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Tuesday November 15, 2016

Why are dental therapists good for both dentists and underserved patients?

By Frank Catalanotto, DMD, University of Florida, College of Dentistry

Dr. Frank CatalanottoWhen I introduce myself to discuss dental therapy, I like to say that I’m a recovering pediatric dentist. I was the typical dental faculty member, then the Dean of the University of Florida’s College of Dentistry where I’m proud to say that more women and minorities enter UF’s College of Dentistry than ever before. And our progress has been recognized by our 2016 HEED Award and our Summer Health Professions Education Program (funded by the Robert Wood Johnson Foundation) that just started accepting applications for 2017. I absolutely believe we need more young dentists who reflect our nation’s population – and we want them to choose to serve communities that don’t currently have the oral health care they so desperately need.

The reality is that the current U.S. dental care delivery system is broken for the approximately 190+ million people* who cannot access care for a variety of reasons. We must examine the reasons and look at a variety of solutions or approaches to address the problem. The other reality is Dental Therapy is one of the evidence-based approaches that appears to be working.

When dental therapist critics rattle through their concerns about safety, quality and effectiveness, I have a standard initial response:“Doctor, I understand how you feel about dental therapists. But, can you provide me any published evidence that demonstrates that dental therapists are not technically competent for the procedures they perform or that they are unsafe or ineffective in doing what they do in providing oral health care to patients?” Then, I stop talking and await the answer. I’m usually greeted by deafening silence or a bit more bluster!

“There is no question that dental therapists provide care for children that is high quality and safe. None of the 1,100 documents reviewed found any evidence of compromise to children’s safety or quality of care. Given these findings, the profession of dentistry should support adding dental therapists to the oral health care team.”

– Dr. David Nash
A Review of the Global Literature on Dental Therapists
April 2012

Dental therapists are safe, qualified dental professions who work under the supervision of a dentist. Many dentists worry about the relatively short training of dental therapists (2-3 academic years vs. a dentist’s 8 years) but the scope of practice of a dental therapist includes only about 50 procedures . And for those procedures, they learn them at the same skill and quality level as a dentist. In fact, they may do more of these procedures while in school than a dental student might do.A dentist’s scope of practice includes roughly 500 billable procedures. And now, after years of discussion and debate, the Commission on Dental Accreditation (CODA) has adopted Educational Accreditation Standards for Dental Therapy. (CODA serves the oral health care needs of the public through the development and administration of standards that foster continuous quality improvement of dental and dental-related educational programs.)

Dental therapists can help dentists provide routine services to more patients, expand their practices, and generate additional revenue. Dentists can oversee dental therapists without being physically present, which offers maximum flexibility when employing dental therapists, whether in the dental office to expand operating hours or in community-based settings.Dental therapists earn lower salaries than dentists, so incorporating them into the team can also help dentists provide more cost-effective care. By delegating some of the routine procedures to these mid-level staff members, dentists can lower their per-unit costs, treat more patients, and generate higher revenue.

We can’t ignore the facts about poor oral health – for adults or children. For adults: employed adults lose more than 164 million hours of work a year related to oral health problems or dental visits; and adults who work in lower-paying industries, such as customer service, lose two to four times more work hours due to oral health-related issues than adults who have professional positions. For both children and adults, it is true that dental diseases are strongly associated with poverty, but we must recognize that children of color are less likely than white children to see a dentist and receive preventive care; Asian, Black, and Hispanic children are less likely than their white peers to have sealants; people of color are more likely than whites to suffer from untreated tooth decay; Black and Hispanic adults have more untreated dental decay; American Indian and Alaska Native Children have the highest rates of untreated decay; and adults and seniors of color are more likely than whites to lose their teeth.

Total charges for dental-related ED visits in FloridaWhat is worse is that deaths from preventable, treatable dental infections – like those of Deamonte Driver and Kyle Willis – are not isolated tragedies! A total of 66 patients died in hospitals over 9-year period in one study. And in another, 101 people who went to the ER for a dental problem died there, with the vast majority having no other presenting conditions.

Many of my dental colleagues agree with the ADA opinion that: “When speaking of access to dental care today, we must consider both the availability of care and the willingness of the patient to seek care.”I do not accept this perspective in light of low oral health literacy, high costs of care and the serious effects of lack of access to care. It is our professional responsibility and ethical commitment to turn need into demand. In order to do so, we must tackle the issues that will turn need for oral care into demand: Why do people not access available dental care? Why is care so expensive? Why aren’t there enough Medicaid/CHIP providers? How do we tackle the maldistribution of our dentists and health professions shortage areas? How and why should we tackle the lack of cultural competency? How can we improve the public’s oral health literacy?

I applaud the efforts of the ADA Health Policy Institute for their work on these issues, but I have two concerns with the data: it does not reflect state or regional differences; and many of us working in the field have doubts about the data’s accuracy. For example, the ADA estimates that about 33% of dentists participate in public assistance programs, yet we know in Florida only 8% of dentists participate in Medicaid.

Many dentists say that diversity, cultural competency and attitudes of the existing dental workforce aren’t important but the data shows otherwise: minority dentists were twice as likely as White dentists to accept Medicaid patients; a dentist’s sense of social responsibility is influenced by economics, professionalism, individual choice, and politics; there’s a social stigma attached to being a Medicaid provider; and dentists who are Medicaid providers are more altruistic than non-providers.

ethnic and racial diversity among dentists does not mirror that of the US population

Oral health literacy is also a problem because the public’s lack of knowledge is leading to a lack of care. The ADA Health Policy Institute developed a new, simplified measure of oral health knowledge. Nationally, (only) 50 percent of adults were able to respond correctly to each of the eight general knowledge questions regarding oral health facts. This ranges from 42 percent in New Jersey to 60 percent in Colorado and from 44 percent among low-income adults to 52 percent among high-income adults nationwide. Other literature supports this concerning lack of oral health literacy.

