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Ear, Nose & Throat Associates |
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February 2008 News Archives
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February 1: HPV Causing More Oral Cancer in Men, AP
By MIKE STOBBE
AP Medical Writer
ATLANTA (AP) -- The sexually transmitted virus that causes cervical cancer in women is poised to become one of the leading causes of oral cancer in men, according to a new study.
The HPV virus now causes as many cancers of the upper throat as tobacco and alcohol, probably due both to an increase in oral sex and the decline in smoking, researchers say.
The only available vaccine against HPV, made by Merck & Co. Inc., is currently given only to girls and young women. But Merck plans this year to ask government permission to offer the shot to boys.
Experts say a primary reason for male vaccinations would be to prevent men from spreading the virus and help reduce the nearly 12,000 cases of cervical cancer diagnosed in U.S. women each year. But the new study should add to the argument that there may be a direct benefit for men, too.
"We need to start having a discussion about those cancers other than cervical cancer that may be affected in a positive way by the vaccine," said study co-author Dr. Maura Gillison of Johns Hopkins University.
The study was published Friday in the Journal of Clinical Oncology.
Human papillomavirus, or HPV, is the leading cause of cervical cancer in women. It also can cause genital warts, penile and anal cancer - risks for males that generally don't get the same attention as cervical cancer.
Previous research by Gillison and others established HPV as a primary cause of the estimated 5,600 cancers that occur each year in the tonsils, lower tongue and upper throat. It's also been known that the virus' role in such cancers has been rising.
The new study looked at more than 30 years of National Cancer Institute data on oral cancers. Researchers categorized about 46,000 cases, using a formula to divide them into those caused by HPV and those not connected to the virus.
They concluded the incidence rates for HPV-related oral cancers rose steadily in men from 1973 to 2004, becoming about as common as those from tobacco and alcohol.
The good news is that survival rates for the cancer are also increasing. That's because tumors caused by HPV respond better to chemotherapy and radiation, Gillison said.
"If current trends continue, within the next 10 years there may be more oral cancers in the United States caused by HPV than tobacco or alcohol," Gillison said.
Studies suggest oral sex is associated with HPV-related oral cancers, but a cause-effect relationship has not been proved. Other researchers have suggested that even unwashed hands can spread it to the mouth as well.
Gillison pointed toward sex as an explanation for the increase in male upper throat cancers. However, HPV-related upper throat cancers declined significantly in women from 1973 to 2004.
Merck's vaccine, approved for girls in 2006, is a three-dose series priced at about $360. It is designed to protect against four types of HPV, including one associated with oral cancer.
Merck has been testing the vaccine in an international study, but it is focused on anal and penile cancer and genital warts, not oral cancers, said Kelley Dougherty, a Merck spokeswoman.
"We are continuing to consider additional areas of study that focus on both female and male HPV diseases and cancers," Dougherty said.
Merck officials praised Gillison's research, saying it will elevate the importance of HPV-related oral cancers.
Government officials and the American Cancer Society say they don't know yet whether Merck's vaccine will be successful at preventing disease in men. No data from the company's study are available yet.
Indeed, it's not clear yet that the vaccine even prevents the HPV infection in males, let alone cancer or any other illness, said Debbie Saslow of the American Cancer Society.
Merck plans to seek U.S. Food and Drug Administration approval for the vaccine in men later this year, meaning a government decision would be likely in 2009.
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February 3: Be Careful of the Volume on iPod Earbuds, Chicago Daily Herald
Earbuds are not more dangerous than traditional headphones, but teenagers are notorious for turning the volume way up.
The couple was new to my practice, having recently moved to the area from another state. Their son was in the office for a physical before starting classes and sports at his new junior high. I had already reviewed the healthy teen's medical history and was starting the exam when the boy casually mentioned that he had failed a screening test within the past year.
Yes, the aspiring musician admitted, he had not passed the state-mandated hearing test at his old school. I asked him what advice he'd been given after the testing, and he simply stated, "They told me not to listen to my music so loud."
