April 16, 2012
Last month was an important one in the history of healthcare (and more importantly, health) in this country. The Supreme Court heard arguments related to the Patient Protection and Affordable Care Act (known colloquially as “ObamaCare,” mostly to those opposed to it), and lawsuits brought by twenty-six states to overturn all or part of the act. The Court dedicated six hours of oral arguments to the topic – the most since 1967 (a little history here). Four key topics were covered over three days of testimony. First, whether the Act constituted a “tax”, and if so, whether it could be stricken before the so-called tax was instituted and “harmed” anyone. Second, whether a mandate to every citizen of the country to purchase minimal healthcare coverage was unconstitutional. Third, whether “severability” was an option (i.e., parts of the law could be struck down instead of the entire law). And finally, whether Congress could withhold all or part of Medicaid funding to states that did not fully institute the Act. Today, we’ll leave tax law and Medicaid issues aside, and address the second and third items.
This is likely one of the most partisan topics ever brought before the Court – evidenced by (and highlighted by Justice Scalia) the fact that the twenty-six states opposing the law had Republican governors, and the twenty-four states supporting the law had Democratic governors. Hard to argue that it is anything BUT partisan with that lineup.
We are not constitutional lawyers (although President Obama is), nor do we play them on TV. Our approach is necessarily more at the grass roots level, as part of the industry that will be significantly impacted by the Court’s decision, whichever way it goes.
Let’s start with the parts of the Act that have already been implemented, and by most accounts, are widely supported. First is the ability for a parental health insurance policy to cover children up to age 26. This requirement provides the ability for parents to cover children just coming out of high school or college, who may not have full-time employment, or whose employers may not offer health benefits. This population typically would not purchase health insurance on their own due to financial limitations and the perception that they are unlikely to get sick. Which is fine, unless they actually DO get sick, in which case they may face significant financial distress, including bankruptcy – a stain on their financial record for many years to come. An early report from the National Center for Health Statistics estimated that 2.5 million young Americans are newly covered under this part of the law.
Lifetime and annual limits on benefits were also eliminated in 2010. For those with chronic or catastrophic illness, this is a critical point – and again, one that allows those with these illnesses to maintain both financial and physical health. Linked to this, and certainly as important, insurers are prevented from dropping policyholders when they get sick (a financially sound but ethically abhorrent practice).
As of August 2012, all new plans must provide preventative services without a deductible, including (based on age) blood pressure, diabetes, and cholesterol screening, mammograms and colonoscopies, flu and pneumonia shots, among many others. From a public health standpoint, these are so important for the long term health of our nation – and ultimately should lower the burden of caring for those who would have had more severe illness otherwise caught early by these screenings.
It’s impossible to argue that full repeal of the Act would have minimal consequences to the millions of individuals impacted by these changes. So, should the Court allow the already-implemented programs to stand, but repeal just the mandate that all must purchase health insurance? (Enter the “severability” discussion.) Of massive financial significance is the impact of repealing the “mandate” without repealing some of the other stipulations of the law. Insurance companies are already positioning themselves (and rightfully so) that without EVERYONE paying into the system, they cannot afford to offer unlimited lifetime coverage, cover those with pre-existing conditions and charge no more for those with these conditions. Repealing the parts of the law that fund insurers while retaining the existing “high cost” provisions will cause a ripple effect throughout the healthcare system. It will certainly result in significant cuts in reimbursement to providers (i.e., hospitals), many of whom already struggle to break even, and who remain obligated to provide care to the millions left without any coverage.
It is ironic that the administration’s less heavy-handed approach that allows the market to participate in healthcare reform – rather than creating a single payer system – has exposed the Act to the very arguments that are taking place. Had President Obama been successful at passing an Act with a single payer (i.e., governmental) system, the “broccoli” argument (read more here) would not have arisen.
