BOSTON — Daratumumab plus bortezomib, lenalidomide, and dexamethasone (D-RVd) may be a new standard of care for transplant-eligible patients with newly diagnosed multiple myeloma, according to a speaker at the International Myeloma Workshop.

Jennifer Smith/MDedge News

In the phase 2 GRIFFIN trial, adding daratumumab to RVd deepened responses at all time points and improved rates of stringent complete response and minimal residual disease (MRD) negativity post consolidation.

These results might convince “early adopters of therapy” to change their practice, said Peter M. Voorhees, MD, of Levine Cancer Institute at Atrium Health in Charlotte, N.C., who presented results from GRIFFIN as a late-breaking abstract at the workshop, which is held by the International Myeloma Society.

“But I think you do have to be careful,” Dr. Voorhees added. “We’ll have to see how these patients do over time. Is the MRD sustained, and does that MRD negativity improve progression-free survival?”

Dr. Voorhees presented data on 207 adults with transplant-eligible, newly diagnosed multiple myeloma who were enrolled in the GRIFFIN trial. The patients received RVd, with or without daratumumab, for induction (cycles 1-4). They received granulocyte colony stimulating factor, with or without plerixafor, for stem cell mobilization, and melphalan for conditioning prior to transplant.

Patients received consolidation with D-RVd or RVd (cycles 5-6) and maintenance with lenalidomide alone or in combination with daratumumab (cycles 7-32). Patients could continue maintenance with lenalidomide alone beyond cycle 32.

The D-RVd arm comprised 104 patients, and the RVd arm comprised 103 patients. Baseline characteristics were well balanced between the treatment arms. The median age was 59 years (range, 29-70 years) in the D-RVd arm and 61 years (range, 40-70 years) in the RVd arm.

Most patients had stage I (47% in the D-RVd arm and 49% in the RVd arm) or stage II disease (39% and 36%, respectively) according to the International Staging System. And most patients had standard risk cytogenetics (84% and 86%, respectively).

Response, MRD, and engraftment

The study’s primary endpoint was stringent complete response by the end of consolidation, which was achieved by 42.4% of patients in the D-RVd arm and 32.0% in the RVd arm (odds ratio [OR] = 1.57; P = .068). The overall response rate at that time point was 99.0% and 91.8%, respectively (P = .0160).

Responses deepened over time, and response rates were greater for D-RVd than for RVd at all time points. The complete response rate was 19.2% in the D-RVd arm and 13.4% in the RVd arm at the end of induction; 27.3% and 19.6%, respectively, at the end of transplant; 51.5% and 42.3%, respectively, at the end of consolidation; and 62.6% and 47.4%, respectively, at the clinical cutoff.

D-RVd also improved MRD negativity (10^-5) rates at the end of consolidation. MRD negativity was 44.2% in the D-RVd arm and 14.6% in the RVd arm (OR = 4.70; P less than .0001). The rate of MRD negativity in patients with a complete response or better was 28.8% and 9.7%, respectively (OR = 3.73; P = .0007).

Dr. Voorhees noted that D-RVd was favored across all subgroups for MRD negativity and stringent compete response, except among patients with high-risk cytogenetics and stage III disease.

He also pointed out that stem cell mobilization was “feasible” in the D-RVd arm, and daratumumab did not impact engraftment. The median time to neutrophil engraftment was 12 days in both treatment arms. The median time to platelet engraftment was 13 days in the D-RVd arm and 12 days in the RVd arm.

Safety

“The adverse events are what you would expect,” Dr. Voorhees said. “Grade 3 and 4 neutropenia and thrombocytopenia were seen more often in the dara arm of the trial compared to the RVd arm.”

The most common grade 3/4 treatment-emergent adverse events (in the D-RVd and RVd arms, respectively) were neutropenia (32% and 15%), lymphopenia (23% in both), thrombocytopenia (16% and 8%), and leukopenia (15% and 7%).

“Nonhematologic toxicities were generally equal between the two groups, but I do want to stress that there was a higher rate of infection in the dara arm,” Dr. Voorhees noted.