The bottom line is that organized dentistry is still fighting dental therapy but the training and employment of dental therapists are coming anyway because it’s good for patients and dentists. Educational programs that train dental therapists in Alaska and Minnesota are improving access to care for underserved populations. And now that legislation that creates a pathway to train dental therapists has passed in Maine and Vermont, we will soon have more data to prove their value. Legislation is pending or being discussed in Arizona, Massachusetts, Connecticut, South Carolina, Michigan, North Dakota, Oregon, Washington, New Mexico, North Dakota, Texas, Ohio and New Hampshire.

The existing data on the quality of work done by dental therapists is unequivocal, and confirms the quality for a set number of procedures is equal to that of a dentist. There are not two standards of care as many fear. If we consider ourselves an evidence-based profession, and we read the literature about dental therapy, we must draw this conclusion. To not do so would violate the ethical principle of veracity.We must also look at the principle of justice – treating patients fairly and working with allies in society to assure access to care. Dental Therapy offers a path to quality, expanded care for our communities. It is as simple and as important as that.

* This 190+ million total is extrapolated from a number of sources including HRSA, Kaiser Family Foundation and the ADA Health Policy Institute.

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Saturday October 15, 2016

Why I became a community advocate for better oral care access in Ohio

By Patricia Collins, President, Bootsy Collins Foundation

Kyle Willis

Kyle Willis

August 30, 2011. That’s the day we got an early morning call telling us that our 24-year old nephew Kyle Willis had died suddenly from a brain infection due to complications from a tooth infection. That’s when my husband and I vowed to do all that we could to make sure this tragedy would never happen again. That’s when we began our personal journey to educate as many people as possible about the importance of oral health care, about the dental health services that are available in low-income communities, and the dental providers who can increase access to affordable, quality care for everyone.

Kyle’s dental care story highlights the inherent weaknesses and miscommunications that are possible in our health care system. I’m not a dentist or doctor but as an aunt who cares deeply, it’s unimaginable to lose a younger family member – especially to a tooth ache. Let me tell you his story.

When Kyle first started having intense tooth pain, he was a single Dad raising his daughter Kylie. He couldn’t afford to go to a dentist so he ended up – as a lot of people do – in the local ER. They said they couldn’t do anything for mouth pain so they gave him a sheet of paper with a list of local dentists and sent him on his way. Kyle knew he couldn’t find a dentist he could afford so he threw away the piece of paper and tried treating his pain with over-the-counter medications.

Two weeks later, he was back at the ER with tooth pain too intense to manage himself. The ER doctor prescribed a $4 pain medication and a $27 antibiotic, but because Kyle was short on funds (and didn’t understand the importance of filling both prescriptions immediately), he filled the $4 prescription and battled on without dental care.

Kyle Willis Oral Care programHe went back to the ER two weeks later in an ambulance because by that time, he was writhing in pain and couldn’t take himself. My niece told the paramedics about his intense mouth pain, but they didn’t believe her and strapped him down to the gurney assuming he was on drugs. He got to the first hospital, but they saw fluid on his brain and could only treat his discomfort. He was transferred to University hospital and pronounced brain dead upon arrival. He was placed on life support until my brother had to make the tortuous decision to let him go after 24 hours.

We had so many questions after Kyle’s death. Why would an ER not treat mouth ailments? Why was Kyle not made aware of affordable community dental care options? Why didn’t the ER offer information about where to get cheaper prescriptions? Do ER staff know which antibiotics dentists prescribe for mouth infections? Why did paramedics not believe that this young black man was reacting to intense mouth pain – and not drugs?

Dr. Larry Hill was my first connection to the dental community. He came to Kyle’s memorial service. I noticed him standing at the very back of the congregation and introduced myself at the end of the service. He had read about Kyle’s death in the newspaper and felt compelled to attend. He shared his sadness for our loss – and about how the health and dental care systems had failed Kyle. That introduction led to the beginning of the Bootsy Collins Foundation’s Kyle Willis Oral Care program.

It was Dr. Hill who first made us aware of the Elm Street Dental Clinic that cares for underserved communities in Cincinnati. We learned that first-time Elm Street patients pay just $20 (or less) for care. We felt that it was so important that more people learn about this life-saving community service that we placed a memorial plaque in the Elm Street Dental Clinic lobby. The clinic was glad to recognize Kyle, and also decided to extend their hours in his honor.

We teamed with the Cincinnati Dental Society to create the part of the Kyle Willis Oral Care program that educates students about good oral health. Twice a year (in February during National Dental Month and six months later), we visit the Lighthouse Community School in Madisonville, Ohio to clean students’ teeth, educate them about care, and give out toothbrushes. I talk at the event and get overwhelmed by all of the thank yous and hugs I get from the children. They can’t believe that tooth infections can get into the brain and heart, and kill you if left untreated!

Bootsy and Patti Collins

Bootsy and Patti

We also support the creation of the new dental therapy model that could come to Ohio thanks to legislation supported by UHCAN Ohio and many state legislators. Dr. Hill made us aware of the successful dental therapy program already operating in Alaska. We support these new dental professions who would work under the supervision of local dentists, helping them to increase community access to quality, affordable care, while improving the profitability of their practices. We know the criticism and fear about these new dental providers the opposition is creating, but in fact, training dental therapists in Ohio would be a win-win for our communities – and our dentists – who simply don’t have the capacity to care for everyone!

In the future, we plan to partner with the University of Cincinnati Medical Center (and allies like Dr. Aric Kuehner who just attended our annual gala) to create and distribute materials that will educate ER staff and their patients about where to find lower-cost oral care and medication providers (such as Walmart) in the community. Our entire mission is to educate people about Kyle and what happened to him so they realize it could happen to any of us.

So please, from the bottom of my heart, join us and let’s do all we can to improve awareness of and access to dental care. Let’s stand up for those who can’t help themselves. Let’s do the right thing and make sure no-one else dies or suffers because they couldn’t pay to get dental care.

