wake county physician magazine april 2011

THE WAKE COUNTY PHYSICIANMagazine

Celebrating medicine, the arts, intellect, ideas and curiosity.

April 2011 Volume 16 No. 2

This issue of Wake County Physician isunderwritten by REX UNC Health Care. We welcome the opportunity for fresh

intellectual and clinical cooperation.

WhenRussianspeaking,17yearold,SamuelMalamudsteppedontoEllisIslandin

1911animmigrationofficerrenamedhimSamuelGoldberg.Acarpenter,SamsoonmarriedfellowimmigrantRebeccaWilcotz.Theeldestofthreesons,Bernard,arrivedinAugust1920inPassaic,NewJerseythenaruraltownacrosstheHud-sonRiverfromNewYorkCity.MotivatedbyAmerica’smanyopportunities,Bernexcelledinschoolandrankedinthestate’stoptierofhighschooltennisplayers.DuringtheprivationsoftheGreatDepression,thefamilylosttheirhometoforeclosureandwasforcedtoconsumeSam’shomingpigeons.Bern’sacademictalentslayin

mathematicsandscience.Hespentthesummerof1938studyingfortheen-

tranceexaminationtoCooperUnion,aschoolintheBoweryendowedbyindustrialistPeterCooperthatpro-

videdfulltuition.Hisbrother,Sol,providedhiscarfareandbookmoney.OnceBernhadgraduated,theyagreedhewouldreturnthefavor.However,by1941allthreeGoldbergboyswereinuniform.Bernfinishedhisengineeringdegreeandbecameanof-ficercadetatYale,thenalieutenantinthe8thAirForce.HespentthewarbasedinEnglandconduct-

ingforensicevaluationsofdownedalliedaircraftthroughoutEurope.Whileallthreeboyssurvivedthewar,ironically,thedreadeddeathnotifica-tionannouncingtheirmother’sdeathwenttothesoldiersratherthantheirparents.Afterreturningwithfourbattlestars

NON-PROFITORG

US POSTAGEPAiD

Raleigh, NCPermit #2152

[Continued on page 26]

THE WAKE COUNTY MEDICAL SOCIETY2500 BLUE RIDGE ROAD, SUITE 330RALEIGH, NC 27607

Bernard Wilcox Goldberg: A role Model Worth EmulatingBy Richard Goldberg, MD

A man who dares to waste one hour of time has not discovered the value of life.

Charles Darwin

Classical music elevates the majesty of the human soul. Assad Meymandi, MD, PhD, DLFAPA

Many people think of music as a luxury... Music is actually a gift you give to yourself. Linda Carlisle, NC Secretary of Cultural Resources

Music washes away from the soul the dust of everyday life.

Berthold Auerbach, German Jewish poet (1812-1882) Contributed by Linda Carlisle

Vision for WCPa magazine - with appeal to the family of medicine in Wake County and to the larger world beyond bound together by scientific, intellectual and artistic glue. (Urbi)- with the collaboration of the alliance, bringing together Wake County medical families through words and pictures. To know who dies, who marries, who gets promoted, and those who go to which medical school.- a powerful instrument to attract and induct members to organized medicine, particularly the WCmS, nCmS and ama (orbi)- read globally in intellectual, spiritual, academic and busi-ness centers beyond Wake County and north Carolina through online circulation. - a globally recognized and credible instrument to bridge the gap between medicine, basic sciences, ethics and bio-ethics; the arts, such as music, opera, dance, poetry; and all of the humanities such as philosophy, history, patrio-tism, epistemology, theology and rhetoric.

Page 1 President’s Message Michael Thomas, MD, PhD, FACEPage 1 Words of Wisdom Nortin M. Hadler, MD, MACP, MACR, FACOEM Editorial Assad Meymandi, MD, PhD, DLFAPAPage 4 Letters to the EditorPage 6 rEX UnC Health Care The Power of Partnership Page 10 Physician Profile: Dr. Prashant Patel Fiona Morgan Page 12 Clinical Corner James Tift Mann, III, MD, FACCPage 13 nietzsche: Tragedy, Music and opera in Western Civilization L. Jarrett Barnhill, MD, DFAPA, AACAPPage 14 north Carolina Treasures: The news & observer Felicia GressettePage 16 Poetry CornerPage 17 Quarterly Morbidity report Jeffrey Engel, MD, MPHPage 18 Public Health issues Jeffrey Engel, MDPage 19 History of Journalism in Wake County, raleigh, north Carolina Frank Arthur Daniels, Jr.Page 20 Editor’s notebook Assad Meymandi, MD, PhD, DLFAPAPage 23 The Art of Venipuncture Bruce Blackmon, MDPage 24 on The relationship Between Music and Physician/scientists Leonard S. Gettes, MDPage 28 Book reviews Assad Meymandi, MD, PhD, DLFAPAPage 30 in MemoryBack role Model Worth Emulating: Cover Bernard Wilcox Goldberg Richard Goldberg, MD

THE WAKE CoUnTY PHYsiCiAn

TABLE of ConTEnTs

The Wake County Physician is a publi-cation for and by the members of the Wake County Medical Society. The Wake County Physician is published in April, April, July and October. We will consider for publication articles relating to medi-cal science, editorials, opinion pieces, letters, personal accounts, photographs and drawings. Prospective authors should feel free to discuss potential articles with the editorial board. Manuscript Preparation Submissions should be sent electronically to [email protected]

Submit photographs or illustrations as high quality 5 x 7 or 8 x 10 glossy prints or a digital JPEG or TIF file at 300 DPI no larger than 2” x 3” unless the artwork is for the cover. Please include names of individuals or subject matter for each image submitted. Photos may be sent directly to:

Tina Frost 7741 Ohmann Court Raleigh, NC 27615 [email protected] - 919.671.3963

Authors Bio and PhotosSubmit a recent 3x5 or 5x7 black and white or color photo (snapshots are suitable) along with your submission for publication or a digital JPEG or TIF file at 300 DPI no larger than 2” x 3” (Send to Tina Frost at the above address.) All photos will be returned to the author. Include a brief bio along with your prac-tice name, specialty, special honors and positions on boards, etc. Please limit the length of your bio to 3 or 4 lines.

submissions may be mailed to: Editor, The Wake County Physician2500 Blue Ridge Rd, Ste 330 Raleigh, NC 27607 Phone: 919.782.3859 Fax: 919.510.9162E-mail: [email protected] Ad rates and specifications: Full Page $300 1/2 Page $150 1/4 Page $75 Trim Size: 8 1/2” x 11” Binding: Saddlestitch

For ad placement information contact Paul Harrison. Phone: 919.792.3620 Fax: 919.510.9162 Camera ready artwork for advertise-ments should be sent via email to: Tina Frost at [email protected]

“The Wake County Physician Magazine is an instrument of the Wake County Medical Society; however, the views expressed are not necessarily the opinion of the Editorial Board or the Society.”

Wake County Medical societyofficers and Executive Council

2011 PresidentMichael Thomas, MD, PhD, FACE

secretary Patricia Pearce, MD

Treasurer

David Cook III, MD

President-elect Susan Weaver, MD

Past President

Raynor Casey, MD

Assad Meymandi, MD, PhD, DLFAPA

Founding Editor and Editor-in-Chief

Editorial BoardL. Jarrett Barnhill, MD

Jeffrey Engel, MDBrian Go, MD

Douglas I. Hammer, MD, DrPHKen Holt, MD

Andrew S. Kennedy, MD, FACRO Assad Meymandi, MD, PhD, DLFAPA

Fiona MorganNicholas Stratas, MDPhillip Timmons, MD

Susan T. Weaver, MDRandall W. Williams, MD

Council MembersSusheel Atree, MD

Terry Brenneman, MDJeffrey Engel, MD

Manish Fozdar, MDBrian Go, MD

Warner L. Hall, MDDoug Holmes, MD

Ken Holt, MDM. Dixon McKay, MD

Assad Meymandi, MD, PhD, DLFAPA David Miller, MDDale Oller, MD

Patricia Pearce, MD Brad Wasserman, MDSusan T. Weaver, MD

WCMs Alliance President

Maya ZumwaltWake county physician • apRiL 2011 | 33

theUSgovernment,anantagonismlaterintensifiedbyaradiobroadcastexpress-ingapprovaloftheSeptember11,2001terroristattackontheUS.Anti-Semitismbecamejoinedwithanti-Americanism;theUSdeservedtheattack,hesaid.Heneverreturnedtothiscountry,livingwithchessadmirersintheHungary,Philippines,Japan,andfinallyIceland.AlthoughhecametodenouncetheIcelandersaswell,hefoundrelativepeacethere,havingaspothelikedinaReykjavikbookstore,andwhenthisbecameknowntoreport-ershetookrefugeintheReykjavikpubliclibrary.Thelibrariansthererecognizedhimbutrespectedhisprivacyandhecouldreadwithoutinterruption;thelibrarywasnearaThairestaurantwherehebecamearegular.HislonelinesswasrelievedbyoccasionalvisitsbyhiswifewhoremainedinJapanwheretheyhadmet.Shecamewhenshecouldgetawayfromherjobandtheyhadahappy,lovingrelationship.HediedonJanuary17,2008,andisburiedinasmallchurchyardinruralIceland,inanisolatedbutbeautifularea.WeoweFrankBradymuchforhisfull

presentationofFisher’slifeasachessplayerbutalsoassomeonestrugglingwithhisflawsandlimitationsandaslatertry-ingtoachieveadifferentoutlookandfull-erwayofliving.WearegivenFisher’slifeasfirstachessprodigy,thenayoungnationalchampion,andfinallyworld-conqueringfigure.Hiscareerinthechessworldisfullyanddramaticallydescribed,aswearetakenthroughtheoftendramaticdetailsofthepubliceventsthatbroughthimintoprominence.Fischercanbeseenasrepresentativeofhiscountry’sproudestvaluesofpersonalinitiativeandself-reli-ance;herewassomeonewhocoulddem-onstrateinactualaccomplishmentshowtheseidealscouldbringsuccesseveninanintellectualactivityinwhichthecountryhadnotachievedgreatrecognition.USindividualismcoulddefeatSovietcollec-tiveefforteveninthefieldinwhichinwhichtheUSSRwasaccustomedtothinkofitselfasinvincible.ButBradyalsodescribesBobby’s

lifeawayfromthechessboardandthemedia,andherethepictureismuchmorecomplex.Itisofapersoncharacterizedbyamixtureofself-reliancebasedonrecognitionofhisownrealgenius,im-menseconfidenceborderingonarrogance,extremeandsometimesunbalancedjudg-mentwithelementsofparanoia,obedi-

encetoprinciplesometimesapproachingintransigence,intensecompetitiveness,

andyetacapacityforfriendshipandlove,andgenuineintellectualcuriosity.Adedi-catedmotherandasupportivesisterdidnotmakeupfortheabsenceofafullfam-ilylife,adeficiencythataseriesofchesscommunitiesandcoachescouldnotcom-pletelyremedy.Fischer’salmostcom-pletelackofformaleducation,replacedbyasingle-mindedcommitmenttoanactivityabstractedfromthecomplexitiesofreallife,lefthimignorantofthemanydimensionsofeverydaylivingandwithoutarealisticconceptionofhistoryandpoli-tics.Hewasnevertaughttoquestionthesimplistic,totalisticthinkingthatledhimtoacceptfirstfundamentalistreligionandlateranti-Semitismandanti-Americanism.Itistruethattheextremeindividualismencouragedbyacompetitive,capitalistso-cietyenabledhimtomasterasophisticatedintellectualgames;italsolefthimwithoutbasicsupportservicescommunity.Yetitalsolefthimpreytothosewhowantedtoexploithimfinanciallyorpolitically,anditmadehimunabletocompromiseortoexaminecriticallyhisownandothers’thinking.Hewasnotunawareofthis:hisremark

thathefeltlikegivingupchessfromtimetotime“butwhatelsewouldIdo?”wastragicandrevealing.Hewastrappedinthelifeandhabitsthathehadadoptedearlyinlifeandonlymuchlaterrealizeditsconsequences.Manyofhisgenera-tionwhoachievedchessprominencehadcollegeeducationsandwentontopro-fessionalcareersaslawyers,doctors,businesspeople,universityprofessors.Theyunderstoodthattheworldofchesswasenclosedinthemuchlargeroneoffamilyandsociety,steadyincome,andactivitiesandaccomplishmentsofdiffer-entkinds.InmanywaysFischer’slifeistobecomparedtothatofamoviestarorsportshero;thesehaveusuallybeenabletodevelopalife-styletakingadvantageoftheirwealthandacclaimtofashionaprivateexistenceshelteredfromunwantedintrusions.Americansocietyhasaplaceforsuchindividualsbutcouldnotac-commodateachesschampionmarkedbypersonalintransigenceandoutspokeninextremeandsometimesunacceptablepoliticalviews.YetBobbyhadanintel-lectualcuriosityalsonotcharacteristicofAmericancelebritiesasshowninhislateomnivorousreadingashebegantobreakoutoftherestrictionsofhisnar-

rowexistence–toolatetohelphimfindamorebalancedlife.ThetwopicturesonthefrontandbackcoversofBrady’sbooksographicallytellFischer’sstory:onthefrontheappearsasyouthfulandconfident,hisintensityevidentashelooksdirectlyintothecamera,eagertoenterintocombatandsureofvictory.Onthebackheisadrained,beardedolderman,hiseyestiredandfocusingawayfrompersonalcontact.FrankBradyhasgivenusathorough,

highlyreadable,andaltogetherfascinatingstudyofanimmenselytalentedbutdeeplyflawedindividual,hislifeshowingthegreatopportunitiesopentodeterminationandgenius.Yetitmakescleartherisksofsuchalifeinahighlycompetitivesociety,anditillustratesdramaticallythepenaltiesawaitingthosenotrespectingthelimitsthatalifeaimingatsupremeachievementdemands.§

*A Brief History of the Reviewer: In 1948, at the age of 14, he won the NC State Chess Championship, becoming the youngest state chess champion in the nation, an honor he holds to this day. He dominated NC Chess for a decade. After leaving NC, he played in many major chess tournaments and became a highly rated chess master. (Perhaps he was the first chess master from North Carolina). He obtained his undergraduate degree at UNC, Chapel Hill, and went on to attend graduate school at Cornell University in Ithaca, N.Y, attaining a PhD in Philoso-phy. He taught at California State Univer-sity, Northridge for many years until his retirement in 2002.

news & observer continued from page 14

publisher.TheN&Oreceivedoneofjournalism’s

highesthonors–thePulitzerPrizeforpublicservice–in1996fortheinvesti-gativeseries“BossHog,”whichexam-inedtheriseoflarge-scalehogfarminginEasternNorthCarolinaanditsimpactontheenvironmentandeconomy.Tomanylong-timereaders,thisaffirmedN&O’sroleas“The Old Reliable.”Thatwork,andtheinvestigativejournalismofthepast15years,distinguishestheN&Oanditscommitmenttopublicservice.§

*The Writer joined The N&O in 1995 as features editor and currently serves as vice president for marketing and commu-nity publishing. She is a graduate of The University of Maryland at College Park.

book reviews continued from page 32

“You have chosen your Genius have passed beneath the throne of Necessity, and with the voices of fatal sisters still in your ears, will soon enter the plain of forgetfulness and drink of the waters of its river… It is my duty to say a few words of en-couragement and to bid you in the name of faculty, God speed on your journey.

I could have the heart to spare you, poor, care-worn survivors of hard struggle, so lean and pale and leaden-eye with study. But my tender mercy constrains me to consider but two of the score of elements which may make or mar your lives.

First is a equanimity, imperturbabilities imperturbability is largely a bodily endow-ment, I regret to say there are those among

you, who, owning to congenital defects, may never be able to acquire. Education, however, may do much to help.”

In this address, Sir William Osler goes on to talk to the graduates of the Uni-

versity of Pennsyl-vania Medical school, class of

1889, to acquire a balance of courage, assertiveness but not “Callousness”

and rigidity. Finally, he tells

those about to be doc-tors that medicine is a sacred

profession and not a commodity, not a business and not an entre-

preneurship… Seeing a doctor advertising in a tele-

phone book or a newspapers makes me wonder if Sir William Osler is not rolling in his grave. §

Words of WisdomContributed by NORTIN M HADLER, MD MACP, MACR, FACOEMProfessor of Medicine and Microbiology/ImmunologyUniversity of North Carolina at Chapel Hill, NC

Representative government is not a “city” that prides itself in its intelligentsia. There’s the occasional Moynihan. Most, even those who are exceedingly bright are forced to be “political.” I’ve testified often before Congress; I am amazed about how much that is considered substantive input comes from “friends,” lobbyists, and pre-law interns. Very few on the Hill read for content.

The intelligentsia of America is else-where and sizeable. I write for the joy of coherence in the hope that a moral discussion about “health” will emerge in that realm. I have no need to be powerful or visible or the like; just influential. It’s working - and I’m patient. It will slowly change the social construction of health in the US and then our politicians will listen.

