RHODE ISLAND M EDICAL J OURNAL GROWING A MEDICAL SCHOOL DR. ARONSON’S RECOLLECTIONS MAY 2015 VOLUME 98 • NUMBER 5 ISSN 2327-2228 Your records are secure. Until they’re not. Data theft can happen to anyone, anytime. A misplaced mobile device can compromise your personal or patient records. RIMS-IBC can get you the cyber liability insurance you need to protect yourself and your patients. Call us. 401-272-1050 IN COOPERATION WITH RIMS-IBC 235 PROMENADE STREET, SUITE 500, PROVIDENCE RI 02908 MEDICAL PROFESSIONAL/CYBER LIABILITY PROPERTY/CASUALTY LIFE/HEALTH/DISABILITY RHODE ISLAND M EDICAL J OURNAL 7 COMMENTARY Personalized Medicine Is it a concept only for the super-rich? JOSEPH H. FRIEDMAN, MD Materia Medica & Diagnostic Dilemmas in Downton Abbey HERBERT RAKATANSKY, MD 13 LETTER TO THE EDITOR Cluster of Vaccine-related Invasive Pneumococcal Disease in Previously Vaccinated Healthy Children in Rhode Island THERESA M. FIORITO, MD; KIMBERLE CHAPIN, MD; JACLYN SKIDMORE, MSc; IAN C. MICHELOW, MD, DTM&H 40 RIMS NEWS CME Event: Navigating the Changing Environment to Provide Optimal Patient Care Working for You Why You Should Join RIMS 51 SPOTLIGHT Growing a Medical School at Brown: Dr. Aronson’s recollections MARY KORR 63 HERITAGE 150 Years Ago: Vigil at Lincoln’s bedside Newport-born physician tends to the President MARY KORR RHODE ISLAND M EDICAL J OURNAL IN THE NEWS BROWN EXPERTS 44 46 MEMORIAL HOSPITAL to lead statistical analysis launches Pet Therapy Program of nationwide $100M dementia study 47 URI ENGINEERING STUDENTS develop wristband to SCHOOL OF PUBLIC HEALTH 44 measure tremors in PD holds annual research day 48 GOLD BY SPECIAL DELIVERY ED TEAM AT RIH 45 intensifies cancer-killing radiation publishes results of Google Glass to 49 BORDERLINE PERSONALITY DISORDER diagnose skin conditions as Debilitating as Bipolar Disorder HASBRO STUDY 46 49 W&I’S SANDRA SALZILLO finds link between adverse childhood to speak at international experiences and pediatric asthma trauma treatment conference PEOPLE/PLACES BETTY VOHR, MD 54 58 DENISE M. ARCAND, MD receives award for contributions named president of to high-risk infant care medical staff at Kent ROSEMARIE BIGSBY 54 58 SUZANNE PALINSKI, MD honored for contributions named chief of pediatrics to neonatal care at Bradley MARCO DELBOVE 55 59 AARON BLOOMENTHAL, MD recognized for joins RWMC Department excellence in teaching of Surgery MAI (MIKE) HE, MD, PHD 55 59 TARO MINAMI, MD YUN-AN (ANN) TSENG, DO teaches critical care medicine in Germany honored at 2015 USCAP annual meeting 59 JEFFREY BORKAN, MD, PHD MALASA KAHN, MD MIRIAM HOSPITAL NURSING 55 participate in Tar Wars® earns Magnet recognition for 5th time 60 SAMUELS SINCLAIR DENTAL CENTER making kids smile SCOTT HALTZMAN, MD 57 named medical director, Dept. 60 PETER J. SNYDER, PHD of Behavioral Health at Fatima named editor of new online, open-access Alzheimer’s and Dementia Journal LISA GOULD, MD, PHD 57 publishes study on 61 OBITUARIES healing skin graft wounds Laura B. Fixman, MD; Laura R. Viehmann, MD MAY 2015 VOLUME 98 • NUMBER 5 RHODE ISLAND Rhode Island Medical Society R I Med J (2013) 2327-2228 M EDICAL J OURNAL 98 PUBLISHER RHODE ISLAND MEDICAL SOCIETY 5 PRESIDENT 2015 PETER KARCZMAR, MD May PRESIDENT-ELECT 1 RUSSELL A. SETTIPANE, MD VICE PRESIDENT SARAH J. FESSLER, MD CONTRIBUTIONS SECRETARY BRADLEY J. COLLINS, MD 15 Actual and Perceived HBV Status Among Asian Pacific Islander TREASURER Americans in Rhode Island: A Cross-Sectional Study JOSE R. POLANCO, MD AUSTIN Y. HA, BS; JOYCE E. NGUYEN, BA; RICHARD J. DOYLE, PhD; IMMEDIATE PAST PRESIDENT EDWARD FELLER, MD, FACG, FACP ELAINE C. JONES, MD EXECUTIVE DIRECTOR 19 Expectation, the Placebo Effect and the Response to Treatment NEWELL E. WARDE, PhD WALTER A. BROWN, MD EDITOR-IN-CHIEF 22 How Expectation Works: Psychologic and Physiologic Pathways JOSEPH H. FRIEDMAN, MD WALTER A. BROWN, MD ASSOCIATE EDITOR SUN HO AHN, MD CASE REPORTS PUBLICATION STAFF 25 Divergent Elbow Dislocation and Risk of Compartment Syndrome MANAGING EDITOR P. KAVEH MANSURIPUR, MD; MATTHEW E. DEREN, MD; CRAIG R. LAREAU, MD; MARY KORR [email protected] CRAIG P. EBERSON, MD GRAPHIC DESIGNER 28 MARIANNE MIGLIORI ‘Angina’ of the papillary muscle: an overlooked but reversible ADVERTISING etiology of mitral regurgitation STEVEN DETOY FADY Y. MARMOUSH, MD; MAZEN O. AL-QADI, MD; WASEEM Y. BARHAM, MD; SARAH STEVENS AHMAD M. ABDIN, MD; AHMAD H. DARAGHMEH, MD; JOE F. YAMMINE, MD [email protected] EDITORIAL BOARD JOHN J. CRONAN, MD EMERGENCY MEDICINE RESIDENCY CPC JAMES P. CROWLEY, MD EDWARD R. FELLER, MD 30 Chest Pain in a 60-Year-Old Man JOHN P. FULTON, PhD HEATHER RYBASACK-SMITH, MD; PAUL PORTER, MD; WILLIAM BINDER, MD PETER A. HOLLMANN, MD KENNETH S. KORR, MD MARGUERITE A. NEILL, MD FRANK J. SCHABERG, JR., MD PUBLIC HEALTH LAWRENCE W. VERNAGLIA, JD, MPH NEWELL E. WARDE, PhD 33 HEALTH BY