My first physician colleague who died by suicide

There is a lot more work to be done to de-stigmatize seeking help for those struggling with mental health issues.

How many doctors commit suicide each year?

It is estimated that every year

400 physicians take their own life

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I was busy running around the ER on a particularly busy shift when my phone buzzed, and a text message from Jane’s ex-boyfriend David popped up on the screen. I was surprised since I had not talked to him in over three years; therefore, I ignored it until I had a moment to myself an hour later and finally opened the message.

The first line of his message got straight to the point.

“Hey, I just learned that our friend Jane tragically died a short while ago, and I thought you deserved to know.”

I read this line several times, hoping I had misread something, hoping this was a mistake. However, after a phone conversation with David a short while later, I learned that Jane had committed suicide.

I was not only devastated by this news, but I also felt trapped in a permanent state of melancholy for weeks. Jane had been not only my first close friend to commit suicide, but also my first colleague in medicine to do so.

To me, and everyone who knew her, she was extremely hardworking, compassionate, and brilliant. Since she always appeared happy and upbeat on the surface, people would never assume that she was actually struggling internally.

Jane was someone I strongly felt was bound to change the world and would be lauded on International Women’s Day, yet in a tragic irony, I found out about her death on International Women’s Day.

She worked tirelessly to overcome the grueling trenches of medical school and countless microaggressions as a woman of color in a surgical field in order to earn a spot in one of the most coveted surgical subspecialty residencies where she was a star.

Jane’s story is tragic; however, the reality is that her story is not unique in medicine, especially amongst trainees. Although Jane was my first physician colleague to commit suicide, she will certainly not be the last. A recent study estimated around 400 physicians commits suicide per year. Amongst medical trainees, suicide is more prevalent than it should be. The American Foundation for Suicide Prevention (AFSP) reports that 23 percent of interns (first-year residents) have suicidal thoughts. Additionally, they also report that 28 percent of residents in the U.S. experience a major depressive episode during residency compared to 7 to 8 percent of those in a similar age range in the general population.




What I have learned about Physician Suicide



My first physician colleague who died by suicide: 

The Novel Corona Virus Story

Months after being shuttered following an outbreak of a new strain of coronavirus, the Wuhan wet market was torn down Tuesday.  

China was less than transparent about the COVID-19 epidemic.  It is difficult if not impossible to compare China's public health program compared to the United State's program.

When did Chinese officials realize there was a new viral outbreak? Even today the number of cases seems ridiculously low for a country of 1,408,526,449 people. The last reported figures for COVID-19 (as listed on the Johns Hopkins tracking and mapping tool reported 80,500 cases in mainland China.

Did we see this coming?

The reporting of case rates in the media is subject to extreme doubt as to veracity.

Given the fact that China is a huge country with a huge population and the fact that communications outside of metropolitan having poor internet access and an unknown amount of technology, it is possible that early cases were missed and under-reported. China does not allow freedom of the press and is able to suppress news it deems harmful to the ruling communist party. However, In large metropolitan communities, there is an international presence, which is free to report the unvarnished truth.

The Chinese story became public knowledge became known in the international community in January 2020.  The influenza season in the United States often begins in early September. From known influenza outbreaks, we know it takes several weeks or months to realize a new viral strain has appeared. Assuming the infection took hold in September 2009 and it did not become public knowledge until mid-January 2020 there was a 3.5 month lag in China reporting. The infection rate increased during that period in an unknown fashion.

There is no factual information that the COVID-19 outbreak actually began in Wuhan, China. It may have begun in another city or even another country in Asia.

The Chinese offered the 'Wet Market" in Wuhan as ground zero for COVID 19.  This is a city of 1 million people, and 80,000 cases is a paltry number to declare an epidemic for a country of 1.5 billion people.

The trust index between China and most of the rest of the world is abysmally low.  We do not believe them and they do not believe us. 

The World Health Organization is the only credible source for data.

The United States team of CDC and HHS are powerful teammates. Their reaction was swift and accurate (according to Secretary of HUD, Ben Carson M.D who headed up the Johns Hopkins University Department of Neurosurgery. (in a previous life) In a non-partisan interview, he gave great credit to the CDC and HHS.

