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PUBLIC POUCY.
A million ant
of experience:.
\
\
Give or take a billion
You've h,ad more experience with Dalmane (flurazepam HCI/ Roche) than with any other benzodiazepine-hypnotic. . . 15 years' worth.
You know you can count on it tor sleep that satisfies patients-they fall asleep quickly and sleep through the night. 18 And the wide margin of safety with Dalmane79 satisfies you. As always, caution patients about driving or drinking alcohol.
<=>
\ i X Copyright # 1985 by Roche Products Inc All rights reserved
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References: 1. Kales J, etal Clin Pharmacol Ther 12 691-697, Jul-Aug 1971 2 Kales A, elal Clin Pharmacol Ther 18 356-363. Sep 1975 3. Kales A, etal Clin Pharmacol Ther 19 576-583, May 1976 4. Kales A, elal Clin Pharmacol Ther 32 781 788, Dec 1982 5. Frost JD Jr, DeLucchi MR JAmGenalr Soc27 541-546, Dec 1979 6. Dement WC, elal BehavMed, pp 25-31, Oct 1978 7. Kales A, Kales JD J Clin Psychopharmacol 3 140-150, Apr 1983
8. Tennant FS, el ol Symposium on the Treatment of Sleep Disorders, Teleconference, Oct 16, 1984
9. Greenblatt DJ, Allen MD, Shader Rl Clin Pharmacol Ther 21 355-361, Mar 1977
DALMANE
flurazepam HCi/Roche (g
sleep that satisfies
■ "
15-mg/30-mg capsules
Before prescribing, please consult complete product Information, o summary of which follows:
Indications: Effective in oil types of insomnia characterized by difficulty in falling asleep, frequent nocturnal awaken- ings and/or early morning awakening, in patients with recurring insomnia or poor sleeping habits, in acute or chronic medical situations requiring restful sleep Objective sleep laboratory data have shown effectiveness tor at least 28 consecutive nights of administration Since insomnia is often transient and intermittent, prolonged administration is generally not necessary or recommended Repeated ther- apy should only be undertaken with appropriate patient evaluation
Contraindications: Known hypersensitivity to flurazepam HCI, pregnancy Benzodiazepines may cause fetal damage when administered during pregnancy Several studies sug- gest an increased risk of congenital malformations associ- ated with benzodiazepine use during the first trimester Warn patients of the potential risks to the fetus should the possibility of becoming pregnant exist while receiving flurazepam. Instruct patients to discontinue drug prior to becoming pregnant Consider the possibility of pregnancy prior to instituting therapy
Warnings: Caution patients about possible combined effects with alcohol and other CNS depressants An additive effect may occur if alcohol is consumed the day following use for nighttime sedation This potential may exist for sev- eral days following discontinuation Caution against haz- ardous occupations requiring complete mental alertness (eg operating machinery, driving) Potential impairment of performance of such activities may occur the day follow- ing ingestion Not recommended tor use in persons under 15 years of age Withdrawal symptoms rarely reported, abrupt discontinuation should be avoided with gradual tapering of dosage for those patients on medication tor a prolonged period of time Use caution in administering to addiction- prone individuals or those who might increase dosage
Precautions: In elderly and debilitated patients, it is recom- mended that the dosage be limited to 15 mg to reduce risk of oversedation, dizziness, confusion and/or ataxia Con- sider potential additive effects with other hypnotics or CNS depressants. Employ usual precautions in severely depressed patients, or in those with latent depression or suicidal tendencies, or in those with impaired renal or hepatic function
Adverse Reactions Dizziness, drowsiness lightheaded- ness, staggering, ataxia and falling have occurred, particu larly In elderly or debilitated patients Severe sedation, lethargy, disorientation and como, probably indicative of drug intolerance or overdosage, have been reported Also reported headache, heartburn, upset stomach, nausea, vomiting, diarrhea, constipation, Gl pain, nervousness, talkativeness, apprehension, irritability, weakness, palpitations, chest poins, body and joint poins and GU complaints There have also been rare occurrences of leukopenia, granulocytopenia, sweating, flushes, difficulty in focusing, blurred vision, burning eyes, faintness, hypo tension, shortness of breath, pruritus, skin rash, dry mouth, bitter taste, excessive salivation, anorexia, euphoria, depression, slurred speech, confusion, restless- ness. hallucinations, and elevated SGOT, SGPT, total and direct bilirubins, and alkaline phosphatase, and paradoxi- cal reactions, e g , excitement, stimulation and hyperactivity
Dosage: Individualize for maximum beneficial effect Adults 30 mg usual dosage, 15 mg may suffice in some patients Elderly or debilitated patients 15 mg recom- mended initially until response is determined Supplied: Capsules containing 15 mg or 30 mg fluraze- pam HCI
Roche Products Inc Manati, Puerto Rico 00701
New PMS Medical Economics
Toll Free Line
The Pennsylvania Medical Society expands its service to members by providing a toll free medical economics help line. It’s your direct line to special PMS staff ready to help you with your questions on billing, reimbursement, utilization or policy issues about Blue Cross/Blue Shield, Medicare, Medical Assistance, or commercial insurers.
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Elcomp:.. the best medical office computer system is now even better with the Flexible Package™
■ 1
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Pennsylvania
Medicine
contontc July,S86
wWAlftvAlftiJ Volume 89, Number 7
Medicine
POOR HEALTH,
ECONOMIC FACTOBS,
J.VB
PUBLIC POUCH
COVER
25 The history of policy formation in cigarette use— Herbert Perlman— tobacco use, poor health, important economic factors, and public policy
NEWSFRONTS
6 Medigram — late news at press time
12 State’s medical schools award 1,258 degrees— commencements reported 1 2 PAOO elects officers — Dr. Jaeger president
16 Study before signing PPO contract— Denise E. Zimmerman— legal counsel answers questions
19 AMA forms committee on radiation emergencies— Karen K. Davis— sfafe physicians participate
22 Trustee sees quality of care as main issue— Karen K. Davis— portrait of Jeanine Hahn, MD, residents' trustee
EDITORIAL
10 Cost containment— at whose cost?— David A. Smith— welfare of patients is priority
PENNSYLVANIA MEDICINE
20 Erford Road
Lemoyne, Pennsylvania 17043 Telephone (717) 763-7151
PUBLICATION COMMITTEE
Ernest L Abernathy, MD, Chairman, Washington J Mostyn Davis, MD, Danville Jeannine R. Hahn, MD, King of Prussia John H. Hobart, MD, Easton James A Raub, MD, Sewickley
STAFF
David A. Smith, MD, Medical Editor Mary L. Uehlein, Managing Editor Karen K. Davis, Assistant Managing Editor Jean Beatty, Advertising Manager
SPECIAL FEATURE
32 Physician observes British medical practice — Christine Dotterer — coping with bureaucracy
IN MY OPINION
30 Star wars vs. tar wars — J. Mostyn Davis — trends in cigarette advertising
MEDICAL FEATURE
36 Neurosarcoidosis presenting as chronic lymphocytic meningitis— Gary R. Plotkin, Bhupendra R. Patel — case report
DEPARTMENTS
16 Advertisers’ index
38 New members
39 Classified advertising
47 Obituaries
48 Physicians in the news
Member
Audit Bureau of Circulations
PENNSYLVANIA MEDICINE, established in 1897, is published monthly as the official publication of the Pennsylvania Medical Society All editorial and advertising correspondence should be directed to the Managing Editor Subscription requests and changes of address should be sent to PENNSYLVANIA MEDICINE, 20 Erford Rd . Lemoyne, PA 17043 All material subject to this copyright may be photocopied only for noncommercial scientific or educational purposes. The opinions of authors do not necessarily represent the policy of the publisher. The appearance of advertising does not guarantee or endorse the claims of advertisers. A domestic subscription is $20 per year, foreign is $30 per year; single issues, except for special issues, are $3 00. Second class postage paid at Lemoyne, Pennsylvania 17043 (ISSN 0031-4595)
1986: Pennsylvania Medical Society
INTRODUCING THE DIRECT APPROACH TO BUSINESS BANKING
PSFS Business Banking Direct
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An effective cash management system.
PSFS Business Banking Direct can help you manage and improve your business’
cash flow position. With a few simple commands, it will instantly provide you with a current record of your business bank account transactions, schedule your bill payments, pay your employees and transfer funds between accounts.
A valuable resource for investment information.
PSFS Business Banking Direct helps you keep abreast of changing interest rates and investment opportunities, so you can ensure that your money is earning the highest yield.
In addition, an information service is available which provides stock market quotes and continuous news, weather and sports updates.
-BANKING INDEX
1 - Quick Balance 2- Transaction Account Index 3 - CD Index
4 -Commercial loan Index
5 - Commercial Mortgage Index
6 - Disbursements Index 7- Funds Transfer Index
8 Other Services
9 - Customer Service/Quick Message
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Meritor Financial Group
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medigram
PMS SETS SEPTEMBER 16 FOR TORT REFORM MEETING
A mass meeting and climb up Capitol Hill to push for tort reform through legis- lation is slated for Tuesday, September 16. PMS President Elect R. Robert Ty- son, MD, chairman of the mass meeting, reported that tickets are available from Mass Meeting Coordinators in hospitals throughout the Commonwealth through mid- July. He said the meeting will dramatize the liability crisis in Pennsylvania and demonstrate the commitment of physicians and their sup- porters to tort reform. County medical society officers and Legislative Action Team chairmen also have information about the mass meeting.
PMSLIC RATING PLAN EFFECTIVE JULY 1
A new three-tier premium rating plan was implemented July 1 for physicians insured by the Pennsylvania Medical Society Liability Insurance Co. State In- surance Commissioner George Grode approved the plan which stratifies risk not only by geographic territory and medical specialty, the traditional ways, but also by past claims experience. Physicians with no chargeable claims or lower than average loss records may be charged lower insurance premiums for professional liability coverage than physicians who have had claims. David S. Masland, MD, chairman of PMSLIC ’s Board of Directors said in a letter to in- sureds that PMSLIC has established a system which will moderate the level of future increases for the vast majority of insureds while increasing rates for those whose claims activity is above the average for their specialties and geo- graphic territories.
PHICO SEEKS 63.5% INCREASE IN PREMIUMS FROM PHYSICIANS
NEW LEGISLATION MANDATES COVERAGE FOR ALCOHOLISM
HIGH COURT STRIKES DOWN STATE’S ABORTION LAW
The sixth professional liability insurance company in the last six months to request a premium increase is PHICO Insurance Co. The 63.5 percent increase request applies only to independent physicians, not hospital-employed physi- cians. The request, which would generate an additional $3 million annually was published in the Pennsylvania Bulletin on May 24. Since December 1985,’ the following companies also have filed for premium increases- St Paul (105%); Joint Underwriting Association (51%); Medical Protective (39.7%)- Professional Mutual Insurance (200%); and PMSLIC (24.5%).
Governor Dick Thornburgh has signed S.B. 935, a bill dealing with insurance which, among other things, mandates insurance coverage for “alcohol abuse and dependency.” Also added to the bill before final passage was an amend- ment listing requirements for Preferred Provider Organizations. The bill’s pri- mary purposes are governing the investment practices of life insurance compa- nies and setting automobile insurance rates.
The U.S. Supreme Court on June II struck down the Commonwealth’s Abor- tion Control Act and reaffirmed its own decision in the 1973 Roe v. Wade case. The Supreme Court decision did not, however, eliminate the reporting responsi- bilities required in the Pennsylvania law. All deaths occurring in Pennsylvania related to pregnancy, childbirth, or induced abortion must be reported to the Pennsylvania Department of Health under the Abortion Control Act of 1982 For every maternal death which occurred since July 28, 1984, a report of ma- ternal death should be sent to the department within 15 days of the end of the month of occurrence, in addition to the death certificate. Supplies of the form can be requested from the State Health Data Center, P.0. Box 90 Harrisburg PA 17108, or telephone 717-783-2548. ’
BETTLE COTTLE, MD, REELECTED TO COUNCIL AT AM A MEETING
fuett^AC°ttle’ *fD’ Hollidaysburg, PMS Sixth District trustee, was reelected to the AMA Council on Constitution and Bylaws at the annual meeting last month m Chicago. Some 50 Pennsylvania physicians attended the meeting at which the House of Delegates created a Young Physicians’ Section, with one voting delegate in the House. The AMA will encourage its component state societies to o ow suit. The Pennsylvania Delegation introduced two resolutions. The pro- posal on claims made health insurance was referred for further study. The House of Delegates adopted the resolution on the involvement of physicians in nonmilitary radiation emergencies (See page 19).
6 Pennsylvania Medicine, July 1986
EMERGE FROM
THE FREEWAY flCTORtQUS.HOT
VKTIMIZB).
Highways extract a bitter toll from mod- For those forced to cope with such a de- i drivers. Not at the coin booths, but in moralizing situation, BMW has engineered a e continual onslaught of noise, traffic jams most vivifying solution. The 528e. id pollution A cor whoso high-torpuo, high-officioncy
Estimated [20] mpg, 24 highway Fuel efficiency figures are for comparison only. Your actual mileage may vary, depending on speed, weather and ; BMW trademark and logo are registered.
Eta engine lets you power through traffic with- out endlessly shifting through the gears.
Whose orthopedically-designed seats and ergonomically-designed climate controls en- sure you not only negotiate the highway nimbly, but navigate it in total comfort.
Whose ingenious ABS anti-lock braking system can actually mean the difference between emerging victorious from hazardous roads, and not emerging at all.
And whose parts and pieces mesh to- gether so well that one automotive critic was moved to characterize the 528e as “sump- tuous in a no-nonsense way and immaculately crafted" (Motor Trend).
Your local BMW dealer would be happy to arrange a thorough test drive of the BMW 528e. A triumph of technology in which every day you share in the victory. ___
THE ULTIMATE DRIVING MACHINE.
trip length. ©1985 BMW of North America, Inc
SEE YOUR AUTHORIZED BMW DEALER FOR A THOROUGH TEST DRIVE.
To
dull the point of
moderate
to
noderately
severe
pain...
hydrocodone bitarfrate 5 mg (Warning: May be habit forming.) with acetaminophen 500 mg
Brief Summary
INDICATIONS AND USAGE: For the relief ol moderate to moderately severe poin CONTRAINDICATIONS: Hypersensitivity to acetaminophen or hydrocodone
WARNINGS
Drug Abuse ond Dependence: VICODIN is subject to the Federal Controlled Substances Act (Schedule III) Psychic dependence, physical dependence and tolerance moy develop upon repeated administration ot narcot- ics, therefore, VICODIN should be prescribed and administered with the some caution oppropriote to the use ot other oral-narcotic-contoining medications
Respiratory Depression: At high doses or in sensitive patients, hydrocodone moy produce dose-related respira- tory depression by octmg directly on brain stem respiratory centers Hydrocodone also affects centers that control respiratory rhythm, ond moy produce irregular and periodic breathing.
Head Injury ond Increased Intracranial Pressure: The respiratory qffiressont effects ol narcotics ond their ca- pocity to elevate cerebrospinal fluid pressure may be markedly exaggerated in the presence ot heod injury, other intracranial lesions or o preexisting increase in intracranial pressure Furthermore, narcotics produce odverse reoctions which moy obscure the clinical course ot patients with head injuries
Acute Abdominal Conditions: The administration ot narcotics may obscure the diognosis or clinical course ol patients with acute abdominal conditions
PRECAUTIONS
Special Risk Patients: VICODIN should be used with caution in eJdetty or debilitated patients ond those with severe impairment ol hepatic or renal function, hypothyroidism, Addison's diseose, prostotic hypertrophy or urethral stricture
Information For Patients: VICODIN, like oil norcotics, moy impair the mental and/or physical abilities reguired tor the performance ot potentially hazardous tasks such as driving a car or operating machinery, patients should be cautioned accordingly
Cough Reflex: Hydrocodone suppresses the cough reflex, caution should be exercised when VICODIN is used postoperotively ond in patients with pulmonary disease
Drug Interactions: The CNS-depressont effects ot VICODIN may be additive with that ot other CNS depressants When combined therapy is contemplated, the dose of one or both agents should be reduced The use ol MAO inhibitors or tricyclic antidepressants with hydrocodone preparations may increase the effect of either the antide- pressant or hydrocodone The concurrent use ol anticholinergics with hydrocodone moy produce paralytic ileus Usage In Pregnancy: Pregnancy Category C Hydrocodone hos been shown to be teratogenic in hamsters when
5725
given in doses 700 times the human dose There are no adeguate and well-controlled studies in pregnant women VICODIN should be used during pregnancy only it the potentiol benefit justifies the potential risk to the fetus
Nonteratogenlc Effects: Babies born to mothers who have been taking opioids regularly prior to delivery will be physically dependent The intensity of the syndrome does not always correlate with the duration of maternal opioid use or dose
Labor ond Delivery Administration of VICODIN to the mother shortly before delivery may result in some degree ot respiratory depression in the newborn, especially it higher doses are used
Nursing Mothers: It is not known whether this drug is excreted in human milk, theretore. a decision should be made wtiether to discontinue nursing or to discontinue the drug, taking into account the importance ot the drug to the mother
Pediatric Use: Safety and effectiveness in children have not been established
ADVERSE REACTIONS
Central Nervous System: Seda, an, drowsiness, mental clouding, lethargy, impairment ot mental and physical performance, anxiety, tear, dyspho: ia dizziness, psychic dependence, mood changes Gastrointestinal System: Nausea or . vomiting may occur, they are more treguent in ambulatory thon in recum- bent patients Prolonged administration ot VICODIN may produce constipation Genitourinary System: Ureteral spasm, spasm ot vesicol sphincters and urinary retention hove been reported Respiratory Depression: (See WARNINGS.)
DOSAGE AND ADMINISTRATION: Dosage should be adjusted according to the severity ot the pain and the response ol the patient However tolerance to hydrocodone con develop with continued use, and the incidence of- untoward effects is dose related
The usual dose is one tablet every six hours os needed tor pain (It necessary, this dose may be repeated at tour- hour intervals ) In coses ot more severe pain, two tablets every six hours (up to eight tablets in 24 hours) may be required Revised, April 1982
o
knoll
KNOLL PHARMACEUTICAL COMPANY
30 NORTH JEFFERSON ROAD, WHIPPANY, NEW JERSEY 07981
Februory 1985
“They look at what’s right for medicine/'
That's why Dr. Patrick Forsythe, an anesthesiologist from Camp Hill, is proud to insure with PMSLIC.
“Commercial carriers are constantly looking at the bottom line. They'll make economic deci- sions: ‘Settle and get out of it!’ And if things get tough financially, they'll pull out of the state altogether."
“But PMSLIC is committed to Pennsylvania— and to the viewpoint of its physicians. If you think you can get better coverage elsewhere for less, you’re really mortgaging the future."
To learn more about PMSLIC, call toll-free: 1-800-445-1212 and ask for ext. 99.
PMSLIC:
The doctors’ choice.
editorial
Cost containment
The problem of cost containment in medicine is complex, but with a sensi- ble, long term approach, we can deal with it.
For the average business, the process of containing costs is more cut and dried than it is for the health care indus- try. Since hospitals and physicians are practicing in an increasingly competi- tive environment, keeping the cost of medical care at affordable levels has many considerations other than con- ducting a cost/benefit analysis.
Physicians and hospitals are in the business of providing the best and most readily available health care to our citi- zens. Our first priority is the health and welfare of the patients we treat. We should not place the value of the dollar above the value of the health of the pa- tient. This being so, how do we legiti- mately respond to the current national trends in cost containment?
To be sure, everyone wants to contain costs and provide reasonable medical services at the lowest possible price. This includes all of the players, includ- ing hospitals, physicians, insurers, busi- ness, government, labor, and, of course, patients. There is a real danger of undue intervention from second and third party players in this scenario. Largely because they are not physicians, these decision makers may come dangerously close to losing sight of the primary goal of all care givers— -to preserve, protect,
at whose cost?
and promote the good health of the pa- tients. Reckless attempts at cutting costs threaten patients with across the board cuts under the guise of efficiency and equivalent quality. Neither hospi- tals nor physicians’ practices can be run entirely on bottom line considerations.
Clearly, providers of health care should continue to move in the direction we are currently moving— toward greater efficiency of operations, com- puterization, and independence from government regulatory control. This will have a positive effect on medical practice as a viable and vibrant busi- ness operation. While more emphasis should be placed on competition among health care providers, more also should be done to promote joint business ven- tures between physicians and hospitals. A balance must be struck between health care as a profession and as a business. Concern for the patient will di- minish if we fall into the limited, two / dimensional, profit/loss status of the av- erage business. Medical care is unique in this sense. That is why physicians must have a primary role in the cost containment decision making process.
Further competition and less govern- ment regulation - yes. Compromise of the status of the patient - no. Cost con- tainment cannot be achieved by com- promising patient care.
David A. Smith, MD
Medical Editor
10 Pennsylvania Medicine, July 1986
Don’t Play Games With Medical Office Computers
Just like video games, you don’t need to look very far to find a medical office system . . . they’re everywhere. But just like the hand- ful of quality video games, only a few office systems stand out from the rest.
Consider Keystone Technologies. Backed by the experience of Pennsylvania Blue Shield, Keystone Technologies’ Medical Bil- ling System addresses the #1 paperwork bot- tleneck of most medical practices— the filing of insurance claims forms. And as a total approach to business paperwork, our Practice Management System provides Billing, Accounts Receivable, Patient Scheduling — with optional Accounts Payable, General Ledger, Payroll and Word Processing pro- grams. These systems, customized for the
Pennsylvania medical community, serve phy- sicians in 31 states through 19 Blue Cross/Blue Shield Plans.
If you’re looking for a medical office auto- mation system, don’t play games. Look to Keystone Technologies. For more informa- tion, call (717) 975-7159, or write:
Keystone Technologies, Inc., Dept. PAS, P.O. Box 8075, Camp Hill, PA 17011
■■Keystone ■■Technologies, Inc.
a subsidiary of Pennsylvania Blue Shield
newsfronts
State’s medical schools award 1,258 degrees
The state’s seven medical schools and one osteopathic college awarded de- grees to 1,258 new physicians at cere- monies in May and June. This number is one less than last year, when 1,259 students received MD or DO degrees. While the total number of graduates in the state declined by one, the number of women receiving degrees increased by ten, a growth of 2.5 percent over last year. 384 women earned degrees this year, while 374 women earned degrees in 1985.
PAOO elects officers
The Pennsylvania Academy of Oph- thalmology and Otolaryngology re- cently installed Edward A. Jaeger, MD, Media ophthalmologist, as president. Other new officers also were installed at the academy’s 42nd annual convention, held in June.
Dr. Jaeger was elected to a one-year term, succeeding Donald P. Vrabec, MD, Danville otolaryngologist.
Webb S. Hersperger, MD, Carlisle otolaryngologist, became president- elect, and will take office in 1987. Dr. Hersperger will continue to serve as president of the academy’s otolaryngol- ogy council. Dorothy Scott, MD, Pitts- burgh ophthalmologist, was elected president of the academy’s ophthalmol- ogy council.
Members of the academy reappointed
DR. JAEGER
Hahnemann University School of Medicine
Hahnemann University awarded a to- tal of 171 degrees to 129 men and 42 women at the 139th commencement, June 5. Exercises were held at the Academy of Music, Philadelphia.
Daniel K. Inouye, the United States Senator from Hawaii, addressed the graduates. Senator Inouye, the first Congressman from the state of Hawaii, was elected in 1962, and reelected in 1968, 1974, and 1980.
Thomas B. Souders, MD, West Reading ophthalmologist, editor of Transac- tions, the journal of the academy, and John Penta, MD, Reading otolaryngolo- gist, the academy’s convention chair- man.
Dr. Jaeger is professor of ophthalmol- ogy at Jefferson Medical College, and associate chairman of Jefferson’s de- partment of ophthalmology. He is a member of the medical staffs of Wills Eye Hospital, Philadelphia, and Riddle Memorial Hospital Media. Dr. Hers- perger is clinical assistant professor of otolaryngology at Milton S. Hershey Medical Center. Dr. Scott is clinical as- sociate professor of ophthalmology at the University of Pittsburgh and clini- cal instructor in ophthalmology at St. Francis Hospital, Pittsburgh.
DR. HERSPERGER
At the ceremony, the medical school presented honorary degrees to Senator Inouye, who was awarded an honorary doctor of laws degree, and two others. David A. Hamburg, MD, president of the Carnegie Corporation of New York, received an honorary doctor of science degree. Dr. Hamburg is president elect of the American Association for the Ad- vancement of Science. Ronald Annen- berg Krancer was given an honorary doctor of humane letters degree. Kran- cer, vice president of Advent, Inc., of Philadelphia, helped to found the uni- versity’s Likoff Cardiovascular Insti- tute, and established the Krancer Cen- ter for Inflammatory Bowel Disease Research.
Jefferson Medical College of Thomas Jefferson University
Jefferson Medical College conferred 222 degrees on 163 men and 59 women at its 162nd commencement on June 6. Exercises were at the Academy of Music, Philadelphia.
Hilary Koprowski, MD, and Carol M. McCarthy, PhD, spoke at the ceremony. Dr. Koprowski is director and professor at the Wistar Institute of Anatomy and Biology, Philadelphia. Dr. Koprowski developed a vaccine for rabies that has been used since 1975, and he helped de- ' velop the first oral polio vaccine. He and his associates also developed a vac- cine for rubella, and produced the first all-human cell line that can be used to create monoclonal antibodies. Dr. Ko- prowski, a native of Warsaw, Poland, re- , ceived his medical degree from Warsaw University, and has a degree from the ! Santa Cecilia Conservatory of Music in Rome. He has been a consultant to the World Health Organization for 32 years.
Dr. McCarthy is president of the American Hospital Association. Before this appointment, Dr. McCarthy served as president of the Massachusetts Hos- pital Association. She is also former I president of the Delaware Valley Hospi- tal Council and its affiliated Health Ed- ucation and Research Foundation, based in Philadelphia.
Dr. Koprowski received an honorary doctor of letters degree, and Dr. Me-
12 Pennsylvania Medicine, July 1986
ONLY THE PRICE IS NOT BREATHTAKING.
If you’re a person with an eye for beauty, one look at the striking lines of the Alfa Romeo Quadrifoglio could give you reason enough to buy it.
You’ll find additional ones inside. Supple Italian glove leather seats, air conditioning, power windows and a digital AM/FM stereo cassette deck with four speakers are among its many standard luxury features.
Yet this is not a car to buy for looks alone.
For the Quadrifoglio is the best-performing Alfa convertible ever built, thanks to its spirited 2.0 litre engine, Bosch fuel injection, improved anti- sway bars, 15" alloy wheels and Pirelli P6 tires.
What’s more, this car is built so well, it’s backed by a 3-year/36, 000-mile warranty?
The Alfa Romeo Quadrifoglio is now available for under $19,600?* ** A price that lets you breathe a sigh of relief.
ENGINEERED WITH A PASSION.
J. H. Bennett, Inc.
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Wanamaker and Industrial Highway Essington, PA 19029 (215) 521-9200
Burdumy Motors, Inc.
2711 Philmont Avenue Huntingdon Valley, PA 19006 (215) 947-6363 MPA, Inc.
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Algar Enterprises, Inc.
1100 W. Swedesford Road Paoli, PA 19301 (215) 647-6660
Auto Palace, Inc.
4627 Baum Boulevard Pittsburgh. PA 15213 (412) 687-4000
Cherry Hill Alfa
1100 Haddonfield Road Cherry Hill, NJ 08034 (609) 663-2800 Alfa Northeast, Inc.
1125 N. Washington Avenue Scranton, PA 18509 (717) 346-7691
* Limited warranty applies only to U.S. spec, automobiles purchased from authorized Alfa Romeo dealers.
**Mfr.’s suggested retail price at P.O.E. excluding removable hardtop. Actual prices may vary. Destn. chrgs., taxes, dealer prep. , if any, opt. equip, and license fees are extra. Hardtop not available with initial production.
newsfronts
Carthy was awarded an honorary doc- tor of science degree.
Medical College of Pennsylvania
At the 134th commencement of the Medical College of Pennsylvania, 118 degrees were awarded to 54 men and 64 women. The exercises were held May 31 at the Academy of Music, Philadelphia.
Semour S. Kety, MD, associate direc- tor of basic research for the National In- stitute of Mental Health and professor emeritus of neuroscience and psychia- try at Harvard University, gave the commencement address. He spoke on “Medicine in a World of Changing Val- ues." Dr. Kety has investigated the role of biological mechanisms in psychiatric illness, and with his colleagues, demon- strated the importance of genetic fac- tors in the transmission of schizophre- nia.
Dr. Kety received an honorary doctor of science degree. The college also awarded three other honorary degrees.
The Educational and Scientific Trust of the Pennsylvania Medical Society re- ceived a bequest of $64,800 from the es- tate of Jane Scarlett Harvey of Phila- delphia.
Harvey had made donations to a col- lege in Kentucky, which has a program to educate physicians for practice in shortage areas. She had an interest in educating young people who would re-
Maurice C. Clifford, MD, and Bernard C. Watson, PhD, received honorary doc- tor of laws degrees. Dr. Clifford retired from his post as president of the medi- cal college on June 30 and began new duties as health commissioner for Phila- delphia. Dr. Watson is president and chief executive officer of the William Penn Foundation.
Neurophysiologist Ruth H. Bleier, MD, was given an honorary doctorate of medical science. Dr. Bleier is chair- man of the Women’s Studies Program at the University of Wisconsin.
Pennsylvania State University College of Medicine
63 men and 26 women earned the 89 degrees awarded at the 16th commence- ment of the Pennsylvania State Univer- sity College of Medicine. The exercises took place May 18 in Founders Hall, Hershey.
Graham Jeffries, MD, professor and chairman of the department of medicine at the university, delivered the com- mencement address, entitled “How well prepared are you?”
turn as doctors to rural areas where the need for physicians is great, said a spokesman for the Trust.
James A. Collins Jr., MD, chairman of the board of trustees of the Trust said, “Harvey’s interests coincided with one of the Trust’s programs— that of providing financial aid to medical and allied health students. The Trust will use this gift to promote education."
Harry Prystowsky, MD, dean of the college of medicine and senior vice pres- ident for health affairs, directed the cer- emony for the last time. He will retire this month. Arlene Drack Kobylski, MD, offered remarks on behalf of the graduating class.
Philadelphia College of Osteopathic Medicine
209 doctor of osteopathy degrees were conferred on 149 men and 60 women at the 95th commencement of Philadelphia College of Osteopathic Medicine. Exercises were held June 1 at the Academy of Music, Philadelphia.
The college presented an honorary doctor of laws degree to William Law- rence Silverman, DO. Dr. Silverman, who is professor of pathology and labo- ratory medicine at the college, offered remarks to the graduating class.
Temple University School of Medicine Temple University School of Medi- cine awarded 169 degrees to 118 men and 51 women at its 82nd commence- ment, May 29. The medical degrees were given at a separate ceremony fol- lowing the university’s 100th general exercises.
Medical school officials presided at the ceremony.
University of Pennsylvania School of Medicine
109 men and 43 women earned medi- cal degrees from the University of Pennsylvania School of Medicine. The 152 degrees were presented at a special ceremony on May 19. The diploma cere- mony was held on the university’s Franklin Field.
University alumnus Michael Brown, MD, a Nobel laureate, addressed the graduating class. Dr. Brown is profes- sor of medicine and genetics, and direc- tor of the center for genetic disease at the University of Texas Southwestern Medical School at Dallas.
University of Pittsburgh School of Medicine The University of Pittsburgh School of Medicine awarded 128 degrees to 89 men and 39 women at a ceremony on May 27.
Henry T. Bahnson, MD, and Peter J. Jannetta, MD, spoke at the ceremony. Dr. Bahnson is professor and chairman of the department of surgery, and Dr. Jannetta is professor and chairman of the department of neurological surgery at the university.
A HELPING HAND FOR THE TROUBLED PHYSICIAN
Alcoholism. Drug abuse. Mental and physical disability. The problems of aging. All take their toll on the medical community.
But there’s help — through the Impaired Physician Program of the Pennsylvania Medical Society. The program offers peer support . . . referral to professional treatment agencies . . . and compassionate follow- up throughout the reha- bilitation process.
All efforts are voluntary and strictly confidential.
If you need help — or know someone who does —call the Impaired
Physician Hotline: (717) 763-7937.
To learn more about the Impaired Physician Program, write: Impaired Physician Program. Pennsylvania Medical Society, 20 Erford Road. Lemoyne, PA 17043.
Trust receives bequest from Philadelphia estate
14 Pennsylvania Medicine, July 1986
Fully 60 % of all blindness from diabetic retinopathy can be prevented . . .
That’s 3,000 cases a year . . .
And one of them could be a patient of yours.
Get the latest data on the detection and treatment of diabetes-related eye complications in VISUAL IMPAIRMENT, a self-study module from the Pennsylvania Diabetes Academy. It is a must for the primary care practitioner and eye specialist treating diabetic patients.
Written by Alexander J. Brucker, M.D., of the University of Pennsylvania and the Scheie Eye Institute, it consists of a monograph complete with self-check exams and a final exam for Category I CME credit, color plates and
slides of eye pathology and an audio cassette, all keyed to sections in the monograph text. Its convenient multi-media format makes it suitable for a variety of learning styles and every busy schedule.
To order, send a check or money order for $50.00 (PA residents add 6% sales tax) made payable to:
The Pennsylvania Diabetes Academy 20 Erford Road Lemoyne, Pennsylvania 17043 717-763-7151
VISUAL IMPAIRMENT was produced under a grant from the Centers for Disease Control to the Pennsylvania Department of Health Diabetes Control Program in cooperation with the Pennsylvania Diabetes Task Force The Pennsylvania Diabetes Academy is an independent affiliate of the Educational and Scientific Trust of the Pennsylvania Medical Society
Pennsylvania Medicine, July 1986 15
newsfronts
Study before signing that PPO contract
Denise E. Zimmerman
Deciding to participate in a preferred provider organization (PPO), or any other alternative delivery system, re- quires a thorough examination of the impact participation will have on a phy- sician’s practice. After considering the economic arrangements and the growth potential offered to the practice by a PPO, the physician must examine the obligations in the PPO provider agree- ment or contract. Joining a PPO means much more to a physician than partici- pating just to maintain or build his pa- tient base because by joining the physi- cian is executing a contract (a legally enforceable and binding agreement) to provide medical services under speci- fied conditions.
Before signing a contract, the physi- cian must assess the proposal and be prepared to negotiate terms which will assure the delivery of quality care. To do this, the physician must answer two questions:
Will participation in the plan inter- fere with the delivery of quality care?
Are the obligations imposed by the contract reasonable and fair to both the physician and the patient?
Elizabeth B. Metz, Esq., assistant general counsel for the Pennsylvania
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Alfa Romeo 13
BMW of North America 7
Brown Pharmaceuticals 46, 50
Campbell Laboratories 34
Casualty Reciprocal Exchange 23
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Eli Lilly Company 24
Geisinger Medical Center 32
Health Care Personnel 40, 41
Jefferson Medical College 19
John Downing Associates 40, 41
Keystone Technologies 11
Knoll Pharmaceuticals 8, 44-46
Marion Laboratories 17-18
Medical Personnel Pool 2
Medical Society and principal author of the Society’s PPO contract guide, of- fered the following answers to common questions.
Are there any particular areas in a PPO provider contract that may create problems for a physician?
One of the problems often encoun- tered in PPO physician provider con- tracts is open-ended obligations. An open-ended obligation is one which can be adopted or changed without the phy- sician’s approval. You would be sur- prised at the obligations left open- ended. The provider payment is one. For example, the contract will say, “Physician shall accept as payment in full the amount appearing in the fee schedule found in Attachment A as amended from time to time by the PPO.” Another obligation often left open-ended is the responsibility for uti- lization review. The contract will, for ex- ample, say, “Physician shall abide by the requirements of PPO’s utilization review program,” but there is no expla- nation of those requirements. It is not possible to make an informed and intel- ligent decision about the effect of these utilization review responsibilities on the quality of patient care if they are not
Medical Protective Company 35
Mercy Catholic Medical Center 42
Milton S. Hershey Medical Center 20
NEEMA Medical Services 31
OR-D Systems 47
Pennsylvania Diabetes Academy 15
Pennsylvania Hand Center 31
Pennsylvania State University 37
Philadelphia Savings Fund Society 5
Physician Support Systems 31
Committee on Impaired Physician 14
Council on Medical Economics 2
PMS Liability Insurance Company 9
Provident Mutual 21
Roche Laboratories 1,2, Covers 2, 3, 4
Stuart Pharmaceuticals 41
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Upjohn Company 49
Westmoreland Hospital 41
spelled out or if they can be changed un- ilaterally.
What should a physician do when confronted with a contract that con- tains open-ended obligations?
I’m not saying a physician should never sign a PPO provider contract which has an open-ended obligation. The physician should, however, care- fully review whether the uncertainty created by an open-ended obligation is acceptable. Otherwise, he may find out too late that he has, essentially, signed a blank check. An entire chapter in the PPO contracting guide is devoted to open-ended obligations. The chapter provides additional examples of open- ended obligations and lists factors that physicians should consider when deter- mining whether the uncertainty is ac- ceptable.
Success or failure for many PPOs de- pends on enlisting an adequate number of participating providers. To lure phy- sicians into its plan, a PPO may offer an abundance of new patients, faster reim- bursement, or both. How can physi- cians be assured that a PPO will keep its promises?
A PPO may make promises in promo- tional materials or during negotiations, but neglect or refuse to put them in the written contract. Sometimes these pro- motional promises also are misleading. For example, the PPO will promise “payment within 30 days” in its cover letter, but the written contract says, “PPO shall make payment within 30 days after the date of presentation un- less the PPO contests the claim.” In re- ality, there is no deadline for payment if the PPO contests the claim. There Eire some situations in which a PPO prom- ise not included in the written contract will be enforceable, but they are rare. The safest course is to rely only on those promises which are written in the contract.
The writer is director of practice services for the Pennsylvania Medical Society. A pre- vious article on PPOs appeared in the June issue.
A comprehensive guide, “Provider Contracts: What You Should Know Before You Sign,” is now available to aid PMS members in their evaluation of PPO contracts. This guide, when used in consultation with an experienced attorney, will provide physicians with the information necessary to assess a PPO contract. To order a copy of the contract- ing guide, contact the PMS Council on Medical Practice.
16 Pennsylvania Medicine, July 1986
Give your angina patient added protection...
CARDIZEU: FEWER SIDE EFFECTS
diltiozem HCl/Marion
The lowest incidence of side effects among the calcium channel blockers'
An exceptionally safe choice for angina patients with coexisting hypertension i, diabetes, asthma, or COPD'3
Proven efficacy when used alone in angina1 4 6
Compatible with both beta-blockers and nitrates7
Please see brief summary of prescribing informafion on the next page.