So, we anxiously await the Supreme Court’s ruling, expected in June. Will we move forward with true reform of healthcare in our country? Will we scramble to figure out how to fill the gaps left by a gutted healthcare law? Or will we go back in time to March 22, 2010, and be forced to start over with a sharply divided legislature and country?
A watershed decision for our country. Stay tuned.
Valerie P. Weil, MD
Associate Dean for Finance, Administration, and Operations
Cooper Medical School of Rowan University
March 26, 2012
Two weeks ago, we held the final day of interviews for our Charter Class. Reflecting on the group of outstanding young men and women who will be in the Class of 2016, many thoughts come to mind – but among the most pressing is about money. Money.
Make no mistake, attending medical school is expensive. National data from all students who graduated in 2011 reveal that 86% of all graduates left with debt, with an average of $162,000 accumulated load during medical school — a hefty burden indeed to carry into 3 to 7 years of additional education during residency and fellowship. In addition, 35% of all grads had debt from their college days with a mean of $18,000. These numbers are getting big.
So what is the impact of carrying this financial burden? Some qualified applicants may never make it to medical school – they are unable to bear the debt that awaits them, especially if their families cannot contribute funds. Imagine those talented and passionate souls who may never have the opportunity to realize their dreams.
But there may be other implications for those who do have the wherewithal to enter medical school.
Imagine that you are a med student entering your final year of school. You need to decide upon a specialty since applications for post-graduate residency positions will soon be due. Also imagine that you’ll be graduating with a debt load of $200,000. That’s $200,000!
So are you going to apply to family medicine or general internal medicine programs? You really love primary care, but these are less lucrative specialties and, after three years of additional training, you’re going to need to start repaying your loans…
Well, maybe primary is care is not such a good idea. Maybe a surgical specialty? Or cardiology. Or dermatology.
These are noble disciplines, indeed. But with a projected shortage of 40,000 primary care doctors in 2020, how will we meet this national need?
Reducing the debt of medical students may be one way. All medical schools are under great pressure, appropriately, to limit the costs of medical education that convey to their students. Tuition, at best, contributes to a fraction of the total cost of a year in medical school that we as educators must derive from other sources. The availability of scholarships is one way to mitigate the economic challenge of becoming a physician, and we at CMSRU are working hard to identify these funds.
We recently celebrated a milestone event for our school, and while there have been many notable others, the $1,055,000 scholarship gift of Larry and Rita Salva was a special and enduring moment in our history. A sustainable moment.
Mr. Salva is a Rowan alumnus and Vice Chair of the Rowan Foundation Board; Mrs. Salva is a dental hygienist and dental educator. I urge you to look at a video on our website that features the Salvas as they express, far better than I can, their thoughts about this gift and the reasons for it.
This gift will provide $100,000 in scholarships for the Charter Class, and an endowment that will support future students on an ongoing basis. This remarkable gift builds on the generosity of several others as momentum in support of CMSRU is really beginning to take shape.
Elsewhere on our website, you will find more information about philanthropy and CMSRU. While we receive substantial support from the State of New Jersey, The Cooper Health System and Rowan University, we need additional resources to become a school that can realize remarkable potential and the opportunity to be “great”. In addition to the funding we already receive, our people are a remarkable resource whose value cannot be monetized. We can become a “very special school”. We can.
The “2012 Legacy Society” was created in order to recognize donors who contribute $1,000 or more to CMSRU; membership will close at the end of the first year of the Charter Class – summer, 2013. (Read more about this here on our website.) We will have a permanent Legacy Society display at the Dean’s office in our new education building, acknowledging those who realize the importance of a donation at this early time in our development.
Support for scholarships and other important initiatives increases the likelihood that New Jersey students will stay in the region to attend medical school and ultimately practice and become the kind of providers we desperately need. Many of our accepted students have also been accepted by other medical schools, and our ability to offer them financial assistance is critical for us as we look to attract the most highly qualified students who match our mission and who need financial assistance to attend our school.
