OFD STATEMENT REGARDING MISSION HEALTH/BCBSNC DISPUTE

OFD Patients,

We have been receiving many inquiries of late into the recent contract disagreement between Mission Health and BCBSNC that has been widely covered in the media this past month. Accordingly, we have decided to post this statement of reassurance and clarity for our patients.

First of all, whatever the outcome of the ongoing dispute, if you have BCBSNC insurance, your relationship with Our Family Doctor will not be impacted. We are an independent practice, and while we do participate in the Mission Health Partners ACO (Accountable Care Organization) we are not Mission-owned and therefore contract independently with BCBSNC. Consequently, our practice continues to be a preferred provider within the BCBSNC network. So you will have no trouble seeing your OFD physician in the future.

If the unthinkable occurs, namely that Mission Health and BCBSNC do not resolve this dispute ahead of the October deadline, then unfortunately there will be some alterations in your care if you hold a BCBSNC insurance policy. Specifically, all non-emergent medical procedures done at a Mission Health practice or hospital (including surgeries and diagnostic testing) as well as visits with Mission Health consultants will no longer be preferred by BCBSNC. This will mean that if you choose to pursue said procedures/evaluations with a Mission Health provider your cost will be higher as it will be seen as “out of network”. Emergent care on the other hand that occurs at any of the Mission Health facilities will be covered as “in-network.”

Having said all that, and in spite of the ongoing perception of acrimony between the two sides, we as a practice remain hopeful that this dispute will be resolved before the October deadline. From what we have learned, this type of contract disagreement is not uncommon between hospital systems and third-party insurance carriers. Furthermore, 99% of the time these contract disputes become resolved.

If you will be impacted by this situation, we encourage you to get more involved by writing letters or emails and/or making phone calls to both Mission Health and BCBSNC sharing your concerns and desires for immediate resolution. The independent physicians at Our Family Doctor are hoping that these two important regional health care players will resolve their differences quickly so that our community and primary hospital system will avoid the many negative consequences of disassociation.

Michael Weizman, MD

ARE YOU ADDICTED TO CHEESE? YEAH, ME TOO!

It’s been a couple of months since my last nutrition blog, so I figured with the New Year upon us, and Americans no doubt considering a host of worthy New Year’s Resolution options, why not tackle the food that we all love more than anything – Cheese!!

Why is it that cheese seems to be the hardest thing to overcome when we try to improve our diets? Even for the many Vegetarians who struggle maintaining a healthy weight, it is usually cheese that is their Achilles heel. A recent 2015 study at the University of Michigan determined that the food most commonly linked to “loss of control” was pizza (which beat out ice cream and chocolate). I think we all would agree that it is not the tomato sauce that is fueling this pizza addiction but the greasy, yummy cheese on top. But why?

Did you know that the human brain is actually wired to love and crave cheese? From infancy we are conditioned to crave casein (the protein in dairy products and breast milk). If babies did not “love” milk they might not nurse and would fail to survive. This is where the biological connection between cheese and the human brain gets really interesting. Once consumed, casein protein is converted into another protein called casomorphin (sounds a lot like morphine right?) Casomorphin binds to opiate receptors in the brain and leads to a dopamine release (the feel good neurotransmitter). So when we eat cheese we actually feel really good, and just like with opiates that feeling is addicting.

Separate from this biologically re-enforced “need” for casein, cheese is also packed with two nutrients that pre-historic humans were wired to seek out to enhance survival – namely salt and fat. Yeah, but c’mon Doc, you said it yourself, cheese has protein in it right?! Well, not so fast. Cheese is actually about 70% fat with most of that fat being the unhealthy saturated fat variety. In fact, a 2-ounce serving of cheddar cheese has about the same amount of saturated fat as 8 slices of bacon. Not only do these fat calories pack a high calorie punch, but saturated fat also increases cholesterol and contributes to insulin resistance. Ughh,.. really? Yep. As for the salt load, consider that a 2-ounce serving of salty potato chips has 330 milligrams of sodium while a 2-ounce serving of Velveeta cheese contains 800 milligrams! Holy High Blood Pressure Batman!

OK, but is this cheese fetish really harming our collective health? To answer this, let’s look to history. In 1909, the average American ate less than 4 pounds of cheese each year. Today, the average American eats more than 33 pounds every year. This surge in cheese consumption is certainly contributing to the obesity epidemic in the U.S. (in 1970 11% of Americans were obese while today 36% are obese) as well as to the high incidence of heart disease in our country.

So considering all of this “cheesy” information, my challenge to OFD patients this year is to “Cut the Cheese”. Silly middle school jokes aside, if we all agree to significantly cut down on our cheese intake, our collective health will surely improve. We will have lower cholesterol levels, less heart disease, less diabetes, and less obesity.