CARDIZEM
60 mg fid or qid
diltiozem HCI/Marion
FEWER SIDE EFFECTS IN ANTI ANGINA! THERAPY
BRIEF SUMMARY
CARDIZEM * (diltiazem hydrochloride) is a calcium ion influx inhibi- tor (slow channel blocker or calcium antagonist)
INDICATIONS AND USAGE
1 Angina Pectoris Due to Coronary Artery Spasm. CARDIZEM is indicated in the treatment of angina pectoris due to coronary artery spasm. CARDIZEM has been shown effective in the treat- ment of spontaneous coronary artery spasm presenting as Prinz- metal's variant angina (resting angina with ST- segment elevation occurring during attacks)
2 Chronic Stable Angina (Classic Effort-Associated Angina).
CARDIZEM is indicated in the management of chronic stable angina CARDIZEM has been effective in controlled trials in reducing angina frequency and increasing exercise tolerance
There are no controlled studies of the effectiveness of the concomi- tant use of diltiazem and beta-blockers or of the safety of this combination in patients with impaired ventricular function or conduc- tion abnormalities CONTRAINDICATIONS
CARDIZEM is contraindicated in (1) patients with sick sinus syn- drome except in the presence of a functioning ventricular pacemaker, (2) patients with second- or third-degree AV block except in the presence of a functioning ventricular pacemaker, and (3) patients with hypotension (less than 90 mm Hg systolic)
WARNINGS
1. Cardiac Conduction. CARDIZEM prolongs AV node refractory periods without significantly prolonging sinus node recovery time, except in patients with sick sinus syndrome This effect may rarely result in abnormally slow heart rates (particularly in patients with sick sinus syndrome) or second- or third-degree AV block (six of 1243 patients for 0 48%). Concomitant use of diltiazem with beta-blockers or digitalis may result in additive effects on cardiac conduction A patient with Prinzmetal's angina developed periods of asystole (2 to 5 seconds) after a single dose of 60 mg of diltiazem
2. Congestive Heart Failure. Although diltiazem has a negative inotropic effect in isolated animal tissue preparations, hemo- dynamic studies in humans with normal ventricular function have not shown a reduction in cardiac index nor consistent negative effects on contractility (dp/dt). Experience with the use of CARDIZEM alone or in combination with beta-blockers in patients with impaired ventricular function is very limited Cau- tion should be exercised when using the drug in such patients
3. Hypotension. Decreases in blood pressure associated with CARDIZEM therapy may occasionally result in symptomatic hypotension
4 Acute Hepatic Injury In rare instances, patients receiving CARDIZEM have exhibited reversible acute hepatic injury as evidenced by moderate to extreme elevations of liver enzymes (See PRECAUTIONS and ADVERSE REACTIONS )
PRECAUTIONS
General. CARDIZEM (diltiazem hydrochloride) is extensively metabo- lized by the liver and excreted by the kidneys and in bile As with any new drug given over prolonged periods, laboratory parameters should be monitored at regular intervals. The drug should be used with caution in patients with impaired renal or hepatic function In sub- acute and chronic dog and rat studies designed to produce toxicity, high doses of diltiazem were associated with hepatic damage In special subacute hepatic studies, oral doses of 125 mg/kg and higher in rats were associated with histological changes in the liver which were reversible when the drug was discontinued. In dogs, doses of 20 mg/kg were also associated with hepatic changes, however, these changes were reversible with continued dosing
Drug Interaction. Pharmacologic studies indicate that there may be additive effects in prolonging AV conduction when using beta-blockers or digitalis concomitantly with CARDIZEM (See WARNINGS )
Controlled and uncontrolled domestic studies suggest that con- comitant use of CARDIZEM and beta-blockers or digitalis is usually well tolerated. Available data are not sufficient, however, to predict the effects of concomitant treatment, particularly in patients with left ventricular dysfunction or cardiac conduction abnormalities. In healthy
volunteers, diltiazem has been shown to increase serum digoxm levels up to 20%
Carcinogenesis, Mutagenesis, Impairment ot Fertility. A 24-month study in rats and a 21-month study in mice showed no evidence of carcinogenicity There was also no mutagenic response in in vitro bacterial tests. No intrinsic effect on fertility was observed in rats
Pregnancy Category C. Reproduction studies have been conducted in mice, rats, and rabbits Administration of doses ranging from live to ten times greater (on a mg/kg basis) than the daily recommended therapeutic dose has resulted in embryo and fetal lethality These doses, in some studies, have been reported to cause skeletal abnor- malities. In the perinatal/postnatal studies, there was some reduction in early individual pup weights and survival rates. There was an increased incidence of stillbirths at doses of 20 times the human dose or greater.
There are no well-controlled studies in pregnant women; therefore, use CARDIZEM (diltiazem hydrochloride) in pregnant women only it the potential benefit justifies the potential risk to the fetus.
Nursing Mothers. It is not known whether this drug is excreted in human milk Because many drugs are excreted in human milk, exercise caution when CARDIZEM is administered to a nursing woman if the drug's benefits are thought to outweigh its potential risks in this situation
Pediatric Use. Safety and effectiveness in children have not been established
ADVERSE REACTIONS
Serious adverse reactions have been rare in studies carried out to date, but it should be recognized that patients with impaired ventricu- lar function and cardiac conduction abnormalities have usually been excluded
In domestic placebo-controlled trials, the incidence of adverse reactions reported during CARDIZEM therapy was not greater than that reported during placebo therapy
The following represent occurrences observed in clinical studies which can be at least reasonably associated with the pharmacology of calcium influx inhibition. In many cases, the relationship to CARDIZEM has not been established The most common occurrences, as well as their frequency of presentation, are edema (2.4%), headache (2.1%), nausea (1.9%). dizziness (1.5%), rash (1.3%), asthenia (1,2%), AV block (1.1%). In addition, the following events were reported infre- quently (less than 1%) with the order of presentation corresponding to the relative frequency of occurrence
Cardiovascular Nervous System Gastrointestinal
Dermatologic
Other
Flushing, arrhythmia, hypotension, bradycardia, palpitations, congestive heart failure, syncope Paresthesia, nervousness, somnolence, tremor, insomnia, hallucinations, and amnesia. Constipation, dyspepsia, diarrhea, vomiting, mild elevations of alkaline phosphatase, SGOT. SGPT, and LDH
Pruritus, petechiae, urticaria, photosensitivity. Polyuria, nocturia.
The following additional experiences have been noted A patient with Prinzmetal's angina experiencing episodes of vaso- spastic angina developed periods of transient asymptomatic asystole approximately five hours after receiving a single 60-mg dose of CARDIZEM
The following postmarketing events have been reported infrequently in patients receiving CARDIZEM: erythema multiforme: leukopenia, and extreme elevations of alkaline phosphatase, SGOT. SGPT LDH, and CPK. However, a definitive cause and effect between these events and CARDIZEM therapy is yet to be established
0VERD0SAGE OR EXAGGERATED RESPONSE
Overdosage experience with oral diltiazem has been limited. Single oral doses of 300 mg of CARDIZEM have been well tolerated by healthy volunteers In the event of overdosage or exaggerated response, appro- priate supportive measures should be employed in addition to gastric lavage The following measures may be considered Bradycardia Administer atropine (0 .60 to 1.0 mg). If there is
no response to vagal blockade, administer iso- proterenol cautiously.
High-Degree AV Block
Cardiac Failure
Hypotension
Treat as for bradycardia above. Fixed high- degree AV block should be treated with cardiac pacing
Administer inotropic agents (isoproterenol, dopamine, or dobutamine) and diuretics. Vasopressors (eg, dopamine or levarterenol bitartrate).
Actual treatment and dosage should depend on the severity of the clinical situation and the judgment and experience of the treating physician
The oral LDso’s in mice and rats range from 415 to 740 mg/kg and from 560 to 810 mg/kg, respectively. The intravenous LDso’s in these species were 60 and 38 mg/kg, respectively The oral LDso in dogs is considered to be in excess of 50 mg/kg, while lethality was seen in monkeys at 360 mg/kg The toxic dose in man is not known, but blood levels in excess of 800 ng/ml have not been associated with toxicity. DOSAGE AND ADMINISTRATION
Exertional Angina Pectoris Due to Atherosclerotic Coronary Ar- tery Disease or Angina Pectoris at Rest Due to Coronary Artery Spasm Dosage must be adjusted to each patient's needs Starting with 30 mg four times daily, before meals and at bedtime, dosage should be increased gradually (given in divided doses three or four times daily) at one- to two-day intervals until optimum response is obtained Although individual patients may respond to any dos- age level, the average optimum dosage range appears to be 180 to 240 mg, day There are no available data concerning dosage require- ments in patients with impaired renal or hepatic function If the drug must be used in such patients, titration should be carried out with particular caution
Concomitant Use With Other Antianginal Agents:
1 Sublingual NTG may be taken as required to abort acute anginal attacks during CARDIZEM therapy.
2 Prophylactic Nitrate Therapy CARDIZEM may be safely co- administered with short and long-acting nitrates, but there have been no controlled studies to evaluate the antianginal effective- ness of this combination
3 Beta-blockers. (See WARNINGS and PRECAUTIONS.)
HOW SUPPLIED
CARDIZEM 30-mg tablets are supplied in bottles of 100 (NDC 0088- 1771-47) and in Unit Dose Identification Paks of 100 (NDC 0088-1771- 49). Each green tablet is engraved with MARION on one side and 1771 engraved on the other CARDIZEM 60-mg scored tablets are supplied in bottles of 100 (NDC 0088-1772-47) and in Unit Dose Identification Paks of 100 (NDC 0088-1772-49) Each yellow tablet is engraved with MARION on one side and 1772 on the other Issued 4/1/84
See complete Professional Use Information before prescribing.
0642T5
References I Physicians' Desk Reference*: ed 39. Oradell, NJ. Medi- cal Economics Company Inc, 1985 2. Cohn PE Braunwald E Chronic ischemic heart disease, in Braunwald E (ed): Heart Disease A Textbook of Cardiovascular Medicine, ed 2 Philadelphia, WB Saunders Co. 1984, chap 39. 3. Schroeder JS: Calcium and beta blockers in ischemic heart disease When to use which. Mod Med 1982; 50(Sept) 94-116 4 Subramaman VB Comparative evaluation of four calcium antago- nists and propranolol with placebo in patients with chronic stable angina Cardiovasc Rev Rep 1984: 5 91-104 5. Schroeder IS, Feldman RL, Giles TD, el al Multiclinic controlled trial of diltiazem for Prinz- metal's angina Am J Med 1982; 72:227-231 6. Weiner DA, McCabe CH, Cutler SS. et al The efficacy and safety of high-dose verapamil and diltiazem in the long-term treatment of stable exertional angina. Clin Cardiol 1985; 7 648-653. 7. Shapiro W Calcium channel blockers: Actions on the heart and uses in Ischemic heart disease. Consultant 1984; 24(Dec) 150-159
Another patient benefit product from
PHARMACEUTICAL DIVISION
MARION
LABORATORIES, INC.
KANSAS CITY, MO 64137
newsfronts
AMA forms committee on radiation emergencies
Karen K. Davis
Pennsylvania physicians played a part in forming the American Medical Association’s new Advisory Committee on Nonmilitary Radiation Emergencies. The Pennsylvania Delegation to the AMA supported formation of the advi- sory committee, and two state physi- cians are committee members.
At the AMA Annual Meeting June 15-19 in Chicago, the Pennsylvania Del- egation introduced the resolution call- ing for physicians to have a voice in de- cisions on environmental radiation issues.
The resolution called for the AMA to develop a plan that would make physi- cians knowledgeable about the health aspects of radiation incidents, emergen- cies, and accidents available to the pub- lic, the media, and responsible govern- ment agencies. The committee also is a resource for the AMA’s Council on Sci- entific Affairs.
The advisory committee was orga- nized as a response to the April 26 acci- dent at the USSR’s nuclear power plant in Chernobyl, and also in view of the Three Mile Island accident in the United States, and the numerous small scale incidents that have occurred at nuclear plants over the past few years. Pennsylvania physician Gordon K. MacLeod, MD, Pittsburgh, is chair- man.
The AMA’s advisory committee first met May 12 to organize and outline its goals and scope of action. Members said the committee has several functions. First it will identify physicians who are expert on the health effects of radiation and can act in public advisory roles. It will then develop programs to train physicians for handling nuclear emer- gencies. These programs will include training physicians to furnish health in- formation to the public and the media. Current mechanisms to provide such in- formation are inadequate, committee members said.
AMA officials named seven physi- cians to the advisory committee, includ- ing two Pennsylvanians. The chairman, Gordon K. MacLeod, MD, is professor of health services administration at the Graduate School of Public Health of the University of Pittsburgh. Also serving on the committee is David Brill, MD,
Danville, chief of the nuclear medicine department at Geisinger Medical Cen- ter. Other members are: Frederick T. Bonte, MD, University of Texas Health Science Center; David V. Becker, MD, New York Hospital; William R. Hendee, PhD, American Medical Association; Merle K. Loken, MD, University of Minnesota Hospital, Eugene L.
Saenger, MD, University of Cincinnati Medical Center; and Henry N. Wagner Jr., MD, Johns Hopkins Medical Insti- tutions.
The chairman of the advisory com- mittee, Dr. MacLeod, was Pennsylva- nia’s secretary of health at the time of the accident at Three Mile Island nu- clear plant, March 28, 1979. Since the
Jefferson Medical College
of
Thomas Jefferson University
presents
Preoperative Consultation:
The Surgical Patient With Medical Problems
Wednesday through Friday September 17-19, 1986
at
The Warwick Hotel Philadelphia, Pennsylvania
Description; This course is designed for internists, family practitioners, surgeons, anesthesiologists, nurse anesthetists, and other primary care physicians who desire practical information on perioperative assessment and patient care. A detailed course syllabus and reference materials will be distributed.
Objectives: To provide physicians involved in medical preoperative consultation a review of disease processes which affect the morbidity and mortality of patients undergoing surgery and a rational approach to management of these problems. Through the use of State of the Art Reviews, Therapeutic Updates, and Core Consultative Seminars, a distinguished faculty will discuss the multisystem approach to assessment of operative risk and maximization of perioperative care. Case oriented workshops will provide an informal environment for faculty/participant interaction and discussion.
Fee Schedule: $360.00 for Physicians
$260.00 for Nurse Anesthetists,
Residents, and Fellows CME Credit: 17 credit hours in Category 1
For further information and registration, contact the Office of Continuing Medical Education, Jefferson Medical College, 1025 Walnut Street, Philadelphia, PA 19107; (215) 928-6992.
Pennsylvania Medicine, July 1986 19
newsfronts
accident, he has urged the state and fed- eral agencies to develop extensive plans for dealing with a nuclear accident, and has been a proponent for physician’s in- volvement in making plans and taking action in the event of an accident.
“At the time of the Three Mile Island accident,” he said as an example, “there were no physicians employed by the Nuclear Regulatory Commission (NRC), despite the fact that the com- mission has some 4,000 employes. This is a sad commentary on the priority given to public health matters involv- ing nuclear regulation. Several days af- ter the accident, a radiologist was sent to Harrisburg by the NRC. It took some five days for the physician radiol- ogist to be sent up to the site.
“The large coal companies and the large oil refineries in this country often, if not invariably, have physicians avail- able full time to handle accidents; how- ever, rarely, if ever, is a physician em- ployed full time in caring for the personnel at a nuclear power plant,” said Dr. MacLeod.
“Upon leaving my position as secre- tary of health, I presented a report which recommended that there be a bu- reau of radiation health in the health de- partment to complement the Bureau of Radiation Protection in the Depart- ment of Environmental Resources,” he said. “Unfortunately, no changes were made. Pennsylvania is not much better off today than it was at the time of the accident at TMI— there is practically no
health input into the considerations of a possible nuclear power plant accident.
“After the accident,” Dr. MacLeod continued, “I made several presenta- tions proposing that we anticipate the public health aspects of a nuclear acci- dent. My concern was that physicians be involved.”
Dr. MacLeod expressed this concern in articles written after the TMI event. In a paper for the Journal of the World Association for Emergency and Disas- ter Medicine (Vol 1, Supplement 1, 1985) he wrote, “As health officials, we were fully aware of the rising level of con- cern—in some cases outright panic— among the general public as conflicting reports of radiation fallout mounted in the news media. We knew full well that fear of radiation — however unreason- able that fear may have been— could cause health impacts as damaging as actual radiation itself.”
In another article, Dr. MacLeod docu- mented the increased stress in the Har- risburg area during the TMI accident (American Journal of Public Health, March 1982, Volume 72, Number 3): “The week-long stress from the threat of an imminent nuclear catastrophe was reflected in data showing increases of 113 percent in the number of persons using sleeping pills and 88 percent in those using tranquilizers, while 14 per- cent used more alcohol and 32 percent smoked more cigarettes in the area around Three Mile Island. The side ef- fects from drugs and the known conse- quences of smoking and alcohol con- sumption may be just a small fraction of the adverse effects from stress upon
the public’s health.”
He continued in that article, “The to- tal absence of epidemiologists, or for that matter any other physicians em- ployed by the U.S. Nuclear Regulatory Commission, Pennsylvania’s Bureau of Radiation Protection, or its parent DER does not enhance the likelihood that public health effects from radiation exposure will be investigated.”
In an article in Forum on Health, March 1980, he wrote: “It seemed that no one outside professional health cir- cles could appreciate the potential for the health hazards of the TMI accident. There was no blast— no meltdown— so there was no health hazard: that’s the attitude that seemed to reign among nuclear engineers and radiation health physicists throughout the accident.”
In a related article in the March 1980 Forum on Health magazine, George L. Jackson, MD, then governor for the eastern Pennsylvania region of the American College of Physicians, wrote: “Physicians were clearly at a disadvan- tage (during the TMI accident) because factual information available to the medical community was initially frag- mentary or nonexistent. With so many conflicting reports in the press, patients trusted neither industry nor govern- ment. Thus, practicing physicians were deluged with telephone calls from their patients requesting interpretation of the accident’s significance in terms of their personal health. Many of these physicians simply did not have the knowledge or expertise to offer advice on nuclear matters.”
Dr. Jackson concluded, “I would hope that if any similar accidents occur, the character and amount of emissions will be reported immediately to the medical community. This information could then be interpreted by those skilled in radiation dosimetry (nuclear medicine physicians, therapeutic radiologists, and diagnostic radiologists). Through the information systems of the medical community and the hospitals, these in- terpretations could be channeled to practicing physicians and, in turn to anxious patients.”
Dr. MacLeod said, “Again and again, the physicians have been left out of the play, so to speak.” He said dealing with medical effects and responding to pub- lic concerns are the key missions of phy- sicians during radiation emergencies, adding that the new advisory commit- tee will try to increase physicians’ con- tributions to dealing with problems as- sociated with the use of nuclear power.
The
Division of Ophthalmology at
The Milton S. Hershey Medical Center
of
The Pennsylvania State University
is pleased to announce the association of
Lenworth N. Johnson, M.D.
as Assistant Professor and Head of the Neuro-Ophthalmology Section
Appointments may be made with Dr. Johnson
by contacting the Ophthalmology Clinic at 531-8696
20 Pennsylvania Medicine, July 1986
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Trustee sees quality of care as main issue
Karen K. Davis
“I think young physicians have a larger stake in assuring that medicine stay on a scientific basis rather than on a financial basis, and it’s up to us to help protect the ability to provide qual- ity care,” said Jeannine Hahn, MD, speaking on the importance of early in- volvement in organized medicine.
Dr. Hahn is the resident physician member of the Pennsylvania Medical Society’s Board of Trustees. She is a surgical resident at Abington Memorial Hospital.
Quality main issue
Her own involvement in organized medicine began, she said, “when a su- pervising physician at the hospital where I’m in residency pointed out the benefits of membership, and suggested I go to a meeting.” After attending just one meeting of her county’s society, she “became very interested,” and she soon joined the county, state, and national societies. She was appointed to the Governing Council of the PMS Resi- dent Physician Section, and then elected a delegate to the Resident Phy- sician Section of the American Medical Association. Dr. Hahn served as chair- man of the PMS resident section in 1985.
“Quality of care is the main issue for me,” Dr. Hahn said. “The ability of phy- sicians to provide quality care to their patients is being threatened, and we have to join together to do something about it. We must be able to provide sound medical care based on science and humaneness and not be restrained by insurance companies and govern- ment agencies.
“Physicians are best able to make medical decisions for their patients,” she emphasized.
Dr. Hahn said she considers her posi- tion as a trustee one of “great responsi- bility.” She said her election to the posi- tion has given her a voice at a decision making level “much earlier than I ex- pected,” adding that her perspective as a young physician leads her to regard the quality of care issue as one of the most salient.
Her interests also range to the fields of research ethics, medical ethics, and professionalism. “I hope to continue to
22 Pennsylvania Medicine, July 1986
be involved in these categories,” she said.
Inspired by father
Bom in the state of Washington, near Seattle, Dr. Hahn grew up in Oregon,
where her father was a country physi- cian. “He was a real ‘old time doctor,’ ” she said. “He traveled from farm to farm, delivering babies, performing eye examinations, and doing whatever he could to patch up the tough old farmers in our region. I spent a lot of my child- hood going with him to the farms to make house calls.
“Then, when I was about six years old, he joined a practice with a former classmate in Sacramento, California,” she continued. He still made house calls, but the new practice was both a country and city practice and the office was next to a large metropolitan hospi- tal.” Therefore, as a young child she was exposed to two types of practice, she said.
Her father’s love of medicine influ- enced her. “I was always fascinated with what my father did, and with the whole hospital environment,” Dr. Hahn said. “I could see that he enjoyed tak- ing care of people, and that his help was appreciated.
“There was never any question about going to medical school,” she said. “I knew that is what I wanted to do.”
Interest in social issues
Dr. Hahn earned her undergraduate degree from the California State Uni- versity. During her premedical training, while working in a coroner’s office as a radiographer, she became aware of the problem of ‘the battered child.’ Sensi- tized to this issue, she urged college of- ficials to offer family counseling activi- ties. “I helped start a program at the university that deals with stressed fam- ilies and helps them work through their problems without battering their chil- dren.”
While at college, she also was active in a related area. She said, “I felt frus- trated to see single mothers locked into a life-long welfare situation with no way to get out of it. I felt if the state could provide those mothers free child care so they could complete their educations, they could become tax payers rather than tax burdens, which would increase their levels of self esteem, as well as benefit society.” She helped to establish the children’s center at California State University, a facility that provides child care for low-income mothers attending classes. In addition, she lobbied the state legislature to obtain funding to open day care centers at all the Califor- nia state colleges.
Also during her undergraduate years, Dr. Hahn was a research assistant to Paul Donald, MD, vice chairman of the otorhinolaryngology program at Davis School of Medicine (University of Cali- fornia).
Her first choice of medical schools was her father’s alma mater, Hahne- mann University School of Medicine. “I came to Philadelphia to be a second generation Hahnemann physician,” she said. After receiving her medical degree in 1984, she began graduate work in general surgery at Abington Memorial Hospital. She hopes to specialize in co- lon and rectal surgery.
Outside medicine, Dr. Hahn enjoys riding her horse, an Arabian hunter- jumper named Reno. With her husband, a computer software engineer, she has worked to develop several computer programs for storage and retrieval of medical data and evaluations. She also enjoys spending time with her daugh- ter, Jennifer.
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special feature
The history of policy formation on cigarette use
Tobacco use, poor health, important economic factors and public policy
Herbert Perlman, MD
Tobacco has been influential as an economic force in the United States for centuries. As the economic clout of the tobacco interests has in- creased, Congress has reacted favor- ably on behalf of the tobacco industry. The favored status of the tobacco in- dustry has been in decline, however, in the past two decades because of shifts in power within the policy-making appa- ratus of the federal government. This paper describes the economic power of the tobacco industry in the United States, the effect of tobacco use on the health of its citizens, and the financial burden created by tobacco-related ill- ness. Finally, an episode relating to the development of policy on tobacco use
will be described in an effort to under- stand the application of the various forces in the policy-making apparatus of our society.
History
The Indians introduced the use of to- bacco to the discoverer of the New World. Columbus brought the leaves of the tobacco plant, ultimately named nicotania tabacum, back to Spain. In Europe, tobacco initially was used in the belief that it was an herb with some medicinal value.1
The use of tobacco spread in England, but not without critics. In 1604, King James I published an antismoking tract entitled, “A Counterblaste to Tobacco.” He also instituted high import duties on tobacco. Objections to tobacco use as early as the Seventeenth Century in- cluded allegations that tobacco was del- eterious to health as well as morally of- fensive. Despite opposition, however, the use of tobacco continued to increase throughout Europe.
In America, as elsewhere, methods of use of tobacco changed. In the early days, pipes and snuff were favored. Later, chewing tobacco and cigars be- came popular. Gradually, the use of cig- arettes increased due to two factors. One was their use by Union soldiers during the Civil War. These soldiers spread cigarette use throughout the Union.2 A second and major reason for
Dr. Perlman is chairman of the department of radiology at Carlisle Hospital and clinical as- sociate professor of radiology for Jefferson Medical College of Thomas Jefferson Univer- sity.
the increase in the use of cigarettes was the invention of the cigarette-making machine in 1881, permitting the mass production of 200 cigarettes per min- ute.3
Although cigarettes initially were not considered very respectable, with the passage of time their use became so- cially acceptable— both for adult men and adult women. Smoking by young people always has been discouraged. There were serious antismoking move- ments in America, often directed at pro- tecting the young people. As of 1890, there were laws prohibiting the sale of cigarettes to minors in 26 states. The laws, however, were not successful. Antismoking activists pressed on until
Pennsylvania Medicine, July 1986 25
special feature
laws causing total prohibition on ciga- rette sales were enacted in 15 states. Two states had heavy taxation on sales.4 Such antismoking forces were comprised of educators, reformists, and businessmen. They founded the Na- tional Cigarette League, the Consoli- dated Anti-Cigarette League, and the Non-Smokers Protective League of America.5
The antismoking groups during this era made three major assertions. They indicated that smoking led to moral de- generacy, caused poor health, and in- fringed on the rights of others.
There were prosmoking forces in the late 1800s and early 1900s, but they were not well organized. With the ad- vent of World War I, a shift in the sta- tus of cigarettes occurred so that smok- ing became more popular. After World War I, the various states began to re- peal the antismoking laws despite the efforts of various reform groups.
At the war’s end, organizations in support of tobacco use became active. The Tobacco Merchants Association, the Allied Tobacco League of America, and Smokers Against Tobacco Prohibi- tion were formed.6 The prosmoking forces held that there was no medical evidence of harm from smoking, that legislation against smoking was an in- fringement on personal liberty, and, for the first time, that the tobacco industry was an important economic factor in the nation. Smoking progressed in pop- ularity from the 1930s to the 1950s. A shift in the status of smoking occurred, however, with the publishing of scien- tific evidence of the dangers of tobacco use and the resultant change in attitude of the public.
Economic impact
The use of tobacco in America has a vast economic impact on the country— both positive and negative. To under- stand the continued reason for the toler- ation of the negative economic factors relative to the health care dollar, the positive economic influence must be un- derstood.
About 1.3 million part-time or full- time workers were employed on 276,000 tobacco farms in America in 1977. 7 The tobacco crop amounted to $2.5 billion in 1978— representing 2.3 percent of farm income, as the sixth largest cash crop in the United States. Significantly, to- bacco is extremely important as a crop in the six southern states of: North Car-
olina, Kentucky, Tennessee, Virginia, South Carolina, and Georgia. Other states producing tobacco include: Maryland, Pennsylvania, Ohio, and Wisconsin. Of the top six, North Caro- lina and Kentucky account for about 60 percent of the tobacco crop. The to- bacco farmers have not been organized into a powerful interest group. Their power, however, results from the great number of tobacco farmers, particularly in the top producing states. Such great numbers— translated into voters— affect the members of Congress from those states. Despite the lack of organi- zation into a vigorous interest group, the influence of the farmers as a voting block is substantial as exemplified by the tobacco price-support program. The Federal Government sets a minimum for tobacco and then buys the tobacco that cannot be sold above that price.6
There are six major cigarette manu- facturing companies in America. They
About 1.3 million part-time or full-time workers were employed on 276,000 tobacco farms in America in 1977.
The tobacco crop amounted
to $2.5 billion in
1978 — representing 2.3 percent
of farm income, as the sixth
largest cash crop in the United
States.
are: Brown and Williamson Tobacco Company, R.J. Reynolds Tobacco Com- pany, American Tobacco Company, R Lorillard Company, Philip Morris Company, and the Liggett and Myers Tobacco Company. Utilizing advertis- ing, the companies compete among themselves vigorously. The combined advertising expenditures of the ciga- rette manufacturing companies in 1983 amounted to $1.5 billion.9
The expenditure is for newspaper, magazine, and billboard advertising, and is 500 percent greater than the $300 million spent on advertising in 1970, the year of the prohibition on ra- dio and television advertising.10
Tax revenues from federal, state, and local excise taxes on tobacco amounted to about $6.2 billion in 1977. State ciga- rette taxes amounted to an average of 15.3 cents per pack in 1983. 11
As of 1982, tobacco products were re- sponsible for $60 billion of the nation’s economy, or about 2.5 percent of the
GNP (gross national product) and for employing 2.5 percent of the national work force.12
Approximately 53,000,000 Ameri- cans smoke. Smokers constitute 38 per- cent of the male population and 30 per- cent of the female population. They spend approximately $16 billion per year for cigarettes. Of interest is the fact that the money spent on cigarettes equals 40 percent of that spent on new cars and 150 percent of that spent on drugs and sundries. 1,1
Mitigating against the positive eco- nomic effects of tobacco use are the neg- ative effects— both economic and rela- tive to health care. That cigarette smoking is a very significant cause of death and illness in America has been proven conclusively.
Linking smoking and health
Ascertaining that there is a link be- tween smoking and diseases has been slow in developing. Actual scientific studies on tobacco as a carcinogen have been relatively recent and were under- taken largely as a result of suspicions of a possible correlation between smoking and cancer such as that reported in the Journal of the American Medical Asso- ciation in 1958. In that article, the smoking habits of 187,783 men were evaluated. Death rates were higher among the cigarette smokers than the nonsmokers. Such mortality was found to increase with the number of ciga- rettes smoked per day.14 Basic scientific research has determined that chemicals in tobacco smoke caused cancer in ani- mals.
Epidemiological studies, as summa- rized in the various “Reports of the Sur- geon General,” have determined that cigarette smoking is correlated to mor- tality and morbidity in diseases such as cancer of the lung, mouth, larynx, esophagus, urinary bladder, pancreas, and kidney.15
Cigarette smoking is also positively associated with morbidity and mortal- ity from atherosclerosis, coronary heart disease, cerebrovascular disease, peptic ulcer disease, chronic bronchitis, and emphysema.16
Cigarette smoking during pregnancy is to be associated with conditions such as diminished fetal growth, decreased birth weight, and fetal death.1'
Over 129,000 Americans will die from cigarette-related cancer each year.
About 170,000 Americans die of cigarette-related coronary heart disease each year.
26 Pennsylvania Medicine, July 1986
Another 51,000 Americans die of cigarette-related chronic obstructive lung disease each year.
Some information relative to the enormous economic impact caused by such illness and death is now in order. Much statistical evidence has been ac- cumulated relative to the evaluation of the cost of tobacco use. Some statistics are:
1 . Smokers of one pack per day have a 50 percent greater rate of hospitaliza- tion than nonsmokers.
2. Smokers of one pack per day have 50 percent greater absenteeism and ill- ness than nonsmokers.
3. Smokers of two packs per day have 200 percent greater absenteeism than nonsmokers.
4. In 1965, smoking caused the loss of 77,000,000 working days.19
Each year, $15 billion of medical care costs are consumed by the consumers of tobacco. Additionally, annual loss of productivity because of early death and illness related to smoking amounts to $24 billion. With the exception of the vast positive economic impact on the entire chain of tobacco producers, man- ufacturers, retailers, and advertisers, it is obvious that smoking has a marked negative effect on the physical, mental, social, and economic health of our coun- try.
Public policy on smoking
At any one time, the various factors influencing any existing public policy relative to tobacco use are in a state of equilibrium. The equilibrium is achieved when opposing and support- ing forces are arrayed in various combi- nations and coalitions to achieve a polit- ical balance— the result of which at any time is the current public policy. The power of the forces or interest groups wax and wane from time to time thus shifting the state of equilibrium."'
The actual forum for the policy for- mation, whether executive, legislative, or judicial, might itself change within the institution of government. To ob- tain a change of forum, for example, from the legislative to the executive (or the bureaucracy), might be a strategy employed by an interest group to foster a change in policy. A shift in public pol- icy occurred as a result of the battle that developed in the 1960s concerning warning labels on packages of ciga- rettes. (A similar, but less virulent, bat- tle over stronger labeling has occurred in the early 1980s.)
Before describing the battle, it is nec-
essary to enumerate the various players and adversaries as well as the different arenas of confrontation. Arenas for con- frontation and policy formation relative to labeling of advertisements of the po- tential harmful effects of smoking were institutionally located in the Depart- ment of Health, Education and Welfare (subsequently Health and Human Ser- vices), Department of Agriculture, the Federal Trade Commission, the Federal Communications Commission, the Con- gress, and the Office of the President.
The most important lobbying organi- zation of the tobacco interests is the To- bacco Institute with headquarters in Washington, DC. The institute was formed in 1958 and has some 83 staff members. It is widely believed that the major tobacco companies are sup- porters of the Tobacco Institute.* The budget of the Tobacco Institute and fi- nancial support relative to the organiza- tion are not public information.
Each year, $15 billion of medical care costs are consumed by the consumers of tobacco. Annual loss of productivity because of early death and illness related to smoking amounts to $24 billion. . . . Smoking has a marked negative effect on the health of our country.
Until the 1960s, tobacco had favored status, supported by the tobacco sub- system. A subsystem is defined by Fritschler as a “structure dependent upon a larger political entity but one that functions with a high degree of au- tonomy.”22 The tobacco subsystem it- self included the representatives of the various tobacco producers and manu- facturers, the members of the House and Senate representing the tobacco constituencies, the important members of the related congressional commit- tees, and the Department of Agricul- ture. Of extreme importance relative to the tobacco subsystem is the fact that 25 percent of Senate committees and 33 percent of House committees were
*During a personal communication with the institute , the organization would not release any names of supporting companies. A mem- ber of Congress provided some information about the institute, but could not supply the names of any contributing companies.
chaired by members from the six to- bacco states. This subsystem func- tioned to keep factors affecting tobacco use at an optimum level relative to the “tobacco interests.” In this manner, an equilibrium favorable to the tobacco in- terests was achieved. In the 1960s, forces were brought to bear on the sub- system that were meant to diminish the power of the tobacco interests. This re- sulted in a battle to maintain the old equilibrium.
Although force had been brought to bear in the past by various government institutions endeavoring to require warnings to tobacco consumers they were to no avail because of the power of the tobacco subsystem. Events in the 1960s were to change the arena and the players, thus causing a shift in equilib- rium and policy.
The harmful effects of tobacco were proved by the availability of more and more evidence. In 1962, the surgeon general formed an Advisory Committee on Smoking and Health, which released a report concerning the deleterious ef- fects of smoking on January 11, 1964. One week later, on January 18, 1964, the Federal Trade Commission (FTC) announced its intent to evaluate rules pertaining to warning labels regarding advertising and labeling of cigarettes. Hearings for the proposed rules were held on March 16, 1964.
The first rule was a requirement that a health warning be placed on all ciga- rette packages and advertisements, which would take one of two forms:
CAUTION-CIGARETTE SMOK- ING IS A HEALTH HAZARD. The Surgeon General's Advisory Committee has found that “ cigarette smoking con- tributes to mortality from specific dis- eases and to the overall deathrate"; or
CAUTION: Cigarette smoking is dangerous to health. It may cause death from cancer and other diseases.23
Another part of the rule tried to ban from advertising those features which contributed to the impression that ciga- rette smoking caused good health or wellbeing. During the hearing process, the strategy of the tobacco industry was to claim that the Federal Trade Commission did not have the power to make such rules. Their contention was that the FTC was not authorized to make rules under the FTC Act of 1914. The commission, of course, indicated that it had been delegated such powers by the Congress when the Act was passed. This interpretation was made
Pennsylvania Medicine, July 1986 27
special feature
despite the fact that substantive rules had not been written by the FTC except in a few cases. The rules affecting ciga- rette advertising were promulgated in the Federal Register and were to take effect on January 1, 1965.
Representative Oren Harris of Arkansas, chairman of the House Inter- state and Foreign Commerce Commit- tee, asked the chairman of the FTC, Paul Dixon, to delay implementation of the rules until the next Congress. Fol- lowing agreement to do this, hearings were scheduled for both House and Sen- ate committees, in the early months of 1965. The committees evaluating the Federal Trade Commission regulations were the House Interstate and Foreign Commerce Committee and the Senate Commerce Committee. At least eight members of the House Committee were from tobacco-producing states.
The antismoking forces were not as well organized or financed as the to- bacco interests. There was a lack of unity of presentation of the health groups. For example, the surgeon gen- eral indicated that the FTC might not be the agency best able to enforce label- ing and advertising requirements and that such enforcement should be con- trolled by HEW.
The tobacco interests, however, per- formed ably. The thrust of their argu- ment was that policy in a democracy should be made by Congress, and not by an administrative agency. Other ar- guments were used to refute medical testimony relative to the danger of smoking. They indicated that the sur- geon general’s report was not based on clinical evidence— but used statistical data for conclusions.
The Congress used its power of over- sight relative to the agency by passing a bill which was signed, without the usual fanfare, by President Lyndon B. Johnson on July 27, 1965. The legisla- tion was specific in that it abrogated the proposed rule and prohibited the FTC from considering a health warning requirement in cigarette advertising for four years.24
The Cigarette Labeling and Advertis- ing Bill also prohibited other agencies, such as the FCC, from acting to require health warnings in advertising. State and local action along the same lines was prohibited by the bill— a provision very much desired by the tobacco in- dustries.
As opposed to striking down the pro-
posed rules on advertising, the new law required warning labels on cigarette packages. Funds were appropriated to establish a national clearing house for smoking and health to function as part of the Public Health Service. The pur- pose of the agency was to conduct edu- cational programs and to collect data relative to smoking and health.
This brief history events and circum- stances sheds some light on policy for- mation relative to tobacco use. Since 1965, other happenings relative to ciga- rette use can be considered as shifts of equilibrium. It is certain, however, that the overall tilt of equilibrium has been in favor of the health interests. Mention should be made of other recent policy changes. Many states and localities have limited smoking in public or work places.25 There has been a change in the previous federal tobacco subsidy pro- gram through a “no net cost to tax pay- ers” law effective in 1982. This law re- quires tobacco growers to reimburse the government for losses resulting from price support loans to farmers. In- terestingly, prior to passage of the law, the American Medical Association re- versed a policy of 15 years by calling for a halt to federal subsidization of the to- bacco farmers.26
Finally, a new cigarette labeling bill, the Comprehensive Smoking Education Act, was passed on October 12, 1984. This bill required periodic rotation of la- bels and advertising of a more serious and threatening nature than previous labels. Two examples are:
SURGEON GENERAL S WARN- ING: Smoking Causes Lung Cancer, Heart Disease, Emphysema, and May Complicate Pregnancy or
SURGEON GENERAL’S WARN- ING: Smoking By Pregnant Women May Result in Fetal Injury, Premature Birth, and Low Birth Weight.21
This law was the product of fierce ne- gotiations between the interested par- ties. The industry compromised and ac- cepted a bill because of threats of higher cigarette taxes.26
Conclusion
It is important to note that this change in public policy was effected with the help of powerful, yet relatively nameless, bureaucrats. Greater positive access to the bureaucracy might be the correct approach for the medical profes- sion when trying to effect changes in health care policy— of which cigarette smoking is only one segment.
The medical profession should bring more pressure to bear on the bureauc- racy involved in policy-making. Since the politicians as well as the public are clamoring for a decrease in medical care expenditures, the medical profession should be forceful and vocal regarding mechanisms to cut such costs through efforts to diminish preventable ill- nesses.
References
1. Trayer, R.; Markle G. Cigarettes— The Battle over Smoking. New Jersey: Rutgers University Press. 1983:31.
2. Trayer, R.; Markle, G. Cigarettes— The Battle over Smoking. New Jersey: Rutgers University Press, 1983:33.
3. Ashton, H.; Stephney, R. Smoking— Psychology and Pharmacology. London, Tauistock Publications. 1982:16.
4. Trayer, R.; Markle. G. Cigarettes— The Battle over Smoking. New Jersey, Rutgers University Press, 1983:34.
5. Trayer, R.; Markle, G. Cigarettes— The Battle over Smoking. New Jersey, Rutgers University Press. 1983:35-36.
6. Trayer, R.; Markle, G. Cigarettes— The Battle over Smoking. New Jersey, Rutgers University Press, 1983:44.
7. Blum, A. How the cigarette industry is corrupting so- ciety. The Internist, July 1984:8.
8. Womack, J. Tobacco Programs of the U.S. Depart- ment of Agriculture: Their Operation and Cost. Li- brary of Congress, February, 1981.
