriously ill and injured children are better served at pediatric hospitals than at adult hospitals a claim generally supported by the data showing that kids with bone fractures, brain injury and severe sepsis do best when pediatric specialists manage their care. But he makes his case through stories of ill children who were languishing in the care of adult or community providers only to be rescued (often by Newman himself).

In one instance, a friend called Newman from the neonatal I.C.U. of a community hospital, where his newborn son was vomiting bile. Newman recognized the danger and arranged an ambulance to bring the boy to Childrens National, where the boy was saved but faced a prolonged hospital stay.

Newman captures the beautiful collegiality of pediatric medicine and the wisdom of parents and of children themselves, as in this description of a young patient with intestinal failure: He thought more about his parents suffering than his own. As a human being, he put me to shame. Newman also lionizes big donors, and I could not help reading the book as in part a veiled plea for more donations to Childrens National. If this is the books goal, I hope it succeeds. The kids Newman describes are themselves heroic, and they deserve nothing but the best.

OPEN HEART A Cardiac Surgeons Stories of Life and Death on the Operating Table By Stephen Westaby 287 pp. Basic Books, $27.

Westabys book will be a balm to the hearts of curmudgeons everywhere. Sidestepping the contemporary hand-wringing about the lack of empathy in medicine, Westaby, a British surgeon, positions empathy as a threat to the surgical career: Heart surgery, he writes, needs to be an impersonal, technical exercise. Westaby learned this lesson young, when desperately trying and failing to save the life of a child.

Refreshingly, Westaby does not put a positive spin on suffering or cleave to false optimism. The Grim Reaper perches on every surgeons shoulder. Death is always definitive. No second chances. The deaths that truly madden him are those that could have been prevented by available technologies not then funded by the British National Health Service (N.H.S.), his employer. Westaby himself is a pioneer in the development and use of implantable ventricular assist devices little machines that pump blood for a failing heart. When charity funding for these new devices runs out, Westaby finds himself in the unenviable position of having to sit back and watch patients die people I once could have saved.

As a young doctor who imagines nationalized medicine as a way toward comprehensive care for all my patients, I was taken aback. I too have watched patients uninsured Americans die of treatable disease. The book is a reminder that nationalized medicine might ease the racial and economic injustices that currently determine which people die too soon, but it wouldnt spell the end of medically preventable deaths.

SOMETIMES AMAZING THINGS HAPPEN Heartbreak and Hope on the Bellevue Hospital Psychiatric Prison Ward By Elizabeth Ford 247 pp. Regan Arts, $27.95.

Ford is a psychiatrist who cares for mentally ill prisoners. Her book testifies to the kind of love that physicians can offer: a dogged, practical devotion that leaves us missing birthdays, going sleepless and in Fords case driving across a closed bridge toward Manhattan to secure safe care for prisoners who have been stranded by Hurricane Sandy. She coolly describes acts of care like walking into a room to comfort agitated, psychotic men twice her size.

Happily, Ford is human here, and thus imperfect. She describes burning out, her failings as a parent and her inability to care for patients who have seriously harmed children after she herself becomes a mother. Motherhood also imbues her with a new authority in her care, and she discovers that the body of a pregnant physician incites moments of human connection with patients.

Fords bravery emerges not only in acts of clinical devotion but also in some light critique of the tense relationship between medicine and law enforcement. She describes how some correctional officers embedded in her psychiatric unit antagonize patients and occasionally thwart care. She also describes being devastated upon learning exactly how a patient was severely beaten during a takedown in the unit. This is not an expos, however and Ford is still an employee of Correctional Health Services so she does not reveal whether the man was injured by a correctional officer or by psychiatric staff. The story is graphic and real but, as in most physician memoirs, details are withheld.

Rachel Pearson is a resident pediatrician and the author of No Apparent Distress: A Doctors Coming-of-Age on the Front Lines of American Medicine.

A version of this article appears in print on July 2, 2017, on Page BR26 of the Sunday Book Review.

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Four Timely Memoirs from the Halls of Medicine - New York Times

Abstract

About 28 million Americans are currently uninsured, and millions more could lose coverage under policy reforms proposed in Congress. At the same time, a growing number of policy leaders have called for going beyond the Affordable Care Act to a single-payer national health insurance system that would cover every American. These policy debates lend particular salience to studies evaluating the health effects of insurance coverage. In 2002, an Institute of Medicine review concluded that lack of insurance increases mortality, but several relevant studies have appeared since that time. This article summarizes current evidence concerning the relationship of insurance and mortality. The evidence strengthens confidence in the Institute of Medicine's conclusion that health insurance saves lives: The odds of dying among the insured relative to the uninsured is 0.71 to 0.97.

In several specific conditions, the uninsured have worse survival, and the lack of coverage is associated with lower use of recommended preventive services.

The Oregon Health Insurance Experiment, the only available randomized, controlled trial that has assessed the health effects of insurance, suggests that insurance may cause a clinically important decrease in mortality, but wide CIs preclude firm conclusions.

The 2 National Health and Nutrition Examination Study analyses that include physicians' assessments of baseline health show substantial mortality improvements associated with coverage. A cohort study that used only self-reported baseline health measures for risk adjustment found a nonsignificant coverage effect.

Most, but not all, analyses of data from the longitudinal Health and Retirement Study have found that coverage in the near-elderly slowed health decline and decreased mortality.

Two difference-in-difference studies in the United States and 1 in Canada compared mortality trends in matched locations with and without coverage expansions. All 3 found large reductions in mortality associated with increased coverage.

A mounting body of evidence indicates that lack of health insurance decreases survival, and it seems unlikely that definitive randomized, controlled trials can be done. Hence, policy debate must rely on the best evidence from observational and quasi-experimental studies.

