January 2010 Volume 15 No. 1
THE WAKE COUNTY PHYSICIAN
Magazine
Celebrating medicine, the arts, intellect, ideas and curiosity.
THE WAKE COUNTY Wake County Medical Society TABLE OF CONTENTS
PHYSICIAN Officers and Executive Council Page 1 President’s Message
2010 Raynor Casey, MD
The Wake County Physician is a publi- Page 2 Editorial
cation for and by the members of the President
Assad Meymandi, MD, PhD, DLFAPA
Wake County Medical Society. The Wake Micheal Thomas, MD, PhD
Page 3 Return Home
County Physician is published in January, Treasurer Holden Thorp, PhD
April, July and October. We will consider David Cook, MD Page 4 Letters to the Editor
for publication articles relating to medi-
cal science, editorials, opinion pieces, Past President Page 7 Socrates Sense Perception
Kaye Stuffolino
letters, personal accounts, photographs Raynor Casey, MD
and drawings. Prospective authors
Page 8 American Football Loses Something
should feel free to discuss potential Assad Meymandi, In The Translation
articles with the editorial board. MD, PhD, DLFAPA Assad Meymandi, MD, PhD, DLFAPA
Founding Editor and Editor-in-Chief Page 9 The National Tragedy at Fort Hood
Manuscript Preparation Submissions
John Dale Dunn, MD, JD
should be sent electronically to
emeymandi@nc.rr.com Page 10 The Arts
Editorial Board
John Dancy
Submit photographs or illustrations as
Jeffrey Engel, MD Page 12 WCMS Society News
high quality 5 x 7 or 8 x 10 glossy Brian Go, MD Page 14 WCMS Update
prints or a digital JPEG or TIF file at 300 Douglas I. Hammer, MD, DrPH Paul Harrison
DPI no larger than 2” x 3” unless the Ken Holt, MD Page 15 Studying Compassion with the Dalai Lama
artwork is for the cover. Please include L. Jarrett Barnhill, MD Clifford Saron, PhD
names of individuals or subject matter Nicholas Stratas, MD Page 18 Physician Profile: Dr. Burroughs and son
for each image submitted. Photos may
Phillip Timmons, MD Fiona Morgan
be sent directly to:
Fiona Morgan Page 20 North Carolina Treasures
PRN Marketing, Inc. Susan T. Weaver, MD Phillip J. Kirk
1501 Hemphill Dr. Raleigh, NC 27609 Randall W. Williams, MD Page 21 Surgery In NC Prior to Civil War
tina@tinafrost.com Memory F. Mitchell
919.671.3963 Page 22 First Person
Council Members
Authors Bio and Photos Richard A. Lippin, MD
Submit a recent 3x5 or 5x7 black and Susheel Atree, MD Page 23 Placebos, Magic & Faith Healing
white or color photo (snapshots are Margaret Douglas, M.C. L. Jarrett Barnhill, MD, DFAPA, AACAP
suitable) along with your submission for Jeffrey Engel, MD Page 24 Short Happy Life of Bloomsbury Park
publication or a digital JPEG or TIF file Manish Fozdar, MD Nancy Cobb Lilly
at 300 DPI no larger than 2” x 3” (Send Page 25 BioMusic Research
Brian Go, MD
to PRNmarkeing at the above address.)
Warner L. Hall, MD Patricia Gray, PhD
All photos will be returned to the author.
Doug Holmes, MD Page 26 Mental Health Corner
Include a brief bio along with your prac-
tice name, specialty, special honors and Ken Holt, MD Nicholas E Stratas, MD, DLFAPA
positions on boards, etc. Please limit the Dixon McKay, MD Page 27 Medical Board Stand Against Executions
length of your bio to 3 or 4 lines. David Miller, MD David K. Gittelman, D.O.
Dale Oller, MD Page 28 Public Health Issues
Submissions may be mailed to:
Heather Miikles Jeffrey Engel, MD
Editor, The Wake County Physician
2500 Blue Ridge Rd, Ste 330 Page 29 Healthcare Reflections
Raleigh, NC 27607 Robert H. Bilbro, MD, FACP
Phone: 919.782.3859 Page 30 Poetry Corner
Fax: 919.510.9162 VISION FOR WCP John Balaban
a magazine
E-mail: emeymandi@nc.rr.com Page 32 Thinking Things Through
- with appeal to the family of medicine in
Assad Meymandi, MD, PhD, DLFAPA
Wake County and to the larger world beyond
Page 34 Quarterly Morbidity Report
For ad placement information bound together by scientific, intellectual and
artistic glue. (Urbi) Jeffrey Engel, MD
contact Paul Harrison Page 36 Editor’s Notebook
- with the collaboration of the alliance, bring-
Phone 919.792.3620 ing together Wake County medical families Assad Meymandi, MD, PhD, DLFAPA
Fax 919.510.9162 through words and pictures. To know who Page 38 Views & Reviews
dies, who marries, who gets promoted, and J. Bradley Wilson
Ad Rates and Specifications: those who go to which medical school. Page 42 Issues On Care At The End of Life
Full Page 1/2 Page 1/4 Page
- a powerful instrument to attract and induct Edward B. Yellig, MD, FACP
members to organized medicine, particularly Page 44 The Ongoing Brain Activity
$300 $150 $75 the WCmS, nCmS and ama (orbi) Ali Mazaheri, PhD
- read globally in intellectual, spiritual, aca- Page 46 Book Reviews
Camera ready artwork for demic and business centers beyond Wake
Assad Meymandi, MD, PhD, DLFAPA
advertisements should be sent to: County and north Carolina through online
Page 50 In Memory
circulation.
Tina Frost - a globally recognized and credible instru-
Page 51 Teaching Research Ethics
PRN Marketing, Inc. ment to bridge the gap between medicine, Gary Comstock, PhD
tina@tinafrost.com basic sciences, ethics and bioethics; the Page 52 Art & Technology - Mary Ann Sherr
arts, such as music, opera, dance, poetry; Interview by Betty Ellen Madry
Trim Size: 8 1/2” X 11” and all of the humanities such as philosophy, Page 50 Project Access 2009 Thank You’s
history, patriotism, epistemology, theology Back Role Model Worth Emulating
Binding: Saddlestitch
and rhetoric. Cover Kathleen Spellman McLaurin
Robert McLaurin, MD & Paige McLaurin
President’s Message
by Raynor Casey, MD
The economics of medical care
in Wake counTy
T
he biggest of seeing patients EXCEED the Medicare Hampshire, its largest city, is 8% cheaper
role of the allowable or reimbursement. To further than Raleigh, and that the biggest differ-
p r e s i d e n t compound the problem, in North Carolina, ence is housing, which is 30% less expen-
of the Wake we are reimbursed lower than the national sive in Manchester.
County Medical average. Even comparing Raleigh to other cities
Society seems to be signing tax forms and Let us look at a simple code that physi- in North Carolina, it is apparent that the
writing these four quarterly columns. In all cians use for a patient visit - 99213… in cost of living is not uniform throughout our
honesty, I must confess that my science and North Carolina, Medicare allows $58.89, state. Where should I start? How about my
math scores were a major part of going to while the national average is closer to hometown, Greenville, with its own thriv-
medical school. However, just as big a role $62, for a difference of three dollars, even ing medical center: Raleigh is 24% more
was my inability to write a decent essay or though Wake County has higher overheads expensive. As www.bestplaces.net ex-
short answer test. Please bear with me as I than the national average. A review of the plains, “Housing is the biggest factor in the
climb this soapbox once again in my final government’s website covering Medicare cost of living difference,” and compared to
act as president. issues, www.cms.gov, shows that New Greenville, housing is 81% more expensive
The stated role of the Wake County Hampshire reimburses $61.79 for the same in Raleigh.
Medical Society is, “To serve and repre- service. So they get approximately 5% You may not consider this a fair compar-
sent the interests of our ison, how about looking
physicians; to promote at North Carolina’s larg-
the health of all people est city? Raleigh is 17%
in Wake County; and more expensive than
to uphold the highest Charlotte, with housing
ethical practice in medi- being 41% more expen-
cine.” sive in Raleigh. On the
So what is the biggest other hand, compared
problem facing doctors to a small town, Raleigh
and patients of Wake is 37% more expen-
County? I have asked sive than Clinton, and
many of you over the housing is 188% more
past year and the only expensive in Raleigh.
common thread I could What does this matter?
find is Medicare. It is a Well, the cost of renting
rapidly expanding prob- or buying one’s medi-
lem since the 65 and cal office varies greatly
over age group is the upon housing costs.
fastest growing popu- Subsequently, our em-
lation. So what is the ployees also have to pay
problem? Simply put, the increased housing
Medicare reimburses only enough to keep more for the same work? costs and need to be paid more.
the doors open. The fact that allowable reimbursements So there you go, those are the numbers.
Many of our Wake County primary care are higher in New Hampshire is interest- It costs more to run an office in Raleigh
physicians, internists and family doctors do ing. Does it cost more to live there? No, it and Wake County than throughout most of
not accept new Medicare patients. Some does not cost more than Wake County. In North Carolina. However, the physicians
are actively releasing their current pa- fact, a cost calculator on the website www. cannot participate and charge Medicare
tients: Why? Again, it is simple: the costs bestplaces.net states that Manchester, New patients more due [Continued on page 21]
Wake County Physician January 2010 PAGE 1
Editorial
Assad Meymandi, MD, PhD, DLFAPA
Founding Editor
assisTed suicide. sir edWard doWns
Quindecennial issue
I
know this is the Quindennial issue of our magazine. Over one hundred cases, including
I know we should break out the champagne and give Sir Edward and Joan, there have
cheers. However, important issues beckoning the prac- been no prosecutions of those who
tice of medicine prevent us from that luxury. In the last few accompanied seeker of suicides.
months, an event that has profoundly affected me person- In the case of Sir Edward, Joan,
ally was the death of a friend I most admired and loved. He their son, and daughter, no slippery
was the gifted, knighted, and holder of the rank of Com- slopes of misdeed and no con-
mander of British Empire (CBE), conductor Sir Edward spiracy have ever been uncovered.
Downes. He was 85. The lives of both his and his wife, Nonetheless, In England, July 2009,
Lady Joan, were shortened by design. Here is the story: a law to guarantee exemption from
Sir Edward was partially deaf and completely blind prosecution of those persons who
suffering from terminal illnesses and failure of multiple accompany suicide tourists was de-
organs including heart and kidneys. His wife, Joan, 74, had feated. Likewise, it is the case in the
terminal cancer and was in a great deal of pain requiring United States. The laws are strictly
enormous quantities of narcotics and opiates. They wanted against assisted suicide. Our readers
to take their lives, recall the case of pathologist Jack
but the British law Kevorkian who was sentenced to
does not provide for 25 years of imprisonment and is
such plans. There- now free on parole. He defied the
fore, they travelled Sir Edward Downes
law and assisted terminally ill with
to Switzerland, lethal doses of drugs.
where the law on It is not suggested to do away with the existing laws without
assisted suicide is thoughtful debate. The laws are designed to protect the elderly
the world’s most lib- against avaricious shuffling and coercing older relatives off to die
eral. Their son and before they wasted their assets on nursing home fees and depleting
daughter watched their inheritance. In addition, granted, many terminally ill suffer
Sir Edward and Joan
them as they drank a reversible depression. In my own daily practice of geriatric psy-
lethal dose of barbiturates and died while holding hands. chiatry, I see many elderly who suffer from reversible depression.
In most of the Western world, suicide is not a crime but help- They need to be treated and returned to enjoyable life. However,
ing another to commit suicide is a crime. Not all the incapacitated, we have adequate diagnostic skills to separate those who are de-
terminally ill, or permanently disabled patients are willing to pressed from those who are terminal and close to death. We should
wait for a natural death. Nor are they willing to take the messy allow the patients of this category to die quickly and peacefully.
and uncertain measures to kill themselves without medical help. We also have enough linguistic skills to frame a law that clearly
Increasingly, they travel to Switzerland often with members of offers guideline to achieve these goals. Studying the laws of Neth-
their families to seek assistance in terminating their lives. In erlands, Switzerland and Belgium could be helpful (I have copies
Switzerland, assisted suicide is a crime only if it is done for gain. of these laws and would be happy to share with readers.)
However, there are strict rules and guidelines as to who qualifies. A law of this sort would have allowed the esteemed, hon-
Belgium, the Netherlands, Luxemburg, and the American states of ored, honorable, the famed composer and conductor, Sir Edward
Oregon and Washington are a few places in the world where as- Downes and his wife, Lady Joan, to die as they wished in their
sisted suicide is allowed. People who go to Switzerland to receive own country and in their own home.
assistance for suicide are often called suicide tourists. Physicians and organized medicine, such as American Medical
The history of assisted suicide in England is interesting. In every Association (AMA) and American Psychiatric Association (APA)
case of assisted suicide police investigates the suicide thoroughly. should bring this matter to the forefront of public consciousness.
We must. Editorial continued on next page
PAGE 2 January 2010 Wake County Physician
reTurn home
by Holden Thorp, PhD
Chancellor, UNC Chapel Hill
I
t’s a treat to be back in the pages of the Wake County Physi- Our physicians
cian. Since my last regular column, the Thorp family has quite consider meet-
an exciting ride. We moved from Carrboro to the Chancellor’s ing the needs
residence at Quail Hill and we moved from Section 222, Row R at of our indigent
the Smith Center to the third row next to Dick Vitale. patients to be
We’ve all learned a lot. For me, one of the most rewarding aspects an indispens-
of my new work is my enhanced role in the day-to-day workings able aspect of
of the UNC Health Care System. I am a member of the Board of our work as
Directors of the UNCHCS and am on the Executive and Com- the peoples’
pensation committees. In addition, Bill Roper reports to me in hospital. It is a
his roles as Vice-Chancellor of Medical Affairs and Dean of the vital part of our
School of Medicine. mission.
I’ve taken a lot of time to learn about the inner workings of Late last year, we worried that we would not be able to meet
UNC Hospitals and US health care in general. This includes shad- our obligations in uncompensated care, because our income from
owing in the operating room, emergency department, and labor patients with insurance was falling behind. Fortunately, Bill and
and delivery. I have a hospital badge with my picture on it, and I his team made adjustments that allowed us to continue. However,
wear it with pride. neither Bill nor I believe that the current system is sustainable
It is a privilege to work with Bill Roper. He has seen the US indefinitely, and we are hopeful reform will take place.
health care system from every perspective imaginable. He ran Two aspects of health care reform are worth special atten-
the CDC for George H. W. Bush and Medicare for Reagan. He tion. The first is the need to control costs. It is apparent from my
has been dean of both public health and medicine at Carolina. So time shadowing in the hospital that there are inefficiencies in the
he knows the substance and the politics of health care as well as system. While UNC HCS has done a great job of addressing these
anyone. – including a thorough review by the Boston Consulting Group –
It has been great to have Bill as my guide during this learn- numerous aspects of the way health care is practiced in the US add
ing process for me and this time of incredible change in the US to the costs.
system. A close look at the balance sheet of UNC Health Care One of the big problems is our lack of information about com-
shows why change is needed. This year, UNC Health Care parative effectiveness. We only have hard data on a tiny fraction
System expects to provide $300 million in uncompensated care. of US patients – only those involved [Continued on page 11]
Quindecennial Issue pages of the magazine since she took over Fiona Morgan, the daughter of our learned
F
ifteen years ago, few believed the a couple of years ago. colleague, Dr. Dean Morgan, Hospitalist,
two and a half to three page Wake Raleigh Duke Hospital, to consider joining
County Medical Society Newsletter Some additional good news: the Editorial Board. She will be writing
W
would turn into such a well respected and e have been most fortunate to “Profile of the Month.”
sought after magazine that eminent writers, have acceptance from Dr. L. This is your magazine. Write to us and
philosophers and scientists read and for Jarrett Barnhill, professor of for us.
which they are delighted to write (see table Child Psychiatry, University of North
of content). We owe this literary and intel- Carolina School of Medicine Chapel Hill,
lectual advancement of our beloved medi- to become the newest member of the
cal society, Wake County Medical Society, magazine’s editorial board. Dr. Barnhill is
to our thoughtful and diligent columnists, no stranger to the readers of Wake County
contributors as well as our editorial board. Physician. After Holden Thorp’s ascenden-
In addition, we owe much gratitude to Paul cy to Chancellorship, University of North
Harrison, Wake County Medical Society, Carolina, we conducted an urgent and wide
resourceful and intelligent CEO, for sup- search for someone to write the Interses-
porting the effort throughout the nine and sion column. Dr. Barnhill accepted the
one-half years of his tenure with us. Paul is responsibility. Jarrett is the closest thing
a superb artist and writer in his own right. to a 21st century polymath. He is written
We had one of Paul’s paintings adorn the widely on his many areas of interest includ-
cover of Wake County Physician last year. ing medicine, anthropology, philosophy,
In addition, one should not neglect the the arts and poetry.
artistic contributions of Tina Frost who has In addition, we are very fortunate to
pumped life, exuberance, and elan to the have the consent of a gifted journalist,
Wake County Physician January 2010 PAGE 3
L etters
What do you think? Share your
Excerpts from letters to the Editor
of a blessing you have and give to others: The Editor:
thoughts in WCP Forum. We are You live in a world with a rich past, and You and your magazine enrich my life!
reaching a multitude of readers in that past speaks to the present. I would Please keep me on your mailing list.
medicine, business, universities, feel better about the world if more of our
public libraries, and hospitals. fellow citizens had that gift. Thank you Sara Jo Manning
Letters to the Editor and contri- for helping give it to them. Raleigh, North Carolina
butions are welcome and will be
considered for publication. Larry P Arnn, PhD, President The Editor:
Hillsdale College I read the recent issue of WCP maga-
Hillsdale, Michigan zine.
The-genome-project What an extraordinary message you sent
The Editor: to your family about the Kings of Persian
The Editor: Thank you for online edition of WCP and the Bible. Stories like this tend to put
Thank you for the online edition of magazine. The content is informative, me in a different frame of mind. So often
the Wake County Physician and the very educational and some of your adventure- it is easy to let day to day processes rule
interesting column “MEYMANDI AT some. I learned from the observations of our thoughts and not allow the brain to ac-
LARGE” about “Music, Medicine, Heal- the learned writers. We would very much tively seek new knowledge. I appreciate
ing and the Genome Project.” like to be on your mailing list. having access to this profoundly stimulat-
University life in Tehran is very busy ing information.
and hectic. Among other things, I am Lillian and Logan Kenison
supervising more than 15 post-graduates Chesapeake, Virginia Jimmie R. Overton Jr.
with ongoing theses. Recently, I fulfilled Raleigh, North Carolina
my obligation responding to an invitation The Editor:
to write two chapters for a book on the Your Rosh Hashana Greetings for the The Editor:
international status of probiotic scheduled Jewish year 5770 were heartfelt and wel- I very much enjoyed Dr. Meymandi’s
for publication in four months, Blackwell come. Also, thanks for the Oct. copy of essay, reminding us of the primal healing
Publishing Co. My University work is your beautiful publication Wake County qualities of music. The great physician and
supplemented by obligation in Hygiene Physician Magazine, There are so many philosopher, Maimonides (ca.1135-1204
Ministry and Agricultural Ministry as well wonderful articles in the magazine which I CE) advocated the use of music as part of
as the Institute of Standard and Industrial enjoy reading his regimen for the treatment of depres-
Research of Iran (ISIRI). The music sion. And, though somewhat peripheral to
book, a labor of more than 10 years is Lola Singer Dr. Meymandi’s theme, the use of poetry
under last edit soon to be published. And Jerusalem, Israel also has an important role in therapeutics;
now I am preparing for a piano recital. in fact, “poetry therapy” has its origin in
Life in Iran, for an academician and artist, The Editor: the work of psychiatrist, Dr. Jack Leedy.
is very busy The experience of music in Meymandi Of course, poetry and music have been
Concert Hall surely made feel transported. closely linked since ancient times, when
Amir M. Mortazavian, PhD Your column on “Medicine, Healing, the poems were often recited to music. Our
Assistant Professor arts and the Genome Project” is one of my profession will benefit as we integrate
Department of Food Science favorite “Meymandi At Large” columns. these modalities more comprehensively
and Technology The mysteries of form, in music, literature, into our treatments.
Shaheed Beheshti University painting, and any artistic form--even in-
Tehran, Iran cluding scholarly work--are deep, and you Ronald Pies MD
suggest here that the depth is ultimately Professor of Psychiatry, SUNY Upstate
The Editor: organic and biochemical in nature. Medical University, Syracuse NY
I enjoyed the new web site where the Clinical Professor of Psychiatry at Tufts
Wake County Physician is up and view- Geoffrey Harpham, PhD, Director University School of Medicine, Boston
able. I came across the edition from last National Humanities Center Boston, Massachusetts
Christmas, where you have an article RTP, North Carolina
about the spiritual and the commercial The Editor:
dimensions of that holiday. It reminds me
Check out WCMS at It is always a pleasure to read your
www.wakedocs.org
PAGE 4 January 2010 Wake County Physician
thoughtful and educational articles in WCP great potential of this nation. your opinion on the importance of educa-
magazine and now in syndication. I appre- tion. Thank you for sharing your thoughts.
ciate these remarkable writings and I always Clifford Saron, PhD.
share those with other colleagues. Assistant Research Scientist Margaret Herring
UC Davis Center for Mind and Brain Raleigh, North Carolina
Mohammad Noori, PhD Davis, California
Professor & Chair, Department The Editor:
of Engineering The Editor: Here is why I enjoy your writing: It is
CalPoly I enjoyed “Meymandi At Large” column a reflection of you, as I can imagine you
St Luis Obispo, California about our dismal education! I am on your saying exactly what you are writing. It is
side on this issue and will continue to be. passionate. It is honest. It is often profound.
The Editor: I thoroughly enjoyed this particularly piece,
Congratulations on the letter in today’s Bryant D Paris, Jr. and hope that the doctor at Hopkins (Dr.
N&O regarding measurement of the orches- Raleigh, North Carolina Carson) appreciates the fact that he has been
tra. Well said. favorably compared to legends and saints!
The Editor: As to your thoughts on education, let me
John Dancy “Meymandi at Large” column is interest- echo the saints themselves: Amen!
Emeritus Chief Correspondent ing and enjoyable. I grew up in rural East-
NBC News ern North Carolina to working class parents Jim Jenkins, News & Observer
Durham, North Carolina who emphasized education but couldn’t Raleigh, North Carolina
provide me with the comprehensive ones
The Editor: I ran into among fellow students at UNC The Editor:
Exciting to have such good authors grac- in the late 1960’s. The thing that opened I enjoyed your “Meymandi at Large”
ing our area! Thank you for the excellent my eyes was not only science but also a column. I admire your writing and agree
magazine creative writing professor who took me with the content. Also, I was surprised,
under his wing and opened a new universe. informed and inspired by The Wake County
Lynn Mosier I agree that we need to vastly improve Physician. The President’s Column focused
Raleigh, North Carolina not only math and science education but me on a personal opportunity. Dr. Eliza-
also improve the depth of learning in the beth Ewing’s column informed me about
“Meymandi at Large” column, humanities also. Our current generation of things I can do and resources I can access
America, Education, Famed CEOs/MBAs are functionally illiterate in to be of more service to my aging parents
Johns Hopkins Neurosurgern history and the social sciences. It appears than I was to my aunt during her last years.
Ben Carson and Cultural that making money narrows the focus to a Dr. Kolkin’s advice to young (and older)
critical deficits in the awareness of things physicians has caused me to reflect on my
Righteousness
outside or inside the self. We are a world in priorities and what I want to do about them.
which egotists gained status by manipulat- Thank you for sharing this wonderful publi-
The Editor: ing others and in one sense recapitulate late cation. May I subscribe?
I enjoyed reading “Meymandi at Large” medieval-renaissance commercialism. I
column. I knew much about the work of my make this point because thinking creatively Fred Anderson
colleague, neurosurgeon Dr. Carson. Now may be a lost art- the generation of a new Anderson Automotive Resources
I must get his book, I had been unaware pool of Nobel Prize winners may be at risk Raleigh, North Carolina
of its existence. On galley proof suggest as we pursuit and acquire wealth. I suppose
you change “Bangalore” to “Bangladesh”, we might apply a parable to us today- A The Editor:
I remember Bangalore as a province rather camel is more likely to pass through the Thank you for the online copy of WCP.
than a country. eye of a needle than a Wall street invest- The content is most interesting and informa-
ment banker is to expand our scientific and tive, and I would appreciate remaining on
Victor Keranen, MD cultural knowledge. Perhaps Robert Madoff your mailing list.
Retired Neurosurgeon is our generation’s Machiavelli- we need
Fayetteville, North Carolina to keep looking for the next generation of Earl Fitzgerald
(US children lag the country of Bangladesh Shakespeares Galileos, Newtons, Einsteins, New Bern, North Carolina
in math and science scores. We import Rumis, Avarroes, Michelangelos, Mozarts
enormous number of engineers and scien- and Leonardo Da Vinci etc. The hunger to The Editor:
tists from Bangalore, a province of India-- know may be satiated by computer games Thanks for the article on America which
Editor) and a wish to amass and consume. sums up in a short space a lot of the bless-
ings and a lot of the challenges of America.
The Editor: L. Jarrett Barnhill, MD I forget who among the early American
I applaud your clarion call in “Meymandi Chapel Hill, North Carolina leaders coined the phrase, “Eternal vigi-
at Large” column for raising the priority lance is the price of freedom,” but in sense
culturally of education. It is really the only The Editor: given some of the poor choices we make
way this society will make good on the Wonderful! I could not agree more with about personal [Continued on page 6]
Wake County Physician January 2010 PAGE 5
Letters continued from page 5
and societal priorities, it might just as well behavior of self-indulgence.....” brought to the “elite”. They feel that people with-
be said, “Free choice is the price of free- mind Hamilton’s Federalist Paper No. 1: out health insurance are lazy. I had the
dom.” Thanks for including me on your “A dangerous ambition more often lurks privilege to work in a clinic that served the
distribution. behind the specious mask of zeal for the working poor with no health insurance in
rights of the people than under the forbid- Chicago. Those are the people I think of
George Fleming den appearance of zeal for the firmness when I think of healthcare reform.
Raleigh, North Carolina and efficiency of government. History
will teach us that the former has been Greg Bianchi, MD
“Eternal vigilance is the price of liberty” Duke University Medical Center
found a much more certain road to the in-
is attributed to Thomas Jefferson, third Durham, North Carolina
troduction of despotism than the latter, and
President of US, in his “Notes on the State
that of those men who have overturned the
of Virginia (1781-1785)—Ed.) The Editor:
liberties of republics, the greatest number
have begun their career by paying obse- Thank you! Insightful perspective and
The Editor: eloquent authoring, as always!
quious court to the people; commencing
Teenage athletes’ brains battered and
demagogues and ending tyrants.”
cheer leaders’ bodies broken for life, all Clay R. Dunnagan
sacrificed on the altar of sports. Now Raleigh, North Carolina
Miles Brennagan
the very teachers trusted with their moral
Raleigh, North Carolina
and physical development are the priests The Editor:
making the offering. My beautiful country Hear, hear! Every educator will take
The Editor:
- what’s to become of you? heart at Dr, Carson’s message . . . and
I always enjoy so much what you have
Dear Editor, thank you for giving this your endorsement of it. Thank you! Theo
to say (and how you say it). The piece on
subject the much needed exposure so
America was no exception. I especially
eloquently. Theo W. Coonrod
identified with your example of the mod-
Head of Saint Mary’s School
ern newspaper as a reflection of the vacu-
Name withheld per writer’s request Raleigh, North Carolina
ity (you were more delicate) of contempo-
rary culture. Sad to say, but true.
The Editor: The Editor:
You never fail to stimulate the mind I enjoyed reading your latest column
Michael Skube,
with your insights, lifting us upward. We on education in America. It was thought-
Elon University
are indeed fortunate to live in this great provoking and right on target. I appreciate
Elon, North Carolina
country and today being Veterans Day is your contributions to the dialogue we must
the perfect time to reflect. have if we are to improve our nation and
The Editor:
take it to its potential for mankind.
I just wanted to thank you for your
Judy LeGrand
article. I think you are so right that the Jan Davidson, PhD, Director
Raleigh, North Carolina
need for and the privilege of the pursuit of John C Campbell Folk School
real education is being smothered by the Brasstown, North Carolina
The Editor:
opportunistic use of sports and entertain- The Editor:
Your piece on America and the domi-
ment. Dealing with music myself I think I share your sentiments and evalua-
nant culture was great to borrow from.
it is a good time to re-unite science and tion of the present education system in
Alas, these values are being gradually
music. With science we analyze the fabric our country. You don’t try to balance
replaced by a culture
of our world, with music the fabric of our the budget off education. We should be
of dependency, martyrdom, victim
inner consciousness. Both rely on sensi- enhancing educational opportunities for
hood, entitlement, and politicians who
tivity to living structure. It seems to me all young people. Again thanks for the
encourage the erosion of America’s values
there is a lot of exciting work to be done insightful and uplifting column.
by promising more and more and reward-
to help open the doors to learning. Again,
ing the delinquent behavior of self-indul-
thank you for your article. Evelyn Schmidt
gence. Thanks for sharing.
Raleigh, North Carolina
Nicholas Kitchen
Harry Eberly
Durham, North Carolina The Editor:
Raleigh, North Carolina
(The writer is a renowned concert Thank you for including us in your e-
The Editor: violinist-Ed.) mail list. We so enjoy your writings.