You may have

noticed my column was absent in the past issue of Wake County Physician.

I had the mis-fortune of being

hospitalized for five days with an unusual case of septic arthritis of the shoulder, which left me barely able to use my right arm for nearly a month. However, during my convalescence, I was re-elected to a second term as the president of the Wake County Medical Society (WCMS), and I look forward to serving you in 2011. This past year, we saw continued growth of Wake County. Membership in our county society has remained steady, and we remain financially secure. The

WCMS website [www.wakedocs.org] has been updated with new information, and we have joined forces and strengthened ties with the Triangle-Indian Physicians Society (TIPS). We collaborated with the WCMS Alliance to sponsor a Health Fair in Southeast Raleigh. We had a well-attended speaking event in mid-November that brought two leaders from our local universities to discuss the future roles they will play in Wake County medicine.

This year, I hope to continue and extend some of these projects. We will have our annual picnic at Tara Farms on September 10th and at least one other social outing and perhaps a medical-political sympo-sium later this year. Also, this year looks to be quite politically active in the NC state legislature, and given our proximity to the Capitol, I highly recommend the participation of Wake County physicians in “White Coat Wednesdays,” which will allow our voice to be heard during the upcoming legislation on tort reform and

the NC budget for Medicaid spending. We will continue to explore ways of commu-nicating through our flagship publication, Wake County Physician, and possibly e-mail or other internet-based forums.

Lastly, although I don’t want to be con-sidered self-aggrandizing, I have noticed that the last time a physician was elected president to two consecutive terms of the WCMS was over one hundred years ago (J.J.L. McCullers, MD, 1903-1904). I hope my re-election is not misconstrued as a lack of leadership among our member-ship. I will be working with our executive council to foster new membership and leadership as we enter our 108th year. §

Wake county physician • apRiL 2011 | 1

President’s MessageBy Michael Thomas, MD, PhD, FACE

Reflection on Valedictory address, University of Pensylvania, May 1, 1889,

Aequinimitas, Sir William Osler (1849-1919)

(with V for “valor”). In 1979 the Halls moved to Raleigh, where Bob became the Director of the Wake County Health Department. Among his many accomplishments was the institu-tion of a requirement that cats be immunized against rabies in Wake County, and later, throughout North Carolina. He was ahead of his time with his concern about development in and around Falls Lake. He was the patriarch of a huge family and enjoyed them and his friends up to the last minute.

Samuel Klauber M.D. Age 101

Dr. Klauber, a Purple Heart Veteran of World War II, and a radiologist, died at the age of 101. Asked by his physician how he

explained his longevity, he answered, “The world was my friend.” Today the world has lost a dear friend. Throughout his life Dr. Klauber was known for his compas-sion and humanity, his courage and daring. People were drawn to him, and with their help, he realized an immi-

grant’s dream of creating a better life in America. Sam came to the United States in 1921 and despite the great depression, he graduated from Kansas University Medical School. In 1939 he joined the United States Army Medical Corp. serving in the North

African campaign, in Antwerp, Belgium where he received the Purple Heart, and in France, serving as Commander of the 519th Medical Detachment, landing at Utah Beach in the first invasion of Normandy. He later received a Masters of Public Health at Harvard Medical School and practiced medicine in the Boston, Mass area. After retiring from private practice at the age of 79, Dr. Klauber worked as a phy-sician for the Immigration and Naturalization Service in Boston, retiring at 89. In 2001 he and his wife, Betty, moved to Chapel Hill, N.C. He was proud to be a Tar Heel transplant.

Arthur C. Broughton Jr. Age 96

Dr. Broughton, Jr. graduated from Hugh Mor-rison High School in 1931 and received a BS degree from Wake Forest College in 1935. He continued his education receiving his medical degree from Medi-cal College of Virginia and interned at Erlanger Hos-pital in Chattanooga, Tennessee from 1937-38. Dr. Broughton had a family practice in Raleigh for 45 years. First opening his practice in the Masonic Building downtown and later in the Medical Arts Building at Mary Elizabeth Hospital where he was part owner. He was Director of Medicine for the NC Department of Corrections at Women’s and Central Prison from 1954 to 1980. He was an avid hunter, ac-complished hunting dog trainer, and excellent horseback rider.

Dr. Broughton was a charter member of St. John’s Baptist Church of Raleigh. J ewill be missed by his family, colleagues and friends.

Dr. Charles i. Sheaffer Age 84

Dr. Sheaffer died at his home in Carolina Meadows on January 19, 2011. Dr. Sheaffer was born in 1926, in Acton, IN. Charlie was a beloved pediatrician in Chapel Hill for more than 30 years, and he was a pioneer and driving force in addressing child abuse in the state. He worked tirelessly evaluating and treating vic-tims. After retiring as a practicing physician, he established a nonprofit organization to conduct pediatric medication effectiveness studies.

Charlie had become known fondly as the “Bird Man,” since moving to Carolina Mead-ows in 2009. He carved and painted countless birds, and his creations now adorn the entire facility.

For years, Charlie was an avid gardener, and his abundant flowers and vegetables were a joy to many. He shared his knowledge and skill with family and friends, and his garden-ing prowess remains evident across the state. He also loved hunting and fishing, and enjoyed spending time at the Roanoke and Tar River Hunt Club.

Dr. Sheaffer received his medical degree and a master’s degree in botany from the Univer-sity of Virginia. He served on the Admissions Board at UNC-Chapel Hill Medical School, and on the faculty for many years.

Prior to his graduate studies, he served in the navy. You will be missed, dear friend, the birdman of Carolina Meadows.

32 | apRiL 2011 • Wake county physician

in memory continued from page 30

introduction to these subjects. Later he came to question the Worldwide Church because its leader’s prophesies did not come true, nevertheless it was an ongoing intel-lectual influence in his life.

The obstacles toward his qualifying as challenger for the world championship – made more difficult by Fischer’s continuing demands, which many considered eccentric – were eventually overcome and his long, halting, but ultimately successful drive for the world championship was finally successful. Sometimes his criticisms were borne out – his complaint that the Soviet players were colluding against non-Soviets was later supported by one of the Soviet players. But in 1972 he played Borris Spassky, the Soviet representative, and defeated him handily. Brady’s absorbing account captures the world-wide interest in match. In the US there was a TV program devoted to each game – attention to chess

inconceivable before Fisher’s appearance – and it outdrew baseball and tennis and even the Democratic National Convention. When Fisher won he was offered a ticker-tape parade on Broadway; he declined this for a celebration which turned into “Bobby Fischer Day” in New York.

Now a completely different phase in his life begins, one lacking chess events – he never played an official tournament or match game again – and where, away from media attention and chess publicity, his personal values and lifestyle, and a gradu-ally developing interest in other activities, were dominant. Although he now had op-portunities that would have made millions, except for one small offer he declined them all: “Nobody is going to make a nickel off of me,” he said. The consequence was that he had no funds to fall back on. To be near the Worldwide Church, to which he had long given 10% of his earnings, he moved to Pasadena. But he became disillusioned with the Church, because of its sexual restrictions and prohibitions on music and

particularly because of the prophesies of its leader which he recognized to be false. He also began reading anti-Semitic literature and became convinced that “Christianity is just a Jewish hoax.” As time went on his anti-Semitism became more outspoken and eventually alienated many friends and fur-ther reduced his social circle. Now his life revolved around going to used book stores in Pasadena and downtown Los Angeles, and he began to read history, politics, phi-losophy (chiefly Nietzsche), and religion.

In 1992, after two decades without play-ing tournament chess, Fisher and Spassky had a rematch – which had no official standing although Fischer insisted that it be advertised as for the world championship – that was sponsored by a wealthy Yugoslav banker. Though receiving a US govern-ment warning that such a match violated a Presidential injunction against conducting economic activity in Yugoslavia, he played anyway, spitting on the letter warning him not to participate. Although he won the match handily he became a fugitive from


Faithful readers of this space recall the article on epigenetic that defies Dar-winian Theory of evolution. Darwin

asserted that it takes millennia to evolve changes in an organism. The studies of the families in northern Sweden, sparsely popu-lated Norbotten, just six people per square mile, reveal that it takes only a couple of generations to effect evolution. The ancient Biblical story in Genesis chapters 41 through 47, which describes the Egyptian Pharaoh’s dream of “seven years of plenty and seven years of famine,” prove to be relevant to the science of epigenetic and the rapid two-generation-evolution-cycle in-stead of two millennia. Epigenetic, a 21st century science, is the study of changes in gene activities that does not involve alteration to the genetic code but is passed down to successive generations. Many scientists including British colleague, neurologist/polymath, Raymond Tallis, the 2010 Fall Meymandi Fellow, National Humanities Center, call this phenomenon as “Darwinits.” Here is a summary of research described previously:

In the 19th century, a province in north-ern Sweden called Norrbotten literally ex-perienced seven years of famine followed by good harvest and abundance of food. The feast and famine period that occurred in this sparsely populated province (only six people per square mile) has offered astonishing epidemiologic and scientific data that have given birth to the science of epigenetic. The years 1800, 1812, 1821, 1836, and 1856 (the year of potato famine in Ireland) were years of total crop failure and famine for the people of Norrbotten. But in 1801, 1822, 1828, 1844, and 1863, there was excellent harvest and an abun-dance of food. Scientists of the renowned Karolinska Institute, Stockholm, Sweden, have undertaken the painstaking work of

evaluating this history of famine and feast to see how it affected the lives of the chil-dren. They have found that “life conditions could affect your health not only when you were a fetus, but also well into adulthood,” concluding that parents’ experiences early in their own lives change the traits they pass on to their offspring. The result of the study shows that the years the children were well fed, their own subsequent offspring grew up to be healthier and physically bigger. Epigenetic makes it possible to enhance the activities of the good genes and silence and discourage the activities of the bad genes. The task is not very difficult. To chemically flip the “good” switch on, one must intro-

duce a methyl group (CH3) to the side chain of DNA—a very simple procedure; or vice versa, to flip it off, introduce a demethylate compound to suppress the activities of the bad genes.

The exciting science of epigenetic is very much like a switch on the outside of the genetic circuits and genome that influences the behaviors of a gene. The very prefix epi, which means to lie outside of the root

structure, helps explains that, while not an integral part of an organism’s genetic code, epigenetic can influence the gene’s activi-ties from the outside. Flipping the switch enhances (turns a gene on) or inhibits (turns a gene off) DNA activity. Now we are learning that genetic configuration and longevity of a cell is very much related to telomeres. In 2009 Elizabeth Blackburn, Jack Szostak, and Carol Greider, won the Nobel Prize in Physiology or Medicine for their elucidation of the structure and maintenance of telomeres (the tips of chro-mosomes). These investigators discovered that telomeres are DNA sequences with a structure that protects chromosomes from erosion and that a specific enzyme, telomer-ase, is involved in their repair after mitosis. In daily psychiatric practice one wonders why the incidence of suicide is so high in so many families irrespective of socio-economic and religious orientation. Here is an examination of depression. Is there a depression gene?

Depression GeneRecent suicide of Ali Reza Pahlavi, 44

year old son of the late Shah of Iran (Jan. 4, 2011) which followed by the suicide of his sister, Leila Pahlavi in 2001, has stirred many questions regarding the genetic aspect of depression. We have known depression as a distinct clinical illness since the days of Hippocrates (460 BC-370 BC) and Galen (129 BC-217 BC). It was called melan-cholia with the fascinating etymology of melon, black; cholia, colon, or black bowel. The ancient clinicians thought the origin of depression was in the intestines. It was not until the Persian physician-polymath, Abu Ali Sina (Avicenna 980-1037 AD) and Abū I-Walīd Muḥammad bin Aḥmad bin Rušhd (Averroes 1126 – December 10, 1198), and his



EditorialAssad Meymandi, MD, PhD, DLFAPAFounding Editor

Epigenetic, Depression Gene, Book of Genesis and Pauline Theology of

Faith, Hope, Love and Redemption

Granada, Seville and Cordoba, facilitating flourishing centers of learning there for at least five centuries, paralleling, ironically, the “Dark Ages” in Northern Europe and the British Isles.

Muslim rule in Iberia came to an end on January 2, 1492 with the conquest of the Nasrid kingdom of Granada. The last Muslim ruler of Granada, Muhammad XII, better known as Boabdil, surrendered his kingdom to Ferdinand II of Aragon and Isabella I of Castile, the Catholic Mon-archs, los Reyes Católicos. Ferdinand II, a very nasty piece of work, expelled the non-converso Jews to Kiev and Morocco in 1492 (as Columbus sailed the ocean blue). In 1568, Phillip II introduced laws prohibiting Moorish culture, and after an-other half century of turmoil, Phillip III, in 1616, expelled the remaining Moriscos.

Meanwhile the struggles for power among the Mohammed succession, Persia that you know so well, the Timurid dynas-ty and so on emerged and transpired in all of their complexities. I spent some time at the Archives in Barcelona over the past de-cade, and was profoundly impressed with the importance of La Convivencia and how it could serve as a role model for the modern Middle East. Moorish Spain (al-Andalus), from 711 until 1492, particularly in Seville, Cordoba and Granada, until the beginnings of the 11th century Reconquest (La Reconquista) was the center of West-ern learning, virtually unrecognized, even today, in the modern Western World.

Alexandrian Arabs and Jews, from 400 to 700 BC, saved the scientific learning and literature of classical Greece from the ravages of Christian zealots like Cyril of Alexandria. Cyril is controversial because of his involvement in the expulsion of Novatians and Jews from Alexandria and the murder, in 415, of the Hellenistic math-ematician, astronomer and philosopher Hypatia, considered the most intelligent woman who ever lived. Some suggest her murder marked the end of what is tradi-tionally known as Classical antiquity.

Just as the west dates its origins, simplis-tically, by Columbus in 1492 (and Bal-boa and Magellan), and Marco Polo’s Il Milione in 1299 (describing his travels in Kublai Khan’s China from 1271-1291), the west has continually ignored the traditions of Persia and China, whose scientific and artistic discoveries go back three, four and five millennia. Westerners love Prince

Henry the Navigator’s 15th century Afri-can voyages of discovery (and subsequent-ly those of Diaz and Vasco da Gama) who discovered a sea route to India by 1499.

However, the Chinese had long before discovered the compass, not simply by the 11th century, but as early as the second century Qin Dynasty, if not earlier, and actively traded with India, Egypt, the Horn of Africa, Madagascar and the East coast of Africa two thousand years ago (recall Punt). The Silk Routes to China had been important paths for cultural, commercial and technological exchange between trad-ers, merchants, pilgrims, missionaries, soldiers, nomads and urban dwellers from Ancient China, Ancient India, Ancient Tibet, Persia and Mediterranean countries for almost 3,000 years. This trade was extended further eastward in the Mediter-ranean of the Phoenicians in 1500 BC, and earlier, where tin was traded as early as 1500 BC if not 2,200 BC in Bronze Age SW England.

Many of the mythic Greek pantheon(s) of deities (especially Hephaestus) emerged from the tradecraft of the Bronze Age four millennia ago and the Iron Age three millennia ago, especially in Anatolia, and slightly before in what is now modern India. The Silk Routes trade was consoli-dated during the Hittite suzerainty in Ana-tolia from 1800 to 1200 BC, a same time period when the prophet and philosopher Zoroaster, the founder of Zoroastrianism gave rise to the religions(s) of Persia of antiquity. The exotic wisdom of Zoroas-trian literature is said to be the forerunner of subsequent classical Greek imagination and literature.

Hephaestus was the god of technology, blacksmiths, craftsmen, artisans, sculp-tors, metals, metallurgy, fire and volca-noes. Hephaestus’s depicted lameness and carcinomic skin scarring, like that of most Bronze age blacksmiths, likely reflects low levels of arsenic poisoning, as, arsenic was added to copper in the Bronze Age in place of tin to harden it.

We westerners are so caught up in the past two millennia that we forget that that Chinese seafarers were navigating the Southern Pacific to the west coast of South America twenty millennia (20,000 years) ago (recall Easter Island), and the Phoeni-cians likely reaching the Caribbean three millennia ago, long before Leif Erickson ventured to Greenland and Vinland, the modern Canadian Maritime provinces twelve hundred years ago, or when, in

1492, Columbus “sailed the ocean blue.”

David Scott, PresidentPolyglot PressPhiladelphia, PA

The Editor:I disagree with those who believe that

the public schools are “broken”, but as with so many other pieces of our soci-ety, they need reform. One must first realize that although educators work in the schools, they do not CONTROL the schools. Because the schools are PUBLIC, they have many stakeholders. Therefore, there are many conflicting opinions about what the public schools should teach, how they should be organized, and how teach-ers and students should interact. These opinions derive from different values held across communities, and even within families.

The BIG decisions about what will be taught in K-12 schools are made by non-educators, e.g., members of a local or state board of education, and legislators, and the citizens who influence them. Educa-tors often write up the details, but non-educators hold the RESPONSIBILITY for the big decisions. (Much as war is too important to leave to the generals.)

