Jack Bonner, MD, was honored as co-recipient of the 2002 American Psychiatric Association Area V Warren Williams Award in Philadelphia in May. He is currently the medical director of behavioral health services of the Greenville Hospital System and Marshall I. Pickens Hospital in Greenville, S.C.

The award honors people or programs for their outstanding contributions to psychiatry and mental health. Bonner has been an ACPE member since 1979.

Every November, the American Diabetes Association encourages the public to learn more about diabetes and the risks associated with the disease. American Diabetes Services, which provides low-cost or free diabetic self testing supplies to those with Medicare or qualifying insurance, supports these efforts. “We commend the efforts of the American Diabetes Association and National Diabetes Awareness Month for bringing attention to diabetes health risks,” said Lorne Yaffe, Vice President of Marketing for American Diabetes.

Diabetes is a disease in which the body does not produce or properly use insulin. Insulin is a hormone that is needed to convert sugar, starches, and other food into energy needed for daily life. The cause of diabetes is not known, but genetics and environmental factors such as lack of exercise and obesity tend to play a role.

The major types of diabetes include type 1, which results from the body’s failure to produce insulin, the hormone that “unlocks” the cells of the body, allowing glucose to enter and fuel them; and type 2 diabetes, which results from insulin resistance (a condition in which the body fails to properly use insulin), combined with relative insulin deficiency. Most Americans who are diagnosed with diabetes have type 2 diabetes.

About seven percent of the US population, 20.8 million adults and children, have diabetes. While an estimated 14.6 million have been diagnosed with diabetes, 6.2 million people do not know they have the disease. Unfortunately, there is no type 1 or type 2 diabetes cure. Each year, an estimated one million people are newly diagnosed with the disease. American Diabetes Services helps those with diabetes by offering free or low-cost access to necessary diabetic supplies, such as meters and test strips.

Many people first become aware that they have diabetes when they develop one of its serious and life-threatening diabetes health risks. These include the following:

* Heart Disease and Stroke

* High Blood Pressure

* Blindness

* Kidney Disease

* Nervous System Damage

* Amputations

* Dental Disease

* Pregnancy Complications

* Sexual Dysfunction

Yaffe explained how people with diabetes can get help managing their disease with free diabetic self-testing supplies. “In most cases, individuals with Medicare or qualifying private insurance can get their diabetic supplies free of charge or for a very small co-pay. Diabetics can complete a simple form on our website (www.americandiabetes.com) to find out if they qualify for low-cost or free diabetic supplies.”

American Diabetes is one of the nation’s leading online and mailorder distributors of brand-name diabetic supplies delivered directly to the individual’s home. American Diabetes supports finding a type 2 diabetes cure and provides personalized customer service and reduced expenses to those with diabetes; often, diabetic self-testing supplies are delivered at no cost to the patient. American Diabetes benefits include the following: free delivery directly to patient’s homes, no insurance paperwork to complete, no up-front costs or waiting weeks or months for reimbursement. Diabetes supplies are delivered at very low or no cost to you. Leading products include One Touch Ultra, Accu-Chek Compact, and Abbott FreeStyle. American Diabetes is a Medicare-participating provider, specializes in providing supplies paid for by Medicare, and accepts Medicare assignment. In addition, we support private insurance, major medical, and group health insurance plans; we accept most plans in all 50 states with the exception of HMOs.

Clinical Quiz questions are based on selected articles in this issue. Answers appear in this issue.

American Family Physician has been approved by the American Academy of Family Physicians as having educational content acceptable for Prescribed credit hours. Term of approval covers issues published within one year from the beginning distribution date of December 2001. This issue has been approved for up to 2 Prescribed credit hours. Credit may be claimed for one year from the date of this issue.

The American Academy of Family Physicians is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The AAFP designates this educational activity for a maximum of 2 hours in Category 1 credit toward the American Medical Association Physician’s Recognition Award. Each physician should claim only those hours of credit that he or she actually spent in the educational activity.

AAFP Credit

Each copy of AFP contains a Clinical Quiz answer card. AAFP members may use this card to obtain the designated number of Prescribed credit hours for the year in which the card is postmarked.

AMA/PRA Category 1 Credit

AAFP members who satisfy the Academy’s continuing medical education requirements are automatically eligible for the AMA/PRA.

Physicians who are not members of the AAFP are eligible to receive the designated number of credit hours in Category 1 of the AMA/PRA on completion and return of the Clinical Quiz answer card. AFP keeps a record of AMA/PRA Category 1 credit hours for nonmember physicians. This record will be provided on request; however, nonmembers are responsible for reporting their own Category 1 CME credits when applying for the AMA/PRA or other certificates or credentials.

