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Progress Notes features doctors and medical students across the country on the frontlines of our health care system. Our views and experiences are diverse, but we share common goals and values. We speak up to move toward a future where everyone can have access to affordable, high-quality health care. Please share our posts, and follow us on Facebook and Twitter!


Orlando

By Nina Agrawal, MD
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Orlando. 49 dead. 53 injured. Most were in their 20's and 30's. Vibrant, healthy people who were in the right place at the right time - dancing and enjoying life with a community where they could be free. One angry person should not be able to kill and injure so many.

Some would prefer a moment of silence to address this tragedy. As doctors and medical students, we know silence is not the answer. We must raise our voices louder and honor the lives of those lost with action.

Even as we write, our colleagues in hospitals across Orlando are scrambling to treat and save those who were injured. 

Our profession is doing our part. Congress needs to do theirs. Every year, for twenty years, they have voted to pass a federal budget that restricts the CDC from doing gun violence research.  We won't let them do that again.  

As early as today, we expect an amendment to be introduced in the House to end the ban on gun violence research. 

It's time to flood Congress with calls from doctors and medical students EVERY DAY.

It's easy. Call the Capitol Switchboard now: 202-224-3121

Then email us at info@drsforamerica.org to let us know what happened and tell your friends to call too.

Never called Congress before? You can bet the NRA will be calling them and telling them to hold strong. Here's what you can say: 

"My name is [X]. I am a [Doctor or Medical Student] from [your city] with Doctors for America. I am outraged by what happened in Orlando. It is past time for us as a nation to see that gun violence is a public health crisis that we can no longer ignore. Will you vote to end the ban on CDC gun violence research and fund the CDC to do this important work?"

Every day, we mourn with the families of the 32,000 people every year who are killed by guns. We struggle to heal the 108,000 people every year who are injured - many of them permanently robbed of a fully functioning life.

Because of you, Doctors for America is leading the way on this critical issue. We delivered a petition to Congress from doctors and medical students in all 50 states. We have gathered a growing coalition of over 100 medical, public health, and science organizations who are taking a stand including the American Public Health Association, the American Medical Association, the American Association for the Advancement of Science, and many more. And we are working with champions in both the House and Senate to build support in Congress including organizing a bipartisan letter signed by 146 House members two weeks ago.

We can win this fight if all of us work together. In the days and weeks to come, your advocacy will make all the difference.

 

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Tell Congress to provide Zika funding NOW

By Dr. Mona Mangat
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Many of you have been following the news of the the Zika virus, which is spread to people primarily through the bite of an infected Aedes species mosquito. Just last week doctors confirmed that a baby had been born with Zika-linked microcephaly at the Hackensack University Medical Centre in New Jersey. Zika has the potential to cause a lot of illness and suffering in the United States. We know that those of us living in the Gulf Coast states, like my home state of Florida, where the tropical climate is hospitable to mosquitoes, are most likely to be impacted by Zika. But, this public health crisis can be controlled -- if we act now.

Unfortunately, many members of Congress have opposed allocating the $1.9 billion in funding requested by the Obama administration. This funding is needed right now -- as we head into mosquito season -- and is vital to ramping up surveillance efforts, controlling the mosquitoes spreading Zika, accelerating research into new vaccines and diagnostic tests and helping countries already battling the virus.

As doctors and medical students, we know all too well that the lives of our most vulnerable patients are at stake. I hope you will join me in speaking up to make our voices heard.

Here’s what you can do:

  • CONTACT CONGRESS - This is the time to call or email your local representatives to let them know you are concerned about the spread of Zika. Use this activation page to demand Congress put patients over politics and approve the funding necessary to control this impending crisis.
  • GET INFORMED - No local mosquito-borne Zika cases have been reported in the U.S., but there have been travel-associated cases. With the recent outbreaks, the number of Zika cases among travelers visiting or returning to the US will likely increase. Use this site to get up to speed. And, watch this video from U.S. Surgeon General Vivek Murthy to learn three ways patients can protect themselves and their families.
  • INFORM YOUR PATIENTS Put up this poster in your clinic or office. Urge patients to take preventive measures to avoid mosquito bites. And, talk with pregnant women about whether they or their male sex partners have recently traveled to an area with Zika.
  • PEN AN OP-ED OR LTE- Write an opinion piece or letter to the editor urging your member of Congress to put patients over politics and provide the funds needed to prevent the spread of the Zika virus.

 

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last day of the drive

By Dr. Alice Chen
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Over the last 10 days we have been humbled by the support of physicians and medical students from across the country.

