Great Equalization: Is MBBS From India Equal To M.D. In U.S.A?
Great Equalization: Is MBBS From India Equal To M.D. In U.S.A?
Great Equalization: Is MBBS From India Equal To M.D. In U.S.A?
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• Reflections on the Second <strong>In</strong>do-US Summit<br />
• Partners with AAPI to Host a Successful<br />
Medical Conference<br />
• Prevention of Deafness: A Vision for <strong><strong>In</strong>dia</strong><br />
• Crisis!<br />
• Obesity, Acanthosis Nigrican and Type 2<br />
Diabetes in High School Youth<br />
Membership Update<br />
Form <strong>In</strong>side!<br />
on page 32 of this issue
AAPI Journal • March 2009<br />
AAPI (American Association<br />
of Physicians of <strong><strong>In</strong>dia</strong>n Origin)<br />
Sanku Rao, M.D., President<br />
600 Enterprise Drive, Suite 108<br />
Oakbrook, IL 60523<br />
Phone: 630-990-2277<br />
Fax: 630-990-2281<br />
www.aapiusa.org<br />
AAPI Journal Editor<br />
Sivaprasad Madduri, M.D.<br />
2817 Charlton Lane<br />
Poplar Bluff, MO 63901<br />
O: 573-778-7158<br />
H: 573-686-3632<br />
F: 573-686-1298<br />
madduri@semo.net<br />
The AAPI Journal is published<br />
quarterly by the American<br />
Association of Physicians of <strong><strong>In</strong>dia</strong>n<br />
Origin (AAPI). This publication<br />
may not be reproduced in whole<br />
or in part without the express<br />
written permission of the AAPI.<br />
All articles published including<br />
editorials, letters and book reviews<br />
represent the opinions of the<br />
authors and do not reflect the<br />
official policy of AAPI.<br />
Copyright ' 2009 AAPI.<br />
All rights reserved.<br />
Designed & Printed by:<br />
GR Marketing & Graphic Design<br />
Tampa, Florida<br />
(813) 886-4500<br />
www.grgraphics.net<br />
CONTENT<br />
Executives<br />
• Presidential Message by Sanku Rao, M.D. ........................4<br />
• Editor’s Desk by Sivaprasad Madduri, M.D. ..........8<br />
• President-Elect’s Report by Vinod Shah, M.D. ....................10<br />
• Vice President’s Report by Ajeet R. Singhvi, M.D ..............11<br />
• Secretary’s Report by Prasad Srinivasan, M.D. ............13<br />
• Treasurer’s Report by Narendra R.Kumar, M.D. ..........14<br />
Feature<br />
• Reflections on the Second<br />
<strong>In</strong>do-US Summit by Prasad Srinivasan, M.D. ............15<br />
• Partners with AAPI to Host a<br />
Successful Medical Conference<br />
<strong>In</strong> Goa, <strong><strong>In</strong>dia</strong><br />
by Nasir Khan, M.D.......................19<br />
• Prevention of Deafness:<br />
A Vision for <strong><strong>In</strong>dia</strong> by Raj Desai, M.D. ......................21<br />
• Pharmaceutical Advertisement:<br />
Makes for Better Healthcare<br />
For All?<br />
by Sidharth Bagga, M.D.<br />
Shagun Bagga-Malhotra, M.D.<br />
Pankaj Malhotra, M.D...............22<br />
• <strong>Great</strong> <strong><strong>Equal</strong>ization</strong>...<br />
<strong>Is</strong> <strong>MBBS</strong> <strong>From</strong> <strong><strong>In</strong>dia</strong> <strong>Equal</strong> <strong>To</strong><br />
M.D. <strong>In</strong> U.S.A? by Akshay Desai, M.D. ................23<br />
• Crisis! by M. P. Ravindra Nathan, M.D. ....24<br />
Special Articles<br />
• Obesity, Acanthosis Nigrican<br />
and Type 2 Diabetes in High<br />
School Youth<br />
• Probiotic Theraphy<br />
by Naznin M. Dixit, M.D.<br />
Mehul P. Dixit, M.D. ................26<br />
by M. S. Reddy, M.D.<br />
D. R. K. Reddy, M.D. ................27<br />
• The Behaviorally<br />
Disruptive Physician by Gopal Lalmalani, M.D. ............29<br />
• Suffocation by Riddhi Shah, M.D. ....................30<br />
• Distinguished AAPI Members<br />
AMA Awards ......................................................31<br />
• AAPI Membership Update ......................................................32<br />
• AAPI Membership Registration ......................................................33<br />
• AAPI Membership Status Report ......................................................35<br />
• AAPI Upcoming Events ......................................................42<br />
Depatments<br />
• Members in the News:<br />
Raj Gupta, M.D., AppaRao Mukkamala, M.D.,<br />
Shastri Swaminathan, M.D., Prasad Srinivasan, M.D.,<br />
Roshni Kulkarni, M.D., ......................................................37<br />
• Poem (Autumnal Burst) by Monita Soni, M.D. ......................7<br />
• Poem (When I <strong>To</strong>ok Off My<br />
White Coat) by Sharmeela Saha, M.D. ..............39<br />
• Poem (Superwoman) by Vimol Goyle, M.D. ....................42<br />
About the Cover<br />
The second <strong>In</strong>do-US summit, held from January 2nd to<br />
4th, 2009 in New Delhi in collaboration with the<br />
Government of <strong><strong>In</strong>dia</strong> and IMA.<br />
www.aapiusa.org<br />
3
AAPI Journal • March 2009<br />
President’s Message<br />
by Sanku Rao, M.D.<br />
Dear members, it’s my privilege to<br />
present the President’s report.<br />
AAPI Convention 2008:<br />
I am very happy to inform you that<br />
the Las Vegas Convention held in<br />
June 2008 was a success. I thank you<br />
all for the active participation in<br />
making this event a profitable one.<br />
Teleconferences:<br />
The monthly Executive Committee<br />
teleconferences are being held with<br />
an active participation from the<br />
Officers with useful discussions and<br />
exchange of ideas.<br />
<strong>In</strong> the past seven months, I visited:<br />
• Orlando, FL: Met with Chair and<br />
Co-chairs of 2009 Convention<br />
committee.<br />
• Tampa, FL: Keynote speaker at a<br />
conference held by Federation of<br />
<strong>Great</strong>er Tampa<br />
• New York: Attended the annual<br />
meeting of Federation of AAPI of<br />
<strong>Great</strong>er NY and NJ and Long<br />
<strong>Is</strong>land and Queens Chapter on<br />
October 18, 2008<br />
• Cleveland, OH: Attended the<br />
25th Silver Jubilee meeting of<br />
APINO as a keynote speaker on<br />
November 1, 2008<br />
• Grenada: Attended St. George<br />
University, Grenada conference<br />
on November 13, 2008 and met<br />
with Dr. Charles Modeca,<br />
Chancellor of SGU. The<br />
university has setup scholarships<br />
amounting to $500,000 which<br />
will be issued to students of<br />
<strong><strong>In</strong>dia</strong>n Origin every year and<br />
AAPI will select the awardees.<br />
• Anaheim, CA: Attended the<br />
annual meeting held jointly by<br />
<strong><strong>In</strong>dia</strong>n Medical Association of<br />
<strong>Great</strong>er Los Angeles and <strong><strong>In</strong>dia</strong>n<br />
Medical Association of Southern<br />
California on November 22,<br />
2008.<br />
• Wichita, KS: Attended the annual<br />
meeting held by AAPI Wichita<br />
Kansas Chapter on December<br />
12, 2008.<br />
Membership and Membership<br />
Benefits Committee are working very<br />
hard to put together a<br />
comprehensive membership<br />
package.<br />
AAPI Charitable Foundation:<br />
At the Fall Governing Body<br />
meeting held at Oklahoma City, the<br />
AAPI Charitable Foundation<br />
fundraiser dinner event was held in<br />
association with the AAPI-Oklahoma<br />
Chapter on Friday, October 24th,<br />
2008 and raised $37,000 which will<br />
help AAPI Charitable Foundation to<br />
continue and expand its charitable<br />
activities in <strong><strong>In</strong>dia</strong> and here in US.<br />
Second <strong>In</strong>do-US Healthcare Summit:<br />
The second <strong>In</strong>do-US summit, held<br />
from January 2nd to 4th, 2009 in<br />
New Delhi in collaboration with the<br />
Government of <strong><strong>In</strong>dia</strong> and IMA was a<br />
huge success attended by more than<br />
175 delegates both from USA &<br />
<strong><strong>In</strong>dia</strong>. After the press conference and<br />
Strategic Planning Committee<br />
meeting on the 2nd followed by<br />
Johnson & Johnson sponsored dinner<br />
with key MDs and CEOs from <strong><strong>In</strong>dia</strong>,<br />
Honorable Minister for Overseas<br />
<strong><strong>In</strong>dia</strong>n Affairs Mr. Vayalar Ravi<br />
inaugurated the summit on 3rd<br />
morning. <strong>In</strong> his inaugural speech,<br />
Mr. Ravi said that AAPI is in a<br />
position to play a leading role in the<br />
healthcare arena given its vast<br />
expertise and skill set and informed<br />
that the<br />
Government<br />
of <strong><strong>In</strong>dia</strong><br />
would soon initiate talks<br />
Sanku Rao, M.D.<br />
AAPI President<br />
with the Medical Council of <strong><strong>In</strong>dia</strong><br />
and the <strong><strong>In</strong>dia</strong>n Medical Association<br />
to enable physicians living abroad to<br />
practice in <strong><strong>In</strong>dia</strong>. Dr. Ramesh Mehta,<br />
President of British Association of<br />
Physicians of <strong><strong>In</strong>dia</strong>n Origin (BAPIO)<br />
informed that the BAPIO will partner<br />
with AAPI from next year in the rural<br />
healthcare projects in <strong><strong>In</strong>dia</strong>.<br />
The meeting aimed at bringing<br />
together caring and dedicated<br />
physicians from both the countries to<br />
focus on six disease categories –<br />
Asthma and Allergy, Cardiology,<br />
Diabetes, <strong>In</strong>fectious Disease,<br />
Maternal and <strong>In</strong>fant Health and<br />
Mental Health. Several break-out<br />
sessions were done where the US<br />
Delegates worked with their <strong><strong>In</strong>dia</strong>n<br />
counterparts on six disease states<br />
and strategic planning. The summit<br />
concluded with the summaries of<br />
recommendations from each of the<br />
disease states. Follow up with the<br />
chairs and co-chairs are being<br />
planned so that our goals are<br />
achieved and their recommendations<br />
can be presented at the upcoming<br />
annual convention.<br />
The Strategic planning committee<br />
will draw their action plan for the<br />
next five years and give<br />
recommendations on which AAPI<br />
will act.<br />
AAPI delegation met the Chief<br />
Minister of New Delhi, Honorable<br />
Mrs. Sheila Dixit and informed about<br />
our activities and goals. The Chief<br />
Minister was very gracious to offer<br />
office-space in New Delhi for AAPI.<br />
Continued on page 5<br />
4 www.aapiusa.org
AAPI Journal • March 2009<br />
President’s Message<br />
Continued from page 4<br />
On January 5th, I met with Chief<br />
Minister of Andhra Pradesh Dr. Y.S.<br />
Rajasekhara Reddy and updated him<br />
regarding the Health Summit and<br />
need to implement the rural health<br />
care initiative. At the press<br />
conference on the afternoon of the<br />
5th, AAPI along with Andhra<br />
Pradesh Medical Graduates (APMG)<br />
outlined our vision in implementing<br />
the rural healthcare in Andhra<br />
Pradesh.<br />
I also met with Chief Minister of<br />
Gujarat, Mr. Narendra Modi. Mr.<br />
Modi requested a proposal on a<br />
rural healthcare project in the state<br />
of Gujarat.<br />
Pravasi Bharatiya Divas:<br />
The Ministry of Overseas <strong><strong>In</strong>dia</strong>n<br />
Affairs (MOIA) in partnership with<br />
the State Government of Tamil Nadu<br />
and the Confederation of <strong><strong>In</strong>dia</strong>n<br />
<strong>In</strong>dustry, (CII) organized the Pravasi<br />
Bharatiya Divas at Chennai Trade<br />
Center, Chennai, <strong><strong>In</strong>dia</strong> from January<br />
7-9, 2008. AAPI delegation was<br />
invited for the event. I was one of<br />
the panelists for the session ‘Health<br />
for All: Role of Diaspora’.<br />
Global Association of Physicians of<br />
<strong><strong>In</strong>dia</strong>n Origin (GAPIO):<br />
The world’s first comprehensive<br />
healthcare organization to be named<br />
as Global Association of Physicians<br />
of <strong><strong>In</strong>dia</strong>n Origin (GAPIO) was<br />
launched by the Government of<br />
<strong><strong>In</strong>dia</strong> at the Pravasi Bharatiya Divas<br />
in Chennai, <strong><strong>In</strong>dia</strong>. This global<br />
consortium of healthcare<br />
professionals consists of international<br />
medical fraternaties such as<br />
American Association of Physicians<br />
of <strong><strong>In</strong>dia</strong>n Origin (AAPI), Canadian<br />
Association of Physicians of <strong><strong>In</strong>dia</strong>n<br />
Heritage (CAPIH) and British<br />
Association of Physicians of <strong><strong>In</strong>dia</strong>n<br />
Origin (BAPIO). The Consortium lays<br />
emphasis on improving health<br />
provision and addressing health<br />
inequalities in <strong><strong>In</strong>dia</strong>. The consortium<br />
will promote the contribution of<br />
approximately 1.2 million physicians<br />
and dentists of <strong><strong>In</strong>dia</strong>n origin to<br />
global health and to harness their<br />
skills and expertise to address<br />
healthcare issues in <strong><strong>In</strong>dia</strong>.<br />
GAPIO is fully backed by<br />
Government of <strong><strong>In</strong>dia</strong> and founding<br />
members would be given<br />
membership free of charge for first<br />
two years and benefits include<br />
newsletters, access to educational<br />
programs, networking and right of<br />
access to fraternal associations and<br />
academic journal.<br />
Elected Chair: Dr. Pratap Reddy<br />
Elected vice chairs: Dr Sanku<br />
Rao (AAPI) and Dr. Ramesh<br />
Mathur (BAPIO)<br />
Honorary Healthcare Advisers:<br />
Anwar Feroz & Haresh Kaneriya,<br />
Johnson & Johnson, NJ<br />
AAPI Academic Affairs:<br />
• Develop a Directory of<br />
Academic Notables<br />
• Assist CME Committee in<br />
development of agenda with<br />
topics and speakers.<br />
AAPI CME:<br />
This year’s first CME Program was<br />
held on a Greek <strong>Is</strong>land’s cruise Sept.<br />
21 to 28th, 2008 and was<br />
successful. The CME was well done<br />
and everyone enjoyed the visit to<br />
the Greek <strong>Is</strong>lands.<br />
The second CME program was<br />
held in Goa from December 28 –<br />
January 1st. The CME was very well<br />
done with interested sessions on<br />
‘Hypertension and Cardio Metabolic<br />
Syndrome’, ‘Impaired Medical<br />
Students & Physicians’, ‘Neglected<br />
Bladder’ etc. The participants<br />
enjoyed the visit to Goa.<br />
The third CME will be on March<br />
7th in Roswell, GA in association<br />
with Georgia Association of<br />
Physicians of <strong><strong>In</strong>dia</strong>n Heritage. Dr.<br />
P.K. Natrajan, CME Chair and Dr.<br />
Naresh Parikh, Regional Director,<br />
Southern Region are working closely<br />
to finalize the program.<br />
Externship Program:<br />
This Clinical Observership<br />
program is organized based on the<br />
model of the IMG Observership,<br />
which currently has been in<br />
existence in Oklahoma since 1999.<br />
The primary purpose of this<br />
Observership is to assist IMGs in<br />
gaining admission into US residency<br />
training programs.<br />
Currently, externship programs are<br />
in Oklahoma City, San Antonio and<br />
Boston. However, there are<br />
approximately 4,000 IMGs awaiting<br />
placement at this time. For this<br />
reason, AAPI is planning to start<br />
three new externship programs in<br />
Dallas, New York, and Michigan by<br />
April 2009, which will help improve<br />
the chances of more IMGs to gain<br />
acceptance into US residencies.<br />
Women’s Forum:<br />
This year’s Women Health Forum<br />
has been planned on March 14th,<br />
2009 in New Jersey. The Committee<br />
is working very hard to make this<br />
event successful.<br />
Spring Governing Body:<br />
The Spring Governing Body<br />
Meeting, in association with <strong><strong>In</strong>dia</strong>n<br />
Medical Association of New England<br />
is scheduled to be held from April<br />
10 – 12, 2009 at Boston, MA.<br />
Continued on page 7<br />
www.aapiusa.org<br />
5
AAPI Journal • March 2009<br />
President’s Message<br />
Continued from page 5<br />
Legislative Day:<br />
Legislative committee did an<br />
excellent job lobbying the congress<br />
and helped in halting the Medicare<br />
