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Wednesday
Feb102016

JANUARY 2016 PRESIDENT'S MESSAGE

BY: Mona Begum, M.D. (drmonabegum@gmail.com)

Dear West Hudson psychiatric society members, colleagues and friends:

I know many Psychiatrists including myself are disturbed by the denial of prescription
drugs for our patients by insurance companies. It is time consuming to obtain
authorization and therefore at times even inhibit us from prescribing newer drugs.
Recently, I was denied generic Geodon for an adolescent patient I have been treating in a
residential treatment center due to his insurance company’s policy “quantity limit
recommendations.” He has been receiving Geodon 60mg, 3 caps/day for one year and
they want me to lower the number of pills from 3 to 2, obviously to reduce the cost. My
reaction is one of annoyance and then retrospection. How did we as a society got to this
place that our health care system and the cost of medicine is so profit oriented? I looked
into this and one answer is GREED.

Many of you read the recent news about Martin Shkreli, who gained notoriety earlier this
year when his company, Turing Pharmaceuticals, increased the price of a drug used to
treat AIDS patients from around $13.50 to $750. Mr. Shkreli has emerged as a symbol of
pharmaceutical greed for acquiring a decades old drug and, overnight, raising the price
5000%.

Turing’s price increase is not an isolated example. While most of the attention on
pharmaceutical prices has been on new drugs for diseases like cancer, Hepatitis C and
high cholesterol, there is also growing concern about huge price increases on older drugs,
some of them generic that have long been mainstays of treatment.

Prescription drug spending is the third most expensive cost in our health care system.
And spending seems to grow larger every year. Just last year, the average American got
12 prescriptions a year, as compared with 1992, when Americans got an average of seven
prescriptions. In a decade and a half, the use of prescription medication went up 71
percent. This has added about $180 billion to our medical spending.

While there are more medicines on the market today than in 1992, researchers estimate
that around 20 percent of the $180 billion increase has absolutely nothing to do with the
number of medications available, or increases in the cost of that medication. To
understand this change, one place to look is:

“An Advertising Revolution”
It used to work like this: Doctors decided what to prescribe. Drug companies — through
medical advertisers — tried to influence doctors. Patients did what they were told.

The only problem, was that the system wasn't working out for the drug companies. For
them, the system was much too slow.

And so a large medical advertising company came up with a solution: They would
advertise directly to the patient. They'd get the patient to go in and ask the doctor for the
drug.

There was only one small problem with this solution: It was almost impossible to do due
to FDA regulations requiring that drug ads include both the name of a drug and its
purpose, as well as information about all the side effects. But side-effect information
often took two or three magazine pages of mouse print to catalog, and this wouldn't do
for a major television campaign.

But then, in 1986, while designing an ad for a new allergy medication called Seldane, the
medical advertising company hit on a way around the fine print.

They didn't give the drug's name, Seldane, all they said was: 'Your doctor now has
treatment which won't make you drowsy. See your doctor.' "

This was one of the very first national direct-to-consumer television ad campaigns. The
results were nothing short of astounding. Before the ads, Seldane made about $34
million in sales a year, which at the time was considered pretty good. Their goal was
maybe to get this drug up to $100 million in sales but eventually it went to $800
million."

Pharmaceutical companies took note.

Today, drug companies spend $4 billion a year on ads to consumers. The Nielsen Co.
estimates that there's an average of 80 drug ads every hour of every day on American
television. And those ads clearly produce results:

"Something like a third of consumers who've seen a drug ad have talked to their doctor
about it," says Julie Donohue, a professor of public health at the University of Pittsburgh
who is considered a leading expert on this subject.

"About two-thirds of those have asked for a prescription. And the majority of people who
ask for a prescription have that request honored."

By taking their case to patients instead of doctors, drug companies increased the amount
of money we spend on medicine in America.

The good news is the AMA calls for a ban on advertising directed at consumers. The vote
reflects concerns among physicians about the negative impact of commercially driven
promotions and the role that marketing costs play in fueling escalating drug prices. I
believe APA also should join in since the cost of medicine affects the quality of treatment
of our vulnerable patient populaton.