The IOM committee also reviewed evidence on the effects of health insurance in specific circumstances and medical conditions. It concluded that uninsured patients, even when acutely ill or seriously injured, cannot always obtain needed care and that coverage improves the uptake of essential preventive services and chronic disease management. The report found that uninsured patients with cancer presented with more advanced disease and experienced worse outcomes, including mortality; that uninsured patients with diabetes, cardiovascular disease, end-stage renal disease, HIV infection, and mental illness (the five other conditions reviewed in depth) had worse outcomes than did insured patients; and that uninsured inpatients received less and worse-quality care and had higher mortality both during their hospital stays and after discharge.

Table 1. Summary of Studies on Relationship Between Insurance Coverage and All-Cause Mortality*

We searched PubMed and Google Scholar on May 19, 2017, for English-language articles by using the following terms: [(uninsured) or (health insurance) or (uninsurance) or (insurance)] and [(mortality) or (life expectancy) or (death rates)]. After identifying relevant articles, we searched their bibliographies and used Google Scholar's cited by feature to identify additional relevant articles. We limited our scope to articles reporting data on the United States, quasi-experimental studies of insurance expansions in other wealthy nations, and recent cross-national studies. We contacted the authors of 4 studies to clarify their published reports on mortality outcomes.

We excluded most observational studies that compared uninsured persons with those insured by Medicaid, Medicare, or the Department of Veterans Affairs because preexisting disability or illness can make an individual eligible for these programs. Hence, relative to those who are uninsured, publicly insured Americans have, on average, worse baseline health, thereby confounding comparisons. Conversely, comparisons of the uninsured to persons with private insurance (which is often obtained through employment) may be confounded by a healthy worker effect: that is, that persons may lose coverage because they are ill and cannot maintain employment. Nonetheless, most analysts of the relationship between uninsurance and mortality have viewed the privately insured as the best available comparator, with statistical controls for employment, income, health status, and other potential confounders.

In sum, the OHIE yields a (nonsignificant) point estimate that Medicaid coverage reduced mortality by 0.13 percentage points, equivalent to a (nonsignificant) odds ratio of 0.84.

Several routinely collected federal surveys that include information about health insurance coverage have been linked to the National Death Index, allowing researchers to compare the mortality rates over several years of respondents with and without coverage at the time of the initial survey. One weakness of these studies is their lack of information about the subsequent acquisition or loss of coverage, which many people cycle into and out of over time. This dilutes coverage differences and may lead to underestimation of the effects of insurance coverage.

Two studies have analyzed the effect of uninsurance on mortality using data from the National Health and Nutrition Examination Survey (NHANES), which obtains data from physical examination and laboratory tests among participants.

Several researchers have used data from the Health and Retirement Study (HRS)a longitudinal study that has followed cohorts enrolled at age 51 years or olderto assess the effect of insurance coverage on mortality. The HRS periodically surveys respondents and their families and has been linked to Medicare and National Death Index data.

The evidence accumulated since the publication of the IOM's report in 2002 supports and strengthens its conclusion that health insurance reduces mortality. Several newer observational and quasi-experimental studies have found that uninsurance shortens survival, and a few with null results used confounded or questionable adjustments for baseline health. The results of the only recent RCT, although far from definitive, are consistent with the positive findings from cohort and quasi-experimental analyses.

Table 2. Why the Causal Relationship of Health Insurance to Mortality Is Hard to Study

Finally, our focus on mortality should not obscure other well-established benefits of health insurance: improved self-rated health, financial protection, and reduced likelihood of depression. Insurance is the gateway to medical care, whose aim is not just saving lives but also relieving human suffering.

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The Relationship of Health Insurance and Mortality: Is Lack of Insurance Deadly? Free - Annals of Internal Medicine

Scott Olson, Getty Images

Lets say your state faces an opioid epidemic. And a shortage of psychiatric care. And one of the highest suicide rates in the nation.

Lets say you live in Colorado.

If youre an optimist, you might turn to Congress for help. At the very least, youd expect your representatives and senators not to make matters worse.

Unfortunately, the Senate Republicans new health care plan would do real harm to Colorado and to the rest of the country. Since the Senate may vote on this proposal before the end of the week, its important to speak out right now.

The GOP plan is called the Better Care Reconciliation Act. But if you or someone you love is or might someday become old, disabled or sick, theres almost nothing better about it.

Consider these provisions:

The Congressional Budget Office, a nonpartisan agency, is calculating the costs and consequences of the Senate proposal. But if the House version is any guide, this health care plan would hurt millions of Americans and help relatively few.

At Mental Health Colorado, were seeking ways to improve care, expand coverage, and lower costs. Were building a statewide network of advocates to advance those goals. We call it the Brain Wave, and we invite you to join us.

In the meantime, we urge you to call Colorados senators. Tell them how youd vote on this bill before its too late.

Andrew Romanoff, a former speaker of the Colorado House of Representatives, is president and CEO of Mental Health Colorado.

To send a letter to the editor about this article, submit online or check out our guidelines for how to submit by email or mail.

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Senate Republicans' health care bill is bad medicine - The Denver Post

by Susan Ipaktchian on June 26, 2017 4:04 pm

The School of Medicines Office of Communication & Public Affairs has received national recognition for the quality of its news releases and magazine stories, including the top prize in the best articles of the year category.

Overall, the office received six awards one platinum award, two golds and three silvers in the 2016 Circle of Excellence Awards contest sponsored by the Council for the Advancement and Support of Education.

Writer Tracie White earned the sole platinum award in the best-articles category for The puzzle solver, which was published in the spring 2016 issue of Stanford Medicine magazine. The article described the efforts of genetics professor Ron Davis, PhD, to find a cure for chronic fatigue syndrome, the crippling illness afflicting his son. Contest judges said it was a powerful story, deeply compassionate and compelling in its expression. The reader feels this family tragedy while also appreciating the science being done at Stanford. This is the second time that White has won the platinum award in the category.

