Documentos de Académico
Documentos de Profesional
Documentos de Cultura
AUGUST/SEPTEMBER 2015
Tucson, Nogales,
and bullfighting
Sombrero
Pima County Medical
Society Officers
President
Melissa Levine, MD
President-Elect
Steve Cohen, MD
Vice-President
Guruprasad Raju, MD
Secretary-Treasurer
Michael Dean, MD
Past-President
Timothy Marshall, MD
Richard Dale, MD
Charles Krone, MD
Jane Orient, MD
R. Screven Farmer, MD
Board of Mediation
Timothy Fagan, MD
Thomas Griffin, MD
Evan Kligman, MD
George Makol, MD
Mark Mecikalski, MD
Delegates to AMA
William J. Mangold, MD
Thomas H. Hicks, MD
Gary Figge, MD (alternate)
Editor
Stuart Faxon
E-mail: tjjackal@comcast.net
Please do not submit PDFs as editorial copy.
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ABR, CRS, GRI
Thomas Rothe, MD
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Michael F. Hamant, MD
secretary
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$469,500
Arizona Medical
Association Officers
Vol. 48 No. 7
$650,000
Vice President
296-1956 888-296-1956
Inside
5 Dr. Melissa Levine: Medicare at 50and
desegregation.
7 Membership: Focus on Pima
Dermatology.
10 Milestones: Twelve Tucson urologists
open Epoch Health.
12 PCMS News: Sale of the 32-year-old
PCMS headquarters building is on track.
19 Arizona Medical Association News: New
ArMA president says we must unite the
house of medicine.
23 Behind the Lens: In the second of his
series, Dr. Hal Tretbar looks at the local
impact bullfighting once had.
28 Travel: Dr. George Makol finally went to
Australiaand proves it.
30 CME: Pima County Medical Foundation
re-locates CME meetings.
On the Cover
Former matador Diego OBolger stands next to bull-and-matador
statue at Casa Molina Restaurant on Speedway Boulevard. The
design ornamenting the bulls testicles is changed to match the next
Tucson event or holiday. Shot with Nikon D600, 40mm on the 2485mm Nikkor lens, 1/200th second at f.29 with flash fill-in (Dr. Hal
Tretbar photo).
Correction
In the second column, second full paragraph of the first page of our
last issues Time Capsule, we mis-typed route U.S. 60 as a state route.
We also made a numerical typo in the second-page, second-column,
sixth-paragraph reference to Globe: the town was founded in 1875,
though a local sign states 1876.
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In our June issue I left off in 1946 with a Republican Congress and
President Harry Truman calling for comprehensive health
insurance for all, funded through Social Security. When he
couldnt get that passed, President Truman created a national
commission to study the nations health needs. He was able to
get Congress to establish a federal grant program in 1950 that
provided matching funds to states to pay providers caring for
individuals receiving public assistance. He continued to advocate
for a national health insurance program until the end of his
presidency in January 1953.
T
The goal of Social Security was economic
independence for the elderly, and in the
early 1950s officials were troubled that they
were not meeting that objective. The reason
was the high cost of medical care. If you
remember Wagner-Murray-Dingell from the
previous article, some of them came back
then to try and fix the issue.
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Membership
Pima Dermatologys lobby sales area serves as part of the practices one-stop shop for skin
care concerns.
The epidermis is the bodys largest organ, and the most visible, so
in Southern Arizona dermatologists must keep up with the latest
skin treatments and services to battle our environments effects.
There is a need for dermatology care in our rural areas, and Pima
Dermatology is working with Graham County Regional Medical
Center to set up clinical visits every month in Safford.
Some of the farmers in the rural areas have been exposed to the
sun for years, Chanes said, but they just dont have the time to
come all the way to Tucson or Phoenix to get their skin checked
regularly. There is definitely a need in these rural areas.
Use of lasers has become an important part of skin healthcare,
and Dr. Goldberg is considered a pioneer in this field. He began
using laser rejuvenation treatments in 1984. Pima Dermatology
offers 16 on-site laser modalities. A fraction of the laser
procedures available include acne treatment, acne scarring, skin
resurfacing, vein removal, and cosmetic procedures such as hair
and tattoo removal.