Think about it. Gifts such as the Salvas’ (among many others) not only profoundly impact our students but they also have a tremendous “multiplier” effect – each and every patient that receives care from a CMSRU graduate benefits from the generosity of all of those who have already given. So the impact is significant and lasting. These gifts truly leave a “legacy”.
Our medical school is off to a remarkable start and we thank those who have helped us embark on a journey that will positively affect the lives of so many. We thank them on behalf of our students and on behalf of those who cannot thank them yet – the tens of thousands of people who will be cared for by CMSRU physicians.
Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University
March 7, 2012
Simulation has been utilized for years in the training of both military and civilians. Originally, the methodology was employed for situations where “real-life” experiences would have been cost prohibitive or too dangerous. We know that simulation has greatly enhanced the safety profile of the aviation industry, and it was just a matter of time until medicine incorporated the process of simulation into its training methods.
At CMSRU, education through simulation will take several forms. One of the first encountered and most important methods is the standardized or simulated patient. This approach uses individuals trained to “act” as patients. For example, they may relate or “act out” symptoms of liver or heart disease during a simulated interview process. Who can forget the “Seinfeld” episode where Kramer simulates having gonorrhea (here)? The actors are trained to provide feedback on their interaction with the student that aids evaluators in measurement of the competencies of professionalism, communication and teamwork.
The second approach is as “high fidelity” simulation. In a nutshell, this involves the use of highly sophisticated mannequins, programmed to simulate the sights, sounds, and technical outputs (e.g., electrocardiograms) of patients with a variety of illnesses. Our medical school has robust high fidelity programs that will allow medical students to train without any possible harm or injury to patients. Additionally, these experiences are “safe” for the student as well which facilitates the learning experience. Scenarios can include something as simple as an intravenous line insertion and learning of sterile technique, to the more complex tasks of handling critically ill patients, women in labor, or surgery.
The third mode, and one that is quite exciting to the generation raised on complex video games – is the Cave Automatic Virtual Environment, also known by the recursive acronym CAVE. This technology provides an immersive virtual environment that truly approaches reality. A CAVE can range from a three to six-wall room, with the latter being a totally immersive environment with four walls, floor, and ceiling, creating a 360 degree experience in all dimensions. Using complex 3D modeling applications, students can each practice dissection of any portion of the body, at any time, without worrying about limited resources for this educational activity.
Rowan University’s College of Engineering has been on the cutting edge of this technology for years, and is working with CMSRU to overcome some of the limitations of virtual dissection. (See Rowan’s CAVE in action on the Science Channel here.) One of the biggest issues with the virtual environment (as expressed by students) is the lack of ability to “feel” the tissues being dissected (or surgically manipulated). Rowan Engineering faculty and students are working on just this problem, building upon existing technology that provides tactile feedback, in order to provide the true feeling of dissection. Ultimately, it will be possible to almost entirely recreate the experience of traditional anatomic dissection (although, without the unforgettable, and certainly unmissed, aroma of formaldehyde!).
We are fortunate enough to participate in both the development and the use of this technology – and we look forward to advancing simulation for our students in the coming years!
Michael E. Goldberg, MD
Associate Dean for Academic Affairs
Cooper Medical School of Rowan University
Shreekanth Mandayam, PhD
Associate Provost for Research
Rowan University
February 23, 2012
In my last blog I wrote about food insecurity and touched on “food deserts” and “food literacy”. The “formula” for a good diet that I proposed was -
Financial Resources + Food Access + Food Literacy = A nutritional and balanced diet.
Addressing subpar access to food has received an enormous amount of attention in recent years. According to the U.S. Department of Agriculture (USDA food deserts), in 2009 over 23 million Americans were reported to reside in “food deserts” – “low-income census tract[s] where a substantial number or share of residents has low access to a supermarket or large grocery store” – this includes much of our city of Camden. Notably, the phrase “food desert” was supposedly first used in west Scotland in the early 1990’s by a public housing resident.