The American Academy of Otolaryngology notes that noise damage is the most common cause of hearing loss in the United States. Noise-induced hearing loss is not a new medical phenomenon, but while occupational exposure used to account for most of these cases of sensorineural hearing loss, recent decades have seen an upswing in recreational hearing damage.
The rising popularity of smaller, more portable music devices and more form-fitting earbuds has added a new wrinkle to an old problem. Though many teens think they can build tolerance to loud music over time, experts assure us that this is not the case. Once it occurs, noise-induced nerve damage can never be fully reversed, despite the best efforts of modern medicine.
Otolaryngologists explain that the intensity of sound is measured in decibels, with 0 decibels equaling the faintest sound able to be detected by the human ear and 60 decibels representing normal levels of conversation. Prolonged or repetitive exposure to 85 decibels or greater can cause permanent hearing loss.
Loud rock concerts can reach noise levels of 115 decibels. If your teen was out in the workforce, by law, his unprotected ears could be exposed to that same 115 decibels of sound for no more than 15 minutes per day.
Though rock concerts are an infrequent source of noise exposure for many kids, what about their personal music systems? An eye-opening study conducted in 2006 by the American Speech-Language-Hearing Association found that nine popular handheld sound devices reached maximum decibel levels of 106 to 125 when played at full volume.
Is there an acceptable volume level for these music devices? In papers presented at a recent NIHL in Children Meeting, researchers from Harvard and the University of Colorado used occupational noise standards to develop their own recommendations for iPod earbud use.
The authors suggest restricting listening time based on selected volume. If the device is kept at 10 percent to 50 percent of its maximum volume, no limit needs to be put on its use. If, however, the owner chooses to listen at 80 percent volume, suggested listening time drops to 90 minutes per day. At maximum volume, no more than five minutes of listening time should be allowed in a day.
The same researchers found that the much-maligned earbuds are not more dangerous than over-the-ear headphones. Earbud users, however, are notorious for turning the volume way up when they find themselves unable to hear their music due to loud background noise.
Volume guidelines can be helpful, but parents will find that each child has his or her own individual noise limit. Some kids (and adults) really are more sensitive to noise and will need to drop the volume level even lower than the accepted safe levels.
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February 11: Smoking can extinguish a good night’s sleep, The Boston Globe
SLEEP
Here's another good reason to put away those cigarettes - a new study shows that smoking can lead to unhealthy sleep patterns, making you feel groggier the next day. Scientists have long speculated that smokers have poorer sleep quality than nonsmokers because of conditions associated with the habit, such as sleep apnea and lung disease. Now, research from Johns Hopkins University School of Medicine led by Dr. Naresh M. Punjabi, shows that smoking might be the culprit for decreased sleep quality. Researchers chose 40 smokers and 40 nonsmokers who were otherwise healthy. They sent them to bed with EEG machines that pick up sleep patterns in the brain. Using mathematical models, researchers were able to determine that smokers tended to spend more time in light sleep and less time in deep sleep - with the result that nearly one-quarter of smokers, compared with only 5 percent of nonsmokers, said they weren't getting restful sleep.
BOTTOM LINE: "If smokers have sleep disturbances, smoking probably has an important contribution," Punjabi said.
CAUTIONS: "We didn't look at former smokers," Punjabi said, so this study has no way of predicting whether quitting smoking might help restore normal sleep habits.
WHAT'S NEXT: Researchers plan to follow the patients over the next five years to see whether sleep is affected over the long term.
WHERE TO FIND IT: Chest, February.
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February 13: Study Says India Has Smoking Crisis, AP
By MUNEEZA NAQVI
Associated Press Writer
NEW DELHI (AP) -- India is in the grips of a smoking epidemic that is likely to cause nearly a million deaths a year by 2010, more than half of them among poor and illiterate people, according to a study released Thursday.
One in five of all male deaths and one in 20 of all female deaths between the ages of 30 and 69 will be caused by smoking, said the study, conducted by a team of doctors and scientists from India, Canada and Britain and published in the New England Journal of Medicine.
"The results we found surprised us, because smokers in India start later in life and smoke fewer cigarettes or 'bidis' than those in Europe or America, but the risks are as extreme as in the West," said Prabhat Jha of the Center for Global Health Research at the University of Toronto, the lead author of the study.
