wcpm january 2014

contents

4 wcms update

8 6

10

welcome new wcms members

wcms alliance update

medication non-adherence

18 book review: five formidable geniuses

14 madness in women: euripides and medea

17 become a wcms member

WAKE COUNTY PHYSICIAN | 1

Publisher

Editor

Wake County Medical Society

Officers and Executive

Council

Council Members

WCMS Alliance

Co-Presidents


Paul Harrison

2014 President | Patty Pearce MD Secretary | Patricia Pearce, MDTreasurer | Patricia Pearce, MD President Elect | Andrew Wu, MDPast President | Dick McKay, MD Founding Editor | Assad Meymandi, MD, PhD, DLFAPA

Terry Brenneman, MDMaggie Burkhead, MDWarner L. Hall, MDKen Holt, MDM. Dixon McKay, MDAssad Meymandi, MD, PhD, DLFAPARobert Munt, MDDale Oller, MDPatricia Pearce, MDDerek Schroder, MDMichael Thomas, MD Brad Wasserman, MDSusan T. Weaver, MDAndrew Wu, MD

Deb Meehan Louise Wilson

WCPM

Wake County Medical Society2500 Blue Ridge Road, Suite 330

Raleigh, NC 27607 Phone: 919.782.3859

Fax: 919.510.9162 [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.”

January 2014

contributors

L. Jarrett Barnhill, MD is a professor of Psychiatry at the UNC School of Medicine and the director of the Developmental Neuropharmacology Clinic within the Department of Psychiatry. He is a Distinguished Fellow in the American Psychiatric Association and Fellow in the American Academy of Child and Adolescent Psychiatry.

Cheryl Viracola, Pharm Dis a Doctor of Pharmacy and has worked for Community Care of Wake and Johnston Counties since 2006 as a Network Pharmacist and is currently CCWJC’s Pharmacy Programs Coordinator. She received her Doctor of Pharmacy and Bachelor of Science in Pharmacy from UNC-Chapel Hill. At Community Care of Wake and Johnston Counties, Cheryl’s primary role is to coordinate communication among patients, providers, case managers, and community pharmacists as well as assist with the education, coordination, roll-out, and oversight of all pharmacy benefit programs within the network.

Additional contributors include:Paul Harrison | WCMSPam Carpenter | Membership Manager, WCMS

2 | JANUARY 2014

Assad Meymandi, MD, PhD, DLFAPA is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.

Wake County Physician Magazine (WCPM) is a publication for and by the members of the Wake County Medical Society. WCPM is a quarterly publication and is digitately published January, July, April, and October.

All submissions including ads, bio’s, photo’s and camera ready art work for the WCPM should be directed to:

Tina FrostGraphic Editor [email protected] 919.671.3963

Photographs or illustrations:Submit as high resolution 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.

Contributing author bio’s and photo requirements: Submit a recent 3” x 5” or 5” x 7” 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”. All photos will be returned to the author. Include a brief bio along with your practice name, specialty, special honors or any positions on boards, etc. Please limit the length of your bio to 3 or 4 lines.

Ad Rates and Specifications:Full Page $800 1/2 Page $400 1/4 Page $200

Cover photo: Fayetteville Street, Raleigh NC 1910


4 | JANUARY 2014

Patty Pearce, MD, Wake County Medical Society President 2014 congratulates Dick McKay, outgoing 2013 WCMS President for

outstanding leadership during the past year. Dick, who also volunteers physician services through several nonprofit programs in Wake County, oversaw the separation of the Community Health Foundation from the Medical Society with the establishment of a new board of directors for the Foundation I 2013. WCMS started the Foundation in 2000 with one community service program,

Project Access of Wake County. Since that time, the Foundation has grown to offer several service programs including Community Care of Wake and Johnston Counties and the Capital Care Collaborative. As a result, the Foundation had grown in size to an 80 staff member organization with a $10 million budget at the time of separation in early 2013. Patty Pearce steps into the key WCMS leadership role at a time of great overall uncertainty in the health care sector; 2014 will be an exciting year for us all.


Past and future CMS Presidents at the November 2013 WCMS Executive Council quarterly meeting.

WCMS UPDATE

JOIN TODAY!