Critics of the schools need to realize that every program is there because someone wanted it there, and pushed to get it ad-opted. We have arts because some citizen pushed to have them included. We have special education because some parent did not want his/her child excluded from the opportunities that public education provides. When school systems would not, or could not, provide the services that people wanted, they petitioned the state. Later, when states did not provide certain programs/services, parents petitioned their federal legislators to provide them. Hence, we have vocational education, ESEA, NDEA, 94-142, Title IX, etc. Every new program requires someone to initiate it and teachers to teach it. As each program ex-pands, more people are needed to provide support to the teachers, and to provide the mandated auditing of the instructional and financial resources devoted to that pro-gram. Thus is born a bureaucracy. §

Robert T. WilliamsAssociate Dean EmeritusSchool of EducationN. C. State UniversityRaleigh, NC


Letters continued from page 22

contemporary colleague, the Jewish physi-cian, Rabbi, theologian and philosopher, Moses Maimonides of Cordoba (Rambam 1135-1204) who stirred up academic ker-fuffle and forwarded the basic thesis that depression had to do with the brain and not the guts. Rambam in 1150, not yet 25, a physician to the Muslim Caliph, described depression, obsessive compulsive disorder (Vasvas), and designed methods of treat-ment that we today continue to use, namely cognitive behavioral treatment (CBT). Of course, they used many herbs and botanical products. Their pharmacopeia is replete with plants, herbs and roots. Edinburgh University in Scotland, around 350 years ago, created the famous Edinburgh Botanic Garden with nearly 400 acres of plants with the single purpose of copying Avicenna’s pharmacopeia. Avicenna’s medical text-book “Cannon of Medicine” was taught in all European medical schools well into the nineteenth century. Sir William Osler’s writings have many references to these gi-ants of medicine. Three learned colleagues interested in history of medicine, Moham-mad M. Sajadi, MD; Davood Mansouri, MD; and Mohamad-Reza M. Sajadi, MD, of Baltimore, Maryland, have written a comprehensive article in Ann Intern Med. 2009;150:640-643. Visit www.annals.org for further details about the genius of Avi-cenna as a clinician, teacher, author and polymath. Avicenna’s brilliance continues to shine and give guidance to the teachers of medicine even a millennium after his death.

Fast forward the clock of medical sci-ence and technology. We now know that DNA provides powerful clues to under-standing disease. Data from the National Institute of Mental Health strongly sug-gest a particular gene may increase the risk of depression. The scientists have found that people with one form of a protein that transports serotonin, one of the many mood-related neurotransmitters, are especially prone to depression when faced with traumatic events, such as alien-ation, loss of power, country and princely positions. The displacement is especially consequential for members of disposed royalties. In exile, these privileged chil-dren often forget their native tongue and do not learn the language of their adopted country which exacerbates the sense of alienation and social isolation.

The version of the particular depression gene prevents the neurons (brain cells) from re-absorbing serotonin, which leads to feelings of sadness and negative mood

and may make it harder for them to recover emotionally from a crisis. Depletion of the good juices of the brain such as Dopamine, indoleamine, serotonin and catecholamine, epinephrine and nor epinephrine leads to depression. Untreated depression often leads to poor quality of life, addiction to, abuse of, substance and other forms of self destructive behavior including suicide.

Just as there are families predisposed to paucity of brain Dopamine and familial suicide, I know of many families geneti-cally predisposed to an abundance of brain Dopamine, especially in the Locus Coeru-leus and the Limbic system, particularly hippocampus, the seat of memory in the brain. This is the biochemical and neuro-endocrinological equivalence of Pauline theology of hope, love, faith and redemp-tion. Fortunate folks with well endowed Dopamine circuitry face adversities and vicissitudes of life with optimism and possibilities. Science has accumulated enough knowledge about the mechanisms of cognition, mentation and perception and their molecular underpinnings at the synaptic junctions that we can make bold advancement in the area of understanding the nature of depression gene. We reviewed the book by the learned science journalist Sharon Begly, “Train Your Mind, Change

Your Brain,” in which she cited her work with Dali Lama and the interest His Holi-ness, has exhibited in neuroplasticity. One of the strongest findings in neuroplasticity, the science of how the brain changes its structure and function in response to input, is that “it is almost magical to observe the ability to physically alter the brain and enlarge functional circuits…” We may have depression genes. But we also have a plastic brain, and chromosomes that have flexible telomere length, even making us live longer.

We now are learning the molecular biochemistry and endocrinology of joy, a constant running brook of Dopamine, producing Straussian symphonic poem of life. Let it be known that joy is not the same as happiness, Happiness is the uncorking a bottle of wine and celebrating an evanescent moment. Joy, on the other hand, is steady, permanent, and life giving. Like a running brook, it is constant and it refreshes. Joy changes the morphology and molecular structure by our brain. And these changes may be brought about by a simple change in our attitude and approach to life. Scientists have shown that by just showing purpose and determination, and by merely uttering positive words and intentions, the level of brain Dopamine is raised. §


The Third Annual Triangle Area Hindu Temples (BAPS,HSNC and SV temple) and Triangle Indian-American Physicians Soci-ety (TIPS) Health Fair 2011 is scheduled for Saturday, June 18, 2011. For the past two years, this event has attracted people from all walks of life and last year, over 750

people took an advantage of great event. The Health Fair committee and com-munity were very appreciative of the enthusiastic participation by the physicians last year, which ensured the success of the Health Fair and would like to thank each for their dedication of time. Like last year, this year’s health fair is being hosted by the Hindu Society of North Carolina in their Main Hall. Physicians from all specialties including primary care are requested to serve in this community event. Physicians would review lab results and consult on various medical issues.

TAHT HEALTH FAIRSaturday, June 18, 2011

9:00 am to 1:00 pmHindu Society of North Carolina

309 Aviation Parkway Morrisville, North Carolina

Contacts: Jaylan Parikh, MD - 919.745.7070 / [email protected]

Vandana Devalapalli, MD - 919.413.1318 / [email protected]


IBy Assad Meymandi, MD, PhD, DLFAPASolidas et amice, ave atque vale

n MemoryDr. William M. “Buck” Fowlkes Jr. Age 91

Dr. Fowlkes was born November 22, 1919 in Rockingham, NC, died on January 9th in Raleigh, NC. Buck at-tended Mars Hill College and received a B.S. in Medicine from Wake Forest College in Wake Forest, NC before receiving his medical degree from Bowman Gray School of Medicine, Wake Forest College in Winston-Salem, NC. He com-pleted his residency at the US Naval Hospital in Portsmouth, VA and served two tours of duty in the US Navy as a Medical Officer. Dr. Fowlkes practiced general medicine in Enfield, NC and Wendell, NC before pursuing a psychiatric degree offered jointly through Duke University and the University of North Carolina at Chapel Hill. After completing his psychiatric residen-cy, he was on staff at John Umstead Hospital as head of the Forsyth County Unit and was promoted by the state of North Carolina to Regional Commissioner of the Western North Carolina Department of Mental Health.

After retiring from the Department of Mental Health, Dr. Fowlkes held other part-time positions with the state of North Carolina Department of Mental Health while continu-ing a limited private practice in psychiatry in Raleigh. Among his other achievements, Dr. Fowlkes served as Chairman for the North Carolina Medical Society (Section on Neurolo-gy and Psychiatry), Vice President of the Wake County Medical Society and Secretary of the North Carolina Neuropsychiatric Association. In his retirement, Buck volunteered with Lu-theran Family Services and the North Carolina Museum of History.

Buck is survived by his wife of 49 years, and three children. With the death of Drs. Buck Fowlkes, Wilmer Betz and N.P. Zarzar, the universe of NC Psy-chiatric Association is in deep mourning.

Dr. Paul C. Bennett Jr. Age 82

Dr. Bennett died January 8th, 2011 at home.

He was born in Kinston, NC. Dr. Bennett was an honor graduate of Wake Forest Uni-versity in 1951 and a graduate of Duke University Medical

School in 1955. He served in the United States Army from 1956-1958. Dr. Bennett completed his post graduate studies at Duke University Hospital with a residency in Internal Medicine and Pediatrics.

He opened a practice in Family Medicine in Goldsboro, N.C. on January 5, 1959 and it was his honor and privilege to take care of his patients for 34 years. While he loved a round of golf, his joy was practicing medicine. He was an active member of the medical community and served as president of the Wayne Memorial Hospital staff and the Wayne County Medical Society.

Dr. Bennett is survived by his wife of 56 years, Marcia Drake Bennett; and four children. He loved his family, his friends and the com-munity he served. He will be missed.

Dr. Edward S. “Ned” SnyderAge 72

Dr. Snyder, died at his home in Raleigh on January 10, 2011 from idiopathic pulmonary fibrosis. Besides practicing radiology, Ned could sculpt a bust, bring a French vineyard to life with paint, repair an appliance, and

clearly demonstrate how a machine works with a diagram on an index card or cocktail napkin.

Born in Toms River, NJ, Dr. Snyder graduated from Rutgers University and Georgetown Medi-cal School. He completed his internship in general

medicine at Newark City Hospital and subsequently served as a U.S. Air Force General Medical Officer with his wife Ann in Karamursel, Turkey. He completed his residency at University of Alabama Hospitals in Birmingham, Alabama and then joined Raleigh Radiology Associates and the Rex Hospital Medical Staff in 1972. While at Rex Hospital, he served for a time as Chief of Radiology and was on the Rex Hospital Executive Committee. Dr. Snyder’s chief interest was Interventional Radiology and Angiography and he belonged to numerous medical organizations including the Radiological Society of North America and The American College of Radiology. He was instrumental in helping design the radiology department at the “new” Rex Hospital when it moved to its present location. He served on multiple community related foundations includ-ing the Poe Center for Health Education.

Throughout his life, his love of learning took him and his family on hiking, skiing, biking, and golfing adventures around the world. Since retiring in 1991, he found his second calling as an artist, gifted in both painting and sculpture. A humble artist at best, who loved the artistic process.

He is survived by his best friend and wife of 44 years, Clare “Ann” Jassa Snyder, three children, all of Raleigh and a son of Atlanta.

Colonel Robert McCue Hall M.D. Age 93

Colonel Hall, died on January 28. He leaves behind his beloved wife of fifty-six years, and twelve grandchildren.

Bob was a soldier, doctor, musician, of-ficer, writer, historian, son, brother, father, and grandfather. He was a veteran of three different wars who felt deep pride in what he had done in service of his country.

He was born in Spring Ranch, Nebraska. The family moved to Raleigh in 1931, and he attended Needham Broughton High School, where he played foot-ball and the clarinet in the high school band; he dreamed of being an orchestra conductor. He He taught military medical subjects to medical officers at the British Army’s Field Medi-cal Training Center at Mytchett. In October 1962 during the Cuban Missile Crisis he was sequestered with the Army’s potential invasion force, of which he was the chief medical of-ficer. During his time in the Army, he received Masters degrees in Public Health from the University of North Carolina School of Public Health and in Health Care Administration from Baylor University. He was a graduate of the Army’s Command and General Staff College, the Navy’s School of Aviation Medicine (where he learned to fly a fixed wing aircraft and a helicopter), and the National War College. He was a Fellow of the American College of Preventive Medicine and a member of many professional societies, including the Society of Medical Consultants to the Armed Forces, from which he received its Seale Award.

He was a highly decorated soldier--by the time he retired as a Colonel in 1976 he had earned one Purple Heart, two Silver Stars, and four Bronze Stars [Continued on page 32]

A critic from a well read critique

The Editor:Regarding Dr. Jarrett Barnhill’s letter,

WCP, January 2011 issue, I have no need to re-read The Merchant of Venice. I re-member the story well. The merchant col-lateralized a pound of his flesh to obtain a loan from Shylock and when the said merchant was unable to pay, Portia agreed the lender was due a pound of merchant’s flesh but not one drop of blood. Case dismissed.

William GarrabrantRaleigh, NC

Hanukkah The Editor:

Thanks for the nice Hanukkah wishes. A Happy Holiday to you too. Nobody rubbed my head with knowledge but your comments reminded me of the tune that my father would whistle, sort of like we use cell phones these days but at a much shorter range, the melody from Ravel’s Bolero. It was his signature call, originally the love message between my parents, imprinted on me. I definitely had the ad-vantage in my Music Appreciation courses in grammar school.

Roger Spencer, MDChapel Hill, NC

The Editor: What a lovely note. Thank you for

sharing as I’ve learned some things about Hanukkah that I did not previously know. It was an honor to host you and your fam-ily recently at the Museum in recognition

of your gift as well as your Citizen of the World Award. I do hope everyone enjoyed the luncheon and exhibition. You have a lovely family.

I hope you and Emily will be attending the Humber dinner next week. It is hard to believe that just a year ago we were closed to the public and this annual event had to be held at the Umstead. I’m looking forward to holding our first Humber din-ner post the opening of both buildings. If you are not able to attend, let me take this opportunity to wish you both a wonderful Christmas!

Caterri WoodrumRaleigh, NC

Rule of Law, the Miracle of America

The Editor: Wonderful comment. Wish the whole

world agreed with you. Our nation is unbelievably outstanding because it is founded on solid principles. I enjoy your writings. Thank you.

Anne WeathersbeeRaleigh, NC

The Editor: Unfortunately the rule of law doesn’t

always take place: police routinely violate the Bill of Rights, create falsified evidence (i.e. - Greg Taylor), and brutally treat detainees; I could go on.

Prisoners are treated worse than caged animals; due process for them is a joke. But, as it is said, “The American system is the worst in the World, except for all the rest.” I’m sure you had some experience with that.

Larry E. Warren, Ph.D, MD, JDRaleigh, NC

Education in America The Editor:

I continue to be grateful for inclusion in your list serve. Each of your offerings inspire and challenge the intellect. My

background is English Literature and theology/philosophy; my career included college and university teaching and concluded with the presidency of Barton College. All of this is simply to say that I deeply appreciate your insights, knowl-edge of history and the great thinkers, many of whom most know little about. Finally, I am constantly re-convinced that the greatest reward of education is defin-ing over and again how little we know and how much there is to learn. If I learned anything from a PhD it is the extent of my own ignorance. You help me to fill some of the gaps, while reminding me of my conviction about education. I look for-ward to having an opportunity to converse with you once again. Gratefully,

Jim Hemby, PhDEmeritus President, Barton College in Wilson, NCRaleigh, NC

The Editor: The dumbing down of education is part

of the ALARMING shift in our view of individuals and their role in society. Most often today we hear them referred to as “consumers” rather than “citizens.” The MIRACLE of the United States has been our assertion that being a nation is a do-it-yourself proposition. By abandoning the use of the word citizen – which implies responsibility and “holding up your end” – we encourage passivity and entitlement? Ah yes, bread & circuses.

At 80 years old, my dad – a retired pediatrician and former director of the one of the National Institutes of Health – started an educational foundation on the economically-depressed Eastern Shore of Maryland because he felt the best way to upgrade economic opportunity was to EDUCATE the workforce [www.delmar-vaed.org] Pediatricians see the connection between a commitment to education and the well-being of families and children in particular.

On an analogous topic, in my view the national debate over health system reform lacks an intellectual foundation – wide-

What do you think? Share your thoughts in WCP Forum. We are reaching a multitude of readers in medicine, business, universities, public libraries, and hospitals. Letters to the Editor and contri-butions are welcome and will be considered for publication.

LExcerpts from letters to the Editor

etters

4 | apRiL 2011 • Wake county physician Wake county physician • apRiL 2011 | 29

ity of many universes, and by extension, physics. Medieval philosopher-theologians attributed such uncertainty to first causes (God) who is impenetrable to human understanding. If we accept Hawking and Mlinodow’s position; they may have inadvertently re-unified mathematics, experimental physics, cosmology, creation myths and theology. Many cannot accept this view but to paraphrase John Paul II’s encyclical on Faith and Reason: both science and faith are the wings that allow the human spirit to soar above our daily lives; neither alone is sufficient. This book leaves our cage open so if we wish to, we can crawl through the worm hole and seek other levels of understanding. §

Endgame: Bobby Fisher’s Remarkable Rise and Fall – from America’s Brightest Prodigy to the Edge of Madness By Frank Brady Crown Publishers, New York: 2011

Reviewer: Charles “Kit” Crittenden, PhD*

In this engrossing biography Frank Brady gives a personal yet objective portrayal of a brilliant, difficult, utterly idiosyncratic figure. Bobby Fisher is argu-ably the world’s greatest chess player and Brady is very well placed to present him. Brady is author of several biographies (on Orson Welles and Aristotle Onassis, among others), former head of the Com-munications Department at St. John’s University. He knew Fisher well during Bobby’s playing days as a New York prodigy and later in various international venues. Brady has done about as thor-ough a job of researching his subject as is possible, and this book, easily understand-able by the non-player, is likely to be the definitive biography on this fascinating individual.