The study, one of the most comprehensive ever in India, sent 900 field workers to survey 1.1 million homes across the country. They compared the smoking history of 74,000 adults who died from 2001 to 2003 with 78,000 living adults.
The study says there are currently about 120 million smokers in India. More than 30 percent of men and 5 percent of women between 30 and 69 years of age smoke either cigarettes or "bidis," small, cheaply made cigarettes which contain about one-fourth the tobacco of a regular cigarette, the study said.
Bidis are popular among poor Indians because they are significantly cheaper. A packet of 10 costs about 2 rupees (about 5 US cents; euro0.03) while the cheapest cigarettes cost 1 rupee (2 US cents; euro0.01) apiece.
Jha said the study found more than 50 percent of smoking deaths are likely to be among poor, illiterate Indians, suggesting that pictorial health warnings on packages - instead of the current written warnings - may be part of an effective anti-smoking strategy. Raising taxes on bidis could also help, he said.
The study also found that only 2 percent of adult smokers in India quit before falling ill. "Typically people quit smoking only after disease strikes," Jha said.
A World Health Organization official in New Delhi said the study was "very representative of India."
"It's going to be a good tool for advocacy and a good tool for policy in intervention," said Poonam Khetrapal Singh, a WHO deputy regional director.
Health Minister Anbumani Ramadoss said he was alarmed by the study's findings.
"The government of India is trying to take all steps to control tobacco use - in particular by informing the poor and the illiterate," he said in a statement.
While an increasing number of countries prohibit smoking in public places, people in India freely puff away in playgrounds, railway stations, sidewalk cafes and even hospitals.
Ramadoss has helped enact a number of laws banning smoking in various public places, but most are routinely ignored. Last month he asked some of the country's top movie actors to stop smoking on screen.
A recent government effort to introduce pictorial health warnings recommended by WHO has run into legal delays, with tobacco companies fighting to keep them off cigarette packets.
According to a WHO study released last week, nearly two-thirds of the world's smokers live in 10 countries led by China, which accounts for nearly 30 percent, and India with about 10 percent. They are followed by Indonesia, Russia, the United States, Japan, Brazil, Bangladesh, Germany and Turkey.
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February 17: Health officials keeping eye on drug-resistant flu strain, Chicago Tribune
Drug-resistant virus could limit treatment options, doctors say
By Jeremy Manier | Tribune reporter
Ten Chicago-area patients have tested positive for an unusual type of drug-resistant influenza, prompting concern and increased surveillance by local and federal health officials.
The strain of flu can be treated successfully with some drugs, but it does not respond to Tamiflu, the most common anti-viral medication for flu. The Illinois Department of Public Health issued a health alert to doctors and hospitals Thursday, suggesting that flu patients who are in intensive care receive a combination of drugs until their virus can be analyzed.
Officials said eight of the Tamiflu-resistant infections came from an outbreak at a single Chicago health-care facility, the name of which has not been released.
Nationwide, 4.6 percent of flu samples tested have shown signs of drug resistance this season, said officials with the federal Centers for Disease Control and Prevention. In previous years, resistance to the drug hovered below 1 percent of all cases.
"We have seen this before, though not at this level," said Dr. Joe Bresee, chief of epidemiology and prevention in the CDC's influenza division.
The worry among some experts is that flu strains could develop resistance to more than one drug, leaving doctors with few options for treating severely ill patients. One way that could happen would be for patients to get infected with two flu strains at once, each with resistance to a different type of anti-viral medication.
"If you had two viruses in the same cell, they could recombine and generate a new virus," said Dr. Steven Wolinsky, chief of infectious diseases at Northwestern University. "The fact that we're seeing resistance to first-line medications is worrisome."
Anti-viral drugs work by preventing viruses from making more copies of themselves inside human cells. They are different from antibiotics, which kill bacteria. Just as bacteria can evolve resistance to antibiotics, viruses can develop into strains that do not succumb to anti-viral medication.
In other news, the CDC reported Friday that this season, the flu has killed 10 U.S. children. Bresee said the deaths are "not totally unexpected," given the rate of 44 to 73 child flu deaths the last few years; the agency continues to monitor the fatality rate.