In California and Washington State Governors have declared a state of emergency. If and when needed they will have the authority to shut down schools, businesses, transportation to areas that are actively infected.

If needed this would be instituted in a progressive fashion for affected areas.

China Responds to Virus Investigation Demand by Demolishing 'Ground Zero,'

Months after being shuttered following an outbreak of a new strain of coronavirus, the Wuhan wet market was torn down Tuesday, journalist Jennifer Zeng reported.  China’s communist government claims the location was ground zero for the deadly outbreak now coursing around the world. Meat from exotic animals is suspected to have been contaminated by the virus, which made the jump to humans in the unsanitary conditions of the market.

World Count COVID19 March 1, 2020

After infecting market patrons, the speed and ease of modern transit guaranteed the disease would soon begin popping up all over the planet.

Not everyone is buying China’s official story, however. Arkansas Sen. Tom Cotton has hinted at a “super laboratory” in Wuhan — a reference to the high-security bio lab in the city — as a possible point of origin for the contagious disease.  Arkansas Sen. Tom Cotton has hinted at a “super laboratory” in Wuhan — a reference to the high-security bio lab in the city — as a possible point of origin for the contagion. This is highly speculative at best.

The situation is also obscured by political motives. According to Sen. Marco Rubio of Florida, Russia doesn’t seem to be buying China’s claims of a random outbreak.

“American officials have noted the existence of networks of thousands of social media accounts, many reportedly Kremlin-tied, with identical posts, publishing messages claiming that the virus is meant to ‘wage economic war on China’ and propagate ‘anti-China messages,'” Rubio wrote in a Tuesday Op-Ed for the New York Post.

Iran isn’t totally convinced of the official Chinese story either, instead claiming that the virus is the result of biological warfare.

Gholam Reza Jalali, the head of Iran’s Civil Defense Organization, told Fars News Agency that the virus’ effects and the panicked media coverage mean it could be a “biological attack” meant to destabilize the economies of Iran and China.

We may never know, one thing is for certain this strain will comix with other previous COVID strains and become a new seasonal illness.  Community immunity will increase and by next year there may be a vaccine.




Wuhan Fish Market (Video)

Reclaiming Death:

Those Advanced directives we are all asked about each time we are admitted to a hospital. For me, it is not at all reassuring to be asked that question. It is only slightly less than asking "Where shall we send the body ?"  I always ponder a silly answer,  such as 'beam me up, Scotty".  The title "Advanced Directive" is a subterfuge, as well. It is one of those papers you sign at the hospital, designed to save expenses. It is a very objective thing for a very subjective circumstance.  In today's world, it has been enumerated into categories, ranging from disconnecting a ventilator if you are brain dead or have little chance of surviving a fatal illness such as cancer, multiple sclerosis. It is also a good chance it will never be read if you are admitted in a coma, or unable to respond. If someone is with you there is also a good chance they do not know if you have one.

When we talk about death what we’re really talking about is life.” – Dr. Dawn Gross, host of the radio show “Dying to Talk”

“What happens when you die?  That to me is the only thing really that’s of any importance.” – George Harrison

What about those patients who want to accelerate their trip from existence to the unknown,  due to extreme pain, or symptom they cannot bear?

For those who are not in extremis, walking around there is another option. California’s End of Life allows doctors to prescribe life-ending drugs for terminally ill patients who must meet strict guidelines and follow lengthy procedures before taking the medicine themselves.

The law is the culmination of decades of efforts that peaked when Brittany Maynard moved from California to Oregon, where she availed herself of a similar law just before her 30th birthday in 2014. Her death sparked a national debate and an explosion of proposed state legislation.

On the surface, California’s law is the latest headline in a growing national movement towards the kinder, gentler end of life care.

Guidelines have been published to assist doctors and patients who agree on 'assisted death.  There are 4 main types of euthanasia, i.e., active, passive, indirect, and physician-assisted suicide

Yet the End of Life Option Act is much more than that.