But, but, but ……. we’re talking about CHEESE!!!! Don’t worry, there are vegan cheese alternatives out there, some of which actually taste good, or maybe try a different cracker topper like hummus or almond butter – at least some times anyway. We can do this people. It’s going to be OK, I promise.

If you would like more information on the latest cheese research, check out the new Neal Barnard, MD book “The Cheese Trap.”

MICHAEL WEIZMAN, MD

ARE HOT DOGS REALLY AS BAD AS CIGARETTES?

Two months ago, I promised to share a series of nutritional blog posts on our website and Facebook page after attending a plant-based nutritional conference over the summer. Well after a busy September and October I have finally found a bit of time to write the 2nd blog post of the series. For this post, I will talk about the dangers of regularly eating processed meats – an all too common American eating habit. Before I get started though, let me just say that like many of you I have always enjoyed eating processed meats especially a good grilled hotdog with mustard and relish – yum! However, after learning what I have learned this past year, I have basically stopped eating processed meats in the interest of maximizing on my health – since my family and some of my patients have requested that I stick around for a while.

Before we get too far along on this topic, we need to define what a “processed meat” is. Meat that has been transformed through salting, curing, fermentation, smoking or other processes to enhance flavor is considered processed. Common examples are hotdogs, cold cuts, sausage and yes, beloved bacon. All of these tasty foods can contribute to cancer formation by a combination of factors including added nitrates (sodium nitrite), containing heme-iron and/or the formation of heterocyclic amines through cooking. At the cellular level, nitrates promote cancer cell propagation, mammalian heme-iron can attack the colonic mucosa directly and heterocyclic amines lead to DNA damage.

In 2011, the World Health Organization (WHO) concluded that processed meat of any kind was a Class 1 carcinogen (the same classification as cigarettes) and that fresh (“red” or mammalian) muscle meat was a Class 2 Carcinogen. A recent review of 20 cohort studies representing 144 case control studies looking at this question proved the WHO conclusion to be accurate. The colon and rectum are the most “at risk” organs to these effects. All of us hot dog and bacon lovers are surely saying “aw come on Doc, really !!??” To which I must reply, “Yes, really!” In fact, eating 50 grams of processed meat daily (which is equivalent to 6 slices of bacon, 2 slices of ham, 1 hot dog or 5 slices of salami) will increase ones risk of colorectal cancer by 18%. Put another way, 86% of lung cancers are caused by smoking while 21% of colorectal cancer is likely caused by processed meats. I have learned over the years that many of my patients are eating processed meats on a daily basis – sometimes 2-3 times a day. What’s even worse is that our public schools are regularly feeding processed meats to our children as well. So considering all of the above troubling information, the natural question should be how much is too much? Nobody really knows for sure what a “safe” amount of consumed processed meats is, so my advice to patients is basically if you are going to eat these foods, consume them as seldom as possible as they are really not healthful foods.

OK, so you probably can guess how this blog post is going to end right? Dr. Mike is going to put in a plug for a plant-based, whole foods diet to help maintain good health and prevent metabolic disease and cancer. Wow, I guess I am becoming quite predictable. But what about those who simply must consume meat as part of their regular diet to feel well? Based on what we know from these and other studies, I’d advise eating no more than 500 grams of meat per week (which is just 18 ounces), with most of this meat being poultry or fish and with most of this being fresh and NOT processed. That translates to about 71 grams or 3 ounces each day of meat. And yes, the rest of your daily calories should be coming from a plant-based, whole-foods diet.

MICHAEL WEIZMAN, MD

LET’S ALL LEARN TO “VEG OUT” A BIT MORE

It has been quite a while since I have written a piece for our website blog. The truth is that Dr. Mike has had a bit of “writer’s block” this past year – just waiting for a source of inspiration worthy of sharing with our patients. Well, I’m happy to report that I feel inspired and now have something to share.

Last month, I attended a fantastic medical conference in Washington D.C. put on by the PCRM (Physician’s Committee for Responsible Medicine) in collaboration with the George Washington University titled the “International Conference on Nutrition in Medicine.” It was a fabulous meeting, outlining the many well researched benefits of a plant-based diet. What I’d like to do over a series of website blogs and Facebook posts is to share bits of information that I learned at this conference that I think will have an impact on how each of us approaches the food we eat. There was so much information shared in D.C. with the conference attendees (physicians, mid-level providers, dietitians etc.), that I will break down the information into “bite-sized” pieces for easier consumption (yes, pun intended). I suspect the reactions from our patients will be mixed – ranging from full acceptance to robust denial of this information and everything in between. I do hope that we can each integrate at least one dietary change to our daily diet based on this information.

Let’s start off the sharing with a riff on fiber and colon health……….