A portion of your dues contributes

to the volunteer and service programs of WCMS. Memberhip is also available for PA’s. There is even

an opportunity for your spouse to get involved by joining the Wake County

Medical Society Alliiance

To become a member of the Wake County

Medical Society go to our website at

www.wakedocs.org and complete the

online application or contact us by phone

at 919.792.3623

From left to right- Dick McKay, MD, President 2013, Patty Pearce, MD, President 2014, Andrew Wu, MD, President 2015

Dear WCMS Executive Council Members,

Please note the following Executive Council meeting dates for 2014. Dates: January 28 2014 April 29, 2014 July 22, 2014 November 6, 2014

Time: All meetings will take place at 6pm

Where: 2500 Blue Ridge Rd. #330 | Raleigh NC 27607 A light dinner will be served at each meeting.

On behalf of Susan Davis, Executive Director of Community Health Foundation and myself, we look forward to working with you throughout 2014.

Best wishes for a happy new year.Paul Harrison

6 | JANUARY 2014

Kevin M. Bowman, MDPractice: Raleigh OphthalmologySpeciality: OphthalmologyMedical School: Wake Forest University School of MedicineGraduation: 1987

William T. Bradford, MDPractice: Raleigh American Anesthesiology of NCSpeciality: AnesthesiologyMedical School: UNC Chapel HillGraduation: 2008

Edwin R. Cadet, MDPractice: Raleigh Orthopaedic ClinicSpeciality: Orthopedic SurgeryMedical School: Brown UniversityGraduation: 2003

William T. Cushing, MD, MBA, JDPractice: HP Enterprise ServicesSpeciality: Administrative MedicineMedical School: Ross UniversityGraduation: 1987

Claudia Y. DiGiaimo-Nunez, MDPractice: West Cary Psychiatry PLLCSpeciality: PsychiatryMedical School: University of South FloridaGraduation: 1998

Returi P. R. Elkins-Williams, MDPractice: Raleigh Cornerstone Pediatric & Adolescent MedicineSpeciality: PediatricsMedical School: UNC Chapel HillGraduation: 2010

Robin L. Elledge, PA-CPractice: Bariatric Specialists of North CarolinaSpeciality: Abdominal SurgeryEducation: Methodist CollegeGraduation: 1998

Dawn P. Evancho, PA-CPractice: David Paul Adams, MD, PASpeciality: Family MedicineEducation: Charles Drew UniversityGraduation: 1990

Alison S. Powell, MDPractice: American Anesthesiology of NCSpeciality: AnesthesiologyMedical School: Louisiana State University - ShreveportGraduation: 2009

Nicholas J. Rosage, PA-CPractice: Raleigh Orthopaedic ClinicSpeciality: Orthopedic SurgeryEducation: Philadelphia University Physician Assistant Program


Graduation: 2008

Michael F. Soboeiro, MDPractice: Wake Health Services, Inc.Speciality: Internal MedicineMedical School: UNC Chapel HillGraduation: 1991

Sarah Stout, PA-CPractice: Bariatric Specialists of North CarolinaSpeciality: General SurgeryEducation: Union College Physician Assistant ProgramGraduation: 2011

Christopher M. Terry, MDPractice: American Anesthesiology of NCSpeciality: AnesthesiologyMedical School: UNC Chapel HillGraduation: 2009

James P. Zidar, MDPractice: Rex Heart & Vascular SpecialistsSpeciality: CardiologyMedical School: Loyola Univ-StritchGraduation: 1985

The leaves are off the trees. Memories of Thanksgiving Day stuffing, Black Friday,

and Cyber Monday linger on our hips and wallets. All are signs that autumn has blended into the season of celebrating holidays and a new year. The Alliance has much to be thankful for this past quarter. We kicked off with our Annual Java Jumpstart at the lovely

home of Jan Garside with an impressive attendance of new members, active members, and a few fabulous members with 20 and 30 years of history with the Alliance! Following the Jumpstart, we had another annual event at Quail Ridge Books and Music where the staff shared their recommendations for the best books and gifts this season. The newest of our Interest Groups, Creatively Crafty, also held a meeting at North Hills Club to teach us techniques in fall painting and decoration. The WCMSA is once again hosting the NCMS Alliance Get Fit 10k and 5k road race along with the WCMS Alliance Get Fit Great Kids Marathon. We are proud to be the organizers of these events

with the purpose of raising awareness and resources to assist physical education programs in public schools across the state. The start of 2014 will be busy and fun filled with annual favorites such as the Chili Cook-off and new events organized by our groups such as Global Flavors. If you are not receiving our invitations or lists please email me or Deb Meehan at

[email protected]. May your season be happy, merry, and bright and we look forward to seeing you in the upcoming year!