Some people wondered why I was getting so involved in using
SOMBRERO August/September 2015
Colleen Cotton, third-year resident at the UofA College of Medicine, consults with Dr. Matthew Beal
at Pima Dermatology.
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Milestones
520.544.9890 | www.casahospice.com
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PCMS News
GERALD N. GOLDBERG, MD
AND ASSOCIATES
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The Present
For years PCMS has made about $13,000 annually renting our
meeting room. The many room renters are being notified that as
of Oct. 1, we will no longer be available for their meetings. We
are working with TMC to see if they can provide some
replacement meeting space for our renters.
Though a small amount of roof repair was done, and three new
air conditioning units, and some new, energy-efficient lighting
was done in cooperation with T.E.P., he said, we still need a new
roof and much painting and patching. The parking lot needs repaving and painting. We are probably out of code with EPA,
whose regulations would add to cost of any related updates. The
Colorado water alternating with hot, hot Arizona sun was the
order of the day. To paraphrase PCMS President Melissa Levine,
M.D., as recently stated in these pages, we lived the life the river
gave us daily.
Professionally, evening lectures were stimulating, collegial and
enjoyed by all. Low-tech prompts and handouts were effective
alternatives to PowerPoint presentations as you can see in the
photos. As we evolved over six days into a seasoned band of river
runners, we all grew and were enriched from the professional
interaction and discourse.
And it was fun!
PCMS Member-at-Large Richard Dale, M.D. has been the driving
force behind this CME/travel event. We think you should start
planning to go on the sixth version!
Dr. Stephen Curtin, who wrote our report on this years CME
river conference, had to compete with the Colorado for attention
(Jim Herde photo).
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An independent member of
MERITAS LAW FIRMS WORLDWIDE
AHSCs Med-Start
aims to change face
of healthcare
High school students competitively selected
statewide spent six weeks this summer
exploring healthcare careers and education
opportunities in a program conducting
research and taking college-level courses at
the Arizona Health Sciences Center, the
university reports.
The six-week Med-Start summer program
ended July 11. Students presented their
research projects July 10 at UofA Cancer
Center. Students from Douglas, Kearney,
Nogales, Payson, the Phoenix area (Gilbert,
Glendale, Goodyear, Mesa), San Carlos,
Sells, Tuba City, Tucson, Whiteriver,
Winslow, and Yuma competed for a place in
Med-Start. They lived on campus.
The highly competitive program is a proven
success, the university reported. Eighty
percent of its participants go on to enroll in
higher education courses. Med-Start has
two goals: to address the critical shortage of
a diverse health-care workforce, and to
provide high school students with
opportunities to explore health careers and
college experiences to successfully reach
their academic and career goals.
Creating a diverse healthcare workforce
representative of the populations it serves
is a priority for Joe G.N. Skip Garcia, M.D.,
UA senior vice president for health sciences.
He and Francisco A. Moreno, M.D., assistant
vice-president for diversity and inclusion at
AHSC, professor of psychiatry, and deputy
dean for diversity and inclusion at the UA
College of MedicineTucson, are leaders in
AHSCs efforts to recruit and train a
SOMBRERO August/September 2015
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Medjacking: Absurd
yet deadly tech
In the summer Sharknado 3 Oh hell no category, The University
of Arizona reports that it is part of an elite committee studying
medical device electronic security, recognizing the potential for
medjackingmalicious medical device hacking.
The UofA College of Medicine sent surgery professor David
Armstrong, D.P.M., M.D., Ph.D. to the first committee meeting in
July in Bethesda, Md. Called the Cybersecurity Standard for
Connected Diabetes Devices Steering Committee, it joins forces
with the Department of Homeland Security, National Security
Council, NASA, and other government and industry leaders to
create strategies to keep the world safe from medjacking.
A podiatric surgeon and the director of the UA Southern Arizona
Limb Salvage Alliance (SALSA), Dr. Armstrong is the lone medical
academician on CSCDDS committee, the UofA reports, though it
is otherwise well represented on the committee. While devices
associated with diabetes are the initial focus, Dr. Armstrong said
the committee is expected to examine the security of other
medical devices. As connected devices become more pervasive
and powerful, the potential for malicious medical device hacking
is becoming increasingly real, he said.