The magazine also won a gold award for periodical staff writing. Judges said the magazine stories met the difficult task of relaying complex medical and scientific ideas clearly and concisely, in a way that appeals to both lay readers and a professional audience, and did so while drawing readers in with compelling writing that emphasizes the human aspect behind the science. The articles demonstrated how Stanford is on the forefront of medical education, research, and development, yet each story was written with a focus on the human perspective, which demonstrates the why.

The five stories in the staff-writing entry included:

The news releases written by the offices staff earned a gold award in the Research, Medicine and Science News Writing category. The judges commended the entry for high-end writing that presents topics in ways in which the average reader can peruse them comfortably. Good use of quotes, which drive but do not overpower the writing. The news releases were edited byJohn Sanford.

The five news releases included in the entry were:

This illustration received a silver award in the annual Circle of Excellence Awards. (Image credit: Jason Holley)

Stanford Medicine magazine received a silver award in the special-constituency magazine category. Judges cited the magazine for deeply personal and affecting stories and for exploring pressing issues affecting health care, often detailing the human impact on physicians, patients and families. The magazine is edited by Rosanne Spector and Kathy Zonana.

An illustration by Jason Holley that accompanied the story Building a better drug, in the winter 2016 issue of the magazine, won a silver award in the design category. Judges said the drawing showed strength in the forced perspective, the asymmetry and the abstract narrative of the background.

CASE is a professional organization for those in the fields of communications, alumni relations and development at educational institutions. It includes more than 3,600 colleges, universities, and independent elementary and secondary schools in 82 countries. To recognize the best work in these fields, CASE sponsors its annual Circle of Excellence Awards.

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Stanford School of Medicine Communication office wins six national awards - Stanford University News

PITTSBURGH -- In what has become a ritual for a handful of Pittsburgh Steelers who train in Arizona during the summer, James Harrison's crew is taking to the sand courts for some medicine ball volleyball.

And it's no surprise that Harrison had impressive moves in a two-on-two matchup that included teammates Vince Williams and Robert Golden and veteran free-agent linebacker Sean Weatherspoon.

At one point during the game, which Harrison and Williams apparently won 7-0, Harrison jumped and double-clutched before tossing what looks like at least a 20-pound ball over the net.

The game is informally called "Danney Ball," after Harrison's head trainer, Ian Danney of Performance Enhancement Professionals in the Phoenix area -- which has an average high of 104 degrees in June, by the way. These workouts are legitimately tough and ill-advised for the average NFL fan.

Harrison spends his offseasons in Arizona and likes to host teammates for training sessions. Safety Mike Mitchell spent a few months with Harrison before organized team activities and said he gained about 10-12 pounds of muscle during that stretch. Williams looked noticeably more agile in team workouts after training with Harrison.

Harrison, 39, will be with the Steelers as the starting outside linebacker as the team takes the field for training camp on July 28.

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James Harrison practically spiking medicine balls on volleyball court ... - ESPN (blog)

James Harrison is 39 years old and entering his 15th season, yet he remains one of the league's most efficient pass rushers.

His longevity is no accident; Harrison's workout regimen certainly plays a role, and that includes his version of beach volleyball. But instead of a regulation volleyball, he prefers a medicine ball.

Harrison and teammate Vince Williams go up against another teammate, Robert Golden and former Falcons linebacker Sean Weatherspoon. If this all sounds familiar, it should; Harrison, Williams, Golden and Ryan Shazier squared off two offseasons ago and again last summer.

And when Harrison isn't playing modified volleyball or terrorizing quarterbacks, he spends his offseason pushing 1,395 pounds like most of us push the lawn mower back to the garage after 30 minutes of cutting grass, or doing135-pound one-handed shoulder presses, or hip-pressing 528 pounds like he doesn't have a care in the world.

Your move, Father Time.

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WATCH: James Harrison still loves playing volleyball with a medicine ball - CBSSports.com

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Houston Methodist Center for Performing Arts Medicine Receives National Award - Texas Medical Center (press release)

MARQUETTE, Mich. (WLUC) - The Marquette Family Medicine Residency Program is pleased to welcome our new incoming residents, beginning July 1, 2017. The residency program is an education collaboration between UP Health System Marquette, Michigan State University College of Human Medicine and Lake Erie College of Osteopathic Medicine.

Match Day was March 17, 2017. The ranking and results are computed by the National Resident Matching Program, a system that matches medical students with residencies. The results for the Marquette Family Medicine Residency Program from this years Match Day are as follows: Victoria Bobik, M.D., of Bear, Delaware, received her undergraduate degree from the University of Delaware, and her medical degree from the American University of the Caribbean School of Medicine.

Dexter Clark, D.O., of Muskegon, Michigan (originally from Skandia), received his undergraduate degree from Northern Michigan University, and his medical degree from Michigan State University College of Osteopathic Medicine.

Cara Crawford-Bartle, M.D., of West Branch, Michigan received her undergraduate degree from Northern Michigan University, and her medical degree from Wayne State University School of Medicine.

Joel Phelps, D.O., of Cape Girardeau, Missouri, received his undergraduate degree from the University of Wisconsin Superior, and his medical degree from A.T. Still University of Health Sciences Kirksville College of Osteopathic Medicine.

Jeffrey Sweers, M.D., of Grand Rapids, Michigan, received his undergraduate degree from Hope College, and his medical degree from Michigan State College of Human Medicine Grand Rapids.

R. Anne Reinertsen, M.D., of Grosse Pointe, Michigan, received her undergraduate degree from the University of Michigan, and her medical degree from Wayne State University School of Medicine.

To learn more about the Marquette Family Medicine Residency Program, please visit http://www.mgh.org/residenc.

--------------------

About Michigan State University College of Human Medicine Upper Peninsula Region The MSU College of Human Medicine Upper Peninsula Region Campus works in conjunction with the UP Health System-Marquette to coordinate the training of family medicine residents and Michigan State University College of Human Medicine medical students. Since its inception in 1974, 278 medical students and 192 resident physicians have graduated from the two programs. Currently, approximately 30 percent of the students who graduated from MSU College of Human Medicine UP Campus and 50 percent of family medicine resident graduates are practicing across the Upper Peninsula Region.