The incidence of infection was 82% in the D-RVd arm and 55% in the RVd arm, but the rate of grade 3/4 infection was 17% in both arms. The rate of pneumonia was 10% in the D-RVd arm and 9% in the RVd arm.

All-grade infusion-related reactions occurred in 41% of patients in the D-RVd arm, and grade 3/4 infusion-related reactions occurred in 5%.

The trial was sponsored by Janssen. Dr. Voorhees reported relationships with Janssen and several other companies.

jensmith@mdedge.com

SOURCE: Voorhees PM et al. IMW 2019. Abstract OAB-087.

BOSTON — Daratumumab plus bortezomib, lenalidomide, and dexamethasone (D-RVd) may be a new standard of care for transplant-eligible patients with newly diagnosed multiple myeloma, according to a speaker at the International Myeloma Workshop.

Jennifer Smith/MDedge News

In the phase 2 GRIFFIN trial, adding daratumumab to RVd deepened responses at all time points and improved rates of stringent complete response and minimal residual disease (MRD) negativity post consolidation.

These results might convince “early adopters of therapy” to change their practice, said Peter M. Voorhees, MD, of Levine Cancer Institute at Atrium Health in Charlotte, N.C., who presented results from GRIFFIN as a late-breaking abstract at the workshop, which is held by the International Myeloma Society.

“But I think you do have to be careful,” Dr. Voorhees added. “We’ll have to see how these patients do over time. Is the MRD sustained, and does that MRD negativity improve progression-free survival?”

Dr. Voorhees presented data on 207 adults with transplant-eligible, newly diagnosed multiple myeloma who were enrolled in the GRIFFIN trial. The patients received RVd, with or without daratumumab, for induction (cycles 1-4). They received granulocyte colony stimulating factor, with or without plerixafor, for stem cell mobilization, and melphalan for conditioning prior to transplant.

Patients received consolidation with D-RVd or RVd (cycles 5-6) and maintenance with lenalidomide alone or in combination with daratumumab (cycles 7-32). Patients could continue maintenance with lenalidomide alone beyond cycle 32.

The D-RVd arm comprised 104 patients, and the RVd arm comprised 103 patients. Baseline characteristics were well balanced between the treatment arms. The median age was 59 years (range, 29-70 years) in the D-RVd arm and 61 years (range, 40-70 years) in the RVd arm.

Most patients had stage I (47% in the D-RVd arm and 49% in the RVd arm) or stage II disease (39% and 36%, respectively) according to the International Staging System. And most patients had standard risk cytogenetics (84% and 86%, respectively).

Response, MRD, and engraftment

The study’s primary endpoint was stringent complete response by the end of consolidation, which was achieved by 42.4% of patients in the D-RVd arm and 32.0% in the RVd arm (odds ratio [OR] = 1.57; P = .068). The overall response rate at that time point was 99.0% and 91.8%, respectively (P = .0160).

Responses deepened over time, and response rates were greater for D-RVd than for RVd at all time points. The complete response rate was 19.2% in the D-RVd arm and 13.4% in the RVd arm at the end of induction; 27.3% and 19.6%, respectively, at the end of transplant; 51.5% and 42.3%, respectively, at the end of consolidation; and 62.6% and 47.4%, respectively, at the clinical cutoff.

D-RVd also improved MRD negativity (10^-5) rates at the end of consolidation. MRD negativity was 44.2% in the D-RVd arm and 14.6% in the RVd arm (OR = 4.70; P less than .0001). The rate of MRD negativity in patients with a complete response or better was 28.8% and 9.7%, respectively (OR = 3.73; P = .0007).

Dr. Voorhees noted that D-RVd was favored across all subgroups for MRD negativity and stringent compete response, except among patients with high-risk cytogenetics and stage III disease.

He also pointed out that stem cell mobilization was “feasible” in the D-RVd arm, and daratumumab did not impact engraftment. The median time to neutrophil engraftment was 12 days in both treatment arms. The median time to platelet engraftment was 13 days in the D-RVd arm and 12 days in the RVd arm.

