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While More Americans Need Access to Essential Healthcare, Fewer Primary Care Clinicians Are Available to Treat Them. UVA Professor Says Increased Funding for Title VII Programs May Help\nAlleviate National Shortage of Primary Care Doctors and Dentists

I want to commend, and cry over, what WP wrote: "What I am seeing in needy areas are things/conditions I thought only existed in previous distant centuries. The patient populations have been well described by Charles Dickens and depicted graphically by Giordano in his opera set during the French revolution…a stream of ragged peasants limping across the stage, right here in the United States, in 2009." I can vouch for it here in Vermont…right next to Dartmouth's great Dartmouth-Hitchcock Medical Center in Hanover, NH…where - at BEST - most Blue Cross/Blue Shield of Vermont clients CANNOT find a primary care physician (PCP) taking new patients… and where - at WORST - several women I know are choosing to die from their breast cancer because they cannot afford medical care and will not burden their kids or society. One woman has an MA in Counseling, and the other a PhD in Human Nutrition. These are not uneducated people… But they are most definitely poverty-stricken…and were poor before the 2008 global economic collapse.

Rader also believes that the MEGA trial raises important questions about just how widespread the use of statin therapy should be in primary prevention...reignite discussion on over-the-counter low-dose statins.

Primary source: Gehricke JG, et al "Nicotine-induced brain metabolism associated with anger provocation" Behav Brain Func 2009; DOI: 10.1186/1744-9081-5-19.

Natural Standard Herbal Pharmacotherapy: An Evidence-Based Approach is now available for purchase. The book provides practical guidance on the use of herbal therapies for medical conditions. This reference tool will be an essential part of herbal pharmacy core curricula for all healthcare disciplines. Chapters are organized by medical condition and present supportive evidence, including potential mechanisms of action and dosing, for selected herbal therapies. The chapters also include integrative therapy plans to help clinicians quickly assess patient needs and create cohesive treatment plans. In addition, adjunct therapies, including herbs, supplements and modalities, that are commonly used in combination with primary treatments are discussed. Case studies, which summarize efficacy, safety, dosing and interactions for high-utilization products, help prepare healthcare providers for patient counseling in clinical practice. Review questions, similar to those on national board exams, allow readers to evaluate their learning and identify areas for further study. The book also includes several appendices, which provide information about lab values as well as the safety, interactions and pharmacokinetics of select herbs.

A $10 billion investment in community health centers, expected to go to $14 billion when Congress completes work on health care reform legislation, was included in a final series of changes to the Senate bill unveiled today. The provision, which would provide primary care for 25 million more Americans, was requested by Sen. Bernie Sanders (I-Vt.).

There is reasonable evidence that the use of imiquimod for small (<2 cm) superficial BCC that occur other than on the face provides outcomes only marginally less satisfactory than surgery. There would be a place for imiquimod in treating patients with frequent multiple primary lesions when access to surgery is difficult or where clinical judgment may be influenced by patient factors as reported in some of the studies, eg, where patients may have contraindications to surgery.  It was noted that if recurrences occurred in this study they mostly occurred during the first 9 months after the end of treatment. The initial response was therefore predictive of long-term outcome so these authors recommend and encourage continued monitoring of skin lesions.

FDA-approval:  * Biopsy-confirmed, primary superficial basal cell carcinoma (sBCC) in immunocompetent adults; maximum tumor diameter of 2.0 cm on trunk, neck, or extremities (excluding hands and feet), only when surgical methods are medically less appropriate and patient follow-up can be reasonably assured (1.2)

Superficial Basal Cell Carcinoma Aldara™ cream is indicated for the topical treatment of biopsy-confirmed, primary superficial basal cell carcinoma (sBCC) in immunocompetent adults, with a maximum tumor diameter of 2.0 cm, located on the trunk (excluding anogenital skin), neck, extremities (excluding hands and feet), only when surgical methods are medically less appropriate and patient follow-up can be reasonably assured.  The histological diagnosis of superficial basal cell carcinoma should be established for other types of basal cell carcinomas, including nodular, morpheaform (fibrosing or sclerosing) types.

Fewer than half of all clinical trials recently published in journals with high impact factors are adequately registered, and about a third of those that are registered properly show discrepancies between the registered primary outcome and the one that actually gets reported.

*In West Chester, Community Volunteers in Medicine treated 332 patients in February, up 26% from February 2008. The cost of care was up 21%. At the same time, the clinic was about $100,000 behind in fundraising for its $1.8 million annual budget. *Ohio's 40 free clinics treated 56,000 uninsured patients in 2008, up from 43,000 in 2007. Marjorie Frazier, executive director of the Ohio Association of Free Clinics, expects the number to increase in 2009. In January, one clinic in Cleveland closed because it lacked funding. Ohio, one of the few states that helps pay for free clinics' operations, is cutting funding. Its two-year allocation for 2008 and 2009 was $2.1 million; for 2010 and 2011, proposed funding is $1.5 million. *California's 800 community health centers saw increases of up to 20% in uninsured patients in the past six months. The state, facing a $42 billion budget shortfall, is eliminating payments for some services for poor adults, including dental care. As a result, the centers will lay off 1,000 dentists and other staff, leaving as many as 400,000 people without dental care, says Chris Patterson, spokesman for the California Primary Care Association.

My "argument" against this guy's lazy, reactionary blog post is at the very bottom of the page, dated April 12, 2009. I think it's the longest comment he's received so far, too. Just look for a verbose passage. That's my rant against his reactionary, unsupported claims against NDs.

Journal of Skin CancerVolume 2011 (2011), Article ID 571734, 6 pagesdoi:10.1155/2011/571734 © 2011 Mary H. Lien and Vernon K. Sondak.

At a time when baby boomers are approaching the age of 65, some physicians attuned to this economic reality have simply stopped accepting Medicare patients.