Link:

Marquette Family Medicine Residency Program welcomes new residents - UpperMichigansSource.com

The Senate vote is a declaration of war

When senators vote on health care they will come face to face with a phantom which has stalked them since Obamacare was first proposed. This is the moment of no return. This will change everything.

This will not only throw millions of Americans off health coverage. Passage of the bill will actually take American lives. And like the Civil War and the two world wars, it will take lives in every town in America and in every extended family in America.

Today we have come to a critical turning in our history which we have been slouching toward for more than a decade. Americans no longer trust their president. We no longer trust Congress.

We in the liberal states are turning now to governors and state legislatures to solve our problem in unprecedented ways.

And California Gov. Jerry Brown is leading the way.

Trumpcare 2.0 has the same stench - and effect - as the bill the House Republicans and the White House slapped together last month: Millions will lose healthcare coverage while millionaires profit, Brown said to the Los Angeles Times.

Not just an idle rant.

Brown is redefining the meaning and purpose of a state. This will redefine America because other states and even nations sympathetic to him more sympathetic to Brown than they are to Trump are following his initiatives, joining him and ignoring Trump.

But can they do that?

Can U.S. states right Trumps wrongs, asks Barry Eichengreen, Professor of Economics at the University of California, Berkeley, and a former senior policy adviser at the International Monetary Fund.

U.S. President Donald TrumpDonald TrumpCarter Page questioned in FBI Russia investigation: report Major progressive group rolls out first incumbent House endorsement Overnight Finance: CBO: 22M more uninsured with Senate ObamaCare bill | Trump gets green light for partial travel ban | GOP: ObamaCare taxes must go MORE, with the help of a Republican-controlled Congress, is undermining many of the fundamental values that Americans hold dear, he writes in Project Syndicate. He is jeopardizing their access to health care by seeking to repeal the 2010 Affordable Care Act (Obamacare). His budget proposes massive cuts in everything from early childhood education to food stamps and medical research. His tax reform plan, and especially its much lower top rate for pass-through business income, implies significant further redistribution of income to the wealthy.

It is a good time to remember that ours is a federal system enshrined in the Tenth Amendment of the Constitution, which stipulates that all powers not expressly assigned to the federal government are reserved to the states he writes.

As he indicates, that presents the problem.

They could invoke the Commerce Clause of the Constitution as part of an effort to prevent states from signing climate accords with foreign countries, he says. They could eliminate the federal deductibility of state taxes to increase the cost of funding state programs. They could curtail federal support for public services in sanctuary cities and states with immigrant-friendly policies.

But states rights and the Tenth Amendment are catching on as an anti-Trump strategy in blue states. Theyre not just for us New Hampshire hillbillies anymore.

And we even heard from John Vogel, a professor at the Tuck School at Dartmouth pitching states rights on the most liberal Vermont Public Radio this past week.

It might be time to consider a council of governors or other leaders in these states to meet to collectively consider their efforts and even a policy planning group which would plan collective and unified action within the blue states both ideas that the great ambassador George Kennan suggested for the U.S. which never materialized. And such a thing might already be at hand in fledgling form.

Professor Trumps curious tutorial tour through the tangled landscape of American checks and balances continues to take enlightening new turns, writes D.J. Tice of the Star Tribune in Minnesota. This month, governors of mainly Democratic-leaning states, including Minnesota Gov. Mark Dayton, have forged something called the U.S. Climate Alliance.

Surely the new U.S. Climate Alliance could take on other issues like health care, immigration and the commerce clause.

Worth noting that Jeb Bush supports a constitutional convention in order to remove restraints on the commerce clause which has given the federal government far more regulatory power than the Founders intended, he says.

But as he opined recently, who cares what I think?

Certainly not the Republicans.

But libertarians might.

Maybe Jeb should get in touch with his old pal William Weld, the most popular (and best) Republican governor in the history of Massachusetts who ran as VP on the Libertarian ticket in 2016 and begin again from scratch with a few other exiles.

Bernie Quigley is a prize-winning writer who has worked more than 35 years as a book and magazine editor, political commentator and reviewer.

The views expressed by contributors are their own and are not the views of The Hill.

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States rights might be best medicine for TrumpCare - The Hill (blog)

A civil war over painkillers rips apart the medical

A civil war over painkillers rips apart the medical community and leaves patients in fear

Hes 20. Has brain cancer. And is caught in

Hes 20. Has brain cancer. And is caught in the crossfire between the FDA and a

Meet one of the worlds most groundbreaking scientists. Hes

Meet one of the worlds most groundbreaking scientists. Hes 34.

More lawmakers want the Army to hold a hearing

More lawmakers want the Army to hold a hearing on Zika vaccine pricing

Pharmalittle: Shkreli jury selection begins; Will Trump pressure India

Pharmalittle: Shkreli jury selection begins; Will Trump pressure India to change patent laws?

Modest clinical trial win for Seattle Genetics, New Ra

Modest clinical trial win for Seattle Genetics, New Ra Pharma data on tap

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Lisa Wong: Conducting an ensemble of music, medicine, and education - STAT

I was privileged this past week to deliver commencement addresses for Bastyr University on their campuses in San Diego, and Seattle, to a combined audience of several thousand, celebrating the graduation of hundreds of students receiving various bachelors, masters, and doctoral degrees in the health professions.

My job was not just to celebrate and congratulate the graduates, pleasant though that might have been for us both. My job as commencement speaker was to provoke and harangue, goad and attempt to inspire. I had only faint hope of achieving all that, but in accepting the invitation, I had pledged my best effort.

Accordingly, and in service to that mission, I asked them to consider these lines from the famous poem If, by Rudyard Kipling: If you can bear to hear the truth youve spoken, Twisted by knaves to make a trap for fools ...

