By Ken Williams

As you surely know, Medicare reached its 45th anniversary recently. It has done a lot in those few decades to help improve health care in America and to reduce health disparities across racial and ethnic divides. Medicare is most known for guaranteeing health coverage for Americans over 65, but it was also a key driver in a variety of other health care innovations – including the desegregation of hospitals. Although Medicare does a lot to ensure that we, as a nation, are able to provide medical care to many of those most in need, its future is uncertain.

Amid tales of impending financial failure, Medicare has found itself potentially on the chopping block. This December, the National Commission on Fiscal Responsibility and Reform (aka the Deficit Commission) will meet to vote on recommendations to reduce the federal deficit, including such drastic measures as reducing Medicare benefits. The American Medical Student Association (AMSA) believes that it is imperative to make our voices heard: we cannot support any bill that will limit our patients’ access to quality, affordable health care. Indeed, we believe that the real solution is not to reduce or eliminate Medicare, but is, instead, to expand Medicare’s coverage to ALL those living in America.

AMSA believes that the expansion of Medicare would hold many benefits for America, not just in terms of the nation’s physical and mental health, but also in terms of our financial health. By expanding and improving Medicare, we can shift the focus of our health care system from the failed for-profit structure that has caused many of our fellow Americans to find themselves in bankruptcy (a 2009 Harvard study found that over 62% of all bankruptcies result from massive medical bills, a 50% increase over the 2001–2007 period) to a system built around preventive primary care and wellness.

AMSA believes that the right approach is to:

• Expand Medicare and "buy-in" options as steps toward improved Medicare-for-all;
• Protect access to care by limiting out-of-pocket expenses for Medicare beneficiaries; and
• Find a permanent solution to the sustainable growth rate (SGR) that appropriately incentivizes primary care and provides adequate compensation to maximize provider participation in the Medicare program.

These and other improvements are the real solution for America’s physical, mental, and fiscal health. For-profit health care is already leading to higher numbers of uninsured Americans, increased bankruptcy rates, and an inflated national deficit. It is time that we look to real solutions such as Expanded Medicare-for-All (H.R. 676), rather than reducing a program that already provides so much to our country and our fellow citizens.

By Andrea Knittel
MD/PhD Candidate
University of Michigan Medical School
University of Michigan School of Public Health

If you have ever attended an International AIDS Conference, you know how gigantic they are. Whether you were there as an activist, an implementer of public health programs, a social science researcher, a clinical investigator, or a basic scientist, you were probably overwhelmed by the sheer magnitude of it all. AIDS 2010 in Vienna, Austria was my first experience, and it was incredible. According to the conference blog, there were over 19,000 people participating this year! Some of the highlights for me included:

• Meeting other conference attendees in my hostel in Vienna and getting the chance to hear about social work with drug users in Taiwan and condom use in Kenya (their respective areas of expertise)
• Conference sessions, posters, and satellite sessions (early morning and late evening sessions organized by outside groups, but vetted by the conference for relevance) about my particular area of interest, HIV and the criminal justice system (materials for these and other sessions are available here)
• Speeches from Deputy President of South Africa, Kgalema Molanthe, Former U.S. President Bill Clinton, and Bill Gates (check out available webcasts of all of these here)
• Bill Gates answering the question I had submitted during the Q&A session following his talk
• Impassioned speeches, moving protests, and incredible advocacy from the individuals and organizations participating in the Global Village – the part of the conference devoted to connecting HIV/AIDS advocates from around the globe (many of these are also available as webcasts)

Overall it was an amazing chance to see everything that’s developing in HIV/AIDS research in a concentrated setting. I got to hear about the CAPRISA 004 tenofovir microbicide gel trial results, and also participated in an inspiring march for human rights through the old city in Vienna. Though it initially seemed odd to try to mix advocacy, science, and program implementation into a single conference, I think I’m convinced that it creates a dynamic and exciting environment in which to learn. 

Leave a comment about your AIDS2010 experiences!