It’s another step towards overthrowing a system in which doctors — even religious leaders – tell people how to live and die.

In my opinion, it is a good thing for all concerned since the patient is making his/her desire known. It affords legal protection for all concerned especially if the family disagrees.

It’s a conflict summarized by Stanford longevity expert Dr. Walter Bortz II in his book “We Live Too Short and Die Too Long.”  Dr. Bortz makes some interesting comments about longevity.

Legality:

Not all states have laws protecting physicians and/or patients from legal repercussions.

States which have formalized the process 

Right to Die in Oregon

A Doctor's Perspective

The right to die in Belgium: An inside look at the world’s most liberal euthanasia law

In California, the patient must self inject the drug, California law prohibits physicians from injecting the medication.  The medical records must be reviewed by two other physicians.

This all leads to a single question — how do we want to die?

Many Americans have decades to answer that question, 

As a quick overview, 258 people started the end-of-life option process by speaking with two different physicians at least 15 days apart, according to the data released by the California Department of Public Health this July. Of these patients, 191 had prescriptions written for aid-in-dying drugs between June 9, 2016 and December 31, 2016. Physicians reported that 111 of the patients died following the ingestion of the drugs.  



Reclaiming Death: California’s End of Life Option Act – California Health Report:

Infection Control Protects Hospital Staff From COVID-19

Wider screening criteria and enhanced anti-infection measures resulted in no coronavirus infections among healthcare workers, despite treating 42 patients with confirmed coronavirus 

Hospital-related infections have been widely reported during the ongoing coronavirus outbreak, with healthcare professionals bearing a disproportionate risk. However, a proactive response in Hong Kong's public hospital system appears to have bucked this trend and successfully protected both patients and staff from SARS-CoV-2, according to a study published online today in Infection Control & Hospital Epidemiology.

The Hong Kong success story may be due to a stepped-up proactive bundle of measures that included enhanced laboratory surveillance, early airborne infection isolation, and rapid-turnaround molecular diagnostics. 

Proactive Bundle

The Hong Kong success story may be due to a stepped-up proactive bundle of measures that included enhanced laboratory surveillance, early airborne infection isolation, and rapid-turnaround molecular diagnostics. Other strategies included staff forums and one-on-one discussions about infection control, employee training in protective equipment use, hand-hygiene compliance enforcement, and contact tracing for workers with unprotected exposure.

In addition, surgical masks were provided for all healthcare workers, patients, and visitors to clinical areas, a practice previously associated with reduced in-hospital transmission during influenza outbreaks, the authors note.

Hospitals also mandated the use of personal protective equipment (PPE) for aerosol-generating procedures (AGPs), such as endotracheal intubation, open suctioning, and high-flow oxygen use, as AGPs, had been linked to nosocomial transmission to healthcare workers during the 2003 SARS outbreak. 

As the outbreak evolved, the Hong Kong hospitals quickly widened the epidemiologic criteria for screening, from initially including only those who had been to a wet market in Wuhan within 14 days of symptom onset, to eventually including anyone who had been to Hubei province, been in a medical facility in mainland China, or in contact with a known case.

All suspected cases were sent to an airborne infection isolation room (AIIR) or a ward with at least a meter of space between patients.  

"Appropriate hospital infection control measures could prevent nosocomial transmission of SARS-CoV-2," the authors write. "Vigilance in hand hygiene practice, wearing of surgical mask in the hospital, and appropriate use of PPE in patient care, especially [when] performing AGPs, are the key infection control measures to prevent nosocomial transmission of SARS-CoV-2 even before the availability of effective antiviral agents and vaccine







Infection Control Protects Hospital Staff From COVID-19:

1 in 3 Patients Worried About Healthcare Costs, Out-of-Pockets

A new poll found that out-of-pocket costs are top-of-mind for most Americans, with many saying it sways their vote in the presidential election.

 Nearly one-third of patients are worried about healthcare costs, including the ability to pay for health insurance and out-of-pocket prescription drug costs, according to a new poll from NBC News and the Commonwealth Fund.