Medical devicesinsulin pumps, pacemakers, artificial hearts,
left ventricular assist devices, artificial pancreas constructsare
susceptible to the same unintentional or intentional and
nefarious interruption and invasion as are bank accounts, ATM
machines and credit card devices.
While medjacking currently exists in the imagination and in
laboratories, Dr Armstrong said it is only a matter of time before
the issue comes front and center. No one really thinks about
these things until there is catastrophic failure. These sorts of
hacks are definitely feasible, and reasonably clever people
without a lot of resources can do some serious damage. We are
trying to get out in front of this problem.
The challenge for the CSCDD steering committee is to mitigate
danger without stifling innovation. Dr. Armstrong said patients
must be confident in the safety of their medical devices, and
companies must be secure that they are investing millions of
dollars in technology that is safe from cyber attack. The
committee will examine how key elements included in embedded
systems within devices can make them less susceptible to failure
or malicious or unintentional breach.
Discussion has swirled around the concept of medjacking for
years, the UofA reported. Since at least 2012 we have been
talking about the impending merger of medical devices with
consumer electronics, Dr. Armstrong said. Even the most
advanced medical devices are similar to the things we have in our
pockets or in our hands, such as iPhones, tablets, and home
computers.
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I am a medical graduate of
McGill University in Montreal,
as is Bob Orford, one of our
past presidents. Having come
from Canada, I have a
somewhat different perspective on the U.S. healthcare debate
and on the turmoil we are undergoing. I see the beginnings of the
Canadian healthcare problems and more developing in the U.S.
as the healthcare dollar continues to shrink and the healthcare
reform starts to take hold.
In the words of Dr. William Osler, Medicine is a science of
uncertainty, and an art of probability. This statement continues
to hold true today, not only with the practice of medicine, but
also with the business of healthcare. We are living in uncertain
times, and yet have to make medical and business decisions
without having all the facts at hand.
Current challenges to physicians include:
1.The physician shortage.
Physicians are retiring or changing careers at younger ages, and
those who remain are increasingly dissatisfied with their career
choiceso much so that many dont recommend the medical
profession to the next generation.
Medical education funding has not kept up with the demand for
qualified primary care and specialty care training. It is estimated
that the U.S. will face a shortfall of more than 130,000 physicians
in 10 years, equally divided between primary care and the
specialties.
2. The administrative load and competing regulatory programs
are increasing.
One of the greatest frustrations to physicians is the time and
expense they must devote to administrative and regulatory
requirements, taking their time away from patient care. Some of
these administrative burdens include PQRS and Meaningful Use
documentation, HIPAA security risk analysis, and ICD 10
implementation.
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finish the third stage, tercio de muerte, on foot. Carlos was very
graceful, artistic, and adept with the sword. He was awarded
many ears and tails.
Hollywood filmmaker Budd Boetticher was a close friend of
Arruza and made an hour-long documentary about him. After it
SOMBRERO August/September 2015
OBolger was tossed by his bull. The bull charged and knocked
him to the ground. OBolger tried to roll his body and protect his
face, but the bull hit him in the mouth and arm. OBolgers right
front tooth was broken, and his lip was left with a hole A few
minutes later OBolger was standing on his own and waved to the
crowd that he was all right The rest of the night went smoothly,
with three inaugural fights managed by Diego OBolger.
By the late 1980s and early 90s, bullfighting was losing must of
its popularity and fewer fights were being scheduled. However
Mario de la Fuentes son, also named Mario, had other ideas. The
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Laredo Morning Times for Nov. 13, 1999 reported that he had just
finished building a $4.5 million bullring in Nogales. The Fiesta
Brava was covered with transparent acrylic plastic. The 5,000seat air-conditioned arena had a bar and restaurant. There were
three inaugural fights, managed by Diego OBolger.
The timing could not have been worse. On Nov. 16, 1999 the
Arizona Daily Star carried two viewpoints on bullfighting.
Matador Diego OBolger, a Tucson resident, argued that
bullfighting had a long history of being a traditional art form. Lisa
Markkula from the Animal Defense League called it animal
cruelty. That same day, Dillards stores stopped selling bullfight
tickets. The last regular fight in Nogales was in December 1999.
There was an infrequent minor event until the State of Sonora
banned bullfighting on May 2, 2013.