Endgame is a study on several levels. It is, first, the story of a boy growing up in a Brooklyn family headed by his mother (his paternity is uncertain, there was no father in the home), finding chess at age 6 and quickly discovering his love of the game and his immense aptitude for it. The

support by his mother, encouraging his interest by taking him to chess clubs at an immense cost of time – she would leave him at a club in the afternoon and pick him up at night to escort him back to Brooklyn, among other sacrifices – is very impres-sive. His abilities were quickly recognized by local players who gave him lessons and introduced him to the most impor-tant playing sites in the city. At home Bobby – as Brady calls him throughout the book – studied the games of masters and also chess openings; at various locations – clubs, parks, at the homes of his mentors – there were many, many games of speed chess against opponents of all ages and strengths, giving him experience beyond his years. Brady very helpfully describes the large network of resources available in the New York area to the young and devel-oping player; these were probably unique in the country and were undoubtedly an immense factor in fostering his ability and confidence and in allowing him to be recognized as a coming force.

Inevitably Bobby began to play at the Manhattan Chess Club, the premier chess club in the country, where he could go every day – his home club, the Brooklyn Chess Club, was open only twice a week. Many of the country’s best players were members and Bobby could compete with them in the weekly speed tournaments and in individual speed games. The Marshall Chess Club, in Greenwich Village, was also a chess center. This was close to ex-cellent, inexpensive restaurants and stores selling chess materials, including Soviet chess magazines – which Bobby could study. This was another great advantage that New York had for the aspiring player. These opportunities corresponded with his intense commitment to mastering chess and he made the most of it.

About this time he began to compete in national tournaments such as the US Junior, the US Open, and the Canadian Open, where anyone could enter and which attracted strong players from around the country and internationally. In 1956 he traveled with the Log Cabin Chess Club, created by E. Forry Laucks, an eccentric millionaire; on the way back a match with a hastily organized NC chess team was arranged. The 13 year-old Fischer played board two for the Log Cabineers and defeated Dr. Albert M. Jenkins of Raleigh, NC Champion in 1955, for Fischer’s only chess appearance in the state. NC’s board one was your author; I lost to N. T.

Whitaker, long a force in American chess and one of the highest rated players in the country.

Fischer’s progress in the US chess world was meteoric, and in 1957 he won the US Championship – the youngest na-tional champion ever. His victory gained nationwide attention – for example he was a guest on the TV program ‘I’ve Got a Secret’, and the panel did not guess that he was chess champion of the country. There were also international successes. At 15, he became the youngest international grand master – the highest rank possible. His successes continued. Despite his increasing tendency to set demanding, seemingly arbitrary requirements on play-ing conditions, his victories and interna-tional reputation grew as a fierce attacking player with an unerring positional instinct. Organizers were willing to meet his de-mands for lighting in tournament rooms, scheduling of rounds, size of boards and men, dimensions of chairs, and so on. He achieved a celebrity never before seen for an American – movie star status for a chess player.

Brady describes these chess victories and the dynamics within the tournaments themselves vividly. But non-chessic themes appear in his narrative. These was the time of the Cold War, and competi-tion with the Soviet Union in all areas was intense – Fischer’s chess victories a political significance beyond their results within the chess world. His mother was already watched by the FBI; she was an activist, participating in protests, associat-ing with some the FBI considered suspi-cious, and had affiliations with left-wing political organization. Although she was questioned by the agency, no charges were ever brought. But Fischer learned to sus-pect that he was under surveillance and his uneasy relationships with the US govern-ment began, to become a major factor in his life later.

Another element in Fischer’s life was his attraction to the Worldwide Church of God, an evangelical form of Christianity, with headquarters in Pasadena, California. Although there is some evidence to the contrary, Fisher claimed that he had no formal initiation into Judaism – his mother, although Jewish did not practice the reli-gion. He was entirely dedicated to chess at this stage; he did not study religion or philosophy and did not enroll in university courses where he could receive a critical


spread social agreement on a set of general expectations for what our health system ought to DELIVER and how it ought to PERFORM. If such a social agreement were embodied in a document, we could use it to evaluate the merit of various legislative proposals. I have written a short paper with a set of proposed design specifications for a healthcare system the country can be proud of – and afford. Perhaps more importantly, I suggest that a grassroots process begin to engage CITI-ZENS in this conversation on a commu-nity by community basis. One way to do it would be to use a modified version of a technique called “kleroterion” or “partici-pative democracy.”

Jennifer Christian, MD, MPH Wayland, MA

Thanksgiving The Editor:

I am compelled to let you know how much your writings mean to me. I feel quite blessed to be one of those on your e-mail list to receive your newsletters and comments. Your insights give me pause. Your words remind me of my own bless-ings. I do consider you a true “Wise Man from the East” – in fact, at this season of the year I would consider you a compila-tion of the “Three Wise Men from the East” who came to visit Jesus…. Only, instead of gold, frankincense, and myrrh you bring wisdom on a physical, emotion-al, and spiritual level. I treasure that more that the original gifts. Thank you for shar-ing your insights. I wish you and yours a very Merry Christmas and a prosperous New Year.

Connie G. CrumplerRaleigh, NC

The Night of Yalda The Editor:

The overlap and intermingling of customs between different religions and civilizations are quite interesting. It makes me scratch my head in bewilderment when people of one or another faith take as literal all the “miracles” they profess to be irrefutable truth.

Jon Kolkin, MDRaleigh, NC

The Editor: I once visited The Temple of

Mazdaznan near Oceanside, California. It was located across a small canyon from the property of my friend, Dr. Stub Harvey. It was under the supervision of a gentleman who referred to a resident of the US who had reached some 120 years of age, and who practiced a “science of daily life”. I later found the connection to Zoroastrianism, still widely practiced. The darkest day of the year was celebrated in my hometown, far north of the Arctic Circle. The Aurora Borealis and the reflec-tive snow offset the fact that the sun was totally absent.

Tor DahlWhite Baer Lake, MN

Beethoven’s NinthThe Voice of Experience

The Editor:Beethoven’s Ninth Symphony is where

the amateur singer hits the big-time and performs with an orchestra as part of its subscription series. The Ninth is a wonder-ful work, often listed as the favorite of classical music lovers. For its last move-ment Beethoven chose Schiller’s text about the brotherhood of man, calling on people to love one another. Its Adagio, which precedes the Choral movement, is serene and sublime. Listen to it and try to stay upset. I wanted to establish my admiration for this great music before I express a complaint, which is about the way it is staged by conductors, who are, of course, professionals and don’t understand the amateur’s need for psychic pay. Their cluelessness is demonstrated when they reserve seats for the soloists on the front of the stage and give them curtain calls–-while giving short shrift to the chorus, as I shall prove. It’s traditional, but to under-stand why this is unfair consider the rela-tive workloads of the chorus and soloists. The chorus begins rehearsals four months before the concert and practices every week. Each singer gets a score which has all four chorus parts, the soloists’ parts and a piano accompaniment. Before the first rehearsal the choral director has a conference with the orchestra’s conductor, who will lead the concert, and who tells the chorus master how he wants things done: “We’ll use the Breitkopf and Hartel edition, of course, it’s the authentic one,” says the Great Man, to which the lesser mortal nods vigorous assent, even though he really prefers another. Instructions are given for an emphasis here and a diminu-

endo there which isn’t in the score but which the Great One knows Beethoven would have put in, had he thought of it. The rehearsals are grueling. “You’re be-ginning ‘Deine Zauber,’ too loudly. That’s piano, people! With a crescendo! If you begin it forte, you’ll be screaming your heads off by the end of the phrase!

“Hold those half notes two full beats and cut off on three! Put a little space between the dotted eighths and the sixteenths. Write that in. Does everyone have a pencil? Always bring a pencil to rehearsal! Sopranos support the tone. You’re going flat on those thirteen bars of high A’s! Look at me, please, everyone. Don’t bury your heads in your books.” It is hard work, and we leave every session exhausted. The performance is tomorrow, and the chorus and orchestra rehearse together for the first time; the former keyed up, excited; the latter utterly bored. They have not seen the score since they did it five years ago, but they know they can handle it, and they also know that the whole rehearsal will be spent going over and over the chorus’ mistakes; they will have a separate session in which they polish the other movements, and it won’t take long. The four soloists are there, too, not quite as bored as the orchestra. Each of them knows he or she is better than the other three, though they’ll try not to be too blatant about stealing the show. The Great Man is leading the combined forces, and he doesn’t like anything our choral direc-tor has taught us, apparently. Our pencils are constantly in hand, erasing old instruc-tions and putting in new ones. There’s a limit, though. Whereas the amateurs are used to staying a little longer to get something right, the union musicians will walk off in mid-beat when the contracted rehearsal time is over, so it ends when it is supposed to. The evening of the perfor-mance comes. It’s show time. In evening dress we sit silently and motionless on hard, backless risers through three orches-tral movements. I can’t see the audience in the darkness beyond the conductor, but I can see something the audience can’t, his expressions: solemnity, concern, joy. Sometimes he even makes faces at his players. When I tire of watching him, I read the French horn music for a while and then focus at close range on the hairdo of the alto wedged in front of my knees. Finally, the Adagio movement is finished. In spite of the discomfort of the bleacher seat,



The Grand Design

By Hawking Stephen and Mlidonow Leonard Bantam Books, New York 186 pages

Reviewer: Jarrett Barnhill MD DFAPA, FAACAP

Professors Hawking and Mlidonow take the reader on a journey in search of the theory of everything. Travelers reading this book will pass through the history of physics beginning with Democritus and “atoms” and the clockwork universe of Newton. Along the way they open the doorway to Einstein’s breakthrough into photoelectric effect, the effects special and general relativity and space time. Like Moses, Einstein helped birth quantum physics (quantized photons), but never crossed over into the Promised Land- he never accepted what Bohr and others did with his ideas. Even though he was wrong about quantum physics, Einstein seemed to speak for many of us.

This book analyzes the great dream of unifying gravity with electroweak and strong nuclear forces (gluons and quarks) into a “theory of everything”. But unit-ing gravity proves to be a difficult nut to crack. It seems more closely associated with mass and space-time and therefore related to more to general relativity and less so to the standard model of subatomic or microscopic studies (e. g. particle physics, quantum electrodynamics, and quantum chromodynamics). The authors describe one potential solution: string theory in which matter and quantum forces are tied together with a filamentous “it” that twists, twirls and vibrates into what we call the universe. For most of us this solution not only overwhelms descriptive language, it seems to replace human ex-perience with mathematics as the starting point for acquiring knowledge. In short, mathematical formulae might explain cre-ation ex nihilo better than Genesis 1.

“In the beginning” occurred sometime/place before 10 -43 seconds after the

singularity (Big Bang). Light, matter and energy as we know them were still in the “future”. Theoretical physicists postulate that this is the time when gravity, elec-troweak and strong-color forces were uni-fied. This was also the frame of reference when relativity and quantum physics were fused. According to the authors we have difficulty modeling these phenomena but there may be one source of insights: the “center” of black holes in which matter is so densely packed that the approach the early periods of unity or symmetry. Because we are blind to what happens beyond their event horizons, studying this phenomenon is still out of reach. Our hopes currently lie in experiments designed to crudely approximate the lower ranges of these unimaginable energies. Particle accelerators like the Large Hadron Collider at CERN are our primitive dis-secting tools (looking for the Higg’s boson or field that imparts mass to matter); time

machines (moving back to the singular-ity) and telescopes (peeping beyond the event horizon and into the center of black holes). Even though we have mathemati-cal descriptions and experimental hints of its existence the Higgs boson or field, we lack basic experimental and mathemati-cal insights into what is really going on in black holes.

But there is more. The authors raise the philosophical/theological questions: how and why are we here? Their answer lies in string theory and quantum physics. Both

destroy our notion of determinism and a predictable Newtonian universe. Hawk-ing and Mlinodow take the randomness of these models and apply them to the evolution of our universe. Some years ago Hoyle described a model of nucleo-genesis within ancient massive stars as a driving force to cosmic evolution, and ultimately our existence. He argued that heavy elements were born then spewed out in a cycle of birth-death-rebirth. Our sun is a grandchild or third generation star in this sequence. In this sense we are star children recycled from elements spewed into space when supermassive stars exploded their alchemized elements (carbon, oxygen, iron etc). Our just right sun (as in Goldilocks) was at the center of a metal rich accre-tion disc. The earth developed from these heavy elements within a habitation zone that permitted liquid water, a narrow range of radiation levels and temperatures.

Many are dubious of Darwin’s views of the randomness of natural selection, but Hawking and Mlinodow make a quantum leap beyond Darwin into a probabilistic universe. The “why” question brings prob-ability to the forefront: the universe could have unfolded in many directions and each might be associated with radically differ-ent laws of physics. This leap leaves Ar-istotle, Augustine, Thomas Aquinas, Kant and fellow travelers in its wake. It forces us to come to grips with the theological and philosophical foundations of what we once called the unmoved mover- in more controversial terms, the “intelligent designer”. Hawking and Mlidonow do not accept this design model. They counter with string theory variations in Lemaitre’s singularity (Big Bang): the bewildering mathematical modeling of string theory requires not one but 11 dimensions or universes.

For many this book leaves too much to chance and mathematics. We share Einstein’s discomfort with strange actions and forces. We are more comfortable with the first human looking at a comet or waning moon and asking “why”? For Hawking and Mlinodow, this “why” might be answerable in terms of the probabil-


Book ReviewsBy Assad Meymandi, MD, PhD, DLFAPA


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Being elected a Fellow of the American College of Phy-sicians in 2009 was a major accomplishment for Patel. He has also served on the Clinical Quality Committee of the Key Independent Physicians As-sociation, an organization of more than 140 physicians who promote quality assurance initiatives. Patel and Juneja were the first physicians in Wake County to be recognized by the National Committee for Quality Assurance.

In 2006, Patel joined other physicians in establishing the Triangle Indian-American Physician’s Society. “I real-ized that 15 to 20 percent of doctors in the United States are of Indian descent,” but they make up only 1 percent of the population. “We should give back,” he said. TIPS hosts Continuing Medical Education (CME) as a means of “establishing a professional collaboration between physi-cians of various backgrounds and fostering relationships with medical societies to bring

the best of medical attention to Triangle citizens,” Patel said. TIPS member physicians also serve patients at annual health fairs.

Two years later, he ex-panded his efforts to build a voice for Indian-Americans in the state. He is a founding executive member of the North Carolina Indian-American Political Action Commit-tee, which raises money for candidates of both political parties. The group hosted the first ever Indian-American Day at the state capitol in Raleigh in 2009, drawing state legisla-tors, Governor Bev Perdue, and members of the Council of State. Later that year, Patel joined a group of nine doctors who flew to Washington, D.C. to discuss Medicare reimburse-ment formula, tort reform and other policy issues with North Carolina’s representatives in Congress.

In 2010, Governor Perdue appointed Patel to the State Health Coordinating Council, a body that serves the N.C.

Department of Health and Human Services by directing the development of the annual State Medical Facilities Plan. In January of this year, Patel spoke before the GOP House Caucus Health Policy Com-mittee about ways to reduce healthcare costs for the state. He is currently also a member of the Legislative Cabinet of the North Carolina Medical Society.

Given his growing involve-ment in health care policy, it’s fair to ask whether Patel would consider a run for office him-self. He quickly answers, “No. I can work on shaping policy, but I love to come to the office to see patients. This is a dream job.”

At home, Patel and his wife Poonam are focused on their two sons, Sahaj, age 11, and Sahil, age 9. Above all, he wants them to build a strong educational foundation. “In the U.S.,” he said, “if you’re educated, you’re going to get a fair shot.” §


Physician ProfiLe continued from page 11nietzsche: continued from page 13

religious expression (mystics like Hildegard of Bingen excluded) to one that increasingly emphasized an identified composer and more secular modes of self-expression. The style of music morphed in tan-dem with the accelerating pace of socio-cultural change. As a result some 21st century critics of hard rock (heavy and/or death metal) suggest that the composer and lyri-cist are dying in popular culture. Yet according to my 25 year-old son there are widespread efforts to fuse Medieval, Mozart, Beethoven, Wagner and Bluegrass with metal. These steps are redefining not eliminating the composer as we know him/her. We are also seeing the dissolution/redefinition of the self in these synergetic art forms.

In literature, Shakespeare used poetic drama while later novel-ists like Virginia Wolff, William Faulkner, Latin American magical realists and modern poets struggled to capture and convey individual experiences through evocative lyricism or metaphors. Although writers grapple with troubling emo-tions, metaphysics and spiritualism, few would confuse the Faulkner’s Sound and Fury or TS Eliot’s The Wasteland, or Shakespeare’s King Lear with theological or philo-sophical treatises. These authors grappled with the limitations of language, plot and story-telling, the unpredictability of reality and the inner dialog or streaming of thought and perceptions. Applying Nietzsche’s hypotheses we wit-nessed a collision between Apol-lonian order- Dionysian sensuality and the inherent limitations of printed language.