Theres a lot there to ponder, I noted, in a post-truth world of alternative facts. There is a lot to those lines in a world where every opinion mistakes itself for expertise; every voice can access the megaphone of cyberspace; and every assertion can amplify itself in echo chambers populated by those attending carefully only to the opinions they already own, drowning out all else.

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We all presume that Kipling is speaking to us, and thus that the truth is our truth. But if everyone is the person to whom Kipling is speaking if each of us owns the truth then who is the knave, who twists the truth? Who is the fool taken in by such willful distortion? Recall the precautionary lyrics, courtesy of The Main Ingredient: everybody plays the fool, some time

Sometimes our view of the truth can be too narrow. Those of us who embrace and espouse holism see just that liability in staunch conventionalists who refute any truths that reside outside the bounds of their comfortable conventions.

Sometimes, though, our view of truth can be too broad. Not all that glitters is gold; not every therapeutic modality with intrinsic appeal and vocal proponents actually works. In the pursuit of truth, we must keep open minds but not ever so open our brains flop out!

We can all too readily believe what isnt true, and play the fool. In our fervor, we can pass along that misguided conviction, playing the knave- and making fools of others.

Sometimes, our view of truth is too proprietary. Many of us try on our own to be that source of truth that rises above the shouts of the knaves, and reorients the gullible fools. But in this age of incessant din and endless echoes of every opinion no one voice can reliably deliver the signal of truth; no one voice can overmaster the din. Only in our unity is there sufficient strength to try.

That, in turn, brought me to the one truth of my own I presumed to share with the graduates and their loved ones, reflecting on my own efforts to do good in the world. I believe the best measure of our worth is not how much better we can be than average, but how much we do to make the average better.

What difference does it make if you know that health care should be a right, but society treats it as a privilege? What difference does it make if you know that access to care should be universal, but it remains privileged? What difference does it make if you know that holistic models of care can be kinder and gentler and highly effective, but the system is unreformed? What difference does it make if you know that climate change is real, and we are complicit in it, but our culture remains committed to doing far too little far too late? What difference does it make if you know that multicolored marshmallows are no part of a 6-year-olds complete breakfast, but Madison Avenue doesnt give a damn?

Gertrude Stein famously said: a difference, to be a difference, must make a difference. To make a difference, we must make the mean different. We must raise the average. Society does not do the bidding of outliers; it heeds the tolling at the center of the bell curve. Society, and culture, regress to the mean. They are governed by the popular imperatives, not the best informed.

Like John Donnes famous church bell, the bell curve tolls for us all. We will rise or fall together.

The true measure of our worth is not how much better we can be than average, but how much we can do to make the average better. So I called upon these new graduates to put their shoulders to the unyielding line drawn through the mean and lift but to start tomorrow. The challenges will be there, waiting for them. Today, I suggested they simply honor the milestone and their personal triumph with family and friends.

Their youth and energy and idealism renewed my own hopes for the future. I was privileged to be there to say to them: we need you, welcome, and congratulations.

Dr. David L. Katz;www.davidkatzmd.com; founder, True Health Initiative

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Dr. David Katz, Preventive Medicine: Truth about the bell curve and health - New Haven Register

FAIRFIELD Does community hospital conjure an image of a place where complex brain and spinal surgery happen on a regular basis?

Where life-saving orthopedic care is available 24/7/365?

Where cutting-edge technology, equipment and medical know-how allow cancer patients to get treatments close to home?

Where open heart surgery regularly saves lives?

Or where parents of fragile newborns can keep an eye on their baby using their cellphones and a video monitoring system?

Unless youve had a stroke, heart attack, brain tumor, traumatic accident or a fragile baby, chances are you dont realize these services exist in your local, community hospital.

But they do. And thats because NorthBay Healthcare has been committed to systematically redefining the concept of a community hospital, according to President and CEO Konard Jones.

NorthBay Healthcare is Solano Countys only homegrown health system, Jones said.

We not only make all of our health care decisions right here, we are residents, neighbors, family, friends and care providers. Weve grown with Solano County, he said.

Primary and specialty services have grown from ground zero to 130-plus providers in less than 10 years. Additionally, as a member of the Mayo Clinic Care Network, NorthBay physicians have access to more than 4,000 physicians and scientists at Mayo Clinic for second opinions, knowledge and expertise.

When it comes to saving lives, every minute counts. Advancing care in Solano County with the help from the No. 1 hospital in the nation is a badge of honor, Jones said.

NorthBay Medical Center in Fairfield was the first verified Level II trauma center in Solano County and is the only Baby-Friendly facility and accredited Chest Pain Center. Both NorthBay Medical Center and NorthBay VacaValley Hospital are accredited Stroke Centers.

And VacaValley Hospital offers a fully accredited Joint Replacement Program, specializing in hips, knees and shoulders.

NorthBay expanded in Vacaville in 2016, opening the VacaValley Wellness Center, which is now home to the Center for Diabetes & Endocrinology, the Center for Integrative Medicine and the 30-year-old NorthBay Cancer Center. Cancer patients have state-of-the-art equipment for radiation oncology, and spacious infusion bays for chemotherapy.

Also in the building is the countys first medical fitness center open to the general public for membership. The 56,000-square-foot NorthBay HealthSpring Fitness is managed by EXOS|Medifit, a worldwide industry leader in training professional athletes and the military, among others. On three floors it comprises workout equipment, rooms for exercises classes, three swimming pools, fitness specialists, massage therapists and more.

Work is progressing on the Fairfield hospital campus on a $183 million, 77,000-square-foot, three-story wing that will replace older parts of the 57-year-old hospital. It will offer six new operating rooms, 22 patient rooms of the future, a new caf, imaging services, cardiac catheterization labs and 16 post-acute care beds.

An expanded Emergency Department is also in the works.