cuts. This year the Legislative<br />
Conference will be held on April<br />
28th, 2009 at Washington D.C.<br />
Dinner/Reception is scheduled on<br />
April 27th.<br />
Annual Convention:<br />
The 27th Annual AAPI Convention<br />
will be held at the Walt Disney<br />
World Dolphin Hotel and<br />
Convention Center from Wednesday<br />
through Sunday, June 10-14, 2009.<br />
The Convention Committee is<br />
working very diligently. Exhibition<br />
booth registration is online.<br />
Member registration will go live in<br />
first week of March.<br />
IT Committee:<br />
When I took over as President,<br />
AAPI website was optimally<br />
functional, very poorly designed and<br />
was not serving the membership or<br />
the organization in a desirable<br />
manner, and it needed to be<br />
revamped. Redesigning the entire<br />
website and starting from scratch is<br />
one of the high priority tasks for me.<br />
I had several teleconferences with<br />
our IT Chair Dr. Anil Gupta and<br />
discussed the needs and advantages<br />
to build a new site rather than<br />
spending time to fix the current one<br />
which, according to the IT engineers,<br />
may never provide functionalities we<br />
desire and expect for the AAPI<br />
website because of the poor design<br />
inherent in the current website.<br />
We purchased a 80 Gigabyte<br />
Dedicated Server for AAPI. Phase I<br />
& II of the project is completed and<br />
the new website is projected to be<br />
unveiled in 1st week of April 2009.<br />
All the subchapters are invited to<br />
use our server for free. <strong>In</strong> the new<br />
website, we are planning to put easy<br />
links to subchapters of AAPI.<br />
With the development of new<br />
website, an important thing I am<br />
very interested in is to explore the<br />
possibilities of developing industry<br />
partnerships for mutual benefits such<br />
as working with Electronic Medical<br />
Record (EMR) companies.<br />
AAPI Journal:<br />
AAPI Publications Committee did<br />
a fabulous job in bringing the AAPI<br />
Journal on time. The Journal was<br />
sent out to 14,000 members in<br />
December 2008. <strong>To</strong> make the<br />
Journal self-sufficient, Journal<br />
Resource Committee did a<br />
tremendous job in raising funds<br />
through advertisements.<br />
Finances:<br />
Financially, AAPI is stable and<br />
strong. Weekly teleconferences with<br />
our Treasurer Dr. Narendra Kumar<br />
are being scheduled and the<br />
finances are being monitored very<br />
closely. We are following all the<br />
guidelines and paying bills very<br />
promptly. Checks above $2,000 are<br />
being signed by the Treasurer and<br />
me. We filed all the relevant tax<br />
returns as of June 2008.<br />
AAPI Office:<br />
Rama, Sam & Vijaya have been<br />
managing the AAPI Office very well.<br />
Search for an Executive Director is on.<br />
I invite you all to attend the<br />
Women’s Forum on March 14th,<br />
2009 at New Jersey, Spring<br />
Governing Body Meeting April 10 –<br />
12, 2009 at Boston, MA and the<br />
annual convention at Orlando, FL<br />
from June 10-14, 2009.<br />
Poem: Autumnal Burst<br />
by Monita Soni, M.D.<br />
A crisp fall morning<br />
Follows the glorious<br />
Historic Tuesday night<br />
The night of prayers<br />
Answered ....the night<br />
Of happy tears...<br />
The night of jubilation<br />
The eve of hope....<br />
My lips smile, my eyes sparkle<br />
The whole world sings<br />
The clear blue sky<br />
After a terrible terrible storm<br />
Holds up a promised wreath<br />
Of Leaping yellows, flaming oranges<br />
Chocolate browns<br />
Melting into fierce reds<br />
A gusty gale lifts my spirits<br />
Echoes the chorus of the<br />
Swirling leaves<br />
Yes we can! Yes we can!<br />
This Tumultous Tuesday<br />
Will resonate forever<br />
Linking the "chosen" one<br />
<strong>To</strong> those who believe in......Yes we can!<br />
www.aapiusa.org<br />
7
AAPI Journal • March 2009<br />
<strong>From</strong> The Editor’s Desk<br />
by Sivaprasad Madduri, M.D.<br />
It <strong>Is</strong> Time <strong>To</strong> Start Work Mr. President!<br />
(An open letter to President Obama)<br />
Sivaprasad Madduri, M.D.<br />
Editor-in-Chief<br />
Dear Mr. President,<br />
Congratulations. With your win as<br />
the President of the United States, you<br />
accomplished a victory that was<br />
beyond the scope of imagination. The<br />
events that followed also are euphoric:<br />
the spectacular inauguration<br />
ceremony; the adoration you created<br />
amongst the younger generation of<br />
this country; and the eloquence with<br />
which you conduct press conferences<br />
has kept the nation in awe.<br />
Health care is an issue that deserves<br />
your prompt attention. I have been a<br />
practicing physician in the same rural<br />
town in Southeast Missouri for 30<br />
years. I have seen and experienced<br />
ups and downs of health care. Now,<br />
unfortunately, like the economy, it is<br />
on a downward slump and is at its<br />
cross roads; one wrong turn can ruin<br />
it further.<br />
There are three fundamental<br />
problems plaguing our health care<br />
system today: lack of access,<br />
skyrocketing costs, and disparity of<br />
quality of care. America is facing a<br />
health care crisis. As of 2006, 47<br />
million Americans have no health<br />
insurance, 16 million are under<br />
insured, and the number keeps<br />
growing. It is not the poor and the<br />
indigent that are affected, as they<br />
qualify for government funded health<br />
insurance, Medicaid. Tragically, it is<br />
the young and the working<br />
populations who do not have<br />
insurance through their employment<br />
and cannot afford to buy their own<br />
insurance. They fall through the cracks<br />
and are left in the cold. Nearly 8.7<br />
million Americans without health<br />
insurance are children and eight of 10<br />
8 www.aapiusa.org<br />
uninsured live in working homes.<br />
Health care is a major issue in every<br />
job contract negotiation, and an<br />
estimated five million families, since<br />
2000, have filed for bankruptcy in the<br />
aftermath of serious medical<br />
problems. Health care dictates the<br />
every core of our social fabric: when<br />
to get married, when to have children,<br />
when to get a divorce, when to quit or<br />
not to quit a job, when to retire, when<br />
not to own a house – to name a few.<br />
Ironically, we spend more in health<br />
care dollars than any other<br />
industrialized nation in the world.<br />
Health care spending per year in U.S.<br />
is a whopping two trillion dollars, or<br />
16 percent of GDP, while Switzerland,<br />
the next most expensive health<br />
system, spends only 10 percent. Yet,<br />
according to a recent World Health<br />
Organization report, the U.S. ranks<br />
37th in overall health system<br />
performance out of 191 member<br />
nations. We are 10th in life<br />
expectancy, 15th in infant mortality<br />
rate, 7th in vaccination of general<br />
population. It is true beyond doubt,<br />
the health care dollar is not being<br />
spent efficiently and, to say the least,<br />
wisely.<br />
Why health care is so expensive, yet<br />
inefficient in our country? The reasons<br />
are many and to name a few:<br />
sophisticated technology that is<br />
widely, yet indiscriminately used;<br />
profit-seeking middle men including<br />
insurance companies; and<br />
corporations trying to dictate how to<br />
run the system. The ever worsening<br />
medical-legal atmosphere that is<br />
choking health care providers and is<br />
forcing them to practice ‘defensive<br />
medicine’ is responsible for 15-20<br />
percent of health care costs.<br />
Skyrocketing costs of prescription<br />
medicines are forcing our citizens to<br />
travel to Canada and Mexico to<br />
purchase their daily medications.<br />
Paper work and the money spent to<br />
comply with the government<br />
regulations is also a major culprit for<br />
the escalating health care costs in the<br />
Unites States.<br />
I am sure there are quite a few<br />
solutions to mend the ailing health<br />
care system. The one possible answer<br />
is Universal Health Care, where every<br />
one gets health care under one single<br />
payer (federal government) system.<br />
However, historically, universal health<br />
care did not withstand the test of time.<br />
The European and Asian countries<br />
with universal health care were found<br />
to be ineffective in satisfying the needs<br />
of their citizens. So is the reason for<br />
the two-tier system in those countries<br />
where in the wealthy and the affluent<br />
go to private hospitals, and the poor<br />
end up in underfunded, poorly<br />
managed health centers.<br />
Continued on page 9
AAPI Journal • March 2009<br />
<strong>From</strong> The Editor’s Desk<br />
Continued from page 8<br />
During the presidential campaign,<br />
the much-publicized Obama-Biden<br />
plan promised to provide affordable,<br />
accessible health care for all<br />
Americans. It is built on the existing<br />
health care system and uses existing<br />
providers, doctors and plans. Under<br />
the Obama-Biden plan, the patients<br />
will be able to make health care<br />
decisions with their doctors, not with<br />
their insurance company bureaucrats.<br />
We have been promised to reduce the<br />
insurance costs to go down by $2,500<br />
dollars per year, and people who do<br />
not have insurance will have a choice<br />
of new, affordable health insurance.<br />
The plan also requires insurance<br />
companies to cover pre-existing<br />
conditions, create a new Small<br />
Business Health Tax Credit to help<br />
small businesses provide insurance to<br />
their employees; lower costs for<br />
businesses to cover catastrophic<br />
health costs.<br />
We also need more help from the<br />
legislators:<br />
• Federal tort reform that mandates<br />
caps on malpractice settlements<br />
and arbitration committees to<br />
monitor the medical-legal cases.<br />
• Make employers more<br />
responsible: those that do not<br />
provide health insurance should<br />
make a meaningful contribution<br />
to the cost of coverage for the<br />
employees.<br />
• Reduce the federal and state<br />
mandated regulations in health<br />
care and the associated paper<br />
work, so doctors and nurses can<br />
spend their time with the patients,<br />
not doing paper work.<br />
• Corporations that run health care<br />
facilities should reinvest the profits<br />
into improving the local facility,<br />
rather than shipping the money to<br />
their corporate offices.<br />
• All hospitals should have their<br />
share of ‘service beds’ to take care<br />
of patients without insurance, an<br />
usual norm in 70’s and 80’s.<br />
So, Mr. President: The tasks ahead<br />
to mend the health care system are<br />
many, difficult and arduous, yet<br />
achievable if every one works hard<br />
at it. You have already proved that<br />
nothing is impossible to achieve<br />
with dedication, hard work,<br />
integrity, and humility.<br />
Wishing you luck and praying for<br />
your success.<br />
Editorial Committe<br />
Chair:<br />
Members:<br />
Sivaprasad Madduri, M.D.<br />
Urologist, Poplar Bluff, MO<br />
madduri@semo.net<br />
M. P. Ravindra Nathan, M.D.<br />
Cardiologist, Brooksville, FL<br />
ravinath@tampabay.rr.com<br />
Subruto Kundu, M.D.<br />
Neurologist, San Leandro, CA<br />
virtualme2@comcast.net<br />
Venkit S. Iyer, M.D.<br />
Palm Harbor, FL<br />
Jayesh Shah, M.D.<br />
Regional Director, SW ( 2006-2008),<br />
AAPI Vice Chair, AMA- IMG Section<br />
Medical Director<br />
Rita Frenchman, M.D.<br />
Hendersonville, TN<br />
Purvi Parikh, M.D.<br />
MSRF Representative for Publications Committee<br />
purviparikh7@hotmail.com<br />
Monita Soni, M.D.<br />
President, PrimePath, P.C.<br />
Decatur, AL<br />
Janine Saldahna, M.D.<br />
Anesthesiologist, Mass. Eye and Ear <strong>In</strong>firmary and<br />
Mass. General Hospital<br />
jansaldanha@gmail.com<br />
Niruma Madduri, M.D.<br />
Dept. of Developmental Pediatrics<br />
nsmadduri@texaschildrenshospital.org<br />
Julie Y. Patel, M.D.<br />
Assistant Professor<br />
Texas A & M Health Science Center<br />
Pooja Voria, M.D.<br />
Radiology Resident, University of Washington<br />
AAPI MSRF Executive Committee<br />
img.aapimsrf@gmail.com<br />
VenuGopal K. Menon, M.D.<br />
Allergy and Immunology, Pearland, Texas<br />
doctorvmenon@hotmail.com<br />
www.aapiusa.org<br />
9
AAPI Journal • March 2009<br />
President-Elect’s Report<br />
by Vinod K. Shah, M.D.<br />
I would like to express my<br />
profound gratitude to the entire<br />
membership for giving me the<br />
opportunity to serve our<br />
organization as President Elect for<br />
the year 2008-09. The year started<br />
on a very positive note and I am<br />
honored to represent you at different<br />
meetings.<br />
After a long tenure, Ambassador<br />
Ronan Sen is leaving Washington<br />
D.C. He is gracious to invite us for a<br />
farewell party that is planned on<br />
March 28th. It will be my pleasure<br />
to represent you for this occasion.<br />
We have been closely in touch with<br />
the Embassy of <strong><strong>In</strong>dia</strong> who has<br />
always been supportive of <strong><strong>In</strong>dia</strong>n<br />
Diaspora and the Ambassador has<br />
always graced our conventions by<br />
his presence.<br />
As a special guest of House<br />
Majority Leader Steny Hoyer, it was<br />
my pleasure to attend the<br />
Democratic National Convention.<br />
The Convention gave me an<br />
opportunity to network with many<br />
senior members of Democratic Party<br />
and I learned a lot about healthcare<br />
agenda which will be an extremely<br />
important issue for all of us.<br />
I recently visited Capitol Hill to<br />
arrange for our forthcoming<br />
Legislative Day.<br />
Association with other<br />
Organizations:<br />
1. Attended the Legislative<br />
Conference held by Asian<br />
American Hotel Owner’s<br />
Association (AAHOA) on<br />
Wednesday, September 10th at<br />
Capitol Hill. I will be attending<br />
the annual conference of<br />
AAHOA on April 24 & 25,<br />
2009.<br />
2. Attended the annual meeting<br />
held by <strong><strong>In</strong>dia</strong>n Medical<br />
Association of Central Florida.<br />
AAPI Events:<br />
1. Participated in the CME<br />
program conducted in the last<br />
week of September 2008 under<br />
the leadership of Dr. Sanku Rao<br />
on Cruise to the Greek <strong>Is</strong>lands.<br />
Members participated in the<br />
CME enjoyed the visit to the<br />
Greek <strong>Is</strong>lands and the entire<br />
event was very exciting.<br />
2. Attended the Fall Governing<br />
Body meeting at the Oklahoma<br />
City on October 25th.<br />
3. Attended the Ohio Chapter<br />
annual meeting. The group in<br />
Columbus is dedicated,<br />
energetic and focused. I was<br />
impressed with their event and<br />
friendship.<br />
4. Planning to attend the<br />
upcoming CME events in<br />
Atlanta and Tampa, Women’s<br />
Forum in New Jersey, Spring<br />
Governing Body meeting in<br />
Boston.<br />
Constitution & Bylaws Committee:<br />
As a chair of Constitution &<br />
Bylaws Committee, the first Bylaw<br />
Committee meeting was held on<br />
October 8, 2008. Existing revision of<br />
the Bylaws was reviewed which was<br />
proposed and approved at the<br />
Spring Governing Body meeting<br />
held in Michigan in March 2008<br />
and subsequently forwarded to the<br />
General Body. No objections were<br />
received from any members. We<br />
also discussed extensively how<br />
modifications to the Bylaws can be<br />
made to improve membership, to<br />
create a strong and positive image<br />
and to<br />
develop<br />
member<br />
satisfaction.<br />
We are<br />
planning to have another<br />
teleconference in next few days to<br />
work diligently to propose a revision<br />
in the Bylaws to achieve those<br />
objectives.<br />
Legislative Day:<br />
The next AAPI Legislative<br />
conference will be held on April<br />
28th, 2009 at the Cannon Caucus<br />
Room on Capitol Hill, Washington<br />