Louise

Louise Wilson Co-presidentWake County Medical Society Alliance

Happy New Year!

8 | JANUARY 2014


Back by popular demand is our Where In Raleigh game. Each issue we will publish a photograph of a local North Carolina site. If you would like to venture a guess about the site’s location please email Tina Frost at [email protected]. In a following issue we’ll share the names of the first winners to respond as well as other historical details about the site. Do you know where this pictures was taken...?

WHERE IN RALEIGH?

The New England Health Care Institute reported in 2007 an estimated one-third of the $2.4 trillion spent on US Health Care could be eliminated without reducing quality of care. 1 Although overuse and misuse of medical services has long been considered a leading factor to wasteful

spending there is a growing concern medication non-adherence is becoming a significant burden to the health economy as well.

Adherence by definition is the “active, voluntary, and collaborative” involvement of the patient in a mutually acceptable course of behavior to produce a therapeutic result. 5 It’s a heavy definition but simply means that the patient worked together with the provider to establish obtainable treatment goals. “Lack of medication adherence is increasingly becoming America’s other drug problem leading to unnecessary disease progression, disease complications, reduced functional abilities, a lower quality of life, and even death”.6

Staggering Statistics

• The average length of stay in hospitals due to medication non-adherence is 4.2 days. 7

• Preventable deaths due to non-adherence are estimated to be at least 125,000 each year. 7

• Costs to our nation’s health care system due to medication non-adherence are estimated to be over $290 billion dollars. This represents 13% of the total healthcare spent in this country. 7

• It’s estimated that out of the 3.6 prescriptions filled annually in the US, only 50% of those prescriptions are taken correctly by patients.1

In this pictorial based on statistics from the American Heart Association non-adherence is quantified by behavior.3 There is a progression of non-adherence that starts with not filling the prescription (12%). Then there are those patients that fill the prescription but do not take it (12%). Then there are those patients who take the medication but do not persist with it (29%). And within the percentage of patients that take their medications, there are 22% that take less than prescribed. According to these statistics only 25% of patients prescribed medications actually take it like they should. 3

Medication Non-AdherenceBy Cheryl Viracola, Pharm D

10 | JANUARY 2014

A retrospective analysis on adherence and costs by Sokol, et al showed as medication adherence rates increase, the total costs (both medical and prescription) decrease. For example: those patients who were adherent 1-19% of the time- the total costs were $15,186 per patient; those adherent 80-100% of the time the total costs were only $6,377 per patient.

Five Dimensions affecting Adherence

According to the World Health Organization (WHO) there are five interacting dimensions affecting adherence. Patient related factors are just one dimension and the belief that patients are solely

responsible for taking their medicines is misleading but most often reflects a misunderstanding of how other factors affect people’s behavior and capacity to adhere to their medications. 4

• Social/ Economic: Cost is a factor in non-adherence and increases when the socio- economic status of the population is low. Patients are met with the challenges of having to choose between competing priorities. Such priorities frequently result in directing limited resources towards others especially when it involves the care of family

members or children.

• Patient-related: A Patient’s perception of their disease and the value of treatment is critical. Often patients indicate that they are afraid of becoming dependent on medication- even if the medication is not addictive.

• Therapy related: The more complex the drug regimen, the greater chance for non-adherence. In a recent study looking at the association between prescription burden and medication adherence in patients initiating antihypertensive and lipid-lowering therapy found that among patients with 0, 1, or 2 prior medications, 41%, 35% and 30% respectively were adherent to antihypertensive and lipid lowering therapy. Among patients with 10 or more prior medications, 20% were adherent. 8


[continued on page 12]

12 | JANUARY 2014

• Condition-related: Compliance tends to be lower for an “asymptomatic disease” (i.e. hypertension, high cholesterol) vs “symptomatic disease” (back pain).