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Thursday September 15, 2016

Mentoring, career development, and diversity: Q&A with Dr. Doris Rubio

Dr. Doris RubioThis month, we were pleased to talk with Dr. Doris Rubio about her just-launched Professional Mentoring Skills Enhancing Diversity program (PROMISED) that is a supplement to the NIH-funded National Research Mentoring Network (NRMN).

Tell me about the PROMISED program. When and why was it formed?

The PROMISED program launched on September 1, 2016 and is designed to help mentors, who are committed to building a diversity workforce, to improve their leadership skills. As professors and researchers, we aren’t really taught how to manage others so this program helps to fill that training gap – and build critical leadership skills.

What activities does the PROMISED program offer? Have minority researchers found them?

There are two parts to our program: an in-person event and a fellowship with online training modules. The first two-day career coaching event is taking place in Pittsburgh this week. Our mentors will learn the skills needed to coach and facilitate career guidance with their mentees. Ultimately, our goal is to have mentees feel confident in self authoring their own career trajectories.

Our fellowship program includes a series of one-month online training modules that will occur monthly from September to June 2017. The modules will teach our fellows how to be better leaders and will include online and offline activities.

Anyone who is at the associate professor level or above is encouraged to apply to the program but it’s essential that they have a commitment to creating more diversity in the workforce. For this session, our mentors come from 16 states: California, District of Columbia, Georgia, Hawaii, Illinois, Indiana, Kentucky, Maryland, Missouri, Pennsylvania, Puerto Rico, South Carolina, Texas, Tennessee, Virginia, and Wisconsin.

PROMISEDWhat challenges have you faced as you built PROMISED and its programs?

So far our biggest challenge is having so many great applicants but not being able to accept everyone. There has been considerable enthusiasm about the program but in order to make the fellowship work, we selected just 30 fellows to participate. We have a dozen modules and everyone wanted to participate in all of them. Some modules, like “Strategic Planning” were extremely popular and we had to limit enrollment.

Can you share any "breakthrough moments" when you realized that PROMISED might achieve its goals -- and reach the researchers you want to help most?

PROMISED officially launch on September 1. And last week’s Orientation was definitely our breakthrough moment. It was that moment when we felt everyone’s enthusiasm and realized this is really happening! I’ve started teaching the “Understanding Academia” module. Our first synchronous session was also filled with such enthusiasm, so it was another great moment for the program. Other professors have contacted me offering to teach modules – and I had expected that I’d have to convince people to teach – so that seems like a breakthrough too!

How do PROMISED, NRMN and the NIH Diversity Program Consortium programs work together?

PROMISED is supported by NRMN which is funded by the NIH Diversity Program Consortium. All of our PROMISED fellows are committed to – and are very enthused about helping to diversify the workforce. We have a couple of our fellows who are from BUILD sites and next year, we want to specifically target faculty from the 10 BUILD sites for the program. We also have a partnership with six Minority Serving Institutions with our Leading Emerging and Diverse Scientists to Success (LEADS) where we are training junior faculty and postdocs from these institutions to help launch their research careers.  So, we will use our partners to advertise PROMISED to more senior faculty at their institution.

first PROMISED career coaching event

Dr. Doris Rubio with participants of the first PROMISED career coaching event, Pittsburgh, September 15, 2016.

What future PROMISED activities would you like people to know about?

We will be holding more career coaching events May 17-19, 2017. And soon, we’ll be opening the application for the 2017 Spring Session so we look forward to receiving applications from many more great candidates. Please “like” PROMISED on Facebook so you can stay informed about program deadlines!

In addition to leading PROMISED at the University of Pittsburgh, Dr. Rubio is Professor of Medicine, Biostatistics, Nursing, and Clinical and Translational Science; Director, Data Center, Center for Research on Health Care; Co-Director, Institute for Clinical Research Education; Director of Academic Programs, Institute for Clinical Research Education; and Co-Director, KL2 Clinical Research Scholars Program.

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Monday August 15, 2016

Grasping At The Moon: Enhancing Access To Careers In The Health Professions

By Louis W. Sullivan, MD

Health AffairsThe latest issue of Health Affairs focuses on disparities as they relate to health policy and healthcare. Dr. Sullivan wrote an essay entitled “Grasping At The Moon: Enhancing Access To Careers In The Health Professions” that’s featured in the Narrative Matters section. In the essay, Dr. Sullivan discusses his early childhood in rural Georgia during the 1930s, the impact of segregation, the family and community leaders who influenced and inspired him to become a medical professional, and the difficulties that he and others faced – and still face – as the cost of a medical degree becomes ever higher.

We encourage you to read your copy of Health Affairs – or go to the Health Affairs website to review the whole article but to pique your interest; we’ve highlighted a few excerpts where Dr. Sullivan discusses his experience as he began his medical education and how it contrasts with the financial realities that today’s aspiring medical professionals now tackle.

Health Affairs has also featured Dr. Sullivan’s article, and a podcast (for those of you who prefer to listen), in their “Narrative Matters: On Our Reading List” blog.

Copyrighted and published by Project HOPE/Health Affairs as Louis W. Sullivan, MD, Grasping At The Moon: Enhancing Access To Careers In The Health Professions, Health Aff (Millwood). 2016: 35(8): 1532-1535. The published article is archived and available online at

“In 1950 I enrolled at Morehouse College…. My family had only modest resources, but I had no financial concerns about attending medical school. Scholarships were available to financially needy students like me, and medical school tuitions were not in the stratosphere where they are today, costing as much as $60,000 per year…. The concept of having to borrow and incur massive debt to become a doctor did not exist during my medical school years. When I graduated, I had only $500 in educational debt, which I paid off by the end of my internship year.

As a result of the investment made in me through scholarships available in the 1950s, I was able to make…contributions to society that I otherwise could not have made….Today, graduating from medical school with a mere $500 of debt seems unimaginable. With high tuitions for medical school and limited scholarship dollars, it is now common for a medical student to accumulate debts of $150,000 to $250,000 by the time he or she graduates — and some owe even more.