D.C. I am planning to meet with the<br />
Senator Conrad to discuss regarding<br />
proposed renewal of IMG J-1 Visa-<br />
Waiver Program which is going to<br />
expire this year.<br />
Orlando Convention:<br />
Vinod K. Shah, M.D.<br />
President-Elect, AAPI<br />
I had several meetings with the<br />
Chair of Orlando Convention Dr.<br />
Ravi Jahagirdar and his team. I am<br />
sure under his leadership we will<br />
have a fantastic convention. I would<br />
like to compliment the entire<br />
convention team who is working so<br />
hard to make the annual event a big<br />
success. I am looking forward for<br />
our next convention committee<br />
meeting on 8th of March.<br />
We are united as a team and we<br />
have enormous support of our entire<br />
membership. I am looking forward<br />
to working with you all in the years<br />
to come.<br />
I hope that you will call me with<br />
your suggestions to make AAPI a<br />
stronger and more formidable<br />
organization. Thank You very much<br />
for your friendship and trust.<br />
10 www.aapiusa.org
AAPI Journal • March 2009<br />
Vice-President’s Report<br />
by Ajeet R. Singhvi, M.D.<br />
As the Vice President of the<br />
American Association of Physicians<br />
of <strong><strong>In</strong>dia</strong>n Origin (AAPI), it is my<br />
privilege to present the Vice<br />
President’s report.<br />
As your Vice President I have been<br />
assisting the President, the President-<br />
Elect, the Secretary, and the Treasurer<br />
in whatever capacity they have asked<br />
for my services. Dr. Sanku Rao has<br />
been working very hard, along with<br />
the Executive Committee to move<br />
our organization forward.<br />
One of the major responsibility, as<br />
the Chair of membership committee<br />
is to increase our current<br />
Ajeet R. Singhvi, M.D.<br />
Vice President, AAPI<br />
membership.<br />
Organization is only<br />
as strong as its membership. Our<br />
current membership as of February<br />
28, 2009 is as follows:<br />
As of June 30, 2008 As of February 28, 2009 <strong>From</strong> July 1 to February 28, 2009<br />
a. Patron – Life member 6,311 6,428 117<br />
b. MSRF – Our Future 6,721 7,433 712<br />
c. YPS - Our Youth 193 213 20<br />
d. Annual – Our Strength 734 851 117<br />
<strong>To</strong>tal 13,959 14,925 966<br />
Considering the total strength of<br />
45,000+ physicians and over<br />
10,000+ MSRF & YPS, we have a<br />
long way to go. We had set a<br />
modest goal to increase our total<br />
membership at least by 5% at the<br />
beginning of the fiscal year. We have<br />
already achieved that goal. The<br />
MSRF section has seen the greatest<br />
increase which is very heartening<br />
and needs to be commended.<br />
However, the Annual membership<br />
and YPS membership growth has<br />
been dismal. Patron membership<br />
usually sees two peaks during the<br />
year. First one just before the<br />
General Election (January 31st of<br />
each year is the cutoff date to be<br />
eligible to vote for the General<br />
Election) and the other peak is<br />
before the convention (patron<br />
members get their registration fee<br />
waived). With the Orlando<br />
Convention preparation is in full<br />
swing, the membership and<br />
convention committees will be<br />
working hard to increase the<br />
numbers. You can apply online or<br />
ask for an application by<br />
fax/mail/email from the AAPI office.<br />
Recruiting new members is<br />
challenging in any organization,<br />
especially with physicians. They are<br />
not only very busy in their<br />
profession, but also do not perceive<br />
it to be crucial. <strong>To</strong> be able to wield<br />
influence in Washington (for<br />
professional issues and legislative<br />
concerns) as well as with the<br />
pharmaceutical industry and other<br />
vendors (for CMEs, charitable<br />
activities, conference, and raising<br />
funds) membership number counts.<br />
Your membership benefit committee<br />
under the leadership of Dr. Anil<br />
Khosla, Dr. Lakhu Rohra and Dr.<br />
Rajendra Gupta, Chair, Board of<br />
Trustees has been working hard over<br />
a ‘Benefits’ Package’. We hope to<br />
present it at the Spring Governing<br />
Body meeting.<br />
AAPI’s strength and image<br />
continues to grow, yet great many<br />
Physicians who are well reputed and<br />
widely known nationally and<br />
internationally are not members of<br />
our Organization. We need to bring<br />
them into the fold and tap their<br />
resources. I seek your help and<br />
guidance in this regard. If we can<br />
somehow convince our colleagues<br />
to become members and attend one<br />
or two AAPI events, they will be<br />
very happy and will feel good being<br />
part of our organization. Let’s try to<br />
add one member each this year. We<br />
will be twice as strong instantly.<br />
I will be happy to receive and<br />
respond to your comments.<br />
www.aapiusa.org<br />
11
AAPI Journal • March 2009<br />
Secretary’s Report<br />
by Prasad Srinivasan, M.D.<br />
It is a pleasure and privilege for<br />
me to present this report. The<br />
Second <strong>In</strong>do-US Summit focused on<br />
the implementation of the<br />
recommendations from the six<br />
disease states and strategic planning.<br />
It was unanimously felt that it is<br />
crucial to have follow up<br />
teleconferences and to start planning<br />
the next year’s Summit. I could not<br />
go with the AAPI delegation with<br />
the Chief Minister Madam Sheila<br />
Dixit as I was co-chairing one of the<br />
disease states at the summit.<br />
However during a subsequent visit I<br />
had the opportunity to meet the<br />
Chief Minister and discuss with her<br />
the importance of having a<br />
representative of AAPI in New<br />
Delhi.<br />
Our Office in Chicago is currently<br />
overworked and short staffed as Ms.<br />
Rama Khatri has been out of the<br />
office for health reasons. Both Ms.<br />
Vijaya Kodali and Mr. Sam<br />
Fulambarker are doing an<br />
outstanding job in keeping up with<br />
the numerous requests and<br />
deadlines.<br />
<strong>In</strong> a teleconference of the<br />
Standing Committee Chairs, the<br />
various Committees updated the<br />
Officers of the work accomplished<br />
during the year.<br />
I have been a spokesperson for<br />
AAPI at numerous events in <strong><strong>In</strong>dia</strong>.<br />
I was invited to participate on the<br />
healthcare panel on the First World<br />
Economic Tamil Meet and Diaspora<br />
in Chennai. I highlighted AAPI’s<br />
activities both in <strong><strong>In</strong>dia</strong> and the<br />
United States. I received a lot of<br />
positive feedback about our<br />
involvement and the externship<br />
program.<br />
I was a consultant at the super<br />
specialty hospital at Puttarparthi,<br />
<strong><strong>In</strong>dia</strong>. I had the opportunity once<br />
again to speak about<br />
AAPI’s activities in<br />
<strong><strong>In</strong>dia</strong> and focused on<br />
the work done by<br />
the AAPI charitable clinics.<br />
Prasad Srinivasan, M.D.<br />
Secretary, AAPI<br />
<strong>In</strong> my address at the 28th<br />
<strong>In</strong>ternational Congress of NR<strong>Is</strong> in<br />
New Delhi, the NR<strong>Is</strong> across the<br />
globe got a bird’s eye view of our<br />
organization, its multiple platforms<br />
and its accomplishments.<br />
I want to thank you for giving me<br />
the opportunity to serve you in the<br />
capacity of Secretary.<br />
AAPI Executive Officers<br />
President<br />
Sanku Rao, MD<br />
(580) 234-0285<br />
sankuraook@sbcglobal.net<br />
Secretary<br />
Prasad Srinivasan, MD<br />
(860) 246-7273<br />
prasads268@yahoo.com<br />
President Elect<br />
Vinod K. Shah, MD<br />
(301) 373-7416<br />
vinnyshah@hotmail.com<br />
Treasurer<br />
Narendra Kumar, MD<br />
(989) 793-1040<br />
kum73@aol.com<br />
Vice President<br />
Ajeet R. Singhvi, MD<br />
(951) 929-0124<br />
asinghvi@aol.com<br />
Past President<br />
Hemant Patel, MD<br />
(873) 373-7700<br />
drhemantpatel@gmail.com<br />
600 Enterprise Drive, Suite 108 • Oak Brook, IL 60523 • Phone: (630) 990-2277 Fax: (630) 990-2281<br />
www.aapiusa.org<br />
13
AAPI Journal • March 2009<br />
Treasurer’s Report<br />
by Narendra Kumar, M.D.<br />
It is my privilege to report that the<br />
state of our finances continues to be<br />
strong, and we are making every<br />
effort to maintain and improve the<br />
current financial status. This<br />
requires the help and support of our<br />
constituency. As AAPI Treasurer, I<br />
will fulfill my promise to keep AAPI<br />
finances in proper order by<br />
maintaining fiscal stability,<br />
accountability and enhance<br />
financial health. It is important to<br />
keep financial matters transparent to<br />
the membership. This requires<br />
cautious spending and enhanced<br />
revenues especially during this<br />
current economic climate. I am<br />
closely monitoring financial<br />
activities at the AAPI National<br />
Executive Office, and I am keeping<br />
our President appraised on the<br />
financial status at a regular interval,<br />
Narendra Kumar, M.D.<br />
Treasurer, AAPI<br />
and the<br />
Executive<br />
Committee at our monthly<br />
teleconferences. A detailed report<br />
will be presented at the Governing<br />
Body meeting in Boston and at our<br />
General Body meeting in Orlando.<br />
Citi Bank Operating Acct Balance ......................$101,351.55<br />
Citi Bank Money Market Acct Balance ..............$150,332.98<br />
<strong>In</strong>do-US Healthcare Summit Acct Balance............$40,656.89<br />
Women’s Healthcare Summit Acct Balance ............$2,768.72<br />
AAPI Orlando Convention Account......................$44,524.85<br />
AAPI-Charitable Foundation Acct as of 1/09....$1,029,289.89<br />
AAPI-CF Elite Account (Current) ........................$143,005.53<br />
BOT Account (Smith Barney)as of 1/09............$2,079,021.33<br />
Major <strong>In</strong>come/Expenses As of February 19, 2009<br />
Major <strong>In</strong>come<br />
Balance <strong>From</strong> Previous Year (6/30/08)................$122,459.87<br />
Patron Fund Allocation (from BOT)....................$122,795.25<br />
Las Vegas Convention Balance (approx) ............$178,119.30<br />
<strong>To</strong>tal Membership Dues ......................................$63,850.00<br />
AAPI Emergency Relief Fund ....................................$652.00<br />
CME ......................................................................$7,974.14<br />
Journal Ads..........................................................$43,250.00<br />
Website Ads ..........................................................$2,100.00<br />
Nomination Filing Fee ........................................$10,000.00<br />
Royalties................................................................$6,854.09<br />
Resource Directory Sponsorship............................$7,500.00<br />
2005 Convention - Closing balance ......................$3,049.97<br />
Philadelphia 07 Convention ................................$24,984.67<br />
Refund from 2008 LV Conv. (Advance refunded) $54,510.80<br />
June 2008 Year-in Review Ads <strong>In</strong>come ..................$7,833.00<br />
Money Market acct Balance ................................$11,768.16<br />
Uncleared Checks from July 1 to Nov 14, 08 ......$21,702.24<br />
Accounts Payable ....................................................$648.06<br />
AAPI Charitable Foundation ....................................$100.00<br />
Major Expenses<br />
AAPI MSRF/YPS Support ................$12,500.00<br />
Accountant Fee ................................$4,800.00<br />
Computer Related ............................$5,286.70<br />
Computer Related ..........................$12,640.88<br />
Constant Contact (Email) ......................$967.94<br />
Media Consultant............................$10,500.00<br />
Copy Machine Lease ........................$3,930.54<br />
Media Consultant............................$14,900.00<br />
Condo Association Fee......................$4,394.14<br />
Office Expenses ................................$3,307.41<br />
<strong>In</strong>surance ..........................................$3,146.00<br />
Postage..............................................$2,415.35<br />
AAPI Journal--June 08 <strong>Is</strong>sue ............$29,249.00<br />
AAPI Journal (2 issues) ....................$44,598.17<br />
2008 Resource Directory ..................$7,600.00<br />
Printing – Other ................................$4,216.65<br />
Governing Body Expenses ......................$1,429.40<br />
Employee Wages & Misc...............$126,736.26<br />
Telephone/Storage/Bank Fees etc.......$7,937.72<br />
Travel ................................................$6,399.20<br />
Promotions........................................$3,274.11<br />
2009 Orlando Convention Advance ..$82,184.83<br />
2007 Real Estate Taxes ......................$3,535.90<br />
14 www.aapiusa.org
FEATURE<br />
AAPI Journal • March 2009<br />
Reflections on the Second <strong>In</strong>do-US Summit<br />
by Prasad Srinivasan, M.D.<br />
Prasad Srinivasan, M.D.<br />
Secretary, AAPI<br />
It was a great second act.<br />
The second <strong>In</strong>do-US summit, held<br />
from January 2nd to 4th, 2009 lived<br />
up to its expectations. It was<br />
fortunate that the weather in New<br />
Delhi was very pleasant and the fog<br />
did not deter the enthusiasm of the<br />
summit.<br />
At the press conference on the<br />
afternoon of the 2nd, President Dr.<br />
Sanku Rao, outlined to a well<br />
attended press conference our goals<br />
and expectations. As Secretary I<br />
shared the podium and had the<br />
opportunity to express my thoughts<br />
as well. The <strong><strong>In</strong>dia</strong>n press had a lot of<br />
questions for both of us. It was a<br />
good platform to showcase AAPI.<br />
The meeting on that evening was<br />
on strategic planning. The healthcare<br />
landscape of <strong><strong>In</strong>dia</strong> was looked into<br />
at length. A physician’s perspective<br />
was given by Dr. N. Saini, the Hon.<br />
Joint secretary IMA. The research<br />
done by Mckinsey & Co was<br />
presented by Dr. Mandar Vaidya,<br />
Senior Partner, Mckinsey and Co,<br />
<strong><strong>In</strong>dia</strong>. An expert panel then<br />
convened and shared their thoughts<br />
and answered questions from the<br />
international delegates. The expert<br />
panel comprised of Dr. V. Monga,<br />
Head Health Services Delhi State,<br />
Dr. Shakti Gupta, Head of<br />
Administration, All <strong><strong>In</strong>dia</strong> <strong>In</strong>stitute of<br />
Medical Sciences, Dr. Anupam<br />
Sibal. Group Medical Director,<br />
Apollo Group of Hospitals and Dr.<br />
Parvez Ahmed, Executive Director,<br />
MAX Health. This session was<br />
moderated by Mr. Anwar Feroz and<br />
Mr. Haresh Kaneriya.<br />
On the morning of the third Mr.<br />
Vayalar Ravi, Minister for Overseas<br />
<strong><strong>In</strong>dia</strong>n Affairs, said AAPI is in a<br />
position to play a leading role in the<br />
healthcare arena given its vast<br />
expertise and skill set. He added<br />
that the government would soon<br />
initiate talks with the Medical<br />
Council of <strong><strong>In</strong>dia</strong> and the <strong><strong>In</strong>dia</strong>n<br />
Medical Association to enable<br />
physicians living abroad to practice<br />
in <strong><strong>In</strong>dia</strong>. “Several physicians who<br />
have made a mark abroad are<br />
willing to return to <strong><strong>In</strong>dia</strong> and we<br />
Continued on page 16<br />
www.aapiusa.org<br />
15
AAPI Journal • March 2009<br />
FEATURE<br />
Reflections On The Second <strong>In</strong>do-US Summit<br />
Continued from page 15<br />
should use their expertise given the<br />
shortage of doctors in <strong><strong>In</strong>dia</strong>.<br />
Licensing issues should not come in<br />
the way of using their knowledge”<br />
the minister stated.<br />
Dr. Sanku Rao, President of AAPI,<br />
outlined his vision and AAPI’s<br />
commitment to the implementations<br />