Did you know that native Africans rarely get colon polyps and colon cancer yet their African American counterparts unfortunately are among those Americans with the highest rates of both colon polyps and colon cancer? Shockingly, we’ve known the reason for this since 1981! The reason for the dramatic difference in these genetically similar populations is DIET!! The indigenous African diet is very high in fiber (> 50grams a day) and low in saturated fat while the African American (“Western”) diet is very high in red meat, animal fat, processed meats and low in fiber. Researchers have noted a direct relationship between colon cancer rates and the unfortunate “Western” diet, while noting an inverse relationship between colon cancer and a high fiber, high vegetable diet. The reason for this is due to the impact of diet on the bacteria that live in our gastrointestinal tract – or the “Microbiome.”

When considering the microbiome we now know that a low fiber diet “starves” the helpful bacteria that we need to combat inflammation and cancer, while a diet rich in animal fat increases the production of toxic metabolites by our gut bacteria. What’s more is that diet influences the types of bacteria that colonize our bodies. In the guts of native Africans, the dominant species of bacteria is Prevotella which is associated with good colon health, while in African Americans the dominant species of bacteria is Bacteroides – which is more associated with disease of the colon. A fascinating 2-week “diet swap” study has been done which illustrates just how important diet is to our health. In this study, a population of African American subjects was fed an indigenous African diet while a native African subject group was fed a Western diet. In just 2 weeks, the gut flora (bacteria) as measured in stool samples changed drastically in each group. Specifically, the native Africans showed biomarkers of colon cancer in their stool samples, while the stool of the African American subjects showed the suppression of these same biomarkers.

Cool huh?

The bottom line is that all Americans need to increase our fiber intake to >50gm a day (which is significantly higher that the FDA’s daily recommendation) and reduce our dependence on animal protein and fat in our diet to protect our colons among many other benefits. This is perhaps most important in more vulnerable populations who are already at higher genetic risk for cancer and metabolic disease.

Future nutritional blog posts will address the topical subjects of Soy, Cheese, Processed Meat, the Paleo Diet and other issues where I have lots of juicy informational nuggets to share.

Thanks for joining me on this learning adventure.

Michael Weizman, MD

EXCITING UPDATES AND HAPPENINGS AT OUR FAMILY DOCTOR

As we approach the end of 2015 the doctors and staff of OFD have a lot of good news to share with our patients. Accordingly, this post will reflect some of the exciting recent happenings at Our Family Doctor.

If you had reason to visit the practice toward the end of November and early December you may have noticed a work crew and trucks busy at work. The reason for this activity is that OFD has gone solar! We are now one of the few medical practices in town that will be deriving much of our power from the sun. In making this transition, OFD will be able to reduce our electricity usage while at the same time send electricity back to the grid during times of low power use. A move away from fossil fuel reliance is a value shared by OFD physicians and staff, and hopefully with this building “up-fit” OFD will be doing its part to better our planet.

This past year through the efforts of the physicians, staff and our practice manager, OFD has again proven to be one of the highest performing primary care offices in WNC. We have achieved “Tier 3 status” (the highest level) for quality performance among the many practices that are affiliated with Mission Health Partners ACO ( Accountable Care Organization). The various quality metrics that are being tracked are a way for medical practices across the region to ensure that any health care disparities are identified and improved upon. For more information on what an ACO is, and what the OFD collaboration with Mission Health means, please read my previous blog post from March 2015.

For those of our patients who have become accustomed to using our free and secure patient portal we have great news. We will be upgrading our patient portal in the early part of 2016 to a slicker, more intuitive and vastly easier to use portal called “Follow My Health”. For those who have not yet signed on to the portal, this will be a great opportunity for you to do so and experience the ease of communicating with the practice and your doctor via e-communication. Stay tuned for more details on this transition.

As many of you know, there is always staff turnover in health care – it is the nature of the business. Not surprisingly, this past year has seen several staff members move on to pursue work and educational opportunities in and out of town. At the same time we have welcomed several new staff members to our practice family. The physicians and management team are very happy with our current staff and remain committed to the highest level of medical care and patient satisfaction at Our Family Doctor. As always, please feel free to give us feedback on our staff and doctors.

As the end of the year approaches we will be saying good-bye to Dr. Kim Wilson who has been a part of the OFD family this past year. Dr. Wilson will be pursuing other opportunities and we will certainly miss her kind nature and charming personality. We wish her well in the future and look forward to keeping in touch. Dr. Ananda Vieages will be joining the OFD medical staff in January, 2016. Dr. Vieages is a MAHEC-trained Family Physician who is just now finishing up her 4-year rural health commitment in McDowell County. Ananda brings to OFD much enthusiasm and experience and we are thrilled to have her join our team. Naturally her practice will be open to new patients so please help us spread the word. Additionally, she will be assuming care for Dr. Wilson’s patients.

From all of the physicians and staff at OFD we wish our patients health and happiness during this holiday season and into the New Year.