Four of the young flu victims also had been infected with staph bacteria. Experts said patients who are weakened by flu often are more vulnerable to staph and other secondary infections.
Illinois officials said they have seen more flu cases occur in recent weeks, which is normal for this time of year. Although it's too soon to judge whether this flu season is worse than normal, several factors could increase the toll.
For one thing, this season's flu vaccine is not a perfect match with the viruses that are infecting people. Each season's vaccine is formulated based on an educated guess about what flu variants will hit the U.S., and this year's guess was a bit off.
"Slightly more than half of the viruses we're looking at are somewhat different from the vaccine strains," Bresee said. Although people who have been vaccinated should get some protection, it will be less than if the vaccine had matched this season's virus.
This year's form of flu virus also may be naturally more likely to cause disease. In most years, some form of the H1N1 variety is most common, but this time about 55 percent of cases belong to the H3N2 group, which can produce more severe cases of illness.
Bresee said no one can gauge how bad things are until more time has passed.
"I'll tell you in May," he said.
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February 18: Antibiotics Do Little for Inner Ear Infections, HealthDay News
No reason to give them to kids to try to prevent fluid buildup, analysis shows
By Steven Reinberg
MONDAY, Feb. 18 (HealthDay News) -- Antibiotics don't significantly reduce fluid buildup in young children with inner ear infections, a new analysis shows.
Whether such drugs work in this regard has been a matter of conjecture, with one recent study suggesting a benefit in children aged 2 and under. So, Dutch researchers did a meta-analysis of several previously published studies and found the results don't support the use of antibiotics for the fluid buildup that can accompany inner ear infections.
Related News
"Due to the marginal effect and the known negative effects of prescribing antibiotics, such as the development of antibiotic resistance and side effects, we do not recommend prescribing antibiotics to prevent middle ear effusion," said lead researcher Maroeska M. Rovers, from the Julius Center for Health Sciences and Primary Care at the University Medical Center Utrecht in The Netherlands.
Ear infections are very common among infants and children. They can lead to fluid buildup in the ear, which is known as otitis media with effusion. This buildup can result in hearing loss, which can affect language development, cognitive development, behavior and quality of life, according to the researchers.
The report was published in the February issue of the Archives of Otolaryngology-Head & Neck Surgery.
In the study, Rovers' team collected data on 1,328 children aged 6 months to 12 years with acute middle ear infection. These children had participated in five studies that compared treating ear infections with antibiotics to a placebo or no treatment at all.
Among the children in the studies, 44 percent were younger than 2. Of these children, 51.8 percent had recurrent ear infections. It was in this group of children that the risk of fluid buildup was the greatest.
Rovers' group found that the children taking antibiotics were 90 percent as likely to develop fluid buildup as children who weren't taking the medications. However, this difference was not statistically significant. "No difference in the development of effusion could be detected between the placebo and the antibiotics group," Rovers said.
"More research is, however, needed to identify relevant subgroups of children that have middle ear effusion that might benefit from other treatments," Rovers added.
One expert noted that doctors do not routinely prescribe antibiotics to prevent fluid buildup in ear infections.
"To the best of my knowledge, physicians generally don't prescribe antibiotics for acute otitis media in order to prevent middle-ear effusion; they prescribe them to bring about more prompt resolution of the infection and of its symptoms, especially pain," said Dr. Jack Paradise, a professor of pediatrics and otolaryngology at the University of Pittsburgh School of Medicine and a pediatrician at Children's Hospital of Pittsburgh.
The question of prescribing to prevent middle-ear effusion has become a non-issue over the past decade, Paradise said. "Asymptomatic middle-ear effusion is extraordinarily common and has been shown to be essentially harmless under ordinary circumstances," he said.
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February 20: Sleep apnea dangerous for stroke patients, Reuters Health
NEW YORK (Reuters Health) - Sleep apnea, in which breathing briefly ceases or becomes blocked numerous times during the night, is a risk factor for early death in people who have had a stroke, according to a new study.