9. Warner, Kenneth. Cigarette advertising and media coverage of smoking and health. New England Jour- nal of Medicine. Feb. 7. 1985: 312:385.
10. Blum, A. How the cigarette industry is corrupting so- ciety. The Internist, July 1984:9.
11. Blum, A: How the cigarette industry is corrupting so- ciety. The Internist, July 1984:8.
12. Warner, K. The economics of smoking: dollars and sense. New York State Journal of Medicine, December 1983:1273.
13. Blum, A. How the cigarette industry is corrupting so- ciety. The Internist, July 1984:8.
14. Hammond, E., Horn, D. Smoking and death rates— report on forty-four months of follow-up of 187,783 men .Journal of American Medical Associates, June 1, 1984; 251:2840-2853.
15. The Health Consequences of Smoking: Cancer, A re- port of the Surgeon General, 1982.
16. The Health Consequences of Smoking: Cardiovascular Disease. A Report of the Surgeon General, 1983.
17. The Health Consequences of Smoking for Women: A report of the Surgeon General, 1982.
18. Blum, A. How the cigarette industry is corrupting so- ciety. The Internist, 1984:9.
19. Kristein, M. Economic issues in prevention. Preven- tive Medicine, 1977:6:256.
20. Dye, Thomas. Understanding Public Policy. Engle- wood Cliffs, N.J., Prentice- Hall. Inc, 1984:27-28.
21. Jensen, M. Tobacco: A Potent Lobby The New York Times, Feb. 19, 1978:4.
22. Fritschler, A. Lee. Smoking of Politics— Policy making and the Federal Bureaucracy. Englewood Cliffs, N.J., Prentice- Hall, Inc. 1983:p 6.
23. Fritschler, A. Lee. Smoking of Politics— Policymaking and the Federal Bureaucracy. Englewood Cliffs, N.J., Prentice- Hall, Inc. 1983:83, 84.
24. Fritschler, A Lee. Smoking of Politics— Policymaking and the Federal Bureaucracy. Englewood Cliffs, N.J., Prentice-Hall, Inc. 1983:110.
25. Warner, K. The effects of publicity on policy in smok- ing and health. Business & Health, November 1984:2:7-13.
26. Hilts, P: AMA in reversal, urges halt to tobacco subsi- dies. The Washington Post, June 12, 1981 :A7.
27. Comprehensive Smoking Education Act. Public Law 98-474; October 12, 1984.
28. Tough new cigarette warning labels voted, Congressio- nal Quarterly, May 19, 1984:1203-1204.
28 Pennsylvania Medicine, July 1986
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Star wars versus tar wars
J. Mostyn Davis, MD
The tobacco industry has fooled us again! Using the same type of high technology and imaginative fantasies that allowed Luke Skywalker to de- stroy Darth Vader’s spaceships with laser weapons, thousands of billboards and full page newspaper and magazine advertisements have tried to convince the American public that Barclay ciga- rettes contain but 1 mg of tar per ciga- rette. As it turned out, it was the rival tobacco companies who blew the whis- tle on Brown and Williamson, the makers of Barclay.
Anyone who can read must be aware of the “Great Tar War.” At the same time each of the major tobacco compa- nies insists that their cigarettes contain the least amount of tar; they all poo-poo the health dangers of smoking ciga- rettes. In case you ask why all the fuss, let it be known that in its first 18 months on the scene, Barclay captured a 1.5 percent share of the cigarette mar- ket. Current industry figures indicate that each percentage point of the mar- ket share is worth— get this— $123 mil- lion dollars per year. Barclay’s share of the take comes to $195 million per year. Not bad for an 18 month old.
It seems that Brown and Williamson designed a filter which could fool the Federal Trade Commission’s (FTC) smoking machines. By the way, all of the tar figures for cigarettes come from machine smoking tests. It is generally not assumed that people take exactly the same depth puffs at precisely the timed intervals the machines do, so the tar levels— about which there has been so much advertising— really do not ap- ply to smoking people anyhow. Rival cigarette makers complained to the FTC about the sneaky filter. Instead of 1 mg of tar that Barclay has been claim- ing, it turns out that the FTC found the actual level was between 3 and 7 mg of tar per cigarette.
Brown and Williamson went to court to keep the FTC paralyzed and a Ken- tucky federal judge temporarily stopped the agency from proceeding further; however, capital columnist
Jack Anderson got wind of the battle, and some of the information in this es- say is taken from a United Features syndicated column published under Mr. Anderson’s byline.
Three FTC consultants, “all agree that the commission should act to in- form consumers that Barclay is not a 1 mg tar cigarette.” The FTC’s sup- pressed draft statement said in part, “the relative delivery of carbon monox- ide is significantly greater than sug- gested by the current FTC rankings.” In addition, the statement mentions that the tar content is higher than Bar-
This essay deals with current and prospective marketing trends in the tobacco industry. The cover article, on page 31, is a discussion of the history of the industry and its relationship with government.
clay had been advertising and warns that because of the unique construction of the filter, higher tar levels occur auto- matically. “They cannot be avoided even by informed consumers.”
Several other disturbing things have happened in the cigarette industry lately which also are significant. There has been large scale general diversifica- tion by all of the giant cigarette manu- facturers. I wonder if they have seen the “writing on the wall,” or is it simply a part of good business management?
Another trend is to continue to ex- tend the length of the cigarette. It now appears that they are about as long as feasible for a tobacco-filled paper tube. Can anyone better 120 mm? Will 150 mm be next?
Another manufacturer has begun to cram 25 cigarettes in each pack. Now,
Dr. Davis is a family physician at the Geisinger Medical Center in Danville. He is a member of the PMS Board of Trustees repre- senting the Fourth District.
not only will a pack a day a term used j to calculate the total amount of ciga- rettes consumed when taking a smok- ing history, be thrown off, but more damage per pack will be inflicted on the hapless smoking public.
Mr. Melvin Belh, the noted trial law- yer, recently lost a litigation against a tobacco company for liability to a cli- ent. Although this particular case was unsuccessful, Mr. Belli avers he will keep trying until he is able to force the tobacco companies to accept the liabil- ity inherent in marketing a product as harmful as cigarettes. This is good news for two reasons. If Mr. Belh is busy su- ing tobacco manufacturers, he will not be suing doctors, and finally, the to- bacco concerns are due to be made re- sponsible for the unconscionable death and disability they flaunt openly before a nation which has been duped for too long by false advertising.
Ever so slowly I see the pendulum be- ginning to swing back against cigarette smoking. More smokers are stopping and fewer persons are beginning. How- ever, the female teenage population con- tinues to be the only group in our cul- ture with an increase in smoking incidence. This is very discouraging be- cause of the three-fold damaging effects of cigarettes on young women: damage to their own bodies, injury to their de- fenseless unborn babies from smoking during pregnancy, and harm to other children in the family.
So Darth Vader has not given up. He continues to assure us that smoking is a harmless, pleasant, adult pastime en- joyed by millions of Americans. Under- neath that dark exterior, however, there is some turmoil. It was his own hench- men who caused the trouble about the Barclay advertising. It is always nice to notice dissemination in the ranks of your antagonists, but it is far too soon to put away the swords and relax.
The “Force” is slowly gaining strength and must triumph in the end, but it is a tragedy that thousands of lives must be ravaged by tobacco before that time comes. □
30 Pennsylvania Medicine, July 1986
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special feature
Physician observes British medical practice
Christine Dotterer, MD
My husband’s sabbatical leave two years ago presented me with an opportunity to experience medical prac- tice in a socialized system. His work took him to London (he is a professor of English at Susquehanna University). We packed thirteen suitcases, and with our two children (then ages 12 and 2) left Selinsgrove, where I am a family practitioner, to spend a year in Great Britain.
A college friend already practicing medicine in England warned me that I was about to meet an extraordinary beast: the British bureaucracy. There- fore, I arrived in the United Kingdom armed with the originals of all the diplo- mas I had ever earned plus a briefcase full of correspondence with England’s General Medical Council.
Even before we left home I learned that although I am a fellow of the American Academy of Family Physi- cians, I would be permitted to do only house officer work during my stay in Great Britain, because I was a foreign physician. Great Britain has no equiva- lent to the family physician. Medicine there separates general practitioners and hospital physicians absolutely: GPs admit no patients and refer possi- ble hospital cases to specialists. (In some rural areas GPs are the sole physi- cians at “cottage hospitals.”) Although I was unenthusiastic about resuming
in-hospital night duty and apprehensive about grappling with unfamiliar British names for familiar (and unfamiliar) drugs, I decided to look for a position when we had settled in.
The British Medical Journal, the ma- jor professional journal in the country, publishes a weekly supplement listing temporary— or locum tenens— posi- tions. Soon after our arrival I sent out letters applying for various jobs in med- icine, pediatrics, obstetrics, gynecology, geriatrics, and public health.
Despite the formal advertisement of these positions, most posts are filled from a supply of “regulars.” After a few weeks of non-productive postal ex- changes, I circumvented the system, re- lying on my American physician friend for a contact. With his help my first two-week locum was arranged. I served as the registrar (the British term for resident) responsible for running the psychiatric day hospital at one of Lon- don’s largest teaching hospitals and medical schools. That job was the be- ginning of eight straight months em- ployment as a psychiatrist in the Na- tional Health Service of Great Britain.
My first patient was a charming, manic homosexual French waiter sent in by a consultant (attending physi-
Dr. Dotterer maintains a family practice in Selinsgrove.
cian). This young man’s extravagant current plans included a large party in his small flat, to which he had invited several hundred people. He showed me polite notes from, among others, Prime Minister Thatcher and Princess Di- ana—all declining his invitation. His ex- hausted companion was worried about the $500 worth of pate and the crates of French champagne due to arrive, rather than the prospect of greeting the rich and famous.
To my surprise, I was expected to treat this man as a day patient. When, on his way to have a routine chest x-ray, he bought a $75 date palm at the hospi- tal gift shop, I became uneasy. When, over the patients’ telephone, he bought two pianos at auction, I decided to act. Clearly, he needed to be admitted before he bought out Harrod's.
Admitting a psychiatric patient against his will might qualify as a text- book example of British bureaucracy. First, one must locate an available bed— not an easy task, even at one of London’s largest hospitals. Should a bed miraculously appear, there is no way to reserve it— one just hopes it won’t be taken before all the formalities are completed.
Next, the doctor must produce simul- taneously the patient, his general prac- titioner, his nearest relative, the district social worker, and an “approved psychi-
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Topics of Discussion to Include: Eye Movement Disorders, Glaucomatous Optic Neuropathy, Thyroid Ophthalmopathy, Pituitary Apoplexy, MRI of Parasellar Lesions, and Selected Case Presentations
Guest Speaker:
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32 Pennsylvania Medicine, July 1986
atrist” (one of the handful of consul- tants who have agreed to provide a sec- ond opinion at a moment’s notice). Since it is unlawful to restrain the pa- tient until all members of this group ap- pear, it’s not surprising that the patient often decides to move on in the mean- time. This gentleman did. After a search involving the police, the district social worker, and his friend, we were able to admit him to the psychiatric ward two days later. He remained there for about three months, a relatively short psychiatric stay, before returning to the day hospital and eventually, to work.
During the remainder of my training as a British psychiatrist I observed British medicine in general and re- flected on our different methods of health care delivery. Access to health care in Great Britain isn’t based on the ability to pay. Nor is it based on any simple determination of the patient’s need for medical care. Instead, like many features of the society itself, Brit- ish medicine is rationed by the queue.
Acute medical care is recognized by many as good, once the patient arrives at a hospital. Ambulance service is slow, though, and only certain hospitals provide emergency services. Many hos- pitals that currently have accident wards are losing them with the newest budget cuts. In London those hospitals with emergency services are clustered in a relatively small central area, while vast residential districts have none.
Chronic illness poses a greater prob- lem. Procedures considered elective have very long waiting lists, and these waits are becoming longer as a result of recent budget cuts. For example, a forty-year-old with severe rheumatoid arthritis, requiring narcotics for pain control, often has a five-year wait for a hip replacement.
Many of the decisions about who gets treatment and who does not are based on value judgments about a patient’s social worth. People over 65 have a low priority for aggressive treatment. Those over 55 are not candidates for kidney dialysis. Lower social classes and immigrants are less likely to re- ceive adequate treatment. (Of course,
some prejudices also occur in U.S. medi- cine.)
Many preventive health services as we know them are not widely available (for example, blood pressure screening, cholesterol checks, measles/mumps/ rubella immunization.) Also, little effort seems to go into early detection and treatment of potentially serious prob- lems. Routine pap tests are only “al- lowed” once every five years. The rates of cardiac pacemaker implantation and coronary artery bypass surgery are low. Ironically, while British scientists have done pioneering research in these areas, the benefit of this work often hasn’t fil- tered down to the average patient.
Private medical insurance schemes are starting to proliferate, but they only partly address the problem. These new schemes, often offered as “perks” to business executives, merely place peo- ple further forward in the queue- allowing them to see doctors earlier or in elegant surroundings, such as the fashionable Harley Street. They don’t give an alternate delivery system or provide care people wouldn’t eventually get. If people with private insurance need to be hospitalized, they go to a Na- tional Health Service hospital, but to a
more pleasant, private floor. For a doc- tor’s private fee to be reimbursed by the insurance companies, that doctor must also be a consultant in the NHS.
The length of stay in British hospi- tals is much longer than the length of stay for the same illness in the U.S. British doctors, for example, expect a healthy young person to spend two weeks in the hospital for an uncompli cated cholecystectomy. Patients there do have more time to recover, which may keep older people from needing; nursing home care. (Nursing home care is essentially reserved for very disabled elderly people who are unable to stay at, home even with superhuman effort on the part of their families and support from many social agencies.) On the other hand, a major problem is lack of hospital beds, and earlier releases would free more beds for new patients.
British health care is far from “free.” National Insurance payroll deductions from my salary (which include unem- ployment as well as health) were almost equal to the amount that my family paid for Blue Cross/Blue Shield cover- age in the United States. If my husband had been earning a salary in England, he would have paid an additional NI de-
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special feature
duction, determined by his salary level.
Each person must register with a GP; the GP then gets a monthly fee for car- rying this person plus a small fee for each visit. GPs are responsible for 24- hour care for their patients and must make house calls whenever needed. In the larger cities most GPs use a depu- tizing service, where a hired substitute provides out-of-hours services. People don’t go to “Accident and Emergency” (the emergency room) for routine urgen- cies such as ear infections; instead, the local doctor makes a house call if the ill- ness happens at night.
Because of the requirement to make house calls, GPs only accept as patients people who live close to their offices. If you don’t like your GP and want to switch to another one, you need the per- mission of both the old and the new GP. A person cannot be seen by a specialist unless the GP approves (and requests) it. A patient who is dissatisfied with the quality of his medical care does not have much recourse.
GPs also have the option to “throw people off their lists”— that is, to refuse to provide medical care for that person
without advance warning. People who are mentally ill, or who act in a manner which is considered uncooperative, risk medical abandonment. An anecdote may serve as an example: A friend of mine had several episodes of cystitis in a short period of time. Her GP treated her empirically each time, and refused to do initial or follow-up cultures, much less an intravenous pyelogram or cys- toscopy. My friend developed another infection on a weekend and, since she was very uncomfortable, called the dep- utizing service for a prescription. The deputy on call only gave her enough medicine for a few days, so she went to the office for more antibiotics on the fol- lowing Monday. Although she was still febrile and uncomfortable, she was “thrown off the list” simply for calling the deputizing service (the GP had to pay for the visit). She was not given any medicine and had to look for a new doc- tor while she was ill.
As with any system, there are posi- tive and negative aspects to the one in Great Britain. I felt some GPs did not examine their patients carefully: A friend who was in a GP training pro- gram told me his patients were sched- uled every three minutes. The British
Medical Journal published a study showing that 80 percent of men in their 20s, who had been seen by their GPs, had not had a blood pressure reading re- corded in the last ten years. When my son went to the doctor with an earache, only his ears were examined.
On the other hand, British support services are prevalent. Day centers and luncheon clubs for the elderly and the mentally ill are exemplary and effective. There are many types of home health visitors— child health and geriatric visi- tors, psychiatric visiting nurses, and midwives who make home visits. Gen- eral practitioners (or their deputies) make house calls whenever patients need them. Prescriptions are free for children under the age of 16, and adults pay a token fee.
In all, I enjoyed my experience in Great Britain, and I learned from it. But I worry when I see the United States moving in the direction of bu- reaucratic control of health services. As government makes policies on pay- ment, access to services diminishes; in- centives for providing excellent, indi- vidualized care are eroded, and in then- place develops a cumbersome, imper- sonal bureaucracy. □
34 Pennsylvania Medicine, July 1986
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medical feature
Neurosarcoidosis presenting as chronic lymphocytic meningitis
Gary R. Plotkin, MD, FACP Bhupendra R. Patel, MD
Sarcoidosis is a multi-system disease which may present with extrapulmonary manifestations including those referable to the nervous system. A patient with chronic lymphocytic meningitis due to sarcoidosis is reported. Although significant morbidity and mortality is associated with neurosarcoidosis, the daily administration of prednisone improved our patient’s symptomatology. This clinical benefit correlated with the improvement in the abnormal cerebrospinal fluid analysis and was not favorably affected by the administration of colchicine and
indomethacin.
Sarcoidosis of the nervous system is a well recognized clinical and path- ologic entity, and its various manifesta- tions have been reviewed in the medical literature.1 3 Sarcoidosis may affect all areas of the nervous system including both central and peripheral divisions, and disease apparently limited to the central nervous system (CNS) has been described/ Described herein is a patient with neurosarcoidosis whose clinical course emphasizes certain unusual fea- tures of this disorder.
Case report
A 32-year-old male was initially ad- mitted to a hospital in February, 1980, with a two month history of ataxia, dys- praxia, headaches, and right homony- mous hemianopia. Radiographically, a mass lesion was demonstrated in the left occipital cortex which subsequently was partially resected. Histologically, the lesion revealed innumerable granu- lomas involving the leptomeninges and cerebral cortex, and the special stains for fungi and mycobacteria were nega- tive. Based upon a presumptive diagno- sis of CNS tuberculoma, antitubercu- lous therapy was started. Six weeks thereafter the patient required anticon- vulsant therapy for control of grand mal seizures. Apparently, the patient did not return to his private physician after discharge, and thus he received only several months of antituberculous medications.
The patient presented to our medical
center in June, 1982, with headaches and diplopia, and a computed tomo- graphic scan of the head showed the re- siduum of the previous left posterior craniotomy. The cerebrospinal fluid (CSF) analysis revealed a protein 430 mg/dL (normal 15-45 mg/dL); glucose 43 mg/dL; white cell count 39/cu mm with 100 percent lymphocytes; and neg- ative VDRL, gram stain, india ink, Ziehl-Neelsen stain, and cryptococcal la- tex agglutination. The patient was con- tinued on isoniazid and rifampin but required anticonvulsants for partial control of frequent grand mal seizures.
In November, 1983, the patient was admitted for ataxia and lethargy. Posi- tive physical findings were limited to the CNS and consisted of a right ho- monymous hemianopia and impairment of the higher cerebral functions. The pa- tient had been taking isoniazid and ri- fampin for the previous fifteen months, and repeat lumbar fluid analysis con- sisted of a protein 504 mg/dL; glucose 30 mg/dL with simultaneous blood glu- cose 118 mg/dL; white cell count 21/cu mm with 100 percent lymphocytes; and
Dr. Plotkin is a member of the department of medicine at the Veterans Administration Medical Center, Wilkes-Barre, and is clinical assistant professor of medicine at Hahne- mann University School of Medicine, Phila- delphia. Dr. Patel is a former medical resident at the Veterans Administration Medical Cen- ter, Wilkes-Barre.
negative VDRL, gram stain, india ink, auramine-rhodamine stain, Kinyoun stain, Histoplasma capsulatum yeast micro-complement fixation (micro-CF), histoplasmin micro-CF, Cryptococcus neoformans latex agglutination, Asper- gillus fumigatus micro-CF, Blastomyces dermatitidis micro-CF, Candida albi- cans micro-CF, and Coccidioides im- mitis micro-CF. CSF cytology revealed benign appearing lymphocytes. Chest roentgenograms; urinalysis; and serum electrolytes, calcium, phosphorus, cre- atinine, creatine phosphokinase, and protein electrophoresis were normal.
Complete blood count included a white cell count 5,400/cu mm with 72% segmented neutrophils and 28% lym- phocytes, hemoglobin 17.4 g/dL, hema- tocrit 51.1%, and platelets 259,000/cu mm. PPD intermediate strength and booster skin tests were negative (zero mm induration). Because of mildly ele- vated liver function, a percutaneous liver biopsy was performed, and histo- logically there were scattered lympho- cytic infiltrates within the parenchyma and in the portal triads. Stains and cul- tures for bacteria, fungi and acid fast organisms were negative. Bone marrow and transbronchial lung biopsies were also performed; however, these tissues did not demonstrate any abnormalities microscopically and appropriate cul- tures were negative.
Retrospectively, cultures of CSF and brain tissue obtained at the craniotomy in 1980 were all negative, and because
36 Pennsylvania Medicine, July 1986
The Differential Diagnosis and Psychotherapeutic Treatment of BORDERLINE PERSONALITY ORGANIZATION
Speaker: OTTO F. KERNBERG, M.D., F.A.P.A.
Associate Chairman and Medical Director of the New York Hospital, Cornell Medical Center, Westchester Division; Professor of Psychiatry at the Cornell University Medical College
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Place: The Meadows Psychiatric Center
Centre Hall, Pennsylvania
This one-day symposium will address an outline of the differential diagnosis of severe personality disorders, and indications and contra indications of psychoanalytically-oriented psychotherapies, specifically designed for these patients.
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a continuing education service of The Pennsylvania State University College of Medicine in cooperation with The Meadows Psychiatric Center
of the clinical impression of neurosar- coidosis, the antituberculous therapy was discontinued in December, 1983, and a therapeutic trial of prednisone was begun at 60 mg daily. Shortly there- after, repeat spinal fluid analysis dem- onstrated for the first time marked improvement in the lymphocytic pleocytosis, hypoglycorrachia, and ele- vated protein. During the ensuing year, it was determined that prednisone 50 mg daily was required for the control of the patient’s lethargy, seizures, and abnormal CSF findings and that indo- methacin, colchicine, and alternate day prednisone therapy (150 mg) were not efficacious.
Discussion
Ellner and Bennett5 extensively re- viewed chronic meningitis, and in their series, the patients presented in a sub- acute or chronic manner with varying combinations of fever, headache, leth- argy, confusion, nausea, vomiting, and meningismus. Of the infectious etiolo- gies of chronic meningitis, such entities as tuberculosis, cryptococcosis, histo- plasmosis, coccidioidomycosis, blasto- mycosis, actinomycosis, nocardiosis,
brucellosis, cysticercosis, syphilis, lep- tospirosis, and toxoplasmosis must be considered. Of the non-infectious causes, carcinomatosis, sarcoidosis, granulomatous angiitis, Mollaret’s meningitis, chronic benign lymphocytic meningitis, Behcet’s syndrome, and Vogt-Koyanagi-Harada syndrome must be included in the differential diagnosis.
Neurosarcoidosis has a wide spec- trum of clinical presentations, and as demonstrated by our patient, this dis- ease may present as a mass lesion. Ad- ditionally, sarcoidosis may be limited to the CNS and cause chronic lymphocytic meningitis which may be clinically in- distinguishable from meningitis due to various other etiologies. Since neurosar- coidosis has a variable clinical course, it is difficult to determine the efficacy of specific therapeutic modalities; how- ever, prednisone, chlorambucil, azathio- prine, and cranial irradiation have been employed with variable results.68 Since indomethacin and colchicine have been administered to patients with acute ex- udative pulmonary sarcoidosis and aseptic meningitis respectively, these medications were administered sepa- rately to our patient as his prednisone
dosage was being adjusted. Based
upon the analyses of serial lumbar punctures, there was no obvious benefit derived either from indomethacin or colchicine. Lastly, daily prednisone and not alternate day therapy was neces- sary to maintain clinical improvement and control of the spinal fluid pleocyto- sis and abnormal chemistries. □
References
1. Delaney, P Neurologic manifestations in sarcoidosis. Review of the literature, with a report of 23 cases. Ann. Intern. Med.., 87:336-345, 1977.
2. Silverstein, A.; Feuer, M.M.; Siltzbach, L.E. Neuro- logic sarcoidosis. Study of 18 cases. Arch. Neurol. 12:1-11, 1965.
3. Wiederholt, W.C.; Siekert, R.G. Neurological manifes- tations of sarcoidosis. Neurology, 15:1147-1154, 1965.
4. Cariski, A.T. Isolated CNS sarcoidosis. JAMA, 245:62-63, 1981.
5. Ellner, J.J.; Bennett, J.E. Chronic meningitis. Medi- cine, 55:341-369, 1976.
6. Grizzanti, J.N.; Knapp, A.B.; Schecter, A.J.; Williams, M.H. Jr. Treatment of sarcoid meningitis with radio- therapy. Am. J. Med., 73:605-608, 1982.
7. Kataria, Y.P. Chlorambucil in sarcoidosis. Chest, 78:36-43, 1980.
8. Seem, C.P.C.; Norfolk, G.; Spokes, E.G. CNS angio- tensin-converting enzyme in neurosarcoidosis. Lancet, 1:456-457, 1985.
9. James, D.G.. Sarcoidosis. In: Wyngaarden, J.B.; Smith, L.H. Jr., eds., Cecil Textbook of Medicine, 17th ed. Philadelphia: W.B. Saunders Co, 1985; 432-439.
10. Mascia, R.A.; Smith, C.W. Jr. Mollaret’s meningitis; an unusual disease with a characteristic presentation. Am. J. Med. Sci., 287:52-53, 1984.
Pennsylvania Medicine, July 1986 37
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Ronald A. Daltorio, MD, Radiology, Saint Francis General Hosp , Pittsburgh 15201
Michael J. Daly, MD, Pediatrics, 616 Lincoln Avenue, Pitts- burgh 15202
Andrew W Eller, MD, Ophthalmology, 320 Eye and Ear Hos- pital, 230 Lothrop Street. Pittsburgh 15213 James A. Garrity, MD. Ophthalmology, 320 East North Ave- nue. Pittsburgh 15212
John L. Happel Jr , MD. Cardiovascular Surgery, 5975 Parkvue Extended. Pittsburgh 15236 James I. Horsley, MD, Physical Medicine/Rehabilitation, Na- tional Steel Ctr., 2nd Floor, 1 Riverfront, Pittsburgh 15222 Anthony Jabre, MD, Neurological Surgery, 510 South Aiken Avenue, Pittsburgh 15232
Lidia W, L, Kao, MD, Obstetrics/Gynecology, 130 North Bel- lefield, Pittsburgh 15213
Jagannath P Karambelkar, MD, Child Psychiatry, 2550 Cha- pelwood Drive, Pittsburgh 15241 Bruce D. Klaskin, DO, Physical Medicine/Rehabilitation, 3954 North Monet Court, Allison Park 15101 Peter R. Kongstvedt, MD, Internal Medicine, Health Amer- ica, 5 Gateway, Pittsburgh 15222 Andrew C. Krouskop, MD, Physical Medicine/Rehabilitation, 520 Kellingwood Drive, Pittsburgh 15238 Kimberly A, Kubek, MD, Diagnostic Radiology, 1214 Wight- man Street, Pittsburgh 15217
Barbara A Levey, MD, Clinical Pharmacology, 105 Catalpa Ridge Road, Pittsburgh 15238 Gregory A Logsdon, MD, Diagnostic Radiology, 508 Bay- berry Drive, Monroeville 15146 Thomas W. McNamara. DO, Family Practice. 7042 McClure Avenue, Swissvale 15218
Mary F Nawrocki, MD, Physical Medicine/Rehabilitation, PO. Box 11460, Guys Run Road, Pittsburgh 15238 Bharati K. Parikh, MD, Anesthesiology, 2915 Big Meadow Road. Bridgeville 15017
Charles G Quattrone, MD, Emergency Medicine, Coal Val- ley Road, PO. Box 18119, Pittsburgh 15236 Rayasam H Rao, MD, Internal Medicine, 6520 Landview Street, Pittsburgh 15217
Kausar Rashid, MD, Family Practice, 129 Regal Court, Monroeville 15146
Walter E. Smith, MD, Family Practice, 556 Greendale Ave- nue, Pittsburgh 15218
Anthony H S. Tan, MD, General Surgery, 3471 Fifth Avenue, Pittsburgh 15213
Angel Viera, MD, Physical Medicine/Rehabilitation, Harmar- ville Rehab Center. PO Box 11460, Pittsburgh 15238 John K. Vries, MD, Neurological Surgery, 125 DeSoto Street, Pittsburgh 15213
Phuong H. Vuong, MD, Internal Medicine, 341 Gross Street, #101, Pittsburgh 15224
Sally F. Wiseley, MD, Physical Medicine/Rehabilitation, 2762 Clearview Road, Allison Park 15101 Lawrence J Zelonis, DO, Family Practice, 3338 Appel Road, Bethel Park 15102
BEAVER COUNTY
Leslie T Pallone, DO, Family Practice, 426 Green Street, Sewickley 15143
James P Scibilia, MD, Pediatrics. 1035 Murray Hill Avenue. Pittsburgh 15217
BERKS COUNTY
Ronald C. Krol, MD, Pulmonary Diseases. 36 North 11th Street, Reading 19601
David B O'Rourke, MD. Family Practice, 39 Medinah Drive, Reading 19607
Guy N Piegari, MD. Cardiovascular Diseases, 4774 South Evanston Way, Aurora 80015
Anthony H Umpierre, MD, Family Practice, 200 North 13th Street. Suite 100, Reading 19602
BLAIR COUNTY
Michael S. Markoff, MD, Pediatrics, 2 North Juniata Street, Hollidaysburg 16648
BRADFORD COUNTY
Benjamin C. Chu, MD, General Surgery, 103, Chemung Street, Sayre 18840
BUCKS COUNTY
Henry I D'Silva, MD, Internal Medicine, 702 Hood Blvd Fairless Hills 19030
Jonathan Gold, MD, Cardiovascular Diseases, 7 Briarwood Court, Newtown 18940
Cynthia Matossian, MD, Ophthalmology, 485 Main Street, Doylestown 18901
CAMBRIA COUNTY
Richard L. Cartwright, MD, Internal Medicine, 159 Arlington Street. Johnstown 15905
Lourdes Castellon, MD, Internal Medicine, 130 West Os- borne Street, #204, Johnstown 15905
CARBON COUNTY
Cyrus Houshmand, MD, Hematology, RD 1, Lehighton 18235
CHESTER COUNTY
Michael J. Maggitti, MD, Orthopaedic Surgery, 797 East Lancaster Avenue, Downingtown 19335 Lorna B Stuart, MD, Family Practice, 604 Gay Street, Phoenixville 19460
Nenito P. Uy, MD, General Surgery, BSA S. Chester Cty. Med. Bldg., RD 1 Suite 205, West Grove 19390
BLAIR COUNTY
Keith I. Adams, MD, Internal Medicine, RD 3 Route 64, PO. Box 181, Mill Hall 17751
DAUPHIN COUNTY
Roland R. Alexander. MD, Internal Medicine, 425 North 21st Street, Suite 2-1, Camp Hill 17011 George R Coar, MD, Ophthalmology, 2645 North Third Street, Harrisburg 17110
Richard C. Falkenstein II, MD, Family Practice, 550 Ridge Avenue, Harrisburg 17111
Michael R. Gawlas, DO, Family Practice, 111 Clouser Road, Mechanicsburg 17055
William H Lodge, DO, Family Practice, 46 East Chocolate Avenue, Hershey 17033
Jimmy Pacheco, MD, Psychiatry, University Manor #54, Hershey 17033
Daniel S. Romm, MD, Physical Medicine/Rehabilitation, 423 North 21st Street, c/o American Rehab, Harrisburg 1701 1 Larry L. Sollenberger, MD, Colon/Rectal Surgery, 627 Hill- crest Avenue, Westfield, NJ 07090 Allen S. Wenger, MD, Urological Surgery, P.0 Box 4001, Chapel Hill 27515
ERIE COUNTY
Placido M Roquiz Jr., MD, General Surgery, Hamot Medical Center-Surg., 201 State Street, Erie 16550 Brent E. Walker, MD, Ophthalmology, 300 Woodbridge Drive. Pittsburgh 15237
FAYETTE COUNTY
Thomas L. Carbo, MD, Internal Medicine, 513 Market Street, Brownsville 15417
Larry J. Papincak, MD, Anesthesiology, Uniontown Hospital, 500 Berkley Street. Uniontown 15401
FRANKLIN COUNTY
Victor G. Schorn, MD, Neurological Surgery, 764 Lincoln Way East, Chambersburg 17201
INDIANA COUNTY
S P Hewie, MD, Anesthesiology, 916 Garfield Avenue, Braddock Hills 15221
LACKAWANNA COUNTY
Bruce K Branin, DO, Internal Medicine, c/o Marworth, Waverly 18471
Nayan C Shah, MD, Gastroenterology, 79 Bundoff Street, Carbondale 18407
LEHIGH COUNTY
John E Castaldo, MD, Neurology. 1210 South Cedar Crest Blvd , Allentown 18103
Harold G Kunz. MD, Diagnostic Radiology, 820 Ward Street, #7, Allentown 18103
Richard M Lieberman, MD, Urological Surgery, 2830 High- land Street, Allentown 18104
LUZERNE COUNTY
Jay Charabati. MD, Family Practice, 540 Pierce Street, Kingston 18702
Juan J. Derojas, MD, Cardiovascular Surgery. 582 Greene Lane, Philadelphia 19128
Jung T. Huang, MD, Family Practice, 540 Pierce Street, Kingston 18704
Michael Kusiak, MD, Family Practice, 6 Holiday Court, Kingston 18704
Mara S Leyzin, MD, Family Practice, 19 Highland Blvd., Stone Hedge, Dallas 18612
Myung S. Yoon, MD, Internal Medicine, 100 West Diamond Avenue, Hazleton 18201
LYCOMING COUNTY
Timothy J. McCloskey, DO, Pediatrics, 904 Campbell Street. Williamsport 17701
MONTGOMERY COUNTY
Joseph J Cirotti, MD, Pediatrics. 298 Blair Mill Road. Horsham 19044
Calvin M Dubrow, DO, Ophthalmology. 277 Woodcock Lane, Ambler 19002
Carol M Kershbaum, MD, Family Practice, 1400 Old York Road. Abington 19001
Maged S Khoory, MD, Hematology, 302 Ocean Plaza, Longport, NJ 08403
William J. Sohn, MD. Pediatrics. 298 Blair Mill Road, Horsham 19044
MONTOUR COUNTY
Richard J. Cassidy, MD, Internal Medicine, RD 6. Box 71, Danville 17821
NORTHAMPTON COUNTY
Georges J. Bensimhon, MD, Anesthesiology, 1047 Liberty Court, Bethlehem 18017
Mukesh D Bhatt, MD, Physical Medicine/Rehabilitation, 2657 Schoenerville Road. Bethlehem 18017 Che-Yi Chang, MD. Anesthesiology, 55 County Club Lane, Phillipsburg, NJ 08865
Mahakhurshid Irani, MD, Colon/Rectal Surgery, 2030 Lehigh #116, Easton NJ 18042
Eduardo C Lomibao. MD. Anesthesiology, PO Box 617, Memorial Parkway, Phillipsburg, NJ 08865 Volmar A. Mereschak, MD, Obstetrics/Gynecology. 985 Bel- videre Road, Phillipsburg, NJ 08865 Constante D Pacis, MD, Anesthesiology, 4 Briarstone Road, Phillipsburg, NJ 08865
PHILADELPHIA COUNTY
Mitchell E Gibson, MD, Psychiatry, 17 Derry Drive, Glen Mills 19342
WAYNE-PIKE COUNTY
Stephen D. Wakulchik, MD, Family Practice, 1325 North Main Street, Honesdale 18431
YORK COUNTY
Terry W Seidel. MD, General Surgery, 1001 South George Street, York 17405
STUDENTS
Jon M Carson, 1512 South El Dorado, Stockton, CA 95206 Ellen M Humes, 2809 West Queen Lane, #208, Philadelphia 19129
Alan K Miller, 3401 Forbes Avenue, #C-4, Pittsburgh 15213 Alvin J Murn, Box 32, Vestaburg 15368 David R Neiblum, 510 Wesl Queen Lane, Philadelphia 19144
Lori A Paserchia, 5450 Wissahickon Avenue. #203, Phila- delphia 19144
Joseph G Sabol, 108 Harvey Street, Philadelphia 19144 Richard O Stern, 18 Hamilton Circle. Philadelphia 19130 Kathleen M Thomas, 333 Idlewood Road, Pittsburgh 15235
38 Pennsylvania Medicine, July 1986
classified advertising
PHYSICIANS WANTED
Pennsylvania — Emergency physician sys- tem. Needs several fulltime emergency physi- cians for Western Pennsylvania area emer- gency departments. Independent contractor arrangements. The system is on a “fee-for- service” basis. Contact: (412) 228-3400 for interview appointment.
Emergency physicians — Emergency medi- cine opportunities available for career ori- ented medical directors and staff physicians licensed in Maryland and/or Pennsylvania. Full and part-time positions available. Appli- cants must have a minimum of 2 years recent experience. Competitive income and mal- practice insurance provided. Please send CV to Debbie Hibberts, EMSA, 8200 W. Sunrise Boulevard, Building C, Plantation, FL 33322, or call (305) 472-6922.
Neurosurgeon — Excellent opportunity for Board certified or Board eligible neurosur- geon to establish a private practice affiliated with a medium-sized, progressive, acute-care hospital located in northeastern Pennsylva- nia. Significant growth opportunities avail- able. Generally located between two major cities and in close proximity to a variety of ski resorts. Send curriculum vitae and references to Box 138, Pennsylvania Medicine, 20 Erford Road, Lemoyne, PA 17043.
Immediate full-time position available in central Pennsylvania for personable, American-trained physician. Background in family practice, internal medicine, or experi- ence in emergency room preferred. Rural hospital located 20 miles from State College. 15,000 yearly census. Excellent benefit pack- age and competitive salary. Physicians asso- ciated with large teaching hospital. Submit CV to Administrator, M V M G, Three Medical Center Drive, Philipsburg, PA 16866, or call (814) 342-5402.
Family practice physician or internist with primary care orientation to establish private practice in western Pennsylvania. Affiliated with medium-sized, progressive, acute care hospital. Excellent financial and relocation package. Available July 1986 or before. Board certified or eligible and licensed in Pennsylvania. Respond to PMS Physician Placement Service, Department CON-0686- IM29, 20 Erford Road, Lemoyne, PA 17043.
Pediatrician BE/BC to replace retiring third member of corporation of pediatricians in Spring 1986. An interest in male adolescent medicine desirable. Salary first year. Bucks County, Pennsylvania. Reply to Box 158, Pennsylvania Medicine, 20 Erford Road, Le- moyne, PA 17043.
Medical directors— NEEMA Medical Ser- vices has unique opportunities for physicians Board eligible or certified in primary care spe- cialty. Clinical or developmental disabilities/ chronic care background, with administrative experience. NEEMA offers competitive com-
pensation, regular weekday hours with largely optional call/coverage, paid malprac- tice, vacation, holidays, continuing medical education leave. Opportunities also to initiate/direct comprehensive health care pro- gram. Positions in PA and elsewhere, includ- ing staff. Further information: NEEMA Medi- cal Services, Suite 400, 399 Market Street, Philadelphia, PA 19106, or call Mr. Robinson at 1-800-523-0776, in PA/outside U.S., (215) 925-3511.