• Health Care System: The patient may not be clear on the physician’s instructions and/or the physician did not take the time to discuss adherence with the patient

Improving Adherence Due to the complex nature of medication adherence, there is no one ”magic bullet” that can fully address all dimensions. Researchers have found that interventions involving a multimodal approach are best to improve not only adherence but clinical outcomes. The following are some promising interventions supported in the literature:

• Use of heath care professionals: Assembling appropriate care teams: The concept of adherence begins with the physician and the patient. In the clinical setting physicians are increasingly faced with time constraints limiting their contact with patients. They often operate within “silos” that result in inadequate information to make sound clinical decisions. Adherence is a dynamic process that needs to be followed up. Providing support to physicians through physician extenders or the establishment of care teams is gaining national attention. 1 Nurses and pharmacists have especially played active roles promoting delivery of patient care utilizing such interventions as health coaching, disease management and Medication Therapy Management.

• Patient engagement and education: Improving adherence requires patient tailored interventions. Patient engagement and education motivates patients to play a more active role in their health. Interactions aimed at improving patient’s knowledge of their disease, an understanding of their medications and the importance of adherence is key to adherence sustainability. In current

practice this can best be explained through the use of Motivational Interviewing (MI) which takes into account the patients health literacy, language and cultural beliefs. MI helps patients make positive change through resolving discrepancies between their own behaviors, personal goals and values. 1 A recent study found that patients undergoing MI maintained their medication adherence levels over time, compared to a significant decline in adherence among patients who received usual care.

• Payment Reform: Improved adherence correlates directly with the ongoing health debate and the issue of provider reimbursement.1 The debate focuses on realigning reimbursement away from rewarding volume (fee for service) to rewarding on the

Medication Non-Adherence continued from page 11


basis of performance-based outcomes of where improved adherence would qualify as an endpoint. 1 Another school of thought is performance-based reimbursement would incentivize investment opportunities geared at improving adherence through additional staffing, adherence related tools and technologies that provide clinical support, electronic prescribing and electronic medical records. Extending the health care reform to non-physicians should be explored as well. Pharmacists continue to play a vital role in improving adherence however currently they receive no reimbursement for clinical services (beyond the limited MTM programs).1 This leaves little incentive to offering additional adherence related services.

• Health Information Technology (IT): The ability to access reliable health information is crucial to improving adherence. The system should be robust enough to support pharmacy management and address drug use information that is easily translated to all members of the health care team when and where they need it.1 One method gaining in popularity in the literature is the use of Electronic Pharmacy Data. Electronic tracking of medication refills and the ability to historically view refill information across therapeutic categories provides an objective means to assess both medication adherence and therapy persistence. The two most widely used measures of adherence with electronic pharmacy data is the Medication Possession Ratio (MPR) and the Maximum Proportion of Days Covered (PDC). Both formulas use prescription fill data to calculate the percentage of days for which the patient has medication on-hand. Medication possession ratio (MPR)is most beneficial in that it shows, from the first fill to the last fill on record, the maximum percentage of time the patient could have been taking the medication as prescribed. An index of 1.0 implies perfect adherence. “Over-adherent” results >1 would mean the patient appears to be taking the medication more often than prescribed. Results <1 would confirm poor adherence. The debate continues as to whether improving adherence warrants “stand alone” support versus implementing policy reform targeted measures for improvement. There is evidence suggesting that payment reform aimed at rewarding positive outcomes, enhancing health IT with tracking methods for improved adherence and improving information

technologies for clinicians to devise appropriate drug regimen and follow-up are steps in the right direction. However more research is needed to determine if these approaches actually evoke advancement in adherence within the health care system. §

REFERENCES

1. New England Healthcare Institute: Thinking Outside the Pillbox: A system-wide approach to Improving Medication Adherence for Chronic Disease; August 2009.