Thank you for including me in the
distribution of your insightful and timely The Editor: Joseph and Amanda Falsone
column, “Meymandi at Large”. Your I love your column. Thank you. I am Raleigh, North Carolina
reference to “.....a culture of dependency, concerned that this country is involved in
martyrdom, victimhood, entitlement.....” an uncivil war. We have so many people The Editor:
and “.....politicians who (promise) more getting their thoughts and ideas from Fox Well thought and said. I agree that this
and more and (reward) the delinquent News. They feel that education is for is the most serious long term problem that
our country and culture face and I do not
PAGE 6 January 2010 Wake County Physician
see a promising intervention short of a healthy alternatives for them. More The Editor:
national catastrophe of some kind. experienced generations must hold those What an inspiring article. Your feelings
Stuart Bondurant, MD possibilities, that hope, for all to see -- and and beliefs remind me of my heart and my
Emeritus Dean, UNC School of Medicine that is what you are doing. Thank you. love for this country, but you express it
at Chapel Hill with much more eloquence than I.
Jennette Gottlieb
Chapel Hill, North Carolina Oak Brook, Illinois
Cliff Benson Jr.
The Editor: Raleigh, North Carolina
The Editor:
Thank you for continuing to include me I read with interest your recent article,
on your mailing list for your editorials and The Editor:
“Wake Up America!”, a subject that has
other writings. I always read them with Thank you for including me in the distri-
seriously occupied my thoughts for some
interest and Pleasure. I join you in sad- bution of your column. I am always inter-
time, more recently since the political
ness over certain changes in our society ested in the perspectives you so eloquently
campaign of 2008 and its results. I ear-
irresponsibility and dependence and more share.
nestly hope and pray that we do wake up.
-- especially because of my concern over With those presently in power, things look
the life styles that will surround future David Fruend
awfully grim. Thanks for including me on
generations; and I join you in apprecia- Raleigh, North Carolina
your list of recipients.
tion of a hope for what continues to be Check out WCMS at
Henry S. Zaytoun, DDS
available in our society that can provide www.wakedocs.org
Raleigh, North Carolina
Socrates’ Sense Perception
by Kaye Stuffolino*
W
ashing- experiment about perception, taste, and people’s priorities. The
(Editor’s Note: Joshua Bell will play
ton, D.C. questions rose: Do we perceive beauty in a commonplace envi-
at Raleigh Meymandi Concert Hall on
Metro ronment at an inap-
January 10, 2010)
Station on a cold propriate hour; do we
January morning in stop to appreciate it;
2007. He played six Bach pieces for about 45 minutes. During do we recognize tal-
that time, approximately two thousand people went through the ent in an unexpected
station, most of them on their way to work. context?
After 3 minutes, a middle-aged man noticed there was a musi- One possible con-
cian playing. He slowed his pace, stopped for a few seconds, and clusion reached from
then hurried to meet his schedule. this experiment could
Four minutes later: the violinist received his first dollar: a be if we do not have
woman threw the money in the till and, without stopping, contin- a moment to stop and
ued to walk. listen to one of the
Six minutes later: A young man leaned against the wall to lis- best musicians in the
ten to him, then looked at his watch and started to walk again. world playing some
Ten minutes later: A three-year-old boy stopped but his mother of the finest music
tugged him along hurriedly, as the kid stopped to look at the ever written, with one
violinist. Finally, the mother pushed hard and the child contin- of the most beautiful
ued to walk, turning his head all the time. Several other children instruments. ...
repeated this action. Every parent, without exception, forced them How many other
to continue walking. things are we miss-
Forty-five minutes later: The musician played. Only six people ing?
stopped and stayed for a while. About 20 people gave him money
but continued to walk their normal pace. He collected $32. TAKE THE TIME TO
One hour later: He finished playing and silence took over. No ENJOY LIFE AND
one noticed. No one applauded, nor was there any recognition. FIND BLESSINGS
No one knew this but the violinist was Joshua Bell, one of the IN EVEN SMALL
best musicians in the world. He played one of the most intricate THINGS. HAVE A
pieces ever written, with a violin worth $3.5 million dollars. Just BEAUTIFUL DAY.
two days before, Joshua Bell sold out a theater in Boston where
the seats averaged $100 each. *The contributor is a
This is a real story. Joshua Bell playing incognito in the metro Raleigh art Advocate
station was organized by the Washington Post as part of a social
Wake County Physician January 2010 PAGE 7
american fooTball loses
The Lighter Side someThing in TranslaTion
by Assad Meymandi, MD, PhD, DLFAPA
“I don’t know,” I replied.
“I thought they were doing the dance in response to those half-
naked girls dancing on the sideline…,” she said.
Editor’s Note: Superbowl has become an unofficial National “Oh, the cheerleaders, you mean? Cheerleading is a highly
holiday. The following is reprinted from Fayetteville Observer, competitive field. Cheerleaders are a national resource honored
Sunday, January 31, 1988. by Playboy, Penthouse, presidents, senators and congressmen,” I
explained.
A
while back, my sports-minded, slim, trim, 67-year-old “There they go again, beating on that guy who carried the ball.”
sister (she is now 89) was visiting us. In her younger She observed.
days in Iran, she taught physical education and music. So “Yes, the are celebrating again,” I said.
her interest in American sports was genuine. One day she asked “Will they arrest or penalize those who knocked out the other
me to explain American football to her. I tried. We sat down on a guy?” she asked.
Monday night to a Cowboys/Bears game on TV. “No, Sis, they are heroes. They get their pictures in the paper.”
“The ball—way is the ball egg-shaped and not round? She I said.
asked. My sister’s frown got a mite deeper.
“I don’t know,” I said. “Tell me, is this a state-supported game?” she asked.
Then came the kickoff, the convergence of defense and of- “No, Sis, this is private enterprise at work,” I explained. “You
fense. I could not quickly find an equivalent for “first and ten” see, the players go on strike if they don’t get their way. An aver-
in Farsi (the Iranian language) as I translated the play by play.
So I set out to say “You see, Sis, the offense—that’s the team
that has the ball—had four chances to gain ten yards…” By the
time I had gotten this far, a Bear defense had intercepted Danny
White’s pass with what the color commentator was colorfully and
screamingly calling spectacular, fantastic and unbelievable catch
‘n runback. Golly, I was getting behind in my translating. The
interceptor was tackled.”
“Why are these fellows beating on the guy who intercepted the
ball?” she asked.
“Oh, they are just congratulating him!” I said.
“I don’t believe it,” she said. “Look, they are hitting him in the
head and pushing him around as hard as they can…”
“Sis, please take my word for it. This is just a friendly celebra-
tion of their victory. There are some things that you just have to
take on faith…” I exhorted.
She was not satisfied I could tell from her subtle frown.
By now, an injured Bear was being worked on. Frank Gifford
guessed that he must have “had the wind knocked out of him,” as
I translated faithfully.
“What do you mean the wind knocked out of him?” she asked age player makes around $250,000 for six months’ work. Why,
in disbelief. “The guy is half dead. He has been lying on the field one fellow, Steve Young, whose contract called for $47 million,”
for five minutes. I really don’t want to watch this violence…” I continued.
“Okay,” I said. My sister’s frown had definitely deepened. She seemed con-
We started to move when the TV cameras panned Mike Ditka cerned and curious.
on the sideline. He was spitting all over the place and hyperthy- “What is the salary of high school or college teachers here?”
roidically pacing on the sideline. she asked.
“Why does that guy spit so much?” she asked, pointing at “In the range of $19,000 to $30,000 a year,” I said.
Ditka. She as visibly upset.
“I don’t know,” I replied. “What is going on now?” she asked, looking at Ditka with an
The next play was a Bear touchdown. We were ready to change expression of disdain.
channels but my sister, hearing the thunderous applause asked me “I don’t know,” I said.
to explain to her what had happened. I did. “You sure don’t know much, do you?” she said. I grinned, and
“Why are they doing this lewd dance after he spiked the ball?” we flipped to the concert on PBS—something that both she and I
she asked. could understand and enjoy.
PAGE 8 January 2010 Wake County Physician
Witness From the Scene at Fort Hood
The National Tragedy of Fort Hood
by John Dale Dunn, MD, JD*
Diplomate, American Board of Emergency Medicine
Consultant Emergency Services, Peer Review
T
oday was a beautiful warm blue- wounded. During the peak easily
make-you-happy-sky-day in more than 100 physicians, nurses,
Texas. I was scheduled to work techs, aids, clerks, housekeepers,
a shift at Carl R. Darnall Army Medical security and so many soldiers and ci-
Center at Fort Hood, Texas, the busiest vilian workers worked feverishly at
emergency department in the Army, at a our hospital. They made a difference
base with always more than 50 thousand and saved lives. I do is as close as I’ll get to working with
soldiers. I have been a civilian contract Tonight I left that emergency depart- angels and heroes as a physician. Today
emergency physician at Fort Hood since ment so proud of what I saw, so proud was the kind of terrible day that makes us
2003. I teach Army Residents and students of the US Army and the people who hope there are angels and heroes, and be
and mid-level practitioners emergency kept their cool, worked hard, and saved pleasantly surprised to be touched by one.
medical practice, working alongside the lives the way their fellow soldiers and Not one cross word, today, nothing but
main group of remarkable and able Army their grateful families would hope. Not a tenderness and concern and peddle to the
Physician Faculty, who do what I do, and slacker to be seen today, a massive effort metal effort. Once in a while an announce-
are regularly deployed “down range” to to save our precious people. Leadership ment would be made to keep the noise
support the Army mission in the field. I and intelligent decision making that kept down, there were so many people doing so
was one of many physicians from the cen- the work distributed. It was just the way many things at once.
tral Texas area who filled in during the hot they like to outline a mass casualty drill So I had to write tonight about the
war in Iraq, and I stayed on. I can’t think in the book—eye on the ball, manage re- angels and heroes. I teach one of the ethics
of a better job than caring for and thanking sources, triage properly, focus on priorities lectures for the residents and remind them
thousands of soldiers and their families for patient survival. It was good because that they define themselves as virtuous
and teaching some of the finest specimens there were so many there with battlefield and extraordinary when they volunteer to
of American youth extant—people who experience and able. They were ready, put on the uniform. I saw the great green-
haven’t forgotten the virtues and the con- they performed. So many great specialists suitors and their support group working
cepts of duty, honor and country and make came down to help. Along with nurses today. I had to tell you, so you could know
their parents and families proud. Some galore, one big patient care machine, hum- that in some parts of America and in some
days I am overcome by the good I see in ming along. segments of our people, there is such won-
these students and physicians in training. I I know these people, and could name derful goodness. If you had been there you
am one lucky old doc. them, put them up for accolades and such, would have cried for joy for how lucky we
Tragedy struck Fort Hood today, sud- but they would do this if no one was are as a people. I started this essay at 8:30
den, violent. I write of the best mass ca- watching—the true measure of greatness p.m. and its 10:00 p.m.--Taps just sounded
sualty drill that could be imagined, made and virtue. My wife Patty, who was at for Fort Hood. RIP, departed heroes and
so by extraordinary efforts in the face of a home worrying and didn’t know what was heroines. Thanks for your effort today—
mountain of awful human carnage. Dozens happening, was like those other wonder- you, the living heroes and heroines.
of ambulances from everywhere, helicop- ful spouses of soldiers who sacrifice, and
ters in the sky, soldiers and Army medics worry, silently when all hell breaks loose. *The writer is an emergency physician,
and paramedics working the scene with ef- We shall not forget them and we grieve resident of Brownwood, Texas. His opin-
ficiency and competence and cooperation with the families who have lost their pre- ions are his own and not attributable to
among area hospitals that allowed remark- cious treasure, how horrific. I wish I could the US Army or Department of Defense.
able and effective evacuation, triage, use be more eloquent
of resources and superlative resuscitation. describing what Carl R. Darnall Army Medical Center at Fort Hood, Texas
I couldn’t help but note and admire their I do, why I love
performance—and be happy they are my these people so
colleagues and friends in many cases. I much or why
was very concerned after the first wave when I left the
that we would be overwhelmed, but the Department
regional ambulance and hospital physician tonight I just
help and dispersal of cases to surrounding had to write
hospitals made it possible for our hospital this in tribute
to achieve great success along with the to their effort
successes of those other groups and facili- today. I can
ties—pitching in to care for more than 30 say that what
Wake County Physician January 2010 PAGE 9
T he Arts by John Dancy, Emeritus Chief Foreign Correspondent,
NBC News. Special to the Magazine’s Quindecennial
S
cholars often refer to Music Director, Grant Llewellyn, and David Chambless Wort-
classical music as the ers, CEO of the orchestra, enthusiastically agreed to the idea and
most abstract of all the arranged for me to go before the orchestra players at their next
arts because it requires an edu- rehearsal.
cated ear to enjoy it. Because On that day, I mounted Grant Llewellyn’s podium, a little
of that, classical music occu- awed by stepping into such sanctified territory. I explained what
pies only a niche in American I wanted to do… stories about the orchestra that would pull the
culture. An orchestra is somehow godlike and mysterious in its curtain back and reveal what goes on behind the scenes at a major
ability to take the combined effort of dozens of players and make symphony orchestra. The players, and their music, would be a
it into a coherent and pleasant experience for the mind. central part of the series.
Who are all these men and women who make this music? An orchestra makes one major product: its music. It can be
As a lifelong concertgoer, I have often wondered. I believe, sold… but it can also be stolen. I think the tipping point came
for example, that players in the North Carolina Symphony de- when I told the players before me that, as a lifelong member of
serve the same kind of celebrity as rock stars, but because of the the broadcast union AFTRA, I would not do anything in the series
conventions of orchestral music, they subsume their individual that allowed their work product to be stolen or pirated. When or-
personalities in the larger fabric of the chestra members began tapping their
music they play. Classical music is music stands, I knew they had agreed.
the ultimate team sport. Our first piece in the series was
As a former correspondent for NBC the Verdi “Requiem,” performed at
News, I have long wanted to tell this the end of the 2008-2009 seasons in
story in video images. The economic both the Duke University Chapel and
crisis of 2009 gave me the perfect Raleigh’s Meymandi Hall. It was a
opening. In a conversation with a wonderful kickoff to the series… the
friend on the orchestra staff, Michael gothic splendor of the chapel with
Guillot, former Vice President for its stained glass windows and the
Development, I suggested that the majestic music of Giuseppe Verdi.
orchestra needed some new ways to True to my promise to the orchestra,
reach people and one way was to per- we taped both the rehearsal and the
sonalize the orchestra making it more performance, combining both into a
accessible to more North Carolinians. six-minute piece that gave new in-
Michael told me the North Carolina sight into what goes on as an orches-
Symphony had just revamped its website and could now stream tra prepares for a major concert.
video on the site making it available to viewers. Perfect! How- The series has continued with a story about the orchestra’s
ever, how would the orchestra fund the production costs? We “beach music” tour in early summer, a Summer fest look at both
then pitched the idea to Tom Howe, Manager of University of rehearsal and performance of “Cirque de la Symphonie,” a con-
North Carolina TV, North Carolina’s statewide public television cert that combined great music by the orchestra with high-flying
network. Howe, an orchestra fan himself, offered to contribute a circus acts. We have detailed the orchestra’s financial trials and
cameraman/editor, at no cost to the orchestra, if we would allow efforts to deal with the problems. In addition, we have detailed
the network to broadcast the pieces on “North Carolina Now,” the a piece on the Symphony’s education concerts, a major focus of
network’s nightly program of news and features. I agreed to work the orchestra’s statewide travels that last year introduced classical
as a volunteer, without salary. The series would be cost-free to the music to 60,000 North Carolina school children.
orchestra, and almost cost-free to University of North Carolina The pieces are shot on high definition cameras by a talented
TV. If the orchestra approved the “North Carolina Now,” pieces team of University of North Carolina TV videographers and
would be put up on both the symphony website and the University edited on Final Cut Pro, a computer editing software program.
of North Carolina TV website giving the North Carolina Sym- The stories are broadcast in HD. Once aired, the pieces are avail-
phony double the exposure. able on both the North Carolina Symphony and the University
The next step: getting approval from the orchestra management of North Carolina TV websites. (ncsymphony.org and unctv.org/
and the players themselves, who are guided by an existing union ncnow/ncsymphony/index.html) To my knowledge, the series is
agreement, and would have to agree to have their music be a part the only one of its kind on American television.
of the television and website pieces.
PAGE 10 January 2010 Wake County Physician
Etymology Lite! amount of his drink into the glass of the host. Both men would
drink it simultaneously. When a guest trusted his host, he
would then just touch or clink the host’s glass with his own.
Contribution by H. Raymond Madry, MD*
Q: Why are people in the public eye said to be in the lime-
light?
Q: Why are many coin banks shaped like pigs?
A: Invented in 1825, limelight was used in lighthouses and
A: Long ago, dishes and cookware in Europe were made of a
stage lighting by burning a cylinder of lime, which produced a
dense orange clay called pygg. When people saved coins in jars
brilliant light. In the theatre, performers on stage in the lime-
made of this clay, the jars became known as pygg banks. When
light were seen by the audience to be the center of attention.
an English potter misunderstood the word, he made a bank that
resembled a pig and it caught on. Q: Why do ships and aircraft in trouble use mayday as their
call for help?
Q: Did you ever wonder why dimes, quarters, and half dol-
A: This comes from the French word m’aidez -meaning help
lars have notches, while pennies and nickels do not?
me -- and is pronounced mayday.
A: The United States Mint began putting notches on the edges
of coins containing gold and silver to discourage holders from Q: Why is someone who is feeling great on cloud nine?
shaving off small quantities of the precious metals. Dimes, A: Types of clouds are numbered according to the altitudes
quarters, and half dollars are notched because they used to they attain, with nine being the highest cloud. If someone is
contain silver. Pennies and nickels are not notched because the said to be on cloud nine, that person is floating well above
metals they contain are not valuable enough to shave. worldly cares.
Q: Why do men’s clothes have buttons on the right while Q: Why are zero scores in tennis called love?
women’s clothes have buttons on the left? A: In France, where tennis first became popular, a big, round
A: When buttons were invented, they were very expensive zero on scoreboard looked like an egg and was called l’oeuf,
and worn primarily by the rich. Because wealthy women were which is French for egg. When tennis was introduced in the
dressed by maids, dressmakers put the buttons on the maid’s United States, Americans pronounced it love.
right! Since most people are right-handed, it is easier to push Q: In golf, where did the term Caddie come from?
buttons on the right through holes on the left: That is where A. When Mary, later known as Queen of Scots, went to
women’s buttons have remained since. France as a young girl (for education & survival), Louis, King
Q: Why do X’s at the end of a letter signify kisses? of France, learned that she loved the Scot game golf. There-
A: In the Middle Ages, when many people were unable to read fore, he had the first golf course outside of Scotland built for
or write, documents were often signed using an X. Kissing her enjoyment. To make sure she was properly chaperoned
the X represented an oath to fulfill obligations specified in the (and guarded) while she played, Louis hired cadets from a
document. The X and the kiss eventually became synonymous. military school to accompany
her. Mary liked this a lot
Q: Why is shifting responsibility to someone else called pass-
and when she returned to
ing the buck?
Scotland (not a very good
A: In card games, it was once customary to pass an item,
idea in the long run), she
called a buck, from player to player to indicate whose turn it
took the practice with her.
was to deal. If a player did not wish to assume the responsibil-
In French, the word cadet is
ity, he would pass the buck to the next player.
pronounced ca-day and the
Q: Why do people clink their glasses before drinking a Scots changed it into caddie.
toast?
A: It used to be common for someone to try to kill an enemy *The writer is a retired
by offering him a poisoned drink. To prove to a guest that a Raleigh Radiologist
drink was safe, it became customary for a guest to pour a small
outcomes with observations. This work fought so long to achieve.
RetuRn Home continued from page 3 can dramatically reduce the costs of In spite of these challenges, though, we
health care. can’t lose sight of our primary objective,
in clinical trials – so we know very little A second big problem is whether the and that is to care for the people who
about the comparative effectiveness of special nature of academic medical centers come to our hospitals during the most
different medical options for a huge part will survive reform. Academic medical trying moments of their lives. The men
of the patient population. At Carolina, centers combine the public mission of a and women who work in our hospitals and
we have numerous efforts underway to safety-net hospital with access to some of provide their leadership have never forgot-
gather data on the effectiveness of medical the greatest specialists in the world who ten their purpose. It’s a privilege to work
practice in wider samples. Much of this are transforming medical care and prac- with them on behalf of the people of North
work will occur in our new Biomedical tice. The public has come to expect this Carolina.
Research Imaging Center, where we will combination at places like UNC Hospitals, The WCMS
use modern imaging to correlate patient and we need to maintain what we have Your advocate for HEALTH
Wake County Physician January 2010 PAGE 11
Society News
Events and Happenings of Your Medical Society
A very special THANKS to all those who
helped make the annual Tara Farms Picnic
another huge success! Hea
the
Pat U r Mik
dekw les (A
u (A lli
llian ance Pr
ce P e
ast P sident)
resid and
ent)
The Triangle Indian Physician Society (TIPS)
celebrated its 4h Annual meeting on November
Jane and
7, 2009 at Embassy Suite in Cary. The scientific Dr. Dwayne Patterson
program offered four CME credits.
(Dwayne was our
guitarist at the picnic) and
rank
r. F
(D
sels son)
Welcome
s
We sel’s
ew s
ndr sa We
A is
el
New M
WCMS
Members
Benjamin S. Alexander, MD
Medical School: UNC School of Medicine
Year Graduated: 1995
Specialty: Pediatrics
Practice: WakeMed Faculty Physicians Mim
Sha i, the
and nno Clo
Barb avage n a
Stacy K. Bennett, MD k S nd wn pa
Dic Dr. i
Da nts wo
Medical School: Ohio State vid
Ed nderfu
del
University College of Medicine ma l creat
n’s
Year Graduated: 2002 ch ions o
ildr
en n
Specialty: General and Trauma Surgery
Practice: WakeMed Faculty Physicians and
WakeMed Specialty Physicians, General Tara Farms Picnic, September 2009
Surgery
Asst Professor UNC School of Medicine
[Continued on page 16]
PAGE 12 January 2010 Wake County Physician
Society News
Fall 2009 Meymandi Fellow Dr. Fox
A Honored
lthough the triangle book
lovers frequently see the best
writers in the country on a by the
regular basis; however, rarely does
such a renowned author as A.S. Byatt Raleigh
visit them. It was a delightfully rare
treat to have the English novelist’s Hall of
appear twice this week. She is visit-
ing only 12 United States cities on
Fame
O
this tour to promote her new novel, n Sep-
“The Children’s Book,” which was tember
short-listed for the Man Booker Prize 24, 2009,
that went to Hilary Mantel last week. Dr. Powell G. Fox
Byatt won the Booker in 1990 for Jr., Chief Medical
her most famous work, “Possession.” Officer Emeritus
Byatt has been knighted, and two of of Duke Raleigh
her stories have been made into mov- Hospital was
ies. Frequently she is mentioned as a candidate to win a Nobel Prize in honored as an inductee into the Raleigh Hall of Fame.
literature some day. The mission of the Hall of Fame is to honor individu-
Toril Moi, a literary scholar and Duke Professor, will talk with Byatt on als and non-profit organizations that have made lasting
stage on Friday said, “She is a world-class writer, ‘she has written very contributions to Raleigh’s proud history. Dr. Fox was
serious work, and she has been doing it now for about 40 years.’” honored for a legacy of service to his community and a
Moi said she would ask Byatt what it means to write fiction, particu- primary role in the development of what is now Duke
larly fiction that is so “densely wrought,” and what it tells us about the Raleigh Hospital. He was one of only 13 individuals
world. In addition, she plans to ask what Byatt thinks it means to be a and two organizations honored in this Hall of Fame’s
woman writing today and about her new novel published in the United fifth year.
States last week. It is the story of an English children’s book author
and three families whose lives are woven together as Europe is about
to plunge into World War I. Moi said it presents a conflict between the Camille Lambe, R.N.
beauty of art and the destruction of war and how they somehow coexist.
Moi said, “It’s a marvelous book, and it is very moving, stunning.”
Earns ACHPN
On Thursday, Byatt will give a free reading at the Perkins Library at Certification
Duke University.
Friday’s conversation between Byatt and Moi will take place at the Na- Camille Lambe,
tional Humanities Center in Research Triangle Park. Although the event RN, PhD, AOCN,
is free, registration is required, and the 200-seat center is expected to have NP has earned the
a full house. Advanced Certified
Don Solomon said the center had hoped Byatt could have attended last Hospice and Pallia-
year for its series of conferences on science, art and the humanities, but tive Nurse (ACHPN)
she was unavailable. Fortunately, with Duke University co-sponsoring, certification from the
the timing was right for organizers to obtain her on this United States National Board for
tour. Certification of Hos-
Solomon said, “Since her work often deals with the mix of arts and pice and Palliative
science and humanities -- the world of the academy and thought -- she’s Nurses. Lambe is a
attractive to people who live in the Triangle.” palliative care nurse
Moi was chosen to participate because she was a fellow at the National practitioner with
Humanities Center. Byatt’s visit will be paid for through a fellowship Horizons Palliative
fund established by local philanthropist, Dr. Assad Meymandi that has Care, a division of
brought such speakers as E.O. Wilson, Michael Pollan and Oliver Sacks. Hospice of Wake County. She is one of only 19 nurse
practitioners in North Carolina with this certification.
Wake County Physician January 2010 PAGE 13
WCMS Update
by Paul Harrison, Executive Director WCMS
execuTive direcTor’s message
local hotels. In recent years attendance at those events dwindled.
Beginning in 2008, we experimented with Saturday evening
events in association with the NC Symphony and/or the NC Bal-
let. None of these events were particularly well attended.
W
elcome President Mike Thomas, MD, Ph.D For the November 2009 “dinner event”, just two months ago,
The first of each new year reflects a change in outgoing WCMS President Raynor Casey, MD suggested the
presidential leadership at the Wake County Medical concept of a physician networking social evening with a focus
Society. We are grateful for the leadership and service of Raynor on enhancing the patient referral process. The evening event, the
Casey, MD, 2009 President and now Past President. And we first of its kind for our Society, was held at the Umstead Hotel.
welcome Mike Thomas, MD as 2010 President. Mike hails from Thirty physicians attended and reported having both an enjoy-
Morgantown, WV. He attended Duke University and graduated able evening and a worthwhile investment of time. Participant
from the School of Medicine at West Virginia University in Mor- recommendations for improvements are being incorporated into
gantown, with an M.D. and Ph.D. in Pharmacology & Toxicol- planning for a similar event in 2010. We plan to provide physi-
ogy. He completed his post-graduate training at Barnes Hospital cians with fellowship and valuable referral exchange information
at Washington University in St. Louis, including his internship, in a very pleasing and comfortable setting.
residency, and fellowship in Endocrinology. He was previously
a faculty member in Endocrinology/Medicine at Washington Uni- Electronic Medical Records and Health In-
versity, the University of Iowa, and the University of North Caro- formation Exchanges
lina at Chapel Hill. Mike established Carolina Endocrine, P.A., The Wake County Medical Society has been engaged in dis-
here in Raleigh, in the summer of 2005. He is board-certified in cussions with area hospitals and providers about support for the
Internal Medicine and Endocrinology, and is licensed to perform development of a health information exchange. Preplanning with
endocrine nuclear medicine procedures and therapies. We look hospital leaders may lead to increased opportunities for financial
forward to his leadership and a successful 2010. support to develop a regional information system with potential
funding or loan support for private practices which purchase
Physician Referral Networking Reception EMR systems and which link to the regional network. All of
The Wake County Medical Society continues to experiment this planning depends on whether proposed funds for network
with evening events for members that will be meaningful and development remains a part of the health care reform legislative
relevant. Historically, speaker events were held on weeknights at package.
Your Advocate for HEALTH
The WCMS is a county association of
medical doctors with more than 700
physician members dedicated to the best “In Health Care,
interest of their patients. WCMS is a Physicians Need To
501(c)6 non-profit organization that serves Be In The Driver’s Seat.”
the licensed physicians of Wake County.
WCMS has been a trusted source for health Assad Meymandi, MD, PhD, DLFAPA
policy leadership since 1903 when it was
chartered by the North Carolina Medical
Society.
Already a WCMS member?
Then refer a friend.
Check out WCMS at Joining is fast and easy.
www.wakedocs.org Visit www.wakedocs.org or call
919.792.3623
PAGE 14 January 2010 Wake County Physician
Studying Compassion
mindandlife.
ing of these special monks who are living
org) in which I
in retreat in the surrounding hills. The fol-
presented findings
lowing morning, we approached Dr. Alan
from The Shamatha
Wallace, a former monk, Buddhist scholar
Project, a large
and meditation teacher, who lived for 14
unprecedented
years as one of those yogis and was serv-
study of the ef-
ing as co-translator of the meeting with
fects of intensive
the Dalai Lama. He immediately signed
meditation on brain
on and has remained a collaborator ever
processes, emotion
since. Richie Davidson and several other
regulation, psycho-
scientific and Buddhist scholar colleagues
social functioning,
joined in as well.
and health-related
Our task was clear, or so we thought.
biomarkers. My
We had to find senior practitioner-experts,
conversations with
negotiate with them some common
His Holiness have
grounds for collaboration, and design
been unlike any
experiments that would maximally reveal
others. Spacious
Cliff Saron and Dalai Lama listening, focused the effects of contemplative mental train-
ing. The Dalai Lama provided us unprec-
with the
attention, and
edented access to experienced meditators
rigorous critical
in retreat within hand-made mud-packed
regard character-
stone huts on nearby Bhagsu Mountain.