of the recommendations. AAPI has<br />
signed a MoU to train the trainees in<br />
screening the rural population for<br />
hypertension, diabetes, cardio<br />
vascular diseases, and other<br />
ailments. The project is yet to begin<br />
although it has been four years since<br />
the MoU was signed. Dr. Rao hoped<br />
that the projects would soon get<br />
started. Dr. Ramesh Mehta,<br />
President of British Association of<br />
Physicians of <strong><strong>In</strong>dia</strong>n Origin (BAPIO)<br />
said half the population of United<br />
Kingdom is treated by <strong><strong>In</strong>dia</strong>n<br />
doctors. There are about 40,000<br />
<strong><strong>In</strong>dia</strong>n physicians in the National<br />
Health Service and <strong><strong>In</strong>dia</strong>ns<br />
constitute more than one third of all<br />
physicians in the UK. BAPIO will<br />
partner with AAPI from next year in<br />
the rural healthcare projects in<br />
<strong><strong>In</strong>dia</strong>. Dr. Narendra Saini, coordinator<br />
of the summit,<br />
congratulated AAPI for having the<br />
conviction to hold the <strong>In</strong>do-US<br />
summit at a time when several<br />
international conferences in <strong><strong>In</strong>dia</strong><br />
were cancelled following the<br />
Mumbai massacre. Mr. Anwar Feroz<br />
welcomed the gathering. Dr. Ajeet<br />
Singhvi, Vice President of AAPI and<br />
acting chair of the strategic planning<br />
session proposed a vote of thanks.<br />
The rest of the day was spent in<br />
break-out sessions where the US<br />
Delegates worked with their <strong><strong>In</strong>dia</strong>n<br />
counterparts on six disease states<br />
and strategic planning. The US<br />
Chairs of the disease states were<br />
Asthma and Allergy - Dr. Jayesh<br />
Kanuga, Cardiology - Dr. Enas Enas,<br />
Diabetes - Dr. Anuj Bhargava,<br />
<strong>In</strong>fectious Disease - Dr. Vijay<br />
Yeldandi, Maternal and <strong>In</strong>fant Health<br />
- Dr. Arun Pramanik, Mental Health -<br />
Dr. Ananda Pandurangi, the Chair of<br />
the Strategic Planning Committee -<br />
acting co-chair Dr. Ajeet Singhvi. It<br />
was a full working day.<br />
Dr. Sanku Rao & AAPI delegation<br />
met the Chief Minister of New<br />
Delhi, the Hon. Sheila Dixit. The<br />
delegation had the opportunity to<br />
inform the Chief Minister of our<br />
activities and goals. The Chief<br />
Minister was very gracious to offer<br />
office-space in New Delhi for AAPI.<br />
The final morning of the summit<br />
comprised of summaries of<br />
recommendations from each of the<br />
disease states. The presentations<br />
were very concise and clear.<br />
<strong>In</strong> reflection, the second <strong>In</strong>do-US<br />
summit was very well organized<br />
with a clear agenda. It is important<br />
that the recommendations are acted<br />
upon in a timely fashion and not set<br />
aside until weeks before the next<br />
<strong>In</strong>do-US summit. Dr. Sanku Rao is<br />
determined to do his best to<br />
implement these recommendations<br />
in <strong><strong>In</strong>dia</strong>. Follow up with the chairs<br />
and co-chairs are being planned so<br />
that our goals are achieved and their<br />
recommendations can be presented<br />
at the upcoming annual convention.<br />
16 www.aapiusa.org
FEATURE<br />
AAPI Journal • March 2009<br />
Reflections On The Second <strong>In</strong>do-US Summit<br />
www.aapiusa.org<br />
17
AAPI Journal • March 2009<br />
FEATURE<br />
Reflections On The Second <strong>In</strong>do-US Summit
AAPI Journal • March 2009<br />
FEATURE<br />
Partners With AAPI <strong>To</strong> Host<br />
A Successful Medical Conference <strong>In</strong> Goa, <strong><strong>In</strong>dia</strong><br />
by Nasir A. Khan, M.D.<br />
Nasir A. Khan, M.D.<br />
President, <strong><strong>In</strong>dia</strong>n Medical Association<br />
of New England<br />
The <strong><strong>In</strong>dia</strong>n Medical Association of<br />
New England (IMANE), in<br />
collaboration with the American<br />
Association of Physicians of <strong><strong>In</strong>dia</strong>n<br />
Origin (AAPI), hosted a very<br />
successful medical conference in<br />
Goa, <strong><strong>In</strong>dia</strong>, on Dec. 28-30, 2008.<br />
Most of the physicians who had<br />
signed up for the conference<br />
attended, despite the recent Mumbai<br />
tragedy. Twenty-two physicians were<br />
awarded certificates for 6 hours of<br />
Category I CME credits through my<br />
office at Bournewood Hospital. Their<br />
evaluations of the event gave an<br />
average approval rating of 4.85 on a<br />
scale of 1 to 5. I moderated the two<br />
sessions and lectured on “Impaired<br />
Medical Students and Physicians.”<br />
The other speakers included<br />
Rajendra Seth, MD, <strong>In</strong>ternist from<br />
Pennsylvania, who spoke on<br />
“Hypertension” and “Cardio<br />
metabolic Syndrome,” Professor Atul<br />
Bhatnager, DDS, Orthodontist from<br />
Luknow, <strong><strong>In</strong>dia</strong>, who presented on<br />
“Post-Operative Rehabilitation in<br />
Maxillo Facial Surgical Procedures”<br />
and Sivaprasad Madduri, MD,<br />
Urologist from Missouri, who spoke<br />
on “Andropause – Male<br />
Hypogonadism – Fact or Fiction,”<br />
and on “The Irritable Bladder.”<br />
We stayed in Goa four nights at<br />
the Hotel De Cidade, which is<br />
situated on the Vainguinim Beach.<br />
All the participants agreed that the<br />
resort was superb. The all-inclusive<br />
amenities included meals, spa, pool<br />
and beach, and were befitting of a<br />
world-class resort. During the day,<br />
temperatures reached 90 degrees.<br />
The evenings were cooler with a<br />
gentle breeze. The conference<br />
facility was conducive for formal<br />
power point presentations, coupled<br />
with opportunities for relaxation and<br />
socialization.<br />
Located on the West Coast of<br />
South <strong><strong>In</strong>dia</strong> along the Arabian<br />
Ocean, Goa is a visitor’s paradise<br />
and all of us had the chance to<br />
sightsee and learn more about its<br />
long and interesting history. Goa<br />
had Hindu and Muslim rulers but<br />
was actually settled by the<br />
Portuguese in 1510 to further the<br />
spice trade and spread Christianity.<br />
Goa’s harbor and wide rivers were<br />
felt to be ideal for their ships. <strong>In</strong><br />
1961, <strong><strong>In</strong>dia</strong> reclaimed its territory,<br />
but even now, Roman Catholicism<br />
remains the predominant religion<br />
with world famous churches and<br />
skirts outnumber saris.<br />
<strong>To</strong> get better acquainted with the<br />
area and its scenic points of interest,<br />
we had bus tours arranged to some<br />
of the most popular local attractions.<br />
Panjabi, the capital of Goa and the<br />
smallest of all capitals in <strong><strong>In</strong>dia</strong>, was<br />
a pleasant city to wander around<br />
and bargain for souvenirs. Old Goa<br />
was more historical. The Basilica of<br />
Bom Jesus was built in 1605 and<br />
houses the remains of St. Francis<br />
Xavier and the Se Cathedral,<br />
supposedly the largest church in<br />
Asia, were some of the highlights<br />
from a tourist perspective. Other<br />
sights we admired included the<br />
Hindu Mangueshi Temple, with its<br />
well-preserved white tower, and the<br />
Fort Arguada on the coast, which<br />
conveyed the past need for<br />
fortification against other European<br />
predators.<br />
<strong>In</strong> addition to exploring Goa’s<br />
illustrious past, we also enjoyed the<br />
Goa of today, which is renowned for<br />
its superb, sandy beaches and the<br />
warm ocean waters. <strong>In</strong> fact, it has<br />
become a major attraction for<br />
Europeans and Russians fleeing from<br />
the dark, cold winters. Some of the<br />
tourists are backpackers and stay in<br />
Continued on page 20<br />
www.aapiusa.org<br />
19
AAPI Journal • March 2009<br />
FEATURE<br />
Partners With AAPI <strong>To</strong> Host<br />
A Successful Medical Conference <strong>In</strong> Goa, <strong><strong>In</strong>dia</strong><br />
Continued from page 19<br />
bed and breakfasts, while others<br />
(such as doctors from the U.S.!)<br />
prefer to stay in five-star hotels. But<br />
regardless of the accommodation<br />
choices, one of the high points of<br />
the season is Goa’s grand New Year’s<br />
Eve celebration.<br />
conference. Now I really look<br />
forward to seeing several AAPI<br />
members at the Governing Body<br />
Meeting in April, 2009, in Boston<br />
and at the Annual Meeting in<br />
Orlando, FL, in June of 2009<br />
I have to admit this, along with<br />
the chance to get to know the<br />
various speakers and other attendees<br />
and their spouses – especially Dr.<br />
Sanku Rao, President of AAPI and<br />
his wife Rohini, was the highlight of<br />
the trip for me as well. The outdoor<br />
New Year’s Eve dinner at the hotel<br />
had several hundred attendees,some<br />
who were staying there, while others<br />
came from surrounding lodgings to<br />
enjoy the incredible variety and<br />
quantity of food offered. The music,<br />
orchestra and dance floor truly<br />
made the night a fantastic finale to<br />
our trip.<br />
Following my return to the U.S.,<br />
I received several emails from<br />
attendees, which were highly<br />
complimentary of the medical<br />
Policies and Guidelines for Writers in AAPI Journal<br />
AAPI Journal seeks articles from<br />
members on medical and social matters,<br />
memorable experiences in your life,<br />
practice tips and techniques etc. Articles<br />
may be sent as e-mail (Microsoft Word, if<br />
possible) attachments only. Feature<br />
articles should be about 1 - 1.5 pages<br />
(500 -750 words), and news items about<br />
1/4 to 1/2 page (100 words). Stories<br />
should be based on personal experiences,<br />
should be written in a conversational<br />
style, easy to read and must be relevant<br />
to our journal. Kindly do not send any<br />
scientific papers or case reports which are<br />
more suitable for a peer reviewed<br />
journal.<br />
We also encourage submissions for the<br />
regular columns “A Glimpse of My Life,”<br />
“The best of AAPI humor,” “AAPI and<br />
Poetry” and, “AAPI Travelogues.” Author<br />
photographs and illustrative pictures for<br />
the articles are welcome. <strong>In</strong> discussing<br />
personal stories, the more specific you<br />
can be about your situation including the<br />
impact on your patients, the better. Also,<br />
please include in your response your<br />
specialty, practice situation and e-mail<br />
information if you'd be willing to talk to<br />
us at greater length about your<br />
experience.<br />
The Editorial committee reserves the<br />
right to accept or reject any articles and<br />
edit all accepted articles as needed.<br />
Please visit our web site<br />
www.aapiusa.org for detailed<br />
instructions. The receipt of the articles<br />
will be acknowledged; please restrain<br />
from calling and/or sending e-mails, as<br />
we do not have an office or secretary for<br />
the journal itself. As soon as the Editorial<br />
Board accepts the article for publication,<br />
the author will be notified.<br />
Editor, AAPI Journal<br />
Sivaprasad Madduri, M.D.<br />
madduri@semo.net<br />
20 www.aapiusa.org
AAPI Journal • March 2009<br />
FEATURE<br />
Prevention Of Deafness:<br />
A Vision For <strong><strong>In</strong>dia</strong><br />
by Raj Desai, M.D.<br />
Raj Desai, M.D.<br />
President, Project Deaf <strong><strong>In</strong>dia</strong><br />
As One Person, I Cannot Change The World, But I Can Change The World Of One Person<br />
Paul Shane Spear<br />
Deafness is one of the commonest<br />
congenital disabilities in the world. It is<br />
estimated to be 30 times more common<br />
than other newborn birth defects such as<br />
sickle cell anemia, cystic fibrosis, or<br />
hypothyroidism.<br />
As reported by the WHO, there are<br />
about 250 - 300 million deaf people in<br />
the world, 2/3 of them live in the<br />
underdeveloped nations and of these<br />
<strong><strong>In</strong>dia</strong> has the largest share. With such a<br />
large number of hearing impaired young<br />
<strong><strong>In</strong>dia</strong>ns, it amounts to a severe loss of<br />
productivity, both economic and<br />
physical. The present estimate records<br />
even a larger number of people with<br />
milder degrees of hearing loss or<br />
unilateral hearing loss in age group<br />
overs 45 years of age in <strong><strong>In</strong>dia</strong>.<br />
Dr. Desai met the Ex-President Dr.<br />
Abdul Kalam for 30 minutes and<br />
requested that INDIA must start “EARLY<br />
detection of newborn hearing loss and<br />
intervention.” Dr. Kalam appreciated the<br />
idea and within a few days following<br />
their meeting a report occurred in the<br />
leading daily newspaper THE TIMES OF<br />
INDIA JAN. 27 2007: “That one out of<br />
twelve (1/12) persons in <strong><strong>In</strong>dia</strong> has<br />
hearing loss. The problem is receiving<br />
political attention. The Health Ministry<br />
has launched a project called NPPCD<br />
(NATIONAL PROGRAM FOR THE<br />
PREVENTION AND CONTROL OF<br />
DEAFNESS,) in addition, the program<br />
will treat ear infections and other<br />
diseases causing hearing loss...”<br />
This Campaign was introduced at the<br />
end of Jan. 2007 in 10 states and 25<br />
districts and one Union territory of <strong><strong>In</strong>dia</strong>.<br />
These are Andhra Pradesh, Assam,<br />
Gujarat, Karnataka, Manipur, Sikkim,<br />
Tamil Nadu, Uttarkhand, UttarPradesh,<br />
Delhi, and Chandigargh.<br />
This project will be expanded to<br />
include 203 districts covering all states<br />
and union territories of INDIA by 2012.<br />
The expansion will be done in a phased<br />
manner with inclusion of 45 new<br />
districts each year.<br />
All the training for the program will be<br />
provided by the medical colleges, ENT<br />
doctors and Audiologists of the state and<br />
districts.<br />
Expected Benefits from the Program are:<br />
1) Decrease in the magnitude of<br />
hearing impaired persons.<br />
2) Decrease in the severity/extent of<br />
ear morbidity and hearing<br />
impairment.<br />
I have introduced a model for<br />
screening newborns at hospitals, and<br />
home birthing centers in several states of<br />
<strong><strong>In</strong>dia</strong>. This involves carrying a screening<br />
machine, the size of a laptop computer<br />
on the back of a scooter by a health care<br />
worker, or audiologist. The fact is that<br />
Newborn Baby and Mom are kept at the<br />
hospital post delivery for 5-7 days<br />
throughout <strong><strong>In</strong>dia</strong>. Thus an audiologist<br />
can go from one birthing center to<br />
another and screen several infants for<br />
hearing loss daily. For home/village<br />
deliveries also it is practical to go to a<br />
central location in the village, i e., a<br />
church or a temple and screen the<br />
newborns.<br />
The computerized screening machines<br />
are fairly accurate, and provide a taped<br />
record of the child’s hearing loss. It is<br />
necessary to data base all screenings<br />
and further establish a followup of all<br />
babies detected for hearing loss and<br />
provide immediate treatment or Hearing<br />
Aids or Cochlear Implants (CI). Although<br />
CI are expensive at present Dr. Abdul<br />
Kalam and his research team are<br />
working on an economical model. IF<br />
THE ABOVE IS REALIZED IN NEXT FEW<br />
YEARS, THE PEOPLE OF INDIA WITH<br />
DEAFNESS WILL ENJOY THE SAME<br />
STATUS AS IN THE USA.<br />
Prevention Of Deafnes <strong>In</strong> <strong><strong>In</strong>dia</strong><br />
As we discussed earlier, <strong><strong>In</strong>dia</strong> has one<br />
of the highest incidences of deafness on<br />
the globe. There are many causes such<br />
as: chronic ear infections, poor ear care,<br />
malnutrition, poor or absent prenatal<br />
care contaminated water supply, abuse<br />
of common drugs used for malaria,<br />
tuberculosis, and the misuse of<br />