2. Henry J Kaiser Foundation, May 2010

3. Medication Non-Adherence: The Hidden epidemic Managing Medication Adherence & A Safe Hospital Discharge; [PPT].David R. Donahue, M.A.,Qualitative Technoligies, Inc. Milwaukeem WI, Dr. Tom Muscarello,PhD, DePaul University, Chicago, IL. 4 World Health Organization. Adherence to Long-Term Therapies: Evidence for Action. Publication WHO/MNC/03.01. Geneva, Switzerland: WHO; 2003. 5. Medication Adherence: Its importance in Cardiovascular Outcomes; P. Michael Ho, MD, PhD; Chris L. Bryson, MD, MS; John S. Rumsfeld, MD, PhD. Circulation. 2009; 119:3028-3035. 6 American Heart Association http://www.americanheart.org. National Council on Patient Information and Education. Enhancing Prescription Medicine Adherence: A National Action Plan 2007. 7.Vermeire, E., et al. Patient adherence to treatment: three decades of research. A comprehensive review. J Clin Pharm Ther. 2001 Oct;26(5):331-42.and American Heart Association 8. Sokol MC, McGuigan KA, Verbrugge RR, Epstein RS. Impact of medication adherence on hospitalization risk and healthcare cost. Medical Care. 2005;43(6):521-530. As cited in: Pharmaceutical Research and Manufacturers of America (PhRMA). Value of Medicines: Facts and Figures 2006. August 10, 2006. p. 37.

14 | JANUARY 2014

I n In Greek mythology Medea is a woman thinking and acting as a male warrior. As a result, she is perceived as a dangerous

antisocial to the misogynous warrior class. Medea is also a sorceress and a barbarian from the Black Sea who earns her taste of Greek civilization by helping Jason steal the Golden Fleece. In the course of this adventure, Medea succeeds in cutting herself off from her family by slaughtering her brother to delay her father’s pursuit, rejuvenating Jason’s father and killing his uncle. The playwright/poet Euripides transformed this myth into one of his most powerful dramas, Medea. In this play Euripides downplayed Medea’s magical powers by replacing them with single-minded need for vengeance. Granted she was deeply hurt by Jason but her brutality and lack of remorse leave us few opportunities to empathize with her. Emotionally we are even more unnerved second layer of actions- her double infanticide (her two sons) and hideous murder of Jason’s new wife and his father-in-law.

About Euripides, critics describe Medea as his most Sophoclean character. She becomes the tragic hero/protagonist whose obsession with vengeance overwhelms reason and duty. The chorus of Corinthian women in this play (antagonist) responds with horror at her savagery. Yet in spite of antisocial behavior, Medea is rescued by her grandfather (Helios, the Sun god). She escapes punishment and flees to Athens in a chariot carrying the bodies of her sons. She fulfills her obsession to destroy Jason by depriving him everything held dear by Greek males. Jason is crushed and spends his final days vacantly wandering about his ancient ship (Argos) until a beam collapses and kills him.

We need to answer three questions before rushing to use our modern skills to psychologically dissect Medea’s descent. Why did Euripides change an ancient myth that his

audience knew well and place a woman in the role of murderous protagonist? Who or what is Medea in this play? Was she truly mad?

The historical backdrop of its production is the impending Peloponnesian War (431 BCE). Euripides provides his audience a series of heinous murders, the destruction of Jason, and unraveling his sense of social order through human savagery. This caveat leads some critics to interpret this play as an extended metaphor- a dose of reality added to counterbalance Athenian hubris and jingoistic calls for war with Sparta. In this sense, Medea’s brutality will pale in comparison to a war that killed countless sons and debunked the superiority of Greek civilization. Euripides turns Medea into the passionate madness of war and peels back the veneer of refinement to reveal the true horror of history.

There is another twist to this plan. Scholars note that even though Euripides downplays Medea as a sorceress, he seems to elevate her at the close to god-like status. This hypothesis gains credence when we look at the slaughter of her children through the lens of mythology. In ancient fertility/agricultural cults, children were often sacrificed to assure good crops. Placing Medea in the role of a goddess resurrects this ancient motif. Yet, the Greeks abandoned these ancient rituals and replaced them with a male dominated pantheon, the Olympian gods. In doing so they purged earlier female centered fertility rituals. But Medea intrudes into this world and reminds us that like the Peloponnesian War, Medea (and Eros) represents passion and savagery that lie beneath the veneer of culture. Art no longer constrains the terror of history as the dark forces of the unconscious break into the world.

