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Medicine Health RHODEI SLAND VOL. 85 NO. 1 JANUARY 2002 Cancer Update A CME Issue UNDER THE JOINT VOLUME 85, NO. 1 JANUARY, 2002 EDITORIAL SPONSORSHIP OF: Medicine Health Brown University School of Medicine Donald Marsh, MD, Dean of Medicine HODE SLAND & Biological Sciences R I Rhode Island Department of Health PUBLICATION OF THE RHODE ISLAND MEDICAL SOCIETY Patricia Nolan, MD, MPH, Director Rhode Island Quality Partners Edward Westrick, MD, PhD, Chief Medical Officer Rhode Island Chapter, American College of COMMENTARIES Physicians-American Society of Internal Medicine Fred J. Schiffman, MD, FACP, Governor 2 Demented Politicians Rhode Island Medical Society Joseph H. Friedman, MD Yul D. Ejnes, MD, President 3 Some Comments On a Possible Ancestor EDITORIAL STAFF Stanley M. Aronson, MD, MPH Joseph H. Friedman, MD Editor-in-Chief Joan M. Retsinas, PhD CONTRIBUTIONS Managing Editor CANCER UPDATE: A CME ISSUE Hugo Taussig, MD Guest Editor: Paul Calabresi, MD, MACP Betty E. Aronson, MD Book Review Editors 4 Cancer in the New Millennium Stanley M. Aronson, MD, MPH Paul Calabresi, MD, MACP Editor Emeritus 7 Update in Non-Small Cell Lung Cancer EDITORIAL BOARD Betty E. Aronson, MD Todd Moore, MD, and Neal Ready, MD, PhD Stanley M. Aronson, MD 10 Breast Cancer Update Edward M. Beiser, PhD, JD Mary Anne Fenton, MD Jay S. Buechner, PhD John J. Cronan, MD 14 Screening for Colorectal Cancer in Rhode Island James P. Crowley, MD Arvin S. Glicksman, MD John P. Fulton, PhD Peter A. Hollmann, MD 17 Childhood Cancer: Past Successes, Future Directions Anthony Mega, MD William S. Ferguson, MD, and Edwin N. Forman, MD Marguerite A. Neill, MD Frank J. Schaberg, Jr., MD 23 Brain Tumors Fred J. Schiffman, MD Lloyd M. Alderson, MD, DSc Lawrence W. Vernaglia, JD, MPH Newell E. Warde, PhD 28 CME Information William J. Waters, Jr., PhD OFFICERS COLUMNS Yul D. Ejnes, MD 30 Rhode Island Quality Partners President Tilak K. Verma, MD PREVENTION AND TREATMENT RECOMMENDATIONS FOR COMMUNITY Vice President ACQUIRED PNEUMONIA David B. Ettensohn, MD Deidre Spellisey Gifford, MD, MPH President-Elect Fredric V. Christian, MD 32 Health By Numbers Secretary RHODE ISLAND HISPANICS HAVE MAINSTREAM CANCER RATES Peter A. Hollmann, MD John P. Fulton, PhD, and Jay S. Buechner, PhD Treasurer Michael B. Macko, MD 34 Public Health Briefing Immediate Past President THE RHODE ISLAND CANCER COUNCIL Arvin S. Glicksman, MD, and Paul Calabresi, MD, MACP DISTRICT & COUNTY PRESIDENTS Pamela A. Harrop, MD 37 Judicial Diagnosis Bristol County Medical Society WHAT NOW?! THE OIG WORRIES ABOUT PHYSICIAN BILLING, REFLECTED Robert A. Salk, DO N THE ORK LAN Kent County Medical Society I 2002 W P Jayanthi Parameswaran, MD Lawrence W. Vernaglia, JD, MPH Newport County Medical Society 38 Vital Statistics Stephen T. Conway, MD Pawtucket Medical Association Edited by Roberta Chevoya Patrick J. Sweeney, MD, PhD, MPH 39 A Physician’s Lexicon Providence Medical Association NAUSEA AND VOMITING R. Scott Hanson, MD Washington County Medical Society Stanley M. Aronson, MD, MPH Naeem M. Siddiqi, MD 41 Rhode Island Medical Journal Heritage Woonsocket District Medical Society 42 2001 Index Cover: “Some Freesias,” a hand colored etching by Penny Feder. Penny Feder’s artwork can be seen at her website, www.pennyfeder.com and at the JRS Gallery Medicine and Health\Rhode Island (USPS 464-820), a monthly publication, is owned and published by the Rhode Island Medical Society, 106 Francis Street, Providence, RI 02903, Phone: 401-331-3207. Single copies $5.00, individual subscriptions $50.00 per year, and $100 on Wickenden St. in Providence. per year for institutional subscriptions. 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 imply sponsorship or endorsement by the Rhode Island Medical Society. Periodicals postage paid at Providence, Rhode Island. ISSN 1086-5462. POSTMASTER: Send address changes to Medicine and Health\Rhode Island, 106 Francis Street, Providence, RI 02903. Classified Information: RI Medical Journal Marketing Department, 175 Mathewson Street, Providence, RI 02903, phone: (401) 331-4637, fax: (401) 331-3594 COMMENTARIES Demented Politicians newspaper recently reported that ies, of course, with the politician (the one draw the line in declaring a Presi- Aa U.S. senator described his friend, analogy of the physician “thought dent unfit for office? another U.S. Senator, Strom leader” who lectures for a corporate We all applaud Senator Thurmond, almost 100 years old, as sponsor for a fee should be kept in Thurmond’s determination and dedi- “not keen.” I am not completely con- mind here). However, regardless of cation, but even Cal Ripken, Jr., the fident what this means although I’m who wields the power, the fact remains new “iron man” of baseball had to re- pretty sure. I’m also pretty sure that that the buck stops with the voter. tire when his skills weakened with age. Thurmond’s press aide’s response, Legislation backed by a senator, or ini- I think that questions of competence “That’s nonsense. He