Dalai Lama
ized his response
In 1992, with the support of The Fetzer
to every sentence
and Mind and Life Institutes, we hiked up
I spoke. His un-
the mountain to engage in life-changing
derlying kindness
interactions with advanced practitioners.
was unbroken
We asked the monks to provide insights
by Clifford Saron, PhD* when pointing out
both from the formal teachings of their
a potential experi-
N
tradition and from their own direct experi-
early 20 years ago, in a crowded mental confound
ence of meditative practice to help shape
Boston hotel lobby filled with or challenging an assumption of the work.
the design of experiments on attention,
psychophysiologists, I ran into Most important was capacity as a collab-
visualization, linguistic processing, and
a close colleague and friend, Dr. Rich- orative listener to hold a thought, examine
emotional resilience.
ard Davidson. In a matter of weeks it from multiple points of view, and either
Somewhat surprising to us scientists,
he was due to travel to the foothills of accept it as part of the incremental unfold-
what mattered the most to our collaborator
the Himalayas to present results of our ing of the story or come back with a ques-
monks was whether our study was altruis-
research directly to His Holiness the tion or critique that it had sparked.
tically motivated. Would the outcome of
Dalai Lama at a small, intimate private When I first met the Dalai Lama I did
the study be of benefit to others such that
conference. However, due to a sudden not know that his infectious compassion
it would help to attenuate suffering? We
family illness he would have to miss this would set the tone of a good part of my
articulated our own conviction that, if it
exciting opportunity, and he asked if I’d research for the next two decades. And
proved possible to demonstrate that atten-
be able to go in his place. Three weeks when I met him again earlier this year, I
tional skills and positive qualities such as
later I was in the Dalai Lama’s living did not know that the interaction would
compassion and kindness could be trained,
room in MacLeod Ganj, India engaging teach me yet another lesson about compas-
there would be significant potential
His Holiness in a 2½ hour discussion of sion.
benefits for healing and education in the
our research about emotional states, brain During my 1990 stay in MacLoed Ganj,
Western world. Not so surprising in retro-
function and health. Although my current I had the good fortune to have as a room- spect, compassion became the most salient
work revolves around similar themes, life mate the late Dr. Francisco Varela, the recurring theme in our conversations. One
has not been the same since that trip two intellectual father of the Mind and Life
of the monks described compassion as be-
decades ago. dialogues between Buddhist and Western
ing a state “beyond sadness,” in which the
scholars. One night, as we talked late in
I had the happy privilege of talking to the heart is filled with a desire to help those
the darkness within our guesthouse Fran-
Dalai Lama again earlier this year in a suffering. In compassion, he explained,
cisco said “we’re two old EEGer’s – we
similar conference sponsored by the Mind the sight [Continued on page 45]
should do something” to investigate the
and Life Institute (www.
effects of Tibetan Buddhist mental train-
Wake County Physician January 2010 PAGE 15
Welcome New WCMS Members Continued
Specialty: Orthopaedic Surgery Anesthesiology of NC
Practice: Orthopaedic Specialists of NC
Gloria Patricia Herrera, MD
Paige L. Gausmann, MD Medical School: Pontificia Javeriana-S.
Medical School: UNC Chapel Hill America
Year Graduated: 2002 Year Graduated: 1990
Ann B. Bonpain, MD Specialty: Obstetrics and Gynecology Specialty: Internal Medicine
Medical School: UNC Practice: Capital Area Ob/Gyn Assoc., PA Practice: Gloria Patricia Herrera, MD
School of Medicine
David K. Gittelman, MD Danielle L. Hogan, PA
Year Graduated: 2001
Spouse: Micha Pyon Gittel- Medical School: Shony Brook
Specialty: Obstetrics and
man, BSN Year Graduated: 1986
Gynecology
Medical School: Philadel- Specialty: Physical Medicine and
Practice: Cary Obstetrics
phia College Of Osteopath- Rehabilitation
and Gynecology, PA
ic Medicine Practice: Carolina Rehab and Surgical
John Buttram, Jr., MD Psychiatry Residency: Associates
Medical School: Brody Mayo Graduate School of
School of Medicine at ECU Medicine, Rochester, MN Jeffrey A. Huang, MD
Year Graduated: 2002 Year Graduated: 1983 Medical School: Wake
Specialty: Neurosurgery Specialty: Psychiatry Forest University School
Practice: Raleigh Practice: WakeMed Faculty Physicians and of Medicine
Neurosurgical Clinic, Inc. UNC-Chapel Hill Department of Psychiatry Year Graduated: 2000
Toni M. Czito, MD Specialty: Family
Wanda L. Godfrey, MD
Medical School: Medical College of Medicine
Medical School: Univ. of Massachusetts
Georgia Practice: Blue Ridge Family Physicians
Year Graduated: 1989
Year Graduated: 1996 Specialty: Family Practice
Specialty: Critical Care Surgeon Hany C. Ibrahim, MD
Practice: Wake Urgent Care & Family Medical School: Univ of Medicine and
Practice: Wake Emergency Physicians, PA Clinic
Dentistry of New Jersey
Milan M. DiGiulio, MD Peter M. Grossi, MD Year Graduated: 2001
Spouse: Stephanie Medical School: Duke Univer- Specialty: Emergency Medicine
Medical School: sity School of Medicine Practice: Wake Emergency Physicians, PA
Mt Sinai Medical School Year Graduated: 2002
Year Graduated: 1995 Specialty: Neurological Robert Glen Jones, MD
Specialty: Orthopaedic Surgery Medical School: Emory University School
Surgery & Sports Med. Practice: Duke Neurosurgery of Medicine
Practice: Performance of Raleigh Year Graduated: 2001
Orthopaedic Surgery & Sports Medicine Specialty: Orthopaedic Surgery
Bobbie A. Gupta, MD Practice: Impact Orthopaedics
Lisa M. Figueroa MD Medical School: UNC Chapel
Medical School: UNC Chapel Hill Hill Robert Lacin, MD
Year Graduated: 1991 Year Graduated: 1997 Medical School: University
Specialty: Emergency Medicine Specialty: Ophthalmology of Lausanne Switzerland
Practice: Nextcare Urgent Care Practice: Raleigh Year Graduated: 1988
Ophthalmology Specialty: Neurological
Benjamin P. Fischer, MD Surgery
Medical School: Baylor College of Michael M. Haglund, MD, PhD Practice: Raleigh
Medicine Medical School: University of Neurosurgical Clinic
Year Graduated: 2000 Washington
Specialty: Internal Medicine Year Graduated: 1987 Douglas T. Lane, PA
Practice: Raleigh Medical Group, PA Specialty: Neurological Surgery Medical School: Duke University Medical
Practice: Duke Center Physician Assistant Program
Mark W. Galland, MD Neurosurgery of Raleigh Year Graduated: 2007
Spouse: Amy Quarles- Specialty: Orthopaedic
Galland Michael W. Hauser, MD Practice: Raleigh Orthopaedic Clinic, PA
Medical School: Medical School: UNC
Tulane University School of Medicine William F. Lestini, MD
School of Medicine Year Graduated: 1994 Medical School: Georgetown
Year Graduated: 1994 Specialty: Anesthesiology Year Graduated: 1983
Practice: American
PAGE 16 January 2010 Wake County Physician
Specialty: Orthopaedic Surgery Chaitany R. Patel, MD Susan M. Steele, MD
Practice: Triangle Spine & Back Care Ctr. Medical School: Ross Uni- Medical School:
versity School of Medicine University of Illinois
Courtney H. Mann, MD Year Graduated: 1998 Year Graduated: 1983
Medical School: Vanderbilt University Specialty: Family Specialty: Anesthesiology
Year Graduated: 1983 Medicine Practice: American
Specialty: Emergency Medicine Practice: Tri City Family Anesthesiology of NC
Practice: Wake Emergency Physicians, PA Medicine & Urgent Care
Lisa W. H. Thompson, MD
Erik A. Manring , MD Josie D. Prabhakar, PA Medical School: University of Illinois
Medical School: East Carolina University Medical School: Univer- Year Graduated: 1983
Year Graduated: 1994 sity of Saint Francis Specialty: Emergency Medicine
Specialty: Emergency Medicine Physician Assistant Practice: Wake Emergency Physicians, PA
Practice: Wake Emergency Physicians, PA Program
Year Graduated: 2002 Louie E. Tsiktsiris, MD
Rowena B. Mariano, MD Specialty: Orthopaedic Medical School: University of Ottawa
Medical School: UCLA School of Practice: Raleigh School of Medicine
Medicine Orthopaedic Clinic, PA Year Graduated: 1993
Year Graduated: 1994 Specialty: Rheumatology
Specialty: Physical Medicine & Fernando Rene Puente, PA Practice: NC Arthritis & Allergy Care
Rehabilitation Medical School: East Carolina Center
Practice: Dr. Rowena B. Mariano University School of Medicine
Year Graduated: 2003 Scott M. Wein, MD
Steven H. McKinley, MD Specialty: Dermatology Spouse: Anne
Medical School: University of Michi- Practice: Raleigh Dermatology Medical School: UNC
gan Medical School Associates Chapel Hill
Year Graduated: 2002 Lawrence M. Raines, III, MD Year Graduated: 2002
Specialty: Ophthalmology Medical School: University of NC Specialty: Orthopaedic
Practice: Raleigh Ophthalmology Year Graduated: 1993 Surgery
Specialty: Psychiatry Practice: Raleigh Ortho-
Steven J. McMahon, MD Practice: Maynard Office Center Cary paedic Clinic, PA
Medical School: Emory University School
of Medicine Jennifer L. Raley, MD Joseph G. Wiater, MD
Year Graduated: 2002 Medical School: St. Louis University Medical School: University of Michigan
Specialty: Otolaryngology School of Medicine Year Graduated: 1998
Practice: Raleigh Ear Nose & Throat Year Graduated: 1998 Specialty: Emergency Medicine
Specialty: Emergency Medicine Practice: Wake Emergency Physicians, PA
Sital P. Mody, MD Practice: Wake Emergency Physicians, PA
Medical School: Medical Academy of David A. Wilfret, MD
Lublin Shannon V. Scholl, MD Spouse: Anya Tatarchuk
Year Graduated: 1996 Medical School: UNC Chapel Hill Medical School: University of Florida
Specialty: Hospitalist Specialty: Gastroenterology Year Graduated: 2001
Practice: WakeMed Cary Practice: Cary Gastroenterology Specialty: Pediatric Infectious Disease
Practice: GlaxoSmithKline
Sachin S. Mudvari, MD K. Kolby Sidhu, MD
Spouse: Shraddha Medical School: McMaster Matthias M. Zinn, MD
Medical School: State Univ. School of Medicine Medical School: University
University of New York - Year Graduated: 1995 Massachusetts Med School
Syracuse Specialty: Radiation Year Graduated: 2002
Year Graduated: 2003 Oncology Specialty: Child/Adolescent
Specialty: Vitreo-retinal Practice: Cancer Centers of Neurology
Surgery North Carolina Practice: Raleigh Neurology
Practice: Retina Associates, PC Associates, PA
Michael Spiritos, MD
Johathan Brent Myers, MD Medical School: Cornell Interested in becoming
Medical School: Bowman Grey Medical University Medical College a WCMS Member?
School Year Graduated: 1983
Year Graduated: 2003 Specialty: Oncology
It’s fast and easy! Just go to
Specialty: Emergency Medicine Practice: Duke Raleigh www.wakedocs.org and
Practice: Wake County EMS Cancer Center JOIN TODAY!
Wake County Physician January 2010 PAGE 17
PHYSICIAN Drs. Paul & Paul Burroughs
PROFILE: by Fiona Morgan
Dr. Paul Burroughs Jr. and due to be born. So in order
Dr. Paul Burroughs III to get back to Chapel Hill on
time, Paul Burroughs III was
induced early.
O
ften, when a child follows a par- It was an exciting time for
ent into medicine, it’s because the the field, as Dr. Frank C. Wil-
family tradition was instilled early son, chairman and chief of
and often. Not so in the Burroughs family. orthopedic surgery at UNC,
“I had no idea what he would go into,” brought to the department
Dr. Burroughs Jr. says of his eldest son. “I fantastic improvements in
can you tell you if we had tried to push that joint replacement surgery, in
boy in any direction, he would have gone particular the Walldius knee
in the opposite for sure.” prosthesis.
Yet today Paul Burroughs III sits at his Dr. Burroughs Jr. person-
father’s solid wood desk in the office of ally helped advance improve-
the Raleigh orthopedic practice Paul Bur- ment in hip replacements for
roughs Jr. co-founded in 1972. The young- North Carolina patients. “I
er Dr. Burroughs laughs when he points was very fortunate in that,
out that the wallpaper hasn’t changed since when I was in my fourth year
the office was built in 1978. of my residency, I was offered
But much else has changed. Both doc- what would now be called a
Burroughs Jr. with grandchildren Katherine, Emily, and
tors say what they love about practicing Joseph and their father, Paul Burroughs III fellowship, a year to develop
medicine is relieving the suffering of their this acrylic method of fixation.
patients, and dramatic advances in orthopedic I happened to be the first one
technology have only increased that reward. to do the procedure at UNC.”
“The advantages to the patient and the doc- While doing his residency at
tor are huge compared to when I started,” Wake Med, he met George Ed-
Dr. Burroughs Jr. says. “There’s a lot to be wards, with whom he started his
thankful for.” practice.
Namesake of the family Paul Burroughs Throughout college and medi-
served in the U.S. Navy during World War II cal school, the younger Dr. Bur-
on the U.S.S. Wilkes Barr. He fought in the roughs worked hard to follow
battles of Okinawa and Iwo Jima. “I’ve got his own path. “I changed majors
his diary and he really had a real adventure eight times. I intentionally tried
over there,” Paul Burroughs Jr. says. The to find something else I’d like,
decorated veteran died when his son was 8 and I kept trying. Economics,
years old. business, anthropology, phys-
Paul Burroughs Jr. grew up in Raleigh Standing: Dr. Burroughs Jr., Dr. Rendleman III ics.” He credits a summer job in
Seated: Dr. Edwards Sr., Dr. Venters - circa 1978
and attended Myrtle Underwood Elementary a UNC orthopedics research lab
School at a time when Mrs. Underwood served as its principal. He while in college with piquing his curiosity in the field.
graduated from Needham B. Broughton High School. Throughout He went on to medical school at UNC and received an NIH grant
his childhood, he and his sister spent a lot of time at their grandpar- to do an additional year of research. He completed his internship
ents’ farm in Seagrove. and residency in Gainesville, Florida, where he was elected most
Throughout medical school at the University of North Carolina at outstanding chief resident. It so happened that his father’s practice
Chapel Hill, he planned to go into cardiology. It was not until his had an opening at precisely the moment he was looking for a job.
last rotation that he discovered orthopedics. “I said, ‘These guys “I did look around for other places, but I kind of always in my
have so much fun, man!’” heart knew I was going to come back,” Dr. Burroughs III says. He
He was already committed to an internship in cardiology at the returned to Raleigh a married man with five years of experience
University of Florida at Gainesville. He earned a spot as an ortho- working on his own.
pedics resident back at UNC, but the residency was to begin imme- The two had the opportunity to work side by side for about five
diately after his internship ended—only days after his first son was years before Dr. Burroughs Jr. retired in [Continued on page 35]
PAGE 18 January 2010 Wake County Physician
PAUL LEACH BURROUGHS, JR., MD PAUL LEACH BURROUGHS, III, MD
BORN: 1940, Greensboro, N.C. BORN: 1967, Gainesville, Florida
EDUCATION: University of North Carolina at Chapel Hill, EDUCATION: University of North Carolina at Chapel Hill,
A.B. Chemistry, 1962 B.S. Biology, 1989
UNC School of Medicine, 1966 UNC School of Medicine, 1994
Editor: North Carolina Student Medical
CAREER HISTORY: Internship, University of Florida,
Journal: The Fax 1993-1994
Gainesville, 1967
Residency, UNC, orthopedics, 1971 CAREER HISTORY: Research fellowship, UNC-Chapel Hill,
Fellowship and medical staff, UNC, 1972 Division of Orthopaedic Surgery, Department
Co-founder of orthopedic practice Bone and of Surgery, 1991-1992
Joint Surgery Clinic, 1972 Internship, University of Florida, Gainesville,
Retired from practice, 2004 General Surgery, 1994-1995
Residency, University of Florida, Gainesville,
COMMUNITY: President, Raleigh Community Hospital
Orthopaedic Surgery, 1995-1999
Medical Staff, 1983-1984
Orthopedic practice, Bone and Joint Surgery
Board of Trustees, Raleigh Community
Clinic, 1999-present
Hospital, 1985-1987
Past member, Committee on Sports Medicine, COMMUNITY: Medical Mutual Community Board
North Carolina Medical Society Currently serving on Pharmacy and
Therapeutics Committee Duke Health Raleigh
PROFESSIONAL SOCIETIES:
Project Access Wake County
North Carolina Orthopedic Association
Past volunteer physician for North Carolina
Southern Medical Association, Orthopaedic
State University football team
Section
Wake County Medical Society PROFESSIONAL SOCIETIES:
North Carolina Medical Society Southern Medical Association
Rainey Orthopaedic Society, the alumni University of North Carolina Medical Alumni
association at UNC Association
American Medical Association Florida Orthopaedic Society
American Academy of Orthopaedic Surgeons
FAMILY: Wife – Dianna Burroughs
Wake County Medical Society
Children—Paul, Peter, Marshall
North Carolina Medical Society
Grandchildren—Emily, Katie, Joey, Adam,
Raleigh Academy of Medicine
Keith, Amelia.
American Medical Association
FAVORITE LEISURE ACTIVITY: Fishing
FAMILY: Wife – Jennifer K. Burroughs
FAVORITE AUTHORS: W.E.B. Griffin and Lee Child’s Jack Children—Emily, Katherine, Joseph
Reacher series.
FAVORITE LEISURE ACTIVITIES: Golf, fishing, sailing,
LAST BOOK READ: Super Freakonomics, the sequel to woodworking, running
Freakonomics, by Steven D. Levitt and Stephen J. Dubner
LAST MOVIE SEEN: “UP” – Disney Pixar
LIKES ABOUT THE TRIANGLE:
It’s just perfect. If you like to go to the beach, you can do so FAVORITE BOOK: I don’t know how to answer this one. The
easily. If you like to go to the mountains, you can. It’s got a Only Three Questions that Count by Ken Fisher
wonderful education system. My boys all went to public school.
I’m very happy with Raleigh and that’s why I came back. LAST BOOK READ: Nothing to Lose by Lee Child
DISLIKES ABOUT THE TRIANGLE: LIKES ABOUT THE TRIANGLE: Big city resources with
I don’t know of anything I dislike about it. small town feel (for the most part)
ADVICE TO YOUNG PHYISCIANS STARTING PRACTICE:
DISLIKES ABOUT THE TRIANGLE: Poor snow driving skills
I always avoided small groups of two or three doctors with very
serious expressions, with one or more of them shaking their
ADVICE TO YOUNG PHYISCIANS STARTING PRACTICE:
heads, because they were almost always talking how the practice
Try to enjoy time with your patients. Learn about the business
of medicine is going down the tubes. There’s a certain amount
side of medicine for yourself—don’t let others tell you what is in
that you have to pay attention to such things, but you’re hap-
your best interest.
pier if you can avoid thinking about that part of it more than you
have to. Focus more on your patients.
Wake County Physician January 2010 PAGE 19
North Carolina Treasures
by Phillip J. Kirk*
norTh carolina Wine
D
id you know North Carolina was ing season, which is 150-200 days. Other
the number one wine producing positives include our soil composition --
state in the United States prior to heavy clays to sandy clay loam to sandy
Prohibition? dunes, our temperature differential, and
That and many other facts about the rainfall average.
growing, dynamic wine industry in North Other factors include support from
Carolina are gaining the attention of the the legislature in changing various laws
public, not only in North Carolina but also including permitting Surry Community
throughout the country. College that has the most comprehensive
From the time former Commissioner viticulture program east of the Missis-
of Agriculture Jim Graham and the North sippi, to operate a bonded winery as a
Carolina General Assembly created the part of its program. This allows North
Wine and Grape Council in 1986, the Carolina residents to receive wine from
number of wineries in our state has grown North Carolina or other states by mail or
from six to 91 with an average of one new Fed Ex or UPS. Thus, allowing wine to
winery opening each month. We now rank be sold at wine festivals, and permitting of the typical visitor to North Carolina
ninth in the country and if present trends directional signs to be placed on highways wineries. Nearly half are from outside
continue, could move into the top five in although the wineries pay for the signage. North Carolina and for 61 percent, it is
the next decade. California ranks first with James Sprunt Community College, Appala- their first visit to a winery. Visitors tend
1300 wineries, followed by New York, chian State University, and North Carolina to be middle-aged, highly educated, and
Washington, Oregon, Texas, Florida, New State University are among the institutions have higher than average incomes which
Jersey, and Ohio. of higher learning in North Carolina that accounts for an average purchase of $176
North Carolina’s involvement with are heavily involved in viticulture educa- per travel party!
grapes and wine goes back to 1524 when tion. Tourism continues to grow in North
the first cultivated grape was discovered in In addition, North Carolina has people Carolina despite the economic downturn.
North Carolina. In addition, the first com- of wealth who are interested in establish- More than 40 million visitors a year make
mercial winery in the United States was ing wineries as businesses, such as the us the sixth most visited state in the nation
opened in Halifax County in eastern North Shelton’s, Cecil’s, and Childress’s, just to and there is a direct economic impact of
Carolina in 1835. Prohibition wiped out name a few. The story goes, “If you want more than $18 billion. The wine industry is
the wine industry in our state and we were to make a small fortune in the winemaking an important component of tourism.
slow getting back in the business. business, you had better start out with a The North Carolina wine industry
The Duplin Winery, located off I-40 in large fortune.” employs more than 6,000 with a payroll
southeastern North Carolina, was opened North Carolina wines are winning both approaching $200 million. More than
in 1972, and is the oldest, continuously national and international awards for excel- one million visitors are recorded at NC
operated winery in the state. It also is the lence. On the Today show, food editor Phil wineries and there is an economic impact
largest in terms of annual wine production Lempert proclaimed that the Napa Valley approaching one billion dollars.
and sales. is out and doomed by global warning. He In the United States, wine consump-
At the beginning of this decade, North said, “North Carolina is poised to claim tion has surpassed beer consumption! The
Carolina had only 15 wineries operating Napa’s crown.” Southeast has the lowest average consump-
and a few years later, the Wine and Grape The state has been named as one of the tion rate of wine in the United States at
Council was moved from the Department top states for wine and culinary tourism. 1.7 gallons per person while the national
of Agriculture to the Department of Com- North Carolina ranks third in the nation as average is 2.1 gallons. Compare this to 16
merce where it operates within the Division a wine-related travel destination, tied with gallons per person in France. The United
of Tourism, Film, and Sports Development. Missouri, Oregon, and Pennsylvania and States will soon surpass Italy as the world’s
North Carolina has some unique charac- trailing only California and New York. number one consumer of wine!
teristics that account for this growth. Our More to come. Wine consumption is growing dramati-
elevation is a positive factor as is our grow- A study recently developed a profile cally in China [Continued on page 33]
PAGE 20 January 2010 Wake County Physician
surgery in norTh carolina
Prior To The civil War
by Memory F. Mitchell
P
atients who underwent surgery in the early to mid-1800s Surgical procedures were usually carried out in the doctor’s
were brave souls. Noteworthy was the case of one Mrs. office or in the patient’s home. Before the use of chloroform, the
Woodward of Wake County. Her jaw was split open from most a patient could hope for in relief from pain during surgery
behind the ear to the mouth without any kind of chloroform. The would be laudanum, with its high opium content, or a big dose of
Raleigh Star’s edition of February 9, 1848, reported that the op- whisky. He would then be tied down and held by assistants. Dr.
eration was performed by Dr. Fabius J. Haywood “with the skill J. L. Ludlow’s Manual of Examinations gave directions for pre-
and nerve” for which he was well known. And poor Mrs. Wood- paring a patient for a pelvic operation: “He should be placed upon
ward was characterized as one who withstood the procedure his back on a low table, with his hips and shoulders elevated,
“with the firmness and fortitude” for which her sex was noted. and his pelvis resting upon the edge of the table; a roller is then
The problem that necessitated the operation was not recorded. fastened to each wrist, and while the patient grasps the soles of
Dr. Haywood, who was born in 1803, was a graduate of the Uni- his feet, his hands and feet are securely fastened together by the
versity of North Carolina who received his medical degree from rollers, and the patient’s legs and thighs held firmly by assistants
the University of Pennsylvania School of Medicine in 1827. The on each side.”
Raleigh native returned to his hometown to establish his medical Though general practitioners usually performed all kinds of
practice. operations, there were a few specialists. Dr. John Beckwith of
General practitioners were the ones who usually performed Raleigh treated diseases of the eye for more than twenty years.
surgery during those years. Some North Carolinians traveled to The Raleigh Register of September 7, 1839, reported that he had
northern cities for surgery because there were more skilled doc- had few instances of failure in operations to relieve blindness.
tors there. For example, John Butler of Halifax went to Philadel- During that time Drs. Edmund Strudwick of Hillsborough and
phia to have a tumor removed from his neck. Edwin Anderson of Wilmington were also having success with
Many people relied on almanacs and family medicine books for eye operations.
instructions when emergencies arose, because no doctors were By the 1850s more attention was being given to surgery as a
available. Individuals who attempted to set broken bones, deal special branch of medicine, with the result that North Carolina
with cuts or gunshot wounds, etc., often met with sad results. was able to supply numbers of surgeons to the medical corps of
But Dr. Haywood became known as a competent surgeon, and the Confederate Army when the Civil War erupted in 1861.
he is credited with being the pioneer in the use of chloroform.
That case involved the removal of a growth under the arm of Le- Sources: Direct quotations and other information is taken from
roy Moore, also of Wake County; the removed wen weighed one Guion Griffis Johnson, Ante-bellum North Carolina: A Social
pound, four ounces. The Star published an account of that opera- History (Chapel Hill: The University of North Carolina Press,
tion, reporting that “The effect was as perfect and happy as if an 1937), 743-745; Sketch of Fabius Julius Haywood, by Vance E.
allwise and merciful Providence had prepared it especially for the Swift, in William S. Powell (ed.) Dictionary of North Carolina
purpose.” It is of interest that reports of the two operations were Biography (Chapel Hill: The University of North Carolina Press,
published in the same edition of the newspaper, leading one to 6 volumes, 1979-1996), III, 85.
wonder why chloroform was not also give to Mrs. Woodward.
PResident’s message continued from page 1
to federal regulations. Currently, due to the industry of senior centers in 2010. It may fee in the waiting room, and free parking. If
greatly flawed SGR or “sustainable growth be our first insight into our health care re- people are willing to spend more for those
rate,” Medicare is scheduled to “provide” form. extras, they should be allowed… we are
a 21% cut as of January 2010. Therefore, What else can be done? As individuals still in America right. If not, patients (and
instead of receiving $60 for services ren- you can lobby our United States Senators their sons and daughters) end up driving
dered, physicians will receive $48! How and Representatives to fix Medicare, name- further and spending more time in the super
will that work? ly to stop the SGR and implement an infla- senior centers.
What do we do, and what do we tell our tion adjustment to increase the codes year- It has been an honor to serve as your
patients? The only answer so far is that the ly. That is a start. Nevertheless, if increased president this year. Thanks to our Execu-
local non-profits or hospital systems have access is a goal, I think it would help to let tive Director, Paul Harrison, the Wake
opened senior centers, hiring their own physicians charge above the Medicare al- County Medical Society increased its dues
physicians. The centers can make some lowable to meet their local costs. It is Eco- paying membership by 10%, added some
profit off blood and imaging tests to coun- nomics 101, supply and demand. Currently new social events, and expanded programs
ter the losses from the physician codes. If there is increasing demand but with fixed with a new vaccination grant. Good luck to
patients are lucky enough to get in, they of- prices, the supply curve cannot shift. our next president, Dr. Mike Thomas.
ten end up paying for parking at the bigger Some doctors are in higher demand;
centers and will be out another five or ten maybe they have a comfortable office, a Where there is no vision, the people perish:
dollars anyway! Be prepared for a growth nice bedside manner, a good location, cof- Proverbs
Wake County Physician January 2010 PAGE 21
First Person
by Richard A. Lippin, MD*
hoW The common loWly earThWorm
led me To my life’s unifying PrinciPle
tant human ovary) or frightening words like cachetic (the emacia-
“How appropriate it is for me to find a publication tion of the dying). This experience led me to founding the Ameri-
resource for my essay like Wake County Physician Magazine can Physicians Poetry Association (APPA) in 1976 where I found
edited by Dr. Assad Meymandi which has been extraordi- other wonderful and creative doctors who were in love with words
nary model for integrating medicine, culture and the arts.” and recognized their importance to our profession on medicine.
However, medical school in the late 1960s in a Philadelphia
Rick Lippin, M.D. black minority ghetto was not a very humanistic or humanizing
I
experience for me. Therefore, while other fellow med students
t took about a half of a century for me to realize that the Arts,
used other coping skills, I turned to the Arts for solace. In addition
Medicine and Spirituality were really the same. This welcome
to my childhood love of natural beauty, I began to discover what
realization has become my life’s unifying principle.
beauty man could create in music, the visual arts, dance and poetry
It all began with my recollections of gazing at a common earth-
to name a few. I began going to many museums and concerts and
worm. Having grown up in working class row home in Philadel-
began reading more poetry. I also began collecting art, music and
phia, I had just a very little patch of earth, which summoned me to
poetry books.
explore. Digging one day, as a very young child, I recall seeing a
I began to realize the many rich and varied links between the
large earthworm which, contrary to popular dismissal or even dis-
healing and the creative arts, which led to my founding the Inter-
gust, in my mind appeared mysteriously beautiful. Those undular
national Arts-Medicine Association (IAMA) in 1985 whose vision
movements of slimy highly segmented skin were wondrous to me.
statement became “The true healer neither knows nor seeks bound-
Little did I know then that this seemingly trivial experience was
aries between Medicine and the Arts.” And that indeed Arts and
seminal for me - the beginning of developing the concept of awe
Medicine were really one discipline as advocated by C P Snow’s
for all things beautiful in nature.