Research released this week suggests that 8 out of 10 female medical students in the U.K. would freeze their eggs as a way to prolong fertility as they pursue their career. The study was released at the annual meeting of the European Society of Human Reproduction and Embryology, currently underway in Rome.

This left us wondering how American medical students feel about this. Let's say the procedure was affordable (according to the LA Times, the procedure can top $12,000 per cycle!), would you consider freezing your eggs while you finish medical school and residency? 

This week, the Accreditation Council on Graduate Medical Education (ACGME) released resident work hour recommendations. If you haven't seen them, you can check them out here. What do you think of the recommendations - right on the money? or not enough?

If you want to read AMSA's response to the recommendations, click here. Basically, AMSA thinks that they are a good step toward establishing evidence-based work hour scheduling for resident physicians HOWEVER, they would be stronger if the 16-hour shift applied to all residents. AMSA also hopes that the ACGME continues to monitor, enforce and update work hour regulations so that U.S. medical schools can maintain the highest standards of learning and self-care.

Posted by Jack Rusley

“Maybe it’s time for us to think: WWID,” Dr. Jerry Avorn said. “What would industry do?” After many years of arguing with classmates and others that the pharmaceutical and device industries should do more to provide access to essential medicines and less to influence physicians to use their products with flashy marketing and shotty research, I was taken aback by this question at first. As I settled into my seat, I realized that Dr. Avorn – a well known internist, geriatrician, and drug epidemiologist at Harvard – was pushing us to consider the most cost-efficient and effective methods for educating prescribers and changing their prescribing behavior…toward safer, more cost-effective drugs.

In recognition of AMSA’s extensive work on industry interaction and conflict of interest issues, the organization was invited to select 15 students to join more than 100 physicians, lawyers, policy makers, and allied health professionals at the University of Illinois at Chicago for a two day conference titled “Critical Prescribing Skills: Advances from the Attorney General Consumer and Prescriber Education Grant Program.” The grants and the conference were made possible by a $2.3 billion settlement between Pfizer and the state Attorneys General over the marketing of Neurontin (gabapentin) for off-label uses.

We heard from more than 20 grantees—a nurse practitioner who contributes to the Consumers Union Best Buy Drugs program, a PhD from UCSF who sits on World Health Organization committees on drug research and development, the AMA’s Vice President for Ethics, and many more—but the common goal was helping prescribers make better decisions and use the most efficacious, evidence-based, and cost-effective treatments available. Ah, if only this was as easy as it sounds! Most groups developed online modules that physicians, pharmacists, nurse practitioners, and other targeted prescribers can complete, ideally raising their awareness of marketing influence and conflicts of interest and leading them to make better prescribing choices. Almost all the groups struggled to get a large number of prescribers to participate, and when they did, had trouble quantifying any changes in behavior—both common issues in medical education research.

Thomas Abrams, head of the Food and Drug Administration department that regulates industry marketing was the other keynote speaker, and gave us a fascinating overview of how the agency works, what they can do (i.e. require black box warnings, which they do occasionally; call for a drug recall, which they do rarely), and what they can’t do (i.e. pull TV ads). He made it clear that the FDA does its best to work with drug companies instead of trying to impose it’s will, and that for the most part, industry cooperates and pushes the envelope at the same time.

AMSA and student activists received many acknowledgements throughout the conference, especially around their force for policy changes at their academic medical centers (AMCs). Outgoing Chair of AMSA’s PharmFree Campaign, Nitin Roper, spoke on a panel about AMSA’s work on the Physician Payment Sunshine Act (now law), the PharmFree Scorecard (now in its 4th year), and numerous AMC policy changes spurred by student activism.

As I flew home to Providence after two days of conference fun (minus the Disneyland rides), I was heartened by three things:

• the amazing students I met and reconnected with are not only extremely well-informed, passionate, and articulate, but are also clearly the future leaders on industry interaction issues,
• there is a small but growing group of physicians, nurses, pharmacists, policy makers, and lawyers who have committed a large part of their careers and lives to these issues (translation: we are not alone, and you will have somewhere to go after graduation), and
• government is on our side, from the FDA to Attorneys General to Senator Grassley, there is a strong sentiment that access to safe, affordable medicines is a public good and a human right.

