Surgery News - November 2007 - (Page 6)

6 OPINION EDITORIAL SURGERY NEWS • N O V E M B E R 2 0 0 7 Meet Darryl Stephens in dark suits The menthat requested Darryl Stephens be called out of BY LAZAR J. his high school GREENFIELD, M.D., FACS classroom to meet with them. For a black foster child living in a group home in Richmond, Va., this would not usually be a good sign. Darryl hoped it had something to do with his college application, and in fact, the president of the College of William and Mary, Williamsburg, Va., had come to offer him a full scholarship. This was not charity; Darryl has made himself a worthy candidate by achieving a 4.0 grade average despite working 20 hours a week. He also has been doing sickle-cell anemia research, although his goal is to become a pediatric neurosurgeon. His research opportunity at Virginia Commonwealth University in Richmond was made possible by two other men at the meeting: Sen. Benjamin J. Lambert III (D-Va.) and Louis W. Sullivan, former Secretary of Health and Human Services. Mr. Sullivan is chairman of the VirginiaNebraska Alliance, a group that works to increase the ranks of minorities in the health care professions. Dr. Lambert, an ophthalmologist, helped start the alliance when he learned that black men constituted less than 1% of matriculants to the nation’s predominantly white medical schools in 2003. The alliance consists of Virginia’s five historically black colleges and universities; three of Virginia’s largest universities; the University of Nebraska Medical Center, Omaha; and Eastern Virginia Medical School, Norfolk. These organizations are working to expand the ranks of minority health professionals and researchers nationwide. Although minority groups constitute 25% of the nation’s population, they contribute only 6% of its doctors. Does that really make a difference? We know that patients from minority groups prefer to obtain health care from minority health care providers and are more likely to return for follow-up care, thereby improving outcomes. We also know that minority health care providers are more likely to practice in underserved areas, and minorities are more likely to participate in clinical research studies when a minority professional is on the research team. So the benefits extend well beyond the minority populations. Overall, health science education within a diversified environment benefits all students by advancing cultural understanding and competence. Since most of us don’t live in Virginia or Nebraska, we must look to national support for a diversified health workforce, which traditionally exists in Title VII of the Public Health Service Act. The programs supported by this appropriation have encouraged more than 460,000 underrepresented minorities, educationally disadvantaged, and economically handicapped students to pursue careers in the health professions. Historically, these funds have leveraged other funds, 69% of which matched or surpassed the federal allocation. But the appropriation was cut by 52% in FY 2006, and the Administration budget for 2008 contains only a small amount of scholarship funds. Although there is current bipartisan support to restore funding to the 2005 level, the reality of congressional priorities makes that unlikely. So we are left with a documented need for more minority health care professionals, potential candidates who are academically qualified, and minimal to no federal funding of legislated programs. The Virginia-Nebraska Alliance is a good example of the kind of grassroots action that deserves our support and that minimizes political rhetoric. Obviously, we want to encourage all underprivileged students interested in health care, but we must be particularly sensitive to the challenges faced by underrepresented minorities. As Justice Sandra Day O’Connor stated in Grutter v. Bollinger: “Effective participation by members of all racial and ethnic groups in the civic life of our Nation is essential if the dream of one Nation, indivisible, is to be realized” (Grutter v. Bollinger [02-241] 539 U.S. 306 [2003] 288 F.3d 732). ■ DR. GREENFIELD is editor in chief of SURGERY NEWS. LETTERS To Transfer or Not to Transfer I was intrigued by the comments of Dr. David Ciesla, who commented in a recent article that half of the trauma patients transferred to his facility had minor injuries (“EMTALA Panel Addresses Concerns About Hospital Transfers,” June 2007, p. 10). This struck me as an illustration of trauma surgeons hoping to have their cake and eat it too. Advanced trauma life support makes a big point of urging expedient transfer of the trauma patient to be evaluated by a trauma surgeon. In reality, at a small community hospital— where the CT tech may need to be called in, the radiologist is not in house, etc.— the workup for the trauma patient to evaluate the need for transfer may require a number of hours. The actual act of transferring the patient may then require considerable time also. This being said, I have found that for patients with a significant mechanism of injury and/or significant complaints, it is more efficient to transfer the patient with a minimal workup, rather than taking the time to document injuries that would not be handled at a small community hospital. Evan Weinstein, M.D. Indianapolis Defending Transplants in Iran Your report on patients who travel overseas to receive transplants appears insulting to those who are desperate to find a kidney donor after living on dialysis for years (“ ‘Transplant Tourists’ Present Ethical Dilemma,” June 2007, p. 17). In my experience with end-stage kidney disease patients, those who go abroad in search of kidney donors have sympathetic relatives or close friends who are willing to donate their kidneys out of generosity and religious beliefs. Any gift or monetary reward to the donor is only a sign of appreciation and admiration, since no one is so desperate for money that they would sell his or her organs. The physicians in the Iranian transplant team are highly professional and committed. Some 35 years ago, I was one of the early members of the team, and since then, I have watched their progress and achievements closely. Their superb statistics are frequently presented in international congresses of nephrology, and their rate of success matches that seen in the United States. Those transplant patients that I saw, including my brother, had perfect longevity, although some had rejections—which occurs in some cases wherever a transplant is done. Patients who go to Iran for a transplant undergo extensive pretransplant studies and are kept under close observation for the critical posttransplant period. If some return to the United States prematurely and against their physician’s advice, and develop posttransplant complications, they should be blamed for the failure. Bijan Nikakhtar, M.D. Los Angeles LETTERS TO THE EDITOR SURGERY NEWS is your publication, and we’re eager to share your opinions. Please send correspondence, including your name and address, to surgerynews@facs.org or to: American College of Surgeons Communications Office 633 N. St. Clair St. Chicago, IL 60611-3211 Letters may be edited for space and clarity. http://www.ce-university.org/surgery http://www.ce-university.org/surgery

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Surgery News - November 2007 Contents Black Patients Fare Worse Than Whites After Liver Surgery Survey Suggests Need For Acute Care Surgery New Law Bolsters FDA Funding, Authority Working Together Oncology: Marginal Evidence? Trauma: Screening Scrutinized News From the College: Healy Takes Helm

Surgery News - November 2007

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