The poll, which questioned nearly 2,300 adult patients living in the US, investigated the top of the concern of mind for the American patient, with healthcare affordability leading the way. Overall, 31 percent of respondents said they are worried about being able to pay for their health insurance, while 29 percent are concerned about the out-of-pocket costs associated with many prescription drugs.

The poll also looked at how those concerns may influence votes during the upcoming presidential election.

“Health care costs are at the top of voters’ minds,” said Sara Collins, the Commonwealth Fund’s vice president for Health Care Coverage, Access, and Tracking. “For many people, health care costs are growing faster than wages, leaving many vulnerable to medical bills they might not be able to pay or illnesses that go untreated.”  Those identifying as Democrats, those who said they might vote Democrat come November, patients who are black or Hispanic, and those making less than $50,000 annually specifically shared this concern.

Patients reported resorting to drastic or unusual methods for paying off a large medical cost, the survey showed. About 46 percent of respondents with a medical bill issue said they have dipped into their savings or retirement funds to pay off a medical bill, while the same amount said they have borrowed money from family or friends.

Thirty-four percent took on credit card debt, 26 percent sold items like furniture or jewelry, and 7 percent used medical crowdfunding on websites like GoFundMe.

Patients are also reporting limited adherence to treatment or care access avoidance due to medical costs. Thirty-one percent of those ages 18 to 35 said they or a family member delayed care access because of the risk of a high medical bill. Thirty percent of them said they or their family’s health suffered due to that care avoidance, while 22 percent of the survey population overall said the same.

.This comes as leadership in Washington picks through various legislative proposals to stem the tide of surprise medical bills. Legal proposals include setting hospital rates at a certain percentage of the average Medicare reimbursement rate or using an independent, third-party arbitrator. 

Patients who are Hispanic or black and those making less than $50,000 annually specifically shared this concern expressed worry about healthcare affordability overall, the survey continued. Forty-four percent of Hispanic patients said they are concerned about paying their payer deductibles and premiums in the next year, compared to only 28 percent of white patients who feel the same way.

The report also looked at how these healthcare concerns might be influencing an individual’s voting decisions to come in November 2020. Fifty-four percent of survey respondents said they are somewhat or very confident that a Democratic president could successfully lower healthcare costs, to 42 percent who said the same should President Trump be re-elected. Respondents who are black, Hispanic, younger, and female were more likely to report such than others





https://tinyurl.com/wgf53da

Coronavirus COVID-19 (2019-nCoV) Global Dashboard (Johns Hopkins) WHO and China's National Health Consortium

Chart comparison of COVID-19 to other epidemics

The following link will bring readers to information derived from the CDC (USA) and WHO (World Health Organization


This tracker from Johns Hopkins University provides realtime information and counts cases of COVID-19 coronavirus in China, as well as around the world, including numbers of deaths, recovered patients, and countries affected.

Coronavirus COVID-19 (2019-nCoV)

Click on the above real-time display about COVID-19 from John Hopkins University


World Health Organization Stats

The World Health Organization has its own coronavirus dashboard as well but includes only its own information, whereas the Hopkins team synthesizes data from WHO and four additional sources: CDC, European Centre for Disease Prevention and Control, China's National Health Commission, and ncov.dxy.cn, an independent data source maintained by Chinese physicians.

School Replaced Detention With Meditation And It Created Incredible Results - Healthy Food House

REWARD HERE. >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Numerous researchers and experts have questioned the effects of detention on kids’ development. Detention is punishment, so we can all agree on is that it is always experienced negatively, and children understand it as an attempt to shame them. Therefore, any alternative to detention that will not affect the self-esteem of children would be more …

The Robert W. Coleman School in Baltimore replaced detention by disciplining students’ thoughts instead, and it was found to be highly successful. In a partnership with the Holistic Life Foundation, it introduced the Mindful Moment Room, where students learn to calm and deal with stress and anxiety.

The room is decorated, and filled with lamps and purple pillows. Kids who misbehaved are there encouraged to sit and meditate, to calm and re-center. Over time, the effects of the change surprised many- suspension rates were drastically lower.