Michael Weizman, MD

The U.S. Healthcare System – “It turns out it isn’t all bad”

Several months ago one of my longstanding patients gave me a fascinating book entitled “The Healing of America – A Global Quest for Better, Cheaper, and Fairer Health Care” by T.R. Reid. Taking some time this summer, I have finally had a chance to read this very well written book. Mr. Reid’s writing style is quite enjoyable and his method of exploring various health care systems around the world through the use of a personal ailment is both unique and relevant. I highly recommend this book for any American who wants to learn more about our healthcare system as it compares to those in other countries. Furthermore, I think this book ought to be required reading for any lawmaker who endeavors to discuss healthcare at either the state or national level, particularly if they feel strong support for or revulsion toward the Affordable Care Act – a.k.a. Obamacare.

This summer, Our Family Doctor had the pleasure of hosting two young Scottish medical students from the University of Glasgow for three weeks. Patrick and Euan came to our practice with the hopes of learning a bit more about the American Healthcare system as part of an international rotation during their final year of study in the U.K. While this international elective provided the students with many learning hours during their stay, their visit also created a fascinating learning opportunity for the doctors at Our Family Doctor as well. In this blog post I’d like to share some of the observations made by these students after having been embedded within our (very different) healthcare system for three weeks. My hope is that the take away message will be that while the American healthcare system has many flaws and shortcomings to be sure, from the perspective of these fresh foreign eyes, our system isn’t all bad.

Euan and Patrick are learning and practicing medicine in Scotland (a nation within the United Kingdom) and therefore participate in the National Health Service or “NHS” as it is affectionately called. In this system, health care is provided and financed by the government through tax payments. There are no medical bills as medical treatment is considered a public service. Not surprisingly, in this system many hospitals and clinics are owned by the government, though some doctors and clinics are private. Other countries that use this model of healthcare include Spain, Italy and most Scandinavian countries. Some Americans refer to the NHS as “socialized medicine”. But as T.R. Reid explains in his book, the NHS is not a pure form of “socialized medicine”. Perhaps the purist example of socialized medicine (ironically) is the U.S. Dept. of Veteran Affairs that we find right here in America which provides complete medical care (free of charge) to our active military personnel, veterans and their families. Keeping this bit of background information in mind, here are just a few of the observations shared by our visiting Scotsmen during their time in Asheville, NC.

First of all, our students were impressed by the fact that patients are assigned to one doctor in the U.S. and in many cases can choose their own doctor. In the U.K. by contrast, a patient is assigned to a clinic based on where they live, and rarely sees the same doctor for two successive visits. Consequently, they observed that patients in the U.S. seem to form better relationships with their doctors (and vice versa) as compared to the U.K. This naturally leads to better communication in the exam room and more informed and satisfied patients. Our visiting students were impressed by how engaged and educated our patients were with respect to their healthcare. They surmised that when one pays for something directly, in this case healthcare, (be it through insurance premiums and/or co-pays), there seems to be a stronger sense of personal investment and value derived from the service. According to them, this sense of personal engagement in one’s healthcare and perceived value is often lacking in the U.K.

Secondly, Patrick and Euan were impressed by the relatively short waiting times experienced by patients when trying to secure appointments with their primary care or specialist doctors. Often both of these types of appointments take much longer to obtain in the U.K. But what impressed them even more was how much time we doctors were able to spend with our patients. Yes, even the oft-maligned 15-minute acute or follow up visit is actually twice the time for a typical visit is in the U.K. where primary care visits average 7 minutes according to our students. A 30-minute wellness exam (such as what we have at OFD) is essentially unheard of in the U.K. They found this increased time to be well used by OFD physicians and their patients for things like explaining medical diagnoses, shared decision making, lifestyle coaching and expanded physical exams. In comparison they realized that there is far less focus on prevention in the U.K. where wellness exams are not routine.

Finally, they found the team-like atmosphere at our practice to be very efficient, embracing a workflow paradigm where physicians rely on medical assistants and other ancillary staff to help keep the doctors focused on patient care. They felt this resulted in higher quality health care and improved patient satisfaction. During their one-day experiences making rounds with the hospitalists at Mission Hospital as well as with a local specialist, they observed a similar team-based model of healthcare which really stood out for them.

As for their criticisms of the U.S. healthcare system, well those were fairly predictable. They commented negatively on the high cost of medical insurance and the fact that even with the Affordable Care Act there were still those who could not afford insurance (or healthcare). They were also quite surprised by the many administrative and bureaucratic burdens placed on physicians and their staffs aimed at satisfying the government and insurance companies or protecting physicians from medico-legal risks.

The fact that in the U.S. practices and hospitals use many different electronic health record systems that don’t seem to communicate well with each other was easily recognized as an obvious disadvantage by our students. By comparison, a single E.H.R. system is used within the NHS in the U.K.