Its an exciting time to work for NorthBay Healthcare, as were redefining what it means to be a community hospital, Jones said. We are committed to developing and growing services in neuroscience, heart and vascular, stroke and trauma care and to embrace new technology as we go.

That desire to embrace advanced medicine is not new to NorthBay, according to Elnora Cameron, vice president for strategic planning. In fact, it is part of the organizations mission statement, Compassionate Care, Advanced Medicine, Close to Home.

NorthBay Healthcare is the smallest health care system in the county, but ironically, we also provide the most sophisticated services, Cameron said. From neonatal intensive care to trauma to neuroscience, we have brought services home to Solano County, allowing patients to receive treatment here, instead of having to travel far from home, far from loved ones.

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NorthBay redefines community medicine - Fairfield Daily Republic

With pediatric concussions on the rise nationally, the Marshall Sports Medicine Institute is launching a new initiative to offer free baseline concussion testing for children.

This proactive approach to concussion management establishes baseline data in healthy patients using ImPACT Pediatric, the first and only FDA-approved concussion assessment aid for ages 5-11.

With this new pediatric concussion test, we can now evaluate neurocognitive function after sustaining a concussion and compare their function to baseline levels, said Tom Belmaggio, MS, ATC, CSCS, coordinator of the Marshall Sports Medicine Institute. This allows our physicians to provide safer return-to-play decisions for younger athletes who sustain a concussion.

According to a study by researchers from the University of Washington, Seattle Childrens Research Institute and the University of Colorado, nearly 2 million children suffer sports-related concussions each year.

As more children under the age of 12 participate in recreational physical activity, baseline testing in children is increasingly essential to overall concussion management, said Andy Gilliland, M.D., a primary care sports medicine physician with Marshall Orthopedics and an assistant professor of orthopedics at the Marshall University Joan C. Edwards School of Medicine. This provides us greater insight into cognitive changes and develop a personalized treatment plan accordingly.

Free pediatric baseline concussion testing is available by appointment at the Marshall Sports Medicine Institute, located at 2211 Third Ave. in Huntington by calling 304-691-1880 and at Marshall Health-Teays Valley, located at 300 Corporate Center Dr. in Scott Depot by calling 304-691-6800.

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Marshall Sports Medicine Offers Concussion Testing for Children - The Exponent Telegram (press release) (registration)

KOBE Prime Minister Shinzo Abe said on Saturday that he wants to create more veterinary schools nationwide, saying that his governments recent decision to approve just one the first in the past 52 years had stirred doubts about the credibility of the process.

We dont have to limit it to the city of Imabari (Ehime Prefecture). We will quickly seek a nationwide move, Abe said.

Abes suggestion came as criticism grows over the opaque process by the education ministry to greenlight a plan for a new veterinary school run by Kake Gakuen (Kake Educational Institution), operated by a close friend of his, in a national strategic special deregulation zone in Imabari, Ehime Prefecture.

No new university veterinary medicine faculty has been established in Japan in over half a century because the government rejects opening them due to strong opposition from the Japan Veterinary Medical Association, which says that enough already exist.

Deregulation in this area should be promoted nationwide, Abe said in the speech in Kobe. The government will permit the opening of such faculties by any willing university, and not limit it to Imabari, Abe said.

The public support rate for Abes Cabinet has dropped sharply recently over public dissatisfaction with his teams explanations about the Kake Gakuen affair, in which he is suspected of influencing the approval process.

In his speech Saturday, Abe again denied any wrongdoing over the matter, saying the process was clear and serene.

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Reacting to Kake scandal, Abe now urges even more new animal medicine departments - The Japan Times

A group including a UW Health doctor plans to launch the Madison Street Medicine Initiative this fall to help people who are homeless get medical care.

Madison Area Care of the Homeless, also known as MACH OneHealth, hopes to start the project by September, said Dr. Ann Catlett, a palliative care specialist at UW Hospital and a leader of the effort.

The group seeks volunteer doctors and other health professionals to make weekly rounds to shelters, campsites and streets, and provide basic care to homeless people, Catlett said. Eventually, the providers will accompany homeless patients to clinic visits and help them navigate the health care system.

Our vision is that everybody has access to the health care that they need, Catlett said.

UnityPoint Health-Meriter started a similar program in 2009, called Helping Educate and Link the Homeless, or HEALTH. Providers visited shelters and meal programs, and saw patients at a Quonset hut outside of the St. Vincent de Paul food pantry on Fish Hatchery Road.

The Affordable Care Acts expansion of health insurance in 2014 caused Meriter to leave the hut and shift to helping the homeless sign up for coverage and get to clinics, said Matt Julian, a social worker who does outreach through the program.

Im a friendly face in the community who tries to get them into the clinic, Julian said.

MEDiC, a program involving students at the UW School of Medicine and Public Health, has clinics for the homeless and other underserved populations at set times and places.

Catlett said providers with the Madison Street Medicine Initiative will treat wounds and simple infections, but a main goal of the weekly visits will be establishing trust with homeless patients. That should make the patients more comfortable going to clinics or the hospital when needed, she said.

Whether its the clinic, the hospital, the emergency room or back out on the street, we would like to be a link between all those places, she said.

The initiative, supported by $100,000 from the Baldwin Wisconsin Idea Endowment at UW-Madison, is an extension of a foot care clinic MACH OneHealth started in April 2016. It has been held monthly Downtown at First United Methodist Church, with the next one on July 15.

Catlett also hopes to open a house where the homeless and other isolated people who are dying could receive end-of-life care.

We all want to be really comfortable, and to be in a safe place, and to have love around us when near death, she said.

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'Street medicine' project for the homeless to start in Madison this fall ... - Madison.com

ANALYSIS/OPINION:

Treating emergencies isnt your insurance talking. Its doctoring. Its nursing. Its medical technology. Its your stone-filled gallbladder obstructing and a top surgeon operating on it without delay. You cant prove that a junior attending surgeon wouldnt do just as well, but you can feel it when the wound is healing so well two days later where the angry raw organ was scope-sucked successfully from your body.