Because of this reality, many college students, especially minority students from low-income families, are discouraged from ever applying to medical school, no matter how much they wish to do so.

Breaking GroundWhen minority students give up their dream of becoming a doctor or other health professional, they are depriving themselves;…future patients who would benefit from having a more ethnically and racially diverse health care workforce; and…the nation of the contributions they could make to improving their lives, their community, and the country.

By allowing our educational system to evolve over the past few decades into one in which so many students in the health professions incur massive debts to support their education, we have… inadvertently created a national environment that has impaired access to health services for too many of our citizens.

A fundamental requirement for a strong nation is a healthy population. For the United States, this means having sufficient numbers and sufficient diversity of health professionals in urban and rural communities across the country to promote healthy lifestyles and a culture of wellness, and to care for people who are afflicted by illness or injury. In the U.S. health care system, greater racial and ethnic diversity is essential to providing high-quality care, promoting the cultural competence of health professionals, and developing the trust and confidence in health professionals needed by the people served by the system.”

For more information about Dr. Sullivan’s compelling life and professional experiences, we encourage you to read his two recent books: NAACP Image Award-winning “My Life in Medicine” co-authored with David Chanoff and “The Morehouse Mystique” co-authored with Marybeth Gasman.

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Friday July 15, 2016

Think Research, Act Collaboratively!

By Jay A. Gershen, D.D.S., Ph.D., president of Northeast Ohio Medical University

Mary Woolley, president and CEO of Research!America

Jay Gershen Mary Woolley

Dr. Jay Gershen and Mary Woolley

Achieving a healthy population and a thriving economy starts with strong collaborations within communities. Ohio is an example of how powerhouse research institutions and health facilities are partnering with industry, philanthropy and government to improve health and drive the economy.

High rates of diabetes and obesity are among Ohio’s most serious health challenges. Ohio ranks 30th among all states in America’s Health Rankings by United Health Foundation. To address these conditions – thereby saving and improving lives as well as lifting the ranking -- university hospitals and other institutions are reaching out to communities to tackle the underlying causes of poor health, and to promote innovative ways to prevent and treat disease. Partnerships have unleashed new approaches to finding solutions to deadly and disabling conditions, and ways to expand economic growth in a region that has historically been a magnet for world-class scientists and cutting-edge research and development.

Scientists at the Center for Neuromodulation at The Ohio State University, working with Battelle Memorial Institute, have created technology that allows individuals suffering from paralysis to regain the use of hands and legs in what is known as limb reanimation. With chips implanted in the brain, patients can transmit their thoughts directly to hand and leg muscles, bypassing the spinal injury and restoring movement to limbs. Funding from the National Institute of Neurological Disorders and Stroke, a component of the National Institutes of Health, supported a training program in spinal cord injury research methods at The Ohio State University. Grants from the U.S. Economic Development Administration supported a project at Northeast Ohio Medical University (NEOMED) to accelerate pharmaceutical commercialization, enabling local companies and NEOMED researchers to advance their research towards clinical trials. GOJO industries and the Centers for Disease Control and Prevention (CDC) are helping to raise awareness of the importance of hand sanitizing and handwashing in health care facilities to reduce hospital acquired infections and the need for antibiotics.

Lucinda Maine, Walter Koroshetz, Sudip Parikh and Thomas F. Zenty III

“Medical Research: The Right Prescription for Economic Growth” summit, June 6, 2016. Panelists (L-R) Lucinda Maine, EVP and CEO of American Association of Colleges of Pharmacy (AACP); Walter Koroshetz, Director, National Institute of Neurological Disorders and Stroke; Sudip Parikh, VP and GM of Health and Analytics, Battelle; and Thomas F. Zenty III, CEO, University Hospitals.

Such partnerships not only provide hope to patients and their families but they contribute to the state’s economic expansion. In 2015, Ohio businesses received nearly $30 million in federal funding for the research and development of technologies with potential commercial applications. The state is also home to more than 2,500 bioscience business establishments and nearly 50,000 bioscience industry jobs. The average annual wage in the bioscience sector was $25,222 higher than the private sector overall.

Public and private sector investments in innovative research are critical to public health and Ohio’s public health research ecosystem as it works in conjunction with research hubs across the country that are addressing health threats such as the Zika virus and opioid abuse. According to a Centers for Disease Control and Prevention report, Ohio had the second-highest number of drug overdose deaths nationwide in 2014.

Drug addiction is pervasive in the state with heroin claiming the lives of at least 23 residents a week, according to CBS News, and impacting productivity and the local economy. In a five-day span during March of this year, heroin and fentanyl overdoses left at least 12 people dead in the state’s largest county (Cuyahoga). And just a few weeks ago, on a single day, the neighboring Summit County, had at least 23 people who overdosed. One of them died.

A recent University of Cincinnati study found that one in five Ohio residents knows someone who is struggling with heroin. Treatment facilities are struggling to keep up with the demand. Local academic research institutions are taking measures to help reduce addiction rates including Ohio State University College of Medicine which will require medical students to take prescriber education in line with guidelines from the CDC.

Ohio’s biomedical research industry is a national leader in benchside innovation that addresses current and emerging health threats to improve the health of its citizens and the health of the local economy. Federal funding, along with private sector support, is vital to ensuring collaborations in research are sustainable. And on June 6, at a summit hosted by NEOMED and convened by Research!America, which featured leaders from the local and national research community, it became evident that there were three areas of which public-private partnerships with research institutions and health facilities were heavily dependent: industry, philanthropy and government.

Susan Dentzer, Michael Drake, Joe Kanfer and Lucinda Maine

“Medical Research: The Right Prescription for Economic Growth” summit, June 6, 2016. Moderator Susan Dentzer, President and CEO of The Network for Excellence in Health Innovation (NEHI) with Panelists (L-R), Michael Drake, President, The Ohio State University; Joe Kanfer, Chairman and CEO, GOJO Industries; and Lucinda Maine, EVP and CEO of American Association of Colleges of Pharmacy

Titled “Medical Research: The Right Prescription for Economic Growth,” the summit called attention to the impact of biomedical research on wellness and the economy, and pointed out the need for more advocacy for research. Results presented from a state online survey conducted by Zogby Analytics on behalf of Research!America in May 2016 showed that 83% of Ohioans agreed that the Ohio State Legislature should support legislation that will encourage private investments in medical research.