Medea sound like those of a “goddess” and Euripides reinforces this, by using the deus ex

Madness in Women: Euripides and Medea By L. Jarrett Barnhill, MD

machina (appearance of God in the machine) to allow her to escape. Medea leaves Corinth to infect Athens and by doing so, introduces us to another theme-Euripides’ ambivalence towards the gods. He seems to conceptualize these supernatural beings as personifications of natural forces- lust, passions, rage, storms, and pestilences. They lack moral qualities. For example, the god of storms and a severe tornados strike without mercy or regard for human life. Medea is the personification of vengeance and rage. Destroying her children is analogous to accidents, storms or infectious diseases. She is an ever present threat to a society plagued by high infant-maternal mortality and infanticide (remember Oedipus). Death by war, plague or starvation has no moral compass.

So what can Medea teach us about madness? Is it a sacred disease arising from the gods or an eruption of dark, ancient passions bursting through art, civilization and culture? A modern playwright might focus entirely on her mental illness, presenting Medea as a psychopathic

killer or a desperate, hopeless, psychotically depressed mother who kills her children to protect them. Both extremes reflect the fragility of socialization and civilization. There are echoes of Freud in this scenario. Today we look at primitive regions of the brain escaping top down regulation by civilizing neurotransmitters and the prefrontal cortex. But would a play based on our modern scientific explanations have the power to capture us as Euripides did with Medea?

Next we will look at Lady Macbeth as a possible 16th century heir to Medea. As we shall see that in the hands of William Shakespeare Lady Macbeth collapses “when a little water clears us of the deed” fails to assuage her sense of horror at her husband’s malignant transformation. §


Membership in the Wake County Medical Society is one of the most important and effective ways for physicians, collectively, to be part of the solution to our many health care challenges. A strong, vibrant Society will always have the ear of legislators because they respect the fact that doctors are uniquely qualified to help form health policies that work as intended. It’s hearteningto know the vast majority of Wake County physicians, more than 700 to date, have chosen to become members of the Wake County Medical Society.

Member’s dues also help support the Society’s three community service programs: Community Care of Wake and Johnston Counties, Project Access of Wake County and the Capital Care Collaborative. We need your support of these services programs, which are serving the disadvantaged in our community in the name of physicians in Wake County, through the Wake County Medical Society.

Service Programs - The spirit of volunteerism is strong in Wake County. Hundreds of local physicians volunteer to help our indigent. The Society coordinates several programs that allow low income individuals access to volunteer doctors and to special case management services for children with diabetes, sickle cell anemia or asthma.

Publications - Members receive the peer-reviewed The Wake County Physician Magazine four times a year, and we keep you informed regularly via pertinent emails. The magazine focuses on the latest health news from the State Capitol and Washington, DC, along with information about what physicians can do to accomplish critical advocacy goals. It also features Society news, practice management information and answers to your frequently asked questions.

Socializing with your physician colleagues - Many physicians feel too busy to do anything except work long hours caring for patients. But, the WCMS provides an opportunity for physicians to nourish relationships through social interaction with one another at our dinner meetings featuring prominent speakers and at other events.

Finally, joining the WCMS is plain and simple the right thing to do - Physicians and ultimately your patients benefit from our membership and our leadership in local affairs.

The Wake County Medical Society (WCMS) is a 501 (c) 6 nonprofit organization that servic-es the licensed physicians and physician assistants of Wake County. Chartered in 1903 by the North Carolina Medical Society.

Become A MemberWake County Medical Society

BENEFITS OF MEMBERSHIP

WHY JOIN

JOIN TODAY!


A portion of your dues contributes to the volunteer and service programs of WCMS. Membership is also available for PA’s. There is even an opportunity for your spouse to get involved by joining the Wake County Medical Society Alliance.

To become a member of the Wake County Medical Society follow link to our website and complete the online application or contact Pam Carpenter, Membership Manager at [email protected] or by phone at 919.792.3623

CURRENT PROGRAMSProject Access - A physician-led volunteer medical specialty service program for the poor, uninsured men, women, and children of Wake County.

Community Care of Wake and Johnston Counties CCWJC has created private and public partnerships to improve performance with disease management initiatives such as asthma and diabetes for ACCESS Medicaid recipients.