When students and professionals in the health fields attend an institute, PowerPoint presentations are to be expected. But this past weekend, at the Indigenous Health Leadership Institute, participants got a different experience. It was a PowerPoint-free institute, where the entire three days were spent with community leaders in the Kewa Pueblo and Tohajiilee community on the Navajo Nation in Albuquerque, New Mexico.

The Native Health Initiative purposely used the word “indigenous” for the institute, hoping to deconstruct and decolonize the notion that Indigenous communities and traditions from north of the border are distinct from those south of the border.  

Did you attend this institute? We'd love to hear from you about your experience!

Every premed is confronted with the question, “So, why do you want to be a doctor?” The knee-jerk response is almost always, “Because I want to help people.” But could it not be said that for nearly every profession or line of work, somewhere and to some extent, there can be found this very same motivation? Is it not true that people in professions as diverse as academics, sanitation, or politics may also feel compelled - impassioned – to help people?

The question becomes, then, not “Do you want to help people?” (Of course you do), but “How does the medical profession uniquely provide for you the kinds of opportunities to help people that drive you to become a part of it?” The answer to this second question is not one that ought to be framed in the future tense, such as “I will be able to impact people at their moments of rawest human experience.” Rather, the answer ought to be historical – or more to the point, the answer ought to be found in your history, in your story.

The question behind the question, “Why do you want to be a doctor?” is two-fold: “Why do you want to become a doctor?” and “Why do you want to become a doctor?” Read again these two questions – out loud if you can – to catch the difference. The first is asking about the uniqueness of medicine. The second is asking about the uniqueness of you.

The entire medical school application process is designed to give you the chance to answer these two questions. And yet, these are the two questions, the second especially, that students are least prepared to give answers for. For every component of your application – and there are seven components – you must think about how the information you provide contributes in some way toward answering these two questions.

The seven components of the medical school application are:

1. GPA/MCAT
2. Volunteerism/Research
3. Personal Statement
4. Primary Application
5. Secondary Application
6. Letters of Recommendation
7. Interview

Premedical students – you – have many questions: about your goals, your dreams, the challenges and opportunities before you, near and far, as you enter into your chosen profession. Sometimes you know what questions to ask, and sometimes you don’t. Sometimes you know whom to ask; and sometimes, you don’t. The important thing here is this: you have to talk through this. You have to talk and ask questions, and listen and think. You have to be in conversation with your mentors and your peers. To that end, we invite you to join us in a special evening of dialogue on the issues that impact your entry into the healthcare profession.

Kaplan Test Prep, in partnership with the American Medical Student Association, Phi Delta Epsilon International Medical Fraternity, and the Student Doctor Network, will present a live online medical school admissions panel discussion called the Medical School Insider TONIGHT, Tuesday, May 11, at 7:30 pm ET. This two hour event will feature a panel of leading experts in medical school admissions, premed and medical education, and life in medicine. Following the panelist presentations, attendees will have the opportunity to engage with the panelists in an hour-long moderated Q and A session.

Confirmed panelists include:

Dr. Carlyle Miller
Associate Dean for Student Affairs
Weill Cornell Medical College

Dr. Karen Hamilton
Assistant Dean for the Office for Diversity and Community Outreach
University of Pennsylvania School of Medicine

Dr. Adam Aponte
Associate Director for Recruitment and Retention
Mount Sinai School of Medicine

Mr. John Brockman
MS4, Case Western Reserve University School of Medicine
National President
American Medical Student Association

Dr. Emil Chuck
Health Professions Advisor
George Mason University

Mr. Budge Mabry
Director, Texas Medical and Dental Schools Application Service
Director, Joint Admission Medical Program

Click here to enroll in this exciting event. This is a great opportunity to converse with medical education experts to learn from their perspectives about all the factors – your curricular and extracurricular activities, the MCAT, your personal statement, the primary and secondary applications, and the interview – that contribute to your success in gaining admission to the medical school that’s right for you.