An overwhelming majority of Ohio residents said it is important for the state to be a leader in education (89 percent) and in medical and health research (87 percent). Drug and substance abuse is considered to be the most important health issue facing Ohio residents, according to survey respondents, followed by cancer, obesity, mental health and heart disease, in that order. And, as is evident given that nearly 60 percent of Ohioans report having at least one chronic condition — arthritis, asthma, cancer, chronic kidney disease, COPD, diabetes, heart disease, high cholesterol, high blood pressure and stroke – chronic diseases are driving increased health care needs and higher medical costs.

During the summit, six Ohio members of the U.S. Congress participated, speaking of the value of medical research to the health of the public and the health of the Ohio economy. Congresswoman Marcia Fudge stressed the importance of research on health disparities in minority communities as studies show that certain health problems such as diabetes, heart disease, and infant mortality happen more often among minorities or citizens with lower incomes.

In the Ohio survey, seventy-eight percent of respondents agreed that it was “very” or “somewhat important” for both Ohio’s state government and the federal government to conduct medical or health research to understand and eliminate such differences.

Half of respondents (50 percent) agree that research to improve health is part of the solution to rising health care costs. Next week the Republican National Convention takes place in Ohio (a swing state with 18 electoral votes) and the week after the Democrats will gather in Philadelphia. If Ohioans responses are a bell weather for the nation, it begs a reasonable and timely question: What role will medical research and collaboration play in both conventions and in the general election debates?

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Wednesday June 15, 2016

Congratulations to the Class of 2016!

By Louis W. Sullivan, MD

Louis W. Sullivan at Des Moines University commencementIt’s an important time of year when academic institutions across the country celebrate the hard work and achievements of our nation’s newest graduates.

This year, I had the honor of speaking at commencement ceremonies at three esteemed institutions, all matriculating those on the way to professional health careers: Des Moines University, Drexel University – College of Medicine, and Charles R. Drew University of Medicine and Science.

As always, I was honored and inspired by the intelligence, passion and persistence these graduates display. Below I’ve shared some of the advice I offered the Class of 2016.

“Congratulations on reaching this important milestone in your personal and professional development! Be sure to thank those who have helped you reach this point in your career – family, friends, faculty, mentors and counselors. You stand on their shoulders; you’ve been helped by their giving of themselves – for you.

You are lucky to be joining the medical profession during this time. It has changed significantly over the past 100 years. When the Flexner Report was issued in 1910, average life expectancy was just 47 years (1900). Today, it’s 80 years due to improvements in public health, in our expanded knowledge of human biology (thanks to research), in advances in healthcare, and in improved living standards. We’ve benefitted from changes in medicine and healthcare, thanks to significant advances in technology, communications, data processing and analysis.

The 20th century was the century for improvements in healthcare, resulting from an expanding base of scientific knowledge. The 21st century presents the challenge and the promise of improvements in health and longevity due to improvements in health literacy and health behavior (that enable personal empowerment), environmental enhancements (that improve our air, water, and housing), access to more education (that yields higher incomes), and knowledge of disease prevention strategies (that will keep us healthier, longer).

Louis W. Sullivan speaking to the Class of 2016

(ltr) Louis W. Sullivan speaking at: Charles R. Drew University of Medicine and Science, Drexel University – College of Medicine, Des Moines University

Louis W. Sullivan at Drexel University commencementThe U.S. has the world’s leading scientists, strong health professions educational programs, and spends the most on healthcare – but, is not the healthiest nation. Why? It’s a distribution problem. Even in 2016, not everyone has clear access to healthcare due to lack of insurance, income, education, or to geography, bias (conscious and unconscious), and insufficient diversity (racial and ethnic) among the nation’s health professionals (cultural competency). The Affordable Care Act of 2010 was a good beginning but there are many systemic issues still to tackle so all Americans have access to quality, affordable care.

You must work to preserve professionalism, integrity, high ethical standards and humanity in medicine. You must always try to achieve open, honest communications with your patients, the highest ethical standards, and continuity of care. The greatest success in providing patient care is achieved by caring for the patient. By all means, use technology to assist you – to extend your reach and your capabilities. But never let technology be your master. Communication, touch, empathy, and listening, all contribute to better patient care and better outcomes.

What you do in your professional lives, your commitment to life-long learning, your standards for care, your ethics, your personal integrity will shape the health professions throughout your career.

I challenge you, to live your lives to the fullest – personally and professionally. For in so doing, you will have a profound positive impact on the lives of your patients, your community, our nation and the world.

Congratulations to you, to your family and friends!”

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Sunday May 15, 2016

Vermont Says “Yes” to Affordable, Quality Dental Care

By Louis W. Sullivan, MD

I want to commend the Vermont legislature for passing S.20, “An act relating to establishing and regulating dental therapists.”

As a country, we say our children are our future. But when it comes to dental care, we are failing them. I’m glad that Vermont is joining Minnesota and Maine in correcting this failure by permitting a new dental professional – a dental therapist – that can make quality, reliable oral health care available to Vermonters statewide.

Dental therapists work with dentists to extend care to more people who have little access to quality, affordable dental care. After completing a rigorous educational program, dental therapists can perform preventive care and routine restorative procedures, such as filling cavities.

As a physician and former U.S. Secretary of Health and Human Services, I am acutely aware of the many consequences of untreated tooth decay: life-threatening infections, heart disease, and other serious health conditions later in life. Clearly, Vermonters are also aware of these consequences and want to prevent them, too.