Safety

“The adverse events are what you would expect,” Dr. Voorhees said. “Grade 3 and 4 neutropenia and thrombocytopenia were seen more often in the dara arm of the trial compared to the RVd arm.”

The most common grade 3/4 treatment-emergent adverse events (in the D-RVd and RVd arms, respectively) were neutropenia (32% and 15%), lymphopenia (23% in both), thrombocytopenia (16% and 8%), and leukopenia (15% and 7%).

“Nonhematologic toxicities were generally equal between the two groups, but I do want to stress that there was a higher rate of infection in the dara arm,” Dr. Voorhees noted.

The incidence of infection was 82% in the D-RVd arm and 55% in the RVd arm, but the rate of grade 3/4 infection was 17% in both arms. The rate of pneumonia was 10% in the D-RVd arm and 9% in the RVd arm.

All-grade infusion-related reactions occurred in 41% of patients in the D-RVd arm, and grade 3/4 infusion-related reactions occurred in 5%.

The trial was sponsored by Janssen. Dr. Voorhees reported relationships with Janssen and several other companies.

jensmith@mdedge.com

SOURCE: Voorhees PM et al. IMW 2019. Abstract OAB-087.

BOSTON — Daratumumab plus bortezomib, lenalidomide, and dexamethasone (D-RVd) may be a new standard of care for transplant-eligible patients with newly diagnosed multiple myeloma, according to a speaker at the International Myeloma Workshop.

Jennifer Smith/MDedge News

In the phase 2 GRIFFIN trial, adding daratumumab to RVd deepened responses at all time points and improved rates of stringent complete response and minimal residual disease (MRD) negativity post consolidation.

These results might convince “early adopters of therapy” to change their practice, said Peter M. Voorhees, MD, of Levine Cancer Institute at Atrium Health in Charlotte, N.C., who presented results from GRIFFIN as a late-breaking abstract at the workshop, which is held by the International Myeloma Society.

“But I think you do have to be careful,” Dr. Voorhees added. “We’ll have to see how these patients do over time. Is the MRD sustained, and does that MRD negativity improve progression-free survival?”

Dr. Voorhees presented data on 207 adults with transplant-eligible, newly diagnosed multiple myeloma who were enrolled in the GRIFFIN trial. The patients received RVd, with or without daratumumab, for induction (cycles 1-4). They received granulocyte colony stimulating factor, with or without plerixafor, for stem cell mobilization, and melphalan for conditioning prior to transplant.

Patients received consolidation with D-RVd or RVd (cycles 5-6) and maintenance with lenalidomide alone or in combination with daratumumab (cycles 7-32). Patients could continue maintenance with lenalidomide alone beyond cycle 32.

The D-RVd arm comprised 104 patients, and the RVd arm comprised 103 patients. Baseline characteristics were well balanced between the treatment arms. The median age was 59 years (range, 29-70 years) in the D-RVd arm and 61 years (range, 40-70 years) in the RVd arm.

Most patients had stage I (47% in the D-RVd arm and 49% in the RVd arm) or stage II disease (39% and 36%, respectively) according to the International Staging System. And most patients had standard risk cytogenetics (84% and 86%, respectively).

Response, MRD, and engraftment

The study’s primary endpoint was stringent complete response by the end of consolidation, which was achieved by 42.4% of patients in the D-RVd arm and 32.0% in the RVd arm (odds ratio [OR] = 1.57; P = .068). The overall response rate at that time point was 99.0% and 91.8%, respectively (P = .0160).

Responses deepened over time, and response rates were greater for D-RVd than for RVd at all time points. The complete response rate was 19.2% in the D-RVd arm and 13.4% in the RVd arm at the end of induction; 27.3% and 19.6%, respectively, at the end of transplant; 51.5% and 42.3%, respectively, at the end of consolidation; and 62.6% and 47.4%, respectively, at the clinical cutoff.

D-RVd also improved MRD negativity (10^-5) rates at the end of consolidation. MRD negativity was 44.2% in the D-RVd arm and 14.6% in the RVd arm (OR = 4.70; P less than .0001). The rate of MRD negativity in patients with a complete response or better was 28.8% and 9.7%, respectively (OR = 3.73; P = .0007).