"Sleep apnea occurs frequently among patients with stroke, but it is still unknown whether a diagnosis of sleep apnea is an independent risk factor for mortality," Dr. Karl A. Franklin, of Umea University Hospital, Sweden, and colleagues write in the Archives of Internal Medicine.
To better understand this relationship, the researchers examined long-term survival among 132 stroke patients admitted for in-hospital stroke rehabilitation between 1995 and 1997.
All of the subjects underwent overnight sleep apnea recordings about three weeks after their stroke, and were followed for an average of 10 years.
The investigators report that 116 (88 percent) of the subjects had died at follow-up, which included all of the patients with obstructive sleep apnea (in which breathing is blocked by collapsing airway tissues), 96 percent of those with central sleep apnea (in which respiration controlled by the brain is interrupted), and 81 percent of patients without either form of sleep apnea.
The mortality rates of patients with obstructive sleep apnea were 76 percent higher than in patients without apnea. Central sleep apnea was not associated with increased mortality.
A drop in nighttime levels or oxygen in the bloodstream and an increased risk of cardiac arrest may account for the increased mortality among stroke patients who have sleep apnea, Franklin's team suggests.
SOURCE: Archives of Internal Medicine, February 11, 2008.
The authors report that 23 patients (17.4 percent) had obstructive sleep apnea and 28 patients (21.2 percent) had central sleep apnea during Cheyne-Stokes respiration. Two patients who had both obstructive and central sleep apnea were excluded. A total of 79 patients served as controls.
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February 19: Eyes a Window to Hearing Loss?, HeathDay News
(HealthDay News) -- The eyes may not just be a window to the soul, they may also provide a clear view to the state of your other senses.
A new study reports that the eyes can provide clues that tell researchers how well a person can hear. This finding may be especially helpful for diagnosing hearing problems in babies, very young children and in people who can't actively take a hearing test, such as those with a traumatic brain injury.
"When most animals detect a change in their environment, their pupils dilate. And, the quieter the sound, the less the dilation," explained study author Avinash Bala, a research associate at the University of Oregon in Eugene. "One of the things you can use this for is to see when a sound becomes detectable."
About 28 million Americans have some degree of hearing loss, according to the National Institute on Deafness and Other Communication Disorders. Approximately two to three out of every 1,000 children are born deaf or hard-of-hearing. Because hearing is so critical to speech and language development, experts believe that the sooner a hearing problem is diagnosed in babies and young children, the better.
However, detecting hearing problems in infants and young children can be difficult, because they can't respond to normal hearing tests as older children and adults do.
When Bala was working with barn owls, he realized that their pupils dilate in response to sound, and that the pupils responded in proportion to the volume of the sound. Bala said this is called an "orienting reflex response."
"Whenever there is a change in our environment, the natural reaction is to turn and look at it," he explained. At the same time, the heart rate slows, breathing slows, and the pupils dilate to allow the ability to assess the threat of the change. If the sound is repeated numerous times, and there's no threat detected, animals and humans quickly learn to ignore such sounds, according to Bala. This is known as habituating.
Bala and his colleagues thought they might be able to use this pupillary dilation response (PDR) to measure a person's ability to hear.
To test this theory, they recruited 22 healthy volunteers and asked them to listen to a variety of noises. While they were listening to the sounds, their eye movements were tracked by a camera. In this study, the subject kept their heads still by placing their chin in a chin rest, but Bala said that if a camera were mounted far enough away from the subject, they wouldn't need to be still. Or, he said, it's possible that they could use a pair of specialized goggles to detect changes in pupil size.
They found that when a novel sound was introduced, the pupils in human eyes dilated, and if the sound was repeated numerous times, the volunteers quickly became habituated to the sound. To counter this habituation, the researchers varied the sounds.
For 11 of the study participants, the researchers also asked when they heard a certain noise and compared those results to those obtained by the pupil response, and found that the results were very similar, within three decibels.
Results of the study were to be presented Tuesday at the Association for Research in Otolaryngology meeting in Phoenix.
Diane Sabo, director of the division of audiology and communication disorders at Children's Hospital of Pittsburgh, said the findings were "intriguing" and that a three-decibel difference was very small.