Lack of dental care impacts both the young and old. Tooth decay is the number one chronic illness affecting our children today. Despite calls to fight this epidemic that disproportionately afflicts children of color and the poor, nearly 40% of children with Dr. Dynasaur (Vermont’s publicly-funded healthcare program) had no dental visit in 2011. Vermont is ranked 30th in the nation for adults 18-24 who have lost six or more teeth due to gum disease or tooth decay. And nearly 100,000 Vermonters went without dental care in 2011 and 2012.

Dr. Daniel Kennedy, DHAT at the Swinomish Dental Clinic in LaConner, WashingtonOur current dental care system does not meet the needs of millions of people in our country. Currently, 47 million people nationwide live in federally-designated health services shortage areas. Also, insurance coverage does not guarantee access to care. An estimated 65 percent of practicing dentists do not see Medicaid patients. In the majority of Vermont’s towns, less than 50% of people eligible for Medicaid had received any oral care in 2010. And with nearly 50 percent of Vermont’s dentists over age 55, without this new legislation, Vermont will have an even greater shortage of dental care in the coming years.

For five decades, the nation’s physicians have effectively worked with physician assistants and nurse practitioners to expand access and improve the quality of medical care. By adding dental therapists to the oral health team, states will witness similar improvements in access to dental care. Minnesota was first, then Maine, and now Vermont will now join them in offering more dental care to those in need.

We thank the Native American tribes in the Pacific Northwest for setting the example for the nation by bringing the dental therapy model to the United States. In Alaska, more than 40,000 Alaska Natives now have access to dental care and Alaska is witnessing its first generation of cavity-free kids. Building on Alaska’s success, the Swinomish Tribal Community in Washington has become the first tribe in the lower 48 to employ a dental therapist. In Oregon, the Oregon Health Authority approved the Northwest Portland Area Indian Health Board’s proposal to integrate dental therapists into participating clinics serving the Confederated Tribes of Coos, Lower Umpqua and Siuslaw Indians and the Coquille.

We must pursue all options to end the crisis in oral health care access in America. Again, I commend the Vermont legislature for passing legislation that will enable dental therapists to be trained and provide much needed dental care to communities around your state. I am confident that more states in our nation will follow your lead.

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Friday April 15, 2016

Dental therapists bring oral health that’s just, equitable and accessible to all Minnesotans

By Leon A. Assael, DMD, Dean, University of Minnesota School of Dentistry

University of Minnesota Dental

At the University of Minnesota (UM) School of Dentistry: (L to R): Dental assisting student Khina Khatiwada (Minneapolis Community and Technical College), Jenny Meyers (second-year dental therapy student, UM School of Dentistry), Dr. Chuck Watkin, team care clinic group leader, Dr. Louis W. Sullivan, and Dr. Karl Self, Director, dental therapy program.

Minnesota is known for its leadership in making efforts for diversity and inclusiveness in healthcare, both for patients and caregivers. One of the keys to success in these endeavors is developing a health professions workforce that reflects the cultural and economic communities receiving care, and at an affordable cost: and with the highest quality. The goal is to achieve healthcare that is just and equitable and accessible to all. For oral health, the development of dental therapy in Minnesota is one vehicle towards improving access to oral health care with a diverse cadre of healthcare professionals, from the communities they will serve, and with a strong commitment to excellence in patient care. Seven years after achieving this newest oral health profession in Minnesota, about 50 dental therapists are members of the oral health care team, headed by the dentist, providing greater access to care for children, elderly, medically challenged, and economically disadvantaged patients.

Thanks to leaders from our communities and beyond dentistry, such as Dr. Louis Sullivan, dental therapy has now been given a consideration beyond Minnesota as a possible way to help address the vast burden of untreated dental disease. Dr. Sullivan visited us last week in Minnesota after presenting in Bismarck, North Dakota on the value of considering dental therapy as a way to improve oral health.

Dr. Louis W. Sullivan and Dr. Leon A. Assael

Dr. Sullivan and Dr. Assael

Untreated dental disease is the most common chronic disease in children and in the elderly. The cost of care is the number one reason that oral health care is not completed. Cultural, economic, medical barriers, unconscious and conscious bias all play important roles in the severe oral health disparities seen in the United States. The University of Minnesota participates in over 20 sites delivering oral health care to these communities, including some communities uniquely mixing in Minnesota, such as immigrants among Somali, Hmong Middle Eastern and Eastern European Communities as well as American Indian, African American, and rural Minnesota residents. Over 100 languages are spoken in our clinics that represent many of the world’s religions as well. Developing healthcare professionals from those communities and serving those communities is a key positive outcome we hope to achieve at the university. A diverse pathway in the health professions is needed to inspire students from all communities to seek careers in health care. Dental assisting, dental hygiene and dental therapy, along with dentists provide a complete array of opportunities and possibilities in healthcare for all.

I found Dr. Sullivan’s visit especially inspiring in that he spoke to our dental therapy students and learned of their passion of oral health care and their desire to give back to their communities. He also inspired them to be the type of caring and compassionate healthcare professional that will make a difference in the lives of their patients and give back to their communities. Thank you to Dr. Sullivan for his continued leadership in healthcare that will also make a better world with improved oral health for all.

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Tuesday March 15, 2016

Progress, passion, and place-based engagement: Celebrating Healthy Start’s 25th Anniversary

By Louis W. Sullivan, MD

National Healthy StartI had the pleasure of participating in the National Healthy Start Association’s 2016 Spring Conference in Washington, DC last month. This is a very special year for Healthy Start – and for me – because it’s the 25th Anniversary of the Healthy Start program which was founded while I led the U.S. Department of Health and Human Services.

Here is an excerpt from my February 27th remarks that capture my thoughts about the Healthy Start program, the 25th anniversary, and the current state of infant and maternal healthcare in America.

National Healthy Start Louis Sullivan Award“Twenty five years ago we created the Healthy Start program. Many in this room were part of that beginning. The program was launched as a 5-year demonstration project to reduce infant mortality in 15 urban and rural communities with high rates of infant death, and to deliver a national public information and education program. From 15 original sites, today, the Healthy Start program has grown to 105 federally-funded Healthy Start projects in 39 states, the District of Columbia, and Puerto Rico. Healthy Start activities have reached over half a million (524,484) women, children, and families in underserved urban, remote rural, tribal, and border communities. Not bad for a 5-year demonstration project!