For health care professionals who are not physicians and are AFP subscribers, a record of CME credit is kept by AAFP and will be provided to you on written request. You are responsible for reporting CME hours to your professional organization.

NOTE: The full text of AFP is available online (http://www.aafp.org/afp), including each issue’s Clinical Quiz. The table of contents for each online issue will link you to the Clinical Quiz. Just follow the online directions to take the quiz and, if you’re an AAFP member, you can submit your answers for CME credit.

INSTRUCTIONS

E Read each article, answer all questions on the quiz pages and transfer your answers to the Clinical Quiz answer card (bound into your copy of AFP). This will help you avoid errors and permit you to check your answers against the correct answers.

E Mail the Clinical Quiz answer card within one year (by December 31, 2002). The bar code on the answer card contains your identification for CME credit hours.

Before beginning the test, please note:

Each Clinical Quiz includes two types of questions: Type A and Type X.

Type A questions have only one correct answer and may have four or five choices. Here is a typical

It’s already that time of year again–by now you’re wrapping up your training runs for the Boston Marathon and getting mentally prepared to tackle the race course. And once again, the American Medical Athletic Association (AMAA) will be there to support your efforts and provide you with an educational and fun weekend.

The following details outline the AMAA-sponsored events for the Boston Marathon weekend and address questions frequently asked by runners and/or meeting attendees.

The AMAA’s 33rd Annual Sports Medicine Symposium at Boston: The Runner’s Body

The symposium is scheduled for April 17 and 18 and will be held at The Colonnade Hotel (Huntington Ballroom), 120 Huntington Avenue, Boston. Registration will be available online until April 12–go to www.amaasportsmed.org. Following that date, call 800-776-2732 to register. Onsite registration begins at 7:00 a.m. on April 17; however, be prepared to pay an additional onsite registration fee.

ACPM Continuing Medical Education

The 33rd Annual Sports Medicine Symposium at Boston has been planned and implemented in accordance with the Essential Areas and Policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American College of Preventive Medicine and the American Medical Athletic Association. ACPM designates the lecture portion of the educational activity for a maximum of 10.6 Category 1 credits. This activity has been approved for American Medical Association Physician’s Recognition Award credit. This activity has been reviewed and is acceptable for up to 10.75 prescribed credits by the American Academy of Family Physicians. 1.1 CEUs will be awarded for athletic trainers through the NATA.

Saturday

AMAA Cocktail Hour

Join us for an AMAA-hosted cocktail hour in the conference foyer immediately following the symposium on Saturday. It’s a perfect way to unwind after a day of lectures and meet fellow AMAA members.

Pasta, Pasta, Pasta!

All AMAA members and their family and friends are invited to attend a private dinner at Maggiano’s Little Italy on Saturday, April 17 at 7 p.m. To make a dinner reservation, please contact Nancy Talbot at 800-776-2732 or send an e-mail to ntalbot@americanrunning.org. Tickets are $30 per person.

Monday

Bus to the Starting Line

Everyone registered for the Race Package or Meeting Package A has a seat reserved on the AMAA bus to Hopkinton. The buses will depart from the front of The Colonnade Hotel on Monday morning, April 19 (departure time TBD, but it will be approximately 8 a.m.). Two buses will remain at Hopkinton until the start of the race; these are used for AMAA members waiting to run and baggage (which will be returned to The Colonnade Hotel after the start of the race).

Post-Marathon Celebration

Following the race, AMAA members and their “cheerleaders” are invited to toast their achievements at a post-marathon celebration at Brasserie Jo (located adjacent to the hotel). The gathering, which will last from approximately 3-6 p.m., will include food, beverages and recorded footage of the 2004 Boston Marathon. Gear left on the bus in Hopkinton can be retrieved during this time and AMAA runners will be given the opportunity to shower.

SATURDAY, APRIL 17 (On-site registration and continental breakfast begin
at 7:00 a.m.)

Welcome (8:00 a.m.)
8:10-8:50   Cardiovascular Medications & Exercise  James Ziccardi, D.O.
8:50-9:30   Statins for Everybody?                 Frank Yanowitz, M.D.
9:30-10:10  Statin Myopathy                        Paul Thompson, M.D.
BREAK
10:25-11:05  Menopause & Marathons                  Susan Love, M.D.
11:05-11:45  Sudden Death with an Apparently        Sumeet Chugh, M.D.,
Healthy Heart                          FACC
11:45-1:00   LUNCH (on your own)
1:00-3:00   Hyponatremia:                          Steve Clement, M.D.,
A Panel Discussion                     Lewis Maharam, M.D.,
Art Siegel, M.D.,
Joseph Verbalis,
M.D.
BREAK
3:15-3:55   Overtraining                           Tom Howard, M.D.
3:55-4:35   What’s New in Treating Heel Pain?      Amol Saxena, D.P.M.
4:35-5:15   Chronic Exertional Compartment
Syndrome of the Lower Leg              Fred Brennan, D.O.
Saturday Meeting adjourns at 5:15 p.m.
Cocktails (5:15-6:45 p.m.)  Bus Ride to Maggiano’s (6:45)
Dinner at Maggiano’s (7:00-9:30)

SUNDAY, APRIL 18 (On-site registration and continental breakfast begin
at 8:00 a.m.)