NUMBERS Socio-demographic Variation of Adult Seatbelt Non-use in Rhode Island – Different Data Sources YONGWEN JIANG, PhD; MICHAEL SPRAGUE, MA; BEATRIZ PEREZ, MPH; TARA COOPER, MPH; DESPINA ESINA METAKOS; SAMARA VINER-BROWN, MS 38 Vital Statistics RHODE ISLAND MEDICAL JOURNAL ROSEANN GIORGIANNI, DEPUTY STATE REGISTRAR (USPS 464-820), a monthly publication, is owned and published by the Rhode Island Medical Society, 235 Promenade Street, Suite 500, Providence RI 02908, 401-331-3207. All rights reserved. ISSN 2327-2228. Published articles represent opinions of the authors and do not necessarily reflect the official policy of the Rhode Island Medical Society, unless clearly specified. Advertisements do not im- ply sponsorship or endorsement by the Rhode Island Medical Society. Advertisers contact: Sarah Stevens, RI Medical Society, 401-331-3207, fax 401-751-8050, [email protected]. In a healthcare system where physicians and By harnessing data and leveraging analytics, we’re hospitals are called upon daily to improve the able to put our business intelligence, proven risk quality of care while reducing costs, we believe reduction strategies and innovative educational there is an opportunity for innovative solutions programs to work, so that you can anticipate risk to influence outcomes. and improve overall outcomes. To go beyond reacting to events to actually If you’re ready to change the way you think about anticipating them before they happen. medical malpractice insurance, call 800.225.6168 or visit ThinkCoverys.com Better Intelligence for Better OutcomesSM ProSelect Insurance Company 800.225.6168 www.coverys.com COMMENTARY Personalized Medicine Is it a concept only for the super-rich? JOSEPH H. FRIEDMAN, MD 7 [email protected] 8 EN I READ ABOUT PRESIDENT each of which, by the that changes every year. A drug that Obama’s recent call for way, has been associated had required a co-pay of $10 per month something he called, “the with a large number of is now, commonly, costing $300 per precision medicine initia- individual gene derange- month. Of course, this is for inexpensive tive,” popularly referred ments, implying that drugs. Expensive drugs are a different to in the press as “per- there are many sub-types kettle of fish. These require prior autho- sonalized medicine.” I of both of these diseases. rization, the bane of most doctors. I can’t did not read the White In the future we may talk blame insurers for putting up hurdles. House’s press releases so I about having Alzheimer’s They want to make the doctor think, or may be behind the times. type 27 running in a fam- at least sweat and swear, before ordering I have read some of the ily, as distinct from the a drug that costs $5,000/month. Some news coverage, and, quite other 50 types of Alzhei- drugs cost $100,000/year. In general, the frankly, I’m stunned by the gap between mer’s disease. We will hopefully learn, “the cup and the lips.” Perhaps “gap” before too long, which of the many My patients are increasingly is too euphemistic a term. Chasm or different abnormalities that may cause finding themselves unable to pay mountain, may be a better description. seizures are causing epileptic seizures for their old, generic medications The notion behind personalized med- in our child, which will guide us to because they have become “tier icine is reasonable and appropriate for choosing the best anti-convulsant drug. 2” or “tier 3” drugs, a classifica- super rich people in the 21st century. These will be wonderful advances, but tion that changes every year. A The goal is to choose therapies spe- what will they mean? Every new drug on cifically targeted for each individual’s the market is expensive. In some cases drug that had required a co-pay illness. If you have a cancer caused by a this is because its development required of $10 per month is now, com- particular mutation you may be likely to huge outlays and must be recouped, and monly, costing $300 per month. respond to some chemotherapy regimes excesses used to fund future research. but not to others. If you have cystic In some cases the costs are simply due fewer the number of patients getting a fibrosis, there may be unusual therapies to lack of competition. When generic drug, the more expensive it is. When that will work for your expression of the drugs suddenly get approved for well you’re talking about targeted therapy, disease. The issue of cost has not entered known uses, the price may skyrocket you’re talking about very small numbers the discussion, other than to state that a hundred-fold (such as has happened of patients. This translates into tens or the federal government is interested with some drugs for epilepsy and gout), hundreds of thousands of dollars per in putting $215 million dollars into without any justification except the year, possibly for the rest of one’s life, the research.