Dr. Voorhees noted that D-RVd was favored across all subgroups for MRD negativity and stringent compete response, except among patients with high-risk cytogenetics and stage III disease.

He also pointed out that stem cell mobilization was “feasible” in the D-RVd arm, and daratumumab did not impact engraftment. The median time to neutrophil engraftment was 12 days in both treatment arms. The median time to platelet engraftment was 13 days in the D-RVd arm and 12 days in the RVd arm.

Safety

“The adverse events are what you would expect,” Dr. Voorhees said. “Grade 3 and 4 neutropenia and thrombocytopenia were seen more often in the dara arm of the trial compared to the RVd arm.”

The most common grade 3/4 treatment-emergent adverse events (in the D-RVd and RVd arms, respectively) were neutropenia (32% and 15%), lymphopenia (23% in both), thrombocytopenia (16% and 8%), and leukopenia (15% and 7%).

“Nonhematologic toxicities were generally equal between the two groups, but I do want to stress that there was a higher rate of infection in the dara arm,” Dr. Voorhees noted.

The incidence of infection was 82% in the D-RVd arm and 55% in the RVd arm, but the rate of grade 3/4 infection was 17% in both arms. The rate of pneumonia was 10% in the D-RVd arm and 9% in the RVd arm.

All-grade infusion-related reactions occurred in 41% of patients in the D-RVd arm, and grade 3/4 infusion-related reactions occurred in 5%.

The trial was sponsored by Janssen. Dr. Voorhees reported relationships with Janssen and several other companies.

jensmith@mdedge.com

SOURCE: Voorhees PM et al. IMW 2019. Abstract OAB-087.

With the help of a key celebrity spokesperson, the American College of Rheumatology is hoping Rheumatic Disease Awareness Month (RDAM) will continue to raise the profile of the related illnesses and help more patients recognize their symptoms and get on the road to treatment.

This year, the celebrity tapped to lead the now-annual campaign that began in September 2016 is tennis champion Venus Williams, who has been competing while battling Sjögren’s syndrome. She was diagnosed in 2011.

Having a high-profile individual like Venus Williams will “bring more awareness to not a specific illness but just rheumatic diseases in general,” Suleman Bhana, MD, chair of the ACR’s marketing and communications committee, said in an interview, adding that it is a way to help get attention from patients and their family members to be more aware of what they are facing when afflicted with a rheumatic disease.

It also helps to drive traffic to a website (simpletasks.org) set up to help build a community around rheumatic diseases, he noted.

“By signing up on the website, patients and others can get connected with wellness articles and can be informed about any advocacy opportunities in their local area or the national level,” said Dr. Bhana, a rheumatologist with Crystal Run Healthcare in Middletown, N.Y. “It helps us a lot from an ACR point of view just by getting the word out about rheumatic diseases.”

Dr. Bhana said that part of the success of the RDAM campaign is being measured by the number of people who sign up for the website. “Last year we had about 1,600 people sign up, which was more than double from the previous year and we are hoping to do even better this year now that we have Venus Williams as our spokesperson.”

But the campaign involves more than just a celebrity spokesperson and an online community to build awareness for rheumatic diseases and their associated symptoms and treatments. The ACR is working with patients to make sure their voices are heard on Capitol Hill to help ensure proper access to medical care and those treatments.

This year, the ACR – along with more than 100 advocates – met with members of Congress to push for policies that will benefit people with rheumatic diseases. One key item on the agenda targets the use of step therapy.

“This year the ACR’s Government Affairs Committee had a list of several pieces of legislation that they are looking at heavily. [One bill is about] having brakes on what is called step therapy, which is a fairly egregious practice by many insurers that forces patients to use different medications than what the physician and patient decide in their mutual doctor-patient relationship before they can use the medicine that was originally decided upon,” he said. “The reasons for this practice mostly are financial in that insurers get kickbacks from certain pharmaceutical companies, and that is what they term as preferred drugs. It’s a lot more than just cost savings. It’s about the insurers financially benefiting from patients rather than doing the right thing and preserving the doctor-patient relationship.”