“two cultures theory” which still has many adherents today. What
I loved my limited natural world even as a city boy from the
a wonderful world IAMA and Art-Medicine opened up for me
neighbor’s honeysuckle vine to the common sparrow or robin to
from spending a day with journalist Bill Moyers in New York
the azure blue of even the city sky. Then, a few years later, my
City discussing the healing power of the Arts to hearing wonderful
parents took me to the New Jersey seashore where yet another set
speeches from extraordinary inspirational people like psychologist
of natural beauty awakened my young senses including the almost
Rollo May. In addition, meeting literally thousands of artists and
limitless assortment of seashells with highly intricate beautiful
healers who intuitively knew they were doing the same good work.
patterns, the seagulls almost suspended in breezy air currents, and,
Then about ten years ago, it hit me. I wish I could remember the
of course, the ocean itself with a its vast and hypnotic rhythmic
precise personal experience. However, I know it had something to
power. What puzzled me though was why other people were not
do with my inability to fully comprehend or fathom infinite and
talking about what I was experiencing? Why were they not as
abundant beauty in the world and my persistent desire to express
smitten as I was? Well, of course, others were but, not then, in my
gratitude for all that I found healing and beautiful. Nevertheless,
immediate circle of family and friends.
I was left with the question of whom to thank? What then hit me
Therefore, I decided to select biology as my major in college,
was that from gazing at my first earthworm to founding a physi-
which just reinforced many times over my love of the beauty of
cian’s poetry association to founding an organization that brought
all things natural. I recall even marveling at the complex life cycle
artists together with healers that this was my personal path to God.
of deadly parasites because despite the harm they caused humans
In the last decade, in particular, I added yet another component to
there was natural intelligence and elegance found their own life my unifying principal of beauty and healing which was spiritual-
cycles driven not by values but by their own biological need to ity.
reproduce.
A few colleagues said it well but none better than Dr. Michael
In medical school, I fell in love with medical lexicon almost to
Samuels when he wrote,”
the point of being swept away by aesthetics instead of focusing on
Today, the artist and the healer feel the rebirth of these ancient
content of such onomatopoetic words as borborygmous (sound of
traditions. At the source they and we are [Continued on page 49]
gas in intestines) or majestic words like oophoron (the all impor-
PAGE 22 January 2010 Wake County Physician
Placebos, Magic and Faith Healing
by L. Jarrett Barnhill, MD, DFAPA, AACAP*
O
ur concept of disease arises from the old Cartesian mind-body dualism
systematic observation and ex- and force a redefinition of our cur-
amination of signs and symptoms; rent ideas of illness and disease. One
selection of treatment programs to match crucial difference involves etiology.
these findings and adjustments in care For these disorders, causal theories
based on the efficacy of each intervention. have their roots in ancient beliefs and
Our tendency to link findings to a specific practices that straddle the boundary
physical cause (no supernatural etiologies) between science, religion and magic.
stretches back to Greek physician-philoso- To understand these ideas, a good
phers of the 4th century BCE. Although na- scholar might consult Renaissance
ive by modern standards, medicine remains texts on spiritual disunity, hermeneu-
the grandchild of their materialism, empiri- tics, and effects of cosmic misalign-
cism and rationalism. ments on disease states. Next to mag-
Koch’s postulates represent an updated ical texts are early scientific works
form of work done by the Greek medical by Harvey and others. A Biblical
philosophers. Even though grounded in historian might go back even further
infectious diseases this method of system- in search of folk beliefs and cures for
atic analysis is critical to modern diagnosis demon possession in first century Galilee. a fluid one. As science improved, the body
-- Defining syndromes based on demon- Medical practices in these cultures were became less of a symbol and more of the
strable pathophysiology and targeted treat- not grounded in Greek philosophical con- focus. The causes of illness became less
ment. Yet there are many chronic disorders cepts of sickness and suffering. These supernatural and more to natural ones --
that fail to meet these criteria in the strictest medical systems describe illness in terms Science and materialism gained the higher
sense. For these palliative or maintenance of an expression of the state of the soul, ad- ground.
treatment rather than cure is the best-case herence to orthodox doctrines or faithful- Of course, few modern believers in crys-
outcome. There are other disorders with ness. In this context, illness and suffering tals, pyramids, and amulets are aware of
poorly defined pathophysiology and treat- can be attributed to supernatural causes, the ancient roots of their ideas in super-
ments that rely on anecdotal or a very lim- many seen as judgments by God; tests of natural interventions. Healing rituals bor-
rowed from nonwestern practitioners are
taken out of their cultural context. Many
holistic practitioners use interventions
steeped in history and medical folklore. In
our times, some tend to look back to older
traditions and accept ancient ideas about
treatment without fully understanding their
historical and cultural origins. Like people
of the Renaissance, we frequently turn to
treatments assuming that these practices
are closer to ancient truths about healing.
Many stick with these approaches even if
scientific evidence debases them as largely
placebo cures. The argument often hinges
on Hamlet’s comment to Horatio, “There
are more things under heaven and earth
than are dreamt in thy philosophy.”
Others turn to psychological causalities
or somatization disorders. One subtype of
ited evidence base. The third group present religious zeal, part of a predetermined plan somatization disorders involve those for
with symptoms that do not match known lost in the mystery of God’s unfathomable whom psychological forces masquerade as
models of pathophysiology. This group is will. Under such circumstances, success- physical symptoms -- Hysteria (conversion
often responsive to interventions that lie ful treatment requires more than a medi- disorder in today’s nomenclature). Such pa-
outside the pale of modern medicine -- Re- cal cure. The provider-patient relationship tients intrigued the young Sigmund Freud.
sponding to placeboes, faith healing, magi- must address the spiritual or cultural un- At the time, he was just out of his neurol-
cal rituals, ceremonial cures by shaman and derpinnings of the dis-ease (distress and ogy training at the University of Vienna.
indigenous healers. suffering) to recover fully. The balance Patients whose symptoms violated neuro-
As a group, these disorders challenge between saving the body or the soul was logical models of [Continued on page 49]
Wake County Physician January 2010 PAGE 23
The shorT haPPy life of
bloomsbury Park
by Nancy Cobb Lilly*
Raleigh – an annex if you please.” Bloomsbury Park opened July 4, 1912,
Bloomsbury Park, originally called an amid much publicity and fanfare, and was
Electric Park, was a magical place, ablaze a huge success. Not only local railway
with 8,000 electric lights in what was then customers, but also residents from miles
a country setting. The park was laid out around arranged to charter Raleigh street-
by Mr. H.L. Parker, engineer for Carolina cars. The fun seekers arrived with picnic
Power and Light, who built roads, bridges baskets, paying a nickel fare to board
and paths. The park was considered one the trolley. Inside the Park, customers
of the best-appointed parks in the South frequently stood in long lines to ride the
with construction costs that reached roller coaster and carrousel, again paying
$150,000. From Glenwood Avenue, the a nickel per ride. The dancing pavilion
streetcar track roughly paralleled what was also a busy place in the afternoon and
A Piece of Raleigh History is now Lakeview Drive. At the bottom evening. Bloomsbury Park was filled, all
E
lectric trolleys had been running of the hill, there was a picturesque little day long, to overflowing with enormous
since the early 1900’s from crowds that kept every attraction
downtown Raleigh to Pullen on the jump daily from 10:00am
Park, near North Carolina State Col- to 11:00pm.
lege. The first streetcars, patterned after In addition to the rides and
the mule-drawn variety, were open-air dancing pavilion, there were
and thought to be a lot of fun. George boat rides on Crabtree Creek. A
London later remembered, “It was a broad walkway extended to the
fabulous thing. The seats ran all the way shore of the creek where motor,
across like pews in a church.” row, and paddleboats awaited to
Carolina Power and Light Company take passengers on the two-mile
(now Progress Energy), founded in
1908, had acquired the Raleigh Railway
Company. Originally, the company
mostly powered electric trolleys and
streetlights, the latter coming on for
a short period after sundown. By 1911, station where the track looped
Carolina Power and Light extended the around to head back up to
railway along Glenwood Avenue to the Glenwood Avenue. After off-
Carolina Country Club. The railway com- loading, passengers entered
pany formerly owned the 100-acre park the park by crossing Beaver
just north of the Club. Dam Creek via a rustic bridge
A year later, Carolina Power and Light made of stone and tree limbs.
announced plans to develop the park as Prior to the park opening,
a destination for streetcar customers. the Raleigh Times listed five
General Manager Carr reported, “We now major Bloomsbury Park attractions: journey up the stream. Olds again wrote,
have a long railway line for ‘Joy Riders’ 1. A $12,000 merry-go-round, electri- “This is really something worthwhile and
that terminates at the park, and we are cally operated, safely carries 100 gives Raleigh another asset in the way of
hopeful that the combination will be most passengers; enjoyment.”
beneficial to us.” 2. A large dancing pavilion, with an The press delighted in telling the story,
Fred A. Olds, writing in the Raleigh orchestra, advertising no classical whether true or not, of the night watchman
Times, May 1912 said, “The extension music but the quick, snappy Ragtime; who was fascinated by the roller coaster.
of the street railway to Crabtree Creek, 3. A third-of-a-mile roller coaster with One evening he turned the switch and
by way of Glenwood, has opened what is no hair-raising dips that makes such jumped on, only to realize that he had no
really a new world to most people; a very things dangerous; way to make it stop. He rode around all
beautiful country, hill and dale, forest, 4. A Penny Arcade offering moving night, until a staff member arrived the next
stream and field, with a wonderful variety pictures, talking machines, etc. for a morning. Carl Goerch later embellished
of vegetation and some strange blending penny each; the tale in the State Magazine, estimating
of plant life – very interesting to anyone. 5. A fleet of motor launches and row- the man rode about 141 miles that night!
Crabtree Creek now becomes accessible boats ready to provide a most de- By November of the first year, the
to everyone and is almost like a part of lightful water trip. Raleigh Times [Continued on page 41]
PAGE 24 January 2010 Wake County Physician
biomusic research: is music making
more WidesPread Than We realize?
by Patricia Gray, PhD*
M
usic is a magnificent human ers. It is collaborative and assumes that
obsession. Surveys of American listeners are also doers through turn taking
adults list music as one of the (active or passive). It is intentional. In ad-
five most important things in their lives; dition, the manipulation of its components
young adults between the ages of 12 and – sound and time - enables self to interact
22 listen to over 10,000 hours of music an- with others for basic survival needs,
nually; and infants can recognize melodies for wellness, and for culture creation.
they have heard in utero. It appears this It is logical, therefore, to presume
powerful role for music in human culture that our innate musical faculties are
is not new. Evidence of its practices are phylogentically very old. Indeed,
reflected in ancient hominid sites includ- neurological evidence reveals that the
ing Neanderthal, in ancient Greek texts auditory system, rooted in the oldest
and Indian Vedas, Buddhist caves along parts of our brain, is exquisitely at-
To address these questions, BioMu-
the Silk Road, pictographs depicting tuned to convey the intricacies of muick’s
sic research seeks to integrate complex
music-making from the Upper Kingdom components as the perceptions of sounds
and nuanced non-verbal communication
of Egypt, Olmec sites in the Yucatan, and time exploit an elaborate and grand
systems, with the study of non-material
Karnatic sites at Hampi, and the San cave network throughout both hemispheres of
culture in humans and other animals, with
paintings in southern Africa. Such ubiqui- the brain that includes areas associated
new developments in interdisciplinary fo-
tous presence in historical and contempo- with the highest cognitive skills and abili-
cus, research methodology, and technolo-
rary life suggests music making has deep ties.
gy. This enables research to move beyond
roots in cultural and biological processes Considering the evidence suggesting
traditional techniques of observation of
for us humans. musicking’s intrinsic significance, how
others in isolated, non-social contexts with
To investigate the phenomena associ- is it that we understand some of the parts
expectations of a music product – in most
ated with the music experience requires
cases, an acceptable humanly understand-
marshaling the resources of multiple
able musical statement – to a socially
knowledge bases and collaborative in-
driven process of musicking.
terdisciplinary approaches. Furthermore,
If we consider animal vocalizations and
to explore the evolution of human music
other musicking episodes within social
requires abandoning preconceptions of
contexts as the intentional sound and
music as exemplified by the Western Clas-
temporal interactions of the social space,
sical model with its emphasis on produc-
as well as the individual actors’ temporal
ing a product, i.e. a musical score. The
interactions within a communal continu-
score, based on elaborate learned rules,
ity of events, then we are presented with
is conveyed by an independent group of
robust opportunities for the pursuit of
performers in a staged, formal presenta-
musicking’s role in meaning-making. This
tion to a quiet audience. Instead, BioMusic
vibrant path for studying non-material
research focuses on the building blocks of
cultural processes builds on important
music-making across time, cultures, and
research such as emergent behaviors
species with particular attention on the
across evolutionary time. It offers ways to
spontaneous music-making found across
cross species’ lines to more fully grasp the
human cultures that often make music as
interactive complexities between all play-
part of a natural and organic outcome of a
ers within a given environmental space
social process. Indeed, participation in the
(cf. niche hypothesis, vocal learning).
group’s manipulation of sound and time
Proceeding in this manner also enables
becomes a central element of citizenship but cannot grasp the whole? That we have
conduits to the underlying processes of
in the group and of the group’s cohesive- yet to postulate an evolutionary narrative
verbal, non-verbal, and gestural communi-
ness. From this perspective, music-making that embraces the dynamical temporal and
cation and meaning making.
is transformed into a verb or a process that sonic capacities of other species, espe-
What are the various and successive
is referenced here on as musicking. cially our closest relatives – non-human
elements of the evolutionary process that
In this context, musicking establishes a apes? In addition, how do we move toward
culminates in the human musical capacity
connection from self to the external world. an inclusive narrative that echos a non-
and eventually into the culturally cre-
It enables self to have affinities with oth- biased, non-anthropocentric position?
ated and agreed [Continued on page 41]
Wake County Physician January 2010 PAGE 25
Mental Health Corner
by Nicholas E. Stratas, M.D., DLFAPA
Mental Health Editor
The anniversary
mately, recognition of celebratory events is dramatized with newly
in love partners and with couples in their teens or early twenties.
Thus we see the celebration of a week, a month, two months, and so
T
he word anniversary comes from the Latin anniversarius, on. In our western culture, the celebration of birthdays is traditional.
formed by the word “annus” for year and “versa” to turn. However, this is not so in all cultures. In the Eastern Orthodox cul-
An anniversary is commonly a day or time of year that com- ture, it is the nameday which is celebrated, the day of the annual
memorates and/or celebrates an initial event. The word was first reverence of the day of the Saint after whom the person is named –
used for Catholic feasts to commemorate saints. Many cultures thus my name Nicholas, after Saint Nicholas, who is revered (in the
have one or more special days. Jewish boys have a bar mitzvah Eastern Orthodox religion we have icons of the Saints however we
on or around their 13th birthday. Jewish girls now have a bat mitz- do not pray to the Saint, rather we revere the Saint) every January 7.
vah on or around their 12th birthday or now their 13th birthday Moreover, celebrations of anniversaries are frequently occasions to
in Reform and Conservative Judaism. In some Christian traditions, gift the celebrant. Again we find a difference in the Hellenic tradi-
generally Roman Catholic and Anglican, confirmation is the ritual tion. The celebrant is indeed the celebrant, being not only the focus
by which a young person receives a Sacrament thought to bestow of the celebration but in a turnaround is also the one who hosts and
certain gifts of the Holy Spirit. The timing of the reception of this treats those who acknowledge the occasion.
Sacrament serves, on a sociological level, as a sort of “rite of pas- Generally, when we speak of anniversaries we associate celebra-
sage” into adulthood. In some Asian countries, the 14th birthday is tion and happy times: This is not always so. Those of us who work
celebrated as the day one becomes a man, or a woman, in society] with patients (or clients if you prefer) and those of us who have
In India, the 12th or 13th birthday is replaced with a grand “thread had significant losses or traumata experience something we call the
ceremony.” The child takes a blessed thread and wears it, symbol- anniversary phenomenon or anniversary reaction. The anniversary
izing his coming of age. This ceremony is more common amongst phenomenon is an experience where there is a perception without
boys in the Hindu culture. awareness in which time of year is the unconsciously perceived cue.
People, couples, and families as well as organizations, institu- These reactions may be evident in various forms including somatic
tions nations and cultures need to have rites and rituals. The ritual symptoms and diseases, depression, psychosis, suicide, and homi-
of celebration of an anniversary is amongst the notable. It invites cide on the anniversary date of a significant past traumatic event.
the remembrance of foregone events and the joyous anticipation [Continued on page 33]
of additional significant anniversaries. In the Hellenic culture it
is customary to drink to “natakatostee’sis” that is, may you make
it a hundred. The Hindu tradition wisely waits and has a special
ceremony on a person’s sixtieth birthday with the Sanskrit name
Sashtiabdhapoorthi.
Since this column was started well before this occasion, I will
take a small sidebar here. My search for a 15th produced the bit
of information that in Hispanic countries the quinceanera celebra-
tion traditionally marks a girl’s 15th birthday. The Latin term dies
natalis is applied to the anniversary of an institution. And so on this
quindecennial dies natalis of the Wake County Physician Magazine
I say na’ta’ katostee’sis.
Couples and families develop their own rituals over time. The
development of these rituals is a part of the bonding and the expe-
rience of us. Anniversaries are very much an experience of “us”.
While much of my prior writing has focused on the individual, self-
reliance, self-directedness, self-management, the development of an
us is a critical part of the development of the individual and comes
with the clarification of one’s boundaries. The better separated/in-
tegrated one is the better the connectedness with the other. Ulti-
PAGE 26 January 2010 Wake County Physician
The North Carolina Medical Board’s Stand
Against Physician Participation in Judicial
Executions: Implications for Physician Ethics
and Professionalism
by David K. Gittelman, DO*
adoption in January 2007 of its first posi-
tion statement on Capital Punishment.3
The NCMB Position Statement on
Capital Punishment “attempted to harmo-
nize the Medical Board’s obligation to
enforce the ethics of the medical profes-
sion with the statutory requirements of
sections §15-190 and –192 of the North
Carolina General Statutes that a physi-
cian be present (italics added) at a judicial
execution and certify the execution of the penalty opponent. In fact, the American
condemned inmate…”4 The NCMB Posi- Medical Associaiton does not take a stand
tion Statement expressly forbid a physi- on the death penalty itself. Instead, the
cian from participation (“any verbal or American Medical Association views a
Setting: On November 18, 2008, At- physical activity, beyond the requirements physician’s involvement in executions as
torney Todd Brosius stood before the of North Carolina Gen. Stat. § 15-190, that a contradiction to the professional conduct
North Carolina Supreme Court (NCSC) facilitates the execution”5) in an execu- of a physician. The American Medical As-
arguing that the North Carolina Medical tion, adopting language directly from the sociation bases its standard of professional
Board (NCMB) has a right to discipline American Medical Association’s Council conduct in Opinion 2.06 on the idea that
physicians who participate in a judicial on Ethical and Judicial Affairs Opinion “A physician, as a member of a profession
execution, according to North Carolina 2.06 on Capital Punishment.6 dedicated to preserving life (italics added)
Gen. Stat. § 90-14(a), “to protect the One month after the NCMB adopted the when there is hope of doing so, should
public from unethical and unprofessional Position Statement on Capital Punishment not be a participant in a legally authorized
conduct by physicians.”1 Assistant At- the NCDOC revised their Execution Pro- execution,” which is grounded in the Hip-
torney General Joseph Finarelli represent- tocol explicitly to include a physician to pocratic dictum of “Primum non nocere”
ing the North Carolina Department of “monitor the essential bodily functions of or “First do no harm.”6
Corrections (NCDOC) told the court a the condemned” and “to notify the Warden The public ideally, respects the medical
doctor’s presence is needed to monitor the (if) the inmate shows signs of undue pain profession for the expertise, dedication,
inmate’s vital signs and pronounce death. and suffering.”7 This revision, accord- and high moral conduct of its members
“Our position is the term ‘present’ does ing to the NCMB, constituted physician and allows the profession exclusive rights
not preclude participation,” he said, “The participation in execution, a violation of to the practice of medicine and self-
Medical Board can not discipline physi- medical ethics worthy of disciplinary ac- regulation of its profession. The public
cians for doing something the Legislature tion. The NCMB Position Statement effec- entrusts our profession with its health and
has told them to do.”2 tively halted judicial executions in North confidences, without fear of being taken
Background: In 2006, prisoners in Carolina. Thus, conflict arose between advantage of, believing the physician will
Eastern North Carolina challenged the two state agencies resulting in this case follow the professional principle of putting
legality of the NCDOC execution proto- that were appealed to the North Carolina the patient’s interests before self-interest.8
col, contending that it violated the Eighth Supreme Court. It is public trust in the beneficence of the
Amendment of the United States Constitu- Issues for physicians and the medical profession that is threatened when
tion banning “cruel and unusual punish- medical profession: Physicians in physicians participate in capital punish-
ment.” This challenge was denied because the United States may support or op- ment.
the NCDOC satisfied the Eighth Amend- pose the death penalty in their personal Outcome: Ultimately on May 1, 2009,
ment by including a registered nurse and or political opinions, as recognized by a divided North Carolina Supreme Court
licensed physician’s presence “to monitor American Medical Association Opinion upheld the lower court’s ruling in favor
the plaintiff’s consciousness,” (a way to 2.06. However, the American Medical As- of the NCDOC. The NCMB likely has
prevent awareness of pain). Shortly there- sociation has opposed physician participa- no further legal recourse to challenge the
after, the NCMB received inquiries from tion in judicial executions since issuing North Carolina Supreme Court’s deci-
concerned citizens regarding the appro- Opinion 2.06 in 1980. The reasons for the sion, according to attorneys Brosius and
priateness of a physician’s participation in American Medical Association’s opposi- Noah H. Huffstetler, III. In July 2009, the
an upcoming execution. These inquiries tion to capital punishment have little to NCMB amended the Position Statement
led, after discussions with the NCDOC, do with the typical concerns of a death on Capital [Continued on page 40]
the public, and physicians, to the NCMB’s
Wake County Physician January 2010 PAGE 27
Public Health Issues
by Jeffrey Engel, M.D.
North Carolina State Health Director
beginning The nexT chaPTer
in Public healTh
M
any define the beginning of of public health. Today, agencies headed population health. This does not mean that
modern public health with the by the environmental health specialist the core functions will go away, indeed
advent of the science of epi- and communicable disease control health they need to be continuously strengthened
demiology (Greek origin, from epidemic professional, armed with the authority to address ongoing threats such as HIV
meaning upon the people; the study of of law and mandated services, conduct disease and food safety. To address an
diseases in populations). This is widely surveillance and investigate reportable epidemic of obesity will take an entire
ascribed to the work of John Snow, who conditions, inspect and regulate septic and new approach; however I argue that the
in 1845 associated a cholera outbreak in drinking water systems and the food chain fundamental tools of surveillance, evi-
London to contaminated water. Twenty including restaurants, grocery stores and denced based interventions stemming from
years before the germ theory of Louis Pas- production facilities (abattoirs, processing research, and policy will work again for
teur, Snow used an observational method and packaging plants), and keep the vital the new challenges of the next 100 years.
of careful case counting and tabulation of records (birth and death registries). The old saying, “what gets measured
person, place and time to determine that What are the lessons learned from the gets done” is a convenient way to think
the cholera outbreak was emanating from successes of the about surveil-
the Broad Street water pump. His now past 100 years lance. Public
legendary intervention was to remove the for the public health is great
pump handle so that the population had health playbook at measur-
to get drinking water from another pump. for the next 100 ing reportable
The outbreak ended quickly afterward. years? Several communicable
Nearly coincidentally in 1850 “across forces are begin- diseases such as
the pond” (i.e. the Atlantic Ocean), ning to articu- tuberculosis or
Lemuel Shattock completed his seminal late the public dysentery, but
work Report of the Sanitary Conditions of health future that not so efficient
Massachusetts documenting the deplor- focuses on the at measuring
able sanitary conditions in Boston. The broader mission body mass index
Shattuck report led to the creation of the of population (a measure
Massachusetts Department of Health in health, aiming to of obesity) in
1862 created mainly to address the human use the meth- school-aged
health effects of air and water pollution. odology that suc- children. New
The work of Snow and Shattuck, ceeded in infectious disease control to the health outcomes are becoming the “report-
Edward Jenner of the small pox vaccine goals of health promotion and wellness. able conditions” of today’s world. Cer-
fame, and the germ theorists at the turn of Sanitation and vaccination taught us that tainly before interventions (such as daily
the twentieth century began the modern prevention yielded great societal benefits physical education or healthier school
era of public health. In industrialized both in health and cost outcomes; however lunches) are implemented in a population,
countries, the twentieth century saw a dra- the main morbidity and mortality causes measurements of effectiveness need to be
matic decline in infectious disease morbid- are not infections but are cardiovascular in place to ensure that the health outcome
ity and mortality mainly due to sanitation disease and cancer. Upstream prevent- is improving and society is getting its re-
(clean drinking water, safe food and septic able determinants of these two killers are turn on investment. Additionally, short of
systems) and vaccination. In the 1970’s tobacco use, over-nutrition, and physical new laws mandating reporting of prevent-
when small pox was eradicated from the inactivity. Obesity and secondary diabetes able conditions such as childhood obesity,
world and antibiotics were rolling out of are main drivers of poor health outcomes public health is going to have to figure out
the production line, some were predicting and are of epidemic proportion. how to resolve behavioral epidemics with
the end of infectious diseases. Public health is in the midst of tran- new paradigms in health policy and law.
The interventions of sanitation and sitioning from the historical key core Requiring vaccinations before school
vaccination became the core functions functions to being accountable for overall entry has [Continued on page 49]
PAGE 28 January 2010 Wake County Physician
healThcare reflecTions
by Robert H. Bilbro, M.D., FACP
H
ealthcare in this nation has critical problems compounded Fundamental steps need to
by a major economic recession. We spend about twice be taken to curb the defensive
the money per capita as the rest of the industrialized world attitudes of healthcare profes-
and our health statistics rank below most of them. This situation sionals that result from their
is a moral embarrassment for our country. We need substantive ever threatening liability risk.
changes. A change that would be high-
Our society has several remarkable strengths which influence ly beneficial is to have health
healthcare. These attributes include strong entrepreneurial ac- courts analogous to our busi-
tivity, progressive innovation, and successful profit making. We ness courts. Such a change
lead the world in developing newer technologies for diagnosis and could move us away from the
therapy. There is much to celebrate in our healthcare capability. huge problem of trying to get
For patients without financial barriers, it is probably the best in a lay jury to understand complex scientific data. The health court
the world. would more knowledgeably assess the science of an issue and be
Over recent decades we have had a rapidly increasing gap be- less driven by emotional appeals.
tween the wealthy among us and those who live in poverty. With Healthcare resources could be more ineffectively utilized if we
that change in demography there are more persons willing, able, could separate essential services from more elaborate services.
and even eager to spend money for themselves and their families There are some healthcare measures that improve outcomes and
in hopes of better health and longer lives. This phenomenon influ- save dollars in the long-term that should not be left for individuals
ences medical practice patterns, causes institutional maneuvering to elect based on their personal finances. We should not have eco-
to capture market-share, and contributes to greater medical cost nomic barriers to effective management of such problems as high
for all who pay health-insurance premiums. These costs have led blood pressure, diabetes, elevated cholesterol levels, and asthma.
to more small businesses and working people to be without health Similarly we do not want to have economic barriers for effective
insurance. immunizations. We need to recognize that for some diseases each
We need to face the reality that we of us has less risk if all of us are im-
cannot pay for all the technological munized. However, for more elaborate
possibilities for all persons in all clini- and more expensive healthcare, we
cal circumstances. We need to do a should have significant co-pays or co-
better job of providing basic care for insurance costs. Beyond basic health-
all citizens, but some limits are neces- care, our system would work better if
sary for more elaborate diagnosis and patients and families have some “skin
treatment. in the game.”
As I write this article in mid Octo- Currently there is a widespread at-
ber, the information emanating from titude of entitlement for healthcare,
Congress suggests that it will pass whether the payment is through Med-
some legislation which shrinks the icaid or private insurance or Medicare
growing portion of our citizens who plus supplemental insurance. Our
have no health insurance. Such a step system needs to include a small tiered
would be of huge benefit to millions of co-pay for patients whatever their eco-
families. nomic status.
However, Congress seems not to Related to this issue is the need to
be considering substantive changes to have more public awareness of health-
help with our progressively increasing care costs. There should be more
costs for healthcare. Even our current transparency such that individuals
commitments to healthcare generate an who consume healthcare dollars have
economic burden that our society can- better knowledge of how much is being
not sustain. In my opinion the best approach would be to change spent for them. Currently only with great difficulty can patients
incentives for patients as well as for the healthcare system includ- learn what the costs have been for their healthcare.
ing hospitals, doctors, and medical equipment vendors. To alter So often there is patient and family pressure for utilization of
the economic attitude of both consumers and providers of health- futile measures to be taken near the end-of-life. To have some
care would be highly effective in “bending the curve” of healthcare participation in the cost of these measures would encourage more
costs that have been rising consistently faster than inflation. Such scientifically sound decisions. Similarly we need to establish
an approach would be more consistent with the individualism in guidelines as to when not to implement extraordinary rescue mea-
America and with our democratic process. To change economic sures for premature infants below certain thresholds of weight and
considerations would be more politically palatable and far more gestation time. Science has made huge advances in these areas,
effective than having authoritative directives and denials from ei- and scientific data can answer the question as to when millions
ther insurance companies or governmental agencies. of dollars should not be spent on some [Continued on page 40]
Wake County Physician January 2010 PAGE 29
Poetry Corner
John Balaban, Professor of English NC State University
Poetry Section Editor
The End of Autumn
by Lee Bradbury*
When all the woods are spindly with their trees,
stark up and twitching in the cold
and smoky light, a silent peace,
a twilight of thought invades the snow,
on afternoons of sun without the gold,
Ensemble at Dusk when there is only time and tea and sky,
by Brian Turner* a minty scent that only horses know,
and half the night is but the end of day.