antibiotics available over the counter.<br />
Genetics also plays a significant role.<br />
It is estimated that 40% of cases of<br />
deafness are due to lack of a<br />
MANDATORY vaccination for Measles<br />
and Rubella (MR) in the NATIONAL<br />
VACCINATION PLAN.<br />
<strong>In</strong> south <strong><strong>In</strong>dia</strong> and amongst Muslims it<br />
is said to have more deafness (30%) due<br />
to the custom of consanguinity.<br />
As in the developed nations, if <strong><strong>In</strong>dia</strong><br />
introduces mandatory MR vaccination<br />
one can decrease the incidence of<br />
deafness by about 40%. The rest of the<br />
causes of deafness will only be solved as<br />
<strong><strong>In</strong>dia</strong>’s daily hygienic conditions and the<br />
education on deafness, by its doctors<br />
along with socio-economical conditions<br />
get better in the future.<br />
www.aapiusa.org<br />
21
AAPI Journal • March 2009<br />
FEATURE<br />
Pharmaceutical Advertisement:<br />
Makes For Better Healthcare For All?<br />
by Sidharth Bagga, M.D. - Shagun Bagga, M.D. - Pankaj Malhotra, M.D.<br />
Sidharth Bagga, M.D.<br />
Stamford, CT<br />
Abstract<br />
The role of direct to consumer<br />
advertising has changed the<br />
landscape of physician-patient<br />
relationship. <strong>To</strong> date physicians have<br />
adapted to this change with minimal<br />
intervention, and are falling victim<br />
to its misconceptions. We focus on<br />
the pros and cons of having an<br />
unaware consumer decide on a<br />
product or solution that is beyond<br />
their scope of knowledge. Who is<br />
the end recipient of this mass<br />
advertising focus? Who benefits and<br />
who suffers from the decisions<br />
coerced by this medium?<br />
<strong>In</strong>troduction<br />
Why should this ever be a<br />
concern for people? We want what<br />
everyone else has, and want it<br />
because we saw people doing it on<br />
TV, billboards, or endorsed by<br />
celebrities. Doesn’t being advertised<br />
to expand your options, allow you<br />
to compare costs and then make an<br />
informed decision? It does! This is<br />
the same reason why children’s<br />
shows are only given limited<br />
amounts of advertisement time.<br />
What is inherently different in<br />
advertising to children? Why are<br />
there higher standards, and less<br />
power of suggestion for them? The<br />
answer ends up lying in how they<br />
perceive the information. A child<br />
watching the same advertisement as<br />
an adult will take it as the truth;<br />
whereas an adult will have the<br />
ability to weigh and contrast the<br />
claims of the company. This is the<br />
reason why many countries in the<br />
world do not allow Direct to<br />
22 www.aapiusa.org<br />
Consumer Advertising (DTCA) of<br />
pharmaceutical products.<br />
Why DTCA?<br />
<strong>In</strong> DTCA of pharmaceuticals, the<br />
patient is considered to be the<br />
consumer, as he/she will be the end<br />
user of the product. The patient is<br />
not in fact a consumer of a<br />
pharmaceutical drug, but a<br />
consumer of the service by a<br />
physician. Nevertheless, studies<br />
have shown that the prescribing<br />
habits of physicians change if a<br />
patient shows a particular interest in<br />
one brand or class of medications.<br />
This led to an increase in advertising<br />
efforts followed by an increased<br />
usage of brand medications, despite<br />
appropriate generic substitutes.<br />
Many pharmaceuticals impress<br />
upon the public that their<br />
advertisement is a legitimate form of<br />
patient education. Despite<br />
indication, advertisement coerces<br />
purchase of medication from the<br />
patients, but a physician is able to<br />
differentiate between the risks and<br />
benefits. This differing opinion<br />
between patient and physician can<br />
lead to a worsening in the doctor<br />
patient relationship. DTCA claim<br />
that this knowledge will allow<br />
patients to be more readily<br />
agreeable to treatment options, and<br />
increase compliance with their<br />
treatment. Providing information<br />
that allows the patient to be a better<br />
consumer of doctor’s services can<br />
increase the overall quality of<br />
healthcare.<br />
How does DTCA work?<br />
The world as<br />
a whole has<br />
had a<br />
relatively strict<br />
stance<br />
towards<br />
DTCA of<br />
pharmaceuticals.<br />
Pharmaceutical<br />
Companies<br />
have been<br />
attempting to<br />
alter physician<br />
prescribing<br />
habits for<br />
many years,<br />
and realized<br />
that they<br />
had a higher<br />
Pankaj Malhotra, M.D.<br />
Stamford, CT<br />
Shagun Bagga-Malhotra, M.D.<br />
Stamford, CT<br />
impact in altering the patient’s<br />
viewpoints; and thus are having a<br />
bigger impact on physician<br />
prescribing habits. This has led to an<br />
increase in their budgets for DTCA, in<br />
excess of 2.5 billion for 2001 alone.<br />
Since the inception of DTCA,<br />
some countries have noticed<br />
significant changes in branded<br />
prescriptions. Many countries have<br />
realized these trends and are readily<br />
attempting to curtail the use of<br />
DTCA of pharmaceuticals, while<br />
demanding explicit statements of<br />
indications, risks and adverse effects<br />
during these campaigns.<br />
Outcomes and Health Measures<br />
Proponents of DTCA claim to<br />
provide adequate knowledge to their<br />
end user of their product. The<br />
Continued on page 25
FEATURE<br />
AAPI Journal • March 2009<br />
<strong>Great</strong> <strong><strong>Equal</strong>ization</strong>...<br />
<strong>Is</strong> <strong>MBBS</strong> from <strong><strong>In</strong>dia</strong> <strong>Equal</strong> to M.D. in USA?<br />
by Akshay Desai, M.D.<br />
Akshay Desai, M.D., M.P.H.<br />
St. Petersburg, Florida<br />
Recently, a decision in a landmark<br />
case out of Texas was handed down<br />
that greatly affects the membership<br />
of AAPI as well those young doctors<br />
in <strong><strong>In</strong>dia</strong> wanting to come to the<br />
United States of America and who<br />
would be a part of AAPI’s future.<br />
I report with great pleasure that<br />
the Administrative Appeals Office<br />
(AAO), disagreed with Texas Service<br />
Centre (TSC) and ruled that a<br />
M.B.B.S degree from <strong><strong>In</strong>dia</strong> does<br />
indeed equate to an U.S. M.D.<br />
degree. The ruling states that the<br />
beneficiary (M.B.B.S from Pune<br />
University) met the requirements of<br />
the labor certification, (Second<br />
Preference), specifically a foreign<br />
equivalent to a US medical degree.<br />
This recent decision overruled an<br />
earlier negative ruling at the lower<br />
level involving Norman Regional<br />
Hospital.<br />
Prior to this ruling M.B.B.S.<br />
doctors, like you and me could only<br />
apply under the Third Preference<br />
(EB-3) which equated us with “aliens<br />
with at least two years of experience<br />
as skilled workers, and others with<br />
less than two years experience, such<br />
as an unskilled worker who can<br />
perform labor for which qualified<br />
workers are not available in the<br />
United States.“ Yes we were<br />
classified as “Skilled workers”. Our<br />
Medical degree in <strong><strong>In</strong>dia</strong> was not<br />
recognized. Under the Second<br />
Preference (EB-2) we are now<br />
classified as “aliens who are<br />
members of the professions holding<br />
advanced degrees or their equivalent<br />
and aliens who because of their<br />
exceptional ability in the sciences,<br />
arts, or business will substantially<br />
benefit the national economy,<br />
cultural, or educational interests or<br />
welfare of the United States.” This<br />
means, that we the physicians with<br />
M.B.B.S degrees from <strong><strong>In</strong>dia</strong>, can<br />
now legally claim our medical<br />
degree from <strong><strong>In</strong>dia</strong>, being equivalent<br />
to a U.S. M.D. degree. Those of us<br />
who need an immigrant visa can<br />
now qualify for Employment Based<br />
Second Preference (EB-2), reserved<br />
for persons with U.S. advanced<br />
degree or foreign equivalent. The<br />
second Preference (EB-2) has a<br />
better and faster chance of receiving<br />
a Visa as compared to the Third<br />
Preference (EB-3).<br />
This ruling finally recognizes<br />
fellow members of AAPI at least by<br />
the Dept. of Immigration as being<br />
“Medical Doctors” in the true sense<br />
of the word. This takes us back to<br />
one of the prime reasons for forming<br />
AAPI, 28 years ago, that we stand<br />
for our rights and be recognized as<br />
trained medical professionals who<br />
can serve the community with<br />
respect and honor. Yes, we do have<br />
a few more hurdles to cross but if<br />
we are united and not forget our<br />
goals we can achieve them. For this<br />
we might need a change in<br />
ourselves and a grass root active<br />
participation. I will continue to<br />
monitor this ruling on behalf of our<br />
young graduates from <strong><strong>In</strong>dia</strong> and<br />
make sure that this ruling is<br />
enforced.<br />
My objective is to keep you<br />
abreast of information with material<br />
impact on our membership that<br />
would be related to employment,<br />
medical practice, regulatory<br />
compliance, and licensing. If our<br />
members are financially strong, only<br />
then will we be able to affect<br />
“change” within and outside of AAPI<br />
to have a significant impact<br />
throughout the nation.<br />
I will continue to keep a keen eye<br />
out and continue to keep you all<br />
updated as to other news relating to<br />
this decision. If you wish to share<br />
your thoughts about this ruling,<br />
please contact me at<br />
drdesai@univhc.com.<br />
www.aapiusa.org<br />
23
AAPI Journal • March 2009<br />
FEATURE<br />
Crisis!<br />
by Dr. M. P. Ravindra Nathan<br />
M. P. Ravindra Nathan, M.D.<br />
Brooksville, Florida<br />
“Come to the office right away”,<br />
Becky, my nurse, interrupted my<br />
ICU rounds. “Sally fell in the<br />
examining room. I think she has a<br />
fractured hip,” her words exploded<br />
in my ears. Knowing the patient<br />
well, I panicked sensing this could<br />
portend her end.<br />
When Sally presented to me for<br />
the first time, she looked like living<br />
death; very frail and much older<br />
than her age of 60 years. She was a<br />
poor Medicaid patient from another<br />
town where no cardiologist would<br />
accept her. I was the new kid in<br />
town and coming from a teaching<br />
hospital, I was fascinated with the<br />
challenge she offered, too naive to<br />
think in terms of dollars and cents.<br />
Boy, did she turn out to be some<br />
challenge! Sally had chronic<br />
rheumatic heart disease and already<br />
had three mitral valve surgeries.<br />
She currently had a dysfunctional<br />
prosthesis with severe mitral<br />
regurgitation and a baggy left<br />
ventricle which looked more like<br />
end stage cardiomyopathy. Type II<br />
diabetes, peripheral and carotid<br />
vascular disease were additional<br />
burdens to cope with. As expected,<br />
she developed severe heart failure<br />
complicated by pleural effusion and<br />
ascites. During the next several<br />
months, Sally needed multiple<br />
hospitalizations. I thought each one<br />
would be her last, but her<br />
indomitable will and undying<br />
optimism pulled her out.<br />
My nurse even delivered diuretics<br />
and antibiotics to her home, as she<br />
had no money or reliable<br />
24 www.aapiusa.org<br />
transportation. I never saw or talked<br />
to any of her relatives, including the<br />
daughter who worked for a local<br />
dentist, with whom she lived<br />
sporadically. Her folks had<br />
seemingly abandoned her, Sally<br />
having become a big liability.<br />
There was near pandemonium in<br />
the office, by the time I reached<br />
there. Sally was on the floor, quite<br />
short of breath and pale. The nurse<br />
was administering oxygen. The<br />
ambulance promptly arrived to take<br />
her to the ICU. I wanted to inform<br />
the relatives but she gave me,<br />
between short and difficult breaths,<br />
her usual answer: “Oh, don't bother<br />
to call my children, they don’t care.<br />
You are my family, Dr. Nathan, I<br />
trust your judgment”.<br />
During the last few years, amidst<br />
many critical care admissions, there<br />
were no enquiries from the family.<br />
Becky and I were her sole<br />
guardians, literally. I liked and<br />
respected her almost like my mother<br />
and she, of course, was very grateful<br />
for the attention we showered on<br />
her. She used to become visibly<br />
upset whenever we mentioned her<br />
relatives. <strong>To</strong> make matters worse,<br />
Sally developed carcinoma cervix<br />
with pelvic metastasis, and I had to<br />
use my wit and charms on one of<br />
our radiation oncologists to accept<br />
her as his patient. <strong>In</strong>itially, she<br />
couldn't even lie down long enough<br />
for radium implantation and I had to<br />
readmit her to relieve her<br />
pulmonary congestion before she<br />
could complete a course of<br />
radiation therapy.<br />
Now Sally is in the intensive care<br />
unit (ICU), with a fracture of the left<br />
hip and was steadily going downhill<br />
with full-blown heart failure, almost<br />
into cardiogenic shock. An<br />
emergency thoracentesis yielded a<br />
liter of pleural fluid. Her diabetes<br />
was out of control. She was in Atrial<br />
Fibrillation with rapid ventricular<br />
rate and a BP of 90/60 mm of Hg.<br />
The orthopedic surgeon was<br />
reluctant even to touch her and the<br />
anesthesiologist didn't like the idea<br />
of her dying in the operating room;<br />
the risk was much too high, for<br />
surgery. And without surgery, Sally<br />
would never walk in the near future.<br />
Just then, the ICU nurse<br />
announced there is a bunch of<br />
relatives waiting to see me. “Finally,<br />
I get to see Sally's folks, it's about<br />
time,” I thought. My enthusiasm was<br />
very short lived. I saw a half a<br />
dozen hostile, irate faces in the<br />
conference room. The eldest<br />
daughter, the self-appointed<br />
spokesperson of the family, had only<br />
one question for me:<br />
“Doc, what is the name of your<br />
insurance company?”<br />
I was stunned and speechless for a<br />
moment. Trying not to show my<br />
rage, I politely replied, “But first,<br />
don't you want to know how your<br />
mother is doing?”<br />
“Well, she fell in your office,<br />
didn't she?”<br />
Without mincing words, a clear<br />
message was delivered. A barrage of<br />
Continued on page 25
AAPI Journal • March 2009<br />
FEATURE<br />
Crisis!<br />
Continued from page 24<br />
questions followed, faster than I<br />
could answer, each designed to<br />
intimidate me into an admission of<br />
guilt. She didn't care how her<br />
mother was doing. It hardly<br />
mattered if my nurse and I<br />
contributed anything for dear<br />
momma’s welfare in the past six<br />
years. The dialogue deadpanned. I<br />
could sense a legal battle royal<br />
brewing.<br />
I took my lumps and retreated.<br />
Clearly they didn't travel all the way<br />
from New Jersey to Florida to see<br />
their mother getting better or give<br />
me a personal ‘thank you’ for all<br />
what I have done for her. On the<br />
contrary, I realized much to my<br />
dismay, that they have already<br />
retained a lawyer. I informed my<br />
liability lawyer too; I didn't think<br />
that any malpractice has been<br />
committed. With her frail condition,<br />
Sally could have sustained a fall<br />
anywhere, in my office or any public<br />
place.<br />
During the next few days, poor<br />
Sally teetered between life and<br />
death. Even the nurses could sense<br />
that this family didn't care and<br />
probably would be very delighted if<br />
Sally didn’t make it. With a<br />
heightened sense of responsibility I<br />
worked on her, in spite of the odds<br />
stacked against me. With<br />
appropriate hemodynamic<br />