Finally, they were both amused and bothered by the ever present direct-to-consumer advertising efforts by Big-Pharma on full display every time they turned on the television. Being big sports fans and watching sports on TV quite often when not at the office, Patrick and Euan were left with the conclusion that every sports fan in the U.S. suffered from Acid Reflux, Erectile Dysfunction and Depression.

The doctors and staff at OFD thoroughly enjoyed our 3-week exchange with Patrick and Euan and will certainly welcome other international students to our practice in the future. While teaching them much about primary care medicine in the U.S., we also enjoyed showing them what seems to be working well within our healthcare system, in spite of the many inherent weaknesses. As our healthcare system limps with anxiety toward what is sure to be a very messy conversion to ICD-10 this coming October, and as we continue to shift away from a fee-for-service to a fee-for-value model of reimbursement, it is helpful to remember that there are still a few aspects of our healthcare system that are both uniquely American and certainly worth preserving.

MICHAEL WEIZMAN, MD

SO WHAT IS AN “ACO” ANYWAY?

Recently some of our patients (those with Medicare insurance and those employed by Mission Hospital) received a letter from Mission Health Partners (MHP), a newly formed Accountable Care Organization (ACO). The letter explained that Our Family Doctor (along with many other private practices in town) was joining a clinically integrated network called Mission Health Partners. As predicted, this letter raised more questions for patients than it answered. This blog post is an attempt to better inform our patients of what is happening in our community, try to explain what an ACO is, as well as dispel any false conclusions that may have been drawn from the above mentioned letter.

First of all, on the most basic level, the ACO is the logical extension of the PCMH (Patient Centered Medical Home) “team-based” care model that I wrote about back in 2013 in several blog posts on our website. What the PCMH care model has done for practices like OFD as far as improved workflows, outcomes and satisfaction for our practice population, the ACO model hopes to do for our entire community. These two major overhauls on “how” we deliver healthcare share three primary goals. In simple terms, these goals are: (1) improve quality of care for patients and populations (demonstrated by clinical outcome measures), (2) improve efficiency and reduce waste (eliminating unnecessary and redundant diagnostic testing) and (3) reduce the overall costs to the healthcare system.

As an ACO, Mission Health Partners is a collaborative alignment between independent private practices like Our Family Doctor, Mission Hospital, Mission owned practices, and the MAHEC residency program. Note this is a collaborative arrangement and not one of ownership. Our Family Doctor will remain a completely private practice and has every intention of remaining so for the foreseeable future. Please read this last sentence again to make sure you understand this. The formation of an ACO has nothing to with hospital expansion or practice acquisition. Practices like ours have decided to align with Mission Hospital through Mission Health Partners with the expressed goal of improving care for our patients. How will this quality improvement be accomplished you might ask? The simple answer is something that we all learned back in Preschool, and that is through “Sharing”.

Just like with other collaborative efforts, participants in Mission Health Partners will share Ideas. Things like “best practices” for tracking and treating chronic disease states (like Diabetes) and figuring out which strategies work best for increasing the use of evidence-based screenings (such as Colonoscopies and Mammograms). MHP participants will also share Resources. Ancillary services such as those provided by clinical case managers, clinical pharmacists and nutritionists are often cost prohibitive for single practices like OFD. These valuable services which can help us better serve our practice populations will become available to independent practices that choose to align with an ACO such as MHP. And finally, MHP participants will share Clinical Outcomes Data. Sharing clinical outcomes data will not only help raise the quality bar for all practices, but more importantly will help identify care gaps in populations. Through sharing clinical data, MHP will identify those practices or clusters of patients who need extra support toward achieving the three goals explained earlier in this blog post.

So who will be impacted by this ACO? The Mission Health Partners ACO will begin its work focusing on Medicare patients and Mission employees. In time, our community hopes that MHP will expand to serve the needs of Medicaid patients. In all likelihood, over time and as the program demonstrates success, it will expand to include other third party payers as well.

A couple of years ago when I would talk about PCMH to my colleagues and staff, I would say, “The PCMH is the care delivery model of the future, and the future is now”. With the evolving trends that we are witnessing in our country that focus on moving away from a “fee-based” model to a “value-based” model, the ACO is a big step in that process. There are ACO’s like MHP functioning at a very high level right now all over this country providing excellent population-based healthcare. “The future is now” comment certainly applies to ACOs now.

With the formation of Mission Health Partners, Asheville and the WNC region is joining other communities in changing the way healthcare is delivered in our country. For those practices like ours who have signed up to be part of this grand collaborative experiment, we have chosen to put our cynicism of “systematic change” aside and embrace the idea that improving the quality of care for our patients is worth the extra work that meaningful collaboration necessitates.