I have been I, if for ever so short a time The logs to chop, the doorsprings and the keys,
--Bruce Frederick Cummings (1889-1919) are all that stir the air—and then a crow—
through soundless woods, over fields in frigid laze.
There is a twilight of thought in snow
The cypress and the elm have watched us that drowns the ears inside each leafless flow
all summer long, our blankets spread of elms and oaks in a hollypricking way,
under the wine of dusk, our lips no barks of dogs, the birds all roosted low,
when half the night is but the end of day,
in a sweet conversation with each other’s
skin, our signatures held by the pliant as moonrays skim the snowcrust in the fields
blades of grass, long after we’ve left. and horses shudder, stamp, and sneeze, then lope
on home to barn and bay, through glistening flakes
as half the night recalls the end of day.
And all through the quiet hours and thought drifts like twilight on the snow.
these trees watch how the grass *Lee Bradbury is from Kinston and a graduate student at NC State.
slowly releases the memory of us,
each blade rising the way the soul might From the Mystical Poems of Mowlana Rumi (1207-1273)
when we die, an owl calling us home. Again I am raging, I am in such a state by your soul that every
bond you bind, I break, by your soul.
By Autumn, they will have seen too much I am like heaven, like the moon, like a candle by your glow; I am all
to bear. And it won’t be the month of October reason, all love, all soul, by your soul.
My joy is of your doing, my hangover of your thorn; whatever
with its crisp chill that makes it happen.
side you turn your face, I turn mine, by your soul.
And it won’t be the snow that pulls them down I spoke in error; it is not surprising to speak in error in this
come winter. Rather, it’s the bright spark state, for this moment I cannot tell cup from wine, by your soul.
kindling within them. It’s what they’ve seen of love I am that madman in bonds who binds the “divs”; I, the madman,
am a Solomon with the “divs”, by your soul.
that turns their leaves from gold to amber to dust.
Whatever form other than love raises up its head from my
heart, forthwith I drive it out of the court of my heart, by your soul.
*Brian Turner was a soldier with the 3rd Styker Brigade
Come, you who have departed, for the thing that departs
in Iraq. His celebrated book of poetry entitled Here,
Bullet won the annual Poet’s Prize. comes back; neither you are that, by my soul, nor I am that, by your soul.
Disbeliever, do not conceal disbelief in your soul, for I will recite
the secret of your destiny, by your soul.
Out of love of Sham-e Tabrizi, through wakefulness or
nightrising, like a spinning mote I am distraught, by your soul.
PAGE 30 January 2010 Wake County Physician
On Hearing That Music Enhances Brain Development Band of Aides
by Timothy McBride* by Robert Greene*
“Listening to music can actually make your child smarter.” while I held my baby by her shoulders
—WTVN report, November 1998 the vaccination nurse moved towards us like an amoeba
Now that we’re sure it’s good for us, after that first heel stick there was a silent stirring
as she furrowed her brow and poked out her lower lip
let’s add it to our list of vitamin
supplements and stretching exercises then she fought just like I fought
and try to quantify the optimal dose: the psychiatric aides years ago
volume, duration, daily intervals, … who made me guzzle liquid charcoal
We’ll need to know, of course, if “jazz” to clear the tranks from my overdosed system
makes us as smart as “classical”
her wails made me think of how I yelled rape
so that we don’t waste any time when they forced the catheter
on Monk’s “Locomotive”
if Bach can turn out better engineers our attempts to comfort her after the “all done”
moved my mind to those months on the veterans’ psychward
or Chopin has the keys to dental school.
And just for safety’s sake, we’ll want head counts every fifteen minutes from the mental health aides
some answers to some lingering concerns: who woke me every odd hour in those odd days.
Does Mingus lead to drug abuse?
Could Tom Waits harm a child? *Robert Greene, whose poetry has appeared in War, Literature,
What about Stravinsky and ADD? and the Arts, and The New York Quarterly is a MFA student in
poetry at NC State.
Suppose the Surgeon General
had announced the opposite: Sabbath
that “listening to music” imposes risks by Kitty Foley*
including (but not limited to) heart disease,
Sunday morning and nothing has happened but rain.
emotional disorder, and lapses
The leaves so still in the aftermath,
into reverie on standard aptitude tests?
trees look like props still standing after the play.
Or that every minute you listen
All the actors are sleeping in, at every window
shortens your life by a minute?
the muffler of gray, potion of silence.
I’d almost bet that you could pick
Even the birds are taking their rest.
your friends, by what they’d keep
and what they’d throw away.
In the hush there’s no foot-sound on stair or street,
And I’d trade you twenty quiet elevator rides
not even the clandestine padding of cats.
for a chance to meet the kids
sneaking off to practice
There must be a street where a door opens,
in soundproof basements
a man in a suit or woman in dress setting out
and the teachers who’d find them there,
for church, as at the end of the world
mad-eyed and unhealthy,
someone still has to sing in the choir.
in love with something dangerous,
not asking what on earth it does to them.
Kitty Foley received her MA in literature from Middlebury
College in Vermont. A poet and photographer, she currently
*Timothy McBride lives in Cary. His first book of poetry entitled lives in North Carolina and is the author of Forgiving The
The Manageable Cold will be published by Northwestern University Dark (Chapel Hill Press, 2009).
Press in 2010.
Wake County Physician January 2010 PAGE 31
T hinking Things Through
by Assad Meymandi, MD, PhD, DLFAPA
The desPoTic habiT of gambling
I
f there is a clear case of evil in our midst, it is gambling with the expectation that proceeds go toward education.
Philosophers and theologians who seek answer to the The very act of gambling erodes education. In her recent
question of evil and where it comes from Unde Malum book, The Lottery, Shirley Jackson, describes a very May-
agree that man’s tendency to concupiscence is a given. berry type town, where everyone knows everyone. Families
Man’s tendency toward lower things is well acknowledged. carry the very ordinary names of Warner, Martin and An-
By nature, we drift to what is ill and downgrading and not derson. Jackson describes when gambling and lottery came
toward what is elevating and educational. It is useful to into this community; it ruined families, caused divorce,
remember that the very concept of education, from Latin, and increased the incidence of depression and anxiety. She
which means going toward higher things, to help a child to backs up her claim by citing data from Center for Disease
reach higher things in life. Control and Prevention of Atlanta showing that five to
The late Yale theologian/historian Jaroslav Pelikan in an seven percent of the United States population are addicted
astounding treatise looked at the episode when the Lord Je- to gambling and directly participate in uncontrolled and
sus Christ was so angry that he whipped the moneychanger compulsive purchase of lottery tickets. Women are placing
in the Temple. Many have reported that the merchants and more than half of the calls to some state gambling crisis
even the moneychangers were not doing anything wrong lines, double the percentage of a decade ago.
to evoke such volcanic anger in Jesus. However, Pelikan’s In a recent study by Pew Research Center survey, a sur-
scholarship suggests that the moneychangers were engaged vey poll showed that 70% of Americans believe that legal-
in actually selling lottery, in his words, “Selling false hope ized gambling encourages people to gamble more than they
to the innocent multitude. …” can afford. That is a noteworthy increase from 1989, when
I conducted an online search on the topic of the evil lot- 62% expressed that concern in a Gallup survey. In North
tery has caused. There are Carolina, clinicians are see-
nearly one million stories ing more problems related
of ordinary people who to compulsive gambling. I
have been abused by gam- do not understand why we
bling. There are very few create problems then pub-
stories about how lottery lish 1-800 numbers for crisis
has helped. By nature, the lines to offer help: This is a
abominable Lottery estab- gross violation of prevention
lishments are vulnerable principles.
to evil associations and Socrates said, and was
pernicious influence of the reported by Plato in Repub-
unwelcome in the commu- lic, “Cities (polis) states and
nity. governments are like people.
In North Carolina, we They can be beneficent and
passed the lottery bill by altruistic toward their citi-
one vote. I submit that this zens, or they can be psycho-
was not in the best inter- pathic and narcissistic, suck-
est of our state. In our clinical practices, we see increasing ing the life blood out of their citizens” by implementing
number of addicted and compulsive gamblers that inadver- measures like gambling. Gambling is a silent tax on the
tently destroy their families. poor: It should be repealed.
Gambling is evil, despotic, and un-educational. It is sheer
hypocrisy and evil for our politicians to allow gambling
PAGE 32 January 2010 Wake County Physician
noRtH CaRolina tReasuReRs continued from page 20 facturers of vineyard posts and wiring, bottlers, winery equipment,
public relations and advertising agencies, tour buses and limousine
and India. In 2006, 7.2 million bottles of wine were sold in India services, as well as producers of fertilizer, chemicals, farm equip-
and that number was expected to triple in the next three years. In ment, flowers and plants.
China, the demand for imported wine is growing at the rate of 30 There are ways to learn more about the North Carolina wine
percent a year. industry. Perhaps the best way is to visit the website, visitncwine.
Thomas Jefferson once said, “By making this wine known to com. One can also join the North Carolina Wine of the Month Club
the public, I have rendered my country as great a service as if I had at nc-wineclub.com.
enabled it to pay back the national debt..” (Of course, the national If you are interested in promoting the wine industry in North
debt was miniscule then compared to now!) Jefferson also said, Carolina, there are several things you can do, including buying
“Good wine is a necessity of life for me.” North Carolina wine, asking for it in grocery stores and restaurants,
Medical research consistently shows the value of regular and visiting NC wineries and festivals, and giving North Carolina wine
moderate consumption of wine. Red wine works to protect the brain as gifts.
from damage after a stroke -- and drinking a couple of glasses of There are challenges that need to be addressed in order for the
red wine a day may provide protection ahead of time, according industry to continue its growth. We need to continue to improve
to researchers at John Hopkins University. In fact, researchers at quality control in vineyards and wineries. Quality and consistency
Arizona State University have proven that an anti-oxidant found in are big challenges. We need to continue to improve the marketing
red grapes and red wine reduces susceptibility to viral illnesses. I of our wines. We need more shelf space in grocery stores, and we
guess that means those who prefer white wines need to drink twice need to be listed on more menus in restaurants. We need additional
as much to have the same effect although I have not found any public and private funding for viticulture research and continue to
research to prove that theory! produce more professional for the industry through various viticul-
Other unbiased medical research shows that wine can lower the ture programs.
risk of certain types of cancer, may reduce effects of radiation treat-
ment, may prevent gallstones, may reduce dementia, and prevent *Phil Kirk has served as a spokesperson for the for the past three
Parkinson’s and improve cell performance. years and is the Director of Brady Energy Services, a comprehen-
There is a long list of businesses/professions that benefit from the sive energy solutions company located in Greensboro with offices
establishment of a winery. Some of them include real estate bro- in Raleigh, Charlotte, Wilmington, and Fayetteville
kers, lawyers, transportation firms, and mortgage bankers, manu-
tHe anniveRsaRy continued from page 26 year, those of us who experienced school with anxiety are simply
reliving the annual gearing up?
In psychoanalysis, these may be conceptualized as ensuing from in-
Equally well known are the experiences of persons who have ex-
complete forms of mourning, similarly, psychiatrists may think they
perienced a significant loss or traumatic event and who experience
possess Extra Sensory Perception (ESP) as did psychoanalyst Philip
a change of mood and other physical dysfunction at the same time
Seitz. He would suddenly think of and have a concern for an ex- pa-
of the year as the event occurred. Most of these are unique to the
tient. Within a day or so he would usually get a call from the patient
individual, however frequently these are shared community events.
He recorded 47 such experiences, involving 21 different patients.
The most notable event recently is that of 9/11. So much so that in
Two-thirds of the calls proved justified. When Seitz analyzed his
questioning people about it many have forgotten the original year
notes, he found that the patients usually got depressed around the
but experience the altered and heightened awareness at that time of
same time of the year. One patient had been regularly depressed
the year. A more distant event is the assassination of President John
each Labor Day. Another always called for help on December 26.
F. Kennedy.
Before noticing these patterns in his appointment books, the ESP
Regardless of whether sad, happy or anxious, the anniversary is a
explanation seemed likely. After seeing the patterns, he realized he
present phenomenon and may we each have enough.
was basing his premonitions on correlations between time of year
and contacts with particular clients. It is common amongst therapists I am indebted to callers for many ideas for themes and invite ques-
to kid each other about thinking of a long discharged patient as a tions, comments to (stratas1@mindspring.com)
harbinger of word that patient is not doing well.
Today we are more likely to account for this type of anniversary
phenomenon depression with a biological explanation related to our
biorythms. Thus, we now have Seasonal Affective Disorder (SAD)
as a recognized psychiatric disorder, one that occurs at the same cover:
you can’t re
time of the year. This is usually in the fall and winter and is associ- Four things
w.
fter the thro
ated with the shortening of the daytime hours and the decrease in
exposure to the sun. We also have a treatment that is based on this The stone...a
.
fter it’s said
premise – Light Therapy. This involves the use of a bright light
source to which the person with SAD is exposed – usually in the The word...a
sed.
after it’s mis
morning for a half hour or so. To better mimic natural experience
these lights can be placed on a rheostat which allows the light to T he occasion...
e..
fter it’s gon
come on gradually over the half hour before waking and continue
on for another half hour while preparing for the day. On the other The time...a
hand, can it be that since fall is also the beginning of the school
Wake County Physician January 2010 PAGE 33
Quarterly Morbidity Report
by Jeffrey Engel, MD North Carolina State Health Director
WCP Magazine Public Health Editor
Wake County Morbidity Table
(Preliminary data, as of 11/16/2009)
The Morbidity Table
includes the number
Condition 3rd Qtr 2009 YTD 2009 (Q3) YTD 2008 (Q3)
of reportable diseases
and conditions reported Campylobacter 7 27 30
to the Wake County Creutzfeldt Jakob Disease - 1 -
Department of Health Chlamydia 751 2,586 2,704
and Human Services by Cryptosporidiosis 1 6 1
Physicians and labora- E. coli, Shiga toxin 1 8 10
tory directors as man- Ehrlichiosis, Granulocytic - 1 -
dated by NC Law. The Ehrlichiosis, Monocytic 1 3 4
list of reportable diseas- Foodborne disease – other - 12 -
es is not comprehensive Gonorrhea 206 751 913
as rare diseases with
Haemophilus influenzae, invasive 3 6 6
zero case reports (e.g.
CJD, Leprosy) are not
Hepatitis A 1 3 15
shown. Hepatitis B, acute 3 7 1
For a complete list of Hepatitis B, carrier 35 87 34
reportable conditions HIV/AIDS 43 137 207
see: (http://www.epi. Legionellosis - 2 2
state.nc.us/epi/gcdc/ Listeriosis 1 1 2
manual/reportable_dis- Lyme disease - 6 3
eases.html) Meningitis, pneumococcal - 1 -
Mumps - 1 -
Notes: No value in a Novel Influenza A 16 27 -
cell means 0 cases
Pertussis 1 12 1
reported.
RMSF 1 19 21
Previous quarter num- Salmonellosis 28 80 71
bers may change as Shigellosis 1 13 10
reports are verified. Strep, Group A invasive 2 5 8
Surveillance is based on Syphilis, Early 30 80 28
the date of the report,
Tuberculosis 9 17 29
not the date of the oc-
Typhoid, Acute 1 1 1
currence.
Based on feedback from users, we have made ty report using that criteria so the totals match
a change this year in how we present HIV and Wake County totals in our published reports.
AIDS data by county. HIV and AIDS cases that
are diagnosed/reported in prisons (state, federal) The Morbidity Table is offered by the Public
are excluded from individual county totals in our Health Committee of the Wake County Medical
published reports. We calculated this Wake Coun- Society.
PAGE 34 January 2010 Wake County Physician
Role model WoRtH emulating continued from back cover PHysiCian PRofile
continued from page 18
Head of the Department of Neurosurgery the School of Design at NCSU. She found-
the University of Cincinnati at the age of ed her own architectural firm in Raleigh. 2004. Both say the experience was similar to
35 and remained in that position for nearly Meg’s daughter, Anna, graduated from col- the days they spent woodworking together in
three decades. He was a prolific writer and lege at Duke in 2004, and started Medical the workshop at home.
researcher, and he was one of the founders School at University of North Carolina in “He helped me on every difficult case I
of the sub-specialty of Pediatric Neurosur- the fall of 2006. She is currently taking a did,” Dr. Burroughs Jr. says.
gery. At the age of 65, he decided to go to year to get her Masters in Public Health at To demonstrate how much the field has
law school, got his JD, and practiced law Harvard. changed, Dr. Burroughs III shows off a col-
until his mid-eighties. Kathleen’s eldest daughter, Kathleen lection of old joint replacements he and his
Anne McLaurin, MD, like her father and McLaurin Gavin, has attained two master’s father have collected from patients over the
grandfather, graduated from medical school degrees from the University of Cincinnati, years. Some of the heavy, clanging metal ob-
with honors (AOA). In fact, she was only one in special education and another in re- jects date back to the 1950s. They look “bar-
the second person in history to achieve 3rd habilitation counseling. She works with the baric,” he says, compared to today’s prosthet-
generation AOA honors. She did her resi- handicapped and the disabled. ics.
dency in Family Medicine at the University Dr. Kathleen McLaurin practiced medi- He’s particularly excited about a new com-
of Florida after completing medical school cine briefly in Cincinnati, and then shifted puter-assisted design system for customized
at the University of Cincinnati. Anne start- her focus after having her fourth child. She knee replacements that performs all the nec-
ed a successful private practice in Cary, and devoted the majority of her career to medi- essary measurements and calculations prior
then she and her partner were recruited to cally oriented volunteer work. In 1984, she to surgery. The system uses an MRI to build
become the staff physicians at the SAS In- was voted Woman of the Year in Cincin- a 3-D computer model of the entire leg. With
stitute. She is the wife of five term Raleigh nati. She was also the recipient of the Mary that model, the joint replacement company
mayor, Charles Meeker, and is an elected T. Schloss Award on behalf of the Easter builds a custom mold of the knee along with a
member of the Wake County School Board. Seal Society for her work helping people guide the surgeon can use to mark the precise
Robert L. McLaurin, Jr. MD, MBA grad- with disabilities. She co-founded Camp places where cuts and pins are needed. To
uated with Honors in Physics from Emory. Stepping Stones, now known as Camping his knowledge, Duke Raleigh Hospital is the
He got his Medical Degree from the Uni- for the Handicapped, Inc., as well as Liv- only hospital in North Carolina routinely us-
versity of Cincinnati, and completed his Ra- ing Arrangements for the Developmentally ing this system.
diation Oncology Residency at Baylor Col- Disabled (LADD). She also helped estab- While the initial cost is higher (the model-
lege of Medicine in Houston, Texas. He has lish Find A Way, an independent living ing and custom mold cost $1,200), he says the
started several successful cancer centers, complex and the Margaret Bullock Geier overall cost is lower because the surgery time
including the center at Raleigh Community Center. Kathleen volunteered as on-site is significantly shorter, and there is a reduced
Hospital, now Duke Health Raleigh. He got physician for the adolescent trainees at risk of error or infection. For that reason,
an MBA from the Kenan-Flagler Business the Job Corps in Cincinnati. She served he believes it’s vastly superior to the more
School at University of North Carolina, on the boards of United Cerebral Palsy, popular intra-operative CAD technique that
College Hill. He has obtained two United the Convalescent Center for Children, the involves measurement and modeling during
States Patents related to his pioneering Adolescent Clinic, and Children’s Hospi- surgery. “I feel like I’m in the dark ages if I
work in developing proprietary Radiation tal Medical Center. In 1985, the Cincinnati don’t have this.”
Treatment Planning software and a ste- Bicentennial Committee presented her with The tradition of medicine continues in
reotactic immobilization system. More re- an award naming her one of 200 Greater the Burroughs family. Paul Burroughs Jr.’s
cently, he has founded the Franklin County Cincinnatians who had quietly contributed daughter-in-law Michelle Cajulisis a hos-
Cancer Center, the Franklin County Breast to the quality of life in that city. pitalist at St. Luke’s Hospital in New York.
Care Center, and the Franklin County Med- Several years ago, Kathleen sold her It’s too early to tell whether Dr. Burroughs
ical Society. home in Cincinnati, and moved to the Tri- III’s children will follow the path to medi-
Hugh McLaurin, MD, MBA got his angle to be closer to children and grandchil- cine. He certainly won’t put any pressure
Medical Degree from the University of dren. She lives in Abbotswood and was re- on them to do so. But he recalls that his
Cincinnati, and completed his Residency cently elected president there. She can still daughter Emily at the age of 7 discovered a
in Family Medicine at Mercer University be found recounting the details of some of medical textbook with full-color illustrations
in Macon, GA. He then proceeded to get her adventures in California during the ear- of skeletal anatomy and was mesmerized.
his MBA, also from Mercer. He is now an ly days of the movie industry, and speculat- “She’d say, ‘Let me see the bone book!’”
Assistant Professor of Family Medicine ing about how things might have turned out
at Mercer University and the Medical Di- if she had not returned to the east coast for a
rector of Family Health Center in Macon, normal life. Still, we are glad she did, and we
Georgia. Hugh’s son, Sam, is in his first think her life has been extraordinary. Kath-
year at Mercer University School of Medi- leen has made a difference in the lives of The Bone and Joint Surgery Clinic
cine in Savannah, Georgia. many people, and her children continue her (919) 872-5296
Another of Kathleen’s daughters, Meg legacy of leadership and civic contribution, 3410 Executive Drive Suite 103
McLaurin, is also a resident of the Triangle. several of them right here in the Triangle. Raleigh, NC 27609
She graduated from college at Duke and (Kathleen recently died. She dedicated her www.raleighboneandjoint.net
received her masters in Architecture from body to science. Ed.)
Wake County Physician January 2010 PAGE 35
E ditor’s Notebook by Assad Meymandi, MD, PhD, DLFAPA
THANKSGIVING 2009
To My Dear Family, Friends, Colleagues and Readers:
Thanks for being Help Needed With Tennyson
I
Thanks for becoming
Thanks for the arts, the humanities, flowers, music, and trees need your help, Dear Readers:
Thanks for poetry, dance, ballet, ballads, symphony and One of very favorite people and poets is
Thanks for science and the universe Alfred Lord Tennyson (1809-1892). Lord
Thanks for Socrates’ elenchus Tennyson, in spite of his multitude of psychiatric
Thanks for Aristotle’s entelechy problems rose to be appointed by Disraeli as Poet
Thanks for Zarathustra, Buddha, Rumi, Mohammad, Ferdowsi, Avicenna, Laureate of England. Why am I writing this to
Goetha, Jesus, Gandhi, Mozart, Moses and Abraham… you? Recently, I was invited to do a piece of on
Thanks for my own mother, for Mother Teresa, Joan of Arc, Catherine of Siena, psychobiography of Tennyson for a publication
Virgin Mary, Sappho, Matilda Maud, Susan B. Anthony and Queen which I have accepted. We all know that Tenny-
Melisende of Jerusalem. son was married to one Emily Sellwood. Reports
Thanks for family and connectedness have it that she once came to US and somehow
Thanks for the World in their careless manners, the immigration people
Thanks for eternity miss-recorded her name as Ellwood. I have con-
Thanks for transcendence tacted the Ellwoods I know locally. No help. If
Thanks for America you have any knowledge, insight or relations or if
Thanks for life, and oh, yes you know anything about the genealogy of Ten-
Thanks for timely death nyson’s wife, please let me know. Thank you.
Assad Meymandi, MD, PhD, DLFAPA AM
Triangle Indian Physicians Society and compassion are at our disposal to freely share with our pa-
tients. No other profession on earth offers this unique and sacred
Dr. Prashant Patel wrote to Dr. Meymandi… opportunity: to offer knowledge, cutting edge science, along with
genuine empathy and altruism. When it comes to health care,
I will be giving the President’s Message or Opening Remarks we should be united with one voice that physicians and physi-
(in the Fifth Annual meeting of Triangle Indian Physicians Soci- cians only, not the bureaucrats, nor the businessmen, belong in
ety). I would like to recognize you in my remarks. the driver’s seat. Wake County Physician magazine celebrating
Would you send me a couple of your milestones and how the its 15th anniversary with its January ‘01 issue may be used as an
physicians can work with you (i.e. perhaps on the Wake County instrument to unify us and make our collective voice heard.”
Physician Magazine as you are a founding editor) or other ways.
Feel free to provide guidance and any suggestions as you are Assad Meymandi, MD, PhD, DLFAPA
truly a remarkable individual from all that I have heard and seen!
Prashant K. Patel, MD
Director-The Diabetes Center 155th NCMS Annual Meeting & House
Cary Internal Medicine & The Diabetes Center of Delegates
President-TIPS (Triangle Indian-American Physicians Society)
(October 30-November 1, 2009)
Dr. Meymandi’s reply:
T
here were two resolutions, both authored by Assad Mey-
Dr Patel: mandi, one presented by WCMS and one as a late resolu-
I am honored to offer the following brief thought: tion. They had to do with banning advertising alcohol on
college athletic events and one with rewriting HR 3200 to include
“Medicine is a priesthood. We are privileged to dwell in the holy tort reform. Both resolution were given adequate consideration
temple of medicine where knowledge, excellence, service, care by the Reference committees and appropriately acted upon.
PAGE 36 January 2010 Wake County Physician
Wake County Physician January 2010 PAGE 37
Views & Reviews
by J. Bradley Wilson*
ToWard a more
raTional healTh
care debaTe
M
y promotion to president of you go. Speaker Nancy Pelosi and Senate their financial means and health circum-
Blue Cross and Blue Shield leader Harry Reid bemoaned health insur- stances, it is critical that government set
of North Carolina (BCBSNC) ers’ obscene and immoral profits. up a strong requirement that everyone
comes during interesting times. I was Much of the heat behind this approach is have health insurance. Otherwise, many
excited that President Obama required based on a flawed, but seldom-questioned young, healthy people will forgo buying
White House staff to read an article in The premise - that insurers control the price of insurance until they get sick. Proposed
New Yorker by surgeon and writer Atul health care through what they charge for fines for not buying insurance in the Sen-
Gawande about cost differences in similar premiums. The fact is that insurance pre- ate legislation are well below the cost of
locales. I was encouraged by the insurance miums rise with the cost of what insurance most insurance policies. Without a strong
industry’s early commitment to work with covers - costs drive premiums, and not the insurance requirement, health insurance
the White House on health care reform. other way around. will become an unsustainable revolving
Surely, we thought, here was a leader who Reasonable third parties concluded door - people buying insurance when they
understood the complexities, challenges, health insurers’ outrageous profit margins get sick or injured and dropping it when
and rewards of reforming a fragmented are mediocre in comparison to other cor- they are well.
industry representing one-sixth of the na- porations. And while insurance companies Government should also carefully
tion’s GDP. are not exactly beloved by the public, consider how aggressively to constrain
I remember exactly where I was when national polls confirm that four out of five price differentials among groups. Little
I realized that the debate had devolved: people with insurance are satisfied with price differentiation would mean huge
watching President Obama speak to a their coverage. rate hikes for the youngest and healthiest
large crowd (and national television audi- Where the focus should be is on the im- citizens, creating incentives for them to
ence) from Needham Broughton High pact that congressional proposals will have flee the system. Actuarial studies by con-
School in Raleigh in late July. That day on the health coverage costs of Americans. sultants and our own actuaries suggest that
the president abandoned the mission of A Senate proposal would levy $13 billion younger age groups could see premium
bending the curve on costs -- the element in new health care taxes. At the same time, increases approaching 69 percent under
in health care reform supposedly critical to it would give many Americans a financial this approach. Couple that with a small
the economic recovery and managing the incentive to avoid health insurance until fine for not getting coverage and it is clear
deficit. The issue became health insur- they are sick. The result would be dramati- that many will opt out of the system.
ance reform, and the White House staged cally higher premiums for those who do We are also concerned about a vastly
a series of attacks on insurers. “We have a buy insurance. We estimate that five years expanded government role contemplated
system today that works well for the insur- after reform was in place, new buyers of in government-run insurance, the so-called
ance industry, but it doesn’t always work individual policies would pay more than “Medicare E.” The only way a govern-
well for you,” said the President that day. 50 percent more than they would now and ment plan can lower costs significantly is
It is clear what happened. Faced with small businesses would pay 28 percent by forcing health care providers to accept
the difficulty of defending complex, more. This does not include the impact Medicare reimbursement rates, which
expensive legislation that had not been of medical inflation, which continues to are currently 20 to 30 percent lower than
drafted, and reeling from protests at Town increase rapidly. those paid by private insurers are. If the
Hall meetings, leading Democrats control- Americans understand the impact of government does that, the likely result
ling Congress narrowed the mission to reform that is not done right. A recent would be additional cost shifting to those
setting up and knocking down a more Wall Street Journal/NBC poll found that with private coverage and less access to
inviting straw man: health insurers. significantly more Americans think health providers unable to treat patients at artifi-
I am sure that attacking insurers polls care costs will increase under reform (47 cially low rates. Such an approach would
well. Let us face it: the insurance industry percent) than believe reform will reduce undermine the private coverage that most
sometimes is its own worst enemy. And costs (13 percent). people have now, breaking the President’s
it is so easy - just dust off a few of John To assure that we have a sustainable promise that “if you like the coverage
Edwards’ old HMO-bashing lines and off system that covers everyone, regardless of you have now, you can keep it.” Even if a
PAGE 38 January 2010 Wake County Physician
government plan begins by paying negoti- reform are: getting everyone covered (and own, and so we have forged partnerships
ated rates to hospitals and doctors, there is paying something into the system); im- with physicians and hospitals to improve
strong reason to believe that over time the proving health care quality and efficiency; quality and reduce medical errors. We
government would end up dictating prices focusing on better care, not just more care; paid $4.2 million to physicians participat-
to health care providers, as both Medicare and creating incentives to help us all live ing in the national Bridges to Excellence
and Medicaid do now. It is important healthier lives and reduce chronic disease. program to recognize and reward physi-
to remember that Medicare payment Part of the answer is changing our pay- cians who meet stringent national quality
rates were originally equal to health care ment structure to better reward quality. standards. That effort has demonstrated
provider charges, yet are now well below Our current fee-for-service system tends results in terms of higher quality care. We
market rates. to value high volume over good outcomes. have also worked with the North Carolina
Perhaps the least effective way to lower There is a role for better utilizing health Center for Hospital Quality and Patient
health care costs is the centerpiece of information technology. Resources from Safety, an initiative of the North Carolina.
several reform proposals: new health care the federal stimulus package will hasten Hospital Association that helps more than
taxes and fees. The Baucus bill would levy the development of standardization and in- 100 hospitals in the state implement qual-
$13 billion in new fees on insurers, drug teroperability that allow doctors and health ity measures.
companies, and medical equipment mak- facilities to work together better. Health The issue of health care reform is
ers. We estimate this would increase our IT can also help reduce medical errors and simply too important to be left to sound-
own tax burden by about $100 million per duplication of services. bite politics and short-term solutions. For
year, a 60 percent increase over our tax We must invest more in preventive care. its part, Blue Cross and Blue Shield of
bill for 2008. Taxes on other health care While not all preventive measures save North Carolina is willing to make seri-
companies would add to medical inflation, money immediately, it is clear that we ous, fundamental changes that address our
already climbing at a worrisome rate. must address the epidemic of obesity that major health and financial challenges. And
The real irony is that not even insurers pushes up North Carolina’s health care we are ready to partner with everyone to
think our health care system works well costs by $2.8 billion a year. do it.
for insurers. Current premium trends -- not My company has been working for *J. Bradley Wilson is president and chief
to mention health trends like obesity and years on initiatives that advance this operating officer of Blue Cross and Blue
chronic diseases -- bode ill for the future agenda. For example, we were the first Shield of North Carolina. A leader of the
of my industry. Our products are increas- insurer in North Carolina to promote state’s largest health insurer since 1995,
ingly being priced out of reach for many electronic prescribing. We provided doc- Wilson has broad experience across the
customers. If we do not begin by honestly tors with handheld devices and software to business and has been designated by the
facing up to the real problems facing our transmit prescriptions to pharmacies, iden- Board of Trustees to succeed CEO Bob
health care system, we may miss an op- tify generic alternatives, and be alerted to Greczyn upon his retirement in 2010.
portunity to pass reform that could at least allergies and drug-to-drug interactions. A North Carolina native, Wilson has
mitigate these negative trends. We also waived customer copayments broad experience in the practice of law,
There is a thoughtful role for govern- on generic drugs four times, saving our government, higher education, regulatory
ment to play in reform by establishing members tens of millions of dollars in out- affairs and business. He practiced law in
the marketplace rules. They could require of-pocket costs and increasing the use of Lenoir for 14 years before serving as gen-
everyone to purchase coverage and to generics. We were the first major insurer eral counsel to North Carolina Governor
assist those who cannot afford their health in the nation to cover obesity as a primary Jim Hunt. As general counsel to the gover-
insurance premiums. However, none of condition for both adults and children, and nor, Wilson managed the legal department
these goals requires the United States we have established coverage for nutrition within the governor’s office and was the
government to dive even deeper into the counseling visits to licensed, credentialed chief legislative strategist for the gover-
insurance business. dietitians. nor’s legislative program. He also served
The issues that are central to effective Insurers can do only so much on their as acting secretary of the Department of
Crime Control and Public Safety.