monitoring and all other state-of-theart<br />
critical care therapy, we<br />
managed to pull Sally out of the<br />
crisis, the surgeon and the<br />
anesthesiologist handling their parts<br />
very well. At long last, Sally was<br />
discharged on crutches. During this<br />
long-drawn saga, the relatives asked<br />
the nurses repeatedly: “How long<br />
can mother last like this?”<br />
Sally’s recovery was a true miracle<br />
and we gave high-fives to each<br />
other. The relatives appeared<br />
disappointed, or so I thought.<br />
And now, the epiphany. A few<br />
weeks late my lawyer informed me<br />
that the family unsuccessfully<br />
contacted 3 trial lawyers who<br />
refused to accept the case. They<br />
couldn’t find a single thing wrong.<br />
Sally will hear nothing about legal<br />
action against me. She even gave a<br />
Pharmaceutical Advertisement:<br />
Makes For Better Healthcare For All?<br />
Continued from page 22<br />
inception of DTCA has been unable<br />
to raise any of the health indices in<br />
the countries, but has increased the<br />
amount of GDP expenditure on<br />
health care. Although, this does not<br />
disprove the use of DTCA because<br />
the results of the medications<br />
prescribed might be relevant 10 or<br />
20 years in the future, but it does<br />
bring into light the fact that a country<br />
like Turkey spends as much on<br />
childhood vaccinations as it does on<br />
treatment of erectile dysfunction.<br />
Conclusive Remarks<br />
DTCA of pharmaceutical products<br />
has the potential to become a major<br />
changing force in driving healthcare<br />
decisions. Physicians are informed<br />
consumer of medications, not<br />
patients. Advertising to a third party<br />
that becomes the recipient of your<br />
product is reasonable, because they<br />
might be able to stimulate demand<br />
for your product, as evidenced by<br />
increasing number of medications<br />
prescribed in countries with DTCA.<br />
This approach also brings out<br />
statement to the nurses that her fall<br />
in my office was entirely her own<br />
fault. One of the daughters had<br />
hinted that Sally may have been<br />
pushed from the examining table but<br />
this didn't hold much water. Finally,<br />
the attempt at a malpractice suit met<br />
an inevitable demise.<br />
I felt vindicated. Finding that they<br />
couldn't collect from my insurance<br />
company, the family dumped Sally<br />
back in her small house and went<br />
on their way. We arranged a home<br />
health care agency to take care of<br />
her. As a last act of gratitude to me,<br />
the family also transferred Sally's<br />
records to another cardiologist,<br />
much against Sally's wishes!<br />
I get a hearty laugh when I think<br />
that Sally is relaxing in a recliner<br />
surfing TV channels and enjoying<br />
whatever life is left for her. She must<br />
have a chuckle too, having beaten<br />
the odds and taught a lesson to her<br />
greedy, neglectful children. And as<br />
for myself, I learned that relatives of<br />
patients come in various types and<br />
attitudes and I have to handle all<br />
situations with equanimity.<br />
problems that are far worse than that<br />
of the actual disease process and<br />
poor allocation of resources for<br />
disease management.<br />
Pharmaceutical corporations would<br />
be advised to create informative<br />
websites to allow physicians to<br />
direct their patients to those banks<br />
of knowledge rather than provide a<br />
thirty second highlight about noncohesive<br />
symptoms hoping to have<br />
patients inquire enough about the<br />
medication to have the doctor<br />
prescribe it to them.<br />
www.aapiusa.org<br />
25
AAPI Journal • March 2009<br />
SPECIAL ARTICLE<br />
Obesity, Acanthosis Nigricans<br />
and Type 2 Diabetes <strong>In</strong> High School Youth<br />
by Naznin M. Dixit, M.D. & Mehul P. Dixit, M.D.<br />
Naznin M. Dixit, M.D.<br />
Orlando, Florida<br />
<strong>In</strong>troduction<br />
The prevalence of type 2 diabetes<br />
has increased 4- to 6-fold in 30 years<br />
among US adolescents. We aimed to<br />
determine the prevalence of type 2<br />
diabetes and obesity among<br />
adolescents within the border<br />
community of Douglas, Arizona.<br />
Research Design And Methods<br />
Douglas is a rural community<br />
located in Southeastern Arizona, on<br />
the Mexican-U.S.A. border. The study<br />
was approved by the Human Subjects<br />
Review Committee and the School<br />
Board. The study was conducted in 2<br />
phases. Physical data was obtained<br />
from students (grades 9-12) during the<br />
phase 1 of the study. Parent and<br />
student health history questionnaires<br />
were sent home along with the<br />
consent forms. The school nurse was<br />
trained to identify for the presence of<br />
acanthosis nigricans (AN) around the<br />
neck. Casual capillary blood glucose<br />
(CBG) measurements were taken.<br />
During the phase 2 of the study,<br />
students with CBG ® 110mg/dl were<br />
asked to submit a fasting venous blood<br />
sample on two separate occasions for<br />
plasma glucose and insulin analysis.<br />
Statistical Analysis<br />
Data were analyzed using STATA<br />
(version 6.0,).<br />
Fisher’s Exact Chi-Square tests were<br />
used to assess correlation. A P value<br />
< 0.05 was statistically significant.<br />
26 www.aapiusa.org<br />
Results – Of the total 1150 students in<br />
grades 9-12 aged 14-19 years, 778<br />
entered the study, a participation rate<br />
of 68%. The male to female ratio was<br />
1: 1.1. 93.5% were of Hispanic origin.<br />
Mean BMI ± SD was 25.01 ± 5.99<br />
(range 15.1-54.1); BMI z- score ranged<br />
from –1.64 to 4.41. Students with<br />
BMI3 85th and
SPECIAL ARTICLE<br />
AAPI Journal • March 2009<br />
Probiotic Theraphy<br />
by M.S. Reddy, M.D & D.R.K. Reddy, M.D.<br />
Probiotics as Therapeutic Agents:<br />
Probiotics are bacteria or<br />
microorganisms that are beneficial to<br />
the health of an individual. They are<br />
essentially the opposite of<br />
antibiotics, which are inhibitory to<br />
other bacteria (including Probiotic<br />
bacteria). The word ‘Probiotic’ is<br />
derived from two Greek words, ‘Pro’<br />
and ‘Bios’, meaning ‘for life’.<br />
Probiotics are non-pathogenic, do<br />
not produce toxins, and are<br />
considered natural. The Probiotics<br />
organisms are believed to exhibit<br />
therapeutic effects because of their<br />
innate ability to produce lactic acid<br />
and other substances that are<br />
inhibitory to harmful bacteria. They<br />
naturally reside in the human<br />
intestinal tract at receptor sites in the<br />
ileum, where they create a mildly<br />
acidic environment that is not<br />
favorable for the growth and viability<br />
of pathogenic microorganisms,<br />
including viruses.<br />
These beneficial bacteria have an<br />
antagonistic effect on pathogenic<br />
bacteria, while antibiotics have an<br />
antagonistic effect on Probiotics.<br />
Consequently, when a person is<br />
treated with antibiotics, the<br />
Probiotics residing in the<br />
gastrointestinal tract can be inhibited,<br />
adding another layer of complexity<br />
to the illness. <strong>To</strong> counteract this<br />
problem, some physicians prescribe<br />
the use of Probiotics following use of<br />
an antibiotic, in order to restore<br />
healthy gastrointestinal flora.<br />
Considerable judgment should be<br />
exercised by the physician in<br />
prescribing a proper Probiotic by<br />
taking into account its physiological<br />
and biochemical properties.<br />
Since Probiotics are natural<br />
inhabitants of the human<br />
gastrointestinal tract, they have to be<br />
maintained in proper balance to<br />
bestow good health. Modern foods<br />
that contain preservatives and dyes,<br />
etc., are not beneficial to the<br />
gastrointestinal flora, especially<br />
Probiotics. Consequently, in order to<br />
maintain and ensure proper<br />
gastrointestinal eco-flora, continuous<br />
or periodic supplementation of<br />
Probiotics is a must.<br />
Potential Benefits of Probiotic Therapy:<br />
Before proceeding with a<br />
discussion on the benefits of<br />
Probiotic therapy, let us review the<br />
microbiological composition of the<br />
human gastrointestinal tract. The<br />
human gastrointestinal tract harbors a<br />
variety of microorganisms. The<br />
human stomach content, i.e. gastric<br />
juice, has only 10 to 100<br />
microorganisms per milliliter (ml) or<br />
gram. <strong>In</strong> the upper portion of the<br />
small intestine, i.e. the duodenum,<br />
the bacterial population in the<br />
contents range from 1000 to 10,000<br />
per/ml. The bacterial population<br />
increases as we go down to the distal<br />
part of the ileum to 1,000,000 to<br />
10,000,000 per/ml of the contents.<br />
The colon has 100 billion to 1 trillion<br />
bacteria per/ml of the contents. <strong>In</strong><br />
the entire colon, the total number of<br />
bacteria is roughly 100 trillion or<br />
more. The total number of eucaryotic<br />
cells (cells with definite nucleus) in<br />
the human being is roughly 10<br />
trillion. Thus, the colon bacterial cell<br />
population exceeds the total host cell<br />
population by ten times or more.<br />
The bacterial population in the gut<br />
has been adapted through<br />
associative growth relationships.<br />
There are many factors that interfere<br />
with this normal dynamic balance.<br />
Various factors contribute to this<br />
eco-imbalance, including the intake<br />
of chemicals, antibiotics, etc. Under<br />
these adverse conditions, the<br />
microflora that are beneficial health<br />
promoters are replaced by<br />
pathogenic bacteria such as<br />
Clostridia, sulphate reducers, certain<br />
Bacteroides species, etc. These<br />
pathogenic bacteria predispose the<br />
host to a number of clinical<br />
disorders, and infections by transient<br />
enteropathogens. Thus, maintenance<br />
of balanced beneficial intestinal<br />
microflora, consisting of<br />
Lactobacillus and Bifidobacterium,<br />
etc. is essential. It raises a very<br />
important issue regarding the validity<br />
of antibiotic therapy. <strong>In</strong> our opinion,<br />
the microbial ecosystem of the small<br />
intestine and colon dictate the<br />
overall health and well being of the<br />
human.<br />
The following are some of the<br />
benefits of Probiotic therapy:<br />
1. Reduction of lactose<br />
malabsorption: Half of the<br />
world population is unable to<br />
utilize lactose. Lactose<br />
malabsorption can be corrected<br />
by probiotics. Lactose is a<br />
disaccharide made of glucose<br />
and galactose. A person who<br />
lacks the enzyme lactase in the<br />
gut cannot digest lactose and<br />
thus develops clinical symptoms<br />
of typical lactose intolerance.<br />
Probiotics, especially L.<br />
acidophilus, have the B-<br />
galactosidase enzyme, which<br />
can break down the<br />
Continued on page 28<br />
www.aapiusa.org<br />
27
AAPI Journal • March 2009<br />
SPECIAL ARTICLE<br />
Probiotic Theraphy<br />
Continued from page 27<br />
disaccharide lactose into the<br />
simple sugars glucose and<br />
galactose in the Ileum, and thus<br />
reduce the discomfort of lactose<br />
intolerance.<br />
2. Reduction of intestinal<br />
infections: Antibiotic-induced<br />
diarrhea has been successfully<br />
controlled by Probiotics.<br />
Lactobacillus and<br />
Bifidobacterium have been used<br />
in children and adults for<br />
therapy of intestinal infections.<br />
3. Reduction of coronary heart<br />
disease: The fact that Probiotic<br />
supplementation inhibits<br />
cholesterol concentrations in the<br />
blood and increases the<br />
excretion of cholesterol in the<br />
feces has been well<br />
documented. Cholesterol<br />
absorption is interfered within<br />
the gut partly due to<br />
assimilation of cholesterol by<br />
Probiotic organisms. <strong>In</strong> addition,<br />
Probiotics (Bifidobacterium<br />
longum) deconjugate bile salts<br />
with the aid of bile salt<br />
hydrolase, and thus increase the<br />
excretion of free bile salts in the<br />
feces. This has the potential to<br />
reduce serum cholesterol<br />
because the replacement of bile<br />
salts would require the<br />
utilization of some cholesterol<br />
in the body. Thus, the resultant<br />
hypocholesterolemia may<br />
reduce the incidence of<br />
coronary heart disease.<br />
4. Immunomodulation: This is a<br />
very important activity induced<br />
by Probiotics. Immunestimulating<br />
activity is attributed<br />
to their bacterial cell envelope<br />
constituents such as<br />
peptidoglycan. Results of<br />
various investigators indicate<br />
that Probiotics stimulate the<br />
28 www.aapiusa.org<br />
production of antibodies,<br />
enhance the systemic activity of<br />
macrophages, and increase<br />
interferon levels and the number<br />
of killer cells.<br />
5. Suppression of cancer: Dietary<br />
intake of lyophilized cultures of<br />
Bifidobacterium longum has<br />
significantly suppressed the<br />
development of azoxymethaneinduced<br />
aberrant crypt foci<br />
(ACF) formation in the colon.<br />
The same group of scientists<br />
elucidated the ability of the<br />
Probiotic strain to inhibit the<br />
incidence of colon tumors.<br />
6. Suppression of Helicobacter<br />
pylori: Helicobacter pylori is a<br />
gram-negative spiral-shaped<br />
bacterial pathogen that<br />
colonizes in the area between<br />
the mucous layers of the<br />
stomach and gastric epithelium.<br />
The <strong>In</strong>ternational Agency for<br />
Research on Cancer has<br />
classified H. pylori as a Group I<br />
carcinogen. This is the first<br />
pathogenic bacterium to be<br />
classified as such. Limited<br />
research data indicate that even<br />
H. pylori can be inactivated or<br />
suppressed with the use of<br />
proper Probiotics.<br />
Prophylactic Probiotic Therapy for<br />
Cancer Suppression:<br />
Some of the non-Probiotic type of<br />
gastrointestinal flora will convert<br />
procarcinogens to carcinogens. Some<br />
of the end products of digestion are<br />
procarcinogenic. For example, end<br />
products of the digestion of beef may<br />
be more procarcinogenic than those<br />
of vegetables. Procarcinogenic<br />
materials may not cause cancer;<br />
however, if they are acted upon by<br />
certain microbial enzymes (betaglycosidase;<br />
beta-glucuronidase;<br />
steroid 7 alpha-dehydroxylase;<br />
nitroreductase and nitrate reductase;<br />
azoreductase; and tryptophanase) in<br />
the G.I. tract, it will be converted to<br />
a carcinogen. Probiotics, by their<br />
innate nature, suppress the growth of<br />
these undesirable enzyme-producing<br />
non-Probiotic bacteria, and thus<br />
reduce the chance of converting<br />
procarcinogens to carcinogens.<br />
If you analyze the entire<br />
mechanism, cancer starts with one<br />
cell through mutation. If mutagens<br />
are reduced or eliminated in the<br />
body, cancer can be controlled.<br />
Mutagens can be reduced if proper<br />
Probiotics are administered and<br />
made to colonize in the<br />
gastrointestinal tract. <strong>In</strong> our opinion,<br />
a proper diet and Probiotic therapy is<br />
the wave of the future to eliminate<br />
mutagenesis, which is the starting<br />
point of cancer.<br />
<strong>In</strong> conclusion:<br />
Since the efficacy of Probiotic<br />
therapy is linked to the proper<br />
Probiotic organisms and also their<br />
physiological condition at the time of<br />
oral administration, the following<br />
selection criteria should be followed<br />
by the physician:<br />
1. They must be of human origin.<br />
2. They must have high acid and<br />
bile stability.<br />
3. They must have adhesion<br />
properties to stick and colonize<br />
on the intestinal mucosa.<br />
4. They must be safe and clinically<br />
proven.<br />
5. They must be clinically<br />
validated.<br />
6. They must be produced or<br />
manufactured by taking into<br />
account the strain stability<br />
(plasmid retention), phage<br />
resistance and freeze drying<br />
survival.