MICHAEL WEIZMAN, MD

To “V” or not to “V”, that is the question……

After a lot of thought and consideration, the doctors at Our Family Doctor have finally decided it was time to officially and publicly share our views on the topic of vaccination. In the wake of the ongoing Measles outbreak in our country, and against the backdrop of increasing public awareness and discussion regarding the “anti-vax” community, we felt it was important for our patients to hear the OFD perspective on this controversial subject. While I (Dr. Michael Weizman) am the author of this blog post, I have shared this piece with Drs. Polansky, Preston, Schwab and Wilson, and we all stand behind the thoughts expressed in this column.

First off, allow me to share our philosophy or “policy” in dealing with parents who have alternative view points on vaccination. In keeping with our general approach to the doctor-patient relationship, OFD physicians enter into our patient encounters with universal respect and open-mindedness toward the parents and caregivers of our Pediatric patients. Even when parents make decisions about their families that we fundamentally disagree with (as is the case with those who choose not to vaccinate their children), we always try to minimize judgment, to offer informative and science-based counter points when appropriate, and to ultimately do all that we can to best support the children who we are charged with caring for. Whereas other pediatric practices refuse to see these families outright based on a parent’s anti-vaccination sensibility, we at OFD feel that all children deserve a caring physician – even when their parents have alternative viewpoints regarding vaccination. For a not-so-great analogy, consider our patients who habitually smoke cigarettes. We doctors universally think that this is a terrible idea, subjecting our patients to the extreme risks of heart disease, stroke and cancer, and yet we care for these patients even when they do not take our advice to quit smoking.

So just how many parents at OFD do not vaccinate their children? Admittedly, we have not kept careful data on this number (perhaps we need to start doing that), but our best guess would be that roughly 30% of our parents vaccinate their children fully, adhering closely to the CDC recommendations; about 60% vaccinate their children on a slower or delayed schedule with our guidance (usually having their children caught up by Kindergarten), and about 10% do not vaccinate their children at all against our medical advice. For the last group, we bring up vaccination at each well child visit, giving parents many opportunities to ask questions and hopefully reconsider their positions on the subject. This is where being non-judgmental really helps, as many parents do eventually come around to the decision (better late than never) to vaccinate their children in the safe space that we have created for them. All that said, and in accordance with our medical society’s legal advice, we do have these non-vaccinating parents sign a “refusal to vaccinate” waiver at each well visit, which provides us legal indemnity should their child succumb to a vaccine-preventable illness. Often just being asked (required) to sign this document gives parents pause and opens up further dialogue.

OK, now that you understand our philosophy of care regarding this subject, allow me to reflect on some of the controversy surrounding routine vaccination. At this point it should be made clear that OFD physicians recommend routine vaccinations for ALL children who do not have a medical contraindication (such as certain cancers or immune deficiencies). Period.

Consider that the three most important advances in medicine over the centuries as agreed upon by experts the world over have been (1) improved sanitation and hand washing, (2) the advent of antibiotics and (3) … wait for it… routine vaccinations. The Pediatric wards in our nation’s hospitals used to be filled with children suffering (and dying) from meningitis before the advent of the HIB vaccine. Since the Prevnar vaccine was introduced, the residual cases of meningitis caused by Pneumococcal disease have been all but wiped out. We don’t see Polio anymore in the U.S. due to universal vaccination against this dreadful disease, but sadly Polio is on the rise in developing war-torn countries where drops in national funding for vaccination programs have taken a toll. Believe it or not, I have actually been informed by a patient that “the Polio vaccine does not work”, and that “Polio was on its way out anyway, right around the time the vaccine was introduced”. Really? This is of course nonsense! While I am not trying to mock this obviously misinformed patient, I share this story to illustrate just how much bad information is out there. There should absolutely be no debate on whether or not vaccines work to prevent disease – they do. The proof is in the pudding as they say.