Wilson’s commitment to North Caro-
lina extends beyond Blue Cross and Blue
Shield of North Carolina. He has served
on and chaired a number of state boards
and nonprofit organizations, including the
University Of North Carolina Board Of
Governors, the North Carolina Railroad
Company Board, the Meredith College
Board of Trustees, and the 21st Century
Transportation Study Committee.
Wilson has a B.A. degree from Appa-
lachian State University, a Juris Doctor
degree from the Wake Forest University
School of Law, and a Master’s Degree
from Duke University.
Wake County Physician January 2010 PAGE 39
nC mediCal BoaRd’s stand HealtHCaRe RefleCtions continued from page 29
continued from page 27 newborns. We need to collectively recognize the
We need incentives for wider applica- negative impact of lifestyles in this nation
Punishment to reflect the loss of legal right
tion of hospice care for terminal situations. that contribute to chronic disease and
to discipline physicians participating in
Reality tells us that life will end for each of greater healthcare costs. Can incentives
judicial executions, but reiterated the view
us no matter how elaborate our healthcare be effective to change behavior regarding
that it continued to regard such activity as
might be. In many clinical situations the obesity, smoking and lack of exercise?
a “departure from the ethics of the medical
hospice approach helps a patient end life Finally, to come back to some change
profession.”3 Physicians are left to decide
with grace and dignity, with far less cost. in the incentives on the provider side with
whether to follow ancient moral precepts of
It is not unusual for tens of thousands its fee-for-service payment system, let
their profession and the bylaws of their pro-
of dollars to be spent on chemotherapy me briefly describe one possibility. This
fessional organizations or to participate in
applied in some conditions when there is change might begin with Medicare, where-
lethal executions for which they have never
only marginal hope for clinical benefit. An by it would make payments on a per capita
been trained or intended to do. However a
alternative method could be to require that basis to large networks of physicians, clin-
physician participating in judicial executions
such desperate therapy be utilized only ics, hospitals and other medical providers.
may risk expulsion from one’s specialty
through a clinical trial protocol. Such an The network would in turn work out its
organization as many (ex: North Carolina
approach would be more humane, save particular plan to pay for services. Such
Medical Society, Society of Correctional
expenses, and would help us to move an approach could be used to help with the
Physicians, American Association of An-
forward with developing improvements in medical home shortcomings and could be
esthesiologists9) have bylaws that forbid
chemotherapy. used to diminish the major variability in
participation in judicial execution and this is
Data and experience show clearly that costs among different regions of the coun-
reportable to the National Practitioner Data
healthcare is more effective and more try. It would provoke better focus on and
Base. Of course, physicians participating in
efficient if patients have a medical home. assessment of outcomes with less encour-
executions are often afforded anonymity,10
To make that possible, we need a system agement for more units of service.
but is that not enough to inform any moral
that encourages healthcare professionals to If our democratic process would get
person that what they are doing is wrong?
pursue careers in primary care. To accom- beyond smears and exaggerations to
* David K Gittelman has practiced at WakeMed plish that is economically challenging, but strive toward the greater good with more
for 21 years. This article is based on his final re- is essential for effective healthcare. constructive problem solving, we could
search paper for his most recent course on Medi- Another step that should be taken to make needed improvements. We need
cal Professionalism. Dr. Gittelman welcomes any
help with this cost burden is administra- to minimize the people with no health
inquiries regarding this paper, the AMA-MCW
Medical Ethics Program, or medical ethics in
tive simplification of the often aggravating insurance, and we need to have economic
general.
methodology for insurance claims. Large considerations more involved in decisions
numbers of people work to submit claims for elaborate healthcare. With strategic
1 www.ncga.state.nc.us/EnactedLegislation/Stat- while others process, adjudicate, and even- improvements in our system we could
utes/HTML/BySection/Chapter_90/GS_90-14. tually pay some of the claims for work that enhance our collective health, live longer,
html, accessed Dec 2008 has been done. and save on healthcare expenses.
2 N.C. Supreme Court Hears Case on Execution
Doctors Raleigh, N.C., 11.18.2008 AP wbt.com/
news/details.cfm?article_id=44419 accessed Dec
2008
3 www.ncmedboard.org/Clients/NCBOM/Public/
PublicMedia/capitalpunishment.htm, accessed
Dec 2008, Oct 2009
4 Ibid
5 Ibid
6 Code of Medical Ethics of the American Medi-
cal Association, Council on Ethical and Judicial
Affairs, Current Opinions with Annotations,
2006-2007 ed. Pages 19-25
7 Woolverton, P. “Execution Protocol Ap-
proved.” The Fayetteville Observer (NC) 7
March 2007
8 Latham, SR. Medical Professionalism: A Parso-
nian View. The Mount Sinai Journal of Medicine.
2002: 69(6);363-369
9 www.ama-assn.org/ama1/pub/upload/mm/395/
nc_captialpunishment.pdf, accessed December
13, 2008
10 Gawande, A. When Law and Ethics Collide –
Why Physicians Participate in Executions, 354
New England Journal of Medicine. 1221, 1227-
28 (2006)
PAGE 40 January 2010 Wake County Physician
studied, measured, and often assigned as ers, or harmonicas, and even electronic
Bio-musiC ReseaRCH uniquely human. However, are they? keyboards. Spontaneous interactions are
continued from page 25
In assessing the branching nature of captured using digital technology and ana-
upon practice that we call music’? evolution, this question portends profound lyzed as a non-linear dynamical system.
A route with substantive potential to relevance for the emergence of intel- This research method has turned up new
inform this question resides in the con- ligence. Indeed, if intelligence -- as both and very interesting empirical results that
cept of entrainment, i.e. the interaction understood as an ongoing neuronal con- suggest bonobos are capable of rhythmic
and consequent synchronization of two struction in the brain and as the resulting synchronous behaviors and beat entrain-
or more rhythmic actors or oscillators. properties of the co-creation of meaning ment. In other words, we are dissecting es-
Here my emphasis is placed on interac- processes -- is an emergent property wired sential and basic elements of a musicking
tive intentional entrainment, which offers into the social biosphere, then musick- relationship and of human music making.
multiple, complex entries to the moment ing’s temporal constructs – measurable as If these results continue, this BioMusic
of musicking and puts music perception rhythmic synchrony -- suggest possible research will link these critical music-
through a prism of integrated, embod- directions for contributing to a revised making behaviors to a 6 million year old
ied, and interactive processes. These evolutionary narrative. common ancestor. Now that is a very
are grounded in time perceptions across To grasp new ways to work in musick- interesting story.
multiple dynamical planes. These kinds ing research of nonmaterial cultures, Selected references that have influenced
of temporal dynamics, best understood as I have studied for over seven years a this essay:
non-linear systems, more accurately repre- group of language-capable bonobos (Pan Auer, P., Couper-Kuhlen, E., Muller, F. 1999.
sent key processes for both musicking and paniscus). Guided by and sensitive to non- Language in Time. New York: Oxford Univer-
other non-verbal behaviors. By entraining human primate social systems, musicking sity Press.
to a beat, participants can simultaneously research has gone forward in parallel with Benzon, W. L. 2001. Beethoven’s Anvil. New
experience various relational dimensions research in other modes of non-verbal York: Basic Books.
of the underlying internal and mutually communication, stone tool making, and Clarke, E. 2005. Ways of Listening: An Eco-
embraced beat while playing an important play. The bonobo musicking research is logical Approach to the Perception of Musical
structured as part of a social interaction Meaning. New York: Oxford University Press.
additive role in the group’s synthesized
experience. Such collaborative, synchro- with no judgment conveyed of right or *The writer is Clinical Professor and
nous behaviors are dynamic, not metro- wrong, good or bad within the context Senior Research Scientist of BioMusic,
nomic, and therefore are natural, organic, of the musicking episodes. Musicking Music Research Institute, University of
and unrehearsed. These spontaneous, tools can include percussion instruments, North Carolina-Greensboro
innate abilities in our species are regularly wind instruments such as flutes, record-
tHe sHoRt HaPPy life continued from page 24 reported the following incident: “Business came to a sudden
standstill in the crap shooters and poker players’ paradise in the
announced, “Bloomsbury Park has gone into winter quarters, old Bloomsbury Park yesterday afternoon when police officers
and silent indeed are those woods and walks where, but lately, suddenly appeared on the scene. More than 40 gamblers left hur-
so many thousand found amusement. No longer do the strings riedly.”
of electric lights make the place like fairyland; no longer does The rare Dentzel carrousel, with its hand carved, galloping
the music play at the merry-go-round; and everything has been menagerie, was restored in 1976 and was listed on the National
boarded up. Commodores Byrum and Lassiter of the rival Crab- Historic Register. It continues to be enjoyed at Pullen Park by
tree Creek navies put their fleet of boats in winter quarters too. It children and adults of all ages. [Note: At this writing, the carrou-
is hoped that next season there will be more boating, for it can be sel is again being restored.]
a very delightful feature of the amusements at Bloomsbury Park.” Sadly, the glory days of Bloomsbury Park lasted less than
After the first season, Col. L. H. Livingstone became owner ten happy years. Following World War II, the property was
and general manager of Bloomsbury Park. He planned to enlarge purchased and divided into lots. However, the name and place
the park and, in March 1913, he advertised, “Concessions to continues to fascinate those interested in the history of Raleigh.
Rent: Candy Wheel, Bowling Alley, Palmist, Souvenir Stand, Remnants of the ninety-eight year old park remain:
Photo Gallery, and Lunch Room etc.” A dancing instructor from 1. A portion of the trolley terminal’s foundation is on Scotland
Buenos Aires was hired to teach the latest dance steps at the Street.
Pavilion. The Park was declared all new except name. 2. The carrousel’s original concrete foundation serves as a
In spite of the Park’s early popularity, by 1920, the Raleigh basketball court for neighborhood children.
Board of Commissioners purchased the merry-go-round and its 3. Remnants of the pavilion foundation, an area of about 5,000
building for $1500, less 5% discount for cash, and it was eventu- square feet, remain.
ally moved to Pullen Park. 4. The base for the Park’s water tower, which stood 30 feet
During World War I, Bloomsbury Park may have been shut high and held 6900 gallons, is now covered with ivy.
down as a commercial amusement park, but it remained available 5. A few spikes from the old railroad bed occasionally turn up
as a place for individuals to go. In May 1921, it was reported, “A along the general area of Lakeview Drive.
Dance will be given tonight in the Pavilion of Bloomsbury Park *The writer is an amateur historian who was a Regent of Gun-
by young men of the city, complimenting the college girls and ston Hall Plantation, George Mason’s historic home in Virginia,
their friends.” for several years. She is currently working on editing the cor-
Then, in 1922, the Raleigh Times column Looking Back, respondence of her grandfather, UNC professor Collier Cobb.
Wake County Physician January 2010 PAGE 41
Issues On Care at the End of Life
by Edward B. Yellig, MD, FACP
gleanings
encouraging signs of recovery, the clini- (Editor’s Note: Dr. Ned Yellig is retir-
cal staff knew that patients often respond ing from his present post. This is his last
more often to family than the strangers column on end of the life issues. However,
that we were. At 72 hours, the threshold of he promises to continue writing for The
evidential significance for recovery from Wake County Physician and report on his
coma, she had made little if any progress
T
thoughts, musings, and observations. We
wo unrelated friends who do not and I began to introduce the possibil- thank him for his contributions to WCP,
even know each other asked me ity that she in all likelihood would not and wish him well.)
the same question, separately, a recover from this devastating stroke. The
week apart. They asked, “How has this CAT scan of her brain finally revealed the
work changed you?” With my retirement damage done to her brain and I convened and understanding for the beliefs of people
from Hospice of Wake County at the end a family meeting in which I gave them the from different cultures and religious back-
of October 2009, the question deserved a bad news: there was less than one in 100 grounds forced me to listen first and talk
thoughtful answer. Hospice work has held chance of a meaningful recovery from her later to patients and families about the criti-
me captive since August of 2001 begin- coma. The younger family members want- cal elements of medical care from which
ning shortly after my first retirement from ed to allow her the peace and comfort that we had to make life and death decisions.
primary care internal medicine in May that comes with a natural death. It was evident This required respecting each individual
year. Like many of my co-workers, I rap- of her belief in miracles when the oldest of within the framework of his or her life
idly developed a passion for the challenges her children spoke adamantly about her be- story. My respect had to include aware-
that we face working with patients who lief in God and how He was going to bring ness of the knowledge differences between
have serious and often terminal illnesses. her back to them. She wanted a temporary us as well as the educational differences.
There is a time-limited tolerance for this feeding tube placed to provide nourish- Religious beliefs may replace information
kind of work, different for each of us, and ment through the weekend, not yielding an deficits in the decision-making processes. I
I had reached mine. We are all changed by inch to the protestations of her nieces and respect the power these beliefs have on the
it. nephews. outcome of medical care patients receive,
Here is one of many stories that helped The weekend passed, and I returned to sometimes to their own detriment. At some
to change me over these eight years. the bedside Monday morning expecting to point, I learned to allow my patients to cut
Gladys Barber was a 92-year-old African see Mrs. Barber still in a coma. A sleepy their own path and coached myself on how
American woman who was found uncon- but alert Mrs. Barber greeted me with a to walk this journey with them. Perhaps
scious by her niece on the floor of her joyous smile and a pleasant good morning. now I act as a scout for the risks and dan-
bedroom. The niece called EMS who came Shock would not begin to describe my feel- gers as well as the salutary outcomes that
and took her to the nearest hospital emer- ings: joy, surprise, a touch of sheepishness, might accompany medical decisions and
gency room. She had a satisfactory pulse and some puzzlement to name a few. The thus guide them, not command them, to
and blood pressure but did not respond to oldest daughter who had wanted and ex- take this way or that.
voice, touch, or pain. A CAT scan of the pected a miracle claimed it and celebrated In the process of making many journeys
head was normal for her age. Comatose but it. I did, too. In retrospect, we had given with patients and families, my eyes were
with stable vital signs, she was admitted to insufficient importance to the subtle signs opened to the breadth and depth of human
a regular medical floor bed and the family of awakening that had preceded the 72- suffering, itself a compelling force often
was counseled to wait and see what would hour prognostic marker. She had already demanding that I do something, but many
happen. I was consulted to provide support quietly but dramatically begun her road to times suggesting that I only be there, be
and guidance to the family after the attend- recovery. present, and do nothing. I could but be
ing physician had given them the unhappy This helped me to me to examine my un- another soul in the room. I had to learn
prognosis that she may not recover from derstanding of what constituted a miracle, a that suffering is what the sufferer says it
this event. profound event without apparent scientific is. They have said, “I can’t walk across
The children of Mrs. Barber were devout explanation, and accept that the belief in the room to get to the bathroom without
Christians who believed in miracles, con- miracles forms a foundation for decision- wetting myself,’ ‘I don’t know if God
fident that she would recover and return making for thousands of patients and loves me,’ ‘The nurses keep waking me at
home. Not noticing much in the way of families. Developing tolerance, acceptance, night and then I’m too tired to talk to my
PAGE 42 January 2010 Wake County Physician
family during the day.” Not always physi- I am impressed with the important and last breath. Are these examples of life and
cal symptoms create suffering like pain or profound effects of empathy, the ability to death controlled by cosmic forces, a Higher
shortness of breath. It can be loss of spiri- put oneself in another’s shoes and see the Power, or are they just coincidence? It’s
tual direction, loss of a bodily function, or world through their eyes. The discipline of Mystery, and I allow it to just...be.
loss of family. I understand that medical palliative care is now old enough, thirty- I have experienced awe in the presence
care, intended to relieve suffering, can in- five years since the term was coined by of visible, palpable, tender love among
stead create it as with some chemotherapy the Canadian physician Balford Mount, patients and family members and friends.
to treat cancer, as in the malignant effects to have provided an evidence base for the I have also felt the searing tearing pain of
of attempting to prolong a life through tube effects of empathy, as well as the effects separation and loss in the anticipation of
feedings, resuscitations, and infusions of of a listening posture, words that comfort death. I have been troubled by the difficul-
powerful medications. Out of necessity, and guide, and simply being fully present ty that some individuals have with letting
I learned to say to myself, “This is not with mind and body. Sometimes this work go because this can be manifested as the
about me. I am not in control. I trust in the requires the reverse dictum, “Don’t just do inability to allow the timely withdrawal of
wisdom of a Higher Power.” Sometimes, something, stand there.” Stand or sit there artificial life support in the face of impend-
unfortunately, it was not about the patient in sacred stillness and feel, be, experience ing death. Acceptance of the natural timing
either but about a well-meaning family the Ineffable holding the hand of a fellow of death minimizes suffering in the patient,
member who is unable to let go. The fam- mortal while she lay dying. To me, this is in the family, and in the clinical staff. I am
ily then became my focus of care. impressed by the skills, dedication, and
I developed an even more profound compassion of the nurses and physicians
respect for the effects of lifestyle and with whom I have shared responsibility
health habits on the quality and quantity to care for and guide the patients and
of life. In my primary care practice, I families with serious or terminal ill-
saw the day-to-day effects of decades nesses. I hope and pray for the eventual
of smoking, overeating, and sedentary creation of a universal guide which can
living. Now I was seeing how bad health be used for a compassionate clinical
habits were leading to an earlier death framework to allow for the most re-
and one that often became a long pro- spectful and sacred process of dying that
cess, sometimes stretched over a period we can devise. Caring must therefore
of weeks or months and perhaps after include family members whose grief
years of disability. becomes laden with unresolved anger,
Listening became my greatest tool, guilt, or separation. I can understand and
well chosen words my second. Focus- now accommodate different pathways to
ing my attention to what is being said letting go: some long, some short, and
to me and what is happening around me some tortuous. These pathways are re-
gave me critical details about patients flective of different cultures, emotional
and families. These tools created the attachments, and different educational
therapeutic conversation, a piece of levels. I can now walk with them.
interpersonal art that leads to a common I am indebted to the many hospice
understanding of the medical dilemma and palliative care colleagues who have
and the drama that we face together. the one of the ultimate and most holy of taught me well, especially how to accept
Usually, over time and trust, a satisfac- human experiences. and to give freely love and support when
tory resolution evolves for the decisions Another one is mystery. How fortunate needed. I appreciate the patience of the
that have to be made regarding the care of I feel that I have been able to witness and employees of Hospice of Wake County,
another human being. appreciate situations that lack human un- who taught me how to work as a team,
Time, however, can be both comrade and derstanding, at least my understanding. A although it did take years to shed the foible
curse. I suppose one of the greatest lessons man tearfully requests removal of his wife of total and individual responsibility, that
I learned is that calm, watchful waiting was from a ventilator and stays by her bed for stuck to me like a second skin since gradu-
more often my ally than my enemy. When hours, talking to her. I arrive in the room ation from medical school. I have admired
I waited for patients and families to move to comfort him as best I can. I hear him the creative leaders and researchers within
through the uncomfortable morass of their whisper to her, “I love you.” She takes one the new medical specialty and discipline
emotions and move through many family breath and dies. An uncle lies gasping for of Hospice and Palliative Medicine. They
discussions, we often could then see clearly air for days on a ventilator while his nieces have been a source of inspiration to me to
a vision of what is next. Alternately, the and nephews argue about his finances and provide holistic medical care to patients
disease process can take an unexpected but property. I attend and facilitate a tense with serious illnesses, addressing the
critical turn forcing decisions to go only in family conference hoping to defuse and physical, emotional, and spiritual aspects
one direction and not the other, thus spar- postpone conflicts long enough to redirect of suffering, and teach that to others. This
ing families agonizing deliberations. their attention to his suffering and the with- experience has allowed me to behold what
Living with uncertainty requires compas- drawal of life support. We conclude our it means to be a full human being while
sionate collaboration between health care discussions without resolution and return honoring and caring for others as they
personnel and their patients and families. to his room where we find him taking his strive to be the same.
Wake County Physician January 2010 PAGE 43
Scienceby Ali Mazaheri, PhD*
The ongoing brain
acTiviTy and aTTenTion
Recent Research and Information models proposed to interpret EEG changes was developed in the 1990s to evaluate
on ADD, ADHD in ADHD: The “Maturational Lag” model brain damage, ADHD, and other neuro-
and the “Developmental Deviation” model. logical disorders. As participants sat at the
W
hen I stand on the Nijmegen According to the Maturational Lag computer for an hour, a random number
Waalbridge (a historic little model, EEG measures from a child with from one to nine flashed onto the screen
bridge in the Netherlands) on ADHD would be considered normal in a every two seconds. The task was to press a
a cold winter day, one of two things will younger child, a child with ADHD is thus button as soon as any number except five
likely overtake my senses: the picturesque simply lagging behind in development (1). appeared. It has already been established
view of the snow covered city, or the an- In contrast, the Developmental Deviation that participants with ADHD typically
noyance of the sound of cars rushing by. model, proposes that ADHD is a deviation perform exceptionally poorly on this task.
Attention is an essential cognitive ability (as opposed to a lag in development) from However, even in the typical population
that permits us to process and act upon normal brain activity (2). These models of young undergraduates the participants
relevant information effectively while essentially differ in terms of how markedly made mistakes in 40 percent of the time.
ignoring distracting events around us. the EEG profiles of ADHD groups change We found that about a second before
Understanding this neural basis of atten- with increasing age compared to those of these errors were committed, brain activity
tion has been a key challenge for neurosci- healthy controls. At present, neither model in the 10 Hz range (commonly referred
ence for more than a century. The study of is fully supported. to as alpha activity) in the visual and
the underlying mechanisms of attention is I am a basic researcher, who is attempt- sensorimotor regions was much greater
not just a question for the basic scientist, ing to link brain activity, attention, and than when the subjects correctly refrained
but especially relevant for diagnosing and higher order thought. However, I will from hitting the button (3). Moreover, we
treating of psychiatric conditions that in- confess that I have no particular interest found that after the commission of an error
volve deficits in attention, such as attention in how one’s brain responds to a stimulus. there were almost immediate changes in
deficit hyperactivity disorder (ADHD). Rather, I am one of the few researchers brain activity in the frontal regions of the
ADHD is characterized by symptoms of involved in a burgeoning new direction of brain, which appeared to drive down and
inattention, impulsivity and hyperactivity. research that focuses on how the neuronal suppress the excess alpha activity in the
The Electroencephalograph (EEG) activity prior to an event influences sub- occipital region. It almost appeared as if
provides a simple non-invasive tool for sequent perception and human behaviour. the frontal regions were giving the visual
measuring the electric fields produced by Although my work has primarily focused regions a wakeup call to pay attention.
neuronal activity inside our brain. If one on coming up with models of how brain These findings provide a small step into
simply places electrodes on the scalp of a activity prior to a stimulus shapes the understanding [Continued on page 49]
human volunteer performing no particular brain’s future response, some of
task and measures the voltage, a dizzying my most recent work has some
array of seemingly random fluctuations relevance to disorders of attention.
will be recorded. These fluctuations in In a study I conducted with col-
neural activity seem to suggest that the laborators in the Netherlands, we
brain’s neuronal state is continuously used magnetoencephalography - a
changing. However, typically, the majority non-invasive brain-wave record-
of research that attempts to link attention ing technique similar to EEG, to
to neuronal activity ignores this baseline look for brain activity that would
activity, and examines the neuronal events predict a future lapse in attention
after the occurrence of a sensory stimulus during a task that particularly
such as a sound or an image. taxed attention.
This task, known as the sus-
At present, there have been two key
tained attention response task,
PAGE 44 January 2010 Wake County Physician
studying ComPassion continued from page 15 The Shamatha tions that would typically be interpreted
Project. as distancing themselves from others.