Family physician — part time, to relieve busy practitioner on weekends and for vacations. Southwestern Pennsylvania. Send curricu- lum vitae to Box 166, Pennsylvania Medicine, 20 Erford Road, Lemoyne, PA 17043.
Family physician wanted— BC/BE family practitioner to join established IV2 physician group in Lancaster County. Enjoy the chal- lenges of a rural practice yet access to 2 ma- jor hospitals in Lancaster city within 20 min- utes. Salary negotiable. Please send curriculum vitae and letters of recommenda- tion to William D.L. Hunt, MD, P.O. Box 73, Quarryville, PA 17566.
Family practitioners— join the lead hospital in a 255,000 population county on the shores of Lake Erie. Thirty minutes to internationally
recognized medical centers. Modern 360 bed hospital located in county seat city close to all cultural activities with the finest public, pri- vate, or parochial schools and colleges. Ideal recreation areas summer or winter. Reward- ing opportunity for talented family practition- ers. Manageable malpractice rates. Send cur- riculum vitae to Administrator, Elyria Memorial Hospital, 630 East River Street, Ely- ria, Ohio 44035.
Ob-gyn needed— productive and rewarding practice located in beautiful lake/river area of Florida needs third ob-gyn for potential part- nership. Please respond to Box 168, Pennsyl- vania Medicine, 20 Erford Road, Lemoyne, PA 17043.
Northwest Pennsylvania — immediate direc- torship available at moderate volume hospital in summer and winter resort area. Attractive compensation with malpractice insurance provided. Please submit resume to Emer- gency Consultants, Inc., 2240 South Airport Road, Room 27, Traverse City, Ml 49684; or call 1-800-253-1795 or in Michigan 1-800-632- 3496.
Family practitioner wanted to join multi- specialty group. Share obstetrics calls with two other physicians. Financial arrangements
To get the career you want.
1
Send curriculum vitae or call toll-free:
NEEMA • Suite 400 • 399 Market Street • Philadelphia, PA 19106 1-800-523-0776 (In Pennsylvania 215-925-3511)
NAME ;
CITY, STATE, ZIP_
NEEMA provides the right opportunities for physicians looking toward growth within a group practice. We can find the position fitting your needs, and provide com- petitive compensation and other advantages.
NEEMA offers a choice:
Emergency Medicine or Primary Care
—Positions nationwide -Graduated income and incentives -Malpractice insurance — Pre-scheduled time off —Group-sponsored continuing education often available
PHONE ( )
CURRENT SPECIALTY
GEOGRAPHICAL PREFERENCE..
Please check area(s) of interest □ Emerg. Med. □ Primary Care
you need NEEMA
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Pennsylvania Medicine, July 1986 39
negotiable. Respond to Box 176, Pennsylva- nia Medicine, 20 Erford Road, Lemoyne, PA 17043 or phone (717) 265-7484.
Bariatrics — opportunity for personable phy- sician, BC/BE family practice, seeking career in clinical management of obesity. Excellent salary, malpractice, four weeks vacation, leading to partnership and eventual owner- ship for right person. Beautiful office building, suburban Philadelphia. Reply to Box 175, Pennsylvania Medicine, 20 Erford Road, Le- moyne, PA 17043.
Growing bariatric practice seeks estab- lished, energetic physician to join our profes- sional staff. Send inquiries and/or resumes to Westmoreland Health Group, Inc., P.O. Box 200, Greensburg, PA 15601.
Practice opportunities available in modern ambulatory and diagnostic testing centers lo- cated in northeastern Pennsylvania. Compet- itive salary, with incentive pay and investment opportunities. Malpractice insurance offered. Replies: Eugene Turchetti, MD, 3738 Birney Avenue, Scranton, Pennsylvania 18507. (717) 343-1840.
Pulmonologist wanted to join three Board certified pulmonologists in a busy, active, hospital-based, private practice located in Pennsylvania. Reply to Box 172, Pennsylva- nia Medicine, 20 Erford Road, Lemoyne, PA 17043.
General surgeon, Board eligible or certified to join surgeon in private practice. Experi- ence in traumatology and peripheral vascular
surgery desirable. Southcentral Pennsylva- nia. Reply to Box 174, Pennsylvania Medicine, 20 Erford Road, Lemoyne, PA 17043.
Opportunity for urologist Board certified or eligible in urology. Type of practice available: partnership. Size of community and trade area: 30,000 - 100,000. Salary. Reply to PMS Physician Placement Service, Department COM-1286-UR04, 20 Erford Road, Lemoyne, PA 17043.
Physician group seeks EM/FP/IM physician for unique rural family practice/urgent care center. FP is located one hour north of Phila- delphia. Needs physician for 20-30 hours/ week. Hospital patients covered or cover them yourself. Minimum salary guaranteed or sub-let practice with/without option to buy. Shifts available at nearby urgent care center at $35/hour. Contact Joseph Balavage (717) 823-0499.
House staff physician — excellent opportu- nity for a Pennsylvania licensed physician to serve in a 230-bed hospital in south Philadel- phia. JCAH accredited with major medical school affiliation. Salary negotiable, plus fringe benefits and malpractice insurance. For further information, contact John P. Cossa, MD, Vice President of Medical Affairs, St. Agnes Medical Center, 1900 South Broad St., Philadelphia, PA 19145; (215) 339-4226.
POSITIONS WANTED
Anesthesiologist, B.C., practicing in Saudi Arabia, seeking relocation. No O.H. Reply to Box 169, Pennsylvania Medicine, 20 Erford Road, Lemoyne, PA 17043.
Osteopathic physician, 40, wishes to relo- cate. Will consider all areas. Strong back- ground in primary care and emergency medi- cine. Extensive experience in administrative medicine as well as clinical instruction of medical students. Currently director of ambu- latory care center, but will be interested in other settings as well. Reply Box 170, Penn sylvania Medicine, 20 Erford Road, Lemoyne, Pennsylvania 17043.
Board certified general surgeon, licensed New York, Pennsylvania, Oklahoma, seeks surgical or emergency room position. Avail- able soon. Reply to Box 171, Pennsylvania Medicine, 20 Erford Road, Lemoyne, PA 17043.
Physician consultants — available for assis- tance in all aspects of utilization review, qual- ity assurance, risk management, and commit- tee services. Review of documentation, procedures, policies, and manuals. Send de- tails of need to: Box 173, Pennsylvania Medi- cine, 20 Erford Road, Lemoyne, PA 17043.
Seeking position in gastroenterology/ internal medicine. Available now. Board certi- fied in internal medicine. Board eligible in gastroenterology. British and U.S. trained. Li- censed in Pennsylvania. Contact S.P. Na- than, 24024 Evergreen Road, Apt. 112-A, Southfield, Ml 48075, (313) 356-7548.
FOR SALE
50% off previously owned medical, labora- tory, office, x-ray, ultra-sound equipment in excellent condition. We buy, sell, broker, and repair. Appraisals by Certified Surgical Con-
Medical Practices Available
• Allergy — Illinois — gradual transition available.
• Allergy — suburban Philadelphia — large practice.
$550,000 gross.
• Dermatology — New Hampshire — well established
practice.
• Family Practice — northeast Philadelphia — large practice.
$500,000 gross.
• Family Practice — southern New Jersey- — large, well
established practice.
• Family Practice — suburban Philadelphia — large Chester
County practice.
• Gynecology — South Dakota — large practice.
• Gynecology — Upstate New York — very large, well
equipped practice.
• Internal Medicine — Arizona — well equipped. $140,000
gross.
• Internal Medicine — metropolitan DC — well established
practice in desirable Bethesda, Maryland.
• Internal Medicine — western PA — very large practice.
$450,000 gross.
• Orthopedic Surgery — Pennsylvania — well established
practice. $540,000 gross.
• Pediatrics — Colorado — large practice. $200,000 gross.
• Pediatrics — Northeastern PA — growing practice. Modern
equipment.
• General Surgery — New Jersey — well established practice.
Must sell ASAP.
Health Care Personnel Consulting 403 GSB Building
Bala Cynwyd, Pa. 19004 215-667-8630
( A
Anesthesiology
Opportunity
v__. )
Investigate your full career potential in this active mid-Atlantic medical center practice. Our client, a group of four, requires a BC/BE Anesthesiologist with special interest in pain management or trauma/critical care. Highlights include:
• 6000+ surgical cases/year, 80% generals
• heavy SPU caseload, as well as trauma/critical care center
• no OB epidurals
• comprehensive, highly competitive fee for service compensation package with liberal first year guarantee
• 10 full-time CRNA's who take first call
• group members are all certified, active, and share second call equally
The medical center has 300+ beds, is running over 80% occupancy, has over 300 medical staff, and serves an SMSA of 639,000 population. It is located in a town of 80,000 and is readily accessible to New York and Philadelphia, while enjoying proximity to the recreational pleasures of the Poconos.
Send your C.V. or call Bill Gregory, (215) 296-7080, John Downing Associates, Inc., Stonebank Executive Center, #101, Exton, PA 1 9341 .
40 Pennsylvania Medicine, July 1986
Health Care Personnel Consulting...
Recruitment for the Private Medical Practice
• Over 15 years of experience dealing with private medical practices — we can find the right doctor for you!
• HCPC focuses on a combination of the right skills and training, plus the intangibles needed to work closely in the private practice environment.
• We suggest first year salary and benefit arrangements — call for our free pamphlet,
"Dr. New & You.'
• Various private practice opportunities available nationwide in all specialties — call or write for our current listing of positions.
Health Care
Personnel Consulting, Inc.
403 GSB Building One Belmont Avenue Bala Cynwyd, PA 19004 (215) 667-8630
A Division of
Health Care Group
Medical Director Psychiatry
Explore your career potential as the Director of Psychiatry providing administrative and clinical leadership for a total community MH system. Mid-Atlantic regional medical center and O/P facility requires BC psychiatrist to man- age multi-disciplinary team and expand programs in staff education and clinical research. Facility includes:
* 6 psychiatric clinical directors
* 125 staff members
* 44 I/P beds plus large O/P center
Comprehensive care for all patient levels includes MH/ MR services, in-take evaluation/diagnosis, partial hospi- talization, transitional living, community counseling/ aftercare, crisis intervention and emergency care, and residential placement.
University community of 200,000 + is readily accessible to New York and Philadelphia, while offering close prox- imity to recreational pleasures of the Pocono resorts.
Forward your CV promptly to JOHN DOWNING ASSOCI- ATES, INC., Stonebank Executive Center, Exton, PA 19341, (215) 296-7080.
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John Downing Associates, Inc.
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physician search consultants
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STUART
UPDATE
The Name to Watch In Therapeutic Drug Development
Stuart Pharmaceuticals, one of America’s top fifteen pharmaceutical organizations, is the company be- hind the introduction of Nolvadex®, Hibiclens®, Tenormin® and, most recently, Cefotan™.
We’re a world leader in a wide range of therapeutic drugs and one of the fastest growing pharmaceutical organizations in the United States. We’ve created an environment which will encourage your best ideas and foster your personal and professional growth. Our Clinical Research and Medical Affairs Depart- ment currently seeks Physicians with or without in- dustry experience who have specialized in the following areas:
• ANESTHESIOLOGY • CARDIOLOGY
• NEUROLOGY • PULMONARY
• INFECTIOUS DISEASE
Our Wilmington location affords you and your family the best of rural, suburban or urban living in three states. And, all within a short drive from our modern headquarters. We invite you to forward your CV in confidence to: J.C. Gearhart, Employment-PM
STUART PHARMACEUTICALS
Division oi ICI Americas Inc
Wilmington. DE 19897
We are an equal opportunity employer.
Westmoreland Hospital has an
immediate need for the following subspecialists:
1 . Trauma director— Board certified surgeon who has completed fellowship in trauma. Some experience preferred.
2. Hematologist/oncologist— Board certification in hematology and oncology necessary. Physician needed to work in solo practice and help in development of regional cancer center.
3. Emergency room physician — for active, growing emergency department. Pursuing level II trauma designation, developing helicopter rescue service. ED presently has 4 1 ,000 patient visits annually. Applicant must be emergency residency trained and/or ABEM certified, ACLS and ATLS desirable. Competitive salary and benefits.
Westmoreland Hospital services a community of 30,000 - 100,000. It is a cosmopolitan area 30 miles east of Pittsburgh, with excellent schools, churches, and recreational areas, located near the base of the Laurel Mountains.
For more information about these opportunities, contact Dr. Gerald S. Browdie, Director of Recruitment, Westmoreland Hospital, West Pittsburgh Street, Greensburg, PA 15601; 412-832-4037.
Pennsylvania Medicine, July 1986 41
sultants. Medical Equipment Resale, Inc., 24026 Haggerty Road, Farmington, Ml 48018. (313) 477-6880 anytime.
Active Philadelphia general practice and
building for sale. Physician retiring no later than January 1987. 41 years in practice; 6 fig-
ure gross. Good Kensington area — East Al- legheny. Corner property in A-1 condition. Rentals from home and apartment above of- fice more than maintain building. Doctor’s corner for 75 years. Reply to Box 155, Penn- sylvania Medicine, 20 Erford Road, Lemoyne, PA 1 7043.
Family practice for sale— located in greater Harrisburg area. Reasonably priced with fi- nancing available. Potential to expand prac- tice unlimited. Reply to Box 165, Pennsylva- nia Medicine, 20 Erford Road, Lemoyne, PA 17043.
Ob-gyn practice — central Pennsylvania. Thirteen year practice. Five-thousand charts. Physician leaving area. Priced for quick sale. For more information, call W.P. Feuchten- berger, business broker, (717) 243-5185, or write 3109 North Front Street, Harrisburg, PA 17110.
New 1,000 square foot office condomini- ums under construction Bensalem area in lower Bucks County. Finished to your specifi- cations, beautiful buildings, professional landscaping. Many benefits of ownership ver- sus rental. Call Allen Associates, (215) 493- 0400.
FOR RENT
Medical offices available in west Philadel- phia and Delaware County. Newly renovated, well-maintained, multi-office locations. Exclu- sive or time sharing. Accommodations for special needs will be considered. Off-street parking and easy access to public transporta- tion. Call Barbara Kelman, (215) 622-4000, weekdays 9 - 5.
Kailua-Kona, Hawaii — Two bedroom, two bath, fully furnished apartment in the Kona Alii Condominium fronting Kailua Bay on the west coast of the island of Hawaii. Excellent fishing, golf, and swimming. $395/week; $1 350/month. Phone (412) 321-0566 or write P.O. Box 6112, Pittsburgh, Pennsylvania 15212.
Available immediately — spacious, well- planned 6,500 square foot office suite in es- tablished medical building. Excellent location for any practice in busy Bensalem, lower Bucks County. Call Allen Associates (215) 493-0400.
MISCELLANEOUS
Physicians Signature Loans to $50,000. Up
to 7 years to repay. No prepayment penalties. Prompt, courteous service. Competitive fixed rate, with no points, fees or changes of any kind. Physicians Service Assn., Atlanta, GA. Toll free (800) 241-6905.
Medical practice sales and appraisals —
We specialize in the valuation and selling of medical practices. If interested in buying or selling a medical practice, contact our Broker- age Division at The Health Care Group, 400 GSB Building, Bala Cynwyd, PA 19004; (215) 667-8630.
Baltimore — 1830 Mulberry House. Bed and breakfast. Walk to Harborplace, Walters Art Gallery, Maryland Historic Society, Mt. Vernon Place, Aquarium. 1 1 1 W. Mulberry St., Baltimore, MD 21 201 ; (301 ) 576-01 1 1 .
Pennsylvania Sperm Bank — a cryogenic semen storage facility for your patients: pre- vasectomy; pre-chemotherapy; pre-radiation therapy; prior to surgery which may affect fer- tility; before hazardous occupational expo- sures. Inquiries: (215) 886-7706, or write: PSB, Benson East, Suite 415, Jenkintown, PA 19046.
SURGERY
CHAIRPERSON OF SURGERY
Mercy Catholic Medical Center (MCMC) is seeking a board certified General Sur- geon to serve as Chairperson of the Department of Surgery. MCMC is conveniently located in metropolitan Philadelphia and is comprised of two hospital divisions with a total complement of 720 beds. MCMC has extensive surgical facilities including a new Operating Room and Recovery Room Suite at the Fitzgerald Division, new Emergency Room facilities, a T rauma Service, new Short Procedure Units and Kidney Lithotripsy.
The Chairperson will be responsible for the leadership and administration of a department of 120 surgeons which has representation from all major surgical special- ties. The Chairperson will also be responsible for all educational programs including a fully-approved, free-standing, 5-year General Surgery Residency Program. MCMC is a major teaching affiliate of Thomas Jefferson University and operates a broad program of surgical education at all levels.
In addition to board certification in General Surgery, the position requires a Pennsyl- vania license and demonstrated ability in surgical education and administration. Candidates must possess credentials and experience which qualify the individual to hold, at a minimum, the title of Associate Professor on the faculty of an academic medical center.
The position offers excellent salary, clinical practice opportunities and benefits. Qualified applicants may submit their curriculum vitae, in confidence, to:
David M. Raezer, MD Vice Chairman of the Search Committee
ca
MCMC
'II'
MERCY CATHOLIC MEDICAL CENTER
Lansdowne Ave. & Bally Road Darby, PA 19023
Equel Opportunity Employer M/F
ACM A
CENTRAL PENNSYLVANIA
Physician owned group staffing emergency department seeks physicians experienced in
FAMILY PRACTICE EMERGENCY MEDICINE
Salary and benefits package approximates S90,000 first year with progressive increases to full partnership.
Contact:
ACMA
8101 Hinson Farm Road Suite 209, Box P Alexandria, VA 22306
42 Pennsylvania Medicine, July 1986
BILLING
HEADACHES?
Take two aspirins, and call ABC in the morning.
Advanced Billing Concepts offers complete relief for billing headaches for all medical specialties — anesthesia, radiology, pathology, emergency room medicine, and general medicine specialties.
ABC's senior management team has more than 35 years of combined hands-on experience in medical group practice bill- ing, so we understand your business and we talk your language. Just tell us how you want things handled and we do the
rest, working as an extension of your staff. We even provide management reports to help your practice prosper.
ABC has earned a solid reputation among physicians for its professionalism. But you don’t have to take our word for it. We'll put you in touch with any of our clients, and they'll tell you we're accurate, thorough, and effective.
Why wait until morning? Call ABC right now.
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ADVANCED BILLING CONCEPTS, INC.
250 Mt. Lebanon Boulevard — Suite 310 Pittsburgh. PA 15234 Telephone: 412/571 3750
After a nitrate,
add ISOPTIN
Verapamil HCl/Knoll)
To protect your patients, as well as their quality of life, idd Isoptin instead of a beta blocker.
irst, Isoptin not only reduces myocardial oxygen demand )y reducing peripheral resistance, but also increases coro- lary perfusion by preventing coronary vasospasm and dilating coronary arteries — both normal and stenotic, hese are antianginal actions that no beta blocker an provide.
Second, Isoptin spares patients the Deta-blocker side effects that may ompromise the quality of life.
With Isoptin, fatigue, bradycardia and mental Repression are rare. Unlike beta blockers, soptin can safely be given to patients with asthma, COPD, diabetes or peripheral /ascular disease. Serious adverse eactions with Isoptin are rare at recommended doses; the ingle most common side effect is constipation (6.3%).
Cardiovascular contra- indications to the use of Isoptin are similar to those of beta blockers: severe left ventricular dysfunction, hypotension (systolic pres- sure <90 mm Hg) or cardio- genic shock, sick sinus syndrome (if no artificial pacemaker is present) and second- or third-degree AV block.
So, the next time a nitrate is not enough, add Isoptin ... for more comprehensive antianginal protection without side effects which may cramp an active life style.
ISOPTIN. Added antianginal protection without beta-blocker side effects.
Please see brief summary on following page
ISOPTIN
(verapamil HCI/Knoll)
80 mg and 120 mg scored, film-coated tablets
Contraindications: Severe left ventricular dysfunction (see Warnings), hypo- tension (systolic pressure < 90 mm Hg) or cardiogenic shock, sick sinus syn- drome (except in patients with a functioning artificial ventricular pacemaker), 2nd- or 3rd-degree AV block Warnings: ISOPTIN should be avoided in patients with severe left ventricular dysfunction (e g,, ejection fraction < 30% or moderate to severe symptoms of cardiac failure) and in patients with any degree of ventricular dysfunction if they are receiving a beta blocker. (See Precautions.) Patients with milder ventricular dysfunction should, if possible, be controlled with optimum doses of digitalis and/or diuretics before ISOPTIN is used. (Note interactions with digoxin under Precautions.) ISOPTIN may occa- sionally produce hypotension (usually asymptomatic, orthostatic, mild and con- trolled by decrease in ISOPTIN dose). Elevations of transaminases with and without concomitant elevations in alkaline phosphatase and bilirubin have been reported. Such elevations may disappear even with continued treatment, how- ever, four cases of hepatocellular injury by verapamil have been proven by re- challenge. Periodic monitoring of liver function is prudent during verapamil therapy. Patients with atrial flutter or fibrillation and an accessory AV pathway (e g. W-P-W or L-G-L syndromes) may develop increased antegrade conduction across the aberrant pathway bypassing the AV node, producing a very rapid ventricular response after receiving ISOPTIN (or digitalis). Treatment is usually D C -cardioversion, which has been used safely and effectively after ISOPTIN Because of verapamil's effect on AV conduction and the SA node, 1° AV block and transient bradycardia may occur. High grade block, however, has been infrequently observed. Marked 1° or progressive 2° or 3° AV block requires a dosage reduction or, rarely, discontinuation and institution of appropriate therapy depending upon the clinical situation. Patients with hypertrophic car- diomyopathy (IHSS) received verapamil in doses up to 720 mg/day. It must be appreciated that this group of patients had a serious disease with a high mor- tality rate and that most were refractory or intolerant to propranolol. A variety of serious adverse effects were seen in this group of patients including sinus bradycardia, 2° AV block, sinus arrest, pulmonary edema and/or severe hypo- tension Most adverse effects responded well to dose reduction and only rarely was verapamil discontinued. Precautions: ISOPTIN should be given cautiously to patients with impaired hepatic function (in severe dysfunction use about 30% of the normal dose) or impaired renal function, and patients should be monitored for abnormal prolongation of the PR interval or other signs of exces- sive pharmacologic effects. Studies in a small number of patients suggest that concomitant use of ISOPTIN and beta blockers may be beneficial in patients with chronic stable angina. Combined therapy can also have adverse effects on cardiac function. Therefore, until further studies are completed, ISOPTIN should be used alone, if possible. If combined therapy is used, close surveillance of vital signs and clinical status should be carried out. Combined therapy with ISOPTIN and propranolol should usually be avoided in patients with AV conduction abnormalities and/or depressed left ventricular function. Chronic ISOPTIN treat- ment increases serum digoxin levels by 50% to 70% during the first week of therapy, which can result in digitalis toxicity. The digoxin dose should be re- duced when ISOPTIN is given, and the patients should be carefully monitored to avoid over- or under-digitalization. ISOPTIN may have an additive effect on lowering blood pressure in patients receiving oral antihypertensive agents. Disopyramide should not be given within 48 hours before or 24 hours after ISOPTIN administration. Until further data are obtained, combined ISOPTIN and quimdine therapy in patients with hypertrophic cardiomyopathy should prob- ably be avoided, since significant hypotension may result. Clinical experience with the concomitant use of ISOPTIN and short- and long-acting nitrates sug- gest beneficial interaction without undesirable drug interactions. Adequate ani- mal carcinogenicity studies have not been performed. One study in rats did not suggest a tumorigemc potential, and verapamil was not mutagenic in the Ames test. Pregnancy Category C There are no adequate and well-controlled studies in pregnant women. This drug should be used during pregnancy, labor and delivery only if clearly needed. It is not known whether verapamil is excreted in breast milk; therefore, nursing should be discontinued during ISOPTIN use Adverse Reactions: Hypotension (2.9%), peripheral edema (1 .7%), AV block: 3rd degree (0.8%), bradycardia: HR < 50/min (1.1%), CHF or pulmonary edema (0.9%), dizziness (3.6%), headache (1.8%), fatigue (1.1%), constipa- tion (6.3%), nausea (1.6%), elevations of liver enzymes have been reported. (See Warnings .) The following reactions, reported in less than 0.5%, occurred under circumstances where a causal relationship is not certain: ecchymosis, bruising, gynecomastia, psychotic symptoms, confusion, paresthesia, insomnia, somnolence, equilibrium disorder, blurred vision, syncope, muscle cramp, shaki- ness, claudication, hair loss, macules, spotty menstruation How Supplied: ISOPTIN (verapamil HCI) is supplied in round, scored, film-coated tablets con- taining either 80 mg or 120 mg of verapamil hydrochloride and embossed with "ISOPTIN 80" or "ISOPTIN 120" on one side and with "KNOLL" on the reverse side. Revised August, 1984 2385
Knoll Pharmaceuticals
A Unit of BASF K&F Corporation Whlppany, New Jersey 07981
BASF Group
o.
knoll
A peripheral vasodilator
for treatment of
leg cramps cold feet tinnitus discomfort on standing
4
LIPO-NICIN
Nicotinic Acid Therapy
For patient’s
comfort/convenience
in choice of
3 strengths
Gradual Release
LIPO-NICIN®/300 mg.
Each time-release capsule con-
tains:
Nicotinic Acid 300 mg
Ascorbic Acid 150 mg.
Thiamine HCL (B-1) 25mg
Riboflavin (B-2) 2 mg
Pyridoxine HCL (B-6) 10 mg
in a special base of prolonged therapeutic effect.
DOSE: 1 to 2 tablets daily. AVAILABLE: Bottles of 100, 500
Immediate Release
LIPO-NICIN®/250 mg.
Each yellow tablet contains:
Nicotinic Acid 250 mg.
Niacinamide 75 mg.
Ascorbic Acid 150 mg.
Thiamine HCL (B-1) 25 mg
Riboflavin (B-2) 2 mg
Pyridoxine HCL (B-6) 10 mg.
DOSE: 1 to 3 tablets daily AVAILABLE: Bottles of 100, 500
LIPO NICIN®/100 mg.
Each blue tablet contains:
Nicotinic Acid 100 mg
Niacinamide 75 mg.
Ascorbic Acid 150 mg
Thiamine HCL (B-1) .. 25 mg
Riboflavin (B-2) 2 mg.
Pyridoxine HCL (B-6) 10 mg
DOSE: 1 to 5 tablets daily. AVAILABLE: Bottles of 100, 500
Indications: For use as a vasodi- lator in the symptoms of cold feet, leg cramps, dizziness, memory loss or tinnitus when associated with impaired peri- pheral circulation Also provides concomitant administration of the listed vitamins The warm tingling flush which may follow each dose of LIPO-NICIN® 100 mg. or 250 mg. is one of the therapeutic effects that often produce psychological benefits to the patient.
Side Effects: Transient flushing and feeling of warmth seldom re- quire discontinuation of the drug. Transient headache, itching and tingling, skin rash, allergies and gastric disturbance may occur. Contraindications: Patients with known idiosyncrasy Jo nicotinic acid or other components of the drug. Use with caution in preg- nant patients and patients with glaucoma, severe diabetes, im- paired liver function, peptic ul- cers, and arterial bleeding.
Write for literature and samples
(broMJI THE BROWN PHARMACEUTICAL CO., INC.
2500 West Sixth Street, Los Angeles, California 90057 IPD
obituaries
• Joseph D. Anastasi, Philadelphia; Hahne- mann University School of Medicine, 1935; age 79, died May 18, 1986. Dr. Anastasi was a general practitioner.
• Leon Baxt, Philadelphia; Temple Univer- sity School of Medicine, 1930; age 80, died May 16, 1986. Dr. Baxt practiced in Philadel- phia for over 50 years.
• Charles E. Cleland, Kane; University of Pittsburgh School of Medicine, 1932; age 77, died April 12, 1986. Dr. Cleland served as president of the McKean County Medical So- ciety, and was a delegate to the PMS House for many years.
• Martin Francis Hayes Jr., Philadelphia; Hahnemann University School of Medicine, 1969; age 42, died April 5, 1986. Dr. Hayes wets associate professor of surgery at Hahne- mann University School of Medicine.
• Hugh Hayford Jr., Altoona; Temple Uni- versity School of Medicine, 1946; age 64, died May 11, 1986. Dr. Hayford was an orthope- dic surgeon.
• Max D. Kasser, Philadelphia; Temple Uni- versity School of Medicine, 1935; age 75, died April 22, 1986. Dr. Kasser, an ophthalmolo- gist, was a consultant at Wills Eye Hospital.
• Elmer S. A. King, Pittsburgh; University
of Pittsburgh School of Medicine, 1928; age 82, died April 17, 1986. Dr. King was a sur- geon.
• Richard V. Kubiak, Philadelphia; Jefferson Medical College, 1952; age 60, died April 26, 1986. Dr. Kubiak, an orthopedic surgeon, practiced in Philadelphia and was associated with Nazareth Hospital and Holy Redeemer Hospital.
• Victor Maffucci Jr., Bedford; University of Arkansas College of Medicine, 1938; age 73, died April 20, 1986. Dr. Maffucci practiced medicine in Bedford County for 46 years.
• Joseph P. Matus, Philadelphia; Hahne- mann University School of Medicine, 1952; age 63, died April 4, 1986. Dr. Matus was a general practitioner.
• Edward L. McCarthy, Canonsburg; Uni- versity of Pittsburgh School of Medicine, 1925; age 86, died April 11, 1986. Dr. Mc- Carthy was an ophthalmologist in the Canonsburg area for over 50 years.
• George William Miller III, Havertown; Jefferson Medical College, 1939; age 71, died April 8, 1986. Dr. Miller, a general practi- tioner, formerly served as a team physician for the Philadelphia Phillies baseball club.
• Joseph P. O’Riordan, Philadelphia; Hahne- mann University School of Medicine, 1957;
age 54, died April 22, 1986. Dr. O’Riordan was a member of the medical staffs of Naza- reth and Holy Redeemer Hospitals.
• George P. Pilling IV, Wyndmoor; Cornell University Medical College, 1943; age 67, died April 23, 1986. Dr. Pilling specialized in surgery.
• George Sidney Sprague, Philadelphia; Johns Hopkins University School of Medi- cine, 1920; age 91, died May 7, 1986. Dr. Sprague, a psychiatrist, was one of the founders of the Philadelphia Association for Psychoanalysis and its institute.
• Sidney Weiner, Pittsburgh; Received his medical degree in Scotland, 1933; age 86, died April 23, 1986. Dr. Weiner practiced in Pittsburgh for more than 50 years.
Helen Beck, Tunkhannock; Medical College of Pennsylvania, 1929; age 84, died April 4, 1986. Dr. Beck was a general practitioner.
Pauline Williams McCandless, Erie; Univer- sity of Pittsburgh School of Medicine, 1948; age 70, died April 8, 1986. Dr. McCandless was a gynecologist.
Joseph P. Reath, Devon; Jefferson Medical College, 1937; age 82, died April 18, 1986. Dr. Reath was a family practitioner.
•Denotes PMS membership at death.
0R-D is a total business management system for single & multi-doctor practices. 0R-D will monitor a patient from his entry into the practice all through his treatment history. At your fingertips are patient records, diagnosis, 3rd party billing, referral, practice building, etc. 0R*D is surprisingly simple to operate, exceptionally reliable, remarkably fast and affordable— With a user base of over 200 offices in the East Coast, 0R-D is one of the most experienced and reliable vendors in the computerizing of Medical offices— Find out about 0R-D SHARE, the multi-user system for the price of one.
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FOR INFORMATION OR A FREE DEMONSTRATION IN YOUR OFFICE, CALL (609) 665-0RD3/665-2255 OR SEND US THE COUPON BELOW.
□ I would like a free demonstration in my office
□ Please send me information on ORD Systems
L'L'L'LL’L
LLLLL'L
L'L’LLLL’
NAME.
ADDRESS
PHONE .
OR-D SYSTEMS
1 MARTIN AVE.
CHERRY HILL, NJ 08002
L’L’Ll'LL'
LULL'LL*
LLLLL’L
609-665-2255
Pennsylvania Medicine, July 1986 47
physicians in the news
James A. Collins Jr., MD, Riverside, re- tired from his posts at Geisinger Medi- cal Center after spending over 40 years in medicine. Dr. Collins served as chair- man of Geisinger’s division of medical services, and as chairman of the depart- ment of internal medicine. He will con- tinue as a senior consultant on the staff of Geisinger Clinic. Dr. Collins is a past president of the American Society of In- ternal Medicine.
Stuart H. Shapiro, MD, has been ap- pointed to a post at First Pennsylvania Bank. His title is vice president in charge of banking services for the health care industry. Dr. Shapiro previ- ously was health commissioner of Phila- delphia. He also has served as a staff member for the U.S. Senate’s Subcom- mittee on Health and Scientific Re- search, and has held public health of- fices is Pennsylvania, Massachusetts, and Missouri.
Athole G. McNeil Jacobi, MD, Bala, has been elected to membership in the Chapel of the Four Chaplains Legion of Honor for service in the field of medi- cine. Dr. Jacobi is professor and chair- man of the department of anesthesi- ology at the Medical College of Pennsyl- vania, and also is professor of oral sur- gery at the University of Pennsylvania School of Dental Medicine. The Chapel of the Four Chaplains in Philadelphia is dedicated to four World War II army chaplains who gave their life jackets to other men as the S.S. Dorchester was sinking, February 3, 1943.
Members of the department of neurol- ogy at the hospital of the University of Pennsylvania presented clinical and re- search papers at the annual meeting of the American Academy of Neurology in New Orleans. Faculty members who presented papers were: David Pleasure, MD; Francisco Gonzalez-Scarano, MD; Kenneth Fischbeck, MD; Michael Kushner, MD; Robert Lisak, MD; Donald Silberberg, MD; and Austin Sumner, MD.
The University of Pennsylvania School of Medicine’s Class of 1926 celebrated its 60th reunion in May. Francis Wood, MD, Haverford, vice president of the
Class of ’26, and Elizabeth Kirk Rose, MD, Kennett Square, secretary of the class, were among those who attended. Dr. Wood is former professor and chair- man of the department of medicine at University of Pennsylvania. Dr. Rose was chief of child and maternal health in the Philadelphia Department of Health.
Zalman S. Agus, MD, Cherry Hill, New Jersey, has been named a recipient of the Distinguished Service Award by the National Kidney Foundation. Dr. Agus is chief of the renal electrolyte section of the Hospital of the University of Penn- sylvania, and associate professor of medicine at the University of Pennsyl- vania School of Medicine.
Albert B. Ferguson Jr., MD, will be in- ducted in September as an honorary fel- low in Great Britain’s Royal College of Surgeons. Dr. Ferguson, who is chair- man and chief of the department of orthopaedic surgery at Presbyterian University Hospital of Pittsburgh, is one of 30 American surgeons who have received fellowship in this organization. Dr. Ferguson has served as president of the American Orthopaedic Association and the American Board of Ortho- paedic Surgery.
George L. Spaeth, MD, an ophthalmolo- gist from Philadelphia, received the 1986 Medal of Achievement and the Sir Stewart Duke-Elder Glaucoma Award, both from Lederle Laboratories of Wayne, New Jersey, during the Interna- tional Glaucoma Congress. Dr. Spaeth has established two research founda- tions for furthering studies in oph- thalmology. He serves as medical staff president at Wills Eye Hospital and at- tending eye surgeon at Chestnut Hill Hospital.
Joseph A. Ricci, MD, has been elected vice president of risk management and medical director of PH ICO Insurance Company. Dr. Ricci has served as chief of internal medicine at Holy Spirit Hos- pital, Camp Hill; chief of the depart- ment of hematology and oncology at Polyclinic Medical Center, Harrisburg, and associate clinical professor at the
Pennsylvania State University College of Medicine, Hershey.
A collection of porcelain sculptures of birds and flowers has been presented to Temple University School of Medicine in honor of Bernard J. Ronis, MD, pro- fessor emeritus and former chairman of the department of otorhinology. Helen F. Boehm, of the Edward Marshall Boehm Studios, Trenton, New Jersey, presented the collection of Boehm por- celain pieces, which included 19 wildlife sculptures and 18 sculptures of flowers.
Thomas J. Weida, MD, a Rothsville family physician, was appointed to serve a second term on the young physi- cians committee of the American Acad- emy of Family Physicians.
Archibald Laird, MD, has created and opened the Museum of Rotary in Wells- boro. It is the only Rotary museum in the United States, and its exhibits show the history of the United States through the use of Rotary organization banners. Dr. Laird, an ophthalmologist, has been a member of the Rotary for many years. While completing research for the museum. Dr. Laird collected ma- terial for four books, three of which have been published.
Dennis J. Bonner, MD, Summit Hill, served as grand marshal of the Summit Hill Memorial Day Parade. Dr. Bonner practiced medicine in that community for 40 years.
William T. Barnes, MD, State College, received the 1986 Alumni Association Award from his alma mater, Westmin- ster College in Fulton, Missouri. Dr. Barnes is a surgeon in private practice.
Vincent Ciacci, MD, was named Citizen of the Year by the Phoenixville Area Chamber of Commerce. Dr. Ciacci was honored for his 38 years of service to the community.
Berks County Medical Society recently honored five physicians for 50 years of service. They were: Harry Crystal, MD; Theodore W. Eastland, MD; Wilfred F. Heinbach, MD; John B. Levan, MD; and Leopold A. Potkonski, MD.
48 Pennsylvania Medicine, July 1986
(BRggg| THE BROWN PHARMACEUTICAL CO., INC.
2500 West Sixth Street, Los Angeles, CA 90057
For Full Prescribing Information, Please See PDR.
REFER TO
PDR
J\ndroid5 10 25
Methyltestosterone U.S.R Tablets
JVndroid/f
Fluoxymesterone U.S.R Tablets, 10m9
Do Not Substitute
2 mg 5 mg 10 mg
The One You Know Best
Are you writing only half a prescription for it?
Be sure to write a complete prescription.
Specify “Dispense as written” or “Do not substitute” or “Medically necessary.”
Roche Products Inc. Manati, Puerto Rico 00701
Will the doctors of tomorrow have the drugs of tomorrow?
Only if manufacturers of brand-name pharmaceuticals like Roche can continue to develop new products at a time when making them available is both unpredictable and expensive.
On the average, only one in 10,000 promising new com- pounds is ever introduced as a new product. And about $90 million is usually spent on that product before it’s available for your prescription. To follow up on discov- eries like Valium® (brand of diazepam/Roche), Roche is now spending, on a worldwide basis, about 20 cents of every sales dollar in up-front drug research and develop- ment. It’s our way of making sure that tomorrow’s drugs are available tomorrow.
Copyright © 1986 by Roche Products Inc All rights reserved
VALIUM
rdiazepam/Roche
y,. -x
2-mg 5-mg 10-mg
The One You Know Best
The cut out “V" design is a registered trademark of Roche Products Inc
Roche Products Inc. Manati, Puerto Rico 00701
LIBRARY
ACQUISITION 0 1 VI SI CM SERIALS UNIVERSITY OF CALIFORNIA SAN FRANCISCO CA 941430840
Will the doctors of tomorrow
Mr*
have the drugs of tomorrow?
Only if manufacturers of brand-name pharmaceu- ticals like Roche can continue to develop new products at a time when making them available is both unpredictable and expensive.
On the average, only one in 10,000 promising new compounds is ever introduced as a new product. And about $90 million is usually spent on that product before it’s available for your prescription. To follow up on discoveries like Valium® (brand of diazepam/Roche), Roche is now spending, on a worldwide basis, about 20 cents of every sales dollar in up-front drug research and development. It’s our way of making sure that tomorrow’s drugs are available tomorrow.
half a prescription for it?
Be sure to write a complete prescription. Specify “Dispense as written” or “Do not substitute” or “Medically necessary.”