For the health of your children

This school set an excellent example of student-centered education by being open to new potential methods that might help kids in the process, and let’s hope other schools will follow suit.

CLICK HERE FOR REWARD >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

Detention might have been efficient once, as it was the most reasonable form of discipline, but nowadays, I believe it is useless and needs to be replaced.

It has never truly changed students’ behavior, and it never will, as we cannot make a change by being passive. Instead, we should take responsibility for ourselves, the educational system, and the community and start acting. 

Moreover, students claimed that the program even changed their lives- meditation helped them focus on tests even amid the noise, taught them to control anger by breathing in and out, and helped them build their character.

The meditation room is part of an after-school program called Holistic Me, which involves children from pre-K through the fifth grade. The initiative encourages children to talk to behavioral professionals, while they learn to practice mindful meditation and breathing exercises.

The process involves anger management, stress, anxiety and acting out behavior. Often the students bring meditation and yoga home to their parents.  

This learned skill will carry them through the rest of their lives.

CLICK FOR REWARD>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>

YOUR COACH

































School Replaced Detention With Meditation And It Created Incredible Results - Healthy Food House:

How people are using AI to detect and fight the coronavirus

The spread of the COVID-19 coronavirus is a fluid situation changing by the day, and even by the hour. The growing worldwide public health emergency is threatening lives, but it’s also impacting businesses and disrupting travel around the world. The OECD warns that coronavirus could cut global economic growth in half, and the Federal Reserve will cut the federal interest rates following the worst week for the stock market since 2008.

Just how the COVID-19 coronavirus will affect the way we live and work is unclear because it’s a novel disease spreading around the world for the first time, but it appears that AI may help fight the virus and its economic impact

A World Health Organization report released last month said that AI and big data are a key part of the response to the disease in China. Here are some ways people are turning to machine learning solutions, in particular, to detect, or fight against, the COVID-19 coronavirus.

Fever detection in public places

A Singapore hospital and public health facility is performing real-time temperature checks, thanks to startup KroniKare, with a smartphone and thermal sensor. One way AI detects coronavirus is with cameras equipped with thermal sensors.

An AI system developed by Chinese tech company Baidu that uses an infrared sensor and AI to predict people’s temperatures is now in use in Beijing’s Qinghe Railway Station, according to an email sent to Baidu employees that were shared with VentureBeat.

Above: Health officers screen arriving passengers from China with thermal scanners at Changi International airport in Singapore on January 22, 2020. Image Credit: Roslan Rahman / Getty Images

The Baidu approach combines computer vision and infrared to detect the forehead temperature of up to 200 people a minute within a range of 0.5 degree Celsius. The system alerts authorities if it detects a person with a temperature above 37.3 degree Celsius (99.1 degrees Fahrenheit) since fever is a tell-tale sign of coronavirus. Baidu may implement its temperature monitoring next in Beijing South Railway Station and Line 4 of the Beijing Subway.

Last month, Shenzhen MicroMultiCopter said in a statement that it’s deployed more than 100 drones capable in various Chinese cities. The drones are capable of not only thermal sensing but also spraying disinfectant and patrolling public places.

Virus tracking

One company, BlueDot, says it recognized the emergence of high rates of pneumonia in China nine days before the World Health Organization. BlueDot was founded in response to the SARS epidemic. It uses natural language processing (NLP) to skim the text of hundreds of thousands of sources to scour news and public statements about the health of humans or animals.

Metabiota, a company that’s working with the U.S. Department of Defense and intelligence agencies, estimates the risk of a disease spreading. It bases its predictions on factors like illness’ symptoms, mortality rate, and the availability of treatment.

Deep learning for coronavirus detection

The 40-page WHO-China Mission report released last month about initial response to COVID-19 in China cites uses big data and AI as part of response to the disease in China. Use cases include AI for contact tracing to monitor the spread of disease and “management of priority populations.”

But academics, researchers, and health professionals are beginning to produce other forms of AI as well.