Welcome (9:00 a.m.)
9:10-9:50   ITB Friction Syndrome             Robert Fawcett, M.D.
9:50-10:30  The Adolescent Runner             Lyle Micheli, M.D.
10:30-11:10  Exercise and Recovery             Fran Mason, M.D.
from Cancer                       and Sean Swarner
BREAK
11:30-12:10  Psychological Aspects of Long
Distance Runners and How One Can
Enhance Performance               Andrew Lovy, D.O.
12:10-12:50  Sport Specific Strength Training  Bruce Wilk, P.T., OCS and
for Running Injuries              Megan Greco, D.P.T., ATC
Meeting adjourns at 1:00 p.m.

A Dutch study published last month in the Journal of the American Medical Association established a link between the use of proton-pump inhibitors, which are used for heartburn relief, and pneumonia. According to the study, people who were taking PPIs were 89 percent more likely to develop pneumonia than people who had stopped taking the medication. Similarly, patients taking H2 blockers had a 63 percent higher risk of developing pneumonia compared with former users of those medications.

Experts surmise that the acid blockers could be creating an environment within the stomach where harmful bacteria can survive, according to published reports.
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The American Medical Association (AMA) has agreed to supply its files on 650 000 doctors to a company specialising in databases to create a joint venture called HealthCareProConnect. The association will earn about $18.8m (13.4m [pounds sterling]) from the deal.

Three years ago, the association was criticised for its commercial deal with the Sunbeam Corporation that would have allowed the association seal to be placed on the company’s home health care products in exchange for royalties (BMJ 1997;315:502).

Critics are now worried that drug and medical supply companies will use HealthCareProConnect–set up through the association’s deal with Acxiom Corporation–to solicit doctors with controversial marketing practices that violate the association’s own ethical standards.

Dr Arthur Caplan, director of the Center for Bioethics, University of Pennsylvania, Philadelphia, said, “It is a very common practice for professional organisations and groups to sell mailing lists to others. But many will not do so in order to protect their members from unwanted marketing. Still others will not do so since they believe that the kind of advertising their members will be subjected to is too commercial or skewed.

“The AMA wants the American people to respect the professionalism of medicine, but the road to the respect does not run through the sale of membership lists to for-profit marketing entities.”

Richard Corlin, the association’s president elect, said earlier this month: “The American Medical Association strongly objects to certain media reports today that mischaracterise the intent and potential benefits offered by its new joint venture with Acxiom Corporation–HealthCareProConnect. Today, physicians are bombarded with information and solicitations from medical marketers. While many marketers provide needed and useful information to physicians, not all do. HealthCareProConnect seeks to address this situation.”

He added: “Mistakenly, some articles today said that HealthCareProConnect was formed to promote increased access by pharmaceutical companies to physicians. On the contrary, HealthCareProConnect helps improve the quality and accuracy of physician information while enabling physicians to screen out unwanted and unnecessary solicitations.

“It simply does not follow logically, as some media reports suggest, that creating a much better physician database increases the incidence of unethical gifts.”

Why does the American Medical Association support pro-tobacco candidates?

During the campaign season that culminated in November’s election, those senators who blocked comprehensive tobacco control legislation sponsored by Arizona Republican John McCain were rewarded with thousands of dollars in contributions from cigarette manufacturers–and thousands more from U.S. physicians.

Strange bedfellows, indeed. According to Federal Election Commission records published by the Center for Responsive Politics, the American Medical Association’s political action committee (known as “AMPAC”) gave over $8,500, on average, to senators facing reelection who helped kill McCain’s proposal in June. The defeat of this legislation, which would have increased cigarette taxes and granted the Food and Drug Administration authority to regulate tobacco products, effectively ended tobacco control efforts in the 105th Congress.

By comparison, AMPAC gave less than $2,500, on average, to senators up for reelection who had tried to move the McCain bill forward. That’s more than a 3:1 ratio in favor of pro-tobacco senators and begs the question: Why does a group that represents 250,000 physicians preferentially fund the supporters of an industry that annually kills 400,000 Americans?