For us the pace of technological and socio-cultural change plays out in music, literature, dance and the visual arts. But the arts do not occur in a vacuum. The tension described by Nietzsche and Green-berg is in constant flux and creates a sense of emotional uncertainty and social dissonance. Using this formula, our next series of article explore the contraction of artistic tastes due in response to changing ideas about self-expression. §


he had the stock but soon found it saying he never expected to get the money back. General Carr transferred the stock to Dan-iels and said pay me what you think it is worth when you can. Soon after, Daniels was elected state printer, which provided enough money to keep the paper going.

In 1891, The State Chronicle merged with The Call and The State Chronicle became a daily. In 1892, Thomas Jernigan, owner of The Intelligencer, purchased The State Chronicle for all debts and $2600 and in 1893 this combination merged with Captain Ashe’s News and Observer. Later that year, Daniels established a weekly, The North Carolinian. Making no money in the newspaper business, Daniels ac-quired a job as Chief Clerk of the Interior, working for Hoke Smith, and moved to Washington, D.C. In 1894, The News and Observer declared bankruptcy. Daniels, with General Carr’s backing, bought

the paper out of bankruptcy and kept it operating by sending $100 a month home from his salary. The paper cost $10,000. Daniels went on to become Secretary of the Navy and later Ambassador to Mexico.

The predecessor to The Raleigh Times was probably The Evening Visitor, which was started in 1879. There were numerous inconsistencies and The Visitor/Times was not in continuous publication until 1912 through 1989.

The building on Hargett Street, where The Raleigh Times Bar is located, was built in 1906. Even today you can see the name on the top of the three-story build-ing.

The Raleigh Times was first published under this name in 1901. In 1911, John A. Park purchased it and was editor and pub-lisher until 1955, a total of 44 years. Park was Raleigh’s first automobile dealer and in 1909 was issued Raleigh’s first license plate #100.

The News and Observer acquired The Raleigh Times on June 4, 1955 and pub-lished it until closing it in 1989.

The Carolinian came to Raleigh from Wilmington when P.R. Jervay, Sr. purchased The Carolina Tribune, a local African-American paper. It is still owned by the Jervay family and is published twice weekly.

The Mini-Page was founded by Betty Debnam Hunt, of Raleigh, in 1969 and is produced and published in over 400 news-papers across the country.

There is also The Technician, which is the campus newspaper for North Carolina State University.

I have not attempted to trace the history of The Cary News or The Wake Forest Weekly. §

*The writer is the Retired President & Pub-lisher of The News and Observer Publishing Company.

and a bronze star medal, Major Gold-berg secured a job designing airplanes with the Bendix Corporation. Unusual by to-day’s standards his 43-year career began and ended with one company. Bern spent his

free time in upstate New York fishing and boating. After being thoroughly drenched for several days, he checked into a hotel near Lake George to warm up. There he met Miriam Roth, a Philadelphian week-ending with girlfriends and soon the son and daughter of immigrants formed their own family.

Work led them to Bendix’s Fluid Power Division located in the Adiron-dack foothill city of Utica, New York. Bern’s career flourished while raising a son Richard, now a UNC physician, and daughter, Debbie, who teaches elemen-tary school in Long Island. He rose from engineer to chief engineer, production manager, and then plant manager. During that time he patented the gimbal rings for steering the Saturn and later generations

of space rockets that launched the U.S. manned space shots. He also designed generators for starting aircraft and

drive shafts for helicopters. Every time an aircraft with Bendix equipment on it crashed, he and his team held their breath hoping that their products had not been to blame. They were determined to never be the source of a catastrophe. Eventually, back in New Jersey, he became a group executive managing several factories. In addition to working he supported higher education by serving on the boards of and generously supporting Utica College and Mohawk Valley Community Col-lege, Monmouth College and Monmouth County Community College, and the YMCA. One benefit of moving back home was resuming tennis rivalries with some of his childhood competitors. He enjoyed doubles until he banged his head after hit-ting an overhead smash at the age of 78.

After retirement he nursed Miriam through a tumultuous four-year tussle with ovarian cancer supported by the compas-sionate team at Robert Wood Johnson Medical Center. Bern decided to move back to the town where his kid brother Sol (now in his late 80s) lived. He bought an apartment in Cedar Crest, a community for older adults perched on a hilltop in north-ern New Jersey. His window overlooks a reservoir that he fished in as a kid. He had spent a few years alone after Miriam’s death, but found the stimulation at Cedar Crest rejuvenating. Besides establishing a

cadre of mentally agile if physically frag-ile compadres, he participates in or leads a number of discussion groups that include Socrates Café, a current events club, and an opera group. He continues to advise his former colleagues, friends, and family on their lives and careers with a wisdom honed by ninety years of observation and reflection. Every morning he awakens with a sense of wonder and is delighted that the beat goes on. §


JournaLism continued from page 19

roLe modeL continued from back cover

Bernard Goldberg

downloaded onto the clinical record of any patient in the region being evaluated for community acquired pneumonia. This ex-change may prompt the provider to order additional tests for Legionella bacterial infection and institute appropriate antimi-crobial therapy.

In his 2004 State of the Union address, President George W. Bush challenged the nation to eliminate paper medical records within a decade. The federal funding is aligning to accomplish this challenge by 2015. Cost aside, society will also have to figure out ways to ensure that patient con-fidentially is not compromised. Ultimately patients will have the right to decide which elements of their health record they want shared on health exchanges. Public health laws currently exempt reportable diseases from patient confidentiality laws (HIPAA). It will be interesting to see how this plays out in the Information Age of meaningful use and robust health information ex-change. §

heaLth info continued from page 18

8 | apRiL 2011 • Wake county physician 8 | APRIL 2011 • Wake county physician

recounted that Pythagoras first recognized harmonics and described the effects of changing string length, width and tension on the vibrations produced when it was struck. They also stressed that from me-dieval to modern times, music often had a purely mathematical construct. Examples include: “A Musical Offering and “Art of the Fugue” by JS Bach, “Music for Strings, Percussion and Celeste” by Bartok (based on the Fibonacci scale), and the 12 tone system developed by Schoenberg. Rigardo-Floresl et al (4) also write about the “Music of Science” and point out the commonality of rhythm and patterns, and the fact that musical recognition and language develop simultaneously in the brain. It is of inter-est that Sinichi Suzuki, based his theory of talent education and his method of violin teaching (subsequently expanded to many other instruments) on the relationship be-tween music and language acquisition. For that reason his approach has often been la-beled “The Mother Tongue” method. Robert Root-Bernstein stated (3) that Max Planck’s notion of the quantum was “based purely on the mathematics of resonating strings, or harmonic frequencies” These relationships demonstrate the links between science and music but they do not explain the links be-tween musicians, physicians and scientists.

The most scientific approach to this ques-tion was carried out by Charyton and Snel-becker (5). They tested 100 music students and 105 engineering students at a North-eastern University, with a variety of vehicles to determine if there was a difference in general, scientific and artistic creativity in the two groups. Their hypothesis was that the two groups would demonstrate equiva-lent levels of general creativity, but that the engineering students would demonstrate

higher levels of scientific creativity and the musicians, a higher level of artistic creativ-ity. Their results suggested there although there were no “substantial” differences in general, artistic or scientific creativity, the musicians recorded a “modestly” and statis-tically significant greater degree of general and artistic creativity when compared to the engineers and that both groups scored higher in all categories than expected by normative data. It should be noted, however, that the sample size was relatively small, that the different types of engineering were grouped together and that no other scientific disciplines were studied. The authors also stressed that in their opinion, there were “serious questions” about the extent to which the existing testing tools, utilized in this study, were adequate to detect creativity levels in engineers.

So what about the anecdotal evidence and the theories? Einstein believed that intuition was a common trait of musicians and scien-tists. He stated that his Theory of Relativ-ity occurred by intuition and attributed his intuitive ability to the musical perceptions gained from his study of the violin, which he started at 6 years of age (reference in Root Bernstein (3)). I would submit that a fertile imagination is akin to intuition and a common trait of scientists, who frequently perform “mind experiments” before testing them in the laboratory and of composers and performers, who hear new themes in their minds before putting them on paper and new ways to perform established themes, before testing them in the concert hall.

Almost anyone who has thought at all about this is able to identify one or more intellectual or personality traits that they believe may contribute to the link between musicians and scientists. My friends and

colleagues have suggested the following for consideration: 1) the common use of symbols in science and in music 2) the rigor of the educational and training process, and its solitary nature 3) the desire to seek challenges, to take risks and to accept the failures that may occur when performances are not optimal, when experiments fail to produce expected results or when treatments are not effective or cause unanticipated adverse events 4) the desire to communicate and/or to perform, be it in writing, on the stage, in the operating room or in conference and lecture halls. In the final analysis, how-ever, I believe that at the very heart of the commonality between musicians, physicians and scientists are creativity, and the ability to find and to create beauty. § *Writer is the former chief of Cardiology and Foscue distinguished professor at UNC- Chapel Hill. He was born in Boston, Mass. attended Harvard College and the Univ. of Penn School of Medicine and served his resi-dency at the University of Vt’s Mary Fletcher Medical Center. Prior to coming to UNC in 1978, he was on the faculty at the Univ. Ky School of Medicine and an advanced research Fellow of the American Heart Association. He has published more than 150 papers and chapters concerned primarily with the electro-physiology of the heart, the pathophysiology of cardiac arrhythmias, the mechanism of action of antiarrhythmic drugs and the electrocar-diogram. He is also the author of a CD ROM entitled “ECG Tutor”. He has played the cello since age 13, has been a member of several symphony orchestras, including the Durham symphony and the Chapel Hill Philharmonia, and is an avid chamber music player. He is married to Ann Caldwell Gettes,MD, and they had 3 daughters, one of whom, Edith Gettes, MD has been a contributor to this journal.

Wake county physician • APRIL 2011 | 25

Table 1. Scientist-Composers*Ernest Ansermet (1883-1969) MathematicianGeorge Antheil (1900-1959) Endocrinologist and Inventor Joseph Auenbrugger (1722-1809) PhysicianM.A. Balakirev (1837-1910) MathematicianHector Berlioz (1803-1869) PhysicianTheodor Billroth (1829-1894) SurgeonRichard Bing (b. 1909) CardiologistAleksandr Borodin (1833-1887) ChemistDiana S. Dabby (contemporary) MathematicianEdward Elgar (1857-1934) ChemistJohn Conrad Hemmeter (1863-1931) PhysiologistWilliam Herschel (1738-1822) AstronomerElie Gagnebin (1891-1949) GeologistHilary Koprowski (b. 1916) MicrobiologistB.G.E. Lacepede (1756-1925) ZoologistAlexis Meinong (1853-1920) Experimental PsychologistAlbert Michelson (1852-1931) PhysicistArthur Roberts (nd—20th century) ChemistRonald Ross (1857-1932) EpidemiologistCamille St. Saens (1835-1921) Astronomy

Bela Schick (1877-1967) Microbiologist Joseph Schillinger (1895-1943) MathematicianWalter Thirring (b. 1927) PhysicistGeorges Urbain (1872-1938) Inorganic ChemistEmile Votocek (1872-1950) ChemistIannis Xenakis (b. 1922) Mathematician and Engineer

* References in Root-Bernstein (3)

References1. Cerda JJ. Art in Medicine: Musicians, Physicians and Physician-Musicians. In: Doctors Afield. Mary G MCrea Cumen, Howard Spiro, Deborah St. James Eds : Yale University Press, 1999; 228-2342. Bing, RJ. Composing Music and the Science of the Heart: How to Serve Two Masters. Leon-ardo 2008; 41:365-3663. Root-Berstsin RS. Music, Creativity and Scientific Thinking. Leonardo 2001;34: 66-68.4. Rasgardo-Floresl H, Abel MS, Correa MCG, Peria-Rasgadol C, RasgadoV. Science and Mu-sic; Music and Science; The Science of Music; The Music of Science (and the making of “Body Notes,” a Symphonic Suite About Human Physiology). The Physiologist.:2006;49:81-875. Charyton C, Snelbecker GE. General, Artistic and Scientific Creativity Attributes of Engineer-ing and Music Students. Creativity Research Journal 2007;19:213-225

Wake county physician • apRiL 2011 | 9Wake county physician • APRIL 2011 | 924 | APRIL 2011 • Wake county physician

On the Relationship Between Music and Physician/Scientists

By Leonard S. Gettes, MD*

(Editor’s Note: To the list of the notable physician/musician, one may add Jean Pierre Rampal (1922-2000), French flautist/urologist, and John Locke (1632-1704) the noted British physician/philosopher/musician/polymath. Locke was a colleague and contemporary of famed neurologist, Huntington (Huntington Chorea). Also, he is considered to be the intellectual father of America. In US Constitution, Thomas Jeffer-son quoted Locke frequently and verbatim. AM)

I think one reason I received a fairly good grade in Biochemistry as a medical stu-dent at the University of Pennsylvania

was that I was the cellist in a string quartet that read and sometimes performed the work the professor of Biochemistry (Sam Guerin) had composed the summer before at a work-shop in Maine. The workshop was directed by Ernest Ansermet who, at the time, was the musical director of the San Francisco Symphony Orchestra (and, unbeknownst to me, a mathematician - see below, table 1). That was the first time I was impressed by what appeared to be a relationship between music and science. Then I recalled as a col-lege student, I had played in a quartet made up of Harvard Medical students. (We called ourselves the Vanderbilt Quartet because we rehearsed in Vanderbilt Hall, the student residence at the medical school). In addi-tion, my room-mate in medical school was a concert level pianist who had debuted with the Philadelphia Orchestra at age 13 but sub-sequently chose medicine rather than music.

As I looked into this relationship more closely, I was amazed to find not only were there a number of renowned physical and bi-ological scientists and physicians who were serious musicians but also a sizable group of renowned musicians/composers were, or had been physical or biological scientists or phy-sicians. James Creda, himself a jazz pianist

and Professor of Physiology at the Univer-sity of Florida noted (1) Hector Berlioz, was a child prodigy and composer. However, he attended medical school for two years at the insistence of his physician father. It was only after a tortuous struggle and with the urging and support of others that music composition prevailed. Alexander Borodin received a degree in medicine and then be-came a prominent chemist, highly regarded for his work on aldehydes. He continued this work as a chemist even as he established his reputation as a composer. He was one of a group of 5 composers, the “Russian Circle of 5”, two of whom were also engineers. Edward Elgar, the English composer was also a chemist, and Fritz Kreisler obtained his medical degree and even served in the Austrian Army as a physician after being rejected by the Vienna Philhamonia. He then decided he preferred the violin to the scalpel and re-established him-self as a virtuoso violinist and composer.

Creda also noted Hermann von Helmholtz, the famous 19th century German Physicist, not only made great contributions to our understanding of acoustics, but was also a physiologist, who studied optics, and a physician who invented the ophthalmoscope. In addition, he was a skilled pianist and musician who wrote a textbook concerning the physiologic basis for the theory of music that became the standard in the field.

Other notable scientists and physicians include Theodore Billroth, the father of modern surgery who was a fine pianist and violinist and a great friend of Brahms. He played and critiqued many of Brahms’ chamber works before they were published and, in his spare time, was a music critique. Albert Einstein played the violin all of his life and was skilled enough to play with the Budapest String Quartet which, the story goes, chastised him for not being able to count. Albert Schweitzer was a renowned organist before he became a physician and turned his efforts to missionary medicine. He funded much of his work in Africa by

his own concerts and recordings. Renee Laennec, the French physician and the inventor of the stethoscope was a flautist. Richard Bing, a renowned cardiologist and basic scientist was also a cellist and highly regarded composer (2). Table 1, from the article by Root-Bernstein (3), is but a partial list of notable musician-scientists/physi-cians.

Symphony orchestras comprised of physi-cians and scientists are to be found in most large cities in the US and at several univer-sities and hospitals. There are 13 such or-chestras in Germany alone and other similar groups throughout Europe and the Far East. There is also a World Doctors Orchestra which was founded in 2007. Its conductor, Stephan Willich, is Prof of Medicine and

Director of the Institute for Social Medi-cine, Epidemiology and Health Econom-

ics at the Charite University Medical Center in Berlin,

Germany. He is also an accomplished violinist. A few orchestras comprised of lawyers also exist, but in far fewer numbers. A recent informal poll con-

ducted in the Chapel Hill (North Carolina) Philhamonia,

a totally amateur symphony orches-tra in a moderately sized University

town, revealed that approxi-mately 2/3-3/4 of the musicians were physicians, dentists, or physical and biological scien-tists including engineers (or

students thereof), and the quartet in which I play includes a molecular

biologist and a physicist. It therefore seems not unreasonable to conclude that there must be a discernable link between music and sci-ence. Indeed, it is noteworthy that Apollo, the God of Greek and Roman antiquity was not only the God of light, but also the God of medicine, healing, and music! The ques-tion then is: if we acknowledge that there is this link, what is it and can it be document-ed? I have concluded, after reviewing much of the available literature on the subject, there are quite a few theories but very little firm data to explain the relationship.