On Sunday, researchers from Renmin Hospital of Wuhan University, Wuhan EndoAngel Medical Technology Company, and China University of Geosciences shared work on deep learning that detected COVID-19 with what they claim is 95% accuracy. The model is trained with CT scans of 51 patients with laboratory-confirmed COVID-19 pneumonia and more than 45,000 anonymized CT scan images.

The deep learning model showed a performance comparable to expert radiologists and improved the efficiency of radiologists in clinical practice. “It holds great potential to relieve the pressure on frontline radiologists, improve early diagnosis, isolation, and treatment, and thus contribute to the control of the epidemic,” reads a preprint paper about the model published in medrxiv.org. (A preprint paper means it has not yet undergone peer review.)

The researchers say the model can decrease confirmation time from CT scans by 65%. In similar efforts taking place elsewhere, machine learning from Infervision that’s trained on hundreds of thousands of CT scans is detecting coronavirus in Zhongnan Hospital in Wuhan.

AI for predicting survival for patients with severe COVID-19 cases

In initial results shared in another preprint paper updated today on medrxiv using clinical data from Tongji hospital in Wuhan, a new system is capable of predicting survival rates with more than 90% accuracy.

The work was done by researchers from the School of Artificial Intelligence and Automation, as well as other departments from Huazhong University of Science and Technology in China.

The authors say that coronavirus survival estimation today can draw from more than 300 lab or clinical results, but their approach only considers results related to lactic dehydrogenase (LDH), lymphocyte, and high-sensitivity C-reactive protein (hsCRP).

In another paper “Deep Learning for Coronavirus Screening,” released last month on arXiv by collaborators working with the Chinese government, the model uses multiple CNN models to classify CT image datasets and calculate the infection probability of COVID-19. In preliminary results, they claim the model is able to predict the difference between COVID-19, influenza-A viral pneumonia, and healthy cases with 86.7% accuracy.

The deep learning model is trained with CT scans of influenza patients, COVID-19 patients, and healthy people from three hospitals in Wuhan, including 219 images from 110 patients with COVID-19.

Because the outbreak is spreading so quickly, those on the front lines need tools to help them identify and treat affected people with just as much speed. The tools need to be accurate, too. It’s unsurprising that there are already AI-powered solutions deployed in the wild, and it’s almost a certainty that more is forthcoming from the public and private sector alike. 

The use of artificial intelligence will decrease time to diagnose and analyze data reducing the time to establish infection patterns and apply preventive measures such as preemptive isolation and quarantine

AI may also enable emergency measures such as restricting airline, rail or bus transportation to and from specific geographic areas..

Unlike previous epidemics of SARS,. MIRS, and  Equine flu we now have the first chance to use deep learning for diagnosis and epidemiology. 

Amazon's Alexa can now answer more questions about prescription drugs | VentureBeat

Thanks to a partnership between Amazon and First Databank (FDB), Alexa can now supply the answers to prescription drug questions and more via voice.

 Alexa can now answer questions about medication and other health care concerns via voice, thanks to a collaboration between Amazon and drug and medical knowledge provider First Databank (FDB). Content in both English and Spanish allows Alexa users to ask about drug interactions, side effects, precautions, and the drug’s class (all of which FDB says will be updated on a regular basis), complementing the health information sources Alexa already draws from, including the Mayo Clinic and WebMD.

“People lead busy lives, and voice provides a simple way to get helpful information about medications, including side effects and drug interactions, for themselves and the people they care for. And this information will complement advice from their medical and pharmacy teams,” said FDB president Bob Katter. “Ultimately, we believe that more informed consumers will lead to improved medication adherence, the reduction of adverse drug events, and better patient outcomes.”

Here’s a sampling of the questions Alexa can now answer:



Alexa, what type of drug is Ibuprofen?

Alexa, what are the side effects of Sertraline?

Alexa, is Advil safe for pregnant women?

Alexa, what’s the difference between Tylenol and Advil?

FDB — which was founded in 1977 and whose customers are chiefly information system developers in medication- and medical device-related subfields — says the data available through Alexa-enabled devices has been audited by clinicians, based on reviews of content from FDB’s drug information monographs. In an email to VentureBeat, an Amazon spokesperson characterized FDB as simply one of the hundreds of data sources Amazon uses to inform Alexa’s knowledge.