Take a few minutes and visit the USDA’s “Food Desert Locator” site here and type in a place nearby your home – are you surprised by what you found? A map of the U.S. shows that roughly 10% of the country qualifies as a food desert.
An article from “The Economist” last summer suggests that this may not be entirely what it seems, however. Last year, the number of people in food deserts was reported to be 13.5 million, an appreciable drop but one derived by changing the defining distance from a supermarket in rural areas from 1 to 10 miles thereby “increasing” access without really changing anything. Some have stated that the inclusion of proximity to “a supermarket or grocery store” in the definition ignores the large number of small food markets and farm stands – a point well-taken. But there is more to this story that involves having the knowledge to appropriately select healthy food whether at a large national retail chain store or the mom-and-pop market down the street.
I recently came upon a great definition of “food literacy” – “the ability to organize one’s everyday nutrition in a self-determined, responsible and enjoyable way.” The issue of “food literacy” compounds the problems of purchasing power and access. If one doesn’t understand what “healthy” versus “unhealthy” food is, then the informed purchase of good food is impossible.
How do we begin to develop a “food literate” society, especially in economically and educationally challenged area rife with low purchasing power and less than optimal access? To quote author Steven Covey, I think we need “to begin with the end in mind.”
If the goal is equip food purchasers with the information to make healthy choices, we must begin in our schools. Perhaps the most important part of “food literacy” is “literacy”, especially in those communities where reading skills are not what they should be. How can one interpret complicated food nutrition labels that adorn most foods if you can’t read and understand the words?
Second, comprehension about the basics of nutrition and health is essential and also needs to begin no later than elementary school. Additive to this are programs that help educate the parents of these students with the pertinent facts of food selection.
Finally, school lunches offer a wonderful opportunity beyond the provision of good healthy food. Lunch can be a “learning moment” to eat and learn about what’s on the menu; these real life experiences can be very powerful.
While the “equation” for good nutrition may be relatively simple, the “solutions” are multi-factorial and complex. For success, we as a country must address all three “variables” to get to this crucial answer.
Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University
February 6, 2012
It is irrefutable that fresh, wholesome food is necessary for good health. It is similarly undeniable that many people in our country lack the ability to acquire good food. Tragic but true in a land as well to do as the United States. Recently, new information has emerged about this not so new problem, a problem with dramatic health consequences. We all need to pay attention.
The Institute of Medicine (IOM) recently released an important report, “Hunger and Obesity: Understanding a Food Insecurity Paradigm” (IOM article). This extremely comprehensive publication arose from a meeting convened in November, 2010 by the IOM on behalf of the Department of Agriculture’s Food and Nutrition Service.
But let’s start with the taxonomy surrounding the spectrum of “Food Security” (access to nutritional, safe food coupled with the ability to acquire these foods in a socially acceptable way) at one end to “Hunger” (the uncomfortable painful sensation due to lack of food) at the other. Toward the “Hunger” end of the scale is “Food Insecurity”, defined as “limited or uncertain ability to acquire acceptable foods in socially acceptable ways”.
At the very least, this IOM treatise summarizes much of what we already know about the problem. While perhaps intuitively obvious, the data are stark reminders. Before 2008, the prevalence of food insecurity in the U.S. was between 10-12%, highest among Latinos and African Americans. In 2008, this jumped to 15% – the correlation with the beginning of the recession is striking – where it has remained since. Food insecurity is highest in new immigrants, not surprisingly; imagine the challenge in arriving in a new land and not having enough to eat, perhaps coupled with a dim chance of employment on the horizon. Interestingly, however, food insecurity is not synonymous with poverty; the definition of food insecurity includes challenges in access to and acquisition of healthy foods, regardless of one’s ability to pay.