CapitalCare Collaborative - The CCC program is a membership of safety net providers working collaboratively to develop initiatives to improve the health of the region’s medically underserved.

PAST PROGRAMSChildren’s Access Program - Outreach program enrolled 5,500 children in the Wake County Medicaid Program. Program ended June 30, 2007.

CAP-C Program for Medically Fragile Children - A special Medicaid program that targets medically fragile children who meet the eligibility criteria for institutional care. Case Manager work closely with patients and providers to assure that the health, safety and well-being of these children are being maintained.

Early Childhood Development - Identified and treated three and four year olds with developmental disabilities.

Su Hogar Medico - Through network activities, this pilot program aims to provide resources and tools to patients and practices to help build capacity for care of the ever-growing Hispanic population.

To serve and represent the interests of our physicians; to promote the health of all people in Wake County; and to uphold the highest ethical practice of medicine.

WCMS MISSION


18 | JANUARY 2014

Dramatis personae of this huge volume, 1266 pages of dense texts, physics,

mathematics, geometry, functions and calculus, along with warm humane and human stories are five characters. They are Nicolaus Copernicus, (1473-1543), Galileo Galilei (1564-1642), Johannes Kepler (1571-1630), Sir Isaac Newton (1642-1727), and Albert Einstein (1879-1955). I presume the title of the book is from a letter Sir Isaac Newton wrote on February 5, 1676 to his bitter enemy Robert Hooke, which contained the sentence “if I have seen farther, it is by standing on the shoulders of giants.” Of course Robert Hooke, the greatest experimental scientist of the 17th century is relegated to the

dustbin of oblivion and burned out of sight by the brilliance of Sir Isaac Newton. This is perhaps the reason one seldom hears the name Robert Hooke. Some biographers and historians have interpreted Newton’s letter to Robert Hooke as a thinly veiled insult to Hooke, his crooked posture (we do not have a picture of Hooke, but have hundreds of Newton’s), and short stature which made him but a giant…

One of the exciting aspects of this book is that the writings by these five giants on whose shoulders the author, Stephen Hawking proposes subsequent physical scientists have stood, are translation of the original copy. No attempt has been made to modernize the authors’ own distinct usage and spelling or punctuation. As a former United Nations translator, I personally appreciate the discipline of keeping the text pure and uncontaminated by interpretation. The book has an introduction penned by Stephen Hawking, a renowned theoretical physicist. Like Sir Isaac Newton before him, he is a Lucasian Professor of Mathematics at Cambridge. Faithful readers may recall our review of his 1988 book A Brief History of Time which remained on the New York Times bestseller list for a record breaking 237 weeks. His other more recent bestseller book is The Universe in a Nutshell. He enjoys the reputation of being the most brilliant theoretical physicist since Einstein. But this book is not only about dry and inflexible

raw science, the pages are imbued with human history, personal relations, and warmth which reflect the author’s personal humanity. The life story of each of the five heroes is full of accounts of their growth, adolescence, falling in love, marrying and settling down to raising a family. For example, here is the story of Einstein, the closest man to our time (he died in 1955); in 1903, Einstein married his Serbian sweetheart, Mileva Maric, and the couple moved into a one bedroom flat in Bern. Two years later, she bore him a son, Hans Albert. That was the happiest period of Einstein’s life. Neighbors later recalled seeing the young father absent-mindedly pushing a baby carriage down the city streets. From time to time, Einstein would reach into the carriage and remove a pad of paper on which to jot down notes to himself. The notepad in the baby’s carriage contained some of the formulae and equations that led to the theory of relativity.