swims a full lap tiated by a senator, bears that that devolve into medical issues require in the swimming pool each day,” was a politician’s imprimatur and therefore a medical evaluation. Do we know troubling response. I don’t know how his responsibility, regardless of who whether our older leaders have annual old the aide is, or whether he too swims actually wrote it. To exercise this de- medical examinations and if so, do they a lap or two in the pool daily, but I gree of responsibility, the final arbiter include neurobehavioral assessments? wonder if the two of them are “not of a single vote, the voter must be I, for one, would feel reassured to know keen”. “compos mentis.” that Senator Thurmond is cognitively I have wondered about Senator After Woodrow Wilson suffered a intact and that he makes his own deci- Thurmond for some time. William debilitating stroke, his wife took over sions when he votes and signs his name Safire, the New York Times columnist, much of the function of the president. onto legislation. recently vilified a Democratic-run This was a perversion of our constitu- As people live longer and work committee for scheduling lengthy talks, tion. Mrs. Wilson was never voted into longer we need to grapple with the is- that they knew Thurmond would not an office. Even Hillary Clinton was sues of medical competency for elected be able to stay awake for. given powers designated by the presi- officials, just as we have them for air- “Not keen.” Excessive daytime dent as if she were a private citizen and line pilots and some other professions. somnolence. Age 98. Are these early did not simply assume them. It seems Doctors too need to consider this, warnings of my own “ageism?” Al- to me that it is a very straightforward rather than depending on “after the though people don’t get smarter with requirement for those who serve our fact” reporting of incompetence, be- age, many do become wiser. While nation to be held to some standards of cause more of us practice in our old mathematicians peak early, the capac- accountability and capability. While age. Recredentialing requirements help ity to pursue intellectual challenges re- those who serve elected officials are address this issue and the Joint Com- quiring wisdom, knowledge and responsible and hopefully loyal to the mission on the Accreditation of Hos- sensitivity seems to ripen with age, as person they serve, there should be a pitals has recently required bylaw is often seen in fine literature, music higher loyalty to the office that the changes in hospitals to help weed out composition and philosophy. How- elected official fills. When the official incompetent physicians. We need a ever, with age comes frailty and too fre- is corrupt and accepts bribes, the staff similar procedure to deal with public quently, dementia. is obligated to report this. They are officials. Is Strom Thurmond demented? Is equally obligated to report medical in- it possible that an important political firmity, which precludes adequate dis- – Joseph H. Friedman, MD figure, who still votes in the Senate, charge of the office’s responsibility. The may not know what he is voting for? question of Ronald Reagan’s capabil- Of course one might answer that it ity may be considered here as a “gray doesn’t matter, that most politicians are zone.” He was elderly when in office guided by their advisors and “han- and was known to fall asleep during dlers.” Senators have large staffs pre- cabinet conferences that he chaired. sumably full of experts on various He also developed Alzheimer’s disease issues, depending on the senator’s in- that might have been clinically detect- terests and the interests of his constitu- able while in office. Perhaps he may ents and financial supporters. How have exhibited mild cognitive impair- much a politician is independent rather ment (MCI) only without language than a puppet of his financial-base var- or personality changes. Where would 2 Medicine and Health / Rhode Island Some Comments On a Possible Ancestor Lutheran minister from Dusseldorf, Joachim Neumann by disappeared, for unknown reasons, some 30,000 years ago, their Aname, achieved some modest fame in the late 17th Century last stand being in Spain. as an author of sacred hymns. It had been his custom to take Paleontologists agree on this: Modern man [Cro-Magnon solitary walks in a neighboring valley to help assemble the proper man or Homo sapiens ] and Homo neanderthalensis co-existed in words and melodies for his liturgical poetry. He frequently signed Europe for many thousands of years. Earlier scenarios, many text- his completed hymns with the name Neander, the Greek equiva- books and certainly the film industry portrayed the primitive lent of his German name [Neumann, in German, meaning new Neanderthals as incapable of competing with the innovative, tool- man.] And years after his death, his parishioners honored his making, language-speaking, agronomically-skilled Homo sapiens memory by naming this modest valley Neanderthal [thal, in Ger- migrating north out of Africa.