Let’s go back for a moment to the title of the IOM report – “Hunger and Obesity”. Hunger AND Obesity? Yes. While the association of food insecurity and obesity in children and adolescents is somewhat variable among published studies, healthy nutrition is obviously based on not just quantity, but quality. So it does appear that obesity is a problem among the food insecure. Of note, among those with food insecurity, the prevalence of lower obesity is observed in the persistently poor who lack both food quantity and quality; food insecurity among those living below the poverty line approaches 40%.
Negative health outcomes arising from food insecurity exist: hypertension and elevated lipid levels are increased, but also diabetes. In those homes with significant food insecurity, the risk of diabetes is twice that of households with no food issues. Additionally, the finding of increased stress and depression among the food insecure is no surprise either.
Having the financial wherewithal is only part of the cause of food insecurity. A big part but, nonetheless, only a part. In fact, it is very possible to be food insecure in the United States where causality is significantly related to access – easy, convenient and safe access to acquire healthy, affordable food. Areas without such access are designated by another new phrase – Food Deserts – defined by the USDA as “low-income census tract[s] where a substantial number or share of residents has low access to a supermarket or large grocery store”. By the way, much of CMSRU’s own neighborhood in Camden, NJ, has been identified as one of these Food Deserts (see the USDA’s Food Desert Locator here). And there is one more important variable – “Food Literacy – that is, having enough of an understanding of nutrition and food to select appropriate food items. In an upcoming blog, I’ll be writing more about food deserts and food literacy.
So perhaps the “formula” is this:
Financial Resources + Food Access + Food Literacy = A nutritional and balanced diet that will support good health.
Shouldn’t this be possible? As health professionals, we have an obligation to our communities to help ensure that the most fundamental needs are met – the needs that will help foster well-being. The health and human consequences of doing less are not acceptable.
Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University
January 25, 2012
Medical schools educate adults. That’s a simple (and obvious) fact, but it has important implications for how we at CMSRU have designed our curriculum. A great deal has been written about adult learning. Some of the earliest and most influential work on this topic was done by Malcolm Knowles, a late 20th century American educator, who called the field of adult education andragogy (literally translated from the Greek as “man-leading”— although which we wish he would have called it enilikasagogy, or “adult-leading”).
Adults want to know what they are expected to learn. Recognizing this, we have designed all our courses and learning experiences by first explicitly developing the goals and objectives that will drive the content, instructional methods and assessments. These will be readily available to all students in advance.
Adults also like to know why they need to learn something. They want to be able to see the applicability of their knowledge. This led us to allow much of the curriculum’s content to emerge through robust exploration of realistic patient cases, rather than just through subject-driven lectures. (Indeed, only six hours per week are allotted to formal lectures in our curriculum.) Through case-based learning, students can a) see the immediate relevance of the presented material to the practice of medicine and b) determine what additional information they need to obtain to “solve” the case. It is exactly this motivation to “find out more” that drives much of the life-long learning that characterizes the best physicians.
Adults bring a wealth of life experience to the learning environment, and we are recruiting a charter class that is characterized by great diversity of cultural, social, economic and educational backgrounds. Adults learn best in a classroom atmosphere that is informal and friendly, where a sense of mutual respect exists between the teacher and the student, and which provides opportunities for them to share their unique understanding of the material with other learners. We expect our students to learn a great deal from one another. To take maximum advantage of this learning opportunity, we have allocated 25% of the week’s schedule to small groups (Active Learning Groups) of eight students each. Each group has two faculty facilitators who serve as guides to the students as they explore the material. In their role as a “guide on the side,” facilitators recognize that all the participants contribute to the group’s understanding of material.
Finally, adult learners have a concept of themselves as self-directed rather than dependent learners, and their motivation to learn is internal rather than imposed from outside (e.g., teachers, parents). Recognizing this, we have allocated 25% of the week’s schedule to self-directed learning (SDL). Students may use this time to explore topics in greater depth or to learn new material, working alone or in groups of their choosing. Crucial to the success of such self-regulated learning is reflection. Students will share their thoughts about their SDL experiences: what they learned; why they learned it; whether they thought the experience was fruitful, and why (or why not); and what the next steps might be. This sort of “metacognition” (knowledge of our own cognitive processes) enhances learning and creates a firm foundation for successful life-long learning.