I welcome your ideas and exchanges. Our next meeting is on February 12, at 12:30 pm in
Il Fresco restaurant in Orangeburg. I wish you happy New Year.

Wednesday
Apr022014

March 2014 President's Message

By:  Russell Tobe, M.D.

Email:  russell.tobe@gmail.com

Dear West Hudson Psychiatric Society (WHPS) membership, colleagues, and friends:

After a terrible winter, it seems (perhaps) signs of relief and thaw are coming into focus. With
this have come a series of significant policy decisions to which the APA and West Hudson
Psychiatric Society have contributed.

First, APA strongly supported legislation to permanently repeal the flawed sustainable growth
rate (SGR) formula through introduction of the SGR Repeal and Medicare Provider Payment
Modernization Act of 2014 (H.R. 4015). This bipartisan legislation brought with it the promise
of improved physician payment (in the looming context of 24% payment cut on 4/1) and patient
access to care while eliminating the need for SGR patches (totaling, to date, 157 billion dollars).
Ultimately passed by a vote of 237 to 182 in the U.S. House of Representatives, sadly a policy to
delay the Affordable Care Act’s individual mandate for five years was attached by Republican
lawmakers in an attempt to offset the budget required to implement H.R. 4015. This, of course,
prevents mandates developed to encourage all citizens to obtain health care coverage.
Accordingly, APA does not support this and suggests lawmakers should go back to the table in a
bi-partisan fashion. If not resolved, the ongoing need for SGR patches will remain and the 24%
payment cut on 4/1 continues to loom. Accordingly, APA is still advocating for sensible
immediate legislation.

Second, APA supported action against a Center for Medicare and Medicaid Services (CMS) rule
to eliminate antidepressant and antipsychotic medication from protected coverage status. This
action by CMS would have limited beneficiary access to “all or substantially all” medications in
those classes. On 3/11, it was reported that CMS agreed to withdraw the proposal to eliminate
antidepressant and antipsychotic medications from protected coverage status.

With respect to other activities, WHPS recently completed another DSM training dinner in
Central Valley. This made an opportunity for Orange, Sullivan and Delaware county members
to join and participate. While I was able to fumble through the talk without the luxury of my
DSM-partner-in-crime (Dr. Nigel Bark), it was a fun occasion with a bit more time for casual
conversation and collegial discussion than our more intensive educational dinners. Speaking of
which, our next educational dinner will be April 25th, with Dr. Ann Sullivan, who is the new
Commissioner for NYS OMH. It should prove to be an interesting lecture from a very gracious,
knowledgeable, and kind speaker. The fall speaker is still being arranged. So please forward
requests and suggestions.

Finally, I want to invite everyone to our next Executive Council Meeting on April 4th. We will
be spending a significant amount of effort critically appraising the website for WHPS. We
would love to have as much feedback as possible as this is still very much a work in progress. If
you are unable to attend, please send suggestions for improvements. As always, forward
suggestions and comments to make our branch more efficient and helpful for the membership.

Sincerely,
Russ

Wednesday
Apr022014

January 2014 President's Messsage

By:  Russell Tobe, M.D.

Email:  russell.tobe@gmail.com

Dear West Hudson Psychiatric Society (WHPS) membership, colleagues, and friends:

As is often the case, winter time has been quiet for the West Hudson Psychiatric Society. I
sincerely hope everyone, their friends, and families have had a pleasant holiday season and a
Happy New Year. The holiday season was particularly happy for me as we had our baby boy in
December. So, in anticipation of preparing this Presidential column, please forgive gross
spelling and grammatical errors readily attributable to sleep deprivation.
Nonetheless, though WHPS has been in a state of hibernation, we have certainly been breathing
and very much alive. Some recent events have been exciting.

First, given the increasing needs from members and growth of the branch, Scott Wiener has
joined with Dom Ferro to jointly guide membership outreach and coordination. For those of you
who have not met Scott, he is an energetic early-career psychiatrist who recently started practice
in Pomona. With Scott on board, we anticipate a significant boost in membership outreach
coupled to a cultivation of fresh ideas. Welcome, Scott!