SPECIAL ARTICLE<br />
AAPI Journal • March 2009<br />
The Behaviorally Disruptive Physician<br />
by Gopal Lalmalani, M.D.<br />
Gopal Lalmalani, M.D.<br />
Denver, Colorado<br />
Some health care professionals may<br />
consciously or subconsciously be<br />
perpetrators of disruptive behavior in<br />
our workplace. New JCAHO<br />
standards require that hospital and<br />
medical staff leaders recognize such<br />
pattern of disruptive behavior and<br />
confront these professionals. The Joint<br />
Commission states that “safety and<br />
quality thrive in an environment that<br />
supports working in teams and<br />
respecting other people, regardless of<br />
their position in the organization.<br />
Undesirable behaviors that intimidate<br />
staff, decrease morale, and increase<br />
staff turnover can threaten the safety<br />
and quality of care” This new<br />
standard will be applicable to<br />
physicians as well as all other health<br />
care professionals (including nurses,<br />
pharmacists and management).<br />
Who is a disruptive physician and<br />
what is disruptive behavior? Although<br />
there is no clear definition, the term<br />
“disruptive” is sometimes used<br />
interchangeably with the term<br />
“abusive” and the AMA describes this<br />
type of behavior as “a style of<br />
interaction with physicians, hospital<br />
personnel, patients, family members<br />
or others that interferes with patient<br />
care”. Disruptive behavior<br />
encompasses a spectrum of conduct<br />
that includes verbal abuse, emotional<br />
outbursts, yelling and screaming, use<br />
of sarcasm or belittling remarks, and<br />
threats of violence. It may also<br />
include incidents of inappropriate<br />
physical contact, throwing tantrums,<br />
and tossing objects. Other health<br />
team members are likely to try and<br />
avoid contact with the disruptive<br />
physician which may then affect the<br />
communication needed to provide<br />
high quality patient care.<br />
Disruptive physician policies are<br />
often written vaguely and broadly,<br />
and are subjective. As an<br />
organization, we need to ensure that<br />
these policies are not used to target<br />
outspoken medical staff members or<br />
physicians who are not “team<br />
players”. We need to protect<br />
competent and compassionate<br />
physicians who truly care for the<br />
patient’s welfare, and who provide<br />
good-faith and constructive criticisms<br />
in order to improve the quality of care<br />
in the hospital. The AMA code states<br />
that, “criticism that is offered in good<br />
faith with the aim of improving<br />
patient care should not be construed<br />
as disruptive behavior”.<br />
We need to also ensure that these<br />
disruptive physician policies are not<br />
targeted to get a physician off the<br />
medical staff by an economic<br />
competitor who for some reason or<br />
the other may be more “influential”<br />
within the hospital. There have been<br />
instances where the hospital nursing<br />
staff has been instructed to “write up”<br />
every action of a “targeted” physician<br />
as “inappropriate”. Such false labeling<br />
of a targeted but innocent physician<br />
could be a blow to his or her practice<br />
resulting in loss of reputation in the<br />
community and loss of income. Any<br />
correspondence from the hospital or<br />
medical staff leadership that<br />
insinuates that a particular physician<br />
may be “disruptive” should be taken<br />
seriously and responded to<br />
immediately with objectivity and<br />
facts. If necessary, legal counsel from<br />
a health law attorney should be<br />
obtained. Otherwise, the potential for<br />
loss of privileges, loss of liability<br />
insurance, and termination of hospital<br />
contract could be a real one.<br />
Furthermore, reports to the state<br />
professional health program, the state<br />
licensure board, or the National<br />
Practitioner Data Bank may further<br />
jeopardize the physician’s career.<br />
Medical staff leaders need to<br />
carefully craft by-law provisions that<br />
contain procedural safeguards that<br />
protect due process, and offers fair<br />
hearing. Physicians who truly exhibit<br />
disruptive behavior should initially be<br />
referred to a medical staff wellness<br />
committee. The key is to get the<br />
physician involved as soon as<br />
possible. At times, requesting another<br />
respected physician colleague to be a<br />
liaison or a mentor could be useful in<br />
calming a disruptive physician. If<br />
disruptive acts recur, more formal<br />
action is warranted. If the physician<br />
behavior poses a significant risk to<br />
patient safety, immediate suspension<br />
of privileges may be necessary. If the<br />
physician’s behavior does not pose an<br />
imminent risk to patient safety, then a<br />
meeting should be held by the<br />
Medical Executive Committee, and a<br />
formal peer review be initiated. Peer<br />
review needs to be legitimate, with<br />
the sole purpose of protecting patients<br />
in furtherance of their quality of care<br />
and promoting safety.<br />
As physician leaders, and strong<br />
advocates for our patient’s care and<br />
safety, we should champion the<br />
policy on professionalism, define<br />
unacceptable behavior, and agree on<br />
ways and means of rectifying<br />
disruptive physician behavior. Thanks<br />
to the national impetus and the<br />
headlines recently made on this issue,<br />
it is time that we address this matter<br />
urgently.<br />
www.aapiusa.org<br />
29
AAPI Journal • March 2009<br />
SPECIAL ARTICLE<br />
Suffocation<br />
by Riddhi Shah, M.D.<br />
Riddhi Shah, M.D.<br />
Dominica, West <strong>In</strong>dies<br />
...It has been a lifelong pattern<br />
with me to come back to strength<br />
from a position of extreme weakness:<br />
I had been almost suffocated and<br />
then found that I was breathing more<br />
deeply than ever.<br />
Saul Bellow<br />
Doctors need to be both affable<br />
and competent. Both of these traits<br />
are equally important in patient<br />
care. <strong>In</strong> college, I minored in<br />
communications, where a premium<br />
was placed on interacting with and<br />
relating to an extremely diverse<br />
student body. My volunteer<br />
activities at the time – as a science<br />
tutor in an inner-city high school<br />
and working in the Emergency<br />
Room of a sprawling public hospital<br />
focused on honing these skills<br />
outside the classroom. However,<br />
while all of these experiences added<br />
to my appreciation for medicine, it<br />
took a near tragedy in the second<br />
half of my sophomore year of<br />
college for me to fully realize the<br />
responsibilities entrusted to a<br />
physician, and ideals I should strive<br />
towards both as a medical student<br />
and as a practicing physician.<br />
A little more than four years ago<br />
(even though it still feels like last<br />
week), after my friends and I had<br />
returned from a carefree Spring<br />
Break, my routine physical was<br />
anything but routine. My doctor’s<br />
hands lingered a little too long, and<br />
she seemed to grimace a little. First, I<br />
mentally scolded myself for being<br />
paranoid, but I knew as soon as she<br />
asked if I performed monthly breast<br />
exams that something was wrong.<br />
Only after helping me up did she tell<br />
me that there was a suspicious mass<br />
in my breast. She gave me a moment<br />
for this to sink in, and then quietly<br />
asked if I wanted to tell my mother, or<br />
if she should break the news. I<br />
opened my mouth to speak, but no<br />
words came out. Weakly, I nodded,<br />
still thinking that I could wake up<br />
from this bad dream at any moment.<br />
When my mother entered the<br />
exam room, my doctor explained the<br />
situation as delicately as she could.<br />
She detailed tests I would have to<br />
undergo to determine whether this<br />
was a tumor or a cyst, the likely<br />
outcome of each and a tentative plan<br />
of action. Upon hearing “tumor” my<br />
mother’s eyes glazed over, since for<br />
her (and most other <strong><strong>In</strong>dia</strong>n parents),<br />
tumor almost reflexively means<br />
cancer. Patiently, my doctor went<br />
through the explanation again, even<br />
more delicately this time, and then<br />
added that there was no chance I<br />
had cancer.<br />
I returned home utterly shocked and<br />
confused. My head, full of answerless<br />
questions, was spinning. Why me?<br />
Was this because of something I had<br />
done? And of course, what now? Not<br />
knowing what to do, I sought truth in<br />
statistics since after all, numbers don’t<br />
lie. On the <strong>In</strong>ternet, I found statistics<br />
that teenagers develop breast cancer<br />
about 5% of the time. The first thing I<br />
did was call my doctor. She had lied;<br />
there was a chance, albeit a very small<br />
one. She tried her best to console me<br />
and then reminded me that since I<br />
wasn’t just a number, it made no sense<br />
to look for comfort in them.<br />
The rest of that semester was spent<br />
scurrying from one doctor to another.<br />
For the first time in my life,<br />
schoolwork had taken a back seat.<br />
Everywhere I went both the doctors<br />
and the nurses did their best to<br />
convince me that they understood<br />
how I felt. Even though I knew they<br />
couldn’t possibly, their concern was<br />
both palpable and genuine. I still<br />
remember how the doctor performing<br />
my biopsy sent for someone to hold<br />
my hand and talk to me during the<br />
procedure so that I wouldn’t see the<br />
needle she used.<br />
A few days after my biopsy, my<br />
doctor informed me that I had a<br />
benign tumor and that due to its size,<br />
it would be best to remove it. I<br />
could also just leave it alone, and<br />
undergo surveillance in which case it<br />
could potentially do more harm. I<br />
opted for the surgery since although<br />
scary; it was less scary than the<br />
alternative. The surgery was<br />
scheduled for August.<br />
August came and went and<br />
eventually, everything settled down.<br />
<strong>In</strong> the end, I was left with memories<br />
and a scar, neither of which will ever<br />
fade completely. My work<br />
experiences in college had helped me<br />
develop some of the skills required to<br />
me a doctor, but I wasn’t able to<br />
completely internalize what being a<br />
physician required until I had almost<br />
“suffocated”. The opportunity to give<br />
others the same warm care I received<br />
is the impetus that will always keep<br />
me going.<br />
30 www.aapiusa.org
SPECIAL ARTICLE<br />
AAPI Journal • March 2009<br />
Distinguished AAPI Members AMA Awards<br />
Dear Friends,<br />
The AAPI Leadership would like to<br />
congratulate our distinguished AAPI<br />
members who have been recognized<br />
by the American Medical Association<br />
for their commitment and dedication<br />
to excellence in their fields.<br />
Sincerely,<br />
Sanku S. Rao, MD<br />
President AAPI<br />
Dr. Nathan Davis<br />
<strong>In</strong>ternational Award in<br />
Medicine<br />
The AMA Foundation’s Dr. Nathan<br />
Davis <strong>In</strong>ternational Awards in<br />
Medicine and Public Health<br />
annually honor physicians or health<br />
sector organizations that further<br />
health information and medical<br />
practice worldwide. Named for the<br />
founder of the AMA, the awards<br />
expand the thirteen-year tradition of<br />
the Dr. Nathan Davis Awards<br />
Program-currently presented for<br />
outstanding service in the<br />
international arena. With the<br />
presentation of these awards, the<br />
AMA Foundation strives to<br />
encourage and stimulate<br />
international recognition of the<br />
highest standards of service that<br />
advance the well being of all.<br />
AppaRao Mukkamala, MD<br />
Grand Blanc, Michigan<br />
Established NRI Medical College<br />
and General Hospital in the state of<br />
Andhra Pradesh, <strong><strong>In</strong>dia</strong>. The medical<br />
school has dramatically impacted<br />
health care in <strong><strong>In</strong>dia</strong> by providing a<br />
stream of physicians into the country<br />
as well as cutting-edge medical<br />
research and free care to the<br />
community.<br />
Leadership Award Recipients<br />
The Leadership Awards honor 56<br />
outstanding medical students,<br />
residents/fellows, early career<br />
physicians and established<br />
physicians from across the country.<br />
These leaders display strong nonclinical<br />
leadership skills in advocacy,<br />
community service, public health or<br />
education.<br />
RESIDENTS/FELLOWS<br />
(<strong>To</strong>tal 13)<br />
Jaspal Ahluwalia MD<br />
Derwood, MD<br />
Sabesan Karuppiah MD<br />
Paterson, NJ<br />
EARLY CAREER PHYSICIANS<br />
(<strong>To</strong>tal 14)<br />
Noel Deep MD, FACP<br />
Antigo, WI<br />
Apurv Gupta MD, MPH<br />
Barrington, RI<br />
Shilpen Patel MD<br />
Seattle, WA<br />
MEDICAL STUDENTS<br />
( <strong>To</strong>tal 15)<br />
Manisha Bahl<br />
Chico, CA<br />
AAPI Special Recognition<br />
Roshni Kulkarni, MD<br />
National Hemophilia Foundation<br />
Lifetime Achievement Award<br />
www.aapiusa.org<br />
31
AAPI Journal • March 2009<br />
American Association of Physicians of <strong><strong>In</strong>dia</strong>n Origin<br />
MEMBERSHIP UPDATE<br />
(Please use UPPERCASE letters to update the form)<br />
First Name Middle <strong>In</strong>itial Last Name<br />
Primary Address (Home/Office) City/State/Zip<br />
Secondary Address (Home/Office)<br />
City/State/Zip<br />
Home Phone Office Phone Fax<br />
Email Address<br />
Medical School & State<br />
Name of Spouse if MD (Please submit another form with full details of the Spouse)<br />
……………………………………………………………………….......................<br />
Current <strong>In</strong>formation (If different from Above)<br />
First Name Middle <strong>In</strong>itial Last Name<br />
Primary Address (Home/Office) City/State/Zip<br />
Secondary Address (Home/Office)<br />
City/State/Zip<br />
Home Phone Office Phone Fax<br />
Email Address<br />
Medical School & State<br />
Signature Date<br />
Please send correspondence to: (by mail or fax)<br />
AAPI Executive Office<br />
vkodali@aapiusa.net<br />
Attn. Vijaya Kodali O: (630) 990-2277<br />
600 Enterprise Drive, Suite 108 F: (630) 990-2281<br />
Oak Brook, IL 60523<br />
32 www.aapiusa.org
AAPI<br />
MEMBER’S APPLICATION
SPECIAL ARTICLE<br />
AAPI Journal • March 2009<br />
AAPI Membership Status Report<br />
As a patron member of AAPI, you<br />
hold a unique leadership status in the<br />
community you live in. AAPI has come<br />
a long way since its humble beginning<br />
in 1982 to become the largest ethnic<br />
Organization in the USA. However, the<br />
health and strength of our organization<br />
is its membership.<br />
Sometimes we are asked “What is<br />
the benefit of AAPI Membership”? Your<br />
membership benefit committee under<br />
the leadership of Dr. Anil Khosla, Dr.<br />
Lakhu Rohra are working over a<br />
‘Benefits Package’. Here are some of<br />
the areas and companies we are<br />
exploring:<br />
a. Banking: Bank of America, Citi<br />
Group (Exclusively for AAPI<br />
Members)<br />
b. Airline Programs: Air <strong><strong>In</strong>dia</strong>, Air<br />
France, Jet Airways, Continental<br />
c. Life <strong>In</strong>surance: New York Life,<br />
Nationwide<br />
d. Mortgage: JP Morgan-WAMU<br />
e. Medical/Surgical: Henry Schein,<br />
McKesson<br />
f. Telecommunication: Verizon,<br />
Cingular, Sprint, TrueRoots (TATA)<br />
g. Car Rental Program: Hertz, Avis<br />
h. Entertainment: Asian Television<br />