By building our curriculum on the tenets of adult learning theory, we have created the blueprint for an enjoyable, productive and cooperative learning environment that will lay the groundwork for success as a physician in the 21st century.
Cindi Hasit, PhD
Assistant Dean for Faculty & Student Assessment & Development
Cooper Medical School of Rowan University
Lawrence S. Weisberg, MD
Assistant Dean for Curriculum – Phase I
Cooper Medical School of Rowan University
January 11, 2012
In our ongoing series of guest bloggers, Dr. Harry Mazurek, Associate Dean for Research for CMSRU discusses the challenge of developing our research mission – and the guiding principles behind that process.
As a new medical school, one of the challenges faced by CMSRU is deciding the direction of our research endeavors. It is “research endeavors” rather than just “research” because there are two equally important and vital components. The first component is scientific inquiry and the ability to push the frontiers of science. Exciting and often idealistic, it is what draws people to science, as ultimately the goal is benefit to humanity. Much less appreciated is the second component, the infrastructure needed to do support research – the people, the space, the regulatory issues, and ultimately, the money.
Using a nautical analogy, before eager sailors shove off in search of adventure, it is imperative that their course be feasible given the size and capabilities of the ship, the capacity of stores on board, the prevailing and predicted weather, and how crowded the waters are. Similarly, CMSRU has much to consider before embarking on our research “adventure.” To this end, a broad based committee is developing a research strategic plan that we hope to complete this spring. With representation from our basic science and clinical faculty, engineering, life sciences faculty from Rowan University, faculty from the Coriell Institute and the University of the Sciences in Philadelphia – both with which CMSRU has an academic affiliation, and computational and integrative biology faculty from our neighbor in Camden, Rutgers University, we have developed our research mission:
The research program at CMSRU is committed to a collaborative approach to conducting the highest quality research and advancement of knowledge in order to provide our students with opportunities to develop critical thinking skills and empower CMSRU to make discoveries in the art and science of medicine and healthcare delivery aimed at improving the health of our community.
Ultimately, we hope to achieve our research vision:
To be a high caliber, nationally recognized, scientific program committed to the translation of discovery and innovation directly benefiting patients and the public at large.
During the next several months, the committee will be determine research priorities based upon realistic, consensual and measureable goals and arrive at objectives and action plans needed to meet these goals.
It is imperative that CMSRU be deliberate before embarking on research given “the prevailing and predicted weather and how crowded the waters are.” While the very recently signed spending bill has NIH funding increasing 1% from last year, it is significantly below the inflation rate. Thus, it would be foolhardy for CMSRU researchers to compete for a shrinking pool of federal support in the same research areas as those from very large, well-established research-based centers.
Ultimately, research is a business. And just as industry has used the competitive strategy model developed by Harvard professor Michael Porter, similarly, our research strategic planning process will help us find niches where we can effectively compete for research funds. One such area stems from our efforts to address the healthcare challenges facing the residents of Camden – research in the science of healthcare delivery. Another, research in medical education, takes advantage of the fact that we are a new medical school using a very innovative curriculum and approach to educating our medical students, very different from that offered in long established schools.
The CMSRU research strategic plan, once complete and implemented, will afford our students many opportunities to participate in meaningful and innovative research projects whose outcomes will translate into benefits for our patients and the public at large.
Harry Mazurek, Ph.D.
Associate Dean for Research
Cooper Medical School of Rowan University
January 4, 2012
Over the holidays, one of the cable stations showed a marathon of Dr. Kildare movies and, as a fan of old movies and of Dr. Kildare, I watched a fair number. I hope that some readers will remember Dr. Kildare. No, not the 1960’s TV series with Richard Chamberlain as the young Dr. James Kildare, but the 1940’s series of nine movies with the late Lew Ayres in the lead role. Now for a little background.