"Any time you work with babies and young children, you're always looking for a physiological response, because they can't tell you anything," she said. She did express concern that in this study, the participants kept their head still, because that's something that definitely won't happen with babies and young children.
"This sounds really interesting, but whether it can translate into a useful clinical tool is probably a long way off," said Sabo.
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February 26: Shortage of surgeons pinches U.S. hospitals, USA Today
By Robert Davis, USA TODAY
NASSAWADOX, Va. — In the modest building that houses Shore Memorial Hospital in this town of about 600 people between the Chesapeake and Hog Island bays, a health care crisis is brewing.
It's a problem rooted in the 1980s and 1990s, when U.S. medical schools put a cap on enrollments, believing that managed health care, among other factors, would create a glut of doctors.
They were wrong. And now the impact of a national shortage of surgeons and family practice doctors is echoing across the country.
The shortage of surgeons is a particular threat to the health care of 54 million rural Americans, medical specialists say, including the "watermen" who catch crabs, scoop clams and grow oysters here.
Shore Memorial, which on average has 61 patient admissions a day, was built 70 years ago to save lives being lost to simple ills such as appendicitis. Having a surgeon is vital to keeping open the doors of Shore Memorial and thousands of other small hospitals like it.
But as local doctors have moved away from this community or retired during the past 10 years, the ranks have fallen from seven full-time surgeons to two. There also are only two anesthesiologists; one is nearing retirement.
Medical schools were "woefully wrong" in their calculations, says Josef Fischer, who as chairman of surgery at Beth Israel Deaconess Medical Center in Boston trains new surgeons every year. "It's going to be tough in this situation to make it better."
From the late 1970s to the mid-1990s, several national advisory groups, including the Institute of Medicine and the Council on Graduate Medical Education, issued reports forecasting a surplus of physicians. As a result, medical schools voluntarily held enrollment relatively constant at about 16,000 new students a year. From 1980 to 2005, enrollment was flat while the U.S. population grew by more than 70 million, according to the Association of American Medical Colleges (AAMC).
After educators realized the forecasting mistake, medical schools began accepting more applicants. Last year nearly 17,800 students entered U.S. medical schools, the largest entering class ever.
However, Fischer says there's "a perfect storm" forming for a shortage of doctors and surgeons because of the time it takes to train doctors — typically three to seven years — and the fact that the number of senior citizens in the USA is growing rapidly.
As the 79 million baby boomers begin entering retirement age, so are their doctors. From 1985 to 2006, the percentage of doctors 55 and older rose from 27% to 34%, and the AAMC predicted in a 2006 report that members of this group — roughly 250,000 active physicians — will retire by 2020.
The impact often is most severe in rural America, where only 9,334 of 211,908 physicians are general surgeons, according to AMA data. The Census Bureau defines "rural" as open country or small towns with fewer than 2,500 residents.
David Lingle, 43, chief of surgery at Shore Memorial, says he is happy doing the work of several doctors. He answers calls for help when he's in his yard playing with his children or chopping wood. He can venture farther to fish for flounder or speckled trout only when he is not on call.
Because Lingle is a general surgeon in a small town, the alarm from his hospital pager could mean that a stranger needs help following a crash on the highway that connects North Carolina's Outer Banks to the New Jersey shore, or a friend from church might be having an aneurysm.
"I like the variety," says Lingle, who grew up in Arnold, Mo., a suburb of St. Louis. "We've figured out a way to make this work, but access to surgery in the periphery is in jeopardy." He says that he is worried that "nobody will want to sign up for this job anymore."
Thomas Russell, executive director of the American College of Surgeons, says there are not enough new doctors going into general surgery. Surgeons such as Lingle "have no one to sign off to, they are on call all the time," Russell says. "They can burn out after doing this year after year after year."
'They want balance in their life'
The shortage of surgeons is part of a larger shortage of medical professionals that has been recognized as a threat for more than five years. Medical schools have been enrolling more and more students annually to achieve a 30% increase in enrollment over 2002 levels by 2015.
But even a growing corps of young doctors may not help those who need general medical care, particularly if they live in rural areas, because of the career paths physicians are choosing.