Many have stressed the relationship between music and mathematics. Rigardo-Floresl et al (4) [Continued on page 25]


Prashant Patel projects his voice and speaks with a friendly but seri-ous expression as he talks about

the crisis of obesity, which he considers “the greatest threat to national security.” Nearly two-thirds of Americans are either overweight or obese. More than 8 percent of Americans have diabetes, and millions

more are pre-diabetic, which put them at great risk of heart attacks and strokes.

Preventing those conditions and manag-ing them once they manifest is Patel’s pas-sion as a physician. “Very few people lose weight and lose it permanently,” he said. “That’s the greatest challenge we face as physicians.”

In 2000, Patel and Dr. Vijay Juneja co-founded Cary Internal Medicine. The private practice serves many members of the Indian-American community, among other patients, in Cary. In 2005 the part-ners expanded and founded The Diabetes Center, which Patel describes as “a critical

component of our practice.” The center is able to address many needs of diabetic patients that other primary care practices do not, such as managing insulin pumps. He’s proud of his and his partner’s ability to manage even tough cases of patients who are genetically predisposed to diabe-tes. “We attract high-risk patients, but we

try to do such a good job that we don’t have to refer them” to cardi-ologists and other specialists.

Patel also spreads the word about obesity and diabetes preven-tion to community groups, such as the Kiwanis Club and

the Rotary, and to the media. He’s been a guest on AM radio call-in shows, and delivered speeches to physicians as well

as the general public; he’s delivered more than 200 talks in six states.

“Medicine will get us only so far,” Patel said, underscoring the message he sends to his audiences, “but the patient will have to shop right, eat right, exercise and stick with the program.”

As he builds his practice in Cary, Patel is also helping to build a voice for Indian-American physicians and other profession-als across North Carolina.

When Patel was 2-years-old, he and his family left Gujarat, India, and immigrated to the United States. He grew up in the close-knit Indian-American community of Forest Hills, Queens, where he shared a one-bedroom apartment with his parents, sister, and a continuous stream of relatives newly arrived from India, spending a few days in the Patels’ apartment on the way to a new life. His parents spoke Gujarati

at home; to this day, his mother speaks little Eng-lish. As a child, he knew that knocking on a few neighbors’ doors could summon enough kids for a game of nine-on-nine baseball in the public park.

The 1970s and early ‘80s in New York were a tense time. Ethnic communities were more segregated than today. Crime was a major prob-lem, and Patel’s father was once mugged on the street. Rumors of “dot-buster” gangs who sought out Indians colored the atmosphere of Patel’s childhood. But his parents didn’t complain, nor did they allow their children to. “We personally never

let it get to us,” he said.It wasn’t the gangs or the

muggers that almost caused problems for Patel. It was his own unruly behavior as a young child.

Dr. Prashant Patel PHYSICIAN PROFILE: By Fiona Morgan


Dr. Prashant Patel with his wife Poonam

Photos courtesy of Dr. Prashant Patel

Dr. Prashant Patel with his wife, Poonam, and their sons, Sahaj (age 11) and Sahil (age 9)


To do good venipuncture, one needs good eyesight, good touch sensation, and good hearing as well as a good

knowledge of the flow of blood through the arteries, which have muscular vascular walls and operate under pressure in contrast to veins, which have no muscle fiber and serve only as channels for blood on its way back to the heart.

Why an article of this nature to a medically sophisticated audience?

Photo A of the right arm of a senior citizen shows a large vein on the forearm that is well anchored by an incoming branch, which will keep the vein from rolling. The patient needed an indwelling line before going into surgery. The nurse made two noble efforts to puncture the vein and, after failure, turned the job over to the M.D. who was supervising the procedure. The doctor was tall, handsome and strong, so he tightened the tourniquet to the point that it was painful and cut off any arterial flow into the arm. After his first at-tempt failed, you could feel tension in the air. After the second failure, he said, “Let it go. They can fix this in the O.R.”

What went wrong in the execution of this simple procedure?

1. The needle was too long and too sharp and beveled end. (See needle #1 in Photo B.) This beveled end is so long and so sharp that it does not poke a hole in the vein, instead it slices a gash in the side of the vein, and by the time the hollow core gets into the core of the vein, the long sharp end has already sliced its way into the back of the vein and is on its way out. If a blunter needle like needle #2 in Photo B had been used, it would have poked a hole in the side of the vein, a piercing which could have been felt and heard by the operator when the vein buckled in front of the needle and then went “flop” when the needle was actually piercing the vein. (For the sake of complete disclosure in science the photog-rapher touched needle #2 to an Emory wheel to make its bluntness more graphic.) But the fact is that the needle does not need to slice its way into the vein. It needs to poke a hole in the side of the vein.

2. A blood pressure cuff is not needed for a cuff, but it shows that if the tourniquet is tight enough to be half way between systolic and

diastolic pressure, the arteries can keep pump-ing in blood, and the flow out at diastolic pressure will stop or slow the venous return to the heart so that the vein will stay distended.

In order to feel the blunt needle puncture or poke a hole in the vein wall, it is well to use a needle a few times to puncture an orange. It gives the same feeling. A little practice (120 seconds) plus the proper blunt needle and usually less tourniquet pressure will make for a happier staff, who will feel less frustra-tion, and much happier patients, who will feel less pain and more confidence they are in the hands of an expert. §

THE ART oF vEnIpunCTuREBy Bruce Blackmon, MD

Photographs by Linda Blackmon Bourhill

It will surprise no one that

Donald Rums-feld emerges well from his long memoir. The quagmires in Iraq and Afghanistan, it appears, were everyone’s fault but his; ditto the failure to make timely use of America’s armed forces when Hurricane Katrina struck in 2005 and ditto a whole string of lesser blunders, such as Ger-ald Ford’s snubbing of Alexander Solzhenitsyn, which occurred while Mr. Rumsfeld was chief of staff at the White House back in 1975.

Expecting a mea culpa from a political memoir is like expecting modesty from Lady Gaga: it entirely misses the point. People like Mr. Rumsfeld don’t write books for the money; they want to justify themselves. And this Mr. Rumsfeld does reasonably well. Beyond the failure to admit any quilt, which will disappoint only those who were expecting the improbable; this book is interesting and even enjoy-able. Mr. Rumsfeld is the man who, in February 2002, used the phrase “unknown unknowns” to describe the main dangers in any possible confrontation with Iraq. Nearly a decade later, he is still attached to it, as is clear from the book’s title. He is rather less proud of his only other memorable line, said in response to the orgy of destruction that followed the fall of Saddam Hussein: “Stuff happens.”

The reason why this book is still a good read is the extraordinary amount that the author has contrived to pack into his life: a long spell in Congress, a varied series of jobs in Richard Nixon’s dysfunctional White House and then Gerald Ford’s the ambassadorship to NATO and two turns as defense secretary—as both the youngest and the old-est holder of that office—plus a reasonably illustrious business career in periods of enforced political idleness.

If only Mr. Rumsfeld had not responded to George Bush junior’s call-up in 2001, his career would have been judged by history as valuable and successful. Iraq, of course, has ruined all of that, and Mr. Rumsfeld will go down, along with Robert McNamara, as one of the two most calamitous holders of his position. His attempt to shift most of the blame on to others—mainly Condoleezza Rice, the then national security adviser, and Paul Bremer, the civilian administrator of Iraq—is successful up to a point. It is abundantly clear that Ms. Rice badly failed to serve up the right policy options to the present. And it is equally clear that Mr. Bremer’s two first edicts as head of the Coali-tion Provisional Authority—to fire every member of the Ba’ath party and to disband the Iraqi army—were catastrophic. Valiantly though he tries in these memoirs, Mr. Rumsfeld cannot avoid complicity in both of these debacles.

He was, of course, a central participant in the policy meetings that Ms. Rice chaired. And it really is no good blaming Mr. Bremer: Mr. Bremer worked for him, and if Mr. Rumsfeld has any argument with the two decisions, he could and should have taken them to the presi-dent. One amusing oddity emerges. In his quest to exonerate himself, Mr. Rumsfeld is quite prepared to include Mr. Bush—rightly—in his list of the guilty, the latest installment in a lingering feud between Mr. Rumsfeld and both generations of Bushes.

Yet despite the vast influence he wielded, especially in the original decision to go to war on flawed evidence, Dick Cheney (who once upon a time was Mr. Rumsfeld’s assistant) escapes with no hint of blame. A final judgment on how America came to blunder so badly in Mesopotamia is still pending: but this book, as well as being a fasci-nating history, is a clear statement by one of the defendants. §

Ducking and DivingFrom Wire Service


“In elementary school, bad behavior almost got the best of me.” Disruptive in class, unable or unwilling to participate in learn-ing, the young Patel was headed down the wrong path. “Nobody thought I would be a success,” he recalled. He credits his parents’ discipline with steering him back on course.

He loved math and science, and his parents encouraged him to excel in school. Patel decided he wanted to become a doctor. “The field of medicine is a noble field,” he said. “It involves not only mastery in the sciences but fairly good appreciation of the human mind or psyche. I also wanted the economic freedom to support my immediate family and extended community.”

Patel’s father had briefly attended medical school in India but decided to leave after se-vere hazing in school. He pursued a master’s degree in organic chemistry instead, without his father’s support, and had to tutor high school students in order to pay his way. In the U.S., he worked as a medical technolo-gist. Patel’s mother worked as a cashier.

Now their son was faced with a deci-sion between Cornell University, with its $35,000 annual tuition, and attending City College, part of New York City’s public university system, at an annual cost of $1,250.

“My parents were very supportive,” Patel says. “My father said, ‘You go to whatever college you want. I will work two full-time jobs if necessary.’ While my mother had very little education and married very young, she worked menial jobs just to contribute to my educational expenses. I remember being so happy when she stopped working once I graduated medical school.”

He decided on an accelerated seven-year medical program at the Sophie Davis School of Biomedical Education at City College. It offered an integrated baccalaureate educa-tion with preclinical education. Patel com-pleted the first two years of medical school as part of the undergraduate program and the last two at Stony Brook Medical School in Long Island. He went on to complete an internal medicine residency program at the University of Iowa Hospitals and Clinics in Iowa City, Iowa.

“For me, internal medicine provided a vast opportunity to see patients with a wide variety of afflictions, from the realm of mild ailments to terminal ones. I love what I do and I love helping people. Medicine also requires a commitment to a lifelong journey of learning. After all, it is a diverse and fluid field.”

BORN: 1970 in Gujarat, India

EDUCATION:1993, Graduated from the accelerated B.S./M.D. program at Sophie Davis School of Biomedical Education at City College of New York1995, M.D. from State University of New York – Stony Brook 1995-1998, Residency, University of Iowa Hospitals and Clinics, Iowa City, IA

CAREER HISTORY:2000-Present, Founding Partner, Cary Internal Medicine (caryinternalmedicine.com) and The Diabetes Center Cary, NC. (thediabetescenter.net), Director, The Dia-betes Center1998-1999, Attending Physician, Dove Internal Medicine/Union Regional Medical Center, Monroe, NC

HOSPITAL COMMITTEE APPOINT-MENTS: 2002-2003, Quality Assurance Committee, WakeMed Cary Hospital2004-2005, Special Care Committee, WakeMed Cary Hospital

COMMUNITY:2004-2005, Clinical Quality Committee, Key Independent Physicians Association, a 140+ physician organization in Wake County2004-2007, Continuing Medical Education Committee, North Carolina Association of Physicians of Indian Origin2004-2005, Executive Committee-Member At Large, North Carolina Association of Physicians of Indian Origin2005-Present, Leadership Council for Im-proving Cardiovascular Care2005-2006, Leadership Council-American Diabetes Association2006-Present, Cardiovascular Advisory Board Member2006-2008, Secretary, Triangle Indian-American Physicians Society, 2009-Present, President, Triangle Indian-American Physicians Society2008-Present, North Carolina Indian-Amer-ican Political Action CommitteeExecutive CommitteeJan. 14, 2011, Presented to the GOP House

Caucus Health Policy Committee regarding means of reducing healthcare costs for the State of North Carolina2009-Present, Guest Member-North Caro-lina Medical Society-Legislative Cabinet 2010-Present, Member- State Health Coor-dinating Council-Gubernatorial Appoint-ment by Governor Beverly Perdue (http://www.ncdhhs.gov/dhsr/ncshcc/)2010-Present, Member- State Health Coor-dinating Council- Quality, Access, Value (QAV) Subcommittee-2010-Present Pediatric Operating Room Working Committee-2011-Present

PROFESSIONAL SOCIETIES:American College of PhysiciansAmerican Diabetes AssociationAmerican Medical AssociationNorth Carolina Medical Society

FAMILY: Spouse, Poonam Patel, and two sons, Sahaj Patel, age 11, and Sahil Patel, age 9

FAVORITE LEISURE ACTIVITIES: Reading and playing with my kids.

FAVORITE BOOK: Team of Rivals: The Political Genius of Abraham Lincoln by Doris Kearns Goodwin

FAVORITE FILM: A Beautiful Mind be-cause it’s about the human spirit overcom-ing challenges beyond ones’ control

LIKES ABOUT THE TRIANGLE: It’s family oriented, and the people here value education as well as the arts such as Broad-way shows, the NC Symphony, and NC Museum of Art.

DISLIKES ABOUT THE TRIANGLE: I grew up in NYC and I haven’t been able to find my childhood favorite foods: falafels and real New York-style pizza with green pepper and onions. That’s probably best, though.

ADVICE TO YOUNG PHYISICIANS STARTING PRACTICE: Get involved in shaping state and national health care policy and be a strong patient advocate while providing quality medical care.

WISHES THE PUBLIC UNDERSTOOD ABOUT MEDICINE: The greatest threat to national security is the obesity epidemic. Also, medicine is effective only with a patient’s active involvement.

Prashant Patel, MD:


A Voice for Health

I feel so relaxed by the music that I almost can’t rise when the conductor signals us. The last movement, the Choral one, starts quickly, with violent excitement. It would not be practical to bring the chorus on stage now, which is why we had to sit through three movements, but it is a symptom of the complaint I lodge that a musicologist says that “ . . . the soloists sit on stage throughout the three preceding movements, an ordeal which Beethoven sublimely ignored.” The soloists, indeed! Poor souls. They are seated in comfortable chairs with backs. We stand and straighten joints long since locked into a hunched position. The orchestra plays a lengthy passage in which Beethoven toys with the earlier themes representing the world’s discord and then seems to hit on a new one, as if by accident. Some acci-dent! The kind geniuses have when they’ve thought about it a lot. The new theme is joyous, and he embellishes it, and suddenly the baritone soloist comes right out with it: “Friends, no more such discord! Joy! Freude!” And the basses answer, “Freude!” We’re into it, doing what we spent four months learning to do, and it is a glorious, overwhelming experience. When it is over there is thunderous applause, the soloists bow again and again and the orchestra is asked to rise, while the conductor embraces them symbolically and shakes the concert-master’s hand. He doesn’t forget the chorus; he waves in our direction, but since we are already standing we don’t even get to move and the audience hardly notices, yet we did most of the singing, and it is the zenith of our careers. Now contrast the work of the choral and solo singers. We cared and we tried. The soloists did too, but they only rehearsed once; we had sixteen sessions. They sat in chairs; we sat on boards. There are three thousand thirty-eight bars of music in the entire work. The chorus sang three hundred ninety-four. The soloists had one hundred thirteen, with each of them sing-ing only a fraction of those, yet when the performance was over, they took lots of bows and smiled modestly, and the soprano and alto were given flowers. Now I ask you! All that for less than three percent of the work? “All mankind shall be as brothers,” said Beethoven, but if that quartet were our brothers they would be among us, instead of acting like rich relatives at a redneck reunion. If they won’t join the chorus, then in my concert all one hundred twenty-eight chorus members will join them in parading off and on stage and bowing to the wild ap-

plause of thousands.

George M. StephensRaleigh, NC

The Editor:Your Beethoven 9th carries great in-

sights! Since you mentioned him, I offer the following quote from Tillich...

“Absolute faith, or the state of being grasped by the God beyond God, is not a state which appears beside other states of the mind. It never is something separated and definite, an event which could be isolat-ed and described. It is always a movement in, with, and under other states of mind. It is the situation on the boundary of man’s pos-sibilities. It is this boundary. Therefore it is both the courage of despair and the courage in and above every courage. It is not a place where one can live, it is without the safety of words and concepts, it is without a name, a church, a cult, a theology. But it is moving in the depth of all of them. It is the power of being, in which they participate and of which they are fragmentary expressions.” Paul Tillich

Beethoven traveled to the edge and glimpsed the Unknown, and then brought us back a miracle to enjoy.