What about some of the myths which continue to stymie routine vaccination? As physicians we deal with these myths on a daily basis, trying our best to debunk them as they come up. Here are just a few of the top myths that we encounter.
1) Vaccines (particularly the MMR vaccine) cause Autism. This myth has been shown by dozens of scientific studies to be completely false. However, if one is skeptical of science in general, consider this simple fact: the incidence of autism is the same in vaccinated and unvaccinated children. Yep. Read that again to make sure you understand this.
2) Vaccines have mercury in them, and therefore are dangerous. False. There is no mercury in vaccines. In 1999 the FDA recommended the removal of thimersol (ethyl mercury) as a preservative from vaccines. They did this to calm public health concerns about the subject even though repeated studies had not (and have not) shown any link between ethyl mercury and neurological disease. This is in contrast to methyl mercury (which we find in top-of-the-food-chain fish that we eat) which has indeed been linked to neurological disease. Maybe that is where the confusion came from. But this point is of no consequence, since there is no thimersol in vaccines anymore!
3) Vaccines contain dangerous levels of Aluminum. This is false. In fact, there is more aluminum in breast milk than in vaccines. Aluminum is everywhere – it’s in our food, and in our water. The amount of additional aluminum in vaccines is utterly negligible.
4) We can’t trust the vaccine manufacturers or the government because all they care about is money. False. Yes, profits are important to corporations, but so is safety. We have one of the strictest FDA’s in the world, and when there is a question about safety, products are pulled from the market. Case in point: Years ago children were vaccinated with an oral polio vaccine. Unfortunately, since it was a live vaccine there was a very rare incidence of contracting polio (to the tune of about 1 in a million) after vaccination. This was not safe enough for the FDA so oral polio was pulled from the US market. There have been no cases of polio contracted from the injectable, inactivated form of the polio vaccine that we now use. Here is another case in point: A few years ago, during routine inspection, trace amounts of staph bacteria were found on the surface of one of the machines used to make the HIB vaccine. The FDA ordered a recall of some 40 million doses of HIB (creating a national shortage of this crucial vaccine) even though not a single child was sickened by Staph nor was a single dose of HIB found to have Staph contamination. This was a very expensive lesson for this drug manufacturer, further emphasizing the importance of maintaining strict sterility in vaccine manufacturing. I could go on with more examples of strict FDA oversight, but suffice it to say, there is no conspiracy here. Doctors, Scientists, and the people who work for both drug companies and the government all vaccinate their own kids with these very same products.
5) Vaccines have dangerous side effects. True (sort of) and False. Severe vaccine reactions are exceptionally rare. Common reactions like muscle soreness, fever and irritability of course happen often, but are not serious at all. Consider the numbers: 1 in 40,000 children who get the MMR vaccine will have a moderate reaction. 1 in 300 children who contract Measles will die. Just like with all other parenting decisions, parents need to consider the risks and benefits. For example: bike riding and driving in cars is inherently dangerous. In fact more children die in car accidents each year then from diseases. So how does the informed parent respond? Do we avoid cars and bikes altogether? Of course not! We insist that our children fasten their seatbelt and wear a bike helmet, two proven safety measures that will keep them safe from harm. Vaccines are the same. They are proven to keep our children safe from preventable disease.

So how did we get to this point? How is it that the wealthiest, most technologically advanced nation in the world has seen a decline in vaccination rates and an increase in “old-fashioned” diseases like Whooping Cough (Pertussis) and now Measles? Why do we live in a country where parents don’t trust the medical community and it has become fashionable for some to not vaccinate based on myths, fear and non-science? There is a great book that should be required reading for all new parents called “Autisms False Prophets” by Paul Offit, MD (2008). This book more than anything I have read explains in shocking detail how we got to the point where we are. If you have not yet read it, please read this book or buy it for your friends and family who are still not vaccinating their children.

Finally, let’s talk about the Disneyland Measles outbreak. The cause of the recent Measles outbreak in California and beyond is similar to the cause for the Pertussis outbreaks that doctors have been seeing in recent years. Due to reduced vaccination rates nationally, we are losing the protection gained from “Herd Immunity”. We have begun to dip below the 95% minimum threshold for vaccination that is needed to prevent disease outbreaks (within the herd). With the swelling of the ranks of those who have been labeled “anti-vaxxers”, the prospect for this new reality getting much worse is an accurate assessment and very scary. Without getting into the various public policy debates that are floating around state and federal government health departments, the mainstream media and of course social media outlets, we at least need to acknowledge that the loss of our herd immunity is real and serious. At some point new parents will need to consider the public health angle on this subject and figure that into their personal decisions. Parents simply can’t afford to hope that others will vaccinate so that they don’t have to. Those days are over. All of us who share this earth and this community have a responsibility to do right by it. This is why we don’t drive drunk, this is why we don’t send our children to daycare or school with high fevers, this is why we spend hours combing out our kids hair when they have lice, and this is why I teach my kids to pick up litter that others have thrown on the ground. This is our community and we all have to take care of it and of each other.

So back to the title question of this blog: “To V or not to V?” The simple answer is “V !!!”

If you already vaccinate your children, thank you for doing your part. If you are on the fence about vaccination, please keep learning and read Paul Offit’s book before you make your final decision. And if you have chosen not to vaccinate your children, in spite of all the science that has been presented and continues to be presented, please reconsider. Your child’s life and the life of the child living next door to you may literally depend on it.

MICHAEL WEIZMAN, MD

The New Year’s Resolution Trap

It is that time of year when most people are thinking about “New Year’s resolutions.” Often these commitments involve health related goals such as weight loss, exercise or avoiding some evil food or beverage. While sincere in their desire to make these changes, most people fall short of achieving these goals and maintaining them. Changing habits is difficult, and sustaining changes is even more so. How can you make a New Year’s resolution that will actually stick?

