Texas Medicine Letters: April 2012

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 Letters to the Editor – April 2012 

 TMA Raw Milk Opposition Justified 

 The letter from Dr. Smith expresses his view that the Texas Medical Association should not oppose efforts to expand the sale of raw milk in Texas. (See "Raw Milk Not All Bad," February 2012 Texas Medicine, page 7.) To support his view, he impeaches the established practice of pasteurization by calling the data that supports it "dated."  

 While it is true that one may not find large controlled clinical studies that are published in recent issues of scholarly journals supporting the continued pasteurization of milk to protect the public, neither will one find similar studies supporting the established practice of water filtration in public water systems. That is no reason to abandon something that we know prevents morbidity and mortality. Moreover, one should not be persuaded to expand raw milk sales based upon the anecdote that Dr. Smith and hundreds of his acquaintances were raised on it with no reports of ill effects. 

 Pasteurization of milk is a practice our society adopted to prevent serious and sometimes fatal food-borne infections. It suffers the same effects of all good preventive practices -- it becomes a victim of its own success. We forget about the known risks of infection that include salmonellosis and listeriosis. Instead, we would place individual liberty ahead of public health? No. TMA should continue to oppose efforts to erode practices that enhance risk to the public and the patients we are entrusted to care for. That is the only position TMA can take! 

 Jason V. Terk, MD 
 Chair, Council on Science and Public Health 

 Telemedicine: A Brave New World  

"This transition will affect every aspect of your practice," Stephen Spain, MD, is quoted on the front cover of Texas Medicine. (See "The Countdown Begins," February 2012, pages 25-28.) Although the government and third-party payers hope to gather more heath information data with ICD-10 and thereby influence the practice of medicine, the seismic shifts in technology are capable of huge changes in the landscape far broader than government experts can predict, as alluded to in Taleb's The Black Swan.  

While I was sitting in the airport in Paris, France, I received a phone call from my Lufkin office regarding a two-week post-op breast reduction patient from Paris, Texas. who was outside the emergency room (ER) in Palestine, Texas. She was visiting family there and became concerned about an area at the inframammary incision. Upon arrival at the hospital, she had second thoughts and decided to call my office.  

My assistant called me with pertinent information: no fever, 1.5 cm of redness, two days of localized pain, no blistering or tissue stress, no malaise. I told her to call the patient, ask whether she had a cell phone, and to take a picture. Within moments, a picture arrived. I reassured her it was merely a Vicryl suture that was extruding rather than absorbing. There was no need to incur an ER expense. A warm pad on it until she can conveniently make it to my office will likely make it drain, and if the suture is still present upon arrival, my nurse has experience removing extruding sutures.  

This transaction of technology saved the insurance company hundreds of dollars and enabled the patient to be seen by the precise doctor with the expertise to handle that particular problem. This also is a transaction that would be entirely invisible to the ICD-10 bean counters. Counting ICD-10 beans will be no different than other attempts by a third party to evaluate and "grade" doctors. In all such evaluations, the very best and most efficient medical care will be invisible to the graders. 

 William Strinden, MD, Lufkin 

 Editor's Note: On Feb. 16, U.S. Health and Human Services Secretary Kathleen Sebelius announced she had delayed implementation of ICD-10 until an unspecified date. 

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