The best of emergency health care is what we saw represented on the television screen last week, as top doctors came forward to describe their craft, a reminder that the health insurance future weve all been debating lacks real flesh on its bones. An insurance company cant manufacture or guarantee the dedication or skill of a Dr. Jack Sava, head of trauma at Medstar Washington Hospital Center, who directed the lifesaving interventions for House Majority Whip Steven Scalise.

Damaged blood vessels and pelvic organs torn asunder by the wide tracking fragments of a speeding bullet were meticulously repaired. The miracle medical crew managed to pour blood in faster than it was pouring out while managing to preserve essential blood flow to the brain. There will be a long rehab process ahead with pain management and infection control and more surgical repair. Top doctors and nurses will be needed throughout the healing process.

No one-size-fits-all health insurance can guarantee that the best surgical and rehab teams will always be available in lower-profile cases at less prominent trauma centers.

Also appearing at a televised press conference last week was the top team of doctors at the University of Cincinnati Medical Center who received patient and victim Otto Warmbier from North Korea. Dr. Daniel Kanter, medical director of the neuroscience intensive care unit revealed that poor Otto had suffered severe brain damage and was rendered unresponsive from apparent stoppage of breathing and cardiac arrest likely from a pill or poison hed been given and according to neurological testing not from botulism as the North Koreans had claimed. Warmbier sadly died a few days later.

Dr. Kanter and his group also might have made a difference if they werent tragically reduced to an after-the-fact Sherlock Holmesian analysis.

Viewers could look to the screen and wonder would I receive such top-flight treatment if it were me?

The answer for the time being, more often than not, is still yes. But will doctors of this quality continue to survive amid the constrictions of a government/insurance bureaucracy?

Many years ago I was travelling through Europe and met a middle-aged bearded man driving an old VW minivan. He told me that he was a well-known oncologist who was paid the equivalent of $60,000 a year (in the 1980s) to care for very sick patients. He openly admitted that the best thing about his job was the time off it afforded him to travel.

We dont need that sober reality here. Unfortunately, both the Affordable Care Act and the replacement American Health Care Act (being debated in the Senate) rely on an expanded insurance model that limit the role of doctors. We are already struggling with a growing shortage, excess computer documentation and a rising fear of malpractice as we work to master the latest technology. At least the new bill removes the mandate to buy a product that doesnt guarantee you access to our actual care. Thats the right place to start, but it isnt the whole answer.

There needs to be a new focus on rewarding doctors for the work we do and allowing us more freedom to do it. We need less so-called comprehensive insurance and more available and affordable health care tools to choose from.

Marc Siegel, a physician, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Medical Center. He is a Fox News medical correspondent.

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Supporting medicine and its finest practitioners - Washington Times

TOPEKA, Kan. (KSNT) Promoting curiosity in our kids is a good thing! But experts stress doing it in a safe way. Curiosity for medications, is a serious problem today.

According to the Safe Kids Shawnee County coordinator, Teresa Taylor it is absolutely a problem.

It is a very common thing for children to get into medications that arent intended for them or take too many of something that was intended for them.

A major problem is that many medicines look like candy.

You can see here how so many different medications and they look just like candy and its even hard for adults to tell what is what on those. Its really important that we never refer to medication as candy. Sometimes well say things to get kids to go ahead and take their medicines. Its often sweetened so that they will take it and its a little more palpable for them. But we should never refer to it as candy because we dont want to encourage getting into it later, said Teresa.

Its very important to store medicine in a safe location, where your kids wont find them.

Teresa said some of the common culprits that you wont typically think of are night stands.

When medications are kept in or on a night stand. Children can commonly get into them. Also purses and bags.

Medication safety is not just for younger children. Safe Kids Shawnee County says adults should model good behavior for older kids to follow.

We model good behavior. So kids will naturally do what we do, rather than what we tell them to do. If we read the medication label every time, and follow the labels when we take medicine, theyll be more likely to do that. As they get even older, review that medication labels with them, and teach them about the different components on (the bottle) and how to take medicine safely. They need to take them exactly as prescribed. Taking more doesnt mean it will work better or faster, said Teresa.

To avoid any accidental overdoses, make sure you closely follow dosage recommendations and relay any medication instructions to temporary caregivers.

Vitamins, eye drops, and diaper remedies are also common items for kids to get into. Safe Kids Shawnee County recommends having the Poison Control phone number on hand at all time 1-800-222-1222. You can also text POISON to 48484.

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Shawnee County Safe Kids recommendations on kid medicine safety - KSNT News

Welp, here it goes. I cant be silent. I reviewed the Senate Healthcare Bill, and it affects my son. I dont know if my blogging does a darn thing, but I believe Im obligated to advocate for my child. As such, doing what I can to ensure that people are aware of the ramifications of this bill and asking those who care to make their voices heard, is the least I can do.

For the sake of brevity, I will keep this to the two factors which have the greatest impact on my child. The photos below were taken from an NPR summary of the bill.

Image Courtesy of NPR

Many people think that Medicaid is a hand out to able bodied people who choose not to work. However, around 90% of Medicaid dollars go to the elderly, disabled or working people whose income falls below the threshold in their state. Therefore, reduced funding to the program hits heaviest on the most vulnerable populations. As adults, both of my sons will rely on Medicaid for their medical coverage. Its not exactly clear what these cuts will mean to them, and perhaps thats the most worrisome part of this. Alex might be just fine if he stays healthy, but Benjamins health needs are lifelong. If he cannot stay on our healthcare plan, and Medicaid is cut, what would the options be? Nothing here is clear, and for families like ours its terrifying.