Mike LindsayRaleigh, NC

[Writer is a poet. His most recent book of poetry and art is “Dying to Live”—Ed]

Etymology of Hogmanay

Here are a few thoughts on the Scottish heritage, taking off New Year’s holiday, and the word hogmanay. Decades ago, when I first came to US, learning English, I became fascinated with the etymology of the English words. Hogmanay was no exception. Although dictionaries tell you that the Scottish word’s progenitors are old French, especially 16th century language of Gaulois, words such as hoquinane and aguillaneuf (New year), the habit of taking a holiday was the influence of the Moore (711-1492) which continued into the 16th century in northern Spain and Southern France. So while the word is European, the custom and culture is from the East. Last year when we were in Edinburgh, at a formal banquet given by the Dean of Medical School, we were served Haggis! So, we have internalized a bit of Scotland’s gastronomy!

AM (Here is the response of one learned reader)

The Editor:As an amateur scholar of La Conviven-

cia (co-existence of Jews, Christians, and Muslims in Medieval Spain 711-1492); I am chastised because you, polymath that you are, are absolutely correct. Even though Hogmanay’s linguistic origins are likely in Languedoc and/or Catalonia, and the romantic in me says they may have passed through Eleanor’s reign (Aliénor d’Aquitaine, Éléonore de Guyenne), were traditions of Muslim/Persian, likely Zoroas-trian origin.

At the Battle of Poitiers (Tours) in 732, on the northern reaches of Aquitane, ‘Abdul Rahman Al Ghafiqi almost defeated Char-lemagne’s grandfather, Charles Martel, the same Charlemagne that briefly captured Barcelona in 797.

The battle pitted Frankish and Burgun-dian forces, Charles Martel, against an army of the Umayyad Caliphate led by ‘Abdul Rahman Al Ghafiqi, Governor-General of al-Andalus. The Franks were victorious, ‘Abdul Rahman Al Ghafiqi was killed, and Charles subsequently extended his authority in the south.

Had Abdul Rahman Al Ghafiqi defeated Martel, it would have been among those few battles in which a contrary event would have essentially varied the drama of the world in all its subsequent scenes, and Western Europe would have been a Mus-lim territory for many years, perhaps until today.

Regardless, Muslim rule in Al-Andalus was a time of relative prosperity and reli-gious freedom in Spain. Under the Caliph-ate of Cordoba, Muslims, “Mozarabes” (Christians living under Moorish rule) and a significant Jewish minority lived in peace.

Despite Alfonso VI of Leon Castile’s recapture of Toledo in 1035, one of the first actions of La Reconquista, La Conviven-cia continued to flourish, and the School of Translators (Escuela de Traductores) was established by Alfonso X the Wise (El Sabio) in the 13th century. They translated many Arabic and Hebrew works into Latin, making vast stores of knowledge available to Europeans for the first time.

As you and I have discussed, following the destruction of many of Alexandria’s libraries by Cyril’s gang of thugs in the 4th century, many of the works in Alexandria’s great libraries were secreted and transported across and thru North African centers of learning over the subsequent three centuries until their transport across the Straights of Gibraltar, after 711 to what became the great libraries of





Cardiac catheterization is a basic tool for cardiologists in the man-agement of patients with coronary

artery disease. Over the past two decades, refinements in the technique of coronary angioplasty and stenting have resulted in the procedure becoming an important option in the treatment of these patients. The procedure traditionally has been done from the femoral artery, the large artery to the leg. While access is much simpler and easier using this artery, hemostasis or stopping the bleeding after the cath-eter removal may be problematic. This is particularly true in more complex cases in which intensive anticoagulation is required for procedural success.

While the incidence of these bleeding complications has decreased significantly in the past ten years, it continues to occur in 3-5% of patients in whom catheteriza-tion is performed from femoral access. A variety of femoral artery closure devices have been evaluated; but these have not eliminated the problem, particularly after percutaneous coronary interventional procedures (PCI). More importantly, recent data has demonstrated that these bleeding complications are associated with a mortality risk. Indeed, long term survival in patients with PCI-related bleeding is significantly reduced when compared to those without bleeding.

Approximately 15 years ago, the con-cept of using the radial artery as an access site for catheterization procedures was proposed by Dr. Ferdinand Kiemeneij in Amsterdam. The artery is superficial, ly-ing over the radius bone in the forearm. It is thus easily compressible and hemostasis is simple with a very low risk of bleeding.

Multiple studies have now demonstrat-ed access site bleeding complications are virtually eliminated by using the transradial approach. Several hemosta-sis devices which selectively compress the radial artery while maintaining flow in the ulnar artery are currently available (Figure 1).

Another huge advantage of the transra-dial approach is that patients are freely ambulatory after the procedure. Because of the risk of bleeding associated with femoral procedures, patients must lie flat in bed for up to six hours with the associ-ated morbidity of back pain and bedpans.

Patients are encouraged to sit up, walk around, and use the bathroom after tran-sradial procedures and thus overwhelm-ingly prefer the arm approach. Nurses also prefer this technique since patients are more self-sufficient.

As a result of these benefits, transradial procedures are now performed worldwide in large numbers of patients. The adop-tion of the technique in the United States has been slower because the procedure has not generally been taught at teaching centers. There is a definite learning curve for cardiologists who were only taught the femoral technique. However, there are now numerous seminars at national meet-ings and transradial centers in the U.S., and most can learn the technique in fewer than 50 cases. With the recent demonstra-tion that PCI-associated mortality can be reduced with radial access, there is a definite groundswell of support for its use.

A disadvantage of the transradial approach is that this artery is not as large as the femoral ar-tery, and relatively small catheters must be used. However, there has been a consistent miniaturiza-tion of coronary stent

devices over the past decade and virtually all contemporary procedures can now be performed from the wrist. Also due to its small size, insertion of catheters may take longer, and there has been a reluctance to use this access in patients with acute coro-nary syndromes undergoing emergency procedures. However, these patients are intensively anticoagulated and have an increased risk of bleeding complications; thus, they present a compelling indication for radial access. With experience, transra-dial access can be obtained expeditiously and it should become the default strategy in these patients.

Reducing the cost of medical care today is a necessity and there are several op-portunities with transradial access. Simply eliminating bleeding complications alone will reduce hospital costs substantially. Patients require less nursing care after radial procedures and there is increased efficiency in the catheterization labora-tory holding area. Several studies in the past decade have now demonstrated that the risk of coronary stent procedures has become so low when performed from the radial approach that selected procedures can safely be done as an outpatient.

The transradial approach is now ac-cepted worldwide as an alternative access for coronary interventional procedures. It is anticipated it will be increasingly utilized in the future. §

Clinical CornerBy James Tift Mann, III, MD, FACC

TRAnsRAdIAL CARdIAC CATHERIzATIon

JAMES TIFT MANN, III, M.D.WAKE HEART & VASCULAR ASSOCIATES

Figure 1. Radial artery hemostasis device.


Few of us think about evolutionary biology, early infant development and culture change while enjoying

the experience of dance, symphonic music, opera or drama. Nor do we consider such pleasurable experiences tied to our in-nate capacity for play with ideas as adults. Neuro-physiologically play, like learning by imitation are key players in human evolution and brain development. Both are foundational to social attachment and once mastered with primary caregivers provide lifelong tools for processing increasingly complex social information. Embedded in this process is the transformation of lan-guage from infant directed speech (baby-talk) to conversation and social discourse. By early childhood we are ready to master specialized skills with symbols/imagination, social roles and rituals, work-related skills and in our industrialized culture, academic learning. But even as language increasingly dominates communication and learning, it never re-places prosody and nonverbal gestures as a means of conveying social-emotional informa-tion. In this sense the musicality and ballet of language persist.

Some Paleo-lin-guists hypothesize that pantomiming/imitating, dancing and music were vital to our neurological evolution. Imagine an evening when the “conversa-tion” consisted mainly of dancing, chanting and music as group members re-enacted the day’s experiences. We don’t know at what point these event recreations changed into pantomimed stories, proto-myths and rituals. Ethologically we might claim that dancing-singing-imitating and

proto-language complemented each other and gradually replaced grooming as the medium for social hierarchies (dominance), emotional attachment and social bond-ing. This metamorphosis may explain the power of music and dance to express the deeper magic of emotional communication essential to the arts.

Some years ago Leonard Bernstein (Neu-mann lectures at Harvard) explored the relationship between psycholinguistics and music. In this series of lectures Bernstein compared Chomsky’s hypotheses regarding the relationship between the deep structure of language and music. He concluded that music has more in common with poetry than prose, especially in the expression of transcendent, emotional experiences that are unmatched by syntax and conventional semantics. Our capacity to re-enact (drama)

and express emotional through dance also tap into the transcendent and

unconscious power of music. These skills are capable of expanding social and emotional relationships far beyond the

power of words alone. In the 19th century, the German

philosopher Nietzsche focused on the re-lationship between music, drama and language. In the Birth of Tragedy, he used Greek tragedy as the starting point for exploring the ever-chang-

ing relationship between music and drama. To Nietzsche, the

ancient Greeks were well aware that music stirred emotions in ways that words alone could not- music reached more deeply into the soul

by circumvent-ing reason and rational analysis. But the Greeks

were also aware of the dangers of heightened emotionality and the

need for balance. To Nietzsche, this awareness created a dynamic tension between two ancient modes of expression: the Dionysian world in which emotion, sensuality and loss of self; and the Apol-

lonian in which philosophical realism, individual will, search for meaning, and balance helped control the animal passions. In Nietzsche’s view, the philosophies of Socrates, Plato and mostly Aristotle fos-tered the ideal of balance between ego-dis-solving sensuality (Dionysian) and verbal expression, idealism and psychological insight (Apollonian). Yet art that enhanced self-reflection and heightened moral-ethical sensibilities was safer for the psyche and polis than regression and dissolution. As a result new modes of drama transformed the ancient power of music to arouse or tame the beast within. The chorus became the conduit connecting these elemental forces.

The transformation from mystical dis-solution to self-expression also affected “classical” Western music. Compare the Gregorian chants (monophony) of the 9th century; polyphony of the 14th century, 19th-20th century composers. By the height of the Romantic era, Richard Wagner (Nietzsche’s short lived egotistical friend) refocused opera within Apollonian-Dionysian tradition. His operas (music dramas) redefined earlier opera seria and buffa into music drama- both music and drama were on equal and complemen-tary footing. But change continued along many divergent pathways, passing through Schoenberg into today’s death metal. These transitions suggest devolution from the Apollonian (religious and classical music) back to the Dionysian reveries (the chaos of mosh pits and head-banging rock).

Yet according to composer and music scholar Robert Greenberg, these new forms are continuations of historical struggles to define music style and emerging, individ-ual creativity. Musical expression changed from spiritual and


Nietzsche: Tragedy, Music and Opera in Western CivilizationBy L. Jarrett Barnhill, MD, DFAPA, AACAP*


The death of Denis Dutton Faithful readers of this space recall the ar-ticle we had, several years ago, about Denis Dutton, a formidable 21st century patron of the arts. Denis recently died of cancer of prostate at age 66. The late man of letter was the creator of a popular website, Arts & Letters Daily, A forum for debate, discus-sion, ideas, criticism and scholarly analysis of news related to the arts. One critique assesses Professor’s Dutton’s online work: “The judicious deployment of links amount-ed to a rare and extraordinary form of online arts patronage…”

Denis was not really an art collector, he was not burdened by huge wealth, and he did not dine with the likes of Jean Claude Gaudin and Louvre Director Henri Loyrette. He was a professor of philosophy at the University of Canterbury in Christchurch, New Zealand. His untimely death on December 29, 2010 has left his fans and friends stunned. Here is a little glimpse of the interior wall of the architecture of his thought processes. The lines are clear. There is no academic ob-structionism in his presentation: “Authentic,” like its near-relations, “real,” “genuine,” and “true,” is what J.L. Austin called a “dimen-sion word,” a term whose meaning remains uncertain until we know what dimension of its referent is being talked about. A forged painting, for example, will not be inauthen-tic in every respect: a Han van Meegeren forgery of a Vermeer is at one and the same time both a fake Vermeer and an authentic van Meegeren, just as a counterfeit bill may be both a fraudulent token of legal tender but at the same time a genuine piece of paper. The way the authentic/inauthentic distinction sorts out is thus context-dependent to a high degree. Mozart played on a modern grand pi-ano might be termed inauthentic, as opposed to being played on an eighteenth-century forte-piano, even though the notes played are authentically Mozart’s. A performance of Shakespeare that is at pains to recreate Elizabethan production practices, values, and accents would be to that extent authentic, but may still be inauthentic with respect to the fact that it uses actresses for the female parts instead of boys, as would have been the case on Shakespeare’s stage. Authenticity of presentation is relevant not only to perform-

ing arts. Modern museums, for example, have been criticized for presenting old master paintings in strong lighting conditions which reveal detail, but at the same time give an overall effect that is at odds with how works would have been enjoyed in domestic spaces by their original audiences; cleaning, revar-nishing, and strong illumination arguably amount to inauthentic presentation. Religious sculptures created for altars have been said to be in authentically displayed when presented in a bare space of a modern art gallery.”

Majestic Justice With astonishment and awe, I sat and watched the court proceedings of the former Governor Michael Easley on television. Astonishing, because a former Chief Execu-tive Officer of a sovereign state was being sentenced. Awe, because of the majesty of the rule of law in America. America may be down financially, retrenched economically, and our state may have a three billion dollar budget deficit, but nowhere on earth the holi-ness and supremacy of the rule of law are so cherished and enshrined. God has blessed our beloved nation, the United State of America, and we are blessed to be Americans.

Balancing the Budget A relative from Iran writes: drastic reduc-tion in fuel and food subsidy has made Iran to resort to draconian measures in economiz-ing. Among money saving strategies is for the families of the executed dissidents to receive a bill charging them for the expenses incurred by the execution and the cost of the bullets and/or rope in case the prisoners are hanged, like the recent case of Ali Akbar Siadat who was accused of spying for Israel and Ali Saremi accused of ties to a govern-ment opposition group.

What a creative way to meet the deficit and balance the country’s budget. What a wonderful feeling to know that we live in America, where the supremacy of the rule of law and individual freedom are respected, observed and practiced.

Thomas Jefferson on Education The gut wrenching story the Wake County Board of Education may invoke a four day

school to accommodate its budget, N&O, December 27, front page story, is profoundly dismaying. We need to do what we can to increase and enlarge children’s opportunities for schooling, for learning and for develop-ing their brains. Not to cut them. The first and I believe the only “education” President, our third, Thomas Jefferson, in 1781 wrote about educating children born in America. He described the process of education as a child willing to teach, a teacher who knows the subject and is willing to teach, and a place to do it. Jefferson was for public educa-tion and as a part of his small government strategy saw no role for bureaucracy to con-taminate the simple but effective pedagogic triad he described. In Jeffersonian spirit, may I suggest addition of another strategy to money saving list. Do away with the vast and unwelcome bureaucracy in our educa-tional system. Do away with these palatial edifices, board rooms and clipboard carry-ing “consultants” who can glibly recite the federal alphabet soup of organizations and governmental entitlements; and spend that money on extending the hours of learning and the salaries of our embattled teachers.

Hubris in Secular Bioethics In preparing a “Thinking Things Through” piece for my monthly “Meymandi At Large” column, the hubris of secular bioethicists and ignorance of religious and “metaphysical” bioethicists stood out. I have been read-ing and in many cases re-reading he great enlightenment thinkers such as Hegel and Kant. But since my focus is medicine, I have enjoyed re-reading essays by H. Tristram Englehardt (a new book, collection of his essays, edited by Iltis and Cherry, is out), Childress, Beauchamp, and Veatch, and oth-ers, among them, Kavney and Tollefson, and of course 20th century polymaths, Foucault and Derrida. I am requesting that our readers write you’re your views related to this mat-ter. Meanwhile, Englehardt’s essays while not a canonical text gives us good reading. I will have a review of his book in a future issue of WCP magazine. §


Editor’s NotebookBy Assad Meymandi, MD, PhD, DLFAPA

Whether one regards The News & Observer affectionately as “The Old Reliable” or less so

as “The Nuisance & Disturber,” there is no argument that the newspaper has been a force in North Carolina since its early years. It is guided by both tradition and innovation.

Though staffing and circulation have retreated during the economic downturn, today’s N&O is highly regarded for its watchdog coverage of state government, tenacious investigative reporting and energetic and insightful coverage of the region’s college and professional sports teams. Consider these ways in which jour-nalism by The N&O has made a difference to North Carolina in the past year alone:

Governor Mike Easley’s conduct in office was the subject of a series called “Executive Privilege.” The reporting contributed to the resignation of N.C. State University’s chancel-lor and provost and Easley’s be-coming the first North Carolina governor to admit to a felony.

“Agents’ Secrets,” which showed how agents and analysts at the State Bureau of Investiga-tion ignored or twisted the truth and pushed past the bounds of science to support the prosecu-tion, resulted in new SBI leader-ship, changes to procedure and legislative hearings to reshape the agency.

Today’s News & Observer leaders and journalists view their work in the context of public service, but the paper’s roots lie in a more partisan and rambunctious time.

Today’s N&O traces its history to Aug. 12, 1894, when Josephus Daniels pur-chased the paper for $10,000 at a public auction. It would remain in his family’s hands for 101 years. Daniels borrowed the

money from Democratic Party stalwarts, and the paper was intended to advance the party’s interests and agenda.