VALttJM%
brand of /j — \ i
& & &
2-mg 5-mg 10-mg
The One You Know Best
The cut out "V design is a registered trademark of Roche Products Inc.
Roche Products Inc. Manati, Puerto Rico 00701
Copyright © 1986 by Roche Products Inc All rights reserved
Pennsylvania
Medicine
contents
August 1986 Volume 89, Number 8
Pennsylvania X Medicine jstsl
18 Official Call — 1986 House of Delegates
MEDICAL SOCIETY OFFICERS
42 Pennsylvania Medical Society 44 County Medical Societies 67 Medical Specialty Societies 170 Presidents of PMS
HEALTH CARE INFORMATION GUIDE
70 Pennsylvania Health Agencies 74 Organ Donation 74 Washington Information
PENNSYLVANIA MEDICINE
20 Erford Road
Lemoyne, Pennsylvania 17043 Telephone (717) 763-7151
PUBLICATION COMMITTEE
Ernest L Abernathy, MD, Chairman, Washington J Mostyn Davis, MD, Danville Jeannine R. Hahn, MD, King of Prussia John H, Hobart, MD, Easton James A Raub, MD, Sewickley
MEMBERSHIP DIRECTORY, 1986-87
77 Member specialty codes and statistics 79 Membership by county 171 Membership alphabetically
STAFF
David A. Smith, MD, Medical Editor Mary L Uehlein, Managing Editor Karen K Davis, Assistant Managing Editor Jean Beatty, Advertising Manager
DEPARTMENTS
17 Advertisers’ index 210 Classified advertising
Audit Bureau of Circulations
PENNSYLVANIA MEDICINE, established in 1897, is published monthly as the official publication of the Pennsylvania Medical Society, All editorial and advertising correspondence should be directed to the Managing Editor Subscription requests and changes of address should be sent to PENNSYLVANIA MEDICINE. 20 Erford Rd , Lemoyne, PA 17043 All material subject to this copyright may be photocopied only for noncommercial scientific or educational purposes. The opinions of authors do not necessarily represent the policy of the publisher. The appearance of advertising does not guarantee or endorse the claims of advertisers, A domestic subscription is $20 per year, foreign is $30 per year, single issues, except for special issues, are $3 00 Second class postage paid at Lemoyne, Pennsylvania 17043. (ISSN 0031-4595)
1986: Pennsylvania Medical Society
A HELPING HAND FOR THE TROUBLED PHYSICIAN
Alcoholism. Drug abuse. Mental and physical disability. The problems of aging. All take their toll on the medical community.
But there's help— through the Impaired Physician Program of the Pennsylvania Medical Society. The program offers peer support . . . referral to professional treatment agencies . . . and compassionate follow- up throughout the reha- bilitation process.
All efforts are voluntary and strictly confidential.
If you need help — or know someone who does call the Impaired
L
Physician Hotline: (717) 763-7937.
To learn more about the Impaired Physician Program, write: Impaired Physician Program. Pennsylvania Medical Society, 20 Erford Road. Lemoyne, PA 17043.
Member
PIPER NAVAJO TWIN-ENGINE AIRCRAFT COURTESY CHESTER COUNTY AVIATION
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We invite you to meet with a Centrum Account Executive at your convenience for a confidential interview. We’d like to discuss your
financial goals — and the most effective ways you can realize them.
To arrange an interview, contact Kenneth H. Rick, Vice President, Centrum Account Executive. In Pennsylvania call toll-free 1 -800-344-4446. Outside Pennsylvania call collect 21 5-320-3103.
Centrum. The power of total money management. A service of Meridian Asset Management, a Meridian Company.
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Professionals with the personal touch.
You know— perhaps firsthand— how treating a borderline patient can resemble a vicious circle.The harder you try to help, the more adamant, or even abusive, your patient becomes, until both of you are left frustrated and exhausted.
But how do you break the vicious circle? Changing therapists will only begin the cycle all over again. And a brief hospital stay usually produces only temporary improvement.
At Sheppard Pratt, our experience has shown that specialized inpatient treatment, coupled with the opportunity for longer hospital stay, may be the only effective way to attack the vicious circle at its very beginning: to root out and resolve the deep-seated problems underlying the patient’s longstanding difficulties.
The Personality Disorder Program at Sheppard Pratt is designed to provide such long-term care. Our objective is to bring about lasting improvement in patients with personality disorders.
The process is not easy. Serious personality disorders do not lend themselves to a “quick fix.” But we are encouraged by the number of our patients who have, in time, broken out of the vicious circle.
If you would like to know more about the Sheppard Pratt approach to the borderline patient and other patients with severe personality dis- orders, contact Dr. Barry Rudnick, Admissions Officer, (301)823-8200. Sheppard and Enoch Pratt Hospital, PO. Box 6815, Baltimore, MD 21204.
SHEPPARD & ENOCH PRATT A COMPREHENSIVE CENTER FOR TREATMENT. EDUCATION AND RESEARCH
A moment
in country living.
If you are longing for a country place, where the pace is leisurely and the surroundings glorious, consider own- ership of vacation property at The Nemacolin Woodlands. You'll discover gracious country living in our custom-designed townhomes, villas, private residences and estate home sites along the golf course fairways. Ownership includes accessibility to all of Nemacolin's amenities, use of resort facilities and optional participa- tion in a unique rental management program. Experience the glories of The Nemacolin Woodlands with a personal tour of our resort property. Attractive financing is avail- able.
To receive our Real Estate Portfolio or to arrange your V.I.P. Tour including complimentary luncheon phone William S. Watts, V.P. Real Estate.
Call Collect 412/329-8555
Where amenities abound. . .
The Nemacolin Woodlands is a classic country resort community offering a charming inn, fine dining in two grand restaurants, an 18-hole golf course, tennis courts, two heated swimming pools, superior trout fishing, cross country ski trails, 24-hour security and a private landing strip on over 2,000 acres of prime mountain property.
A Legendary County Inn and Resort Community 60 miles southeast of Pittsburgh in Pennsylvania's Laurel Highlands U.S. Route 40, Farmington, Pennsylvania 15437 • 412/329-8555
To
dull the point of
moderate
to
nodeiately
severe
pain...
hydrocodone bitartrate 5 mg (Warning: May be habit forming.) with acetaminophen 500 mg
Brief Summary
INDICATIONS AND USAGE: For the relief of moderate to moderately severe pain CONTRAINDICATIONS: Hypersensitivity to acetaminophen or hydrocodone
WARNINGS
Drug Abuse and Dependence: VICODIN is subject to the Federal Controlled Substances Act (Schedule III) Psychic dependence, physical dependence and tolerance may develop upon repeated administration of narcot- ics, therefore, VICODIN should be prescribed and administered with the same caution appropriate to the use of other oral-narcotic-containing medications.
Respiratory Depression: At high doses or in sensitive patients, hydrocodone may produce dose-related respira- tory depression by acting directly on brain stem respiratory centers. Hydrocodone also affects centers that control respiratory rhythm, and may produce irregular and periodic breathing
Head Injury and Increased Intracranial Pressure: The respiratory depressant effects ot narcotics and their ca- pacity to elevate cerebrospinal fluid pressure may be markedly exaggerated in the presence of head injury, other intracranial lesions or a preexisting increase in intracranial pressure Furthermore, narcotics produce adverse reactions which may obscure the clinical course ot patients with heod injuries
Acute Abdominal Conditions: The administration of narcotics may obscure the diagnosis or clinical course of patients with ocute abdominal conditions,
PRECAUTIONS
Special Risk Patients: VICODIN should be used with caution in elderly or debilitated patients and those with severe impairment ot hepatic or renal function, hypothyroidism, Addison's disease prostatic hypertrophy or urethral stricture
Information For Potients: VICODIN, like oil narcotics, may impair the mental and/or physical abilities required for the performance ot potentially hazardous tasks such as driving a car or operating machinery patients should be cautioned accordingly
Cough Reflex: Hydrocodone suppresses the cough reflex, caution should be exercised when VICODIN is used postoperatively and in potients with pulmonary disease
Drug Interactions: The CNS-depressant effects of VICODIN may be additive with that of other CNS depressants When combined therapy is contemplated, the dose of one or both ogents should be reduced The use of MAO inhibitors or tricyclic antidepressants with hydrocodone preparations may increase the effect ot either the antide- pressant or hydrocodone The concurrent use ot anticholinergics with hydrocodone may produce paralytic ileus Usage in Pregnancy: Pregnancy Category C Hydrocodone nas been shown to be teratogenic in hamsters when 5725
given in doses 700 times the human dose There ore no adequate and well-controlled studies in pregnant women VICODIN should be used during pregnancy only it the potential benefit justifies the potential risk to the
Nonteratogenic Effects: Babies born to mothers who have been taking opioids regularly prior to delivery will be physically dependent The intensity of the syndrome does not always correlate with the duration of maternal opioid use or dose
Labor and Delivery: Administration of VICODIN to the mother shortly before delivery may result in some deqree of respiratory depression in the newborn, especially it higher doses are used
Nursing Mothers: it is not known whether this drug is excreted in human milk, therefore, a decision should be made whether to discontinue nursing or to discontinue the drug, taking into account the importance ot the drua to the mother s
Pediatric Use: Safety and effectiveness in children have not been established
ADVERSE REACTIONS
Central Nervous System: Sedation, drowsiness, mental clouding, lethargy, impairment ot mental and physical pedormance, anxiety, fear, dysphoria, dizziness, psychic dependence, mood changes Gastrointestinal System: Nausea and vomiting may occur, they are more frequent in ambulatory than in recum- bent patients Prolonged administration of VICODIN may produce constipation Genitourinary System: Ureteral spasm, spasm of vesicol sphincters and urinary retention have been reported Respiratory Depression: (See WARNINGS )
DOSAGE AND ADMINISTRATION: Dosage should be adjusted according to the severity of the pain and the response of the patient However, tolerance to hydrocodone con develop with continued use and the incidence ot untoward effects is dose related
The usual dose is one tablet every six hours as needed lor pain (It necessary, this dose may be repeated at tour- hour intervals ) In cases ot more severe pain, two tablets every six hours (up to eight tablets in 24 hours) may be required Revised, April 1982
a
_ KNOLL PHARMACEUTICAL COMPANY
knoll 30 NORTH JEFFERSON ROAD, WHIPPANY, NEW JERSEY 07981
February, 1985
One third of your elderly patients suffer from drug
misuse
With your help, we can prevent adverse drug reactions and noncompliance through use of the Senior Citizen Medication Passport. In all, 1,000,000 copies of the Medi- cation Passport have been distributed to Pennsylvania pharmacies and will be used by many of your patients. They will, in turn, look to you for help in recording their prescriptions and over-the-counter drugs. Through the Medication Passport and a statewide drug education program now underway, we can offer our senior citizens a Passport to better health. For a copy of the Medication Passport, contact the Direc- tor of Professional Service & Review, Pennsylvania Blue Shield, Camp Hill, PA 17011.
he Medication Passport is sponsored by the Pennsylvania Department of Aging, the Pennsylvania Pharmaceutical Association and Pennsylvania’s Blue Cross and Blue Shield Plans.
BILUNG
HEADACHES?
Take two aspirins, and call ABC in the morning.
Advanced Billing Concepts offers complete relief for billing headaches for all medical specialties — anesthesia . radiology, pathology, emergency room medicine, and general medicine specialties.
ABC's senior management team has more than 35 years of combined hands-on experience in medical group practice bill- ing. so we understand your business and we talk your language. Just tell us how you want things handled and we do the
rest, working as an extension of your staff. We even provide management reports to help your practice prosper.
ABC has earned a solid reputation among physicians for its professionalism. But you don’t have to take our word for it. We'll put you in touch with any of our clients, and they'll tell you we're accurate, thorough, and effective.
Why wait until morning? Call ABC right now.
If ll
_T i
r am
r M v a\
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^1
■■I 11
i mmr ik
i
i i
ij
ADVANCED BILLING CONCEPTS, INC.
250 Mt. Lebanon Boulevard — Suite 310 Pittsburgh. PA 15234 Telephone: 412/571 3750
CHALLENGE...
Injuries and illnesses bring about many challenges. People meet those challenges through comprehensive rehabilitation.
Reading Rehabilitation Hospital...
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Reading Rehabilitation Hospital...
located 3 miles from Reading in the wooded beauty of south central Pennsylvania.
For a free information packet, please contact Rae Patterson at (215) 777-7615 ext. 309.
An 8-hour workshop, sponsored by The Pennsylvania State University College of Bus- iness Administration and College of Medicine.
THERE ARE NO MIRACLES is one of a series of financial planning seminars and workshops offered as an educational service to members of the medical com- munity and their spouses.
WILLIAM P. BROWN, D.O., East Shore Surgical Associates, PC., Harrisburg, PA has stated, “In the final analysis, you are responsible for your finan- cial decisions - invest some time to help you make better decisions.’’
GUIDO D. BORIOSI, M.D., PC., Scranton, PA maintains, “New ideas and new techniques are as impor- tant in the financial world as they are in the medical community, here are some new ideas.’’
J THERE ARE NO MIRACLES answers questions about our changing tax laws.
Financial Logic: Provides evaluation techniques to use to determine your individual tax position under our changing tax structure; methods to use to differentiate between abusive and creative tax strategies.
J THERE ARE NO MIRACLES addresses the variety of pension plans available. If you've questioned your present plan, the seminar will show you how you can plan retirement benefites to be an extension of your pre- sent financial goals and objectives.
S^QIMAINltSP
J THERE ARE NO MIRACLES explains the oppor tunities of incorporation. You should be aware of techniques that can create one of the most flexible tools for the accumulation of wealth available to professionals today.
Watch the mail for your invitation. Seminars are scheduled for:
HARRISBURG - Penn Harris Inn and Convention Center October 1, 1986.
P0C0N0S - The Galleria at Split Rock Resort October 2, 1986.
PHILADELPHIA - The Sheraton at Valley Forge October 8, 1986.
PITTSBURGH - The Monroeville Marriott October 22, 1986.
Guest speaker: Richard F. DeFluri,
Pennsylvania Financial Group.
For further information on the seminar programs please contact:
Melinda G. Harr
The Pennsylvania Financial Group, Inc.
PO. Box 259, State College, Pa., 16804 (814) 238-0544.
Pennsylvania Medicine, August 1986 9
A COMPREHENSIVE GUIDE TO THE HEALTH-CARE COMMUNITY
DORLAND’S
MEDICAL DIRECTORY
Delaware Valley Western Pennsylvania and Tri-State Area
Dorland's Medical Directory offers a comprehensive profile of the health-care community by providing the information, separated by tabbed pages for easy reference. Dorland's, whose goal is to increase re- ferrals and utilization of health care facilities, has a subscriber base of thousands of health- care professionals.
In Dorland's you will find.
Listings for thousands of Medical Doctors and Doctors of Osteopathy. This information is submitted by the physicians themselves and is updated an- nually. Listing information in- cludes each doctors specialties and level of certification, hosp- ital staff affiliations, medical school, year of graduation, of- fice and home addresses with phone numbers.
Specialists area listing the phy- sicians by primary and secon- dary specialties.
Paula G. McWilliams
IWllOlltl) IWSSi
a subsidiary of BASIX Corporation
Publishing Division 718 Fifth Avenue
Please send me.
.copy(ies) of
the 1987 Dorland's Medical Direc- tory at the special pre-publication price of $19.95 for:
Pittsburgh, PA. 1521 (412) 391-2428
9
(800) 722
!-2447 outside
PA
(800) 722
'-7800 in PA
-Western PA. tk Tri-State Area
($40.00 plus $2.40 PA Sales Tax after October publication)
Delaware Valley Area
($40.00 plus $2.70 PA Sales Tax after November publication)
All orders under $100.00 must be pre-paid.
Enclosed is my payment
Bill my
MC
Visa
Hospital and Health Care Or- ganizations section highlight- ing the administration, staff members by medical depart- ment, facilities, bed capacities, and accredited programs of the participating area hospitals and health-care organizations.
Special Services Guide
featuring services within the medical community including special treatment facilities, nurs- ing services, durable medical equipment, rehabilitation facilities, laboratories, and many other headings.
Other features including a pur- chasing guide and an index of physicians.
ORGANIZATION
CITY-STATE-ZIP
( ).
Card No
Expiration
Signature
There is a growing gap in our health care system. It is the gap between the ability to save and prolong lives and the capacity to regenerate them— physically, socially and emotionally.
Today approximately 20% of trauma victims leave an acute care hospital with a major functional disability.
As America’s largest provider of inpatient and outpatient rehabilitative care, Rehab Hospital Services Corporation is helping to bridge this Re Generation Gap.
Since 1971 when our first hospital opened in Mechanicsburg, Pennsylvania, RHSC has grown into a
nationwide system of fourteen rehabilitation hospitals and over ten more under development.
Presently we operate six hospitals in
HOSPITALS
Mechanicsburg Rehab Hospital Rehabilitation Hospital of Altoona Great Lakes Rehabilitation Hospital Lake Erie Institute of Rehabilitation Rehab Hospital of Nittany Valley Rehab Hospital of York Greater Pittsburgh Rehab Hospital (under construction)
Pennsylvania providing Comprehensive Medical Rehabilitation, and will open one more this year.
LOCATION
Mechanicsburg, PA Altoona, PA Erie, PA Erie, PA Bellefonte, PA York, PA
Monroeville, PA
For more information on any of our facilities, or for referral information, call: Rehab Hospital Services Corporation: 1-800-654-6331
Rehab Hospital Services Corporation
Marworth Treatment Center:
Caring for the alcoholic and chemically dependent patient in the Geisinger tradition of quality
t MARWORTH ]
A Geisinger Affiliate
Waverly, PA 18471
(717) 563-1112
In Pennsylvania, Theo-Dur is the only oral theophylline that delivers an essentiall equal dose every hour.
But only if you say so.
u -‘O0
o?^c\G^
The only zero-order oral theophylline.
THEO-DUR
(theophylline anhydrous)
Please see next page for brief summary of prescribing information.
Sustained
Action
Tablets
THEO-DUR
(theophylline anhydrous) H“
Today’s most widely prescribed bronchodilator.
Oescrlplion: THEO-DUR sustained action tablets contain anhydrous theophylline, a bronchodilator, in a sustained release formulation (with no color additives) which allows a 12-hour dosing interval for a maiority of patients and a 24-hour dosing interval for selected patients
Clinical Pharmacology: Theophylline directly relaxes the smooth muscle of the bronchial airways and pulmonary blood vessels, thus acting mainly as a bronchodilator and smooth muscle relaxant The drug also produces other actions typical of the xanthine derivatives coronary vasodilator, cardiac stimulant, diuretic, cerebral stimulant and skeletal muscle stimulant The actions of theophylline may be mediated through inhibition of phosphodiesterase and a resultant increase in intracellular cyclic AMP Apparently, no development of tolerance occurs with chronic use of theophylline.
Indications: THEO-DUR is indicated for relief and/or prevention of symptoms of bronchial asthma and for reversible bronchospasm associated with chronic bronchitis and emphysema Contraindications: THEO-DUR is contraindicated in individuals who have shown hypersensitivity to theophylline or any of the tablet components
Warnings: Excessive theophylline doses may be associated with toxicity: serum theophylline levels should be monitored to insure maximum benefit with minimum risk Incidence of toxicity increases at serum levels greater than 20 mcg/ml High blood levels of theophylline resulting from conventional doses are correlated with clinical manifestation of toxicity in patients with lowered body plasma clearances, patients with liver dysfunction or chronic obstructive lung disease, and patients who are older than 55 years of age, particularly males There are often no early signs of less serious theophylline toxicity such as nausea and restlessness, which may occur in up to 50% of patients prior to onset of convulsions Ventricular arrhythmias or seizures may be the first signs of toxicity. Many patients who have higher theophylline levels exhibit tachycardia. Theophylline products may worsen pre-existing arrhythmias Precautions: THEO-OUR TABLETS SHOULD NOT BE CHEWED OR CRUSHED Theophylline should not be administered concurrently with other xanthine medications. Use with caution in patients with severe cardiac disease, severe hypoxemia, hypertension, hyperthyroidism, acute myocardial injury, cor pulmonale, congestive heart failure, liver disease, in the elderly (especially males) and in neonates In particular, great caution should be used in giving theophylline to patients with congestive heart failure Frequently, such patients have markedly prolonged theophylline serum levels with theophylline persisting in serum for long periods following discontinuation of the drug Use theophylline cautiously in patients with history of peptic ulcer. Theophylline may occasionally act as a local irritant to the G I tract although gastrointestinal symptoms are more commonly centrally mediated and associated with serum drug concentrations over 20 mcg/ml Individuals who are rapid metabolizers of theophylline, such as the young, smokers, and some non-smoking adults, may not be suitable candidates for once-daily dosing These individuals will generally need fo be dosed at 12 hourly or sometimes 8 hourly intervals. Such patients may exhibit symptoms of bronchospasm near the end of a dosing interval, or may have wider peak to-trouqh differences than desired.
Usage in Pregnancy: Animal reproduction studies have not been conducted with theophylline. It is not known whether theophylline can cause fetal harm when administered to a pregnant woman or can affect reproduction capacity. Xanthines should be given to a pregnant woman only if clearly needed Nursing Mothers: It has been reported that theophylline distributes readily into breast milk and may cause adverse effects in the infant Caution must be used if prescribing xanthines to a mother who is nursing, taking into account the risk-benefit of this therapy.
Pediatric Use: Safety and effectiveness of THEO-DUR administered every 24 hours in children under 12 years of age. and every 12 hours in children under 6 years of age, have not been established Adverse Reactions: The most consistent adverse reactions are usually due to overdose and are.
Gastrointestinal: nausea, vomiting, epigastric pain, hematemesis diarrhea
Central nervous system headaches, irritability, restlessness, insomnia, reflex hyperexcitability, muscle twitching, clonic and tonic generalized convulsions
Cardiovascular: palpitation, tachycardia, extrasystoles flushing hypotension, circulatory failure, ventricular arrhythmias Respiratory: tachypnea
Renal albuminuria, increased excretion of renal tubular and red blood cells, potentiation of diuresis Others: rash, hyperglycemia and inappropriate ADH syndrome How Supplied: THEO-DUR 100 mg, 200 mg and 300 mg sustained action tablets are available in bottles of 100, 500, 1000 and 5000 and in unit dose packages of 100.
Caution: Federal law prohibits dispensing without prescription.
For full prescribing information, see package insert
Revised 12/83
PHYSICIANS
U.S. NAVY MEDICAL CORPS
Positions are now available in the following areas: General Surgery • Neurosurgery • Thoracic Surgery •
OB/GYN • Pediatrics • Otolaryngology
• Preventive/Occupational Medicine
• Psychiatry • Diagnostic Radiology
• Critical Care • Neurology
NAVY MEDICINE
— provides the qualified physician with the opportunity to become a member of the global health care system
is practiced in excellent medical facilities in conjunction with a highly professional staff of support personnel —is characterized by a broad spectrum of patient age and case diversity —allows extensive experience in all aspects of medicine including teaching, research, without career disruption
—provides the physician with an officer's commission with attendant benefits and privileges
Basic Qualifications: Include U.S. citizenship, graduate of an American Medical or Osteopathic School, Board eligible or Board certified, and excellent professional references.
For complete details call or send Curriculum Vitae to: LT Mike Jewett MSC Medical Programs Officer, 310 North Second Street, Harrisburg Pa 17101-1304, (717) 782-3983 or 3985
BE THE DOCTOR YOU WANT TO BE. IN THE NAV'
Do you know someone who needs nursing care in their home? _
We have a special person to take care of your
Are your patients entitled and/or eligible for ^ I I I Medicare benefits? If you are not sure call MEDI-
CAL PERSONNEL POOL and we will help you get the answer. Bear in mind that a person need not /\1% be a Social Security recipient or over 65 to re-
1 WM 1 ^ ceive Medicare services People who are dis-
abled for 2 years or more are eligible, as are peo- pie who are in dialysis for 6 months or longer MEDICAL PERSONNEL POOL provides a full Vi|[|V range of HOME HEALTH SERVICES, as well as
VIIIIR/ PnV3te dUty nursing We Provide most of these
services in the home as well as in the hospital and nursing home
Medical Personnel Pool .
/Is)/ Key Pharmaceuticals, Inc.
Miami, Florida 33137
KY TD-1398
‘Allentown 434-7277 Harrisburg 233-2444
^^edii
Lebanon 272-5214 Monroeville 824-6730
•Philadelphia 663-0700 •Pittsburgh 683-2227 •Reading 372-4611
•Medicare Certified Home Health Agency
THE BROWN PHARMACEUTICAL CO., INC.
2500 West Sixth Street, Los Angeles, CA 90057
For Full Prescribing Information, Please See PDR.
REFER TO
PDR
Android 5 10 25
Methyltestosterone U.S.R Tablets
Android/f
Fluoxymesterone U.S.R Tablets, 10
dvertisers’ index
CMA.
214
dvanced Billing Concepts 8
lexander Agency 43
Ifa Romeo 45
llegheny General Hospital 44
Jlied Services 61
ff&T 59
tyerst Laboratories 33-36
ertholon Rowland Agencies 65
randywme Hospital 48
irown Pharmaceuticals 16, 58
ampbeil Laboratories 24
aron Foundation 26
asualty Reciprocal Exchange 51
ellular One Car Phones 69
hildren's Hospital of Philadelphia 38
rozer Chester Medical Center 22
Jelaware County Memorial Hospital 21
lorland's Medical Directory 10
).T. Watson Rehabilitation Hospital 71
ducational and Scientific Trust 70
Elcomp Systems 57
Eli Lilly Company 52
Emergency Physician Associates 213
Geisinger Continuing Education 73
Geisinger Lithotripter 72
Harmarville Rehabilitation 75
Healthcare Communications 46
Health Care Group 63
Health Care Personnel Consulting 211, 213
HealthSearch 213
Jeanes Health System 20
Jefferson Medical College 28
John A. Neidel 18
John Downing Associates 55, 211
Key Pharmaceuticals 13, 14
Keystone Technologies 49
Knoll Pharmaceuticals 6
Lake Erie Institute of Rehabilitation 76
Malachy Whalen and Company 47
Marion Laboratories 53, 54
Marworth 12
Medical Personnel Pool 14
Medical Protective Company 56
Medlab 48
Meridian Asset Management 3
Milton S. Hershey Medical Center 30
Monongahela Valley Hospital 41
NEEMA Medical Services 210
Neilson Computer Systems 64
Nemacolin Woodlands 5
Neuro-Otology Group 60
Norrell Health Care 17
OR-D Systems 62
Pennsylvania Blue Shield 7
Pennsylvania Diabetes Academy 39
Pennsylvania Financial Group 9
Pennsylvania Hand Center 40
Pennsylvania Sperm Bank 214
Physicians Cincinnatus Society 19
Physician Support Systems 40
PMS Committee on Impaired Physician 2
PMS Liability Insurance Company 27
Professional Practice Consulting 60
Provident Mutual 29
Reading Rehabilitation Hospital 9
Rehabilitation Hospital Services Corporation 11
Rehabilitation Institute of Pittsburgh 31
Roche Laboratories 1, covers 2, 3, 4
Sacred Heart Hospital 37
Shared Medical Systems 66
Sheppard Enoch Pratt Hospital 4
Small Computer Company 32
St. Christopher's Hospital for Children 23
St. Francis Medical Center 25
Stuart Pharmaceuticals 211
Suburban Health Foundation 66
Thrift Drug 78
Toftrees Resort 213
Upjohn Company 15
U.S. Air Force 50
U S. Army 74, 212
U.S. Navy 14
Westmoreland Hospital 211
West Park Hospital 30
STOP INVESTING IN OIL AND GAS! INVEST IN HOME
HEALTH CARE
Norrell Health Care is a wholly owned sub- sidiary of Norrell Corporation, an Atlanta based $250 million service organization founded in 1961.
Home Health Care is the fastest growing seg- ment of the health care industry. What could be a wiser investment of your money??
Through Norrell’s Agency Program, you can provide home care and supplemental staffing services in your community.
If you would like more information regarding the financial rewards of this unique business opportunity . . . please call:
Ms. Barbara Totten 1-800-233-6297
(9am-5pm Eastern Standard Time) or write:
Norrell Health Care Agency Program Development 3092 Piedmont Road, N.E.
Atlanta, GA 30305 § lOllvll
HEALTH CARE
Official Call to 1986 Meeting PMS House of Delegates
The 1986 annual meeting of the House of Delegates of the Pennsylvania Medical Society will be called to order at the Hilton Hotel, Pittsburgh, Penn- sylvania, on Friday, October 17, 1986, at 10 a.m. The second session of the House of Delegates is scheduled for Saturday, October 18, 1986, at 1 p.m. The third and concluding session of the House of Delegates will be held Sunday, October 19, 1986, at 9:30 a.m.
Elections
In accordance with Chapter XIII, Section 1 of the bylaws of the Pennsyl- vania Medical Society, the following nominations and/or elections will be in order at the second session, Saturday afternoon, October 18, 1986.
General officers to be elected are a vice president, a speaker of the House of Delegates, and a vice speaker of the House of Delegates.
In accordance with Chapter XV, Sec- tion 5 of the bylaws, elections will be in order for a trustee for the First District
to serve three (3) years to succeed John Helwig Jr., MD, Philadelphia County, who is eligible for reelection; a trustee for the Third District to serve three (3) years to succeed John H. Hobart, MD, Northampton County, who is eligible for reelection; a trustee for the Eighth Dis- trict to serve three (3) years to succeed Robert N. Moyers, MD, Crawford County, who is eligible for reelection; a trustee for the Ninth District to serve three (3) years to succeed David L. Miller, MD, Clarion County, who is eligi- ble for reelection; and a medical student trustee to serve two (2) years to succeed Ann K. Messersmith, who is not eligible for reelection.
In accordance with Chapter XI, Sec- tion 1 of the bylaws, elections for dele- gates and alternate delegates to the American Medical Association are in or- der. In accordance with Standing Rule Number 10 (adopted October 22, 1982), elections for delegates will be held on Saturday afternoon, October 18, 1986, and elections for alternate delegates
will be held on Sunday morning, Octo ber 19, 1986. Delegates whose terms ex pire December 31, 1986 are:
1. R. William Alexander, MD (Berk: County)
2. Betty L. Cottle, MD (Blai) County)
3. James B. Donaldson, MD (Phila delphia County)
4. Raymond C. Grandon, MD (Dau phin County)
5. William J. Kelly, MD (Alleghenj County)
6. Michael P. Levis, MD (Alleghenj County)
7. Donald E. Parlee, MD (Bucks County)
8. Irving Williams III, MD (Unior County)
The Committee to Nominate Dele- gates and Alternates to the AMA makes the following nominations for eight (8) delegates for two (2) year terms] commencing January 1, 1987:
1. R. William Alexander, MD (Berks County)
2. Doris G. Bartuska, MD (Philadel- phia County)
3. Betty L. Cottle, MD (Blair County)
4. Raymond C. Grandon, MD (Dau- phin County)
5. William J. Kelly, MD (Allegheny County)
6. Michael P. Levis, MD (Allegheny I County)
7. Donald E. Parlee, MD (Bucks I County)
8. Jonathan E. Rhoads Jr., MD (York County)
9. Irving Williams III, MD (Union County)
The Committee to Nominate Dele- gates and Alternates to the AMA makes the following nomination for del- egate for a partial term commencing October 19, 1986, and expiring Decem- ber 31, 1987:
1. Donald C. Brown, MD (Westmore- land County)
The Committee to Nominate Dele- gates and Alternates to the AMA makes the following nominations for delegate for a one-year term commenc- ing January 1, 1987 and expiring De- cember 31, 1987:
1. William H. Mahood, MD (Mont- gomery County)
We specialize in real estate investments having large cash returns to investors.
Bj
• k v y
Ml ~ - ixmwr rl
John A. Neidel
and Company
105 North Front Street P.O. Box 462 Harrisburg, PA 17108
Member: NASD &SIPC Call for more information
717-238-2548
1-800-242-3470
18 Pennsylvania Medicine, August 1986
The Physicians’
Cincinnatus Society
Invites you to join the struggle for our professional sur- vival. The Society is dedicated to protect your constitu- tional rights. Presently, physicians in Pennsylvania can be priced out of insurance and, if unable to buy the mandated amount of insurance, will have their license revoked without any due process whatsoever. We intend to challenge Act 111, Article VII, Section 701, in Federal Court. We are in- corporated and operational. Join us now. Safeguard medicine and your future.
The Physicians’ Cincinnatus Society takes its name from the legendary hero of ancient Rome, Lucius Quintius Cincinnatus. In 1783, the commissioned officers of the Continental Army founded The Society of the Cincinnati, named after Cincinnatus. These officers of the Con- tinental Army knew the difficulties they encountered in organizing in the beginning of the Revolution. For that reason they wanted an organization in place so that they could respond quickly in time of need and, like Cincinnatus, do the job and return to their private lives. In 1986, we founded The Physicians’ Cincinnatus Society, a nonpartisan organization dedicated to the defense of the constitutional rights of individual physicians and physicians collectively as they relate to their professional lives and to the practice of medicine in general. The Socie- ty shall remain a dues-collecting organization even during dormant, nonthreatening periods and thus remain able to respond at any time. Its first and foremost task, however, shall be to restore the constitutional rights and due process for physicians in Pennsylvania. Each member shall join by paying $100.00 in dues. The monies thus collected will be used to immediately engage legal counsel to file suit in Federal Court against Act 111. Annual dues will be $100.00, a small price to pay to safeguard your constitutional rights. The Society’s counsel and Board will evaluate every case presented to it and, if found to have merit, the case will be challenged in the courts as long as there are funds available. The Physicians’ Cincinnatus Society does not replace existing medical societies. It will work closely with them. The PCS, because of its singular purpose and nonpartisan nature, sees its greatest usefulness in dealing with pro- blems in areas in which multi-purpose medical societies are ineffective or unable to act because of internal or regional politics.
Application for Membership THE PHYSICIANS’ CINCINNATUS SOCIETY P.O. Box 1724
Norristown, Pennsylvania 19404
Name:
Address:
Specialty:
Date of Birth:
Amount of Dues Enclosed:
Degree:
Act now and safeguard medicine and your future.
Pennsylvania Medicine, August 1986 19
September
October
November
December
JEANES HOSPITAL
Department of Medicine Conference Schedule
Fall 1986
3
9 a.m.
Clinical Rounds: Rheumatology— Management of Rheumatoid Arthritis Robert P. Jacobs, M.D.
Chairman, Department of Medicine
3
12:15 p.m.
CME Conference: Current Clinical Applications of Magnetic Resonance Imaging Evan Unger, M.D.
Section Chief, Clinical Magnetic Resonance Imaging
10
9 a.m.
Clinical Rounds: Hematology — Autoimmune Hemolytic Anemia Dennis B. Cornfield, M.D.
Division Chief
17
9 a.m.
Morbidity & Mortality/Business Meeting
24
9 a.m.
Tumor Conference
24
12:15 p.m.
Medical Office Practice Round Table
1
9 a.m.
Clinical Pathology Conference
1
12:15 p.m.
CME Conference: Breast and Colorectal Cancer Screening Programs Speaker to be announced
8
9 a.m.
Clinical Rounds: Pulmonary — Cardiopulmonary Stress Testing
Daniel Draper
Product Manager, Gould Electronics
15
8 a.m.
Pediatric Annual Symposium:
Immunization Update
Sarah Long, M.D.
Chief of Infectious Diseases, St. Christopher ’s Hospital Associate Professor of Pediatrics, Temple University Headaches
Peter H. Berman, M.D.
Chief of Division of Neurology, Children ’s Hospital Unusual Verdicts on the “Bad Baby” Cases James Griffith, Esq.
Senior Partner, Griffith & Burr, PC.
Financial Aspects of health Care Joseph A. Pacera
Vice President, Program of Development/Marketing, Osteopathic Medical Center of Pennsylvania
22
9 a.m.
Tumor Conference/Business Meeting
22
12:15 p.
m.
Medical Office Practice Round Table
29
9 a.m.
Clinical Rounds: Infectious Diseases — Common Zoonoses Israel Lichtenstein, M.D.
Division Chief
5
9 a.m.
Clinical Rounds: Gastroenterology — Malabsorption Syndrome Stephen A. Matarazzo, M.D.
Division Chief
5
12:15 p.
m.
CME Conference: Ultrasound, CT and MR Imaging of Pelvic Pathology Michael Clair, M.D.
Division Chief, Ultrasound
12
9 a.m.
Clinical Rounds: Neurology — Guillain-Barre Syndrome Update
Marcia Halpern, M.D., Paul M. Shipkin, M.D.
Division Chief
19
9 a.m.
Morbidity & Mortality/Business Meeting
26
9 a.m.
Tumor Conference
26
12:15 p.
m.
Medical Office Practice Round Table
3
9 a.m.
Clinical Pathology Conference
3
12:15 p.
m.
CME Conference: Silent Ischemia and Mixed Angina
Albert Brest, M.D.
Chief of Cardiology, Thomas Jefferson Hospital
10
9 a.m.
Clinical Rounds: Cardiology — Cardiomyopathies
Kevin Robinson, M.D.
17
9 a.m.
Morbidity & Mortality/Business Meeting
24
9 a.m.
Cancelled
24
12:15 p.
m.
Cancelled
31
9 a.m.
Cancelled
All programs are scheduled for one hour and held in Stapeley Building 1A. One hour of Category 1 CME credit per conference.
For more information please call 728-3798.
Jeanes Hospital, 7600 Central Avenue, Philadelphia, PA 19111
“Its that special iend of sensitivity and
technology that makes
DCMH
a doctor’s kind of hospital.’’
“You feel the difference when you walk in the door. Delaware County Memorial Hospital is a place where you want to practice medicine.
“They've got all the high-tech capability, of course. Including the only Osteoporosis Detection Center in Delaware County. But it’s more than equipment. It’s a point of view.
“At DCMH, everything is geared toward comfort and conveni- ence. The rooms are large and bright. The staff is professional, loyal and proud. In fact, over 40% of DCMH employees have worked at the hospital for over 5 years. A simple idea governs: quality care, delivered efficiently and with compassion. “Delaware County Memorial Hospital. It’s that special blend of sensitivity and technology that makes DCMH a doctor’s kind of hospital.”
DCMH
Official Call
2. Timothy J. Michals, MD (Philadel- phia County)
Alternate delegates whose terms ex- pire December 31, 1986, are:
1. Charles A. Heisterkamp III, MD (Lancaster County)
2. Robert L. Lasher, MD (Erie County)
3. Gordon K. MacLeod, MD (Alle- gheny County)
4. William H. Mahood, MD (Mont- gomery County)
5. Timothy J. Michals, MD (Philadel- phia County)
6. John S. Parker, MD (Westmore- land County)
7. Jonathan E. Rhoads Jr., MD (York County)
8. Howard A. Richter, MD (Delaware County)
The Committee to Nominate Dele- gates and Alternates to the AMA makes the following nominations for eight (8) alternate delegates for two (2) year terms commencing January 1, 1987, and two (2) alternate delegates for partial terms commencing October 19, 1986, and expiring December 31, 1987.
1. Susan H. Bray, MD (Philadelphia County)
Coronary Care Respiratory Therapy Sports Medicine Center Kidney Dialysis Radiology Maternity
Low Back Pain Center Heart Catheterization Burn Treatment Center Physical Medicine and Rehabilitation Voice of Help Ostomy Management Outpatient Surgery Emergency Care Sleep Disorders Center Community Mental Health Neonatology Trauma Center Cardiac Rehabilitation Mobile Intensive Care Adult Day Care Cancer Therapy
Great hospitals have great services . . . and more of them, too.
Whether you are new to Delaware County or a long-time resident you can take advantage of our extensive range of health care services — as an outpatient, or, when recommended, as an inpatient. We have 400 physicians in the special- ties listed above; 45-50 residents and over 2,200 nurses, technicians and em- ployees and. most importantly, 400+ hospital beds. In addition to the medical center on our 65 acre campus in the Upland Borough, we maintain 2 advance life support stations and a Community Mental Health Center. With health care that is unparalleled in our region, is it any wonder that we make the claim that we have great services (and more of them than most hospitals)? Crozer-Chester Medical Center — the most comprehensive source of health care in Delaware County.