Our results To test whether increased compassion
so far suggest practice supported these differences, we
that it may are currently conducting similar analyses
indeed be from data obtained at the beginning of the
possible to retreat. The rich dataset of the Shamatha
become more Project is allowing us to not only answer
compas- our original research questions but also
sionate with generate new hypotheses and test them.
training. For example, to further assess compassion,
With support we are planning to examine how cultiva-
from the tion of “non-attachment” or release from
Fetzer Insti- mental fixations during the course of a
tute, Her- retreat relates to the growth of compassion
shey Family during training as indexed by electrophysi-
Cliff Saron and the Dalai Lama in April 2009 at the Mind and Life meeting Foundation ological and emotion-related behavioral
and many oth- changes. Such work is important because
or contemplation of suffering moves one
ers, we had 30 compassion requires going beyond per-
to action. Sadness can often serve as a
participants undergo 3 months of intensive sonal distress in the face of suffering, and
catalyst for the arising of compassion. We
meditation training and a wait-list control non-attachment allows one to be released
learned that a compassionate response
group of 30 others who later underwent from one’s own distress.
to others’ suffering implies a genuine
identical training. Retreatants lived in the Finally, compassion is not only an
concern for others, but also an absence of
Shambhala Mountain Center, Red Feather individual-level phenomenon. I learned
personal distress, which can shift the focus
Lakes, Colorado, for 3 months and re- another aspect of compassion when I
away from others’ suffering toward one’s
ceived instructions from Dr. Alan Wallace presented some of the findings of the
own distress. Rather than sympathetic
in practices designed to promote relax- Shamatha Project to the Dalai Lama last
despair for the plight of others or oneself,
ation, attentional stability and vividness, April. At the end of my presentation, I
which is seldom helpful, genuine com-
and complementary practices to develop asked him how we, Westerners, can ef-
passion involves commitment to creative
compassion and kindness toward oth- fectively encourage secular individuals in
and skillful action in accordance with the
ers. We collected extensive longitudinal our societies to engage in contemplative
deepest and broadest understanding of
qualitative and quantitative psychologi- practices that cultivate positive qualities
the causes and conditions of the present
cal, perception-, attention-, and emotion- such as compassion without recourse to
situation.
related behavioral and physiological data Buddhist metaphysics that often accompa-
That trip to India left us changed by our
at pre-, mid-, and post-training. nies such practices in Buddhist contexts.
encounter with extraordinary individuals
I will mention only a couple of ex- He brilliantly threw the ball in the court
wholly committed to a life of contempla-
amples of our findings here relevant to of Western scientists. Through a rigor-
tive practice. We had many questions,
compassion. We found that participants’ ous investigation of compassion using
such as: Were the monks we met excep-
self-reported self-compassion improved state-of-the art scientific methodology, he
tional from the start, or is it possible for
over the course of training. Participants reminded us, we are instilling the value
one to “train” individuals in compassion?
also reported improvements in their of compassion in the society at large. Up
Is it possible to compassionately regard
capacities of perspective taking and em- until that point, I had thought of compas-
the plight of loved ones and strangers with
pathic concern for others and reduction in sion as an immediate response to one’s
the same depth? From a Buddhist point of
personal distress related to empathizing own or other’s suffering, not as a systemic
view, the answer is yes to both questions.
with others. To assess participants’ emo- solution to suffering of individuals in the
Through a philosophical and contempla-
tional responses to suffering, we showed system. As I pursue our ongoing research
tive understanding of the interdependence
them film footage from a recent war, and make plans for future studies on com-
and impermanence of all phenomena,
depicting both the perpetrators and victims passion, I often think of the Dalai Lama’s
particularly one’s mental states, and a rich
of violent acts. Currently, we are conduct- highly affirming and encouraging com-
meditation tradition emphasizing culti-
ing detailed analyses of participants’ facial ment about compassionate research.
vation of qualities such as mindfulness,
expressions in response to these scenes.
attentional stability and flexibility, loving *The author is an Assistant Research
Initial analyses indicate that the retreat
kindness, compassion, empathetic joy, and Scientist at the Center for Mind and Brain,
group showed increased spontaneous
equanimity, the Buddhist path offers many (mindbrain.ucdavis.edu) and M.I.N.D.
expression of sadness compared to the
ways of self-discovery of human capacity. Institute (www.ucdmc.ucdavis.edu/MIND-
control group. Within the retreat group,
Happily for scientists, some of those ways Institute/) at the University of California,
in response to specific scenes of civilian
can be studied empirically, something I Davis. He received his Ph.D from Albert
casualties, those who had engaged in more
have been doing with my collaborators on Einstein College of Medicine.
compassion meditation did not show emo-
Wake County Physician January 2010 PAGE 45
B ook Reviews
mysTeries of
by Assad Meymandi, MD, PhD, DLFAPA
its Alzheimer’s research budge into drugs that don’t target amy-
loid. Harvard Medical School neuroscientist Jie Shen, who thinks
alzheimer’s disease amyloid is a mere accomplice, blames the disease on malfunc-
tions in two proteins called presenilin. If her theory is correct, one
A
class of antiamyloid drugs called gamma secretase inhibitors may
lzheimer’s disease is a bit like a murder mystery with
make the disease worse.
numerous possible culprits and only a few vague clues.
Some researchers are fingering cousins of amyloid as the killer.
For years, the prime suspect has been a protein fragment
Amyloid is produced from a larger protein (amyloid precursor
called beta-amyloid, which forms clumps inside the brains of
protein) that is chopped up into various fragments, including
dementia patients.
beta-amyloid. Until now, the role of the others hasn’t gotten
Big drug companies since the 1990s have bet heavily on the
much attention.
concept that amyloid poisons brain cells and that blocking it will
Neuroscientist Marc Tessier-Lavigne, chief scientific officer
halt a patient’s devastating decline.
at Roche’s Genentech division, has intriguing evidence implicat-
But even as their drugs move into final human trials, the evi-
ing a fragment that binds to something on brain cells called death
dence implicating amyloid is starting to look a little shaky. An
receptor six, which can trigger cells to die or shrivel and is named
amyloid-lowering drug from Myriad Genetics did nothing in a
for its involvement in a natural self-destruct mechanism. High
giant trial. Wyeth and Elan’s amyloid-clearing antibody, called
levels of death receptor six are found in the brain areas that die
bapineuzumab, showed mixing results in a midstage human trial
off in Alzheimer’s disease.
last year. It clearly helped only a subset of patients who lacked a
Could death receptor six be the murder weapon in Alzheim-
certain gene mutation, and it had side effects such as fluid leak-
er’s? Maybe. Tessier-Lavigne’s evidence is indirect and doesn’t
age in the brain.
rule out a role for amyloid (which Roche also has drugs against).
Stranger yet, this summer researchers from the Mount Sinai
But unlike amyloid, his fragment provides a clear mechanism for
School of Medicine in New York City examined an old allergy
brain-cell death, he says, “This mechanism we have described is
drug from Russia that recently showed promising results in
very powerful at killing nerve cells.” Under his concept, Al-
Alzheimer’s victims. They wanted to know whether it lowered
zheimer’s disease results from brain-cell maintenance gone awry.
amyloid. To their surprise, it boosted short-term amyloid levels in
Brain cells constantly prune excess nerve fibers during early
animal and lab experiments, according to results reported at a big
development. This landscaping process may go haywire during
Alzheimer’s conference. Pfizer licensed comarketing rights for
Alzheimer’s and kill healthy cells, he says. Roche has made anti-
the Russian antihistamine from the biotech company
body drugs that block death receptor
Medivation in 2008 for $225 million plus milestone
six and is testing them in mice with
payments, and the companies are conducting large
Alzheimer’s symptoms to see if they
trails. Results are due next year.
block memory loss.
All of this has some scientists wondering if they are
Other drug researchers finger two
targeting the wrong chemical. “People inside and out-
other malfunctioning molecules
side the amyloid field are trying to think what are we
liked to the disease. One is a protein
doing wrong. Either we are treating the wrong thing or
called tau that makes up the neurofi-
using the wrong drug or testing it in the wrong way,”
brillary tangles found in the neurons
says Mount Sinai’s
of
Samuel Grady, who led the research into the Russian
Alzheimer’s sufferers. Proponents
drug and still thinks amyloid is involved. Adds Merck
argue that tangles correlate better
Vice President Richard Hargreaves: “There has been
with dementia than amyloid plaques
a sort of a arrowminded approach to Alzheimer’s dis-
do. Merck, TauRx Therapeutics
ease. Amyloid deposition is only one of the features.”
(cofounded by Scotland’s Wischik) and Allon Therapeutics in
Some go much further. “I think amyloid is a complete nothing,
Vancouver, B.C. are working on drugs that hit tau.
“says University of Aberdeen (Scotland) researcher Claude Wis-
The second is a bad version of a gene called apolipoprotein E.
chik. “ One day someone has to write a book about how a whole
Discovered in 1993, the “bad” form, called APOE e4, can raise
field can get suckered into this for so long.”
the risk of Alzheimer’s disease by a factor of ten for those with
Five million Americans suffer from Alzheimer’s disease, and
two bad copies, and it is involved in 50% to 60% of Alzheimer’s
the number will climb as baby boomers age. Existing drugs such
cases. Only 1% of Alzheimer’s suffers have early-onset forms
as Aricept treat symptoms but don’t stop brain cell death.
caused by inherited genes that boost amyloid production. (But
While the bulk of research money remains focused on amyloid,
two more common genes linked to amyloid were just identified.)
some researchers are looking elsewhere. Merck is putting half of
“It seems perverse,” says Case Western Reserve researcher Mark
PAGE 46 January 2010 Wake County Physician
the next several years we will understand how it fits together.”
ALZHEIMER’S WHODUNIT
WHAT IS KILLING THE BRAIN CELLS OF
ALZHEIMER’S DISEASE SUFFERERS? THERE ARE
MR. GATLING’S TERRIBLE MARVEL
MORE SUSPECTS THAN IN AN AGATHA CHRISTIE The Gun That Changed Everything
MURDER MYSTERY. HERE ARE JUST A FEW. and the Misunderstood Genius Who
BETA-AMYLOID Protein fragments that form Invented It.
plaques inside the brain of Alzheimer’s patients. By Julia Milton.
Illustrated. 294pp. Viking.
NEUROFIBRILLARY TANGLES Another abnor-
mality found in the brains of victims of Alzheim- Reviewer: John Richard Jordan
A
er’s upon autopsy.
t last we are provided
APOLIPOPROTEIN E E4 A common gene vari- with a biography of a
ant that markedly boosts Alzheimer’s disease risk. long forgotten and today
little known North Carolinian
N-APP An amyloid cousin that hits a molecule on whose name in his time was as
brain cells called death receptor six. well known both nationally and
internationally as that of Bill
PRESENILIN Two proteins that help neurons Gates today. This North Caro-
function properly and may go bad during Al- lina farm boy born in Hertford
zheimer’s, says Harvard’s Jie Shen. County is readily remembered
by historians as the inventor and
MITOCHONDRIA Energy-producing structures manufactor of the world’s first
in cells that may weaken during Alzheimer’s. Me- operable machine gun, the Gatling Gun. But that considerable
divation’s drug may protect them. accomplishment is only a part of a unique life. Richard Jordan
Gatling was truly a genius in the Edisonian sense. At the early
age of twenty-two Gatling independently developed the prin-
Smith, an amyloid theory critic. “We have the major genetic ciple of the screw-propeller which was to revolutionize maritime
determinant figured out, and few people are working on it.” commerce only to find that John Ericsson had beaten him to the
One of those few is Robert Mahley, president of the J. David patent office by just a few days. Ericsson gained fortune and
Gladstone Institutes in San Francisco. He has shown that the world fame. Young Gatling though disappointed was not long
APOE e4 gene produces a misshapen protein that can glom on to discouraged. Within two years he had invented and patented a
energy producing structures inside neurons called mitochondria successful seed planter after which he left North Carolina for St.
and disrupt their functions. This may make neurons more prone Louis and began what became a notable career as an inventor and
to damage over time, he says. In 2005, Mahley identified drug manufacturer. During the course of his long life Richard Jordan
like chemicals that can restore the APOE e4 protein to a normal Gatling produced many inventions in addition to his seed planter
shape. He is collaborating with Merck to devise versions that that improved America’s expanding agricultural industry includ-
could one day be tested in patients. One concept would be to treat ing a motorized plow, a cotton cultivator, a hemp brake and a
people with the APOE e4 gene with such drugs in late middle lathe-maker. For the domestic population he invented a flush toi-
age to prevent dementia from developing much like cholesterol- let, a dishwasher and a new type of bicycle that allowed greatly
lowering drugs are used to prevent heart6 attacks in those at risk. increased speed. His inquiring mind took him into the field of
Still, he laments: “There hasn’t been a lot of attention paid to motorized pedestrian transportation in machines similar to the
this. Te field has been very myopic.” motor driven agricultural vehicles he had already patented. As
Overall, 18 of the 41 drugs in efficacy trials for Alzheimer’s late as his eighties he developed a power transmission system for
hit amyloid, says market researcher Datamonitor; most of the sending compressed air through underground pipes to locations
remaining drugs treat symptoms. The bets keep getting bigger. In difficult to reach, an engineering breakthrough used in mining
July, Johnson & Johnson agreed to a $1.5 billion deal to snag an operations and in the building of tunnels. Gatling was denied a
18.4% stake in Elan and a big share of the profits from bapineu- patent for this work on the ground that it was a “discovery” and
zumab, new in final-stage trials. (The deal may be revised, as it not an invention. At the time of his death he held forty-three
breaches a pact Elan has with Biogen Idec.) Amyloid proponents patents in his name.
say early trials were too small to give clear answers. “I think it is However the author, Julia Keller, a previous Pulitzer Prize
pivotal to the disease process,” says Elan Chief Scientific Officer winner, pays scant attention to Dr. Gatling’s contribution of these
Dale Schenk. “The genetic data in favor of amyloid is enormous.” enormous labor-saving improvements for farmers, engineers and
The imbalance worries Zaven Khachaturian, former head of homemakers. His most remembered invention is, of course, his
Alzheimer’s research at the National Institutes of Health. He fears “revolving gun” which he patented in 1862. Not surprisingly, the
that if amyloid drugs fail, “drug companies will walk away from author writes primarily of the Gatling Gun, its use and its impli-
Alzheimer’s disease as untreatable. Roche’s Tessler-Lavigne is cations for society not only in the United States but throughout
more optimistic. “It is a perplexing riddle right now,” he says. “In many parts of the world. The [Continued on page 48]
Wake County Physician January 2010 PAGE 47
Gun itself well but there the quality of in any public
Book RevieWs continued from page 47 the bookends. Generally the rest of place com-
the writing is a rambling commentary memorating
inventor himself in developing the gun on various social and cultural condi- his achieve-
considered it a humanitarian instrument. tions of the times few of which have much ments and
Dr. Gatling had moved his farm imple- significant relevance to either the inventor worldwide
ment business to Indianapolis by the time or his inventions. The tone of Kellers’s fame. No
of the Civil War. There he saw train loads writing is disquieting. Indeed, her attitude university,
of dead and disabled troops being brought toward Dr. Gatling himself is at times college or
in from the battlefields and camps. He condescending. For instance in the book’s learned
found that only three out of eighteen died title and in the text of the book itself the society in
from bullet wounds. The remainder had author refuses to recognize Richard Jordan his native
Richard Jordan Gatling
died from fever, pneumonia or other ill- Gatling as a Doctor of Medicine although state has
nesses contracted in the camps or on the he was a graduate of the Ohio Medical recog-
march. Dr.Gatling reasoned that if there College and was addressed as “doctor” nized
must be war a means should be found that everywhere for the rest of his life. Fur- him even post mortem. But Dr. Gatling
required fewer troops and other military thermore, has not be without his advocates. Three
personnel whereby the death rate would be she missed the opportunity to give her fellow natives of Hertford County have
decreased. It was his belief that the awe- readers an extraordinary illustration of done much scholarly research into his life,
some firepower of the Gatling Gun wound the theory of genetics. Richard Gatling’s and having published on the subject. The
enable one person to replace hundreds father, Jordan Gatling, was largely un- late Dr. Thomas Custis Parramore, profes-
of soldiers on the battlefield and thereby educated. Yet as early as 1835 Jordan sor of history at Meredith College, Frank
“supersede the necessity of large armies”, Gatling had patented both a cotton planter Stephenson of the Chowan College faculty
he hoped as well that the terror created by and a cotton thinner being the very first and Roy Johnson, publisher and historian,
such a weapon would tend to for “opening a ridge, sewing and covering have carried the torch for the remarkable
discourage war altogether. Although cotton seed chopping out cotton plants”. Gatling family for many years. Happily,
Gatling’s hope for his weapon in this Like himself, Richard Jordan Gatling’s Julia Keller acknowledges the life-long
regard did not materialize it was a hope older brother, Henry Gatling, was also a and tireless efforts of Frank Stephenson
respectably shared by others. In Britain, self-taught inventor holding several pat- to preserve this important page of our
where the Gatling Gun was early adopted, ents for agricultural implements. Actually, history.
the press editorialized that the “the use of he held promise of exceeding the inventive Dr. Parramore suggested that the reason
this formidable weapon will tend to dimin- genius of both his father and his famous Dr. Gatling was not more favorably rec-
ish the barbarity and actual carnage of brother Richard. While still a young man ognized by his native state was a matter
warfare, as the known relentless certainty Henry became intensely interested in of human bias. Dr. Gatling was a Union
of execution will help to prevent wars and flight spending much time in its obser- sympathizer during the Civil War. He
thereby aid in keeping peace…” vation and study. In 1873, thirty years chose to live in the industrial North nearly
The Gatling Gun as originally designed before the Wright brothers came to Kitty all of his adult life. When he perfected
was a revolving battery containing six rifle Hawk, Henry Gatling on the family farm his Gatling Gun he offered it to the Union
barrels arranged in a circle which could in Hertford County attempted heavier than forces. The papers of Abraham Lincoln
fire 200 bullets a minute. It was mounted air flight in a machine he had constructed contain a personal letter from Gatling to
on wagon wheels and operated by a hand himself. It is reported that he flew ap- the President requesting an opportunity to
crank. Gatling improved the efficiency of proximately 100 feet which is about the demonstrate the weapon. Dr. Parramore
the weapon to 1200 bullets a minute and same distance attained by Orville Wright concluded that this was too much for the
ultimately to 3000. Later he also adapted in the Wright brothers’ “first flight” in people of North Carolina. Even though
a model for use on naval craft. The gun 1903 at Kill Devil Hills. the gun was little used during the war
was immediately accepted by the Brit- This biography of Dr. Richard Jordan North Carolinians saw Richard Jordan
ish, by every European country except Gatling will certainly raise questions. Gatling as one of the enemy and struck
Belgium and by virtually every South Why has North Carolina for so long him form their memory. Others have
American country. It was not accepted virtually ignored her illustrious native suggested a reason more general: That it
by the United States until 1866 after the son? While the nation has honored him was because of the nature of Dr. Gatling’s
Civil War here ended. Nevertheless, the by naming a warship in his memory the best known invention which was a ter-
worldwide acclaim given the unprec- only tangible recognition here of Gatling’s rible instrument of death and destruction
edented effectiveness of the new weapon genius and his contributions is an obscure sometimes used in after years in behalf
gave its North Carolina born inventor the highway historical marker in of unpopular causes. In the Gatling Gun
undisputed title of “The Modern Vulcan” Hertford County a few miles below the people saw for the first time the mechani-
and changed forever the format of warfare. North Carolina-Virginia state boarder. zation of mass death. It disturbed many,
Even today the principle of the Gatling There is no building, bridge or highway and agitated their conscious. Neither the
Gun is still utilized in certain military and designated as his memorial anywhere in “terrible marvel” nor its creator was to be
naval combat aircraft. North Carolina. There is no painting of commended. “Let’s just not mention it
The author tells the story of the Gatling his likeness on display. There is no plaque further.”
PAGE 48 January 2010 Wake County Physician
Beginning tHe next CHaPteR continued from page 28 PlaCeBos, magiC and faitH Healing continued from page 23
proven to be a very cost-effective intervention. Policy and illness flooded the young Freud. and “la belle indifference.” Mental
interventions for poor behavioral outcomes that predict Based on his training in 19th disorders were no longer diseases
development of chronic diseases are centering on economic neurophysiology, Freud consid- of the mind or soul. The brain is
disincentives. Examples include the so-called “sin taxes” on ered hysterical symptoms as result- the principle object of study and
alcohol and tobacco (sugared beverages may be next) and ing from interrupted nervous ener- the neuroscientist is the new guru.
higher health insurance costs for those who smoke or who gy normally directed at perception However, did the shift away
are obese. Higher cigarette taxes have definitely been shown and willful action. Later while from the introspective method of
to reduce youth smoking; an experience such as New York studying hypnosis with Charcot he gaining knowledge prove any more
City’s where a pack of cigarettes costs $9.50 and youth shifted to a psychophysiological enlightening or better resolve ques-
smoking rates are the lowest in the nation is a case in point. model. Freud adopted hypnosis in tions raised by these patients? The
The population health problems of the United States have order to explore and treat these un- neuroscience revolution like the
dramatically changed in the 21st century. Core public health conventional patients. Once back Enlightenment shifted the focus
successes learned from sanitation and vaccination must be in Vienna, he eventually aban- from intelligibility (what goes on
translated into a world of preventable heart attacks, strokes, doned hypnosis because it was in the mind) to experimental mod-
high blood pressure and cholesterol, and cancer. Although inconsistent with his scientific- els based upon scientific method-
public health agencies are seen as the leaders in health rationalist approach to neurology. ologies and instrumentation -- Am-
promotion, the entire community is ultimately accountable He wanted treatments based on plification and extensions of the
for outcomes that rely on behavior and choices. It will be scientific rationalism not mysteri- senses by electrophysiology and
interesting to see how well we as a society deal with modern ous forces that smacked of super- functional neuroimaging. Hysteria
health challenges. It’s refreshing to see that a good part of natural causes. was dissected into smaller elements
the proposed healthcare reform legislation is addressing Freud eventually settled on a or functional modules with an eye
prevention. technique of guided introspective towards even finer analyses of
as a means of probing the psyche to molecules and gene actions. How-
loWly eaRtHWoRm continued from page 22 explain these unusual symptoms. ever, questions remain. Can dis-
connected. In the place of birth is the universal land, a land Over time, he came to understand tress and suffering be understood
of awesome power and beauty. From it comes painting of hysterical (conversion) symptom as reliably as the activity of c-fi-
stars, of swirls of light, of radiance, from that universal formation as a compromise solu- bers, spinal cord relay centers, sen-
realm comes early movement and the softest sounds like tion to unconscious psychological sitized pain perceptual fields, and
ohm, amen, or mama. In 2003, I was inspired by Michaels traumas and conflicts. Symptoms altered limbic and peri-aqueductal
and others to write an essay on what I called “Spiritual represented misapplication of psy- gray involvement? Sophisticated
Aesthetics” where I said I came to realize that not only chic energy (the will in a larger electrophysiological devices can
were art and medicine one but prayer, art and medicine were sense) into symptoms. Overcoming define physiological pain in exqui-
indeed one. I came to realize how powerful the arts can be resistances and working through site detail but can they capture the
as a special path to God and how engaging in the arts could these conflicts resulted in releasing essential psychological forces cen-
be such a healing experience because of the arts capacity the energy and ultimately resolving tral to misery, spiritual dis-ease,
to help us discover ourselves and realize the divine essence the symptoms. and suffering? From this perspec-
within each of us. By the late 20th and early 21st tive, Job might remain miserable in
Many great thinkers have written eloquently on this topic centuries, Freud’s introspective spite of analgesic-baclofen pumps,
before including Carl Jung, Rollo May and more recently methods were challenged by a new deep brain stimulation, mood stabi-
John Diamond, Shawn McNiff and Thomas Moore. In my scientific revolution. The neurosci- lizing anticonvulsants, and mixed
opinion, my friend, Dr Michael Samuels, again said it best ences were changing the culture norepinephrine-serotonin reuptake
when he simply stated, “Art, prayer and healing all come of psychosomatics and psychiatry inhibitors. He may still require the
from the same source-the human soul. The energy that fuels based largely on emerging evi- voice from the whirlwind to regain
these processes is the basic force of life, the force of creativ- dence from functional brain stud- his health.
ity, of love.” ies. Neuroscientists preached new Next up -- The power of sugges-
ideas about causality. The empha- tion, neurophysiology, and cultural
*The writer is the founder, American Physicians Poetry sis shifted to neurophysiological integration among those we often
Association (APPA- 1976) Founder- The International Arts-
Medicine Association (IAMA-1985). He and his wife live in mechanisms such as the role of refer to derogatorily as placebo re-
Southampton, Pennsylvania. excessive inter-hemispheric inhibi- sponders.
tion in the recognition and accep-
tHe ongoing BRain aCtivity continued from page 44 tance of symptoms (anosagnosia *The writer is a Professor of Child
or anosodiaphoria); insight into the and Adolescent Psychiatry, UNC
the neurophysiological substrate of lapses of attention and
connection between stressors and School of Medicine at Chapel Hill.
error correction.
illness; emotional self-awareness
Our findings are in-line with what has already been estab-
and the ability to describe emotion- Check out WCMS at
lished by previous research: an increase alpha activity in a
al states (alexithymia). Jargon from
particular region signals the inhibition or disengagement of
these neurobiological studies grad- www.wakedocs.org
that region from the rest of the cortex. For example, there
ually displaced primary and sec-
are several studies, which have shown alpha activity in the
ondary gain, psychological denial,
visual system.
Wake County Physician January 2010 PAGE 49
I n Memory Solidas et amice, ave atque vale
Sumner Malone Parham, Lelia Lawrence Blackmon,
by Assad Meymandi, MD, PhD, DLFAPA
was empa-
MD MD thetic and
insightful.
Age 88 Age 89 She was
Dr. Parham was born in Vance Dr. Bruce Blackmon’s wife, Lelia, a giver,
County on May 9, 1921. He attended died Sunday, September 20, 2009, in yet a keen
local public schools, graduating with Lumberton, North Carolina. competitor,
the class of 1938 at Henderson High She was born July 7, 1920, in skilled at
bridge, pool
School. He attended Virginia Military Durham, North Carolina. She at-
and anagram
Institute and after two years, transferred tended Randolph Macon College and
champion,
to the University of North Carolina graduated summa cum laude from Duke
friend of the
at Chapel Hill. He then attended the University. arts, gatherer
two-year University of North Carolina Lelia taught in of people,
School of Medicine and then trans- the Harnett County fierce and
ferred to receive his M.D. degree at the Public Schools, lovely, the most conscientious person
University of Maryland Medical Center serving as a read- you ever met, the thinker of big thoughts
in Baltimore. He served his military ing specialist and and doer of the deeds that followed, wise
duties as a flight surgeon with the 14th received recognition woman, full of spirit and a sophisticated
Air Force during World War II. After for her work by be- spirituality. She was a Wake Forest Citi-
his military service, he resumed his ing named Harnett zen of the year in 2000.
formal education at the university of County Teacher of She leaves behind her husband, Drew
Maryland Medical Center in Baltimore. the Year. She served Bridges, M.D., and daughter, Suzanna
He attended a four-year residency in for many years as a Deacon at Memo- Neely Bridges of New York City to
Obstetrics and Gynecology and was rial Baptist Church, often leading as the whom she passed both her music genes
named chief resident. He returned to Moderator. and her beauty.
Henderson to practice his specialty Those left to cherish her memory
in 195 2. In addition to his private include her husband of 62 years, Dr. Harold R. Hoke, MD
practice, he founded and supervised Bruce B. Blackmon, six children, some Age 83
the Vance County Health Department physicians, and eleven grandchildren.
Prenatal and Postpartum, subsequently Our condolences to the family and Dr. Hoke, a former resident of
the county Family Planning Clinic. He friends of Lelia. Matthews, North Carolina, died on
retired in 1986. Tuesday, September 29, at his home in
Dr. Parham was an honorary member Susan Gayle Neeley, PhD Uwharrie Point on Badin Lake, New
of the Maria Parham Medical Staff, a London, as a result of Parkinson’s Dis-
Age 62 ease and its complications.
member of the county state, and na-
tional medical associations; a diplomat Psychologist Dr. Hoke graduated from Cannon
of the American Board of Ob-Gyn; a Susan Neely was High School, Kannapolis, before ser-
member of the North Carolina Ob-Gyn married to re- vice in the Army during World War II,
Society; a member of the South –At- spected colleague, where he was awarded the Bronze Star.
lantic Medical Society; a fellow of Dr. Drew Bridges. He received an undergraduate degree
the American College of Surgeons; She received her from Wake Forest University and then
BA from Queens an M.D. from Wake Forest’s Bowman
a member of the University of North
College in 1969 Gray School of Medicine in 1952. In
Carolina Berryhill Medical Society; and
and doctorate from the psychology pro- mid-career, he returned to university to
a member of the University of North
gram of North Carolina State University study law, earning a law degree from
Carolina Educational Foundation. in 1976. Her 30-year practice of psycho-
Wake County Physicians celebrates the North Carolina Central University
therapy led to many grateful patients who School of Law while also practicing
the life of our respected colleague, Dr. grew stronger through her ability to apply
Parham. medicine, and then, in addition, medical
her remarkable intelligence in a way that
malpractice.