[Healthy Start] is a successful program for many reasons. Two significant reasons are: The passion and commitment of the people in this room; and the connection and true community partnerships that are at the core of Healthy Start. This is a program that was well ahead of its time. Place based, multi-sector engagement to improve public health is THE public health model now – because it works. And Healthy Start was using this model 25 years ago – and it does work.

The Healthy Start community-level efforts, collaborations, and education have had a direct and significant impact in reducing maternal and infant health disparities. Things like case management, interconception care, and perinatal depression screening. All are important activities that favorably impact and improve the lives and futures of children and families in our communities.

“Place-based, multi-sector engagement to improve public health is THE public health model now – because it works. And Healthy Start was using this model 25 years ago.”

But for all the progress, what was important then remains critically important today. The U.S. ranks 26th in infant mortality among industrialized countries and women still smoke during and after their pregnancies.

The President’s 2016 budget request asked for $100 Million for Healthy Start programs. For a program that can point directly to its community success, this funding is not sufficient. It must be sustained and increased.

I am proud to have been part of the launch of the Health Start program 25 years ago – I am proud to stand with you today. Keep up the good work – you are making a difference in the world, and in the individual lives of mothers, children and families who, through your efforts, have reason to be confident in their Healthy Futures.

Thank you.”

Current and Past NHSA Board Members
Front (left to right): Timika Anderson-Reeves, Deborah Frazier, Louis Sullivan, Charlotte Parent
Standing (left to right): Arthur James, Belinda Pettiford, Yvonne Beasley, Shelby Weeks (back), Risë Ratney (front), Estrellita “Lo” Berry, Angela Ellison, Maria Lourdes Reyes, Regina Davis Moss, Alma Roberts Kenn Harris, Kimberly Brown-Williams, Sharon Ross-Donaldson, Margaret “Peggy” Vander Meulen, Madie Robinson, Celeste Garcia, Salim Al-Nurridin, and Rashid Mizell

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Monday February 15, 2016

Why does heart disease most impact minority women?

A conversation with leading cardiologist Dr. Jennifer H. Mieres

Dr. Jennifer H. MieresIn recognition of American Heart Month, we are proud to be talking with Dr. Jennifer H. Mieres, a leading cardiologist, Chief Diversity Officer and Women’s Health Leader at Northwell Health in New York. Dr. Mieres is also an author and a spokesperson for the American Heart Association.

Q: In your recent interview about women and heart disease on the NBC Nightly News, you highlighted that minority groups are most at risk for heart attacks. Why do you think that is?

A: I think that when you look at the risk factors for heart disease, all women are at risk across their lifespan. Heart disease is the #1 cause of death for women in America. But there’s a disparity in awareness of how lethal heart disease is. The American Heart Association national surveys showed that 65% Caucasian women knew heart disease was #1 killer compared to 34% Hispanics and 36% black women.

There is also a higher prevalence for hypertension in African Americans, who have a higher genetic disposition to developing hypertension at a younger age. In terms of risk factors for heart disease, African American women have a greater prevalence of obesity, sedentary lifestyles, exposure to chronic stress, diabetes, and metabolic syndrome. Put all of those together with a lack of awareness and heart disease goes under-detected and undiagnosed. South Asian women are also at risk because of the unrecognized risk factors of abnormal cholesterol levels lower HDL and higher risk of diabetes. A higher prevalence of risk factors combined with a lack of awareness translates into women not taking their symptoms seriously, delaying a diagnosis, and then delaying their access to life-saving strategies.

As we have gained insights from the decade long research focus on the sex and gender differences in heart disease, a substantial body of evidence supports the fact that social factors, including culture, health beliefs, functionality, mobility, wellness influence the incidence, treatment, and outcomes of heart disease.

“In [the African-American and Hispanic] communities, there’s a high risk of hypertension, diabetes, obesity, inactivity, and exposure to chronic stress.”

– Dr. Jennifer Mieres
NBC Nightly News
January 25, 2016

Q: According to the American College of Cardiology, only about 10-15% of cardiologists are women – and the percent of minority women is even less. Why did you choose the field?

A: I first became interested in medicine for very personal reasons. When I was seven, my paternal grandfather died of a heart attack. Wishing that I could have saved him, I vowed that I would be a doctor. Cardiology intrigued me because of Dr. Alice Jacobs, an interventional cardiologist at Boston University, who sparked my interest. She is still one of my heroes. When I trained at St. Luke’s, Dr. Judith Hochman became my mentor and sponsor. My decision to become a cardiologist was really cemented by these women. Along the way, I became devoted to gender-specific studies. Dr. Nanette Wenger at Emory became an important friend and mentor. Dr. Sharonne Hayes (Mayo clinic), Dr. Leslee Shaw (who is one of the national/international leaders in clinical research), Dr. Kathryn Taubert (Dallas) and I have published together in the area of women and heart disease. We all have this sort of sisterhood. They are all colleagues and friends whom I can call for advice and guidance about my career and the challenges of daily life. I also feel lucky to have meet a few influential men in cardiology, such as Dr. Robert Bonow (Northwestern), Dr. Kim Williams (Rush Chicago), Dr. Robert Hendel (University of Miami), Dr. Clyde Yancy (Northwestern), Dr. Pat O’Gara (Brigham, Boston) and Dr. Gary Heller (New Jersey) all of whom have become mentors and sponsors.

Q: Who or what inspired you to become a health professional? And were there moments when you questioned your decision? If so, how did you overcome those doubts?