CROZER-CHESTER MEDICAL CENTER
15th Street & Upland Avenue • Upland, Chester, PA 19013 (215) 447-2000
2. Victor E Greco, MD (Luzerne County)
3. Charles A. Heisterkamp III, MDi (Lancaster County)
4. William F. Lamberton, MD (Erie County)
5. Robert L. Lasher, MD (Erie County)
6. Gordon K. MacLeod, MD (Alle- gheny County)
7. John S. Parker, MD (Westmore-S land County)
8. Michael J. Prendergast, MD (York County)
9. Howard A. Richter, MD (Dela ware County)
10. Luis E. Sala, MD (Philadelphia County)
11. Cynthia Altman Weinstein, MD (Philadelphia County)
Also to be elected will be one member to serve on the Committee to Nominate Delegates and Alternates to the Ameri- can Medical Association. The term of Ronald J. Clearfield, MD, Westmore- land County, expires; he is eligible for reelection.
In accordance with Chapter XVIII, Section 2 of the bylaws, the Board of Trustees nominates the following mem- bers for one vacancy on the Judicial Council. For the office now held by Ken- neth L. Cooper, MD, Lycoming County, the Board nominates Kenneth L. Cooper, MD, Lycoming County; Leroy A. Gehris, MD, Berks County; and John P. Whitely, MD, York County.
Proposed bylaws amendments
Set forth below is the text of the pro- posed bylaws amendments. Deletions from existing bylaws are indicated by brackets; additions are italicized.
Subject One
1. Seating of Delegates, developed to implement Substitute Resolution 85-1, adopted as amended by the House of Delegates.
Chapter IX - House of Delegates Section 7. Seating of Delegates . . .
(a) Components Unrepresented— If any component society is not represented; by a delegate or alternate at any session of the meeting, then an active or associ- ate member [of that component society]’ within the district in which the unrepre- sented component society lies, regis- tered and in attendance, may be seated as the delegate after receiving approval of the president or secretary of the un-
22 Pennsylvania Medicine, August 1986
ST. CHRISTOPHER'S HOSPITAL FOR CHILDREN
High Tech and Tender Loving Care are the two things we mix so well here at St. Christopher's Hospital for Children.
Not only do we have the expertise and state-of-the-art resources to help us treat our children but we also know how important an ingredient TIC is in the recovery process.
So, when choosing a hospital, choose the very best.
• Pediatric Heart Institute • Burn Center • Kidney Dialysis Unit
• Heart, Liver and Kidney Transplant Programs • Special Care Unit
• Pulmonary and Cystic Fibrosis Center • Neonatal Intensive Care Unit
St. Christopher’s Hospital for Children
5th Street and Lehigh Avenue, Philadelphia, PA 19133 215-427-5000 A nonprofit, nonsectarian children's medical center DIVISION, UNITED HOSPITALS, INC.
Dx: recurrent
-w IA5T HIGH *
for-
herpes labialis
“HERPECIN-L is my treatment of choice for perioral herpes.” GP, NY
‘‘HERPECIN-L appears to actually prevent the blisters . . . used soon enough.” DDS, MN
“HERPECIN-L*. . . a conservative approach with low risk/high benefits.” MD, FL
“Used at prodromal symptoms . . . blisters never formed . . . remarkable.” DH, MA
“(In clinical trials) . . . response was dramatic. HERPECIN-I proven far superior.” DDS, PA
“All patients claimed shorter duration ... at prodromal symptoms . . . HERPECIN-L
averted the attacks.” MD, AK
HeRpecin-
OTC. See P.D.R. for information. For samples to make your own clinical evaluation, write: Campbell Laboratories, Inc.. P.O. BOX 812-MD, FDR STATION, NEW YORK, N.Y. 10150
In Pennsylvania HERPECIN-L is available at all Eckerd, Peoples, Rea & Derick, Revco, RiteAid, Thrift Drug Stores and other select pharmacies.
Official Call
represented component society and the Credentials Committee. In the event more than one member is eligible and re- quests to be seated, the Credentials Committee shall seat the member who is also a member of the unrepresented component society. . .
Subject Two
2. Board Eligibility, developed to im- plement recommendation of Special Committee to Study the Makeup of the PMS Board, as approved by the 1985 House of Delegates.
Chapter XV - The Board of Trustees Section 3. Composition.
The Board of Trustees shall consist of the president, president elect, the vice president, the immediate past presi- dent, the speaker of the House of Dele- gates, the vice speaker of the House of Delegates, ex officio with the right to vote, one trustee who is [an] a full dues- paying active [or associate] member in good standing of this Society from each district, one trustee to represent the AMA Board certified specialties orga-
nized in Pennsylvania who is [an] a full dues-paying active [or associate] mem- ber in good standing of this Society and a member of a specialty organized in Pennsylvania which is an AMA Board certified specialty, one trustee to repre- sent resident physicians who is an ac- tive member in good stein ding of this Society and who, at the time of election, is a resident physician member of this Society, and one trustee, without the right to vote, who is an active member in good standing of this Society and who, at the time of election, is a medical student member of this Society.
Subject Three
3. Eligibility of Specialty Trustee for Election as Board Chairman, developed to implement recommendation con- tained in Report M of the Board of Trustees, as approved by the 1985 House of Delegates.
Chapter XV - The Board of Trustees Section 10. Board Officers.
At the first meeting of the Board of Trustees after the annual meeting of the House of Delegates, it shall elect, from among the district trustees and the specialty society trustee, a chair-
man, a vice chairman, and a secretary to serve until the next such meeting of the Board and until their successors are elected. . .
Subject Four
4. Hospital Medical Staff Representa- tive to PMS Board, developed to imple-1 ment Resolution 85-46, adopted by the House of Delegates.
Chapter XI - Nominations Section 1. Origin of Nomination. . .
Nominations for district trustees shall be made from the floor of the House and only by seated delegates from their respective districts for which positions need to be filled. Nominations for a trustee from the specialties orga- nized in Pennsylvania which are AMA Board certified specialties shall be made by the seated delegates from those specialties in the House of Dele- gates. Nominations for the resident j physician trustee shall be made by seated delegates from the resident phy- j sician section. Nominations for the medical student trustee shall be made; by seated delegates from the medical, student section. Nominations for the j hospital medical staff trustee shall be\
24 Pennsylvania Medicine, August 1986
ZultivationOfTheMind
is as necessary as food to the body. The ancient hilosophers recognized the fact that mind and body ifluence each other.
Because health care professionals at St. Francis ledical Center believe that mind, body and spirit all ?ork in tandem, we continue to provide to the people of ie tri-state area unparalleled comprehensive care.
Since our founding more than 120 years ago, we ave practiced our mission of healing mind, body and pirit. Call St. Francis for all health care needs ... if you me a mind to.
St. Francis Medical Center
412/622-4263
ST.
FRANCIS
HEALTH
SYSTEM
(.
Educational Opportunities in Chemical Dependency
Treatment
PP ose ch^ica. depend
-bilitut odia9noseC
***"'£»• me*h0dS °f breal,,n9 thr<>U9h ^
■ SSSS*-
For over a quarter of a century, professionals education program, is offering four new special-
have referred to Caron Foundation’s Chit Chat ized training experiences for physicians who wish
rehabilitation programs for those patients suffer- to more effectively diagnose and treat their
ing from the disease of chemical dependency. patients suffering from this disease that affects the
Now, Caron Institute, as part of our continuing entire family.
■ Two-day workshop
■ Four-and-a-half-day experiential program
■ Seven-day intensive training
■ Four-week residential training program
Call or write for additional information: Joseph R. Cruse, M.D., Medical Director
Caron Institute
Galen Hall Road, Box A, Wemersville, PA 19565
(215) 678-2332
“PMSLIC stood behind me
100 percent”
Joseph Episcopio, M.D. Internist, Bethlehem, PA
Dr. Episcopio faced the misfortune of a frivolous malpractice suit. But he refused to settle.
And PMSLIC backed him up— fighting the case through to dismissal.
He reflects on his victory: "It was a team effort— PMSLIC, myself, and the attorney we chose. Going into a courtroom is a fright- ening experience for any physician. We went
through the anxiety and the aggravation of it all because we felt we were right. And we were granted a Compulsory Non-Suit, clearly demonstrating we were right."
Doing what’s right for physicians is the heart of the PMSLIC philosophy. To put that commitment to work for you, call toll-free: _ 1-800-445-1212. Ask for
extension 99.
PMSLIC;
The doctors’ choice.
Official Call
made by the seated delegate from the hospital medical staff section in accor- dance with the procedures provided in Chapter XX, Section 4.
Chapter XV - The Board of Trustees Section 3. Composition.
The Board of Trustees shall consist of the president, president elect, the vice president, the immediate past presi- dent, the speaker of the House of Dele-
gates, the vice speaker of the House of Delegates, ex officio with the right to vote, one trustee who is a full dues- paying active member in good standing of this Society from each district, one trustee to represent the AMA Board certified specialties organized in Penn- sylvania who is a full dues-paying ac- tive member in good standing of this Society and a member of a specialty or- ganized in Pennsylvania which is an AMA Board certified specialty, one trustee to represent resident physicians who is an active member in good stand- ing of this Society and who, at the time
of election, is a resident physician mem- ber of this Society, [and] one trustee, without the right to vote, who is an ac- tive member in good standing of this Society and who, at the time of election, is a medical student member of this So- ciety, and one trustee to represent hospi- tal medical staffs who is a full dues- paying active member in good standing of this Society and who, at the time of election, is a member of an allopathic hospital medical staff in Pennsyvlania.
Chapter XV - The Board of Trustees Section 5. Nomination and Election of Trustees.
Nomination for a district trustee shall be made by voting members of the House from the district to be repre- sented. Nominations for the specialty society trustee shall be made by voting members of the House representing the AMA Board certified specialties orga- nized in Pennsylvania. Nominations for resident physician trustee, [and] medi- cal student trustee, and hospital medi- cal staff trustee shall be made by seated delegates from the resident physician, [or] medical student, or hospital medical staff section, as the case may be. Elec- tion of all trustees by the House of Dele- gates is required.
Chapter XV - The Board of Trustees Section 8. Temporary Appointment.
In the event that a trustee is unable to act, the chairman of the Board, after consultation with the components in the district, the specialties, the resident physician section, [or] the medical stu- dent section, or the hospital medical staff section, as the case may be, may promptly appoint a temporary trustee who meets the qualifications of the po- sition vacated. At the next meeting of the Board of Trustees, if conditions are unchanged, the Board may continue the temporary appointment made by the chairman, or the Board may fill the va- cancy, if one exists, according to the by- laws.
Chapter XX - Special Sections Section 4. Medical Staff Section.
Membership in this section shall con- sist of representatives of allopathic hos- pital medical staffs in Pennsylvania. Every allopathic hospital medical staff shall be entitled to one representative to this section provided that the repre- sentative establishes, to the satisfac- tion of the credentials committee, that he was elected by the majority of the active physician voting members of the
Jefferson Medical College
of
Thomas Jefferson University
presents
Preoperative Consultation:
The Surgical Patient With Medical Problems
Wednesday through Friday September 17-19, 1986
at
The Warwick Hotel Philadelphia, Pennsylvania
Description: This course is designed for internists, family practitioners, surgeons, anesthesiologists, nurse anesthetists, and other primary care physicians who desire practical information on perioperative assessment and patient care. A detailed course syllabus and reference materials will be distributed.
Objectives: To provide physicians involved in medical preoperative consultation a review of disease processes which affect the morbidity and mortality of patients undergoing surgery and a rational approach to management of these problems. Through the use of State of the Art Reviews, Therapeutic Updates, and Core Consultative Seminars, a distinguished faculty will discuss the multisystem approach to assessment of operative risk and maximization of perioperative care. Case oriented workshops will provide an informal environment for faculty/participant interaction and discussion.
Fee Schedule: $360.00 for Physicians
$260.00 for Nurse Anesthetists,
Residents, and Fellows CME Credit: 17 credit hours in Category 1
For further information and registration, contact the Office of Continuing Medical Education, Jefferson Medical College, 1025 Walnut Street, Philadelphia, PA 19107; (215) 928-6992.
28 Pennsylvania Medicine, August 1986
My Friends Tell Me TherdsNo
Effective Remedy For Estate Tax Headaches..
Don’t Ask Them. Ask Us.
Our Estate Planning services can help you provide the financial security
Suite 600, Building #4 Penn Center, Pittsburgh, \ PA 15235, 412-824-0422
PENNSYLVANIA
PO. Box 259, State College, PA 16801, 814-238-0544
FINANCIAL
Suite 101, 1401 Professional Bldg., 1401 Cedar Crest Blvd., Allentown, PA 18104, 215-433-3258
GROUP, INC.
2 Penn Center Plaza, 7th Floor, Suite 700, Philadelphia, PA 19102, 215-636-9055
Official Call
medical staff represented or, if prior to October 1, 1985, was selected by the
president of the medical staff, that he is a member of the Society and that he has clinical privileges granted by the medi- cal staff represented.
The section shall elect (a) a governing
The
Division of Ophthalmology
at
The Milton S. Hershey Medical Center
of
The Pennsylvania State University
is pleased to announce the association of
Lenworth N. Johnson, M.D.
as Assistant Professor and Head of the Neuro-Ophthalmology Section
Appointments may be made with Dr. Johnson
by contacting the Ophthalmology Clinic at 531-8696
Choose West Park Hospital!
Establish and advance your practice in Philadelphia’s medical community!
Affiliated with the Medical College of Pennsylvania, our staff provides exceptional and individual patient care in a small hospital setting.
In our brand new, modern Emergency and Outpatient Care Center, we offer mammography and advanced techniques in Clinical Pathology, among many other services including a Cardiac Special Procedures Unit.
For additional information about the opportunities and benefits available to members of our Medical Staff, contact the Medical Staff Recruitment and Development Committee, 215-578-3622.
West Park Hospital
Ford Road and Fairmount Park Philadelphia, PA 19131
council consisting of a chairman, vice chairman, secretary, delegate, and alter nate delegate to the Society’s House of Delegates and two members-at-large, and (b) one or more qualified nominees for the position of hospital medical staff trustee who shall be placed in nomina- tion at the Society's House of Delegates by the delegate of the section. The of- fices of governing council member and delegate or alternate may be held simul- taneously by a single member of the sec- tion as may the offices of governing council member and medical staff trustee. The offices of trustee and dele- gate or alternate may not be held simul- taneously. The regular functions of this section shall include, but not be limited to, the conducting of a business meet ing in conjunction with the Society’s House of Delegates meeting.
Subject Five
5. Procedures of Committee on Aid to Education to Endorse Recipients of Aid, developed to implement recom- mendations contained in Report B of the Committee on Aid to Education, as approved by the 1985 House of Dele- gates.
Chapter IV - Funds Section 4. Educational Fund. . .
The Educational Fund shall be used only to assist, by grants or loans, with or without interest, in paying the educa- tion expenses of children of living or de- ceased Society members. Such children must be (a) in high school, college, or, graduate school, and in financial need; (b) in medical school, in financial need, and not qualified under clause (a) of this section, but who are residents of Penn- sylvania and who are in financial need; and (c) in medical school and residents of Pennsylvania, who, by their superior scholastic achievements, have shown unusual promise. [The trustees of The Educational and Scientific Trust, upon the recommendation of the Society’s Committee on Aid to Education, shall select the recipients of loans or grants on the basis of character, scholastic abil- ity, and, under clauses (a) and (b) above, financial need.] The Committee on Aid to Education shall approve block grant allocation of funds to the medical schools for distribution to students based on criteria established by The Ed- ucational and Scientific Trust. No such [loans or] grants may be made without the approval [by resolution] of a major- ity of the Committee on Aid to Educa- tion.
30 Pennsylvania Medicine, August 1986
* What You Need To Know About Our
_ HEADINJURY - PROGRAM
/ What You Need To Know About Our
CEREBRAL PALSY h PROGRAM
What Vou Need To Know About Ou' Programs Por
BEHAVIORAL & LEARNING DISORDERS
• The Rehabilitation Institute of Pittsburgh is a comprehen- sive rehabilitation hospital that functions through a Program Coordinator system, interdisciplinary team delivery and follow- up, and family involvement to ensure maximum input from all disciplines in treating patients with multiple handicaps.
• The Rehabilitation Institute of Pittsburgh provides inpatient, day patient and outpatient services for children, adolescents and adults from infancy through 35.
• The Rehabilitation Institute of Pittsburgh is licensed as a rehabilitation hospital by the Commonwealth of Pennsylvania and is fully accredited by the Joint Commission on Accreditation of Hospitals and the Commission on Accreditation of Rehabilita- tion Facilities.
• The Rehabilitation Institute of Pittsburgh is licensed as a special education school from nursery through high school.
• The Rehabilitation Institute of Pittsburgh is internationally recognized as a professional training center by colleges, univer- sities, state and federal agencies.
John A. Wilson
President
Anna J. L. Chorezy, M.D.
Medical Director
IER PROGRAM ICHURES AVAILABLE jthma Rehabilitation ader Willi Syndrome abetic □ Arthritis jychological Services utpatient Services ter Stroke Rehabilitation Dcational Development
The
Rehabilitation
Institute
off Milbyofiln)
I Northumberland Street
iburgh, PA 15217 !) 521-9000
(Clip and Mail)
I am interested in the specific program checked.
□ Head Injury □ Spina Bifida □ Cerebral Palsy
□ Behavioral & Learning Disorders □ Programs and Services
Please send a free copy to:
(Name)
(Title and Professional Affiliation)
(Address)
(Phone Number)
Official Call
Subject Six
6. PMS Executive Committee be named the Advisory Committee to the PMS Auxiliary, as recommended by the PMS Auxiliary, the PMS Executive Committee, and the Board of Trustees.
Chapter XVI - Committees, Adminis- trative Councils and Commissions Section 2. Standing Committees. . . a. Advisory Committee to the Pennsyl- vania Medical Society Auxiliary— The Advisory Committee to the Pennsylva-
nia Medical Society Auxiliary shall [consist of five members appointed by the president elect.] be the Executive Committee of the Board of Trustees of the Pennsylvania Medical Society. It shall act in an advisory capacity when- ever called upon by the Pennsylvania Medical Society Auxiliary and provide consultation and direction.
Subject Seven
7. Use of income from Medical Benevo- lence Fund for additional purposes be- yond those presently defined, as recom- mended by the Finance Committee and the Board of Trustees.
ONE COMPANY.
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Chapter IV - Funds
Section 3. Medical Benevolence Fund.
Each year the Board of Trustees may appropriate a sum, not to exceed 15 per- cent of the annual assessment for all ac- tive members, to be set aside by the treasurer as the Medical Benevolence Fund. The Medical Benevolence Fund shall be used only for (1) the relief of pe- cuniary distress of (a) sick or aged ac- tive and associate members or the par- ents, widows, widowers, or children of deceased active or associate members, and (b) active and associate members, resulting from catastrophic natural emergencies, and (2) such other uses as the Board of Trustees shall designate as long as there are sufficient monies to make the payments permitted by (1) above. [The Medical Benevolence Fund shall be under the absolute and confi- dential control of the Committee on Medical Benevolence.] Any money paid from the fund shall not exceed any limi- tations imposed by the Board of Trust- ees. Money paid from the fund as per- mitted by (1) above requires approval by a majority of the Committee on Med- ical Benevolence by general or special resolution. The Medical Benevolence Fund shall be administered by the sec- retary of this Society, who shall certify to the treasurer all amounts to be paid from the fund. Every effort shall be made to keep to identity of fund recipi- ents confidential within the Committee on Medical Benevolence, necessary So- ciety staff members, and the Board of Trustees.
MEDICAL OFFICE SYSTEM
A Prescription for the Perfect Practice
A fast, easy-to-use, easy-to-learn system for managing patient records & accounts receivable
Why more physicians prescribe our Medical Office System to cure their practice ills:
• it provides instant patient tracking and recall
• it automatically prepares any insurance form
• it prepares accounting statements
• it allows customization
• it allows upgrading from single-user to multi-user computers
• it is available for purchase or lease
(412) 885-7100
Call today tor a free demonstration of what the Medical Office System can do for your practice.
The Small Computer Company, Inc.
1211 Streets Run Road, Pittsburgh, PA 15236 (412) 885-7100
32 Pennsylvania Medicine, August 1986
Every day more and more physicians are hearing something remarkable from some of their hypertensive patients...
from the ones on once-daily
INDERAL LA
(PROPRANOLOL HCI)
with a side-effect profile unsurpassed by atenolol or metoprolol.
As seen in this double-blind, crossover, placebo-controlled study.1
Which shows you how truly well tolerated once-daily INDERAL LA can be.
What comes as no surprise, of course, is that it gives you the antihypertensive effectiveness you’ve come to expect from INDERAL.
Selected Side Effects
INDERAL LA as well tolerated as atenolol and metoprolol in a double-blind, crossover, placebo-controlled study of 138 hypertensives1
6-1
4-
1 3~ IT
h¥Hilllll
Impotence Weakness Men (n = 66)
I INDERAL LA— 160 mg
| | Atenolol — 100 mg
| \ Metoprolol — 200 mg
| 1 Placebo
mlml
Nightmares Women (n = 72)
Dizziness
INDERAL® LA. For control. Comfortable control. Once a day. It’s the last word.
Hypertensives: Feeling well and doing well, all in one.
INDERAL LA
(PROPRANOLOL HC)
LONG ACTING
indIride la
(PROPRANOLOL HCI [INDERAL LA]/ HYDROCHLOROTHIAZIDE)
As with all fixed-combination antihypertensives, INDERIDE LA is not indicated for the initial treatment of hypertension.
LONG ACTING CAPSULES
INDERAL LA should not be used in the presence of congestive heart failure, sinus bradycardia, cardiogenic shock, heart block greater than first degree, and bronchial asthma.
Please turn page for brief summary of prescribing information.
Feeling well and doing well, all in one.
Q|^Q£_Q^||_Y LONG ACTING CAPSULES
80 mg
120 mg
160 mg
iNnCQAI* 1 A
o
=IAL LA
V M
o
RAL LA
(PROPRANOLOL HCI)
1AL LA
M
MM
*
w yj
ONCE-DAILY long ACTING CAPSULES
Inderide la
Each capsule contains propranolol HCI (INDERAL® LA), 80 mg, 120 mg, or 160 mg, and hydrochlorothiazide, 50 mg
80/50 120/50 160/50
BRIEF SUMMARY (FOR FULL PRESCRIBING INFORMATION , SEE PACKAGE CIRCULARS ) INDERAL ’ LA Brand of PROPRANOLOL HYDROCHLORIDE {Long Acting Capsules) INDERIDE » LA Brand of PROPRANOLOL HYDROCHLORIDE (INDERAL** 1 LA) and HYDROCHLOROTHIAZIDE (Long Acting Capsules)
INDERAL LA and INDERIDE LA Capsules should not be considered simple mg-for-mg substitutes for INDERAL and INDERIDE Tablets. Please see package circulars.
CONTRAINDICATIONS
Propranolol hydrochloride (INDERAL’ LA): Propranolol is contraindicated in 1) cardiogenic shock; 2) sinus bradycardia and greater than first degree block; 3) bron- chial asthma, 4) congestive heart failure (see WARNINGS) unless the failure is secondary to a tachyarrhythmia treatable with propranolol
Hydrochlorothiazide: Hydrochlorothiazide is contraindicated in patients with anuria or hypersensitivity to this or other sulfonamide-derived drugs.
WARNINGS
Propranolol hydrochloride (INDERAL* LA): CARDIAC FAILURE Sympathetic stimulation may be a vital component supporting circulatory function in patients with con- gestive heart failure, and its inhibition by beta blockade may precipitate more severe fail- ure Although beta blockers should be avoided in overt congestive heart failure, if necessary, they can be used with close follow-up in patients with a history of failure who are well compensated, and are receiving digitalis and diuretics Beta-adrenergic blocking agents do not abolish the inotropic action of digitalis on heart muscle.
IN PATIENTS WITHOUT A HISTORY OF HEART FAILURE, continued use of beta block- ers can. in some cases, lead to cardiac failure Therefore, at the first sign or symptom of heart failure, the patient should be digitalized and/or treated with diuretics, and the response observed closely, or propranolol should be discontinued (gradually, if possible)
IN PATIENTS WITH ANGINA PECTORIS, there have been reports of exacerbation of angina and, in some cases, myocardial infarction following abrupt discontinuance of propranolol therapy Therefore, when discontinuance of propranolol is planned the dosage should be gradually reduced and the patient carefully monitored In addition, when propranolol is prescribed for angina pectoris, the patient should be cautioned against interruption or cessation of therapy without the physician's advice. If pro- pranolol therapy is interrupted and exacerbation of angina occurs, it usually is advisa- ble to reinstitute propranolol therapy and take other measures appropriate for the management of unstable angina pectoris Since coronary artery disease may be unrecognized, it may be prudent to follow the above advice in patients considered at risk of having occult atherosclerotic heart disease who are given propranolol for other indications
THYROTOXICOSIS Beta blockade may mask certain clinical signs of hyperthyroidism Therefore, abrupt withdrawal of propranolol may be followed by an exacerbation of symp- toms of hyperthyroidism, including thyroid storm. Propranolol does not distort thyroid function tests
IN PATIENTS WITH WOLFF-PARKINSON-WHITE SYNDROME, several cases have been reported in which, after propranolol, the tachycardia was replaced by a severe bradycar- dia requiring a demand pacemaker. In one case this resulted after an initial dose of 5 mg propranolol
MAJOR SURGERY The necessity or desirability of withdrawal of beta-blocking therapy prior to major surgery is controversial It should be noted, however, that the impaired ability of the heart to respond to reflex adrenergic stimuli may augment the risks of general anes- thesia and surgical procedures
Nonallergic Bronchospasm (eg, chronic bronchitis, emphysema) —
PATIENTS WITH BRONCHOSPASTIC DISEASES SHOULD, IN GENERAL, NOT RECEIVE BETA BLOCKERS INDERAL should be administered with caution, since it may block bron- chodilation produced by endogenous and exogenous catecholamine stimulation of beta receptors.
DIABETES AND HYPOGLYCEMIA Beta-adrenergic blockade may prevent the appear- ance of certain premonitory signs and symptoms (pulse rate and pressure changes) of acute hypoglycemia in labile insulin-dependent diabetes. In these patients, it may be more difficult to adjust the dosage of insulin Hypoglycemic attacks may be accompanied by a precipitous elevation of blood pressure Hydrochlorothiazide: Thiazides should be used with caution in severe renal disease In patients with renal disease, thiazides may precipitate azotemia In patients with impaired renal function, cumulative effects of the drug may develop Thiazides should also be used with caution in patients with impaired hepatic function or progressive liver disease, since minor alterations of fluid and electrolyte balance may pre- cipitate hepatic coma
Thiazides may add to or potentiate the action of other antihypertensive drugs. Potentia- tion occurs with ganglionic or peripheral adrenergic-blocking drugs Sensitivity reactions may occur in patients with a history of allergy or bronchial asthma The possibility of exacerbation or activation of systemic lupus erythematosus has been reported
PRECAUTIONS
Propranolol hydrochloride (INDERAL* LA): GENERAL Propranolol should be used with caution in patients with impaired hepatic or renal function Propranolol is not indicated for the treatment of hypertensive emergencies Beta-adrenoreceptor blockade can cause reduction of intraocular pressure Patients should be told that propranolol may interfere with the glaucoma screening test Withdrawal may lead to a return of increased intraocular pressure CLINICAL LABORATORY TESTS; Elevated blood urea levels in patients with severe heart disease, elevated serum transaminase, alkaline phosphatase, lactate dehydro- genase
DRUG INTERACTIONS Patients receiving catecholamine-depleting drugs, such as reserpine, should be closely observed if propranolol is administered The added catechol- amine-blocking action may produce an excessive reduction of resting sympathetic ner- vous activity, which may result in hypotension, marked bradycardia, vertigo, syncopal attacks, or orthostatic hypotension.
CARCINOGENESIS. MUTAGENESIS, IMPAIRMENT OF FERTILITY Long-term studies in animals have been conducted to evaluate toxic effects and carcinogenic potential In 18- month studies, in both rats and mice, employing doses up to 150 mg/kg/day, there was no evidence of significant drug-induced toxicity. There were no drug-related tumorigenic effects at any of the dosage levels. Reproductive studies in animals did not show any impairment of fertility that was attributable to the drug PREGNANCY: Pregnancy Category C. Propranolol has been shown to be embryotoxic in animal studies at doses about 10 times greater than the maximal recommended human dose There are no adequate and well-controlled studies in pregnant women Propranolol should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus
NURSING MOTHERS Propranolol is excreted in human milk. Caution should be exer- cised when propranolol is administered to a nursing mother PEDIATRIC USE Safety and effectiveness in children have not been established Hydrochlorothiazide: GENERAL Periodic determination of serum electrolytes to detect possible electrolyte imbalance should be performed at appropriate intervals All patients receiving thiazide therapy should be observed for clinical signs of fluid or electrolyte imbalance namely Hyponatremia, hypochloremic alkalosis, and hypokale- mia Serum and urine electrolyte determinations are particularly important when the patient is vomiting excessively or receiving parenteral fluids Medication such as digitalis may also influence serum electrolytes Warning signs irrespective of cause are Dryness of mouth, thirst, weakness, lethargy, drowsiness, restlessness, muscle pains or cramps, muscular fatigue, hypotension, oliguria, tachycardia, and gastrointestinal disturbances such as nausea and vomiting
Hypokalemia may develop, especially with brisk diuresis, when severe cirrhosis is present, or during concomitant use of corticosteroids or ACTH Interference with adequate oral electrolyte intake will also contribute to hypokalemia Hypokalemia can sensitize or exaggerate the response of the heart to the toxic effect of digitalis (eg, increased ventricular irritability) Hypokalemia may be avoided or treated by use of potassium supplements, such as foods with a high potassium content Any chloride deficit is generally mild and usually does not require specific treatment, except under extraordinary circumstances (as in liver or renal disease). Dilutional hypona- tremia may occur in edematous patients in hot weather; appropriate therapy is water restriction, rather than administration of salt, except in rare instances when the hyponatre- mia is life-threatening In actual salt depletion, appropriate replacement is the therapy of choice
Hyperuricemia may occur or frank gout may be precipitated in certain patients receiving thiazide therapy
Insulin requirements in diabetic patients may be increased, decreased, or unchanged Diabetes mellitus which has been latent may become manifest during thiazide administration
If progressive renal impairment becomes evident, consider withholding or discontinuing diuretic therapy
Thiazides may decrease serum PBI levels without signs of thyroid disturbance Calcium excretion is decreased by thiazides. Pathologic changes in the parathyroid gland with hypercalcemia and hypophosphatemia have been observed in a few patients on prolonged thiazide therapy. The common complications of hyperparathyroidism, such as renal lithiasis, bone resorption, and peptic ulceration, have not been seen. Thiazides should be discontinued before carrying out tests for parathyroid function DRUG INTERACTIONS; Thiazide drugs may increase the responsiveness to tubocurarine
The antihypertensive effects of thiazides may be enhanced in the postsympathectomy patient. Thiazides may decrease arterial responsiveness to norepinephrine This diminu- tion is not sufficient to preclude effectiveness of the pressor agent for therapeutic use PREGNANCY: Pregnancy Category C Thiazides cross the placental barrier and appear in cord blood The use of thiazides in pregnancy requires that the anticipated benefit be weighed against possible hazards to the fetus. These hazards include fetal or neonatal laundice, thrombocytopenia, and possibly other adverse reactions which have occurred in the adult.
NURSING MOTHERS: Thiazides appear in human milk If use of the drug is deemed essential, the patient should stop nursing PEDIATRIC USE: Safety and effectiveness in children have not been established
ADVERSE REACTIONS
Propranolol hydrochloride (INDERAL* LA): Most adverse effects have been mild and transient and have rarely required the withdrawal of therapy Cardiovascular Bradycardia, congestive heart failure, intensification of AV block, hypo- tension, paresthesia ot hands; thrombocytopenic purpura, arterial insufficiency, usually of the Raynaud type
Central Nervous System Lightheadedness; mental depression manifested by insomnia, lassitude, weakness, fatigue, reversible mental depression progressing to catatonia, vi- sual disturbances; hallucinations; an acute reversible syndrome characterized by disori- entation for time and place; short-term memory loss; emotional lability; slightly clouded sensorium, and decreased performance on neuropsychometrics.
Gastrointestinal Nausea, vomiting, epigastric distress, abdominal cramping, diarrhea, constipation; mesenteric arterial thrombosis; ischemic colitis Allergic: Pharyngitis and agranulocytosis; erythematous rash; fever combined with ach- ing and sore throat; laryngospasm and respiratory distress.
Respiratory. Bronchospasm
Flematologic: Agranulocytosis; nonthrombocytopenic purpura, thrombocytopenic purpura
Auto-Immune In extremely rare instances, systemic lupus erythematosus has been reported
Miscellaneous Alopecia; LE-like reactions; psoriasiform rashes; dry eyes; male impo- tence; and Peyronie's disease have been reported rarely. Oculomucocutaneous reactions involving the skin, serous membranes, and coniunctivae reported for a beta blocker (prac- tolol) have not been associated with propranolol
Hydrochlorothiazide:
Gastrointestinal Anorexia; gastric irritation, nausea, vomiting, cramping, diarrhea, consti- pation; laundice (intrahepatic cholestatic jaundice), pancreatitis, sialadenitis Central Nervous System Dizziness, vertigo, paresthesias, headache, xanthopsia Flematologic Leukopenia; agranulocytosis; thrombocytopenia, aplastic anemia Cardiovascular: Orthostatic hypotension (may be aggravated by alcohol, barbiturates, or narcotics)
Fly per sensitivity Purpura, photosensitivity; rash; urticaria; necrotizing angiitis (vascu- litis, cutaneous vasculitis), lever; respiratory distress, including pneumonitis; anaphylac- tic reactions.
Other: Hyperglycemia; glycosuria, hyperuricemia; muscle spasm, weakness, restless- ness; transient blurred vision
Whenever adverse reactions are moderate or severe, thiazide dosage should be reduced or therapy withdrawn
* The appearance of these capsules is a registered trademark of Ayerst Laboratories
REFERENCE:
1. Ravid M, Lang R, Jutrin I The relative antihypertensive potency of propranolol, oxpre- nolol, atenolol, and metoprolol given once daily. Arch Intern Med 1985:145 1321-1323
6213/686
Averst AYERST LABORATORIES
1 yj New York, NY 10017 Copyright © 1986 Ayerst Laboratories
lBlSlSU9lSl91SlSl5lSlSlStS\9l9lEl5l5l51Sl5lSlSlSlB15l51fil5l5l5lSl5lSlSlBl9l5lS15\515l5l5l£
The Neurodiagnostic Laboratory at Sacred Heart Hospital
offers a variety of non-invasive procedures including:
* EEG
* 24-hour Ambulatory EEG Monitoring
* Neurovascular Panel
(non-invasive carotid artery evaluation)
* Perimetry
(visual field screening)
The Neurodiagnostic Laboratory is under the direction of Lawrence A. Kerson, M.D. and Regina Torsney Durkin, M.D.
Sacred Heart has board certified technologists performing and overseeing all neurodiagnostic procedures.
Sacred Heart Hospital
and
Rehabilitation Center
DeKalb & Fornance Sts. Norristown, PA 19401
(215)278-8380
^BlBlSlSlSIS1S1BUnBIB1BUnBlS1SlBl5l5UnBrEIBl5IS\ElSISlSlSl5ISlSlSI91Sl9lS15lBIBlSlSlSMS15tSlSl5tSlSlS\5l9t5rSl@lSU
215/596-9CHP
WHEN TIME IS CRITICAL
With trauma patients, every second counts. Early communication with acute care providers is essential. That’s why The Children’s Hospital of Philadelphia has added a direct telephone line in the Emergency department’s triage area exclusively for trauma consultations and referrals. Now medical personnel can either seek advice on the management of a trauma patient’s care or arrange a child’s transfer to Children’s Hospital. For all other emergencies, call the Emergency department at 215/596-9640.
Trauma Line 215/596-9CHP
GH
The Children’s Hospital of Philadelphia One Children’s Center 34th Street and Civic Center Boulevard Philadelphia, PA 19104
he series no medical reference collection should be without
• • •
The Prevention and Treatment of Five Complications of Diabetes
from
The Pennsylvania Diabetes Academy
Now available
Module 1 - " Adverse Outcomes in Pregnancy"
Each year 10,000 babies are born to diabetic women and an additional 60,000 - 90,000 babies are born to women with gestational diabetes. Careful balancing of glycemic control of the mother and nutritional needs of the fetus significantly reduces serious clinical problems.
Module 2 - "Visual Impairment"
Diabetic retinopathy results in 5,000 new cases of blindness in the U.S. each year, more than any other cause. But early detection, referral and treatment with laser surgery and vitrectomy techniques can reduce this tragic loss by nearly 60 percent.
Written for both primary-care practitioners and specialists in each field, these self-study modules present the latest in practical management techniques for each complication. The self-instructional format offers the practicing physician new advances in diabetes care and an opportunity to earn CME credit. All modules are written by nationally recognized authorities and peer-reviewed. Other modules in the series will be announced as they become available.
To order, send a check or money order for $50.00 (PA residents add 6% sales tax) for each module requested made payable to:
The Pennsylvania Diabetes Academy 20 Erford Road Lemoyne, Pennsylvania 17043 717-763-7151
THE PREVENTION AND TREATMENT OF FIVE COMPLICATIONS OF DIABETES is being produced under a grant from the Centers for Disease Control to the Pennsylvania Department of Health Diabetes Control Program in cooperation with the Pennsylvania Diabetes Task Force. The Pennsylvania Diabetes Academy is an affiliate of the Educational and Scientific Trust of the Pennsylvania Medical Society.
. . . because we care
SPECIALIZING IN HAND, WRIST, AND UPPER EXTREMITY PROBLEMS
Pennsylvania Hand Center, Ltd. 101 Bryn Mawr Avenue Bryn Mawr, PA 19010
Tel. (215)525-1000
Just Moved
Emergencies Bryn Mawr Hospital Bryn Mawr, PA 19010 Tel. (215) 896-3577
. . . Specializing in Billing for Hospital- Based Physicians
Dear Hospital-Based Physician:
Do you realize that a one percent increase in the collection percentage will result in more practice income than a one percent decrease in billing costs?
Call us for details relating to this question.
PHYSICIAN
SUPPORT
SYSTEMS
Physician Support P.O. Box 127
Systems, Inc. Landisville, PA 17538
(717) 898-3190
40 Pennsylvania Medicine, August 1986
July marks the First Anniversary of the Charles L. & Rose Sweeney Melenyzer Pavilion. The Cancer Treatment Center at Monongahela Valley Hospital is the First Serving Patients in Washington, Fayette and Greene Counties.
Qualified, professional staff gives hope to patients by providing quality care and life-saving service
Facility’s location eliminates the discomfort and expense of distant travel
• State-of-the-art technology delivers optimum treatment and special radiological procedures
• The Treatment Center symbolizes a vision of renewed hope for cancer patients
Monongahela Valley Hospital
A Subsidiary of Mon-Vale Health Resources^ Inc.