The fictional Kildare was an intern receiving his post-graduate education at Blair General Hospital, under the mentorship of the irascible and cranky-yet-underneath-there-beats-a-heart-of-gold Dr. Leonard Gillespie, played by the wonderful actor Lionel Barrymore. The wheelchair-bound Gillespie is the master clinician, an incredibly astute diagnostician, and educator. In “Dr. Kildare Goes Home,” Kildare has just finished his internship and, as was commonly the practice 70 years ago, prepared to enter clinical practice. Gillespie offers young Kildare a position as his partner – a fabulous offer indeed. Yet Kildare chooses to go home to Parkersville to help his overworked and incredibly stressed out physician father. The young doctor conceives the idea of he and two of his internship colleagues opening a practice there – a clinic that provides health care services to the community, funded by a 10 cent per week contribution by all local residents. Under this plan, everyone will have access to care that is funded by the community, regardless of the individual’s ability to pay. Is this beginning to sound familiar?
Now recall that Medicaid funding of health care for those unable to pay was still some 25 years away when this movie was made. Based on historic inflation rates, 10 cents in 1940 is worth $15.66 per week in 2011, or a little over $800 per year.
The citizens of Parkersville are skeptical of this unheard of concept and are quite resistant to converting to such a system. This also sounds somewhat familiar, right? Well, as luck would have it, the newly trained Kildare becomes concerned that George Winslow, a community leader and major opponent of the proposal, is ill and offers to “run some tests.” The skeptical Winslow adamantly resists but the clever new physician obtains a blood sample (by somewhat less than ethical means) and learns that Winslow has a elevated white blood cell count suspicious of an infection.
Somehow, Kildare is able to diagnose pneumococcal meningitis (I admit I am mystified how he did this based on an almost total lack of signs and symptoms of the disease, but I digress). Kildare successfully treats the community icon. Winslow recovers and convinces the city to support Kildare’s health care delivery plan. For now at least, the city of Parkersville is happy and healthy!
Like all of the Dr. Kildare movies, there are lessons to be learned and “Dr. Kildare Goes Home” is no exception. Many of Kildare’s ideas about public financing of health care have come true. Yet, resistance to new ideas about access to care and the funding thereof remain ever present.
The day after I watched this movie, I came upon a piece from “The Atlantic” entitled “The Year in Preview: The Top 10 Politics Stories to Watch in 2012” (read it here). Included on the list is health care reform, specifically The Affordable Care Act, and the upcoming court challenges to the legality of the nearly two-year old Act. While 28 states to date have filed challenges, the Supreme Court will hear the challenge from Florida to the law, which specifically argues that the requirement for individuals to buy health insurance is unconstitutional. With arguments scheduled to be heard in March, and a decision anticipated in June, there will be ample time for the Court’s decision to impact the Presidential campaign – and the ultimate election outcome – in a big way.
While the new and unique 1940 ideas of Dr. Kildare about insurance and funding were ahead of their time, the Parkersville-like controversy remains.
Buckle up – the year ahead should be very interesting!!
Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University
December 22, 2011
It’s the time of year when “lists” begin to appear in the media documenting the “Top Stories of the Year”. In looking at a few sites over the last several days, it is not surprising that the lists are very similar: the earthquake in Japan, the Arab Spring, Osama Bin Laden’s death, Libya, Occupy Wall Street, Gabrielle Giffords’ shooting, the death of Steve Jobs, etc., etc. I think it is fair to say that all of us were touched by these stories in some way, as well as by the other events that warranted designation among the “elite” group.
While the “CMSRU Top Stories of 2011” weren’t of the same magnitude, we nonetheless had some pretty wonderful accomplishments during the past 12 months, many of which are detailed in the Dean’s Blog and elsewhere on our website.