No scientific reversal explains the AMA’s backing of tobacco’s friends on Capitol Hill. The nation’s largest physicians group remains committed, in the words of a recent leader, to “take the war to the tobacco companies in every way that we can.” In addition to supporting anti-smoking initiatives, the AMA has called for investors to divest from tobacco stocks and for politicians not to accept money from the tobacco industry. After the Senate vote in June, Dr. Randolph D. Smoak, Jr. of the AMA’s Board of Trustees, declared that his organization “deeply regrets the Senate’s failure to pass landmark anti-tobacco legislation.”

Yet not a month later, AMPAC contributed thousands to help pro-tobacco Senators Kit Bond from Missouri and Sam Brownback from Kansas beat back Democratic challengers. The PAC then went on to give the legal maximum–$10,000–to Ben Nighthorse-Campbell, a Colorado Republican who voted to block the McCain proposal and who faced an anti-tobacco opponent.

* Two studies published in the April 18 issue of the Journal of the American Medical Association report that moderate consumption of ethanol is associated with cardio-protective effects for heart attack survivors and older persons at risk for heart failure.

The first study, conducted by researchers at Israel Deaconess Medical Center in Boston, monitored patients for a four-year follow-up period to assess the effect of prior consumption on long-term mortality among 1,913 heart attack survivors. Among the 896 abstainers, 6.3 deaths per 100 person-years were reported; 3.4 deaths for the 696 light drinkers (under seven drinks per week); and 2.6 deaths for 321 moderate consumers (seven or more drinks per week).

In the second study, researchers at Emory University in Atlanta examined the monthly drinking habits of 2,235 men and women 65 or older and reported that moderate consumption was associated with decreased risks of heart failure in this age group.

A consensus document by the American Medical Association (AMA), the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the National Committee for Quality Assurance (NCQA) establishes a single standard for evaluating the management of diabetes in adults in multiple settings. The document coordinates measurement sets used by physicians, health care plans, hospitals and other health care organizations. The diabetes care measures will be tested in a demonstration project designed with the Maine Medical Assessment Foundation (MMAF). The three health groups plan to release similar performance measures for evaluating cardiovascular disease care, neonatal care and pregnancy outcomes. “The diabetes measures are the first in what we expect to be a series of collaborative measurement sets on clinically important topics. We also see this model as an excellent example of the evidence-based approach advocated by the National Quality Forum,” said AMA Executive Vice President E. Ratcliffe Anderson, Jr., M.D. Former AAFP President Neil Brooks, M.D., Vernon, Conn., represented the AAFP on the physician consortium that developed the measures.

Greetings, and welcome back to the AMAA Journal!

I’m thrilled to re-launch the journal of the American Medical Athletic Association. It’s been a year since our last issue, and there have been a lot of changes with your association.

* We’ve updated our information technology systems, and are now overhauling our business processes.

* We have a new executive director and many new staff.

* New programs and services are in the offering. We’ve just launched our new AMAA web site. Check it out at www.amaasportsmed.org.

* Even this publication has a new title and a slightly changed format. We plan to make bigger changes to the journal over the next year.

We’re making these changes with one goal in mind; to serve you better. As I write that phrase, I’m aware how hollow that phrase may sound to those of you who, because you haven’t been members very long, don’t know us well. From time to time, my mail delivers advertisements that offer a similar claim: some megalith is doing something new or different, “to serve me better.” Riiiiight! In most national organizations, that seems to be the rule.

If you’ve been an AMAA member for a while, you know we’re different. We strive to know each member. Many of you are participants in the Clinic or the Speakers’ Bureau. Or, you participate in national programs like last year s “Stay Fueled, Stay Cooled.” We see you at the Boston Marathon and at other races. Hundreds of you have attended the CME symposia at Boston and the Marine Corps Marathon. We treasure those personal contacts with you; those opportunities build the bonds that make AMAA an exception to the rule.

So, with that in mind, allow me to bid a fond farewell to a familiar face, and introduce you to several new ones (I said there were lots of changes in our office!).

Since our merger with the American Running Association, the American Medical Athletic Association enjoyed the talents and exuberant enthusiasm of Executive Director Susan Kalish. In early December, Susan moved on to the National Recreation and Parks Association (NRPA) to tackle new professional challenges as NRPA’s Director of Communications. We are indebted to her for her leadership, creativity, warmth, and friendship over the years. Although she will be missed in our day-to-day operations, she continues to support the American Running Association by serving on its Board of Directors. We wish her great success in her new endeavors. Good luck, Susan!