Country Club Road • Monongahela, PA 15063 (412) 253-2000
Pennsylvania Medical Society
Officials
Executive Office: 20 Erford Road, Lemoyne, PA 17043 Telephone (717) 763-7151
Officers
‘President
R. William Alexander, MD
544 Elm St.
Reading 19601 (215) 374-4951
‘Immediate Past President D. Ernest Witt, MD
RD 2
Bloomsburg 17815 (717) 784-2190
‘Secretary
John H. Hobart, MD
2001 Fairview Ave. Easton 18042 (215) 258-9131
‘President Elect R. Robert Tyson, MD
Temple Univ. Hosp. 3401 N. Broad St. Philadelphia, PA 19140 (215) 221-3631
‘Vice President Donald E. Harrop, MD
750 S. Main St. Phoenixville 19460 (215) 933-3182
‘Speaker
House of Delegates
James A. Raub, MD 1099 Ohio River Blvd Sewickley 15143 (412) 741-7150
‘Vice Speaker House of Delegates
Jonathan E. Rhoads Jr., MD York Hosp., Dept, of Surgery 1001 S. George St.
York 17405 (717) 771-2756
Treasurer and Executive Vice President John F. Rineman
20 Erford Rd.
Lemoyne 17043 (717) 763-7151
Trustees
J Joseph Danyo, MD, Chairman Robert N. Moyers, MD, Vice Chairman
* First District— John Helwig, Jr., MD, The Germantown Hospital & Medical Center, One Penn Blvd., Philadelphia 19144 - (215) 438- 4944. Term expires 1986. Philadelphia County ‘Second D/sfr/cf— Henry H. Fetterman, MD, 501 N. 17th St., Allentown 18104 - (215) 435-8562. Term expires 1987. Berks,
Bucks, Chester, Delaware, Lehigh, and Montgomery counties.
'Third District— John H. Hobart, MD, 2001 Fairview Ave., Easton 18042 - (215) 258-9131. Term expires 1986. Carbon, Lackawanna, Monroe, Northampton, Pike, and Wayne counties.
* Fourth District— J. Mostyn Davis, MD, Geisinger Med. Ctr. , Danville 17822 - (717) 271-6070, Ext. 4375. Term expires 1987. Columbia, Montour, Northumberland, Schuylkill, and Snyder counties.
'Fifth District — J. Joseph Danyo, MD, 908 S. George St., York 17403 - (717) 848-4800. Term expires 1987. Adams, Cumberland, Dauphin, Franklin, Fulton, Lancaster, Lebanon, Perry, and York counties.
'Sixth District— Betty L. Cottle, MD, 25 Sylvan Dr., Hollidaysburg 16648 - (814) 695-0659. Term expires 1988. Blair, Centre,
Clearfield, Huntingdon, Juniata, and Mifflin counties.
'Seventh District — Irving Williams III, MD, RD 1 , Box 206, Lewisburg 17837 - (717) 523-1142. Term expires 1988. Cameron, Clinton, Elk, Lycoming, Potter, Tioga, and Union counties.
* Eighth District— Robert N. Moyers, MD, 764 Kennedy St., Meadville 16335 - (814) 336-5995. Term expires 1986. Crawford, Erie, Forest, McKean, Mercer, and Warren counties.
'Ninth District— David L. Miller, MD, 237 Broad St., New Bethlehem 16242 - (814) 275-1122. Term expires 1986. Armstrong, Butler, Clarion, Indiana, Jefferson, and Venango counties.
'Tenth District— Walter M. Greissinger, MD, 13 Pride St., Pittsburgh 15219 - (412) 562-3207. Term expires 1988. Allegheny, Beaver, Lawrence, and Westmoreland counties.
'Eleventh District— Ernest L. Abernathy, MD, 1086 N. Main St., Washington 15301 - (412) 225-4423. Term expires 1987. Bedford, Cambria, Fayette, Greene, Somerset, and Washington counties.
* Twelfth District — Victor F. Greco, MD, Greco Med. Arts Bldg., Drums 18222 - (717) 788-4141. Term expires 1988. Bradford, Luzerne, Sullivan, Susquehanna, and Wyoming counties.
* Specialty Societies — Martin A. Murcek, MD, Med. Arts Bldg., 562. Shearer St., Ste. 101-2, Greensburg 15601 - (412) 837-4070. Term expires 1988.
'Resident Physicians — Jeannine R. Hahn, MD, 191 Lowell Terr., King of Prussia 19406 - (215) 265-4489. Term expires 1987 (or upon completion of residency).
Medical Students — Ann K. Messersmith, 1925 W. Norwegian St., Pottsville 17901 - (717) 622-5041. Term expires 1986 (or upon completion of medical school).
‘Voting members of the Board of Trustees
Judicial Council
Kenneth L. Cooper, MD
230 Dunbar Rd., Williamsport 17701 - (717) 323-3671 (Term expires 1986)
Michael P. Levis, MD
4725 McKnight Rd., Pittsburgh 15237 - (412) 931-4353 (Term expires 1988)
Orlo G. McCoy, MD
Box 195, Canton 17724 - (717) 673-5591
(Term expires 1987)
George P. Rosemond, MD
3401 N. Broad St., Philadelphia 19140 - (215) 255-2230 (Term expires 1987)
Joseph M. Stowell, MD
501 Howard Ave., Altoona 16601 - (814) 944-6109 (Term expires 1988)
Address inquiries to John H. Hobart, MD, Judicial Council Secretary, 20 Erford Rd., Lemoyne 17043
42 Pennsylvania Medicine, August 1986
Examineyour professional liability insurance coverage. You’ll find
LOU ARE VULNERABLE,
DOCTOR. Legal developments Doint to the vulnerability of standard professional liability nsurance and Act 111 limits.
[Malpractice awards are rising at an alarming and unprecedented rate.
Six-figure awards are becoming the -norm, not the exception. If an award jagainst you exceeds your insurance limits and Act 1 1 1 protection, your personal assets could be attached. One award . . . even a questionable one . . . could ruin you financially.
EVEN THE INNOCENT SOMETIMES PAY. You don't have to be found guilty of malpractice to be liable for payment. Jury awards are often based on emotions, not on legal issues. Innocence is not always a defense.
PROTECT YOURSELF. Our Excess Professional Liability Program could give you the protection you need . . . and deserve. Look at what we offer.
AVAILABILITY: SI, 000,000 limits in excess of your basic policy and Act 111 available NOW. Broad “claims made” coverage underwritten by a major U.S. insurance carrier.
AFFORDABILITY : Level annual premiums . . . with no yearly surprises. ACCESSIBILITY: Direct, personal service by an agency with more than 100 years experience in all lines of professional, personal, and business insurance.
FAST, FAIR, PROFESSIONAL CLAIMS SERVICE.
SEND THE COUPON BELOW or phone us for more information and an application.
ADMINISTRATOR P
MEXkNDER !
kGENCY INC. j
INSURANCE WORLD-WIDE SINCE 1853
Roosevelt Building
Sixth Street & Penn Avenue
Pittsburgh, PA 15222
Phone 412/261-5800
Send information and application for 51,000,000 excess professional liability insurance coverage to:
Name
Address
City State Zip
Phone
Mail to: Alexander Agency, Inc.
Roosevelt Building Sixth Street & Penn Avenue Pittsburgh, PA 15222
_______
k
County Society Officers
ADAMS COUNTY
President: Robert Tuliszewski, MD, 131 Carlisle St. , Gettysburg 17325, 717-334-6705
President Elect: Horace F. Martin, MD, 54 High St., Box 113, Arendtsville 17303; 717-677-8626
Secretary/Treasurer: David F. Kamsler, MD, 455 South Washington St., Suite 22, Gettysburg 17325; 717-334-9259
ALLEGHENY COUNTY
President: Phillip R. Levine, MD, 3471 Fifth Ave., Pittsburgh 15213, 412-621-8589
President Elect: Gilbert A. Friday, MD, 1901 Highgate Rd., Pittsburgh 15241, 412-681-3333
Vice President: Richard E. Deitrick, MD, 57 Swallow Hill Rd., Carnegie 15106, 412-279-3243
Treasurer: George F. Buerger Jr., MD, 3520 Fifth Ave., Suite 401, Pittsburgh 15213, 412-681-4220
Secretary: Daniel H. Gregory, MD, 490 E. North Ave., Pittsburgh 15212, 412-321-0808
Executive Director: Mr. H. David Moore Jr., 713 Ridge Ave., PO Box 6135, Pittsburgh 15212, 412-321-5030
Assistant Executive Director: Mr. John G. Krah, 713 Ridge Ave., PO Box 6135, Pittsburgh 15212, 412-321-5030
Bulletin Editor: Macy I. Levine, MD, 713 Ridge Ave., Pittsburgh 15212, 412-321-5030
Publication: BULLETIN OF THE ALLEGHENY COUNTY MEDICAL SOCIETY
ARMSTRONG COUNTY
President: Peter N. Sotos, MD, N. Park Dr., Kittanning 16201, 412-548-4120
President Elect: James E. Childs, MD, Armstrong Mem. Hosp., RD 8, Box 50, Kittanning 16201, 412-543-8122
Vice President: Donald W. Minteer Jr., DO, RD 1, Box 170, Worthington 16262, 412-297-3424
Secretary/Treasurer: Roderick B Groomes, MD, 252 Harbison Rd., Sarver 16055, 412-543-8122
BEAVER COUNTY
President: John K. Baska, MD, 701 Fifth St., Beaver 15009, 412-775-3330 or 412-774-8181
President Elect: Narayan Shetty, MD, 2349 Mill St., Aliquippa 15001, 412-375-5401
Vice President: Morris M. Book, MD, 1520 Third Ave., New Brighton 15066, 412-843-3800
Secretary /Treasurer: Wayne W. Helmick, MD, 349 New York Ave.,
Rochester 15074, 412-775-0716
Assistant Secretary: John Notaro, MD, 2349 Mill St., Aliquippa 15001, 412-375-5401
Executive Secretary: Mrs. Caroline L. Mills, 71 Bridge St., Rm. 105, Bridgewater 15009, 412-775-3330
Bulletin Editor: Leon D. Goggin, MD, 71 Bridge St., Room 105, Bridgewater 15009, 412-775-3330
Bulletin Editor: Morgan Taylor, MD, 71 Bridge St., Room 105, Bridgewater 15009, 412-775-3330
Publication: THE BULLETIN
BEDFORD COUNTY
President: Flora M. Torres, MD, 220 W. Main St., Everett 15537, 814-652-6107
President Elect: Daniel J Melkus, MD, 516 Lafayette Ave., Bedford 15522, 717-275-8432
BERKS COUNTY
President: Leonard M. DelVecchio, MD, E. 1st & Spruce Sts., Birdsboro 19508, 215-582-1561
President Elect: Jonathan L. Stolz, MD, 145 N. Sixth St., Reading 19016, 215-378-8355
Treasurer: Jerome I. Marcus, MD, Omega Health Care, 2001 Bern Road, Wyomissing 19610, 215-378-1900
Secretary: Arlington A. Nagle, MD, RD 1, Route 422, Womelsdorf 19567, 215-589-2555
Continued
A Century of Giving Quality to Life
Allegheny General Hospital has been a leader in healthcare for 100 years because of its continuing dedication to patient care, teaching and research. At Allegheny General vve are people caring for people by adding quality to their lives.
For more information about Allegheny General’s services, please call 359 3131
ALLEGHENY GENERAL HOSPITAL
44 Pennsylvania Medicine, August 1986
ONLY THE PRICE IS NOT BREATHTAKING.
If you’re a person with an eye for beauty, one look at the striking lines of the Alfa Romeo Quadrifoglio could give you reason enough to buy it.
You’ll find additional ones inside. Supple Italian glove leather seats, air conditioning, power windows and a digital AM/FM stereo cassette deck with four speakers are among its many standard luxury features.
Yet this is not a car to buy for looks alone.
For the Quadrifoglio is the best-performing Alfa convertible ever built, thanks to its spirited 2.0 litre engine, Bosch fuel injection, improved anti- sway bars, 15” alloy wheels and Pirelli P6 tires.
What’s more, this car is built so well, it’s backed by a 3-year/36, 000-mile warranty* **
The Alfa Romeo Quadrifoglio is now available for under $19,600?* A price that lets you breathe a sigh of relief.
ENGINEERED WITH A PASSION.
J. H. Bennett, Inc.
2300 Hanover Avenue Allentown, PA 18103 (215) 437-6711
Y/B/H Porsche/Audi
Route 3 (West Chester Pike) Edgemont, PA 19028 (215) 356-9000 DeFinizio Imports, Inc.
Wanamaker and Industrial Highway Essington, PA 19029 (215) 521-9200
Burdumy Motors, Inc.
2711 Philmont Avenue Huntingdon Valley, PA 19006 (215) 947-6363 MPA, Inc.
6515 Carlisle Pike Mechanicsburg, PA 17055 (717) 766-0275
Algar Enterprises, Inc.
1100 W. Swedesford Road Paoli, PA 19301 (215) 647-6660
Auto Palace, Inc.
4627 Baum Boulevard Pittsburgh, PA 15213 (412) 687-4000
Cherry Hill Alfa
1100 Haddonfield Road Cherry Hill, NJ 08034 (609) 663-2800 Alfa Northeast, Inc.
1125 N. Washington Avenue Scranton, PA 18509 (717) 346-7691
* Limited warranty applies only to U.S. spec, automobiles purchased from authorized Alfa Romeo dealers.
**Mfr.’s suggested retail price at P.O.E. excluding removable hardtop. Actual prices may vary. Destn. chrgs., taxes, dealer prep. , if any, opt. equip, and license fees are extra. Hardtop not available with initial production.
For more information call Katlileen . . .
1-800-422-6227
Macintosh is a trademark licensed to Apple Computer Iik MediMac is a trademark of Healthcare Communicaiions Word File and Excel are trademarks of Microsoft Corporation
MediMac
Because the business of medicine is as important as the practice of medicine.
The more efficiently you manage the business end of your practice, the more time and energy you have for patient care. Fortunately, the easiest way to put your business in order is also the best... MediMac.
■ An incredibly easy-to-use system utilizing all the power of the amazing Macintosh™ from Apple Computer.
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MediMac the easy way to efficient practice management.
HealthCaie Communications ■ 245 south 84ih street — suite 301 ■ Lincoln, ne ossio
County Society Officers
Executive Director: Mr. Sherwood C. Young, 429 Walnut St. Readina
19601.215- 376-1544
Bulletin Editor: Barton L. Smith, MD, 301 S. Seventh Ave., West Readinq
19611.215- 374-4401 Publication: MEDICAL RECORD
BLAIR COUNTY
President: Charles M. Haas, MD, Mercy Hosp., Pathology Dept Altoona 16603, 814-949-4496
President Elect: Augusto N Delerme, MD, 600 Chestnut Ave., Executive House II, Altoona 16601, 814-944-9471
Vice President: William J. Kirsch, MD, 591 Cove Lane, Roarinq Sprinqs 16673, 814-224-2887 a
Treasurer: Angelo J. Maniglia, MD, 702 18th St., Altoona 16602 814-943-3913
Secretary: David S. Pollack, MD, 909 E. Main St., Roaring Spnnq 16673 814-224-2215
Executive Secretary: Ms Marjorie E. Harker, 503 E. Plank Rd 2nd FI Altoona 16602; 814-942-8691
Publication: BLAIR COUNTY MEDICAL SOCIETY NEWSLETTER
BRADFORD COUNTY
President: Karl J. Dienhart, MD, Guthrie Clinic Ltd., Sayre 18840 717-888-5858
Vice President: Robert M. Michaels, MD, Guthrie Clinic Ltd., Sayre 18840 717-888-5858
Treasurer: Richard E. Shelling, MD, Guthrie Clinic Ltd., Sayre 18840 717-888-5858
Secretary: Joseph B Blood, Jr., MD, Guthrie Clinic Ltd , Sayre 18840 717-888-5858
BUCKS COUNTY
President: Joseph Werner, MD, 450 East St., Doylestown 18901 215-345-6090
President Elect: Arthur J. Alderfer, MD, PO Box 150, Sellersville 18960 215-257-6280
Vice President: Earl K. Connors Jr., MD, 118 West Richardson Ave., Langhorne 19047, 215-757-1525 Treasurer: Carl M. Shetzley, MD, Box 278, Buckingham 18912 215-794-7471
Secretary: Donald E. Parlee, MD, 75 Foxcroft Dr., Doylestown 18901 215-345-2315
Executive Secretary: Mr. John S. Detweiier, 229 West Broad St Quakertown 18951, 215-536-8665 Publication: NEWS BULLETIN
BUTLER COUNTY
President: Ernest Moore, MD, 165 Brugh Ave., Butler 16001, 412-285-3148 President Elect: Charles Lynn, MD, Butler Mem. Hosp. Rad. Butler 16001 412-284-4563
Secretary/Treasurer: Anthony M. Pirrello, MD, Butler County Mem. Hosp , East Brady St., Butler 16001, 412-284-4563 Executive Secretary: Ms. Nancy Snow, 119 Donaghy Ave., Butler 16001 412-283-2828 or 284-4391
CAMBRIA COUNTY
President: Gordon A. Gress, MD, 1111 Franklin St., Johnstown 15905 814-535-2504
President Elect: Stephen T. Bush, MD, 320 Main St., Johnstown 15901 814-533-0660
Vice President: William P. Hirsch, MD, 1020 Franklin St., Johnstown 15905 814-535-1305
Treasurer: Jarvis H. Post, MD, 47 Osborne St., Johnstown 15905 814-535-7661
Secretary: Ferdinand L. Soisson Jr., MD, 353 Market St., Johnstown 15901 814-535-2569
Executive Secretary: Mr Michael P Kohler, 47 Osborne St., Johnstown 15907, 814-535-5493
Bulletin Editor: Joseph W. Raymond, MD, US National Bank Bldg., Room 907, Johnstown 15901, 814-535-1654
Bulletin Editor: Thomas E. Seifert, MD, 353 Market St., Johnstown 15901 814-535-2569
Publication: THE MEDICAL COMMENT
CARBON COUNTY
President: Mario F. Visperas, MD, Second & South Sts., Lehiqhton 18235 215-377-5818
Vice President: Shaukat H. Khan, MD, Palmerton Hospital, Palmerton 18071, 215-836-3141
Secretary/Treasurer: Lian K. Tan, MD, Palmerton Hosp., Palmerton 18071 215-826-3141
CENTRE COUNTY
President: John Reidell, MD, 3901 S. Atherton St., State College 16801 814-466-7931
Continued
46 Pennsylvania Medicine, August 1986
VMLACHY WHALEN
Malachy Whalen & Company, Inc. Henry W. Oliver Building Pittsburgh, Pennsylvania 15222 Phone (412) 2814050
offers
guaranteed issue, non-cancellable, disability insurance for individual physicians
• Guaranteed issue of $3,000 coverage per month regardless of health status for any physician who has been at work for 90 days and is under age 60.
• Up to $15,000 coverage and lifetime benefits are available.
• Non-cancellable contract— guaranteed renewable to age 65 at regular rates. Unlike group insurance, your policy cannot be dropped.
• The cost is surprisingly low. Individual physicians receive the full 13% semi-annual discount.
• Total disability is defined as "the inability to perform the duties of your specialty.”
• Pre-existing conditions are covered; benefits may be limited to two years.
• Proven history of market-oriented claims performance.
• Non-cancellable disability overhead expense insurance of up to $25,000 per month is also available; $1 ,000 per month issue is guaranteed.
Since 1968, Malachy Whalen & Co., Inc. has specialized in insurance for Pennsylvania physicians. Over 300 professional corporations and 1,000 individual physicians are currently protected with combinations of disability and life insurance.
Ask Malachy’s advice. .. Call collect: 412/281-4050
County Society Officers
President Elect: Peter F. Pepe, MD, 3901 S. Atherton St., Ste. 5, State College 16801, 814-466-7911
Vice President: Gay D. Dunne, MD, 137 S. Pugh St., State College 16801, 814-234-3381
Treasurer: Stanley P. Mayers Jr., MD, 648 Wiltshire Drive, State College 16803, 814-238-4014
Secretary: Jane A. M. Strickler, MD, PO Box 59, Boalsburg 16827, 814-238-0563
Bulletin Editor: Pascal J. Imperato, MD, 610 Bough Rd, Exton 19341, 215-647-4240
Publication: CHESTER COUNTY MEDICINE
CLARION COUNTY
President: William M. McKinley, MD, 395 Main St., Brookville 15825, 814-849-7388
Vice President: Sukumar M. Chapa, MD, 82 Barnett St., Brookville 15825, 814-849-5151
Secretary/Treasurer: Barry J. Snyder, MD, 241 R Broad Street, New Bethlehem 16242, 814-275-3320
CHESTER COUNTY
President: Richard C. Uhlman, MD, 580 Lancaster Pike, Berwyn 19312, 215-644-8120
President Elect: William S. Lovrinic, MD, 9 N. Five Point Rd., West Chester 19380, 215-696-8800
Vice President: Mary B. Allan, MD, 602 E. Marshall St., West Chester 19380, 215-436-5822
Treasurer: John J. Pell, MD, 400 Main St. , Phoenixville 19460, 215-935-1120 Secretary: Gary Levin, MD, 1500 Cardinal Dr., Coatesville 19335, 215-269-9100
Executive Director: Ms. Carol Dotts, 580 Lancaster Ave., Berwyn 19312, 215-644-8120
Brandywine Hospital
Offers the skills and technology of the city — in the quiet rural setting of Chester County — just 10 minutes from 120,000 people.
★
24-Hour Trauma
★
Coronary/Intensive
Service
Care
★
Mobile Paramedic Unit
★
Full Body CT Scanner
★
Emergency
★
Hematology/Oncology
Aeromedical
★
Nuclear Medicine
Transport
★
Psychiatric Unit
★
Hemodialysis Unit
★
Industrial Medicine
★
Hemoperfusion Center
Program
★
Physical Medicine/
★
Pediatrics
Rehabilitation
★
Maternity
★
Birthing Room
★
Detox Unit
Brandywine Hospital
201 Reece vi lie Road Cain Township, PA 19320 A 383-8000
For more information call (215) 383-8049
CLEARFIELD COUNTY
President: Thomas L. Baumann, MD, 807 Turnpike Ave., Clearfield 16830, 814-765-1713
Vice President: Carmela S. Lugue, MD, 914 S. Second St., Clearfield 16830, 814-765-2159
Secretary/Treasurer: Brenda K. Baumann, MD, RD 3, Box 216A-1,
Clearfield 16830, 814-765-8312 or 342-3320
CLINTON COUNTY
President: Victoria J. Romeo, MD, 200 S. Jones St., Lock Haven 17745, 717-748-3735
President Elect: Bruce M. Bilder, MD, 37 Pineview St., Flemington, Lock Haven 17745, 717-748-7714
Vice President: David Cowger, MD, 18 N. Laurel Lane, Lock Haven 17745, 717-748-1741
Secretary/Treasurer: William C. Long Jr., MD, 53 W. Main St., Lock Haven 17745, 717-748-4063
Executive Director: Mr. Paul P. John, 2895 Euclid Ave., Williamsport 17701, 717-323-6432 or 323-3611 (pager)
COLUMBIA COUNTY
President: E Lawrence Harasym, MD, 1 S. Hospital Dr., Bloomsburg 17815, 717-387-1444
Vice President: Liveo B. Baldia, MD, 540 E. 11th St., Berwick 18603, 717-759-1400
Secretary/Treasurer: J. Campbell Martin, MD, 549 E. Fair St., Bloomsburg 17815, 717-387-2107
Bulletin Editor: Ali A. Alley, MD, 109 Mulberry, Berwick 18603,
717-759-0351
Publication: THE MEDICAL BULLETIN
CRAWFORD COUNTY
President: Christopher Thomas, MD, 764 Kennedy St., Meadville 16335, 814-724-8331
President Elect: Thomas M. Watson, MD, 505 Poplar St., Meadville 16335, 814-724-8433
Vice President: Mohamed Moakeh, MD, 773 N. Main St, Meadville 16335, 814-724-5072
Treasurer: Edward J. Owens, DO, 118 Railroad St, Cambridge Springs 16403, 814-398-4313
Secretary: Robert N. Moyers, MD, 764 Kennedy St, Meadville 16335, 814-336-5995
Continued
Large Laboratory Technology —Local Laboratory Service
Now serving physicians, nursing homes, hospitals, industry, and laboratories in southeastern Pennsylvania with twice a day pick-ups.
all
INC.
One Pike Creek Center Linden Hill Road Wilmington, DE 19808 (302) 994-5764
lll<M
m|1
48 Pennsylvania Medicine, August 1986
Avoid Computer Cobwebs
There’s nothing more frustrating than an office computer collecting cobwebs. Just ask the doctor who has one.
You can spend from $1,000 to $100,000 on a medical office automation system, but unless your office is trained to use it and receives on-going, follow-up support, you’re probably not getting your money’s worth. Worse still, if the vendor who sold you the software doesn’t keep it current with regulatory and billing changes that affect your prac- tice, your system may end up gathering dust in some corner.
That’s why Keystone Technologies begins with the premise that your office staff needs initial train- ing tailored to the needs of your practice. Once you’re up and running, our Customer Support Representatives are there to answer questions, solve problems, or provide instant assistance via our toll-free “response line”. And software en- hancements, including regulatory-mandated changes, are part of a continuing relationship we have with our clients.
We offer two types of systems: Medical Billing, available on an inexpensive lease basis, and Prac-
tice Management, a total approach to business paperwork. Both enable you to transmit Blue Shield and Medicare B claims electronically for faster processing and payments.
If you’re looking for a computer system, look to Keystone Technologies, a subsidiary of Pennsylva- nia Blue Shield. We’ll get you started, and will be there to keep you going. And you’ll never have to clear away computer cobwebs.
For more information, call (717) 975-7159, or write: Keystone Technologies, Inc.
Dept. PAS,
P.O. Box 8075 Camp Hill, PA 17011
(offices in Monroeville and Fort Washington).
■■Keystone ■■Technologies, Inc.
a subsidiary of Pennsylvania Blue Shield
HEALTH CARE AT ITS BEST: AIR FORCE MEDICINE
Air Force medicine is one of our best benefits, and, with your help, we'll keep it that way The Air Force needs physicians such as you to become members of our health care team
Most administrative responsibilities are in the hands of others, giving our physicians the time to give their full attention to the patients' needs. Our hospitals are staffed with dedicated, competent professionals
You'll find you will have time for your family, and to keep abreast of the latest methods and technologies that you don't have time for now We also offer unlimited professional development and financial security
If you're considering a change, consider Air Force medicine To find out more about Air Force medicine, contact your nearest Air Force recruiter. Experience health care at its best.
Pittsburgh— TSgt. Saracco (412) 644-5875 Call Collect
A great way of life!
County Society Officers
CUMBERLAND COUNTY
President: Gregory Lewis, MD, 220 Wilson St., Carlisle 17013, 717-249-1929
President Elect: Robert F. Hall II, MD, 161 Candelite Dr., Carlisle 17013, 717-245-5400
Vice President: H. Robert Davis, MD, PO Box 38, Boiling Springs 17007, 717-258-3812
Secretary/Treasurer: Herbert C. Perlman, MD, Carlisle Hospital Xray, Box 310, Carlisle 17013, 717-245-5400
DAUPHIN COUNTY
President: Leland Patterson, MD, 3300 Trindle Rd., Camp Hill 17011, 717-763-4764
President Elect: Rosario Maniglia, MD, Holy Spirit Hosp., Camp Hill 17011, 717-761-7439
First Vice President: F. Jane Barton, MD, 100 Conoy St., Harrisburg 17104, 717-232-0843
Second Vice President: Joseph J. Trautlein, MD, 6430 Colchester Ave., Harrisburg 17111, 717-534-8161
Secretary/Treasurer: Bradford K. Strock, MD, Harrisburg Hospital, Family Practice Center, Harrisburg 17101, 717-782-5435
Executive Secretary: Mr. Robert W. Evans, 217 State St., Med. Bureau Bldg , Harrisburg 17101, 717-234-1678
DELAWARE COUNTY
President: Charles Gorby, MD, 138 Brookline Blvd., Havertown 19083, 215-449-7286
President Elect: Alvin E. Gaary, MD, 320 Cherry Lane Wynnewood 19096, 215-284-8430
Vice President: Richard R. Ratner, MD, PO Box 92, Ridley Park 19078, 215-521-3333
Treasurer: Adolph H Bleier, MD, 401 E. 13th St., Chester 19013, 215-876-7083
Secretary: Mandell J. Much, DO, Route One, Concordville 19331, 215-459-3862
Executive Director: David McKeighan, State & Sproul Rds., Ste. 100, Springfield 19064, 215-328-1184
Bulletin Editor: Marcos Krausz, MD, 602 Pine Ridge Rd., Media 19063, 215-566-9391
Publication: THE BULLETIN OF THE DELAWARE COUNTY MEDICAL SOCIETY
ELK/CAMERON COUNTY
President: Maurus L. Sorg, MD, 316 W. Theresia Rd., St. Marys 15857, 814-781-6758
Vice President: David M. Caruso, MD, 20 N. Michael St., St. Marys 15857, 814-781-7531
Secretary/Treasurer: Robert Schmidt, MD, 20 N. Michael St., St. Marys 15857, 814-781-7531
ERIE COUNTY
President: William F. Brereton, MD, 104 E. Second St., Erie 16507, 814-459-4200
President Elect: John C. Reilly, MD, 3216 Erie St., Erie 16508,
814-456-2976
Vice President: Donald N. Vandamia, MD, 1589 W. 54th St., Erie 16509, 814-868-5202
Treasurer: Donald M. Schlabach, MD, 104 East Second St., Fifth FI. , Erie 16507, 814-459-5000
Secretary: Joseph R McClellan, MD, 225 W. 25th St., #410, Erie 16502, 814-453-7767
Executive Secretary: Robert B Stuart, MD, 1565 W. 38th St., Erie 16508, 814-866-6820
Bulletin Editor: John C. Reilly, MD, 3216 Erie St., Erie 16508, 814-456-2976
Publication: THE STETHOSCOPE
FAYETTE COUNTY
President: Honorio Pineda, MD, 115 Morgantown St., Uniontown 15401, 412-439-6340
President Elect: David M. Murello, MD, 650 Cherry Tree Ln., Uniontown 15401, 412-439-8100
Vice President: Mary E. Kunkel, MD, 1 S. Mount Vernon Ave., Uniontown 15401, 412-437-9858
Secretary/Treasurer: Gertrude Blumenschein, MD, 105 Medical Arts Building, Uniontown 15401, 412-437-1539
Executive Secretary: Ms. Anne L. White, PO Box 1212, Uniontown 15401, 412-437-7565
Bulletin Editor: Ms. Anne L. White, PO Box 1212, Uniontown 15401, 412-437-7565
Publication: NEWSLETTER
FRANKLIN COUNTY
President: William A Freeman, MD, 67 W. King St., Shippensburg 17257, 717-532-4148
Continued
50 Pennsylvania Medicine, August 1986
Why pay too much for workers’ compensation insurance?
Dividends for doctors average 43% per year from the Dodson Plan!
A service approved by Pennsylvania Medical Society
Physicians get a discount when policies are issued. Then at year- end, a dividend also is paid, based on claim costs. Dividends have run as high as 47% and now average 43% yearly since 1973.
In this plan, a dividend is paid when claim costs are kept low through safety on the job. From Dodson, you get prompt service with the personal touch. Write or phone for complete details!
LET US HELP YOU SAVE!
Insurance provided by
CASUALTY RECIPROCAL EXCHANGE
Member of Dodson Insurance Group P.O. Box 559, Kansas City, Missouri 64141 Call toll-free 1-800-821-3760 In Missouri 1-800-892-3431
Consider the causative organisms...
cefaclor
250-mg Pulvules t.i.d. offers effectiveness against the major causes of bacterial bronchitis
Haemophilus influenzae, H influenzae, Streptococcus pneumoniae, Streptococcus pyogenes
(ampicillin-susceptible) (ampicillin-resistant)
Note: Ceclor® is contraindicated in patients with known allergy to the cephalosporins and should be given cautiously to penicillin- allergic patients.
Ceclor" (cefaclor)
Penicillin is the usual drug of choice in the treatment and prevention of streptococcal infections, including the prophylaxis of rheumatic fever. See prescribing information
Summary. Consult the package literature for prescribing Information Indications: Lower respiratory intections, including pneumonia, caused by sus- ceptible strains ot Streptococcus pneu moniae. Haemophilus influenzae. and S. pyogenes (group A beta-hemolytic streptococci)
Contraindications: Known allergy to cephalosporins.
Warnings: CECLOR SHOULD BE ADMIN- ISTERED CAUTIOUSLY TO PENICILLIN- SENSITIVE PATIENTS. PENICILLINS AND CEPHALOSPORINS SHOW PARTIAL CROSS-ALLERGENICITY POSSIBLE REACTIONS INCLUDE ANAPHYLAXIS.
Administer cautiously to allergic patients
Pseudomembranous colitis has been reported with virtually all broad-spectrum antibiotics. It must be considered in differential diagnosis of antibiotic-
associated diarrhea Colon flora is altered by broad-spectrum antibiotic treatment, possibly resulting in antibiotic-associated colitis.
Precautions:
• Discontinue Ceclor in the event ot allergic reactions to it
• Prolonged use may result in overgrowth ot nonsusceptible organisms
• Positive direct Coombs' tests have been reported during treatment with cephalosporins.
• In renal impairment, sate dosage ot Ceclor may be lower than that usually recommended. Ceclor should be admin- istered with caution in such patients
• Broad-spectrum antibiotics should be prescribed with caution in individuals with a history of gastrointestinal disease, particularly colitis
• Safety and effectiveness have not been determined in pregnancy, lactation, and infants less than one month old Ceclor
penetrates mother's milk. Exercise caution in prescribing for these patients. Adverse Reactions: (percentage of patients)
Therapy-related adverse reactions are uncommon Those reported include
• Gastrointestinal (mostly diarrhea): 2.5%
• Symptoms of pseudomembranous colitis may appear either during or after antibiotic treatment
• Hypersensitivity reactions (including morbilliform eruptions, pruritus, urticaria, erythema multiforme, serum-sickness- like reactions): 1.5%; usually subside within a few days after cessation of therapy. These reactions have been reported more frequently in children than in adults and have usually occurred during or following a second course of therapy with Ceclor No serious sequelae have been reported. Antihistamines and corticosteroids appear to enhance resolution of the syndrome.
• Cases of anaphylaxis have been reported, half of which have occurred in patients with a history of penicillin allergy.
• Other: eosinophilia, 2%, genital pruritus or vaginitis, less than 1%
Abnormalities in laboratory results of
uncertain etiology
• Slight elevations in hepatic enzymes
• Transient fluctuations in leukocyte count (especially in infants and children)
• Abnormal urinalysis; elevations in BUN or serum creatinine
• Positive direct Coombs’ test
• False-positive tests for urinary glucose with Benedict's or Fehlmg s solution and Clinitest" tablets but not with Tes-Tape ' (glucose enzymatic test strip, Lilly)
e 1986, ELI LILLY AND COMPANY I060485LRI Additional information available to the profession on request from Eli Lilly and Company. Indianapolis. Indiana 46285
Eli Lilly Industries, Inc Carolina, Puerto Rico 00630
<5%
Give your angina patient added proteetion OOO
CARDIZEM: FEWER SIDE EFFECTS
diltiazem HCI/Marion
The lowest Incidence of side effects among the calcium channel blockers’ 6
A safe choice for angina patients with coexisting hypertension,asthma, COPD,or RVD4,7
Proven efficacy when used alone in angina3
Compatible with other antianginals39
*See Warnings and Precautions.
Please see brief summary of prescribing information on the next page.
CARDIZEM FEWER SIDE EFFECTS
diltiazem HCI/Marion IN ANTIANGINAL THERAPY
60 mg fid or qid
Brief Summary
Professional Use Information
CARDIZEM"'
(diltiazem HC!) 30 mg and 60 mg Tablets
CONTRAINDICATIONS
CARDIZEM is contraindicated in (1) patients with sick sinus syndrome except in ttie presence of a functioning ventricular pacemaker, (2) patients with second- or third-degree 41/ block except in the presence of a func- tioning ventncular pacemaker, and (3) patients with hypotension (less than 90 mm Hg systolic)
WARNINGS
1 Cardiac Conduction. CARDIZEM prolongs 41/ node refractory periods wilhout significantly prolonging sinus node recovery time, except in patients with sick sinus syndrome This effect may rarely result in abnormally slow head rates (particularly in patients with sick sinus syndrome) or second- or third-degree 41/ block (six of 1,243 patients for 048%) Concomitant use of diltiazem with beta-blockers or digitalis may result in additive effects on cardiac conduction A patient with Prinzmetal's angina developed periods of asystole (2 to 5 seconds) after a single dose of 60 mg of diltiazem
2 Congestive Heart Failure. Although diltiazem has a negative inotropic effect in isolated animal tissue preparations, hemodynamic studies in humans with normal ventncular function have not shown a reduction in cardiac index nor consistent negative effects on contractility (dp/dt) An acute study of oral diltiazem in patients with impaired ventricular function (ejection fraction 24% ±6%) showed improvement in indices of ventricular function wilhout significant decrease in contractile function (dp/dt) Experience with the use of CARDIZEM alone or in combination with beta-blockers in patients with impaired ventricular function is limited Caution should be exercised when using the drug in such patients
3 Hypotension. Decreases in blood pressure asso- ciated with CARDIZEM therapy may occasionally result in symptomatic hypotension
4 Acute Hepatic Injury. In rare instances, significant elevations in enzymes such as alkaline phospha- tase, CPK, LDH, SGOT, SGPT, and other symptoms consistent with acute hepatic injury have been noted These reactions have been reversible upon discontinuation of drug therapy The relationship to CARDIZEM is uncertain in most cases, but prob- able in some (See PRECAUTIONS )
PRECAUTIONS
General. CARDIZEM (diltiazem hydrochloride) is extensively metabolized by the liver and excreted by the kidneys and in bile 4s with any new dmg given over prolonged periods, laboratory parameters should be monitored at regular intervals The dmg should be used with caution in patients with impaired renal or hepatic function In subacute and chronic dog and rat studies designed to produce toxicity, high doses of diltiazem were associated with hepatic damage In special
subacute hepatic studies, oral doses of 125 mg/kg and higher in rats were associated with histological changes in the liver which were reversible when the dmg was discontinued In dogs, doses of 20 mg/kg were also associated with hepatic changes, however, these changes were reversible with continued dosing Dmg Interaction. Pharmacologic studies indicate that there may be additive effects in prolonging 41/ conduction when using beta-blockers or digitalis concomitantly with CARDIZEM (See WARNINGS )
Controlled and uncontrolled domestic studies suggest that concomitant use of CARDIZEM and beta-blockers or digitalis is usually well tolerated Available data are not sufficient, however, to predict the effects ot concomitant treatment, particularly in patients with left ventricular dysfunction or cardiac conduction abnormalities In healthy volunteers, diltiazem has been shown to increase semm digoxm levels up to 20%
Carcinogenesis, Mutagenesis, Impairment ot Fertility. A 24-month study in rats and a 2 1 -month study in mice showed no evidence ot carcinogenicity There was also no mutagenic response in in vitro bacterial tests No intrinsic effect on fertility was observed in rats Pregnancy. Category C Reproduction studies have been conducted in mice, rats, and rabbits Administration of doses ranging from five to ten times greater (on a mg/kg basis) than the daily recommended therapeutic dose has resulted in embryo and fetal lethality These doses, in some studies, have been reported to cause skeletal abnormalities In the perinatal/postnatal studies, there was some reduction in early individual pup weights and survival rates. There was an increased incidence of stillbirths at doses of 20 times the human dose or greater There are no well-controlled studies in pregnant women, therefore, use CARDIZEM in pregnant women only it the potential benefit justifies the potential risk to the fetus
Nursing Mothers. Diltiazem is excreted in human milk. One repod suggests that concentrations in breast milk may approximate serum levels. If use of CARDIZEM is deemed essential, an alternative method of mtant feeding should be instituted Pediatric Use. Safely and effectiveness in children have not been established
ADVERSE REACTIONS
Serious adverse reactions have been rare in studies earned out to date, but it should be recognized that patients with impaired ventricular function and cardiac conduction abnormalities have usually been excluded In domestic placebo-controlled Inals, the incidence ot adverse reactions reported during CARDIZEM therapy was not greater than that reported during placebo therapy The following represent occurrences observed in clinical studies which can be at least reasonably asso- ciated with the pharmacology ot calcium influx inhibition In many cases, the relationship to CARDIZEM has not been established The most common occurrences as well as their treguency ot presentation are edema (2 4%), headache (2 1 %), nausea (1.9%), dizziness (15%), rash (1.3%), asthenia (1 .2%) In addition, the following events were repoded infrequently (less than 1 %)
Angina, arrhythmia, AV block (first degree). AV block (second or third degree — see conduction warning), bradycardia, congestive head failure, flushing, hypotension, palpi- tations. syncope
Amnesia, gait abnormality, halluci- nations, insomnia, nervousness, paresthesia, personality change, somnolence, tinnitus, tremor Anorexia, constipation, diarrhea, dysgeusia, dyspepsia, mild elevations of alkaline phosphatase, SGOT, SGPT, and LDH (see hepatic warnings), vomiting, weight increase
Petechiae, pmritus, photosensitivity, urticaria
Amblyopia, dyspnea, epistaxis, eye irritation, hyperglycemia, nasal congestion, nocturia, osteoarhcular pain, polyuria, sexual difficulties The following postmarketing events hove been repoded infrequently in patients receiving CARDIZEM alopecia, gingival hyperplasia, erythema multiforme, and leukopenia However, a definitive cause and effect between these events and CARDIZEM therapy is yet to be established Issued 1 1/85
See complete Professional Use Information before prescribing.