Image Courtesy of NPR

This part is even more harrowing. In addition to his developmental and medical needs, Ben has serious mental health needs. He sees a psychiatrist, uses psychiatric medicine, and needs autism therapy, which is a mental health benefit. Without these in place, his wellbeing is in jeopardy. I cannot overstate the seriousness of this situation. As it is, resources for people with developmental, medical and psychiatric needs are sparse, if funding is cut, it would be nothing short of devastating for Ben and our family.

But we arent the only ones. In fact, were pretty fortunate so far. My husband works for the state and has his choice of excellent healthcare plans, of which we have chosen the most thorough and economical coverage. Many are self employed without access to such benefits. For us, the cost of healthcare thus far has been a seriious strain, but one that we can manage. For many, its already past management and only set to get worse, highlighted in this Washington Post article.

Ive followed Parkers story for years now, and his family deserves better. Theyre working hard, being resourceful, and just want their son to live!

Heres the thing, we have spectacular medical science thats evolving and growing daily. We are able to save lives that just a few years or decades ago were hopeless. Its marvelous, simply marvelous. But its expensive, as would be expected, too expensive for any but the wealthiest citizens to afford. Do we reserve such marvels for those who can afford to buy it? Is modern medicine a luxury for the few? Is it a commodity available to only those who have the cash reserves to pay for it?

How do we decide who gets this care? Do we deny children whose parents dont have jobs with a hearty benefit package? Or do we put caps on it and say we can only spend so many dollars to save a persons life, and after that just shrug it off? Or do we leave people with mental illness without access to health insurance? This is dangerously close to eugenics. I shudder to think that denying Medicaid coverage for mental illness is a tidy way of saying society shouldnt be obligated to help them.

Finally, I want to point out that its the pro-life party that is endorsing all of this, and Im calling bullshit. There is nothing life affirming or life-protecting about any of this. This is prioritizing finances over people and its repugnant. If you suggest that charities or churches should fill in the gaps, please just get off that ridiculous notion. In eleven years of managing complex medical, developmental and psychiatric needs, we have tapped into private resources to a great extent, Im quite savvy at finding and accessing them, and we have had a church with a congregational care employee who identifies and designates church resources for families in crisis. Between the two, the help has been incredibly helpful for certain things, but only a drop in the bucket compared to the day to day impact of copays, deductibles, time and miles. Its simply not feasible for private organizations to offset such monumental costs.

So I ask you, do you really think its okay for people to suffer and die when medical care is available, but not affordable?

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Is Modern Medicine a Luxury? - HuffPost

An individual organization that is committed to this at the highest level of leadership and that invests in well-designed interventions can move the needle and run counter to the national trend of physician distress and burnout.

I think most health care leaders now realize this is a threat to their organization, but there is also uncertainty that they can do anything effective to address it, Shanafelt said. They say, Its a national epidemic, what can we do? My experience has shown that an individual organization that is committed to this at the highest level of leadership and that invests in well-designed interventions can move the needle and run counter to the national trend of physician distress and burnout. I hope that the Stanford WellMD Center becomes a paragon that other medical centers want to emulate.

Shanafelt said he first became interested in the issue while a senior resident at the University of Washington. While leading a team of young physicians whom he described as dedicated and altruistic, he observed that some responded to the needs of their patients in a way that seemed out of character. He decided to study the experience of residency training and published a pioneering study in 2001 showing that burnout among residents was impacting the quality of the care they delivered. The widely publicized study became a lightning rod, he said, opening up a national dialogue on the issue.

It became clear that we had identified a big problem that needed a methodologic and consistent approach to studying and defining it and to testing interventions and trying to move the needle, he said.

He went on to the Mayo Clinic as a hematology and oncology fellow and joined the faculty there in 2005. In 2008, he became director of the Department of Medicine Program on Physician Well-Being and launched an effort to address physician distress through programs promoting physician autonomy, efficiency, collegiality and a sense of community. While many were focused on strategies to make individual physicians more resilient, Shanafelt and his team focused on systems, the practice environment, organizational culture, and leadership. As a result, the absolute burnout rates among Mayo physicians declined 7 percent over two years, despite an 11 percent rise in the rate among physicians nationally using identical metrics, surveys showed. A more recent assessment found the burnout rate among Mayo physicians was about two-thirds that of physicians nationally.

Shanafelt will work in collaboration with his new colleagues at Stanford in building on its innovative WellMD Center, which was established in 2016. The center has engaged more than 200 physicians through programs focusing on peer support, stress reduction and ways to cultivate compassion and resilience, as well as a literature and a dinner series in which physicians explore the challenges and rewards of being a doctor. The center also aims to relieve some of the burden on physicians by improving efficiency and simplifying workplace systems, such as electronic medical records.

In October, the center will host the first American Conference on Physician Health, in San Francisco, co-sponsored by the American Medical Association and the Mayo Clinic.

Bryan Bohman, MD, the centers interim director, said the WellMD team has worked closely with Shanafelt over the past year on projects of mutual interest.

All of us at the center have been struck by Taits collaborative nature, his integrity, his warmth, his generosity of spirit and his work ethic, said Bohman, chief medical officer for Stanfords University Healthcare Alliance. Both at Mayo and nationally in the physician wellness community Tait is seen as an inspiring and strong leader.We couldnt be happier that he will be guiding our future wellness work at Stanford.

David Entwistle, president and CEO of Stanford Health Care, and Christopher Dawes, president and CEO of Packard Childrens Hospital and Stanford Childrens Health, both expressed strong support for Shanafelts appointment as the leader of Stanford Medicines wellness effort.

In addition to his work in physician well-being, Shanafelt is an international expert in the treatment of chronic lymphocytic leukemia. He is directing multiple clinical trials testing new treatments for this disease, is the principal investigator for several grants from the National Institutes of Health and is a member of the Leukemia Steering Committee of the National Cancer Institute. He said he plans to continue his work on leukemia at Stanford, devoting about 30 percent of his time to clinical research and the care of patients with the disease.

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In a first for US academic medical center, Stanford Medicine hires chief physician wellness officer - Stanford Medical Center Report