Many of today's young doctors start their careers $150,000 to $250,000 in debt in education costs, so they often go where they can make the most money, Fischer says. And critical areas such as general surgery and family practice medicine are less lucrative than some specialties, such as bariatric or orthopedic surgery.
A typical new surgeon makes about $165,000 in his or her first year, Fischer says. After five years, he or she will earn $220,000 to $300,000 or more a year, depending on whether the practice is private or in an academic setting.
In rural areas, however, surgeons generally make less, Fischer says, especially if their hospitals don't supplement their salaries.
The number of physicians in specialties such as thoracic surgery and emergency medicine has more than doubled since 1990, according to the AMA.
However, "fewer and fewer are going into family medicine and primary care," says James King, president of the American Academy of Family Physicians. And "many are not willing to go" to rural areas.
After an industry-wide review of allegations that surgeons were charging too much, Medicare lowered the amounts that the U.S. government pays doctors during the 1990s. For some common procedures, general surgeons now get about half the money they received 20 years ago, Fischer says.
"Are the best and the brightest going into medicine like they once did? The answer is no," Fischer says. "They are becoming investment bankers, attorneys and captains of industry because the American way — how prestigious things are — depends on money."
During the past three years, Fischer says, none of his surgical students has opted to become a general surgeon like Lingle.
Besides wanting to pay off their debt by earning more money quickly, today's new doctors also put a higher value on their free time. "My generation neglected our families. We neglected our children. We were always operating," says Fischer, 70. "This current generation, much to their credit, says, 'We're not going to do that.' "
Russell says new doctors "want to know when they are on and when they are off. It's no longer a calling for younger people. They want balance in their life."
King says some of his physician friends are telling their children to avoid medical school.
"They tell their kids not to go because of all of the hassles," says the family physician from Selmer, Tenn. "They say it's not worth the headaches anymore."
A call for new priorities
Various physician groups are trying to drive changes that will offset the impact of the doctor shortage.
The American College of Emergency Physicians wants liability and reimbursement changes so that specialists will agree to come to the emergency room to see patients in the middle of the night.
The college of surgeons is promoting rural medicine among its members by focusing on effective rural practices at meetings and pairing country doctors to look for innovative solutions.
Meanwhile, the largest nationwide expansion of medical schools in 40 years has some schools facing challenges ranging from how to pay for new buildings to how to recruit more faculty members, according to the AAMC.
"It will take more than somebody waving a magic wand" to increase the number of surgeons, Fischer says, adding that there still are only about 1,000 spots a year in surgical training programs, he says.
And King says medical schools need to hunt for a slightly different type of student — those who want to practice medicine in rural areas — and focus less on attributes such as an applicant's previous clinical research.
"Just increasing the number of slots for medical schools is not going to solve the problems of supplying health care to the citizens," King says.
Reimbursement an issue
He and others say physician reimbursement has to change in a way that will compensate for treating rural patients "where they live." Many patients have to travel or be transported long distances to get the care they need, the doctors say, especially trauma and critically ill patients. That will only get worse as the shortage grows, they say.
King says doctors should be compensated for helping patients manage chronic conditions. A follow-up phone call, e-mail, or a visit with a dietitian or a nurse on a physician-led team might help eliminate the need for surgery. "If we do this right," he says, "the prognosis for medicine is excellent."
Ben Murphy agrees. A 2003 graduate of Nandua High School here on the Eastern Shore, he met Lingle through his grandmother, one of the surgeon's patients.
While attending the University of Virginia, Murphy began to seriously consider medicine, so he called Lingle, who invited the college student to spend 40 hours a week with him over the summer.
For two months, when the biting flies the locals call "greenheads" are most vicious, Murphy worked in the little white house across the street from the hospital where Lingle and his partner, Charles Goldstein, 48, see patients. He followed Lingle into the operating room to observe surgery.
"I fell in love with all parts of medicine," says Murphy, 22, who begins his training at Johns Hopkins Medical School in Baltimore in August. "The more medicine I saw, the more I loved it."