As we plan for 2012, it is a little daunting to think about how quickly this year has passed. It was December 10th, 2010 (it seems like yesterday!) that we sent our 2,000+ page database to the Liaison Committee on Medical Education for Preliminary Accreditation! After taking a few days off for the holidays, our team began the New Year energized about preparing over next 20 months for the arrival of the charter class.
The activities undertaken and completed since last January are too numerous to recount here and this is not the time or place to do so. Suffice it to say, I am extraordinarily proud of all that we have accomplished – we are on time and on target for August 13, 2012, the first day of Orientation for the Class of 2016!
Our trajectory is true and we are exceeding all of our important milestones – but we are really just beginning to build a medical school that all of southern New Jersey can be proud of – a school that will graduate the kind of physician that every one of us would want to care for our families. To help us develop the resources needed to do this, we have just launched our initial philanthropic initiative at CMSRU, the “2012 Legacy Society”. This program was developed especially for those who believe, as we do, in this rare opportunity to help change the way in which physicians are educated – to help train those doctors who are distinctly recognized as CMSRU graduates. For those who are able to support the school at levels of $1000 and above, you will become members of the CMSRU 2012 Legacy Society. To learn more about the 2012 Legacy Society, go to http://www.rowan.edu/coopermed/giving/.
So as we turn the page on 2011, we at CMSRU owe a debt of thanks to so many who have supported and assisted us – this “list” is also too long to include here. We would not be here without you.
Finally, the CMSRU team offers our very best wishes to you and yours for the holidays and for a rewarding and healthy 2012. To those of you who have tracked our progress and who have followed us on Facebook, Twitter and this website, I promise you that the year ahead will be even more exciting than 2011 as we bring CMSRU to life and as we begin to educate the next generation of physicians.
Stay with us!!
Paul Katz, MD
Founding Dean
Cooper Medical School of Rowan University
December 14, 2011
While biomedical research has led to great strides in medicine over the past 75 years, it has often been accompanied by egregious harm perpetrated on human subjects in the name of medical science. Physician scientists, often reflecting cultural norms of the time, sacrificed patients in the pursuit of medical advancement, assuming that the ends justified the means. All too frequently, it was only after intervention by outsiders that the practices used in these trials were brought to light, and we were forced to take a hard look at the human toll and ethical ramifications of this research.
Only after abhorrent practices were “discovered” post hoc (using ever-evolving ethical norms) did we apply regulatory constraints to prevent future insults to trial participants. Nazi experimentation on concentration camp prisoners came to light at the Nuremberg war crimes trials and resulted in the Declaration of Helsinki in 1964. From that document was formulated a set of ethical principles for medical research involving human subjects, and the concept of informed consent was established.
In 1972, the decades-long Tuskegee syphilis experiment came to the attention of the US public. Poor, rural African-American men who erroneously believed they were receiving treatment for “bad blood” were, in fact, having the progression of untreated syphilis observed and reported by US government investigators. In part due to public outcry, the Belmont Report was issued in 1979, establishing the Office of Human Research Protection.
Henrietta Lacks, an African-American woman who died of cervical cancer in 1951, became the unwitting source of a cell line used by researchers in academia, industry, and NIH for over 25 years. Her story – and the story of how her cells came to be used without her or her family’s knowledge or consent – is told in The Immortal Life of Henrietta Lacks, authored by Rebecca Skloot. CMSRU hopes to host Ms. Skloot in the fall of 2012 to discuss the racial, economic, and education issues that allowed this happen. It is an important story that we hope will prevent future transgressions.
In our efforts to address and study the healthcare challenges facing the residents of Camden, we envision CMSRU becoming a research leader in the science of healthcare delivery. It will be imperative that the research be “Community Engaged Research” – inviting active community participation in study design, recruitment of subjects, conduct, and sharing of data.
We must always remember that while “Camden is our classroom; Camden is our home,” Camden is not our laboratory.
Harry Mazurek, Ph.D.
Associate Dean for Research
Cooper Medical School of Rowan University
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