A: All of the women I mentioned have become mentors, colleagues and friends who have inspired me to advance my career. Cardiology is not an easy path but it is so rewarding. With four years of med school and three years of cardiology training, it’s unforgiving…and almost survival of the fittest, if you will. But we don’t believe it needs to be such a harsh training environment. We are working to change the clinical curriculum and the overall training of physicians of the future at the Hofstra-Northwell School of Medicine (formerly Hofstra North Shore – LIJ School of Medicine). For women, it is challenging because training to be a cardiologist is not conducive to being pregnant and training takes place in our peak years. I turned to my mentors, like Dr. Wenger, who told me not to delay having a family – because there was no ideal time, in any career. I built a strong sisterhood and I’m glad of that. I am committed to paying it forward and being a mentor to junior faculty and women in training. When I meet younger women, I offer to help with guidance on career advancement and the challenges of everyday life. I try to pass the advice on to the next generation.

RX - The Quiet RevolutionQ: To increase health equity, we support the focus on culturally-competent care and interprofessional training. What are your thoughts on those trends? Are they are beginning to impact the health professions. And if so, do you see their outcomes beginning to improve care?

A: We are working to change the model so that physicians are an important member of the medical team that is working together – in partnership with patients – to deliver culturally-customized healthcare. As we focus on outcomes, the evidence supports the fact that the century-old paternalistic model, where doctors make all of the decisions, does not create the best health outcomes. It’s not just doctors and nurses, but all of the medical staff – as well as the patient – that need to be part of the team. The patient as a partner is key. When a patient is part of team, it adds an important component to the diagnosis, treatment and prevention strategy for managing and improving disease outcomes. The information that patients provide about their family history, past treatment, and lifestyle is so important to improving outcomes.

In medical school, we need to change the way we train doctors. The traditional training of medical students focused on coming up with the correct diagnosis and treatment plan. There was a focus on the acute situation. A contemporary model of healthcare delivery is one in which the doctor partners with the patient for all aspects of their health and wellness journey. As Dr. David Nash has said, 85 percent of health outcomes are determined by factors outside of the medical encounter. For example, with heart disease, it’s important to know the family history (i.e. if a mother, or father, or uncle had heart disease)and there needs to be a collaboration with the patient and their doctor and medical team to discuss the risk factors and a customized strategy for the sustainability of the lifestyle changes, medication adherence if needed to control and reduce risk.

RX - Doctors of TomorrowQ: The Sullivan Alliance is focused on encouraging more minority students to go into the health professions. What advice would you give to students who may be considering careers in healthcare?

A: I would encourage early exposure to all of the sciences – so we can build the pipeline in middle and high school. Healthcare is a personally rewarding field but not everyone needs to be a doctor or nurse. It’s important to educate students about all career options. Pairing students with mentors along their education journey is essential too. At Hofstra Northwell School of Medicine, there is a summer program that gives high school students exposure to and first-hand experience with clinical and basic science research, a hospital environment, and the medical school experience.

Q: The Jackson Heart Study and Framingham (Massachusetts) Heart Study are now working together to improve our understanding of heart disease in minority populations. What more can we do to expand this research?

A: We will be most effective if we create partnerships with communities and media to share the stories of people who have been part of research and clinical trials. We need to build trust with minority communities and the only way to do that is to let them see people connected to research that look like them. With trust and an understanding of the importance of clinical research, their participation in research will expand.

Recognizing that there needs to be an expanded approach to translating the scientific advances into health literate information, we need more partnerships with the media. About 70% of people get their health information online, as well as from TV, radio, and magazines. (Source: AHA survey 1999).

Overall, I think we have made significant advances in the diagnosis and treatment strategies for heart disease and we have seen about a 30 percent decrease in the number of men and women dying from heart disease. As we focus on prevention, I think for improved outcomes, we must adopt a patient-centered partnership and the integration of the social determinants of health to include one’s culture and religious beliefs and the tenets of health literacy into our health care delivery system,

About Jennifer H. Mieres, M.D., FACC, FASNC, FAHA Linked In

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Friday January 15, 2016

2016: The Healthy State of Our Union

By Ronny B. Lancaster

It is January! A time to reflect on the successes and challenges of the past year, and an opportunity to look forward optimistically, yet pragmatically to the upcoming 12 months, and beyond. The country collectively nods to this annual tradition in several ways, including, by observing the command of the U.S. Constitution that “He shall from time to time give to Congress information of the State of the Union and recommend to their Consideration such measures as he shall judge necessary and expedient.”

President Obama delivered his 8th and final State of the Union address on Tuesday evening (January 12). And, while the President spoke about traditional and expected themes – what we can accomplish by working together – a significant portion of his speech was devoted specifically to health.

He thanked a bipartisan Congress for its strong support of the National Institutes of Health. He set as a goal, similar to President’s Kennedy’s aspiration to land a man on the moon, to be the Nation to cure cancer, and asked Vice President Biden to lead that effort. And, he spoke about, what is perhaps his proudest achievement, the enactment of the Affordable Care Act, which he credits with providing access to millions of Americans.

Through various funded programs, the ACA recognizes that income, race and other socioeconomic factors influence health status. Data have shown for decades that minorities are substantially underrepresented across the health professions, from healthcare delivery to research, and health experts agree that improving these statistics can lead to improved health status among poor and minority citizens. Indeed, while relatively few themes were met with broad agreement in the Chamber, the President’s observation that every American should be given a fair chance to succeed in our Country was greeted with applause by both Democrats and Republicans.

In about 12 months, President Obama will leave office. He, like his predecessors, urged the Congress to preserve and strengthen what he believes to be his principal accomplishments. And, while he acknowledged that as a Nation, we had not achieved agreement on how to address the complex question of health, he implored the Congress to strengthen and improve the ACA.

Candidates for the Office of President will spend the year proposing and debating various issues, including what to do about healthcare. The options range from “repeal and replace” to “preserve and strengthen” to single payer. We do not yet know who will win the White House in November, and so the direction of the national debate is unclear for now. What we do know is that important issues such as effective access to the Nation’s healthcare system by the poor and health challenged, and efforts to continue to diversify our Nation’s health workforce will be crucial to our enduring effort to improve the wellbeing of our Nation’s citizens.

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