New Year’s resolutions are no different than any other attempt at behavior change. People often set goals that are too ambitious and too long term. It is like trying to throw a long pass in football. If you connect on the pass the reward is great, but the chance of success is small. Instead, it may be better to move the ball down the field in smaller chunks. In other words, try setting small, short term goals and then build on your success. Consider the example of increasing exercise. An initial goal of exercising five times per week may be too ambitious. Instead, try to start with a goal of exercising two times per week over the next two weeks. If you are able to achieve this, then go ahead and increased the frequency to three times. If you are not successful at the initial goal, continue working toward it until you achieve twice a week. Remaining focused on a smaller, short term goal to start, may decrease frustration and disillusionment. It is easier to build on small successes than overcome the psychological consequences of failure.

You may set a goal to lose weight, and you may have a number in mind. However, making a resolution to lose weight without a clear plan to achieve this is unlikely to lead to success. While you keep the weigh t goal in mind, try to focus on simple changes you can make in your food and/or beverage intake that will help you achieve your goal. Stick to one change at a time in order to increase your chance of success. If you decrease or eliminate intake of a food or beverage, be sure that it is not replaced with other items of similar calorie content. Replace sweetened beverages with water, black coffee or unsweetened tea. Replace processed snacks such as chips or cookies with vegetables or fruits. Replace fast food meals with meals prepared at home. These changes should help to reduce your overall calorie intake. As with exercise, begin with one small change and build on your success, by adding new changes as you progress toward your goal.

New Year is traditionally a time of unfulfilled personal promises. Make this year different. Set your sights on small achievable changes- goals that you can achieve in a few weeks. Move through the process of change one step at a time. Keep looking forward and avoid focusing on past failures.
Have a happy New Year and good luck with all of your New Year’s resolutions.

Fred Stichel MS,RD,LDN

Fred is available at OFD to help you work toward your New Year’s resolutions or any of your health and wellness goals. Call 828.252.2511 option 1 to arrange for an appointment.

LOTS OF CHANGES AT OFD THIS SUMMER

It has been many months since my last website blog post, which I can only blame on a very busy Spring and Summer, but as they say, better late than never. In this post I am very excited to share some news and updates with all of our patients.

First of all, Our Family Doctor has again been recognized as the best primary care practice in Asheville in the Mountain Express “Best of” poll. Thank you to our patients for your support. As stated last year, we pledge to work hard as a practice to ensure that we are worthy of this title. And as if that wasn’t enough recognition, this year three of our four doctors swept the “top doctor” category in the same poll. Congratulations to Dr. Polansky, Dr. Weizman and Dr. Schwab for nabbing the 1, 2 and 3 spots of that poll. We are very humbled by your support.

2014 has been a year of weddings at Our Family Doctor. Clinical Supervisor Laura Hawkins, Physician Andrea Preston and Medical Assistant Briana Bushelli all recently tied the knot. We enthusiastically welcome their husbands into the OFD family. Our practice is blessed to have these wonderful women as part of our practice and couldn’t be happier for them.

But wait, there is more exciting news at OFD to share. Dr. Kim Wilson, DO will be joining our practice in October of this year. Kim recently completed her medical residency in Virginia and is very excited to join the OFD family. In addition to sharing our medical philosophy for providing compassionate, individualized and open-minded primary care, Kim will bring a host of physical medicine techniques to our practice taking advantage of her Osteopathic training. Once Kim arrives in October she will be open to new patients so please help us promote Kim to your friends and family in the community. We hope to have her bio on our website in the coming weeks.

We’ve also had some staffing changes recently at Our Family Doctor. In case you have not had a chance to meet her yet, Amanda K. joined our clinical team several months back and has integrated wonderfully as Dr. Weizman’s medical assistant. Recently we said good-bye to Dr. Polansky’s energetic Medical Assistant Megan who left to pursue a long sought after position as a paramedic which she had trained for. We also recently said good-bye to medical receptionists Jackie and Amanda M, as well as Medical Records coordinator Jessica as they all have moved on to pursue other opportunities in the community. But fret not, we have found wonderful replacements for all of these folks. When next visiting with us at OFD, please help us welcome our newest employees: Robyn (medical assistant), Lynn (medical receptionist), Wanda (medical receptionist), and Melissa (medical records coordinator).

Finally, we would like to announce that we have expanded the functionality of our free and secure Patient Portal. Registered patients are now able to e-message with their personal physicians free of charge replacing the now retired OFD Connect program. If you are not yet signed up for our patient portal, please do so via our website.
That’s it for now. We hope that you enjoy the remainder of the summer. Your friends from Our Family Doctor look forward to seeing you next time you are in the office.

Michael Weizman, MD