He's concerned about the direction medicine is heading, he says, but he's excited to become a doctor and thinks he will choose surgery, "though there are still a lot of decisions to be made."
Another uncertainty is whether he will return to Shore Memorial someday. The small local hospital might look different after he has treated patients in a big-city facility.
"I like rural areas," Murphy says in a telephone interview. "I may eventually want to go back there. At first, I'll probably go somewhere else, but I could see myself going back there later in life."
Sitting in a hot, dark conference room near the operating room, Lingle takes a short break as the staff prepares a room and a patient for another procedure. "We joke that in 10 years, Ben will be back," he says. His smile fades as he considers the odds of that happening. "At least he will be a doctor."
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February 27: Panel Recommends All Kids Get Flu Shots, AP
By MIKE STOBBE
AP Medical Writer
ATLANTA (AP) -- All children - not just those under 5 - should get vaccinated against the flu, a federal advisory panel said Wednesday. The panel voted to expand annual flu shots to virtually all children except infants younger than 6 months and those with serious egg allergies.
That means about 30 million more children could be getting vaccinated. If heeded, it would be one of the largest expansions in flu vaccination coverage in U.S. history. The flu vaccine has been available since the 1940s.
The Advisory Committee on Immunization Practices said all children should start getting vaccinated as soon as possible, acknowledging that many doctors have already ordered their vaccine for the 2008-2009 season and may not be able to give the shots until 2009-2010. The flu season generally starts in the fall and continues through spring.
The panel's advice is routinely adopted by the Centers for Disease Control and Prevention, which issues vaccination guidelines to doctors and hospitals.
Flu shots were already recommended for those considered to be at highest risk of death or serious illness from the flu, including children ages 6 months to 5 years, adults 50 and older, and people with weakened immune systems
The panel said that should be expanded to include children up to age 18.
Children ages 5 to 18 get flu at higher rates than other age groups, but they don't tend to get as sick. Of the 36,000 estimated annual deaths attributed to the flu, only 25 to 50 occur in children in that age bracket, CDC officials said.
But children who stay home sick from school cause parents to stay home, so reducing the illness in this group should cut down days of lost work, some experts said.
Experts believe giving flu shots to more children may also prevent the illness from spreading to adults and the elderly, although studies haven't clearly established that will happen.
Shots are not the only option. A nasal spray vaccine, FluMist, is approved for healthy people ages 2 to 49.
Panel members waffled a bit on whether to make the recommendations kick in immediately. Some public health professionals pushed them to make the clearest endorsement possible of the flu vaccine, concerned that the public is losing faith in flu shots because this year's vaccine was not well matched to circulating viruses.
Indeed, a few argued that the committee should recommend flu shots for every healthy person, rather than adding another set of children now and maybe young adults in a few years.
"Creeping incrementalism, I believe, continues to foster confusion" about who should get the shot and how important it is, said Dr. Gregory Poland, a Mayo Clinic infectious diseases expert.
The head of the panel, Dr. Dale Morse, asked for a report on universal vaccination of adults.
Meanwhile, vaccine makers said they expect to be able to produce enough doses next season to accommodate an extra 30 million children, but panel members had concerns about how the doses would be given to so many.
There's no other vaccine that's given to nearly all kids every year. Most schools aren't set up to do it, and physicians groups said they weren't sure if doctors were ready to handle a flood of children seeking vaccinations every year.
"This is the only vaccination that pediatricians in my community don't want to have to give," said Dr. Carol Baker, a Baylor College of Medicine professor who sits on the panel.
Baker said she still felt the recommendation should go into effect for the next flu season. But groups representing pediatricians and family physicians said they wanted more time to plan for a possible crush.
Maybe they shouldn't worry. Some experts noted that only a fraction of people recommended to get flu vaccinations actually go through with it.
"We probably will need to have low expectations for coverage in the first few years of implementation" of the ages 5-through-18 recommendation, said Dr. Tony Fiore, a CDC epidemiologist.
Before the vote, the panel heard a presentation of a study that found the vaccine was 75 percent effective in preventing hospitalizations from the flu in children 6 months to 23 months.
"We haven't had data showing prevention of severe outcomes like that in that age group before," Fiore said.
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