Amazon’s partnership with FDB follows its work with the U.K.’s National Health Service to make NHS-verified health information searchable by voice on Alexa, allowing U.K.-based users to ask questions and receive answers vetted by NHS health professionals and currently available on the NHS website. In a related development, late last year Amazon teamed up with pharmaceutical automation company Omnicell and grocery chain Giant Eagle to refill prescriptions and remind people to take their medication via Alexa.

Amazon Alexa will help to meet the increasing demand for facts about the status of the current  COVID-19 outbreak.






















Amazon's Alexa can now answer more questions about prescription drugs | VentureBeat:

Insurance Titan Drops Doctors, Needy Patients 'Caught in the Middle'

BAYONNE, N.J. — For five years, Rasha Salama has taken her two children to Dr. Inas Wassef, a pediatrician a few blocks from her home in this blue-collar town across the bay from New York City.

Salama likes the doctor because Wassef speaks her native language — Arabic — and has office hours at convenient times for children.

"She knows my kids, answers the phone, is open on Saturdays and is everything for me," she said.

But UnitedHealthcare is dropping Wassef — and hundreds of other doctors in its central and northern New Jersey Medicaid physician network. The move is forcing thousands of low-income patients such as Salama to forsake longtime physicians.

Across the nation, business and contractual disputes are separating patients from longtime doctors. This often occurs when doctors don't want to accept the rates insurers are willing to pay. It sometimes occurs when insurers' business plans require having a narrower network of doctors — doctors whose practice patterns may be easier to control.

But in this case, the cause of the exclusion goes to even deeper business connections: Wassef and other doctors say the insurer appears to be trying to shift patients to Riverside Medical Group, a 20-office physicians' practice owned by Optum, a sister company of UnitedHealthcare, both of which are subsidiaries of UnitedHealth Group. UnitedHealthcare is essentially forcing patients to transfer to doctors it controls, the doctors allege.

Indeed, several patients said the health plan directed them to Riverside when informing them their doctors were being dropped.  "Once you have a trusted relationship with a provider, it means a lot and it goes to the quality [of your care] because if you are seeing the same providers and you trust them, you are more likely to take your medication and adhere to whatever care plan you have," she said.

Dr. Alexander Salerno, an internist who runs a 17-doctor multispecialty practice in East Orange, New Jersey, another plaintiff in the lawsuit, is helping lead the court fight. Salerno's main office is in a three-story, 19th-century house that his father used for his medical practice in the 1960s. About 40% of his patients are on Medicaid.  

Until the dispute began last year, Salerno advised his patients to sign up for UnitedHealthcare because of its broad array of benefits, including vision and dental care, and because of the ease in referring to specialists. And UnitedHealthcare never complained about this group's skill. In fact, the group received a $130,000 bonus last year for its good care to patients. Salerno said Riverside Medical offered to buy his group practice in 2018, but he declined.

Since UnitedHealthcare announced it would drop his group from the network, more than 500 of his practices' patients have already changed doctors to stay with the UnitedHealthcare plan, Salerno said.

Velylia McIver, 83, decided in November to search for another plan so she could stay with Salerno. But it took her more than a month to get coverage for some medications.

Velylia McIver switched to a new Medicaid health plan after Salerno was initially dropped by UnitedHealthcare in order to keep seeing him                                                                                                                                              "I feel caught in the middle of all this, and it's the pits," McIver said."It's not a bad insurance company. It just seems like they have become greedy trying to control both ends of the pendulum — wanting to be the payer and provider," Salerno said.  

A federal judge ordered the case to be heard by a neutral arbitrator, which in late November granted an emergency injunction that will keep Salerno from being removed from UnitedHealthcare's network until an arbitrator makes a decision on a permanent injunction, which is expected in March.   

Flu Vaccine Less Than Half Effective: Flu Report In California

 So far this season, an estimated 32 million people — including 4,940 in California — have been affected by the flu.