Of all the Mexican restaurants in Tucson that at one time had
bullfight posters and artwork, only Casa Molina on Speedway
retains the theme. Several large posters depict man-vs.-bull,
while smaller fliers announce the time, place, and matadors for
coming events.
According to Gilbert Molina, his grandfather Gilberto opened the
restaurant in 1947. In 1966 his father Elias commissioned the
bigger-then-life bull and matador in front of the restaurant. Lee
Copeland, who had done all of the fantastic figures at the nearby
Magic Carpet miniature golf course, sculpted the statue. Gilbert
said no one has ever complained about the bullfighting dcor.
Today few Tucsonans remember anything about the appeal of
bullfighting in Nogales. The pageantry of corrida; the ballet-like
moves of an athletic matador; the bright colors of the gold or
silver suits of light; the waving of the magenta and gold capote
(cape); and the invigorating paso doble (double step) music.
Now only the ghosts of worthy bulls and the memories of famous
matadors hang over the remains of bullrings in Nogales, Sonora.
If you listen closely to gusty winds, you may hear the faint sounds
of Ole! Ole!
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Travel
You may know Three Dog Night as a 1970s American rock group,
but the origin of the name is aboriginal, as on cold nights
indigenous warriors would dig a hole in the gound and sleep with
one or two dingoes (Australian dogs) on top to keep warm; so a
three-dog night represents a very cold one in the Outback.
Yes, there are incredible numbers of black flies in the air around
the Ayers Rock monument, and we were given mosquito net
headgear to wear hanging down from our hats. The Indigenous
find this frankly hilarious, as they seem to just ignore the flies and
I believe the flies ignore them, as they greatly prefer tourists.
Is it worth the long trip? I say it definitively is. In fact, I met many
persons working in Australia and New Zealand who had
absolutely no accents and were obviously at one time Americans.
When I asked them how they got there, invariably I heard, I
came here for vacation 10 years ago and never left. That sums it
up better than I can.
Sombrero columnist George J. Makol, M.D., a PCMS member
since 1980, practices at Alvernon Allergy and Asthma, 2902 E.
Grant Rd. His Makols Call will return in October.
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CME
September
Sept. 22-27: Cycling CME in Colorado says: Please joins us for a
unique CME experience in beautiful Colorado! These two CME
conferences emphasize nutrition, exercise as medicine, and
common musculoskeletal problem therapy. Conference groups
are small, helping to create an atmosphere conducive to
interactive learning in a hands-on atmosphere. Each day we will
be rewarded with a challenging road bike ride through beautiful
terrain. If you enjoy active learning, cycling, and Colorado, please
join us in 2015. Cycling CME Western Colorado is in Grand
Junction Sept. 22-27. Website is www.cyclingCME.com .
Sept. 24-26: The Western Occupational & Environmental Medical
Association presents the Western Occupational Health Conference:
To Workers Health in the West at Loews Ventana Canyon in Tucson,
offering more than 20 hours CME credit for physicians.
WOHC 2015 provides opportunities for learning using the
latest information in medical education to provide for workers
health, organizers say. This includes updates in general health,
effects at the workplace, environmental and medical surveillance,
and late-breaking controversial issues. PCMS member Scott
Krasner, M.D., M.P.H., F.A.C.O.E.M., medical director of Krasner
Medical Consultants, chairs the conference.
Included are work-site tours including Asarco Copper mine and
Raytheon. For staying at the resort, call Loews Ventana Canyon at
800.234.5117. Deadline is before Sept. 1. For more information,
e-mail WOEMA at woema@woema.org, call 415.764.4918, or fax
415.764.4915. Registration fees vary by additional Thursday
events attended. Friday and Saturday Plenary Sessions are $675
for ACOEM/WOEMA member physicians, $795 for non-members,
and $425 for allied health professionals including NPs, PAs, and
RNs. Registration forms can be mailed to WOEMA, 575 Market
St., Suite 2125, San Francisco, Calif. 94105.
October
Oct. 1-2: Ethical DilemmasConsultation and Problem-Solving:
the Mayo Clinic Approach is at Mayo Clinic Education Center,
5777 E. Mayo Blvd., Phoenix 85054. AMA, AAFP AOA, and nursing
accreditation to be announced.
Ethical dilemmas related to patient care can be associated with
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