References: 1. Frishman WH, CharlapS, GoldbergerJ, et at Comparison ot diltiazem and nifedipine tor both angmo pectoris and systemic hypertension Am J Cardiol 1985,56 41 H-46H 2. Weiner DA, McCabe CH, Cutler SS, et at The efficacy and safety of high-dose verapamil and diltiazem in the long-term treatment of stable exedional angina Clin Cardiol 1985, 7 648-653 3. PepmeCJ, Feldman RL, Hill J A eta t Clinical outcome after treatment of rest angina with calcium blockers: Comparative experience during the initial year ot therapy with diltiazem, nifedipine, and verapamil Am Head J 1983, 106(6) 1341-1347 4. Cohn PE Braunwald E Chronic ischemic head disease, in Braunwald E (ed) Head Disease: A Textbook of Cardiovascular Medicine, ed2 Philadelphia, WB Saunders Co, 1984, chap 39 5. McCall D, Walsh RA Frohlich ED, et at Calcium entry blocking drugs. Mechanisms of action, expenmental studies and clinical uses Curr Probl Cardiol 1985, 10(8) 6-80 6. Chaffman M, Brogden RN Diltiazem A review of its pharmacological properties and therapeutic efficacy Drugs 1985,29 387-454 7. SchroederJS Calcium and beta blockers in ischemic head disease: When to use which Mod Med 1982, 50 (Sept) 94- 1 16 8. Shapiro W Calcium channel blockers Actions on the head and uses in ischemic head disease Consultant 1984,24(Dec ) 150-159 9. Johnston DL, Lesoway /?, Humen DP et at Clinical and hemodynamic evaluation of propranolol in combination with verapamil, nifedipine and diltiazem in exedional angina pectoris: A placebo-controlled, double-blind, randomized, crossover study Am J Cardiol 1985,55 680-687
Cardiovascular
Nervous System Gastrointestinal
Dermatologic
Other
Another patient benefit product from
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MARION
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Our Specialty Saves Your Specialty Time . . .
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An experienced physician search firm pro- vides you with an objective evaluation of the psychographics and demographics of your practice. We recognize your needs and can tailor a search effort to find top-notch individ- uals whose professional and personal goals match your own.
A good physician search firm can actually enhance the image of your practice. John Downing Associates, Inc. provides a detailed plan for marketing the strengths of your prac- tice through a comprehensive national net- work of candidate sources. Once the net- working begins, our search consultants screen, interview, reference check and prioritize candidates for you. John Downing Associates, Inc. personally interviews each priority candidate before you do. All you need to do is test the “chemistry” of each candi- date.
Once an associate is chosen, we help you structure a first-year compensation package and will maintain on-going support to review the progress of your new group practice. You can expect us to strive for long-lasting results!
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V.
In ten yearsvour malpractice carrier may be just a memory
Unless it’s Medical Protective.
As you consider professional liability insurance, consider this. The coverages stated in the policy are basically a promise — a promise to be here when needed regardless of legal climate or economic conditions. A company’s ability to keep this promise is critical because your financial security may depend on it. Unfortunately, too many firms are now finding the task impossible.
Analyze your liability insurance options carefully just as you would any important investment. Go beyond the agent and the policy to the company that
stands behind both. How long has it been in opera-, tion? Has it weathered some of the tough times? Wi it be there for you when you need help?
The Medical Protective Company pioneered profes sional liability coverage before the turn of the century and has served doctors exclusively ever since. Over 500,000 of them. Through good times and bad. We’ll be here when you need us.
Contact The Medical Protective Company through one of our general agents. History shows we keep our promises.
C f at u ttnv r, & ur/ e sicr ftp r,i Uw/t^ir
ti r-ypr. v
Lester R. Wilson, Jr., Joseph Pulcini, Jr., Suite 125, Commerce Plaza 5100 Tilghman Street, Allentown, PA 18104, (215) 395-8888
Eugene P. Ziemba, William J. Carey, Robert J. Zucosky, James I. Frazer, Jr. Suite 202, Plymouth Plaza, Plymouth Meeting, PA 19462, (215) 825-6800
Sidney B. Elston, Jr,
1902 Market Street, Camp Hill, PA 17011. (717) 737-9900
Ned Wells, Donald C. Hoffman, Grant R. Stewart, David M. Gusic Suite 212, Manor Oak Two, 1910 Cochran Road, Pittsburgh, PA 15220, (412) 531-4226
Elcomp.. .the best medical office computer system is now even better with the Flexible Package™
• a- 8i,s,On * c /
rould you treat only the symptoms, if you knew here was a proven cure?
s hard to cure chronic ailments ke runaway accounts receivable, jacklogged claim processing, poor Election ratio— by treating only the lymptoms. The Flexible Package rom Elcomp Systems, combined vith Data General’s Desktop Gener- ition computers, has been a proven ure for more than 500 physicians ;ince 1978.
rhe Flexible Package is modular, vhich means you can tailor the system to fit your practice’s specific seeds without any programming changes. We will train your staff in he operation of your system, and show you how your practice can nost benefit from all the features in /our Flexible Package.
The Flexible Package cure for medical office ailments:
• Improved cash flow through advanced collection methods and delinquency reporting
• Account Inquiries — demographic, insurance, and financial information at a touch
• Accounts Receivable and Man- agement Reports, whenever you need them
• Instantaneous retrieval of patients’ procedures and diagnoses
• Appointment Scheduler, to help organize your day
• Automatic preparation of recall letters
• Flexibility to design your own reports with the Report Generator
• and many more benefits...
Elcomp Systems can supply the cure for your practice management ailments. The treatment is singular and straightforward— to give you hardware, software, training, and after-purchase support as one package.
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A peripheral vasodilator
for treatment of
leg cramps cold feet tinnitus discomfort on standing
(
LIPO-NICIN
Nicotinic Acid Therapy
For patient’s
comfort/convenience
in choice of
3 strengths
Gradual Release
LIPO NICIN^/300 mg.
Each time-release capsule con-
tains:
Nicotinic Acid 300 mg
Ascorbic Acid 150 mg
Thiamine HCL (B-1) 25 mg
Riboflavin (B-2) 2 mg
Pyridoxine HCL (B-6) 10 mg
in a special base of prolonged therapeutic effect.
DOSE: 1 to 2 tablets daily. AVAILABLE: Bottles of 100, 500
Immediate Release
LIPO-NICIN®/250 mg.
Each yellow tablet contains:
Nicotinic Acid 250 mg
Niacinamide 75 mg
Ascorbic Acid 150 mg
Thiamine HCL (B-1) 25 mg
Riboflavin (B-2) 2 mg
Pyridoxine HCL (B-6) 10 mg
DOSE: 1 to 3 tablets daily AVAILABLE: Bottles of 100, 500
LIPO-NICIN®/100 mg.
Each blue tablet contains:
Nicotinic Acid 100 mg
Niacinamide 75 mg
Ascorbic Acid 150 mg
Thiamine HCL (B-1) 25 mg
Riboflavin (B-2) 2 mg
Pyridoxine HCL (B-6) 10 mg
DOSE: 1 to 5 tablets daily AVAILABLE: Bottles of 100, 500
Indications: For use as a vasodi- lator in the symptoms of cold feet, leg cramps, dizziness, memory loss or tinnitus when associated with impaired peri- pheral circulation Also provides concomitant administration of the listed vitamins The warm tingling flush which may follow each dose of LIPO-NICIN® 100 mg. or 250 mg. is one of the therapeutic effects that often produce psychological benefits to the patient.
Side Effects: Transient flushing and feeling of warmth seldom re- quire discontinuation of the drug Transient headache, itching and tingling, skin rash, allergies and gastric disturbance may occur Contraindications: Patients with known idiosyncrasy Jo nicotinic acid or other components of the drug Use with caution in preg- nant patients and patients with glaucoma, severe diabetes, im- paired liver function, peptic ul- cers, and arterial bleeding
Write for literature and samples
( BR<Wi?fc THE BROWN PHARMACEUTICAL CO., INC. p^l
2500 West Sixth Street, Los Angeles, California 90057 IPDR;
County Society Officers
President Elect: Thomas W. Bundy, MD, 1035 Wayne Ave., Chambersburg 17201, 717-264-6712
Vice President: Calvin B. Early, MD, 764 Lincoln Way East, Chambersburg 17201, 717-263-3850
Secretary/Treasurer: James C. Barton, MD, 4073 Frecon Rd., Chambersburg 17201, 717-264-6185
GREENE COUNTY
President: Prayun Chayapruks, MD, 189 E. High St., Waynesburg 15370, 412-627-8412/8415
President Elect: Lawrence F Martin, MD, 1150 Seventh St. , Waynesburg 15370, 412-627-6106
Vice President: Jeffrey S. Smith, DO, 734 E High St. , Waynesburg 15370, 412-852-2050
Secretary/Treasurer: John W. Reyes, MD, Greene County Memorial Hosp., Waynesburg 15370, 412-627-3101
HUNTINGTON COUNTY
President: Nicholas Mihelic, MD, 3228 Cold Springs Rd., Huntingdon 16652, 814-643-5752
Vice President: Frederick E. Wawrose, MD, Topowaw Hill Mounted Route, Huntingdon 16652, 814-643-5022 or 643-2290
Treasurer: Winfried W. Berger, MD, 3228 Cold Spring Rd., Huntingdon 16652, 814-643-5752
Secretary: David S. Miller, MD, 3228 Cold Springs Rd., Huntingdon 16652, 814-643-6462
INDIANA COUNTY
President: Mark Boykiw, MD, 549 Route 119 North, Indiana 15701, 412-349-8758
President Elect: Shafic Y. Twal, MD, Indiana Hospital, Indiana 15701, 412-463-0476
Vice President: Minoo D. Karanjia, MD, 1803 Route 422 W., Indiana 15701 412-349-5440
Treasurer: Charles D Petit, MD, 1177 South Sixth St., Indiana 15701, 412-349-8280
Secretary: Thomas McCoy, MD, 875 Hospital Suite 201, Indiana 15701, 412-349-1630
JEFFERSON COUNTY
President: Jose Acosta, MD, DuBois Hosp., DuBois 15801, 814-371-2200
Vice President: Howard Fugate, MD, 633 Maple Ave., Dubois 15801, 814-371-4443
Secretary/Treasurer: Joseph J. Kernich, MD, Medical Arts Bldg., RD 5, Punxsutawney 15767, 814-938-3310
LACKAWANNA COUNTY
President: F. Dennis Dawgert, MD, 802 Jefferson Ave., Scranton 18510, 717-346-1072
President Elect: Michael J. Turock, MD, 397 N. Ninth St. , Scranton 18504, 717-344-8619
Vice President: Thomas E. Zukoski, MD, 802 Jefferson Ave., Scranton 18510, 717-346-1464
Secretary/Treasurer: Douglas L Sheldon, MD, Bank Towers Bldg , 4th FI. Spruce And Wyoming Sts., Scranton 18503, 717-961-5522
Executive Director: W. Richard Kneller, PhD. Comp. Hlth. Serv. Ctr., 1416 Monroe Ave., Ste. 301, Dunmore 18509, 717-344-3616
Managing Editor: W. Richard Kneller, PhD, 1416 Monroe Ave., Ste. 301, Dunmore 18509, 717-344-3616
Bulletin Editor: Anthony M Perry, MD, 1416 Monroe Ave., Ste. 301, Dunmore 18509, 717-344-3616
Publication: LACKAWANNA MEDICINE
LANCASTER COUNTY
President: William D. McCann, MD, 420 W. Chestnut St., Lancaster 1 760' 717-397-5484
President Elect: Clarence H. Rutt Jr., MD, 250 College Ave., Prof. Bldg., F Box 3509, Lancaster 17604, 717-291-1567
Vice President: Terence N. Moore, MD, Lancaster General Hosp., PO Box 3555, Lancaster 17603, 717-295-8302
Treasurer: Charles A. Heisterkamp III, MD, 721 N. Duke St. , Lancaster 17602, 717-397-5104
Secretary: Roland A. Loeb, MD, Box 1724, 435 W. Chestnut St., Lancastei 17604, 717-394-7234
Executive Secretary: Ms. Sally Sigafoos, 137 E. Walnut St., Lancaster 17602, 717-393-9588
Bulletin Editor: Roland A. Loeb, MD, 137 E. Walnut St., Lancaster 17602, 717-393-9588
Publication: LANCASTER MEDICINE
LAWRENCE COUNTY
President: William Pommersheim, MD, 217 N. Jefferson St., Ste A, New Castle 16101, 412-652-4791
President Elect: Michael J. Larkin, MD, 2602 Wilmington Rd., New Castle
16105, 412-658-7702
Continue (
l
AT&T’S NEW DOCTOR’S SOLUTION ASSISTS YOU ROUND-THE-CLOCK WITH EVERYTHING FROM ACCOUNTS RECEIVABLE TO SCHEDULING.
Few doctors like to think of their practice as a business, but of course it is.
So the less you have to think about business, the more you can concentrate on medicine.
That’s why AT&T tailored a complete hardware and software package specifically for the medical profession. The Doctor’s Solution.
It’s just one member of a whole family of Health Care Information Systems. AT&T Doctor’s Solution pro- vides total office management for single and multi-doctor practices.
Far from forcing you to change the way you run your practice, Doctor’s Solution simply allows you to run it more efficiently with help like this:
Automated billing gathers all charges to each patient— including exams, tests and prescriptions— and automatically calculates a single, comprehensive bill.
Accounts receivable tracks all receivables, selects balance-forward or open-item
Doctor’s Solution software takes care of your paper work so you can take care of your patients.
statements, sets aging intervals, and spots delinquent accounts. All of which improve your collection rates.
Practice man- agement improves the flow of your practice with the on- going maintenance of complete patient histories. Both clinical and billing infor- mation follow every patient through your office.
Patient scheduling by practice, doctor, week or month— including rounds and vacations— helps you get the most out of your time so you can give the most to your patients.
Third-party billing in- creases your cash flow by ac- commodating unlimited fee schedules and generating a variety of forms and invoices.
Remote access to your office sys- tem. Now you can get complete clinical and business information at the hospital, at home— anywhere there’s a phone, a • terminal or PC, and a modem.
But one of the nicest features about Doctor’s Solution is that it’s backed by AT&T’s Small Business Connection. Which means our specialists in the medical field will make sure you get the right hardware, the right software and the right ? training.
By tracking who owes what, the system helps pay for itself.
As your practice grows, these specialists will help you keep your system right in step— accepting new doctors, new procedures and new diagnostics.
What’s more, Doctor’s Solution will work with every UNIX™ System- based computer AT&T makes. Just one more example of “The Computers With The Future Built In.”
And if you have a problem? We not only have a Service Hotline; we even do over-the-phone software diagnostics.
It’s all part of AT&T’s unique approach to small business. 'Vbu don’t just buy a system.
You buy AT&T’s end-to-end respon- sibility for that system.
And you buy it from a single source with a proven past. And a very healthy future. Give us a call at 314 444-2842. We’ll show you how to get your practice a lot closer to perfect.
AT&T
The right choice.
© 1986 AT&T Information Systems.
THE NEURO-OTOLOGY GROUP
vasilios J. Kalogredis, JD, cpbc Robert A. wade, JD Susan F. Dubow, JD Jeffrey B. Sansweet, JD Nancy w. Miller, jd
PROFESSIONAL PRACTICE CONSULTING, INC.
Providing Management Consulting; Corporate, Retirement, and Estate Planning; Croup Practice; Practice Sale and valuation; and Related Services for Physicians.
suite 202
997 Old Eagle School Road Wayne, Pennsylvania 19087 (215) 687-4013
County Society Officers
Vice President: Romeo H. Bella, MD, Ellwood City Hosp., Anesthesiology Dept., Ellwood City 16117, 412-752-0081
Secretary/Treasurer: Peter J. Mancino, MD, Leawood Drive, RD 3, New Castle 16105, 412-652-9822
LEBANON COUNTY
President: Horst Bertram, MD, Good Samaritan Hosp., Lebanon 17042, 717-272-7611
President Elect: Burton Marks, DO, Good Samaritan Hosp., 4th & Walnut Sts., Lebanon 17042, 717-272-7600
Vice President: Ramon U. Suarez, MD, 1023 Poplar St. , Lebanon 17042, 717-273-0861 or 273-1811
Treasurer: Kerry H. Gingrich, MD, 618 Cornwall Rd., Lebanon 17042, 717-273-3782
Secretary: Robert G. Heisey, MD, Third & Willow Sts., Lebanon 17042, 717-273-8835
Executive Secretary: Ms. Susan Foltz, Good Samaritan Hosp., 4th &
Walnut Sts., Lebanon 17042, 717-272-7611, Ext. 424
LEHIGH COUNTY
President: John A. Kibelstis, MD, 1210 S. Cedar Crest Blvd., #3200, Allentown 18103, 215-439-8856
President Elect: David O. Williams, MD, 2200 Hamilton St. , Allentown 18104, 215-433-8025
Vice President: Theodore H. Gaylor, MD, 1251 S. Cedar Crest Blvd.,
#202-A, Allentown 18103, 215-437-3545
Treasurer: John J. Stasik Jr., MD, 1275 South Cedar Crest Blvd., Allentown 18103, 215-433-7571
Secretary; Howard L. Carbaugh, MD, 614 N. Sixth St., Allentown 18102, 215-432-6032
Executive Secretary: Mr. Robert R. Parsons, 1620 Highland St., Allentown 18102, 215-437-2288
Publication: THE "DR”
LUZERNE COUNTY
President: Herbert Fellerman, MD, 35 W. Linden St., Wilkes-Barre 18702, 717-829-0503
President Elect: Thomas E. Baker, MD, 610 Wyoming Ave., Kingston 18704, 717-288-5441
Audiology, Electronystagmography, Electro-oculography, Central Auditory Tests, Speech-Language Services
DIZZINESS CLINIC
LEARNING DISABILITY EVALUATIONS
Robert Slater, MD, Neurologic Director
Joseph Ardito, MD, Otologic Director
Maxine Young, MS, CCC/A-Sp, Audiologic Director
DELAWARE CO. MED. CENTER, SUITE 12 LAWRENCE PARK SHOPPING CENTER BROOMALL, PA 19008
(215) 353-4183
Vice President: Victor T. Ambruso, MD, 1732 Wyoming Ave., Forty Fort 18704, 717-283-1400
Treasurer: Ira C. Grossman, MD, 470 Wyoming Ave., Kingston 18704, 717-288-4551
Secretary: Juan Gaia, MD, 451 Third Ave., Kingston 18704, 717-283-0529
Executive Director: Mr. Duane E. Kersteen, 130 S. Franklin St.,
Wilkes-Barre 18701, 717-823-0917
Bulletin Editor: Edward A. Lottick, MD, 130 S. Franklin St., Wilkes-Barre 18701, 717-823-0917
Assistant Editor: Mr. Duane E. Kersteen, 130 S. Franklin St., Wilkes-Barre 18701, 717-823-0917
Publication: THE BULLETIN
LYCOMING COUNTY
President: Daniel R. Gandy, DO, 1201 Grampian Blvd., Williamsport 17701, 717-323-8693
President Elect: Kenneth L. Cooper, MD, 528 W. Fourth St., Williamsport 17701, 717-323-3671
Vice President: Leo M Hartz, MD, 27 S. Washington St., Muncy 17756, 717-546-8255 or 546-8282
Treasurer: Donald E. Shearer, MD, 217 Broad St., Montoursville 17754, 717-368-8188
Assistant Treasurer: Larue Pepperman, MD, 807 Grampian Blvd., Williamsport 17701, 717-322-2497
Secretary: Daniel E. Hill, MD, Williamsport Hosp., Williamsport 17701, 717-322-7861
Assistant Secretary: Young W. Park, MD, 777 Rural Ave., Williamsport 17701, 717-321-2600
Executive Director: Mr. Paul P. John, 2895 Euclid Ave., Williamsport 17701, 717-323-6432 or 323-3611 (pager)
Bulletin Editor: Richard B. Tobias, MD, 1615 Riverside Dr., Williamsport 17701, 717-323-2009
Publication: LYCOMING MEDICINE
MCKEAN COUNTY
President: Douglas Bowman, MD, P.O. Box 443, 113 Marvin St., Smethport 16749, 814-887-5395
President Elect: James Corcoran, MD, Bradford Hosp., Bradford 16701, 814-368-6956
Secretary/Treasurer: Raineldo C. Saquin, MD, 103 Hemlock Ave., Kane 16735, 814-837-8585
Continued
60 Pennsylvania Medicine, August 1986
For Comprehensive Rehabilitation Look to
ALLIED SERVICES
• the largest comprehensive rehabilitation complex in the U.S. • serving the disabled and elderly for over 20 years
Physical Medicine and Rehabilitation
George T. Walters Institute, Scranton, PA/John Heinz Institute, Wilkes-Barre, PA Inpatient and Outpatient Programs available at both facilities
Specialty Programs
• Stroke • Orthopedic Conditions • Chronic Neurological Conditions
• Arthritis • Head Injury • Spinal Cord • Chronic Pain Management
Also offering:
• Long Term Care - 360 Beds SNF/ICF
• Home Health and Homemaker Programs
• Apartments for the Handicapped and Elderly - 10 apartment complexes with 641 units located in Northeastern and Central Pennsylvania
• Vocational Evaluation and Job Placement for workers compensation and other casualty insurance carriers
• Evaluation, Personal Work Adjustment Training, Handicapped Employment, Work Activities, and ICF/MR Day Care
Allied Services
475 Morgan Highway P.O. Box 1103 Scranton, PA 18501 717-348-1300
/
OR-D is a total business management system for single & multi-doctor practices. OR-D will monitor a patient from his entry into the practice all through his treatment history. At your fingertips are patient records, diagnosis, 3rd party billing, referral, practice building, etc. OR-D is surprisingly simple to operate, exceptionally reliable, remarkably fast and affordable— With a user base of over 200 offices in the East Coast, OR-D is one of the most experienced and reliable vendors in the computerizing of Medical offices— Find out about OR-D SHARE, the multi-user system for the price of one.
COMPARE! Customization, support, training at your location, service hotline, warranty . . .
FOR INFORMATION OR A FREE DEMONSTRATION IN YOUR OFFICE, CALL (609) 665-ORD3/665-2255 OR SEND US THE COUPON BELOW.
□ I would like a free demonstration in my office
□ Please send me information on ORD Systems
L'L'L’LLL'
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LL’L'L’L'L
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ADDRESS
PHONE
L'L'L’L’L'L
L’L'LLLL'
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OR-D SYSTEMS
1 MARTIN AVE.
CHERRY HILL, NJ 08002
609-665-2255
County Society Officers
MERCER COUNTY
President: Robert Allen, MD, Medical Arts Bldg , Sharon 16146, 412-981-6732
President Elect: Walter P. Beh, MD, 81 North Main St., Greenville 16125, 412-588-1444
Vice President: Alexander D. Limkakeng, MD, Pine Med. Ctr., RD 1, Box 5611, Grove City 16127, 412-458-5550
Secretary/Treasurer: Paul J. Dowdell, MD, 90 Shenango St., Greenville 16125, 412-588-4240
MIFFLIN/JUNIATA COUNTY
President: Rajeshwar Malhotra, MD, 18 N. Main St., Lewistown 17044, 717-242-1441 or 717-248-5411
Vice President: Charles W. Everhart, MD, 4th St. & Highland Ave., PO Box 48, Lewistown 17044, 717-242-2531
Treasurer: Eleanor M. Aurand, MD, RD 1, Box 442, Lewistown 17044, 717-248-1861
Secretary: Stephen I Dodd, MD, PO Box N, Mifflin 17058, 717-436-2626
MONROE COUNTY
President: Robert Baird, MD, Pocono Hosp., 206 E. Brown St., East Stroudsburg 18301, 717-421-5551
Vice President: Theodore J. Kowalyshyn, MD, 214 Washington St., East Stroudsburg 18301, 717-424-9555
Secretary/Treasurer: Donald W. Hiemenz, MD, RD 6, Box 6259, Stroudsburg 18360, 717-992-4208
Executive Secretary: Candy Forrey, Pocono Hospital, 206 E Brown St., East Stroudsburg 18301, 717-421-4000 or 421-4679
MONTGOMERY COUNTY
President: William H. Mahood, MD, 1245 Highland Ave., Abington 19001, 2T5-887-9690
President Elect: Richard P. Albertson, MD, Lankenau Hosp. An. Dept., City Line & Lancaster Ave., Philadelphia 19151, 215-645-2141
Vice President: Nicholas R. Rorick, MD, 1430 DeKalb St., Norristown 19401, 215-278-8479
Treasurer: Joseph L. Hunsberger, MD, 2803 Stanbridge St., 512-B, Norristown 19401, 215-272-2050
Secretary: H. Craig Bell, MD, 1335 Highland Ave., Abington 19001, 215-886-4000
Executive Director: U. Berkley Ellis, EdD, 1529 DeKalb St., Norristown 19401, 215-277-3690
Bulletin Editor: H. Craig Bell, MD, 1335 Highland Ave., Abington 19001, 215-886-4000
Publication: MEDICAL BULLETIN
MONTOUR COUNTY
President: Peter Cera Jr., MD, Geisinger Medical Ctr., Danville 17822, 717-271-6332
President Elect: Thomas C. Royer, MD, Geisinger Med. Ctr., Danville 17822, 717-271-6464
Secretary/Treasurer: Frederick G. Brown, MD, Geisinger Medical Center, Danville 17822, 717-271-6393
NORTHAMPTON COUNTY
President: H. Newton Olewiler Jr., MD, 1010 W. Macada Rd., Bethlehem 18017, 215-865-4131
President Elect: G. Bruce Miles, DO, 1901 Fairview Ave., Easton 18042, 215-258-2893
Vice President: Robert C. Hunsicker, MD, 65 E. Elizabeth Ave., #31, Bethlehem 18018, 215-866-5555
Treasurer: Walter K. Peters, MD, 724 Barrymore Lane, Bethlehem 18017, 215-867-9017
Secretary: Evan C. Reese Jr., MD, 2005 Fairview Ave., Easton 18042, 215-258-6268
Executive Secretary: Mr. William H. Kilpatrick, 788 Redfern Lane, Bethlehem 18017, 215-865-2900
Bulletin Editor: William H. Kilpatrick, 788 Redfern Lane, Bethlehem 18017, 215-865-2900
Publication: THE BULLETIN
NORTHUMBERLAND COUNTY
President: David C. Scicchitano, MD, 15 East Ave , Mt. Carmel 17851, 717-339-2156
President Elect: Winfield S. Gibbs, MD, PO Box 737, Sunbury 17801, 717-286-7586
Vice President: Nicholas Spock, MD, 300 Shamokin St. , Shamokin 17872, 717-648-2352
Secretary/Treasurer: Edward V. Twiggar II, MD, 325 Center St., Shamokin 17872, 717-644-0494
Executive Director: Mr. Paul P. John, 2895 Euclid Ave., Williamsport 17701, 717-323-6432 or 323-3611 (pager)
Publication: NORTHUMBERLAND COUNTY MEDICAL SOCIETY NOTES
PERRY COUNTY
President: H. Robert Gasull, MD, Box 160-G, Elliottsburg 17024, 717-582-8671
Continuec
62 Pennsylvania Medicine, August 1986
THE HEALTH CARE GROUP
Since 1970, The Health Care Group has provided financial, manage- ment and legal services for physicians and related health care profes- sionals and organizations.
HEALTH CARE CONSULTING, INC.
• Medical Practice Survey
• Long-range Planning
• Income Division
• Computer Analysis
• Practice Valuation
• Retirement Plan Consulting
• Inter-Doctor Arrangements
HEALTH CARE PERSONNEL CONSULTING, INC.
• Physician Recruitment
• Medical Practice Brokering
• Administrator Recruitment
• Medical Office Recruitment
• Personnel Matter Consulting
HEALTH CARE MARKETING ASSOCIATES, LTD.
• Demographic and Competitive Analysis
• Practice Site Selection
• Marketing Planning and Strategy
• Public Relations and Advertising
Call or write for our brochure:
• — T
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ss
Health Care Group
400 GSB Building Bala Cynwyd, PA 19004 (215) 667-2341
Neilson Medical Computer Systems
Neilson Medical System Features:
• Extremely Simple to operate regardless of past experience.
• Insurance Forms - 6 per minute, unattended, saves hours a day.
• Statements - 8 per minute, no stuffing or stamping, saves days per month.
• Receivable age listing -30-60-90 day reports with work & home numbers, cuts receivables by 30%.
• File Security - no lost or misplaced files, bills or records — a modern efficient office.
• Reports - a variety of reports can be generated to your specifications— excellent medical practice management
• An extensive assortment of software packages, including word processing, accounting, spread sheet, etc., are ready to meet your every need.
Neilson, Inc., Features:
• One Year Money Back Guarantee
• 350 Current Medical Clients
• Service:
24 Hours Per Day 7 Days/Week “ Neilson means... Service "
• Complete Delivery, Installation and Training
• Largest Medical Computer Dealer on The East Coast!
Call Today:
1-800-544-4022
In DE: 654-5270
Neilson, Inc.
Neilson means... Service 819 West Street Wilmington, DE 19801
IBM PC AT
County Society Officers
President Elect: Patrick T. Bolden, MD, Duncannon Family Hlth. Ctr., Box 68, Duncannon 17020, 717-834-3108
Vice President: Jonathan E. Keough, MD, 401 Kings Highway, Marysville 17053, 717-957-4937
Secretary /Treasurer: Joseph J. Matunis, MD, RD 2, Box 365, Loysville 17047, 717-789-3553
PHILADELPHIA COUNTY
President: Edward J. Resnick, MD, Temple Univ. Hosp., 3401 N. Broad St., Philadelphia 19140, 215-229-0100
President Elect: Wallace G. McCune, MD, 2 Penn Blvd., Philadelphia 19144 215-843-6093
Vice President: Milton A. Wohl, MD, Klein Prof. Office Bldg., 5401 Old York Rd., Ste. 200, Philadelphia 19141, 215-456-9400
Treasurer: Richard M. Gash, MD, 1401 Redwood Lane, Wyncote 19095, 215-342-0660
Secretary: Timothy J. Michals, MD, 8305 Seminole Ave., Philadelphia 19118, 215-546-7973
Executive Director: Mr. John Trevi, 2100 Spring Garden St., Philadelphia 19130, 215-563-5343
Bulletin Editor: William Weiss, MD, 2100 Spring Garden St., Philadelphia 19130, 215-563-5343
Publication: PHILADELPHIA MEDICINE
POTTER COUNTY
President: David W. Ambrose, MD, Cole Medical Ctr., Coudersport 16915, 814-274-7722
Vice President: Joseph C. Chidi, MD, Cole Medical Bldg., Coudersport 16915, 814-274-9633
Secretary/Treasurer: George C. Mosch, MD, 207 Cartee St., Box 72, Coudersport 16915, 814-274-8450
SCHUYLKILL COUNTY
President: Joseph Marconis, MD, 413 W. Market St., Pottsville 17901, 717-622-8903
Treasurer: Michael S. Pristas, MD, 602 W. Market St., Pottsville 17901, 717-628-2621
Secretary: Richard P Bindie, MD, 150 Avenue D, Schuylkill Haven 17972, 717-622-6120
Bulletin Editor: Leonard J. Tananis, MD, 610 W. Market St., Pottsville 17901, 717-622-5081
Publication: THE BULLETIN OF THE SCHUYLKILL COUNTY MEDICAL SOCIETY
SOMERSET COUNTY
President: Alfred J. Poggi, MD, Neilan Dr , RD 6, Somerset 15501, 814-443-3637
President Elect: Ajay P Singh, MD, 614 S. Franklin Ave., Somerset 15501, 814-443-2888
Vice President: V. Krishnan Nair, MD, 225 S. Center Ave., Somerset 15501, 814-445-7101
Secretary /Treasurer: William C. Ryan, MD, 917 W. Main St., Somerset 15501, 814-443-3648
SUSQUEHANNA COUNTY
President Elect: Dennis Allen, MD, RD 1, Box 349. Hallstead 18822, 717-879-2124
Vice President: Dennis Allen, MD, RD 1, Box 349, Hallstead 18822, 717-879-2124
Secretary/Treasurer: John C. Cavender, MD, P.O. Box 213, Hop Bottom 18824, 717-289-4444
TIOGA COUNTY
President: Curtis P. Swagler, DO, Guthrie Clinic, 24 Walnut St., Wellsboro 16901, 717-724-1122
President Elect: Edward L. Bellinger, MD, 15 Meade St., Wellsboro 16901, 717-724-3636
Vice President: Barry A. Clark, MD, 15 Meade St., Wellsboro 16901, 717-724-3333
Secretary/Treasurer: David F. Gillum, MD, 135 Main St., Wellsboro 16901, 717-724-4704
Executive Director: Mr. Paul P John, 2895 Euclid Ave., Williamsport 17701, 717-323-6432 or 323-3611 (pager)
UNION COUNTY
President: William B. Bruce, MD, Three Hospital Dr., Lewisburg 17837, 717-523-1163
President Elect: P. Ronald Zug, MD, Three Hospital Dr., Lewisburg 17837, 717-523-9631
Vice President: James W. Morgan Jr., MD, 135 JPM Rd., Lewisburg 17837, 717-523-3290
Treasurer: Donald C. Steckel, MD, RD 1, Box 242, Spruce Hills, Lewisburg 17837, 717-523-9631
Continuec
64 Pennsylvania Medicine, August 1986
Endorsed by
THE PENNSYLVANIA MEDICAL SOCIETY
Administered by
fflertAo/w-tflMa/and ytyeficie&
1-800-556-2500
VIS SPONSORED INSURANCE PLANS
:ESS
ZIP
JE # » L
AREA CODE
OF BIRTH _
Please send me information on the PMS Insurance Plans I have checked off below.
INDIVIDUAL INSURANCE
□ Medical Insurance
□ Term Life Insurance
□ Disability Income
□ Overhead Expense Plan
□ Accidental Death Insurance
□ Personal Catastrophe Liability
OFFICE INSURANCE
# DOCTORS
□ Long Term Disability
□ Group Term Life
□ Office Medical Insurance
* EMPLOYEES
• BOX 77, MEDIA, PA 19063 1215) 565-3450
• SUITE 201, CASTE CENTER, BAPTIST & GROVE RDS., PITTSBURGH, PA 15236 (412) 885-6570
irn TO: Bertfwlon-Rowland Agencies
County Society Officers
Secretary: John A. Malcolm Jr., MD, Evangelical Com. Hosp., One Hospital Dr., Lewisburg 17837, 717-286-6553
Executive Director: Mr. Paul P. John, 2895 Euclid Ave., Williamsport 17701, 717-323-6432 or 323-3611 (pager)
VENANGO COUNTY
President: David Wright, MD, 110 N. 13th St., Franklin 16323, 814-437-7651 President Elect: Stuart G. Shapiro, MD, 122 W. 1st St., Oil City 16301, 814-676-8571
Vice President: Mary J. Kinosian, MD, 1261 Elk St., Franklin 16323, 814-437-6563
Secretary/Treasurer: James J. Houser, MD, 150 Prospect Ave., Franklin 16323, 814-437-5776
WARREN COUNTY
President: Paul O. Keverline, MD, 103 W. St. Clair St., Warren 16365, 814-726-2020
President Elect: Paul A. Bialas, MD, 103 St. Clair St., Warren 16365, 814-726-0273
Vice President: Stephen C. Mory, MD, 143 Pleasant Dr., Warren 16365, 814-726-3310
Treasurer: Daniel G. Lareau, MD, Warren General Hospital, Warren 16365, 814-723-3300
Secretary: Thomas E. Carson, MD, 209 N. State St., PO Box 249, North Warren 16365, 814-723-5500, ext 441
Bulletin Editor: Frank H. Butt Jr. , MD, 506 S. State St., North Warren 16365, 814-723-4750
Publication: WARREN COUNTY MEDICAL SOCIETY BULLETIN
WASHINGTON COUNTY
President: David C. Frame, MD, 95 Leonard Ave., Washington 15301, 412-225-9320
President Elect: John F Lane, MD, 152 Lemoyne Ave., Washington 15301, 412-225-7000
Vice President: Charles R. Cortinovis, MD, 101 Woodside Dr., McMurray 15317, 412-222-7000
Secretary/Treasurer: Ernest L. Abernathy, MD, 1086 North Main St. , Washington 15301, 412-225-4423
Executive Secretary: Ms. Coby Bonessi, 218 Washington Trust Bldg , Washington 15301, 412-222-1400
Bulletin Editor: Ernest L. Abernathy, MD, 218 Washington Trust Bldg., Washington 15301, 412-222-1400
Publication: THE MEDICAL BULLETIN
Keep your bottom line from bottoming out
Call SMS Consulting Services
Inefficient business practices could be costing you money, eating into your income. SMS/Medical Associates' Consultants will show you how to streamline your business to assure you’ll keep more of the earnings from your practice.
SMS offers Consulting Services for:
• Fee Analysis
• HMO/PPO Contract
Analysis
• Marketing and
Expansion Programs
• Computer System
Assistance
• Other profit-saving
techniques
For more information, call Paul Valentine at
(302) 655-8514
Your Best Choice
SMS/Medical Associates, Inc. 1 01 0 Concord Avenue Wilmington, DE 1 9802
WAYNE/PIKE COUNTY
President: William R. Dewar III, MD, Box 183A, Tafton 18464, 717-226-2151
Vice President: Jon K. Sternburg, MD, 1500 N. Main St., Honesdale 18431 717-253-1205
Secretary/Treasurer: Harry D. Propst, MD, 507 High St., Honesdale 18431 717-253-2620
WESTMORELAND COUNTY
President: William F. Pfeifer III, MD, Med. Arts Bldg., Washington & Shearer Sts., Greensburg 15601, 412-837-5577
President Elect: Anthony J. Nicolette Jr., MD, 929 Country Club Dr., Greensburg 15601, 412-547-1500
Vice President: Mohammed N. Shaikh, MD, 60 S. Washington St., Greensburg 15601, 412-836-2970
Treasurer: William S. Keck, MD, Professional Building, Greensburg 15601, 412-834-3730
Secretary: Guy L. Bellanca, MD, Westmoreland Hosp. Assoc., 532 W. Pittsburgh St., Greensburg 15601, 412-832-4034
Executive Director: Richard S. Cole, MD, 207 Coulter Bldg., Greensburg 15601, 412-837-505