Several items to point out to readers.

It is important to receive a vaccine early in the season.  It takes 14 days to develop immunity. Past history reveals that the vaccine is about 40% effective, and if you do contract the flue it will be less severe.  So the efficacy of the flu vaccine is slightly less than flipping a coin (50%) in the general population.  So you may ask,  Why is it so important for me to be vaccinated?

There are several reasons. From a public health aspect the more people who are immunized the better herd immunity which protects more people.   Senior citizens and those with compromised immunity are much more susceptible and have a higher rate of death. 

During the past several years a new group of biologic drugs is used by people with cancer, arthritis and other diseases.  Some of these new drugs alter the immune response. This may make these people more susceptible as well as getting more severe influenza.

 Flu Vaccine Less Than 1/2 Effective: CA Flu Report  - So far this season, an estimated 32 million people — including 4,940 in California — have been affected by the flu.

Getting your flu shot is the best way to keep from catching the flu; however, this year's vaccine has been only 45 percent effective in protecting Americans from this season's strains of influenza virus, according to the Centers for Disease Control and Prevention's newly released seasonal flu vaccine effectiveness report.

In California, there is a reason for residents to worry about catching the flu as there have been 125 outbreaks statewide since the flu season began in the fall. Over the week ending Feb. 22, 64 people died from the flu in California, and thousands more have endured the aches and coughs of influenza.

The Communicable Disease Center tracks influenza each year

This season in California, there is a reason for residents to worry about catching the flu as there have been 125 outbreaks statewide since the flu season began in the fall. Over the week ending Feb. 22, 64 people died from the flu in California, and thousands more have endured the aches and coughs of influenza.

In the report, the U.S. Influenza Vaccine Effectiveness Network determined the vaccine's efficacy in 4,112 children and adults who had flu-like illnesses between Oct. 23, 2019, and Jan. 25. From that data, researchers determined the vaccine was 37 percent effective in preventing Influenza A and 50 percent effective for Influenza B.

While the effectiveness of this season's flu vaccine may seem low, Dr. John Epling, a former vaccine fellow with the American Academy of Family Physicians, said it's on par with previous vaccines.

A total of 4,940 flu cases have been reported in California, according to CDC data. Influenza B started out as the dominant strain in California, and it hit young people particularly hard — 12 children have died from the flu in California this flu season. Now, however, Influenza A is the dominant strain in with 2,891 confirmed cases, and that is a concern because it is the strain more deadly for elderly patients who are more likely to die from the flu. A reported 2,049 people have tested positive for Influenza B.

Flu activity remains high in New York City, Puerto Rico and 43 states. In California, reported flu activity is currently high.

The CDC has recorded at least 32 million flu illnesses, 310,000 hospitalizations and 18,000 deaths from flu — 125 of which were children, according to data ending the week of Feb. 22.

If you are unfortunate enough and develop symptoms:

According to the CDC, symptoms of the flu include:

Fever or feeling feverish/chills (though not everyone with flu will have a fever)
Cough
Sore throat
Runny or stuffy nose
Muscle or body aches
Headaches
Fatigue
Some people may have vomiting and diarrhea, though this is more common in children than adults.

An ounce of prevention far outweighs contracting the flu and there are personal activities that lessen the chances of contracting influenza.  These measures also apply to CVID19

1. Try to avoid close contact with sick people.
2. While sick, limit contact with others as much as possible to keep from infecting them.
3. If you are sick with flu symptoms, you should stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone for 24 hours without the use of a fever-reducing medicine.)
4. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it.
5. Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub.
6. Avoid touching your eyes, nose, and mouth. Germs spread this way.
7. Clean and disinfect surfaces and objects that may be contaminated with germs such as the flu.                                      

The flu is a highly contagious illness, which is why the CDC urges everyone to take the following steps to protect themselves and others:

The CDC says it's not too late to get this year's vaccine. However, remember the current flu vaccine does not give immunity to CVID19 (corona viral disease). The CVID19 vaccine will not be available until the next flu season.

Flu Vaccine Less Than Half Effective: Flu Report In California | Patch: