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Chapter Newsletter - Spring 2001

From the Governor's Desk

The upcoming Rhode Island Chapter of ACP-ASIM Regional Conference should be an exciting one. It will be held on Tuesday and Wednesday, April 17 and 18, 2001 at the Radisson Airport Hotel in Warwick, RI.

Our reliable and effective format will once again be followed. On Tuesday, April 17, 2001 from 6:00 to 8:00 PM, there will be a reception and abstract exhibition in the University Ballroom. At the time of submission of this column, a tremendous number of abstracts have been sent in by residents. The topics are interesting and the discussion, I am sure, will prove to be illuminating.

The next morning, April 18, 2001, at 7:30 AM after registration, our College representative (to be named) will make a few remarks. After a brief business meeting, we will have a panel discussion that will include Jeanette Mladenovic, MD, Senior Associate Dean of the College of Medicine and Chair of the Department of Medicine at SUNY Health Science Center in Brooklyn, who will represent the American Board of Internal Medicine (ABIM) and participate in a discussion of the ABIM recertification controversy. This will be followed by the oral presentations by Associates and then the Irving A. Beck Memorial Award will be presented.

Over lunch from 11:30 AM to 1:00 PM, "Meet the Professor" sessions will take place. Our current group of professors will include hematologist Joseph Sweeney MD and rheumatologist Yousaf Ali MD. There will also be additional representatives from the pulmonary, gastroenterology, and cardiology divisions of the Department of Medicine.

Following this we will have Part II of our Associates oral presentations and the afternoon's activities will conclude with a two hour Universal Precautions update to be chaired by Anne Spaulding MD and Timothy Flanigan MD of the Division of Infectious Diseases at Brown University. We intend for this update to satisfy the Rhode Island Department of Health's medical licensure requirement for two hours of CME in universal precautions.

All in all, it should be an exciting two days. We encourage all to attend and participate.

Fred J. Schiffman, MD, FACP
ACP-ASIM Governor for Rhode Island

We Interrupt This Column...

Yul D. Ejnes, MD, FACP
Governor-Elect/Newsletter Editor

When I first planned this newsletter, I intended to write a column on an important bill in the General Assembly that will profoundly change how we practice medicine. The bill, supported by the RI Medical Society and almost all major health care provider groups and entitled "The Health Care Fairness Act of 2001," will allow providers to negotiate jointly, under certain circumstances, with third parties under an exemption from the federal antitrust laws. You will undoubtedly hear more about this bill in the RI Medical News published by RIMS and I urge you to support it by contacting your state legislator.

However, at the AMA's National Leadership Conference that I attended in early March, I heard a panel discussion on a topic that requires all of us to rethink what we do, so I'll focus on it here instead. The panel was entitled "There's No Such Thing As A Free Lunch" and the panelists included our own Herbert Rakatansky MD, FACP who is also Chair of the AMA's Council on Ethical and Judicial Affairs (CEJA).

Pharmaceutical companies spend a lot of money on us in many forms in order to market their products. The AMA has guidelines on what types of relationships with pharmaceutical companies are appropriate and which ones are not. They are worth reviewing and can be found on the AMA's web site at http://www.ama-assn.org.

If I could summarize the guidelines into one sentence, I would state them as follows: Token gifts such as pens, modestly-priced meals during an industry-sponsored educational program, and medicine-related gifts of no more than $100 in value that benefit the care of patients are OK, while anything that has little to do with patient care and/or has strings attached to it is not.

Not a day goes by without the mail bringing an invitation to "dine and dash," a day at the zoo for the family, or an opportunity to overnight in Boston and attend a show, courtesy of a pharmaceutical company, usually with an educational program attached (though occupying a tiny part of the event). If one applies the guidelines to these activities, most don't pass muster.

This topic will be the focus of several organizations over the coming years. The agreed-upon limits on pharmaceutical company marketing practices of several years ago have fallen by the wayside as we again see trips to Las Vegas, ski weekends, and other egregious examples of pharmaceutical company inducements. This has attracted the interest of some in the Congress and consumer groups, who will see to it that something be done about it if we don't fix it ourselves.