I truly believe that there is no organization like Doctors for America. Together, in merely seven years of existence, we have made history together and improved our healthcare system to get it working better for patients. We have formed a networking of caring, committed professionals who take time out of our busy lives to support one another and fight for patients over politics on the most pressing health issues of our time.

I can't imagine a world where Doctors for America is no longer speaking up for our Nation's most vulnerable. Dr. Cat London can't imagine that future either. That is why Cat is so generously donating $20,000 to support the future of this organization. We are so grateful to her for her tremendous support!

This organization doesn't belong to anyone, it belongs to all of us. It requires each of us to carry a portion of the load when we can to ensure we can keep this movement going into the future.

I'm pleased to share that Tania Alfonso and Jose Rivera are joining Drs. Bruce Rector, Carolyn Senger, Umbereen Sultana Nehal,Meghana Desale and Ani Ramesh in pledging to match your donations today up to $3,000.


Yours in service,

Alice Chen, MD
Executive Director

 

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Taking on gun violence


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When it comes to addressing gun violence, doctors and medical students have proven ourselves to be one of the most effective messengers.    

Together, we have made national and international news to raise awareness for the 20-year ban on gun violence research at the Centers for Disease Control and Prevention (CDC). We’ve led over 100 of the Nation’s leading medical and public health groups -- including the American Medical Association-- to support ending the effective ban on gun violence research. Our voices are having a tremendous impact.

In order to keep up this important work we must chip in more than our time. We need to raise funds to keep fighting to reduce gun violence and make our communities safer. Without your generous donation, Doctors for America won't be around to fight these important battles. 

Can we count on you to join Don Nguyen in donating today to help us keep fighting to reduce gun violence? Don has agreed to match your donations up to $1,000.

As doctors, we know the long-lasting devastation that comes with gun violence, with 91 Americans who die each day and the 108 who are injured. It is so important for us to keep speaking up. There has never been a better time to maximize your donation. Please consider giving today.

Nina Agrawal, MD and David Berman, DO

Co-Leaders of the DFA Gun Violence Prevention Campaign

 

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Kicking off our Spring Membership Drive


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It’s that time of year again.

Today, we’re kicking off our Spring Membership Drive.

Over the next week and a half you will hear from us about our victories together, the work ahead and what is required to continue to fund this movement with the same independent approach to advocacy that has allowed Doctors for America to mobilize thousands of physicians and medical students to improve the health and lives of our patients for the last seven years.

In that time, you have helped us prove the power of the collective physician voice in making change for our patients in matters of public health. From the confirmation of our past President and co-founder Surgeon General Vivek Murthy, to our success in helping to pass the Affordable Care Act, to standing up for Flint, and raising awareness for the nearly 20-year effective ban on CDC gun research.  

Doctors for America depends on individuals like you for the majority of our funding. The future of our work together will only be limited only by the scope of our commitment. And, that includes the financial commitment of our membership in seeing the tremendous work of this organization continue in the years ahead.

That’s why I am offering to match your tax-deductible donation today up to $1,000. Will you chip in $25, $50 or $100 today?

Please consider joining myself and your colleagues in supporting Doctors for America today.

Mona Mangat, MD
Doctors for America, Chair

 

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Call to Action: Make your voice heard on drug pricing

By Justin Lowenthal, MD/PhD student
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As physicians and medical students, we know all too well that the price of prescription drugs affects the health of our patients. High prices for prescription drugs prevent many of our patients from accessing the treatments that they need, forcing many to choose between medications and rent as out of pocket costs grow. 

However, what is most frustrating is this: any time a common-sense proposal to address drug prices is put forward, powerful interests mobilize to quickly quash it.

This is happening now with a new proposal. The Centers for Medicare & Medicaid Services is proposing a set of 6 pilot projects aimed at testing possible reforms to how prescription drugs are reimbursed and the “value” of a drug is measured under Medicare Part B. These reforms are sensible approaches that deserve to be piloted and compared, as it is only through their testing that we can make an educated choice about which reforms will be most effective for our healthcare system – especially our patients.

However, political interests are rallying against them, and a battle is brewing.

Your voices – and those of your patients - need to be heard! CMS is seeking public comment on the proposed reforms, and YOU can submit a comment to support them and counteract those with financial interests in fighting these reforms. The deadline for submitting comments is May 9th.

To submit a comment, please click here

Below is sample language to get you started. Feel free to modify with your own perspective and stories about how drug prices have affected your patients. If you are willing, please also EMAIL your comment to Justin Lowenthal (justin.lowenthal@drsforamerica.org) so that we can collect our stories and build a stronger community to advocate for our patients.

For more information, click here and here, or see the recent press statement put out by DFA.