Second, Lois Kroplick has been exploring the possibility of educational opportunities in disaster
psychiatry training through the Red Cross or other avenues for interested members in the branch.
Third, our website is still very much a work in progress, please continue to send feedback and
suggestions. (WestHudsonPsych.org).

With respect to educational programming, the DSM 5 meeting initially scheduled for Feb 7, will
be tabled for the time-being due to logistical issues that arose. Nigel Bark and I are coordinating
another meeting date (likely the end of February or early March). This will still be a free event
to all members. For those members in Orange, Delaware and Sullivan Counties, please stay
particularly posted as we are hoping to make this meeting more accessible to you. An
announcement should be out in the coming days.

Also, I wanted to thank Nigel for coordinating with Dr. Ann Sullivan to conduct our Spring
Educational Forum speaker. Dr. Sullivan is now Commissioner of the New York State Office of
Mental Health. She has an exceptional service record in public psychiatry within New York
State. Accordingly, she is incredibly knowledgeable and experienced. It should prove to be a
wonderful forum. We are also actively in the process of organizing our fall symposium. If you
have suggestions for speakers, please forward them to me.

So we will wrap up here. Please stay tuned for our DSM 5 training announcement. As always,
forward suggestions and comments to make our branch more efficient and helpful for the
membership to me.

Sincerely,
Russ

Wednesday
Apr022014

November 2013 President's Message

By:  Russell Tobe, M.D.

Email:  russell.tobe@gmail.com

Dear West Hudson Psychiatric Society (WHPS) membership, colleagues, and friends:

With respect to our expansion and growth as a district branch, current times are exciting for
WHPS for two primary reasons. First, we have allocated significant effort (in no small order
from our Executive Director) to increase funding through grants in infrastructure and educational
support. This has positioned us as one of the more financially sound district branches regionally
and amongst the most sound (if not so) in our history. Second, we have revitalized our efforts to
reach all members across the district.

These efforts have reestablished longtime professional relationships while developing new
collaborations. Our fall educational forum was an exemplar of this positive advance. The
meeting was superbly attended, without an empty seat, and, sadly, with a need to turn people
away due to space limitations. The audience included new faces, many of whom are energetic
younger psychiatrists looking to forge professional contacts while contributing to and benefitting
from APA initiatives including education, advocacy, and mentorship. This has now spilled over
into our Executive Council meetings bringing fresh perspectives and desire for involvement.
Senior colleagues have also been responsive and generous in advising and guidance. In a year
where the APA is scheduled to be in New York City, the opportunity for further expansion and
adaptation of our branch is ripe.

So for all of you out there who may be on the sidelines after years of prior involvement or for
those of you who have never had an active part within the branch, there will be no better time (in
my estimation) than now to become involved. The next Council meeting is January 17th and all
members or prospective members are welcome to attend.

Now down to business. Please note that though details including DSM 5 topic and venue are still
in the works, we will be hosting a DSM 5 educational meeting with dinner on February 7, 2014.
Because this dinner is supported by grants obtained by and allocated to the branch, there will be
no financial cost to members. But there is no such thing as a free dinner. In this case, the cost is
suggestion of DSM topics by December 9, 2013 through emailing
westhudsonpsych@gmail.com. If topics are not suggested, Dr. Bark and I may be forced to talk
at length about the difference between DSM 5’s “Other Specified Schizophrenia Spectrum and
Other Psychotic Disorder: Delusional Symptoms in Partner of Individual with Delusional
Disorder” and DSM-IV’s “Shared Psychotic Disorder.”

With respect to the educational forum, those who attended were generally quite pleased. Dr.
Leventhal deftly navigated Autism Spectrum Disorders, from epidemiology through
neurobiology into treatment. The lecture was entertaining, interactive, and highly educational.
Dr. Leventhal was incredibly gracious, staying late into the night to answer specific research and
clinical questions. For those who missed, we have included a synopsis, kindly reviewed and
approved by Dr. Leventhal, that outlines the main points of the lecture. So, as usual, we will
leave this column short and sweet. Please remember to stay involved and reach out with
suggestions and requests. I am looking forward to seeing you all at the DSM 5 dinner.

Wednesday
Nov202013

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