PAGE 50 January 2010 Wake County Physician
Teaching research eThics To
scienTisTs and Professionals
by Gary Comstock PhD*
D
r. Meymandi’s kind invitation for a isfaction of thinking creatively, rigorously Some philosophers think ethics education
contribution of 750-1000 words to and self-critically about their work. How is at its most productive when it engages
the Wake County Physician Maga- can we motivate young professionals, for what David Hume called the sympathies.
zine proposes as potential topics “maybe example, to assess the rules they have been Evoking feelings of revulsion at abuse of
‘the future of humanities in America’ or taught or to prepare for the potential conse- research subjects (e.g., Nazi research on
a review of Humanities in the last half of quences of whistle blowing? Simply know- prisoners, the non-treatment of syphilis
20th century.” May I take aim at a more ing rules is not sufficient in these situations. cases by the United States Public Health
modest target, the role of moral philoso- Humanists can be of assistance by helping Service at Tuskegee, the torturing of mon-
phers in shaping the education of scientists students think through the potentially wide- keys, etc.) can mobilize imaginative identi-
and professionals? ranging implications of their decisions. fication with others. In a Human approach,
We might begin our story in October 2000, • Facing the limitations of the ethics education focuses on empirical and
when the National Institutes of Health RCR rule-following approach psychological -- rather than metaphysical
(NIH) required all institutions receiving Ethicists have helped educators in the and theological -- considerations. What
NIH funds to educate trainees in respon- sciences and professions to understand factors incline us toward, or restrain us
sible conduct of research (RCR). The issues that students taught professional codes from, misbehavior and cheating? By build-
addressed in RCR—or as some prefer as abstract rule-following only lack the ing pedagogical models responsive to these
research ethics -- include plagiarism, falsi- historical context and emotional investment considerations, ethicists have been helping
fication and fabrication of data, intellectual needed to grasp the principles that gave rise students cultivate the three sensibilities
property, authorship, conflicts of interests, to the codes. Students who on their own most effective in restraining misbehavior:
and mentoring relationships. Research come to see that professional codes matter recognition of the dignity of persons;
ethics is a subfield of ethics, and ethics of as responses to harmful actions learn to empathy with the suffering of sentient
philosophy, and philosophy of the humani- care about the rules and adopt them more beings; and a deep sense of membership
ties. Therefore, we have here an example of robustly as their own. The reason is not in a moral community.
the role of the humanities in the education necessarily, because they agree with all • Recognizing the role of reason
of researchers and scientists. And what has the rules, but rather that they resonate with Discussion of ethical principles follows
that role been? I have not conducted a study the ethical commitments the rules express. closely behind the mobilizing of emotions,
on which to base my conclusions but will Case studies and narratives have become allowing students to generalize their experi-
proceed nonetheless with a few observa- embedded in all research ethics pedago- ences and apply the results of their delibera-
tions informed by ten years of experience gies for this reason. They effectively evoke tion to analogous cases. Many courses now
as a teacher of research ethics. the emotions required to develop virtues begin with a survey of “heels,” individuals
• Clarifying the goals of ethics such as honesty, respect, beneficence, and who have clearly harmed others through
education conscientiousness. their research misconduct. However, once
Ethicists are assisting the research com- • Understanding the importance students have been gripped by a story they
munity in understanding that one of the of motivation must come to grasp the principles that un-
first goals of ethics education should be to Excellence in research is not an act but a dergird their emotional reaction to it. Once
welcome students into our community. Too habit as Aristotle might say. Good research they have identified principles, they can
often instructors in medical and business requires the exercise of emotion as well as carry the principles from case to case. Rules
schools have aimed at teaching rules, ex- reason. Excellent habits are built on our that apply to one case apply to all other
plicitly stating as the goal compliance with desires, and our desires are stimulated by cases that are similar to the first case in all
policies, rules, and regulations. But is rule- emotions. We experience powerful emo- morally relevant respects. In this approach
following the behavior we should seek? tions when reckoning with harm, be the to research ethics education, students come
Many trained in practical ethics pedagogy harm physical or psychological, to a human to see that ethics matters, that respect for
think acculturation rather than indoctrina- being, animal, or the environment. The others is central to research, and that reflec-
tion should be the first goal. One reason is power of harm as a moral tutor can easily tion on difficult moral questions must be
that academic, research, and professional be overlooked. However, to overlook it is systematic and rigorous.
communities prize independent judgment a mistake. If we start with case studies in • Looking forward
and original critical thinking. A second which harm obviously has occurred, we Humanities scholars have been assisting
reason is that a nascent professional must cannot only stimulate a student’s concern the scientific and research educational
acquire more than the capacity to recite the for victims. We can also assist them to communities by highlighting the respec-
current norms governing her field. She must understand the reasons professional codes tive roles of right emotions and guiding
also learn how to figure out which rule to developed and, perhaps, to strengthen their principles. By collaborating with
follow when facing a dilemma for which no resolve to act courageously and indepen- colleagues in other fields, we can prepare
rule has yet been developed. dently. tomorrow’s leaders to face novel
We serve our graduate students best when • Emphasizing the efficacy of challengesand difficult decisions.
they catch the enthusiasm and internal sat- empathy
Wake County Physician January 2010 PAGE 51
arT and Technology
elecTronic sensing medical devices
concealed in JeWelry
An interview by Betty Ellen Madry
Dr. George Malindzak, then Director of Recently, working with the NCSU and
Medicine at Northeastern Ohio Universi- UNC BioMedical Engineering Depart-
ties College of Medicine and Mary Ann ments, directed by Dr. Troy Nagle and
Scherr, then living in New York City, with his Graduate Student, Ryan Hodges,
and with Parsons School of Design, were the team completed a “Remote Heart
invited to present “Personal Monitor Cos- Monitor,” an electronic system that, from
metology: An Aesthetic Approach.” This a distance, would showcase a necklace
international presentation and demonstra- displaying the heart rate of the viewer.
tion of the Air, Heart, Smoke, and Pulse For this body of research and develop-
monitor prototypes took place in Chapel ment, Ms. Scherr has been awarded an
Hill, North Carolina. Honorary Degree, Doctor of Humane Let-
W
Since that time, Ms. Scherr has been ters. She has also earned a United States
hile 1969 was just the begin-
challenging biomedical engineers, Patent on the development of the Pulse
ning of a life-time of investi-
scientist, and doctors to turn her ideas Monitor. In addition to this attention, the
gations with “BODY MONI-
for medical body monitors into a reality. American Medical Association (AMA)
TORS”, Mary Ann Scherr, Internationally
Within their individual roles these profes- filmed a documentary showing the Heart
known jewelry designer, had at that time,
sional experts have provided the technical Monitor that displays the heart beating in
begun to research and develop medically
knowhow and she has packaged them a helical, full color pattern. Several of the
related jewelry that would warn wearers of
with the artistic elements.” Scherr also has Body Monitors are now in the Permanent
personal health issues.
pioneered what she calls “compassionate Collection of the Museum of Art & De-
Designing the Ms. Ohio costume for the
jewelry” which substitutes beautiful acces- sign (MAD), in New York City.
International Ms Universe Competition,
sories for stark medical devices. Her best The Body Monitor Prototypes are fabri-
Scherr was watching the televised heart
known example is a “Trach Necklace”, cated in Carrot Gold, Sterling Silver, and
movements of the astronaut as he stepped
an individually designed piece for victims Gemstones:
into the historic
of a tracheotomy, • A Bracelet that monitors the wearers
“MOON LAND-
a throat opera- pulse rate and begins to flash and beep
ING”. She was
tion that leave a when the user’s pulse is erratic.
at the same time,
breathing hole in • A Belt that contains “Liquid Crystals’’
creating a HEART
the windpipe. Suf- that checks air quality, radiation, and tem-
MONITOR for
ferers often cover peratures, alerting the wearer with color
the costume’s belt.
the raw wound changes.
Scherr reasoned,
with a scarf. For • A Necklace that electronically reads the
“if we can moni-
this condition she heart rate with LED’s and Fiber-Optics.
tor the heart of an
designs a one-of- • A Belt that warns of contaminated air
astronaut, many
a-kind decora- and is equipped with oxygen and a face-
thousands of miles
tive metal facade mask.
from earth, we can
that attaches to a • A Smoke Sensor Necklace that plays
monitor ourselves.”
curved medically the tune “Smoke Gets In your Eyes” in the
This event caused
issued tube. She presence of any smoke.
the sudden aware-
made a new Trach • A Necklace that rates the quality of
ness of ideas that
for a man who had the wearer’s breath with an LED Light
were followed by
been embarrassed Display.
years of work with
by public stares at • A “Waist-Minder” that beeps to warn of
the support of bio-
the original metal poor posture.
medical engineers,
device lodged • A “NO NOD” Head Gear that sounds a
to create monitors,
in his throat. He loud alert when the head slips into sleep.
which would fulfill
said, “Now I’m • A Necklace, “Portable EKG,” that reads
that dream. Liquid Crystals “Body Air Monitor”
no longer a “Trach the heart beat in a helical, full color, pat-
In 1979, the
wearing a man.” The Smithsonian Institu- tern.
Environmental Protection Agency (EPA),
tion’s Exhibition “Triumph Over Disabil- • Throat Devices that mask the visual ef-
sponsored a World Symposium on the
ity,” also displays an original Trach Cover fects of the standard issue Trach.
“The Development of Personal Moni-
model.
tors for Exposure and Health Affects.”
PAGE 52 January 2010 Wake County Physician
Travel
by Assad Meymandi, MD, PhD, DLFAPA
book of esTher, isaiah, king cyrus The
greaT’s declaraTion of human righTs,
535 bc, magna carTa, 1215 ad, lambeTh
Palace/library, and dame margareT ThaTcher...
the Lambeth Library…visiting Stratford-
F
aithful readers of this space recall the arts and humanities. The program has on-Avon and remembering the genius of
that several years ago, seven people, had four Nobel Prize winners and scores Shakespeare, the 16th century master for
my wife and I were privileged to of brilliant wise men and women, women the English language whose collected work
lunch with Lady Margaret Thatcher in the such as Helen Vendler, Harvard Profes- contains more words compared to the 1611
Plumeri House of William and Mary Col- sor of Shakespeare and Sir Paul Nurse, King James Bible, making one wonder
lege. Our host, P. Geoffery Feiss, Provost President of Rockefeller University, since if Shakespeare knew more words than
of the College, seated me at the left side its inception. Nevertheless, in spite of God!...British Library, the original King
of the Iron Lady, because that is her “good progressive memory deficit, Lady Thatcher John’s Magna Carta, 1215…making me
ear”. The lunch and conversation went on remains elegant, loving, charming and gra- more aware and proud of my heritage that
at a leisurely pace. With the after-lunch cious. We saw much, and enjoyed Mahler according to the Book of Esther and Isaiah
picture-taking and book-signing ceremo- 4 with conductor David Zemans, Emeritus of the Bible, the first treaty or declaration
nies, the Lady stayed around for two and a Conductor of Baltimore Symphony (I of human rights was written by Cyrus the
half hours. Nonetheless the entire experi- knew him form Johns Hopkins/Peabody Great, King of Persian Empire in 535 BC,
ence felt like an extravagant moment, too Conservatory days), several plays some 1750 years before Magna Carta…Why that
short and too fleeting. Her trip was a hush of which, including the much ballyhooed is NOT mentioned in western literature
hush. She was the mystery guest at the “Oliver”, were most disappointing. We of the timeline of human endeavors, one
commencement ceremonies of the previ- walked out of them at the intermission… wonders…Revisiting Trinity College, The
ous evening. The principle speaker was roaming and looking up information about book of Kells, written by monks of Ionian
Ms. Halaby (Queen Noor of Jordan.) But the Anglican tradition in the stacks of Isles…. More on all this later…
with the Lady Thatcher’s sudden appear-
ance in the academic procession, the crowd
erupted into a spontaneous ovation. The
Lady gave a fifteen minute unrehearsed
speech. This summer, Emily and I had
an enjoyable, instructive and sobering
multi-week trip to Europe and the Brit-
ish Isles . I said sobering, because of our
visit with Dame Margaret Thatcher, the
Iron Lady of the 20th Century, the idol
of the conservative universe, and seeing
her in a condition of radically diminished
memory…sobering, because of witnessing
the finality of human life and condition.
Here is a woman with PhD in physical
chemistry before she turned to politics, and
with Ciceronian rhetoric and Churchillian
eloquence rose to be a celebrated Premiere
of England ....I mourn the turn of event be-
cause she was planning to become a Mey-
mandi Fellow at the National Humanities
Center , before the decline in health. She
would have been a good fit for the pro- Dr. Randall Williams, Raleigh OB-Gyn, and President Obama, back stage at Broughton
gram because Meymandi Fellowship at the High School when President Obama visited North Carolina in the summer of 2009.
National Humanities Center was created Robert Gibbs is the President’s Press Secretary. He and Dr. Williams were classmates
to bridge the gap between basic sciences, and graduates of Broughton High School.
Wake County Physician January 2010 PAGE 53
Wake County Medical Society thanks the following
Physicians, Practices, Hospitals and Contributors
for the free medical care provided to
Project Access patients in 2009.
Hospitals & Funders Eric Mason, MD Ronald Gore, MD
WakeMed Health & Hospital Francis "Fran" Abdou, MD Russell Ford, MD
Rex Healthcare Francis "Greg" Brusino, MD Scott Garrison, MD
Duke Raleigh Hospital Gerald Maccioli, MD Scott Tyrey, MD
The Duke Endowment Hsiupei Chen, MD Shawn Kruse, MD
Blue Cross and Blue Shield of Jack Lam, MD Shehzad Choudry, MD
North Carolina Foundation Jafar Shick, MD Sherman Lee, MD
John Rex Endowment James Collawn, MD Stephen Rogers, MD
American Anesthesiology of James Cummings, II, MD Steven Sherman, MD
NC (formerly Critical Health Jeremy Reading, MD Susan Steele, MD
Systems of NC) John McDowell, MD Thomas Buchheit, MD
Ajinder Chhabra, MD Jonathan Blank, MD Thomas Monaco, MD
Al Melvin, MD Justin Hauser, MD Vincent Hoellerich, MD
Amanda Crow, MD Karen Meyers, MD Walter Daniel, MD
Amanda Froment, MD Kassell Sykes, Jr., MD Wendell Zee, MD
Andrew Lutz, MD Keith Kittelberger, MD Whitney Scott, MD
Asra Ali, MD Kimberly Greenwald, MD William Bolding, MD
Benjamin Antonio, MD Manu Gupta, MD William Corkey, MD
Bruce Janson, MD Melanie Lutz, MD Andrus & Associates
Brendon Howes, MD Michael Hauser, MD Dermatology, PA
Carrie Gill-Murdoch, MD Michael Lish, MD Rebekah M. Oyler, MD
Charles Nicholson, MD Michael Neville, MD Atrium Obstetrics &
Christa Gray, MD Nathan Christie, MD Gynecology, PA
Clarence Huggins, MD Nevin Shrimanker, MD Amy Gilbert, FNP
Daniel Amitie, MD Paul Woodard, MD David Henderson, MD
Deborah Pellegrini (Quint), MD Ralph Ramos, MD Jill Barbour, WHNP
Deitra Williams-Toone, MD Randy Efrid, MD Mark Zimmerman MD
Donald Edmondson, MD Reed VanMatre, MD Matthew Alvarez, MD
Earl Crumpler, Jr. Robert Alphin, MD Zoe Beatty, MD
Edgar Garrabrant, III, MD Robert Marshall, III, MD C.A.R.E. Center
Edward Bratzke, MD Robert "Paul" Rieker, Jr., MD Elliott J. Kopp, MD
Elee Stewart, MD Robert Seymour, III, MD Cancer Centers of North
Erhan Atasoy, MD Robert Treadway, Jr., MD Carolina
PAGE 54 January 2010 Wake County Physician
Medical Oncology Steven H. Dennis, MD Eye Specialists of Carolina &
Alan Kritz, MD Carolina Cardiology Demetrius Dornic, MD
Charles F. Eisenbeis, MD PhD Carolina Ear Nose & Throat Friendship Medical Center
Elizabeth Campbell, MD Karen Bednarski, MD Annette Troy, MD
Maha Elkordy, MD Carolina Endocrine, P.A. Fuquay Chiropractic &
Margaret Deutsch, MD Courtney Koppenal, PA-C Wellness Cente, PLLC
Mark Yoffe, MD Julia Warren-Ulanch, MD Jill M. Miehe Currin, DC
Neeraj Agrawal, MD Michael J. Thomas, MD, PhD Kamm, McKenzie, Harden,
P.J. Singh, MD Nicole McDermott, PA-C Smith, Bass
Roy Cromartie, MD Cary Dermatology Cynthia Saacks, MD
Stephen Tremont, MD Catherine Hren, MD Michael White, MD
Virgil Rose, MD Heidi Mangelsdorf, MD Paul B. Harden, Jr., MD
William Berry, MD Cary Ob-Gyn Sheppard McKenzie, III, MD
Radiation Oncology Michael Anthony, MD Landmark Urology
John F. Reilly, MD Sharon Stephenson, MD Cheri Elliott, ANP
K. Kolby Sidhu, MD Cary Surgical Specialists Daniel McRackan, MD
ENT Surgical Oncology Michael A. Tyner, MD Mark W. McClure, MD
Scott D. Meredith, MD Dermatology Skin Cancer Mann ENT
Gynecologic Oncology Center Charles H. Mann, MD
Monica B. Jones, MD Eric D. Challgren, MD Jared E. Spector, MD
Capital Area Ob-Gyn Gregory J. Wilmoth, MD Richard M. Jones, MD
Associates, PA Laura D. Briley, MD Mid Carolina Obstetrics &
Christin N. Richardson, MD Margaret B. Boyse, MD Gynecology, PC
George M. Tosky, MD W. Stacy Miller, MD Amy O. Groff, MD
Katherine E. Barrett, MD Tracey S. Cloninger, PA-C Eloise Watson, MD
Michael F. Buckley, MD Digestive Healthcare Leon F. Woodruff, MD
Paige L. Gausmann, MD Angela N. Hutzenbuhler, MD Myra Lynn Teasley, MD
Richard W. Kurzmann, MD Colm O'Loughlin, MD Ruth Wind, MD
Capital Nephrology Karen Saville, FNP Orthopaedic Foot & Ankle
Associates, PA Kenneth R. Kohagen, MD Sarah E. Dewitt, MD
Allyson Stanton, FNP M. Dixon McKay, MD Pediatric Urology of North
Daniel W. Koenig, MD Morris A. Pollock, MD Carolina
Deborah Siler, NP Naveen V. Narahari, MD Timothy P. Bukowski, MD
Edelizo David, NP Rig S. Patel, MD Piedmont Foot & Ankle
Elizabeth O'Leary, PA Duke Cancer Center of Raleigh Clinic, PA
Frederick S. Jones, MD Michael Spiritos, MD Richard J. Hauser, DPM
James E. Godwin, MD Sharon Taylor, MD Robert J. Lenfestey, DPM
Jeffrey G. Hoggard, MD Yuri Fesko, MD Raleigh Cardiology
Kevin M. Lee, MD Duke Neurology of Raleigh Associates, PA
Leigh McKenzie, NP Paul Peterson, MD Amarendra B. Reddy, MD
Loretta Phillips, NP Duke Otolaryngology of Raleigh Brian M. Go, MD
Matthew J. Ellis, MD Seth Cohen, MD Charles A. Mangano, Jr., MD
Michael I. Oliverio, MD Duke Radiology of Raleigh John R. Sinden, MD
Prabhakar N. Vaidya, MD Alan Rosen, MD Marc T. Silver, MD
Robert S. Schmidt, MD Marc Finkel, MD Mark E. Leithe, MD
Capital Neurology & Headache Morgan Camp, MD George R. Cheely, MD
Center Robert Vogler, MD Senthil N. Sundaram, MD
David H. Cook, MD Tedric Boyse, MD Virgil H. Wynia, MD
Capitol Ear Nose & Throat, PA Vernon W. Pugh, III, MD Raleigh Endocrine Associates
David A. Clark, MD Duke Thoracic Surgery Corey D. Berlin, MD
H. Craig Price, MD David White, MD Elizabeth M. Holt, MD
Mark S. Brown, MD Katie Gillis, PA-C Raleigh Endoscopy Center
R. Glen Medders, MD ENT & Audiology Associates Angela Hutzenbuhler, MD
Stanley Wilkins, MD Douglas K. Holmes, MD Bulent Ender, MD
Wake County Physician January 2010 PAGE 55
Colm O’Loughlin, MD Dwayne E. Patterson, MD Richard A. Chiulli, MD, FACS
Dixon McKay, MD G. Hadley Callaway, MD Seth M. Weinreb, MD, FACS
Kenneth Kohagen, MD Harrison Gray Tuttle, MD Thomas W. Maddox, MD, FACS
Murtaza Parekh, MD Jeffrey K. Kobs, MD Peter M. Milano, MD
Naveen Narahari, MD John B. Chiavetta, MD Woodward Cannon, MD, FACS
Rig Patel, MD Keith Mankin, MD Rex Hematology Oncology
Raleigh ENT Kevin Logel, MD Jeffrey Crane, MD
H. Clifton Patterson, MD Leonard D. Nelson, Jr., MD JoEllen Speca, MD
Kevin M. Doyle, MD Lyman S.W. Smith, MD Kenneth Zeitler, MD
Laura Devereux Brown, MD Mark M. Mikles, MD Lola Olajide, MD
Mark W. Clarkson, MD Robert T. Wyker, MD Susan Moore, MD
Matthew J. Gerber, MD Scott Wein, MD Rex Pathology Associates
Stephen E. Boyce, MD Wallace F. Andrew, MD F. Catrina Reading, MD
Steven J. McMahon, MD William M. Isbell, MD John D. Benson, MD
William F. Durland, Jr., MD Raleigh Pathology Labs John P. Sorge, MD
Raleigh Infectious Diseases Raleigh Plastic Surgery Keith V. Nance, MD
Christopher Ingram, MD Glenn Lyle, MD Preeti P. Sharma, MD
Edwin Brown, MD Rhett High, MD Stephen V. Chiavetta, MD
Hubert Haywood, III, MD Raleigh Pulmonary & Allergy Timothy R. Carter, MD
John Engemann, MD Consultants Vincent C. Smith, MD
Paul Becherer, MD Christopher Pugh, MD Rex/UNC Radiation Oncology
Vicki Morris, MD D. Allen Hayes, MD Catherine Lee, MD
Raleigh Neurology Donald M. Rabil, MD Charles W. Scarantino
Associates, PA Frances Castiller, MD Justin Wu, MD
A. Thomas Perkins, MD Ted Kunstling, MD Lawrence Marks, MD
David Konanc, MD Raleigh Radiology Leroy Hoffman, MD
Eric Kirch, PA-C Andrew B. Weber, MD Robert Ornitz, MD
Gregory Bertics, MD Andrew G. Moran, MD Roger F. Anderson, MD
Karen Riley, NP Cynthia S. Payne, MD Richard D. Adelman, MD
Katharine Kovacs, PA-C Donald G. Detweiler, MD Richard D. Adelman, MD
Keith Hull, MD Gintaras E. Degesys, MD Donna Griffith
Kelly Pate, NP Gregory A. Bortoff, MD Kathleen Janus, FNP
Kenneth Carnes, MD Gregory C. Hinn, MD Southern Eye Associates
Michael Bowman, MD Jason R. Harris, MD Jerome Magolan, MD
Patricia Naslund, MD Jeffrey Browne, MD Philip Martin, MD
Pavan Yerramsetty, MD Jennifer S. Van Vickle, MD Stocks Surgical Center
Rhonda Gabr, MD Jerry L. Watson, MD Lewis Stocks, MD
S. Mitchell Freedman, MD John G. Alley, Jr., MD Taylor Viteoretinal Center
Scott Binford, PA-C Joshua B. Mitchell, MD Jeffrey Taylor, MD
Susan Glenn, MD Juilia K. Taber, MD Nitin Gupta, MD
Theresa Behil, NP Laura O. Thomas, MD The Raleigh Eye Center
Wanda Cecil, NP Mark H. Knelson, MD Holly P. Johnson, MD
William Ferrell, MD Michael C. Hollingshead, MD James W. Kiley, MD
Raleigh Neurosurgical Clinic Neil A. Ramquist, MD R. Jeffrey Board, MD
Robin Koeleveld, MD Satish Mathan, MD Triangle Radiation Oncology
Raleigh Ophthalmology & Steven R. Carter, MD Triangle Orthopaedic
Surgical Eye Associates Todd J. Roth, MD Associates, PA
Timothy Jordan, MD Tracey E. O'Connell, MD Brett J. Gilbert, MD
Raleigh Orthopaedic Clinic W. Kent Davis, MD David B. Musante, MD
Bradley K. Vaughn, MD Raleigh Surgical Specialists Eugenia F. Zimmerman, MD
Cara B. Siegel, MD Daniel R. Vig, MD, FACS Kurt J. Ehlert, MD
Carroll D. Kratzer, MD David B. Eddleman, MD, FACS Mark A. Burt, MD
Daniel J. Albright, MD David A. Smith, MD Paul J. Kerner, MD
David W. Boone, MD George W. Paschal, III, MD, FACS Perico N. Arcedo, DO
PAGE 56 January 2010 Wake County Physician
Shepherd F. Rosenblum, MD Duncan Rougier-Chapman, MD Bonnie Fitts, MA, LPC
William D. Hage, MD Eithne T. Burke, MD Cynthia Dowdy, PhD
William P. Silver, MD Elizabeth A. Rush, MD E. Janice Morgan, LCSW
Kimberly A. Barrie, MD G. Glenn Coates MS, MD Gayle Gonzalez-Johnson, LCSW
Edward Hedrick, MPAS-PA-C Holly J. Burge, MD Jean L.P. Olson, LCSW
Gina M. Garvey, MSBS, PA-C Imre Gaal, Jr., MD Jean S. Gross, LCSW
Roger A. Ordronneau, MMS, PA-C J. Mark Spargo, MD Lou Murray, Substance Abuse
Brian Wood, PA-C John Matzko, MD Counseling
Wake Endoscopy Center John Sierra, MD Margaret J. Dorfman, MD
Chris Schwarz, MD Joseph B. Cornett, MD Nina Segal, LCSW
Michael Battaglino, MD Joseph W. Melamed, MD Patricia A. DeBoer, LCSW
Monica Manzi, PA-C Karen A. Coates, MD Patricia L. Pearce, MD
Neeraj Sachdeva, MD Kerry E. Chandler, MD Patrick Malloy, LPC
Ronald Schwarz, MD Laura Meyer, MD Robert "Jan" Hedgepath, LCSW
Subhash Gumber, MD Louis F. Poscillico, MD Sherry Lindsley, LPC
Tracy Jones, PA-C Lyndon K. Jordan, III, MD Theresa Lewis, PhD
Wake Foot and Ankle Center Margaret R. Douglas, MD
James Judge, DPM Mark Marchand, MD
Wake Gastroenterology Martin Rans Douglas, MD
Bulent Ender, MD Melissa C. Lipton, MD
Wake Heart Associates Michael D. Kwong, MD
Wake Nephrology Michael L. Ross, MD
Associates, PA Nikunj P. Wasudev, MD
Leland Garrett, Jr., MD Paul A. Haugan, MD
Mark Rothman, MD Peter L. Leuchtmann, MD Project Access is a program
Michael Casey, MD Phillip C. Pretter, MD that provides access to
Michael Monahan, MD Phillip R. Saba, MD specialty care for the
Phillip Timmons, MD R. David Mintz, MD uninsured in Wake County.
Sammy Moghazi, MD Randy D. Secrist, MD Since its inception in 2000,
Samsher Sonawane, MD Richard E. Bird, MD over 11,500 patients have
William Fan, MD Richard J. Max, MD been served, over $64 million
Wake Opthalmology Robert A. Cerwin, MD in care has been donated, and
Associates Robert E. Schaaf, MD $561,319.00 in pharmaceuti-
Robert Stone, Jr., MD Russell C. Wilson, MD cals has been provided. The
Wake Radiology Scott Dziedzic, MD program is administered by
Consultants, PA Scott R. Sailer, MD the CapitalCare Collaborative,
Wake Radiology Diagnostic Steven R. Mills, MD but is made possible by the
Imaging, Inc. Susan L. Kennedy, MD generosity of specialty
Wake Radiology Oncology Susan M. Weeks, MD providers, hospitals and
Services Thomas L. Presson, Jr., MD contributors.
Alan B. Fein, MD William G. Way, Jr., MD Through the generosity of
Andrew C. Wu, MD William James Vanarthos, MD Wake County providers and
Andrew S. Kennedy, MD William T. Djang, MD hospitals, Project Access
Brent Townsend, MD Wake Urological Associates offers the following services
Bryan M. Peters, MD Richard Kane, MD to eligible patients:
Carmello Gullotto, MD Mark Jalkut, MD • Lab and radiology
Carroll C. Overton, MD Phillip Newhall, MD services donated by
Catherine Lerner, MD Western Wake Eye Center providers and hospitals
Charles V. Pope, MD Christopher Fleming, MD • Assistance with some
Claire M. Poyet, MD Kevin O'Neal, MD medications
Cynthia I. Caskey, MD Williams, Benavides, Marston • Hospitalization donated
David Ling, MD & Kaminski, MD, PA by providers and hospitals
David Schulz, MD Randall Williams, MD • Specialty care donated by
Dennis M. O’Donnell, MD Mental Health Providers providers
Wake County Physician January 2010 PAGE 57
THE WAKE COUNTY MEDICAL SOCIETY NON-PROFIT
2500 BLUE RIDGE ROAD, SUITE 330 ORG
US POSTAGE
RALEIGH, NC 27607 PAID
Raleigh, NC
Permit #2152
“The most repulsive
sight is that of a fat
health care worker, es-
pecially a fat doctor and/
or a fat nurse. It is even
more repulsive when the
doctor is a public health
official such as a health
officer or a US Surgeon
General.”
Assad Meymandi, MD
Kathleen Spellman McLaurin, MD: A Role Model Worth Emulating
by Robert McLaurin, MD and Paige McLaurin
A Legacy of Medical Leadership United States. He has been referred to as “The American Pope.” It was
through “the Cardinal” that she met, and briefly dated, an up-and-com-
K
athleen Spellman McLaurin, is a pioneer in medicine. To ing young politician from Massachusetts, named John F. Kennedy, Jr.
say that medicine is a tradition in her family would be an Kathleen had many remarkable opportunities early in her ca-
understatement; it is more like a birthright. Her father was reer. One of her first jobs was as Louis B. Mayer’s personal physi-
a physician and her mother was a nurse. Her brother, Robert Spell- cian. Mr. Mayer, the head of Metro Goldwyn Mayer, and a per-
man, MD, is a Urologist. Kathleen married Robert L. McLaurin, sonal friend of Cardinal Spellman, needed a medical consultant he
Sr., a neurosurgeon, who is also from a medi- could trust. Immediately upon graduation
cal family. Together, they had five children, from medical school, Kathleen moved out to
three of whom decided to practice medicine. California and lived in one of Mr. Mayer’s
Now, she has grandchildren in medical school. lavish homes. She routinely dined and social-
At a time when few women pursued profes- ized with such celebrities as Clark Gable,
sional careers, and even fewer entered medicine, Van Johnson, Marianne Davies, and William
she was one of two women in her graduating Randolph Hearst. She rode in chauffer-driven
medical school class from Cornell University limousines, resided in an opulent mansion,
in 1943. She did her residency at St. Vincent’s and spent time in movie production studios.
Hospital in Greenwich Village during World For some reason, she decided to leave all that
War II. Kathleen, who stands about 5 feet tall, and return to a normal life on the east coast.
would regularly ride around Greenwich Village Kathleen met and married Robert L.
in ambulances driven by members of the mob. McLaurin, Sr. while they were in their resi-
She was brave, but probably had too little to fear. dencies. He is a fifth generation physician
After all, she was the niece of “The Cardinal.” who graduated from Harvard Medical School
Her uncle was Francis Cardinal Spellman, with honors (AOA) at the age of 22. He did
the Archbishop of New York, and the highest- his residency in Neurosurgery at Yale. He is
ranking member of the Catholic hierarchy in the also a pioneer in medicine. He was named
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