Network<br />
i. Computers: Dell<br />
j. Payroll: ADP<br />
We are working with Malpractice<br />
<strong>In</strong>surance carriers. We hope to<br />
negotiate most of the benefits by early<br />
2009. We are also working to build a<br />
state of art IT Platform and in the next<br />
few months our website is going to be<br />
interactive and user friendly.<br />
You may consider giving a gift of<br />
AAPI Patron membership to a family or<br />
friend at a reduced rate of $500.00 for<br />
single physician & $750.00 for<br />
physician couple. You can download<br />
the membership application or use the<br />
one found on page 33 of this<br />
publication.<br />
Thank you for your continued<br />
support and wishing you and your<br />
family happines and success<br />
throughout the coming years.<br />
Sanku S. Rao, M.D.<br />
President, AAPI<br />
sankuraook@sbcglobal.net<br />
Ajeet R. Singhvi, M.D.<br />
Vice President, AAPI<br />
asinghvi@aol.com<br />
DR MOHAN DURVE PRESENTS CME PROGRAMS FOR YEAR 2009-2010<br />
*trips Dr. Durve will be escorting.<br />
South Africa July 16 - 31 or Nov 5 - 17, 2009 <strong>From</strong> $2519<br />
Australia/New Zealand Aug 3 - 17or Sept 7 - 21, 2009 $4699w/air from LA<br />
Russian River Cruise July 25 - Aug 5, 2009 <strong>From</strong> $2659<br />
China w/ Yangtze River Cruise September 3 - 19, 2009 (air buy 1 get 1 free) <strong>From</strong> $2849<br />
Croatia (DalmationCost,Italy, Slovenia) June 15-25 or Sept 29-Oct 8, 2009 <strong>From</strong> $2049<br />
Iceland June 21 - 28, 2009 <strong>From</strong> $1849<br />
*Bermuda Cruise July 5 - 12, 2009 (Deadline April 15) <strong>From</strong> $914<br />
Alaska Cruise (Anchorage to Vancouver) July 15-22, 2009 (Deadline April 25) Balcony <strong>From</strong> $1170<br />
*Maan Sarovar & Kailash (by helicopter) Aug 30 - Sept 13, 2009 <strong>From</strong> $3900<br />
Himalayan Kingdoms (Bhutan,Nepal,Sikkim) Sept 13 – 27, 2009 Call for price<br />
Spain & Morocco Sept 17, 2009 <strong>From</strong> $3449<br />
S. America Oct 13 – 27, 2009 <strong>From</strong> $4149<br />
Jordan & Egypt Oct 15 - 29, 2009 <strong>From</strong> $3699<br />
*Scotland Oct 17 - 26, 2009 <strong>From</strong> $1749<br />
Egypt Oct 21 – Nov 1, 2009 <strong>From</strong> $2369<br />
Antarctica Dec 3-16, 2009 <strong>From</strong> $6799<br />
Morocco Dec 24 – Jan 2, 2010 <strong>From</strong> $2399<br />
*Jordan w/opt pre- Syria Jan 10 - 15, 2010 <strong>From</strong> $999<br />
*Namibia w/optional Botswana Safari Feb 17 - 24, 2010 <strong>From</strong> $4999<br />
Antarctica Feb 13 – 26, 2010 <strong>From</strong> $7190<br />
*Oberammergau s Passion Play (Offered only once every 10 years) w/ France & Bavaria<br />
Sept 17-27, 2010; 11 days<br />
$3749 Land Only<br />
Call Dr. Mohan Durve at 888-794-1995 or 440-845-7272 E-mail at: mjdurve@yahoo.com or mjdurve@sbcglobal.net.<br />
We will also organize Family or group vacations to your dream destinations on your dates of choice!<br />
www.aapiusa.org<br />
35
Members <strong>In</strong> The News<br />
AAPI Journal • March 2009<br />
Dr. Raj Gupta<br />
AAPI congratulates its Patron<br />
Member Dr. Raj Gupta, for being<br />
elected as 216th President of the<br />
Medical Society of New Jersey, a<br />
largest and an oldest medical<br />
Association in USA.<br />
Dr. Gupta is a practicing Gastroenterologist<br />
in Princeton, New<br />
Jersey. He is recipient of the<br />
Outstanding Leadership Award from<br />
AMA.<br />
Dr. Gupta has been recognized by<br />
several professional and<br />
philanthropic organizations for his<br />
long dedicated services. He has<br />
served in panel discussions on<br />
Heath Policy <strong>Is</strong>sues at various<br />
national seminars. He has also<br />
participated in AAPI’s Panel<br />
discussion.<br />
Dr. Gupta firmly believes in<br />
“sacred relationship between<br />
physician and patient.” He is<br />
concerned that this sacred<br />
relationship is being ignored and<br />
under attack in the bigger health<br />
care debates, centered around cost<br />
and profitability.<br />
It is matter of<br />
great pride that<br />
one of us, has<br />
been chosen to<br />
lead a prestigious<br />
Medical Society<br />
of New Jersey.<br />
AAPI extends heartiest<br />
congratulations to Dr. Raj Gupta.<br />
Dr. AppaRao Mukkamala<br />
Dr. Nathan Davis <strong>In</strong>ternational<br />
Award in Medicine – The AMA<br />
Foundation’s Dr. Nathan Davis<br />
<strong>In</strong>ternational Awards in Medicine<br />
and Public Health annually honors<br />
physicians or health sector<br />
organizations that further health<br />
information and medical practice<br />
worldwide. Named for the founder<br />
of the AMA, the awards expand the<br />
thirteen-year tradition of the Dr.<br />
Nathan Davis Awards Programcurrently<br />
presented for outstanding<br />
service in the international arena.<br />
With the presentation of these<br />
awards, the AMA Foundation strives<br />
to encourage and stimulate<br />
international recognition of the<br />
highest standards of service that<br />
advance the well being of all.<br />
Established NRI Medical College<br />
and General Hospital in the state of<br />
Andhra Pradesh, <strong><strong>In</strong>dia</strong>. The medical<br />
school has dramatically impacted<br />
health care in <strong><strong>In</strong>dia</strong> by providing a<br />
stream of physicians into the country<br />
as well as cutting-edge medical<br />
research and free care to the<br />
community. Dr. Mukkamala, one of<br />
our past<br />
presidents of AAPI<br />
is a board<br />
certified<br />
radiologist<br />
practicing in Flint,<br />
Michigan for over<br />
30 years. He is<br />
currently the Director/Chairman of<br />
the Board of American Physician<br />
Capital, <strong>In</strong>c. and is the immediate<br />
past president of Michigan State<br />
Medical Society.<br />
Dr. Shastri Swaminathan<br />
President, Illinois State Medical<br />
Society • Shastri Swaminathan,<br />
M.D., is a board-certified<br />
psychiatrist from Chicago. <strong>In</strong><br />
addition to his private medical<br />
practice, he is the current medical<br />
director of the Department of<br />
Psychiatry at Advocate Illinois<br />
Masonic Medical Center in Chicago<br />
and a clinical associate professor at<br />
the University of Illinois College of<br />
Medicine.<br />
A member of ISMS since 1990,<br />
Dr. Swaminathan most recently<br />
served as president-elect of ISMS<br />
representing Chicago area<br />
physicians on the Society’s Board of<br />
Trustees. Locally, Dr. Swaminathan<br />
is a past-president of the Chicago<br />
Medical Society. He has also served<br />
as president for the <strong><strong>In</strong>dia</strong>n American<br />
Medical Association, the Illinois<br />
Psychiatric Society, and is a current<br />
member of the Illinois delegation to<br />
the America Medical Association.<br />
Dr. Swaminathan<br />
received his<br />
medical degree<br />
from All <strong><strong>In</strong>dia</strong><br />
<strong>In</strong>stitute of<br />
Medical Sciences,<br />
New Delhi, <strong><strong>In</strong>dia</strong>. He performed his<br />
residency at Northwestern<br />
University Medical School, Chicago.<br />
Dr. Swaminathan’s term as<br />
president runs through April 2009.<br />
www.aapiusa.org<br />
37
Members <strong>In</strong> The News<br />
AAPI Journal • March 2009<br />
Dr. Roshni Kulkarni<br />
Dr. Roshni Kulkarni, Professor and<br />
Director, Pediatric & Adolescent<br />
Hematology/Oncology.<br />
Director (Pediatric) MSU Centers<br />
for Bleeding and Clotting Disorders<br />
Department of Pediatrics and<br />
Human Development, Michigan<br />
State University and Distinguished<br />
Hematology Consultant, Division of<br />
Blood Disorders (DBD), NCBDDD;<br />
Centers for Disease Control and<br />
Prevention (CDC) was recently<br />
honored by the National<br />
Hemophilia Foundation’s with its<br />
highest recognition, Award of<br />
Excellence, Lifetime Achievement at<br />
the 60th annual meeting in Denver<br />
Colorado in 2008.<br />
Dr. Kulkarni was the former<br />
director of the Division of Blood<br />
Disorders, at the CDC. She is a<br />
member of numerous local, regional<br />
and national committees, reviewer<br />
for many journals and is active in<br />
research and has received numerous<br />
awards. <strong>In</strong> 2003 she was the<br />
recipient of the National<br />
Hemophilia Foundation’s award of<br />
excellence as the “Physician of the<br />
Year”. <strong>In</strong> 2004 she received the<br />
“Distinguished Faculty” award from<br />
the College of Human Medicine,<br />
Michigan State University. <strong>In</strong> 2007<br />
she was named to “Best Doctors in<br />
America”.<br />
Her work includes raising global<br />
awareness regarding women/<br />
adolescents and babies with<br />
bleeding disorders to prevent<br />
complications such as excess<br />
periods, post partum hemorrhage<br />
intracranial hemorrhages.<br />
As a part of her ongoing interest in<br />
education, she has developed<br />
animations on<br />
hemostasis that<br />
are available on<br />
the web at<br />
msu.edu/user/phd,<br />
reddymed.com<br />
and<br />
hemostasiscme.org<br />
(cell based<br />
coagulation). She<br />
continues to mentor junior faculty<br />
both at hers and other institutions.<br />
Dr. Kulkarni’s major interest is<br />
encouraging the development of<br />
well funded Blood Disorders Centers<br />
that will not only serve bleeding and<br />
clotting, rare blood disorders and<br />
hemoglobinopathies communities<br />
but will be a training ground to<br />
retain and sustain providers of this<br />
specialty world wide.<br />
Dr. Prasad Srinivasan<br />
The first World Tamils Economic<br />
Convention Diaspora meeting was<br />
held in Chennai in January 2009.<br />
Dr. Prasad Srinivasan was a speaker<br />
at the health care forum and<br />
highlighted the activities and<br />
achievements of AAPI both in <strong><strong>In</strong>dia</strong><br />
and the United States.<br />
He was featured on the cover of<br />
<strong><strong>In</strong>dia</strong> <strong>To</strong>day (Tamil Edition) with an<br />
article inside the magazine<br />
highlighting his speech.<br />
The caption on the cover reads<br />
“Golden Tamilians”<br />
Poem: When I <strong>To</strong>ok Off My White Coat<br />
by Sharmeela Saha, M.D.<br />
Whenever there’s a pause in my life, I let myself think<br />
about you.<br />
Just before I go to sleep, or when I can relax after<br />
finishing a day’s work.<br />
I know you wouldn’t want anyone to be so sad, let<br />
alone the people you loved.<br />
But you couldn’t stay with ordinary people.<br />
No one could be human and be as kind, selfless as you.<br />
Everyone you interacted with felt like they meant<br />
something to you – which I am sure they did.<br />
No one can ever be as accepting and loving as you.<br />
It’s infuriating to think you aren’t here<br />
For us to call when we need you,<br />
When we might just want to hear your voice,<br />
Give you hug, see your smile,<br />
Or hear your contagious laugh.<br />
I never wanted to feel this deep grief.<br />
It’s not any normal kind of mourning.<br />
It’s the feeling that you really can’t ever be fully<br />
happy again.<br />
I’m chasing something completely unattainable.<br />
But I’m thankful you were my brother.<br />
I’m so grateful that we visited<br />
Just four days before you stopped speaking.<br />
I’m thankful for that last tease.<br />
www.aapiusa.org<br />
39
AAPI Journal • March 2009<br />
December 19, 2008<br />
Krishnoswami Vijayaraghavan, M.B.B.S., F.A.C.C.<br />
2817 E Ludlow Dr<br />
Phoenix, AZ 85032-5665<br />
Dr. Vijayaraghavan,<br />
Congratulations on your position as the newest member of our Board of Governors and welcome to one of the<br />
leading bodies of the College. Being elected by your colleagues to this position of professional leadership reflects<br />
the respect which you have earned from your peers and the high esteem in which you are held.<br />
The Board of Governors advises the college of membership opinions and informs members of the policies and<br />
actions of the College. As a member of the Board of Governors, you will represent the needs and opinions of the<br />
members within your state/province and have the opportunity to implement ACC national initiatives locally.<br />
Your membership in this exclusive body offers you the opportunity to work closely with renowned physicians in the<br />
cardiology profession, as well as much professional and personal growth and satisfaction. Your role as Governor is<br />
timeless during the upcoming national deliberations on health system and payment reform in which ACC and the<br />
Chapters must be intimately involved.<br />
While being a Governor carries with it the responsibility of leadership, the College recognizes that you volunteer<br />
your time to the ACC because of your commitment to your profession. Therefore, the College and its staff will<br />
provide you with the tools and resources necessary to successfully accomplish your goals and the goals of your<br />
constituency. We hope you will take advantage of these resources.<br />
We look forward to working with you in the future and meeting you at the January Leadership Forum.<br />
Our best to you in the coming year and to you and your family during the holidays.<br />
W. Douglas Weaver, M.D., F.A.C.C.<br />
President, American College of Cardiology<br />
Jack Lewin, M.D.<br />
CEO, American College of Cardiology<br />
www.aapiusa.org<br />
41
AAPI Journal • March 2009<br />
AAPI Upcoming Events<br />
AAPI Spring Governing Body Meeting<br />
Hosted by the <strong><strong>In</strong>dia</strong>n Medical Association of<br />
New England<br />
April 10th to 12th, 2009<br />
Boston, Massachusetts<br />
Venue:<br />
Renaissance Hotel on the South Boston<br />
Waterfront<br />
606 Congress Street • Boston, Massachusetts<br />
1-888-796-4664<br />
Group Code:<br />
AAPI/IMANE *Discount available until March 20th*<br />
Registration:<br />
Governing Body members please RSVP with<br />
the AAPI Office<br />
AAPI Spring Legislative Day<br />
Tuesday April 28th, 2009<br />
Capitol Hill, Washington, DC<br />
Registration:<br />
Contact AAPI Office<br />
AAPI 27th Annual Convention<br />
Dolphin Hotel and Convention Center<br />
June 10th-14th 2009<br />
Orlando, FL<br />
Exhibition and Member Registration Online at:<br />
www.aapiconvention.com<br />
convention@aapiusa.net<br />
Poem: Superwomen<br />
by Vimal Goyle, M.D.<br />
Here we come women of WPC<br />
All different sizes and physique<br />
Some of us are tall, medium and short<br />
Some of us are average, thin and fat<br />
We also come in light and dark brown shades<br />
Have different languages and culinary tastes<br />
But will speak with one voice and behave<br />
Debate different issues in GBM and AAPI convention<br />
Will make women forum a real hot event<br />
We wear different hat at home and at work<br />
Make life and death decisions at the job<br />
No matter what we have as career<br />
Will always be the wife and the Mom<br />
The keeper of the social calendar indeed<br />
We also play Mom Doc, when called by kids at 2am<br />
About their allergies, cough, fever and cold<br />
No matter what and whatever it is<br />
We appreciate the family support<br />
Without them, we will not be able to<br />
Act and accomplish like supermoms for sure<br />
Do not mean to be arrogant at all<br />
Just the experiences of women,s lives<br />
We are trying to tell the way it is like.<br />
42 www.aapiusa.org
AAPI Executive Office<br />
600 Enterprise Drive, Suite 108<br />
Oakbrook, IL 60523<br />
PRSRT STD<br />
U.S. POSTAGE<br />
PAID<br />
Tampa, FL<br />
PERMIT # 4309