And about the giant farthest from us in time, Nicolaus Copernicus (1473-1543): After receiving the degree of Doctor of Canon Law, Copernicus practiced medicine at the Episcopal Court of Heidelberg. He returned to Poland in 1503 and moved into his uncle’s bishopric palace in Lidzbark Warminsk where he spent the rest of his life in priestly service. However, the man who was a scholar in mathematics, medicine and theology was only beginning the work for

Five Formidable Geniuses By Assad Meymandi, MD, PhD, DLFAPA*

Book ReviewOn the Shoulders of GiantsBy Stephen Hawking1266 pagesRunning Press Book PublishersPhiladelphia, Pennsylvania


which he would become best known, the theory of motions of heavenly objects, asserting that the earth moves and the sun remains at rest. He wrote that the center of the earth was NOT the center of the universe. The first 400 pages of the book are devoted to Copernicus- his genius for building bridges between theology, medicine, physics, astronomy and Aristotle who lived about 700 years before him is legendary. There is a most intriguing chapter filled with formulae and tables demonstrating the latitudes of Venus and Mercury, additions and subtractions of Saturn and Saturn’s movement of Parallax over the course of a year.

Returning to Newton- 445 pages are devoted to the life and work of Sir Isaac Newton and his seminal work, Mathematical Principles of Natural Philosophy (Philosophiae Naturalis Principia Mathematica) generally known as Principia. Newton is considered the father of infinitesimal calculus, mechanics and planetary motion, and the theory of light and color. But he secured his position in history by formulating gravitational force and defining the laws of motion and attraction. One very interesting thing about Newton’s use of the word Math after he returned to Cambridge- Newton studied the philosophy of Aristotle. He was fluent in Greek. In Greek the word Math means knowledge, and not just numbers and calculation. Newton was a polymath, a man of much knowledge, and that is how he used the word math in his dissertations. One of the significant events of Newton’s life was the 1665 bubonic plague which made Cambridge University close. He called the year away

from Cambridge the “annum mirabilis” (the miraculous year) during which he worked out the laws of motion and gravity. In those years, Cambridge was the convening spot for the likes of Newton, Hooke, the architect of St. Paul’s Cathedral, Sir Christopher Wren, Edmond Halley and others. Newton was the editor-in-chief of the Cambridge publications, and would not allow publication of any of his rival Robert Hooke’s works. This shows the intense enmity Newton held for his intellectual and academic rivals.

Galileo Galilei occupies 235 pages of this colossal volume. Galileo was the son of Vincenzo Galilei, a virtuoso violinist and accomplished composer. As an aside for the opera lovers (not a part of this book) Vincenzo was a member of the Florentine Camerata, a group of writers, musicians and scholars who poured over the ancient Greek operas for a period of 17 years. They gave birth to what we know today as the Western Opera. The first opera, Orpheus et Eurydice, composed by Josepi Peri was performed at Peti Palace in Florence, 8:00 PM, October 6, 1600.

Galileo was teaching Copernican theory of the earth in motion. He got into hot water with the church and his work Two Chief World System was brought before inquisition tribunal in 1616 with an edict forbidding him from teaching Copernicus.

Finally the book on Kepler occupies 96 pages. Kepler was a German astronomer who was famed for his dedication to absolute precision. He was obsessed with measurement and what in today’s parlance we call metrics. His obsession made him calculate his own

gestational period to the minute, i. e., 224 days, 9 hours, 53 minutes. He had been born prematurely. So ladies with preemies don’t fret, you may have given birth to a Kepler or to a Mother Teresa- she, too, was born prematurely. Kepler was a deeply religious man. His relationship with the writings and teachings of Martin Luther who lived and wrote only about fifty years earlier, is most interesting. It makes for fun and exciting readings. In Kepler’s time there was very little difference between astrology and astronomy. Kepler had predicted a severe winter, as well as a Turkish incursion, and when both predictions came true, he was triumphantly hailed as a prophet. Another historical aside (not a part of this book): the first person who wrote eloquently to disparage astrology and establish astronomy as a science was the famed Persian poet, Omar Khayyam (1048-1131), some 500 years before Kepler.

The book is huge. The reading and understanding of the work and character of these giants expand the warehouse of mental space. It is most enjoyable and fun. Finishing 1266 pages feels like having finished climbing Mount McKinley and living to write about it. §

*The writer is Adjunct Professor of Psychiatry, University of North Carolina School of Medicine at Chapel Hill, Distinguished Life fellow American Psychiatric Association, and Founding Editor and Editor-in-Chief, Wake County Physician Magazine (1995-2012). He serves as a Visiting Scholar and lecturer on Medicine, the Arts and Humanities at his alma mater the George Washington University School of Medicine and Health.

wcpm january 2014

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