As always, if you have any questions or ideas, or if you have further thoughts in agreement OR disagreement on this issue, please email one of us and make your voice heard!

Always fighting to make care affordable for our patients,

Justin Lowenthal, MD/PhD student

Bruce Rector, MD

Mark Rood, MD

Dennis Deruelle, MD

Co-leaders of the DFA Drug Pricing/Value Campaign

Sample language:

“As a PHYSICIAN/MEDICAL STUDENT advocating on behalf of the patients I see every day, , I support the proposal by the CMS to test a sensible set of models aimed at changing how CMS pays for medications under Medicare Part B. High drug prices affect all types of patients: those needing chemotherapy, drugs for cardiovascular disease, treatments for autoimmune diseases, even antibiotics for life-threatening infections. 

No matter whether a primary care physician in family practice or subspecialist oncologist, each of us sees the effects of this problem daily. We know that drug prices are too high to be sustainable for our healthcare system and are alarmed by frequent, often exorbitant price increases. As a (INSERT DESCRIPTION – PRIMARY CARE PHYSICIAN, ONCOLOGIST, DOCTOR-IN-TRAINING, ETC.), I have seen first-hand how high and increasing drugprices force my patients to choose between the treatment they need and other essentials.

I think the approach that CMS is taking – to test a set of alternative payment models and other proposed reforms to better reward the value of a prescription drug – is a laudable and common-sense approach. It is only through this testing of pilot reforms that we will be able to choose the best option for our health care system and our patients moving forward.

I urge CMS to resist pressure from political interests on Capitol Hill and to move forward with this proposed set of reforms. In doing so, you will have my full support, and that of Doctors for America.”


 

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Nation’s leading health groups call to #EndTheBan

By Dr. Alice Chen
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We have some huge news.

Doctors for America members spoke up by the thousands to make a national issue of the effective ban preventing the Centers for Disease Control and Prevention from conducting gun violence research. And, today, the Nation's leading voices have signaled they have heard your calls.

Over 100 medical and public health groups, including the American Medical Association andAmerican Public Health Association, representing more than 1 million health professionals across the country have joined with members of the scientific community and research universities to urge Congress to end the ban on gun violence research and to fund this critical work at the CDC.

These calls echo the requests from 17 Senators and 53 members of Congress who recently urged for dedicated funds for the CDC to conduct research into the causes and prevention of gun violence. 

Doctors and medical students know federal research has tackled some of our Nation’s most pressing public health challenges. We believe gun violence must be next.

Help spread the word by sharing this major development today!

SHARE ON TWITTER 

SHARE ON FACEBOOK

We won’t stop fighting to #EndTheBan. Thanks for standing with us.

 

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Blogs from DC: Climate Change and Health at the White House

By Dr. Alice Chen
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This is part of a new blog series sharing goings on in the Nation’s Capitol with doctors, medical students, and interested parties around the country.

Today, Doctors for America was invited to the White House to attend a forum on climate change and its current and future impacts on health.  It coincided with their release of a new report, "Impacts of Climate Change on Human Health in the United States: A Scientific Assessment."

The event was an eye-opener even for me, an environmentalist since the fifth grade when I first learned about the impacts we were having on the planet and our responsibility to be better stewards of it for future generations.  

What I learned today was climate change is not only about polar bears and national parks, it’s about people getting sick and dying . . . not in thirty years, but today.  And particularly the most vulnerable people that Doctors for America has been working to help every day.  

The event was opened by Robert Simon and John Holdren from the White House Office of Science and Technology Policy and Gina McCarthy, EPA administrator -- framing the launch of this groundbreaking report that for the first time draws very specific connections between climate change and many many health impacts.

The first panel was expert scientists largely from the National Oceanic and Atmospheric Administration.  They highlighted a few of the important findings from their scientific modeling:

  • Extreme weather events will increase and disproportionately impact the most vulnerable.  As they said this, I recalled the NICU babies at NYU being transferred out of a powerless hospital during Superstorm Sandy.  I remembered standing outside the fenced off Charity Hospital in New Orleans in 2010 years after it was shut down by Katrina. I thought about patients being unable to get their medications, go to dialysis, or have enough food to prevent a diabetic patient from getting hypoglycemic.  

  • More floods mean more food-borne illnesses. They also mean more mold, which means worse asthma especially for those who can’t afford to remove the mold.

  • Heat will kill more people than will be saved by warmer winters. Fewer people will freeze, but many more people will die from heat in the summer.  I started picturing my frailest poorest patients home alone getting hotter and hotter, more and more dehydrated, and finally succumbing.  It's hard to imagine in our climate controlled hospitals, but this is reality for people who cannot afford to have air conditioners in their homes..

