“From Pittsburgh to the World” is the message on a banner at the Global Links headquarters in Green Tree. Surrounding the banner is detailed pottery from Cuba, lucky ekekos from Bolivia and beautifully painted feathers from Nicaragua. Adjacent to these mementos of thanks from communities around the world is a window that sits eye-level with I-376 West and the rapid traffic and massive semi-trucks that come with it. The colorful art and the grey interstate form a striking dichotomy … and a striking partnership. Those massive semi-trucks that pass by may just have left Global Links filled with medical surplus such as life-saving sutures, hospital beds, wheelchairs, breathing machines, blood pressure cuffs and oto-ophthalmoscopes.
Catherine A. Chappell, MD, MSc
Debra L. Bogen, MD, FAAP, FABM
One of the most significant consequences of the opioid crisis is the increasing prevalence of hepatitis c virus (HCV) infection among young persons, including pregnant women. In 2015, the Centers for Disease Control (CDC) reported a 364% increase in HCV infection among persons less than 30 years of age.1 Now in Pennsylvania, young persons outnumber the “Baby Boomers” (persons born between 1945 to 1965) with HCV infection.2 Currently, recommendations are to universally screen all Baby Boomers for HCV.3 However, there are conflicting guidelines regarding HCV screening during pregnancy. While the Infectious Disease Society of America (IDSA) recommends universal antenatal HCV screening, the American College of Obstetrics and Gynecology (ACOG) recommends risk-based screening.
The Pennsylvania Supreme Court decided Mitchell v. Shikora in favor of Pennsylvania’s physicians.
All seven justices agreed and held that evidence regarding risks and complications of a surgical procedure may be admissible in medical negligence actions to assist in establishing the standard of care. In a dissenting/concurring opinion, however, two of the justices essentially opined that risks and complications evidence is not always germane and should be considered on a case-by-case basis.
PAMED action: On Dec. 1, 2017, the Pennsylvania Medical Society (PAMED) Executive Committee approved the filing of an amicus curiae brief with the American Medical Association (AMA) in the state Supreme Court case Mitchell v.
Background. Cannabidiol (CBD), derived from cannabis (cannabis sativa L.), has been marketed for several years, but interest in CBD products – and the number of outlets selling such products – skyrocketed after Congress passed the Agriculture Improvement Act of 2018 (Farm Bill). The Farm Bill, among other things, established a new category of cannabis – hemp – defined as cannabis with 0.3 percent or less concentration of compound delta-9-tetrahydrocannabinol (THC). Products meeting the definition of hemp were removed from the purview of the federal Controlled Substances Act. Companies manufacturing CBD products interpreted this to mean that their CBD products were legal so long as they were derived from hemp.
Over the past 10 years, there has been a continuous rise in the utilization and cost of echocardiograms, the most widely used diagnostic imaging test for heart disease. Since 2009, utilization has doubled. As a result, concerns were raised about overutilization or misuse of this procedure, and Appropriate Use criteria were subsequently developed by leading cardiologists. Utilization of echocardiography is especially high in the Pittsburgh region, according to Highmark, and not all physicians are complying with the Appropriate Use guidelines. On Jan. 1, 2019, Highmark announced the Advanced Imaging and Cardiology Services Program, which requires prior authorization for specific outpatient, non-emergent, elective cardiology services, including transthoracic echocardiograms and nuclear imaging.
Hepatitis C has reached a high level of awareness among the public in the past several years. It is hard to imagine that only 30 years ago this year, the virus was first identified and the name “non-A, non-B hepatitis” was replaced with “hepatitis C.”
Hepatitis C is a contagious infection of the liver caused by the hepatitis C virus (HCV). Hepatitis C is passed only by blood-to-blood contact from someone who is infected with hepatitis C. Since we were not able to screen for HCV in blood products until 1992, about three-quarters of infections occurred before this time. The other 25 percent of infected people tend to be in their late-20s, early 30s.
It’s no secret that Pennsylvania is ground zero in the national opioid crisis, and in fact Allegheny County is seeing more overdoses than the rest of the state. The Drug Enforcement Agency reported 4,642 total fatal drug overdoses in Pennsylvania in 2016, a 37% increase from the prior year. 2016 represented the third consecutive year in which the number of fatal overdoses exceeded all prior years. Drugs contributing to the crisis include heroin as well as prescription pain medications such as morphine, codeine, methadone, oxycodone, hydrocodone, fentanyl, and hydromorphone.
There is plenty of blame to go around. Although street drugs like heroin remain a factor, opioid manufacturers are under increased scrutiny for their marketing practices.