(The paper that Daniels bought pub-lished daily with a circulation of 1,800 and a $7 annual subscription. Its lineage dates to 1865, when The Sentinel was founded; it was absorbed by The Observer, which merged with The News in 1880 to become The News & Observer.)

After buying the paper, Josephus Daniels continued to work at the Depart-ment of the Interior in Washington, D.C.. In 1897, he moved home to Raleigh and, expecting his tenures as Secretary of the Navy and U.S. Ambassador to Mexico, stayed on as editor of The News & Ob-server until his death in 1948.

In an era of “personal journalism,” in which editors wielded influence to ad-vance causes, Daniels used the newspaper to promote open government and better schools and to oppose “demon rum” and

child labor. Politics were prominent in the paper’s coverage, and in 1934, “Under the Dome” was launched.

Upon the death of Josephus Daniels, the News & Observer torch passed to his four sons. Jonathan Daniels would serve as N&O editor for 20 years, and Frank Sr. as president and later publisher for decades.

In 1950, the N&O launched a feature called Tar Heel of the Week; it continues to this day.

The 1950 and ’60s were eventful for the Danielses: In 1955, they bought The Raleigh Times, an afternoon newspaper. In 1956, they moved the operation to McDowell Street. To celebrate its 100th anniversary in 1965 (remember “The Sentinel”?), the paper published its largest-ever edition – 332 pages that weighed 4.5 pounds.

In 1968, the family hired Claude Sitton, a New York Times veteran, to watch over both news and the editorial pages. Sitton ushered in a watchdog era of crusading journalism focusing on civil rights. In 1983, he would receive the Pulitzer Prize for commentary.

Sitton was succeeded as executive edi-tor by Frank Daniels III, whose love of technology would leave a lasting mark on the paper. Under his leadership, journalists

pioneered computer-assisted reporting, a sophisticated method of data analysis. (Frank Daniels Jr., had suc-ceeded his own father as publisher in 1971.)

The Daniels family had long embraced technology; in 1973, the paper installed its first computerized system for writing and editing stories. Twenty-one years later, it would launch nando.net, one of the first internet service providers and online news sources.

In 1995, the family an-nounced the sale of the company – The N&O, nando.net, and several community newspapers – to the McClatchy Co. of Sacramento, Calif. Publisher Frank Dan-iels Jr. retired at the end of 1996 and was succeeded by Fred Crisp. In January 2000, Orage Quarles III became president and


By Felicia Gressette*

North Carolina Treasures


The News & Observer


HIsToRy oF jouRnALIsm In wAkE CounTy, RALEIgH, noRTH CARoLInA

By Frank Arthur Daniels, Jr*

These are just a few of the people and newspapers that have come and gone in Raleigh. There have probably been a couple of hundred newspapers published in Raleigh and

Wake County.The first newspaper was a weekly founded by James Davis,

in 1751, The North Carolina Gazette. At the time Raleigh had a population of 669. The first daily was published November 19, 1850, to a population of 3000.

William Boylan started The Minerva in 1799 as a Federalist Party newspaper. Several months later, Joseph Gales from Eng-land established The Raleigh Register as a Republican paper.

Boylan was state printer, which paid him a sufficient stipend on which to live. Gales competed for this position which became so heated the two got in to a fight on Fayetteville Street. Boylan threw one punch and Gales later sued Boylan and won $100, which he used to start The Raleigh Academy.

Both Boylan and Gales were active in the development of Raleigh with Boylan turning his interest to land, acquiring 217 acres of Joel Lane’s property which later became Boylan Heights. Boylan acquired the Yates Mill and Crabtree Plantation property and at his death in 1861 was the owner of six plantations in North

Carolina and Mississippi.Gales, in addition to The Ra-

leigh Register, served as Mayor and participated in numerous successful businesses during his lifetime. His son, Seaton, joined The Register in 1848 and was the first college-trained editor in the state. The Register became the first daily and was the first to receive telegraphic news.

Newspaper owners were either printers who employed editors to write the news and opinions or were editors who employed printers to publish them. Raleigh has been blessed with some gifted editors and writers over its long history. Walter Hines Page, who eventually moved to New York to write for magazines, started a publishing house and was ambassador to England under Woodrow Wilson.

The North Carolina Standard was started in 1843 and ran through the civil war. W. W. Holden acquired the paper and made it a financial success. It was the official origin of the State Demo-cratic Party. Initially, he strongly supported secession but soon realized the futility of the war and became a leader for peace. He was an organizer of the Republican Party and elected Governor in 1868. In 1870 he sent troops to suppress the Klan, declaring a state of insurrection. Soon thereafter he was impeached, found guilty and turned out of office.

Josiah Turner was editor of The Raleigh Sentinel, which later was absorbed by The Observer and then merged with The News in 1880. Turner led the fight to impeach Holden.

Samuel A’Court Ashe of Wilmington attended The Naval Academy and rose to be Captain in the Confederate Army. He was a lawyer, member of the NC House of Representatives, a staunch Democrat and the father of nine children. He became editor of The Raleigh Daily News and soon purchased The Daily Observer merging them in 1880. He continued to publish The News and Observer until 1894 when it was acquired by Josephus Daniels.

Josephus Daniels, grandfather of the writer, loomed large in the newspaper world of Raleigh from 1883 until his death in 1948. Captain Randolph Shotwell owned The Farmer and Mechanic, which was losing money. Walter Hines Page had turned The Chronicle over to F.B. Arendell when he moved to New York City which was also losing money, so they merged in hopes of being able to succeed and The Chronicle was the surviving name. Cap-tain Shotwell had been elected State Librarian and therefore had some money and thus ended up with the majority of the stock.

Being the honorable man that he was, Captain Shotwell, who had been borrowing money from General Julian Carr over a period of years to meet his payroll and expenses, endorsed the ma-jority of his stock in The Chronicle to General Carr. Two months later, Captain Shotwell died. Right after the funeral, Daniels took the train to Raleigh to try to acquire The Chronicle. Upon arriving he learned that General Carr was the owner so he took the train to Durham. General Carr didn’t know [Continued on page 26]

James Davis, The North Carolina Gazette, 1751William Boylan, The Minerva, 1799Joseph Gales and son Seaton Gales, The Raleigh Register, 1791Thomas Henderson and D. Calvin Jones, The North Carolina Star, 1808W.W. Holden, The Standard, 1843Josiah Turner, Jr., The Sentinel, 1865Walter Hines Page, The State Chronicle, Walter Clark, The Raleigh NewsWilliam Sanders and Peter M. Gale, The ObserverSamuel Ashe, merged The News and Observer, 1880Josephus Daniels, The North CarolinianHal W. Ayer, The Raleigh Visitor and The Evening CallThomas Jernigan, The IntelligencerJohn Park, The Raleigh TimesP. R. Jervay, Sr., The CarolinianThe Biblical RecorderThe Progressive Farmer

Wake county physician • apRiL 2011 | 1518 | apRiL 2011 • Wake county physician

By Jeffrey Engel, MD North Carolina State Health Director

Public Health Issues

“HEALTH iNFORMATiON TECHNOLOGY iS THE CiRCULATORY SYSTEM FOR THE ViTAL ORGANS OF HEALTH CARE.”

The Information Age has reached the practice of medicine. Bolstered by billions of dollars of new public

and private investments and the promise of improved healthcare quality (better outcomes and controlled costs), electronic medical records will soon be seen in almost every encounter an individual has with the health care system.

Laboratories were the first entities to use electronic records. The machinery and numerical outputs lend themselves naturally to a world of bits and bytes. In the pre-Information Age (dare I say the Dark Age?), I remember in medical school in the 1970’s retrieving lab slips on my patients that were hand-transcribed carbon copies of hemograms and chemistry panels. Rapid improvements in hardware, notably speed and memory, enabled al-phanumeric and imaging data to be added to the electronic record. Hospitals adapted quickly investing in information technol-ogy departments which ran mainframe computers that managed most business and clinical operations.

In the past decade, the World Wide Web, also known as the internet, has become ubiquitous in all corners of the world. With wireless technology, one can access huge amounts of information on a handheld device like a cell phone or a laptop. Software advances allow rela-tional databases to run on the internet on “virtual” mainframes, also known as serv-ers. A user anywhere in the world with a proper device, identification and password can access their personal health record anywhere and any time.

These technological advances and the societal pressure to improve healthcare quality have elevated the concept of health information exchange from a theoreti-

cal construct to a platform that is coming into practice. The clinical benefits of an exchange are obvious. Having the medical record available at the point of care en-ables providers to more accurately assess patients with significant past medical his-tories. On an exchange, recent discharge summaries and clinic notes, labs and imaging studies, and a current medication list are instantaneously available. Hence, unnecessary duplication of tests and drug toxicities can be avoided improving qual-ity and reducing cost of the care episode.

Health information exchange has led to a strategy of “meaningful use” criteria, whereby the government, information technology vendors, providers and patients align incentives to create systemic im-provements in healthcare delivery.

Meaningful use of health information includes, for a start, these four criteria:

• Structured laboratory results reporting,

• Electronic prescribing,• Sharing of clinical record

summaries, and• Public health reporting.The public health reporting meaningful

use criterion on the health information ex-change focuses initially on disease surveil-lance and reporting and immunizations. The reportable communicable diseases (refer to Wake County morbidity table on page 17) are amenable to automatic report-ing to public health agencies from an elec-tronic medical record. The best examples are from electronic laboratory reports of positive microbiologic results for tubercu-losis, Salmonella, gonorrhea, chlamydia and many others. Certain serologic results can also initiate a public health report such as a positive immunoglobulin M (IgM) for hepatitis B core antigen which in the

proper clinical setting (i.e. acute onset of jaundice) fulfils the surveillance definition of an acute case of hepatitis B. Timeliness and accuracy of reporting of these diseases will greatly enhance the ability of public health to respond to potential outbreaks and epidemics. New cancer diagnoses (in-cidence) are also reportable by physicians to public health. An electronic exchange of clinical information including ICD 9 or 10 codes, imaging results and labs could be designed to automatically update the state cancer registry.

A health information exchange can also be programmed to automatically populate the state’s immunization registry. Here, pediatric practices will greatly benefit because they will no longer have to do double-data entry of vaccine administra-tion into both the clinical record and the North Carolina Immunization Registry, as is current practice. Since many vac-cines are given outside the medical home, particularly the influenza shot, a patient’s medical record can be kept up-to-date from multiple points of care. Since flu shot campaigns have now expanded to the retail pharmacy sector and school-based clinics, this meaningful use of an ex-change between the registry and the medi-cal record has obvious benefit for public health practice during routine flu seasons and pandemics.

The public health reporting and ex-change can work as a two-way communi-cation tool to providers. Alerts can be sent to providers via the electronic medical re-cord that are specific to certain community situations and individual diagnoses. An example might be a Legionnaire’s Disease outbreak in a community that is known to the local public health agency. A disease alert could be

DAVID BLUMENTHAL, M.D., NATIONAL COORDINATOR FOR HEALTH INFORMATION TECHNOLOGY


Poetry Corner


You who haven’t studied planets in the space,You who haven’t gone to the wine-bibber’s place,You who know not your gain or your loss,How can you reach the dwelling of the mistress?

My pain and my cure is from the friend,My union and parting is from the friend,Should the butcher pull my skin off my flesh,My soul shall never stay apart from the friend.

Happy mountains, happy mountains and the plain,Happy those who sowed these buttercups in the plain,Where are they? Where they went? Where shall they go- those mountains, the deserts and the plain?

A groaning farmer in this fated field,With bloody eyes lilies sowed and tilled,He sowed and sowed and I heard him say: AlasOne must sow them and leave them in this field.”

He who is a lover fears not to die,A lover neither fears jail nor the iron tie,A loving heart is like a hungry wolf,For the wolf doesn’t fear a shepherd’s cry.

Happy are those who are fools indeed,Who can neither write nor can read,Who like lover Majnoun wander in the desert,Or roam in the mountains and the deer they feed.

I’m that old man, libertine they call me,I own neither an anchor, shed or family;All the day I wander through the world,At nights I lay on dust in the alley.

God forbid the day when in the tomb they will lay,And cover my body with gravel and clay,Neither I shall have legs to escape serpents,Nor hands to fight worms who will eat my body away.

I complain from the inverted spheres, For my heart is bleeding with a thousand cares,My darling is surrounded by pointed thorns,How can I be merry with all these cares?

Come mourners, let us together mourn,From the faithless darling, let’s together mourn,Let’s sit with lover bulbul (nightingale) in the garden,If the bulbul (nightingale) fails to lament, we shall mourn.

When I look at the plain I see you there,When I look at the sea, I see you there,

Wherever I look, whether in mountain or dale,I see your beautiful image painted there.

I am the sea compressed into the bowl,I am the dot that completes the vowel,In every thousand men one rises higher,I am the best of men, the most civil.

A thousand pains torture my chest,A blazing furnace glows in my breast,At down when I break into sigh, beholdA thousand rivals are burnt by the tempest.

Should my hand the revolving spheres reach,From Almighty Maker I shall ask which is which?Why one man must enjoy a hundred bounties,Yet another eat oats running in the bloody ditch?

On Alvand’s skirt a flower I planted,I watered all the day, well tended the bed,When it grew and I sought its heavenly scentThe wind blew the perfume, to other regions spread.

I regret, I regret, I regret, When I see the caravan pass quit by sunset,To all the ancient world has been faithless,In vain we carry the load, in vain we sweat.

Old have I grown, my wit is dead,My vigor is spent, my youth expended,They tell me to go and watch the buttercup,What can I see? My eyesight is fled.

My heart’s grief resembles the wailing reed,All the time for your absence I’m worried, I must burn and lament, till doomsday I must burn,God knows when doomsday will dawn indeed.

At dawn I chanced through tombs to pass,I heard a groaning voice sigh and wail across;A scull was addressing the earth, saying:“This world is not worth the grass.”

Drunk though with red wine our faith is in you,Weak and helpless though, we believe in you,Whether Zoroastrian, Christian or MuslimWhatever our faith, we worship only you.

Your portion is to inflict pain, mine to bear,Your lot is to shed blood, mine to drink with tear;Shall you hear my wailing if I lament?Sweet is the sword from you as my neck to my dear.

Selected quatrains of Baba Taher Oryan

Manavaz Alexandrian, Translator


Quarterly Morbidity ReportBy Jeffrey Engel, MD North Carolina State Health Director WCP Magazine Public Health Editor

The Morbidity Table includes the number of reportable diseases and conditions reported to the Wake County Department of Health and Human Services by Physicians and labora-tory directors as man-dated by NC Law. The list of reportable diseas-es is not comprehensive as rare diseases with zero case reports (e.g. CJD, Leprosy) are not shown. For a complete list of reportable conditions see: (http://www.epi.state.nc.us/epi/gcdc/manual/reportable_dis-eases.html)

The Morbidity Table is offered by the Public Health Committee of the Wake County Medi-cal Society.

4thQtr YTD (Q4) YTD (Q4) Condition 2010 2010 2009

Wake County Morbidity Table(Preliminary data, as of 01/25/2011)

Campylobacter 26 64 45Chancroid 0 1 0Chlamydia 884 4530 2893Cryptosporidiosis - 2 5Cylcosporiasis - - 1E Coli 4 11 13Ehrlichia, HGE 1 4 -Ehrlichia, HME 3 43 18Gonorrhea 234 1249 804Haemophilus influenzae 1 11 12Hepatitis A 1 2 6Hepatitis B - Acute 2 4 7Hepatitis B - Chronic 40 119 104Hepatitis C - Acute - 1 1HIV/AIDS 41 190 189HUS - - 2Legionellosis 2 3 3Listeriosis 0 1 3Lyme disease 7 108 102Malaria 1 14 3Meningococcal - 1 -Non-gonococcal urethritis 80 372 291Pertussis - 10 10PID 35 192 115Rocky Mountain Spotted Fever 9 83 49Salmonellosis 138 259 220Shigellosis 6 14 10Streptococcal infection Group A, Invasive 1 13 10Syphilis, Early 19 84 115Tuberculosis 13 36 22 Toxic Shock Syndrome, streptococcal - 2 -Typhoid acute 2 3 2Vibrio Infection, Other - 1 1

Notes: The data presented are based on cases reported in the most current year. (i.e., comparative of previous year may not be comprehensive for cases reported in that year.) If no events were reported for a disease for all three periods, the disease is not listed.

The report is based on the date the case was accepted as ready to report to the CDC by DPH. This date is the one used in the calculation of MMWR week/year.

HIV and AIDS cases that are diag-nosed/reported in prisons (state, federal) are excluded from this report so that the totals (for Wake County)

match those published in our quar-terly surveillance report. Incomplete reports are not included

Starting 3rd Qtr 2010, table includes suspect cases for tick borne diseases and Malaria not previously displayed and Bacterial STD cases as reported through NC EDSS.