  • Vector-borne diseases. Lyme disease will move northward and start earlier in the year.   We will see more varied tropical disease showing up in the U.S.

  • Shell-fish and vibrio. More shellfish will be exposed to vibrio, so more people will get sick.

  • Mental health. Anything that impacts your health and the health of people you care about will impact your mental health. Extreme weather events exacerbate PTSD, depression, anxiety. 44 million people a year have mental illness.  

Human impact on the planet is making survival of the fittest hardest for the very old and very young, the sick, the poor.  Our most vulnerable patients.  The ones we try hardest to protect.

It turns out that climate change makes social determinants of health even worse for everyone but especially those who have the least..  

Now what can we do about this all?  How do we both address the root causes of climate change and help our patients and communities be more resilient in the face of a changing planet?

For a high level view on this question, we heard from Senator Ed Markey of Massachusetts.  He was pretty pleased with the all-star Massachusetts team working on this - EPA Administrator Gina McCarthy,Surgeon General Vivek Murthy, Director of the White House Office of Science and Technology Policy John Holdren, and Secretary of State John Kerry.

He emphasized that today's report shows that climate change impact on health is much worse than we thought.  A sick planet will impact the health of people.  

Senator Markey is now working on legislation to fund programs to train medical and public health professionals, fund research, and come up with a comprehensive plan.  We have to come up with a treatment plan for the planet, he said.  We need clean energy, low-energy vehicles, and shared solutions and political will with the rest of the planet.  The political climate is contentious, but we have to look back on this time and know that we tried.  

The next panel was moderated by Linda Birnbaum of the National Institute of Environment Health Science and included non-government leaders from the American Lung Association, the Center for Public Service Communications, the George Washington University Milken Institute School of Public Health, and the Maryland Department of Health and Mental Hygiene.

Here are some key notes on what we can do with the new report and what is already happening:

  • Use data to help parents understand impacts of air pollution: A panelist shared a story of a mom of three kids with severe asthma.  She was at her wits end, until her doctor told her to move away from the polluted air.  They picked up their lives and moved to another state.  Today, the kids are thriving, playing soccer, even playing the saxophone at Carnegie Hall.  Not every family has resources to do that, but knowledge helped this family.  

  • What can health care providers do?  Health care providers need to be educated.  They can educate others and urge policymakers to reduce climate change and fund research so we know how best to address the health impacts.  The panelists also gave a shout out to many hospitals that are working hard to reduce their footprint through the Healthy Hospitals Initiative.

  • What should health professional and public health schools do?  Educate students on the facts and how to apply it, conduct research on how to prepare communities and model policy options, work with communities around them.

  • What should departments of public health do?  Everything in public health is impacted by environment. Engage with the true front lines in communities with the information in this report, like working with forecasters to help with reduce heat problems in public workers.  

  • How to reach communities like indigenous communities and other minorities?  Need to make the information relatable to minorities and underserved communities.  Nurture and mentor leaders from within the community.  Need to incorporate the needs, voices, cultures, and languages of urban and rural minorities.

  • Teaching climate literacy in middle and high school.  This must be done to help people be better prepared for civic participation on what's happening and spark interest in STEM fields.  

  • How do we balance mitigating and adapting to climate change?  What’s the bottom line?

    • It's critical for people to know effects are happening right now.

    • It's not only polar bears - it's clean air to breathe, not being flooded, avoiding disease.  

    • It's clear we have to mitigate worsening climate change and adapt to what’s already happened.
      IMG_5112[1].JPG 

After the panel, the closing speaker was Doctors for America's former president and co-founder, our nation’s 19th Surgeon General Vivek Murthy!  He shared stories of caring for patients with respiratory illnesses -- and that so many of our patients say that being unable to breathe is the scariest thing to experience. We have an opportunity to prevent that from happening. He also shared inspiring words about the urgency of acting now, about our American values of being responsible for one another, and of our capacity to face this challenge and overcome it.

Doctors for America has not yet as a movement spoken up about climate change because it felt less directly relevant to a physician’s experience than a patient having no health insurance.  But today’s event and this new report have definitely opened my eyes to the urgency of doctors getting educated and speaking up about the impact of climate right now on the health and lives of our patients.

Read the report at health2016.globalchange.gov, share it with your friends, and let us know your ideas for what we can do by emailing DFAHQ@drsforamerica.org.