While times are not as good for many of us as they used to be, I don't think that we've been hit so hard that we need to depend on the "largess" of the pharmaceutical companies to feed and entertain our families. We physicians are a demoralized lot, with the insults of the insurers, legislators, and regulators chipping away at our collective pride. Let's not demean our professionalism at the same time by fighting to preserve drug company gifts as if they were all that important to us. We can do better than that.

The RIQP Column: Sublingual Nifedipine

David Gifford, MD, MPH
Clinical Coordinator
Rhode Island Quality Partners

Nifedipine given sublingually was a popular treatment for both hypertensive emergencies and elevated systolic blood pressure in asymptomatic patients. However, sublingual nifedipine causes a rapid and often unpredictable fall in systolic pressure; thereby making it contraindicated in the treatment of hypertension. There have been numerous, serious adverse effects reported with the use of sublingual nifedipine as a result of the uncontrolled, rapid drop in blood pressure.

In 1985 the Cardiorenal Advisory Committee of the Food and Drug Administration (FDA) reviewed all the data on the safety and efficacy of sublingual nifedipine for hypertensive emergencies. After much deliberation, the committee concluded that the practice of using sublingual nifedipine should be abandoned because it is neither safe nor efficient. The success of rapidly correcting blood pressure numbers merely represents "blood pressure cosmetics" and has not been shown to impact outcomes or prevent complications from high blood pressure. In the asymptomatic patient who presents with elevated blood pressure, the precipitous lowering of blood pressure is unnecessary. For those with symptoms due to high blood pressure, the lowering of blood pressure should be done in a controlled manner using medications that are short-acting and predictable (e.g. IV medications).

Contact Information:
David Gifford, MD, MPH
Clinical Coordinator
Rhode Island Quality Partners
401-528-3200 voice
401-528-3210 fax

Program - RI ACP-ASIM Regional Conference

Subject to change

Tuesday and Wednesday, April 17 & 18, 2001
Radisson Airport Hotel, 2081 Post Rd., Warwick, RI

Tuesday, April 17, 2001
6 - 8 pm Reception and Abstract Exhibition  
Wednesday, April 18, 2001
7:30 AM Registration and Continental Breakfast
8:00 AM Welcoming Remarks -
Fred J. Schiffman, MD, FACP - Governor
8:10 AM Opening Remarks -
College Representative
8:20 AM Business Meeting -
Fred J. Schiffman, MD, FACP - Governor
8:30 AM Panel Discussion: Board Recertification -
Facts and Controversies
Guest Speaker: Jeanette Mladenovic, MD -
ABIM Representative
10:00 AM Refreshment Break
10:15 AM Associate Presentations - Part I
Moderator: Allan Erickson, MD
11:15 AM Irving Addison Beck Memorial Award presentation
11:30 AM Meet-the-Professor luncheon sessions
1:00 PM Associate Presentations - Part II
Moderator: Dominick Tammaro, MD, FACP
2:00 PM Refreshment Break
2:15 PM Universal Precautions Sessions - 2 CME Hours
Lecturers: Timothy Flanigan, MD and
Anne Spaulding, MD
4:15 PM Closing Remarks -
Fred J. Schiffman, MD, FACP - Governor


Supporting Your Chapter through Chapter Dues


Chapter dues are the backbone of local activities and vital to the success of our chapter. While we are provided some financial support from the national office, the chapter dues collected provide the majority of financial support for local activities. Educational meetings, mentoring programs for medical students, local Associates' research competitions, advocacy with state legislators, and participation by chapter leaders in Leadership Day on Capitol Hill are just some of the activities supported by your chapter dues. Many of these activities are orchestrated by unpaid volunteer leaders in our chapter. However, the increase in activities at the local level has created the need for additional staff support to help manage the day to day operation of the chapter. Your chapter dues help support the cost of local staff and provide funding for new and existing chapter initiatives. When you receive your dues notice, please remember to include the chapter dues in your payment. You will be contributing to the success of many grass roots activities happening right here at home.