 

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A special thank you on National Doctors Day

By Dr. Alice Chen
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Today is National Doctors Day -- a moment in the hustle bustle of life to say thank you for being a doctor or doctor-in-training. For those friends-of-doctors who receive our emails, I hope you'll indulge a moment of self-reflection on this day.
 
I am reminded today of a weekend way back in February 2009 when Doctors for America sent out our first petition -- supporting health care investments in the stimulus package. In that early effort, we collected signatures by email and entered them one by one into a spreadsheet. We heard from hundreds of doctors and medical students. Emails poured in from states and cities I had never been to, but the sentiment was the same -- across the country, doctors and medical students wanted better for our patients and for the practice of medicine, and they wanted it so much they were publicly standing up for it. I particularly remember hearing from a 90-year-old retired rheumatologist who wrote, "I have waited my whole life for health reform to happen. I can't travel anymore, but I want to be a part of this movement."
 
What I love about working with all of you at Doctors for America is the extraordinary diversity of people who share a common generosity of spirit and compassion toward the suffering of our patients and complete strangers.  Some of you are retired after a long career of touching thousands of lives. Some of you are in medical school just learning how to care for people. Some of you see patients in a rural private practice or a large academic hospital. Some of you are world-expert subspecialty surgeons and others are family practice doctors who see it all. In clinics, hospitals, medical school classrooms, public health departments, government agencies, research labs and institutions, the public and private sector, you are making difference in the health and lives of people around you. 
 
Each of you in your own way has made sacrifices to be a physician or physician-to-be. You have spent birthdays and holidays at a patient's side.  You have sat at home after a long day still worried about that one patient. You have clinched that diagnosis with all the art and science of medicine you could muster. You have stood up for your patients when a baffling medical bureaucracy has threatened to hurt them. You have shared sorrows and joys with patients and their families.  
 
Above and beyond that, at some point you chose to be a part of the Doctors for America movement. You chose to join hands with colleagues across the country to take that extra step -- to sign a petition, respond to a survey attend a call with a policy expert, ride along with a bus tour, show up in a white coat at a rally, write to your members of Congress or your local paper, meet fellow Doctors for America members at a national conference, educate the people around you. Your individual efforts big and small have added up to a movement that is transforming the profession of medicine and the health of the nation.
 
Today, we say thank you for all you do as physicians, advocates, citizens. In the midst of news cycles filled with political strife and divisiveness, it is this movement that gives me hope. Colleagues in all 50 states who believe that everyone -- no matter who you are, where you're from, or the color of your skin -- deserves to have the greatest health possible so they can live their lives and follow their dreams.
 
From the bottom of my heart, thank you. May you have a beautiful day today and take a moment to thank yourself and your colleagues in your service to humanity.  

 

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Update from the Drug Pricing Working Group

By Bruce Rector
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The Doctors for America Drug Price & Value Campaign team leaders Dennis Deruelle, Justin Lowenthal, Bruce Rector, and Mark Rood are actively working to inform, encourage, and empower physicians to join discussions on healthcare value and pharmaceutical prices. We are at a critical moment in discussions about reforming our system of pricing drugs, as is evident by heavy media coverage and the surfeit of politicians proposing initiatives to address high drug costs. The US has long had a problem with the rising costs of drugs and the unaffordability of prescriptions to our patients as well as the healthcare system as a whole. We plan to lead the push for solutions in order to foster a health care system that leads in innovation while also delivering medicines that are both affordable and effective. There are many innovative proposals on the table and moving forward will require the perspectives of all stakeholders. We must ensure that the perspective of physicians are included at the table so that we can advocate on behalf of our patients and for the good of the health care system that serves them.

Our team leaders have been actively participating in national and local meetings on drug prices to learn more about possible solutions, to provide the DFA provider perspective on initiatives, and to focus the debate on our patients needs.  Among these high levels meetings are the HHS Pharmaceutical Forum (Bruce), Academy Health National Health Policy Conference (Mark), Center for American Progress Stakeholder Roundtable on Drug Costs (Bruce), John Hopkins Symposium on Prescription Drug Pricing: New Solutions (Justin), and alternative payment reform discussions (Dennis). As part of these, we want to get our membership involved! We will be holding educational events, providing resources, delivering breaking news updates about recent price increases, cataloging legislative initiatives relevant to local DFA chapters, and developing tools for our members to use in their communities when discussing drug prices and their value for our patients and health care system. We also plan to survey the DFA membership to learn more about their particular views, including stories of how drug prices have affected patients they care for and particular policy issues about which they are most passionate. Please contact one of us to get additional information and to become involved! We welcome any and all input, as there is much that we can be doing. Check back here on the blog for additional information on our campaign.  

Bruce Rector is the New York State Director.

 

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