One bill in particular that has been highlighted by the ACR is the Safe Step Act of 2019 (H.R. 2279), introduced by Rep. Raul Ruiz, MD (D-Calif.), and Rep. Brad Wenstrup, DPM (R-Ohio), would put limits on step therapy and create a clear process for patients and physicians to seek exemptions.

Other legislative actions that patients and the ACR were advocating for during the visits for RDAM included the EMPOWER for Health Act (H.R. 2781), which would help increase the number of pediatric subspecialists, including pediatric rheumatologists, through loan repayment for health professionals who agree to work at least 2 years in pediatric medicine, and the REDI Act (H.R. 1554), which would defer the accumulation on student loan interest while future doctors serve in a medical internship or residency program.

“The reality of pediatrics is that they don’t get well compensated as a pediatric rheumatologist subspecialist, so there is an ultimate financial disincentive for training pediatricians to go into rheumatology,” Dr. Bhana said. “So we are trying to get support for loan repayment for pediatric rheumatologists or rheumatology fellowship programs, which may help to incentivize young pediatricians to go into rheumatology to at least expand access to care.”

The RDAM campaign also provides useful contacts for an annual survey that the ACR conducts. This year’s survey found that access issues for both physicians and treatments persist, informing the agenda for the advocacy on Capitol Hill.

For example, the 2019 survey found that more than 60% of respondents had to wait at least 31 days from a physician referral to an initial rheumatologist appointment. Dr. Bhana noted that, in his practice, the wait can be 3 months or longer. A little more than 36% of respondents were able to get that initial appointment after referral in 30 days or less.

Additionally, nearly 47% of respondents were subjected to step therapy in the past year.

Treatment pricing was also raised as a concern in the survey, with a little more than 57% of respondents reporting difficulty affording treatments in the past year, and 25% reporting annual out-of-pocket spending at greater than $1,000, with more than 6% reporting annual out-of-pocket spending of greater than $5,000.

Despite all the challenges that lay ahead, Dr. Bhana believes that, as the campaign continues in its fourth year, it is having a positive impact.

“I think there is more awareness among patients to look up their symptoms and prompt their providers to look into, if not test for, rheumatic diseases, direct referrals, and I think because of these campaigns, we’ve gotten some indication that from a social media awareness that more patients are talking about it, about trying to get into seeing a physician.”

gtwachtman@mdedge.com

With the help of a key celebrity spokesperson, the American College of Rheumatology is hoping Rheumatic Disease Awareness Month (RDAM) will continue to raise the profile of the related illnesses and help more patients recognize their symptoms and get on the road to treatment.

This year, the celebrity tapped to lead the now-annual campaign that began in September 2016 is tennis champion Venus Williams, who has been competing while battling Sjögren’s syndrome. She was diagnosed in 2011.

Having a high-profile individual like Venus Williams will “bring more awareness to not a specific illness but just rheumatic diseases in general,” Suleman Bhana, MD, chair of the ACR’s marketing and communications committee, said in an interview, adding that it is a way to help get attention from patients and their family members to be more aware of what they are facing when afflicted with a rheumatic disease.

It also helps to drive traffic to a website (simpletasks.org) set up to help build a community around rheumatic diseases, he noted.

“By signing up on the website, patients and others can get connected with wellness articles and can be informed about any advocacy opportunities in their local area or the national level,” said Dr. Bhana, a rheumatologist with Crystal Run Healthcare in Middletown, N.Y. “It helps us a lot from an ACR point of view just by getting the word out about rheumatic diseases.”

Dr. Bhana said that part of the success of the RDAM campaign is being measured by the number of people who sign up for the website. “Last year we had about 1,600 people sign up, which was more than double from the previous year and we are hoping to do even better this year now that we have Venus Williams as our spokesperson.”

But the campaign involves more than just a celebrity spokesperson and an online community to build awareness for rheumatic diseases and their associated symptoms and treatments. The ACR is working with patients to make sure their voices are heard on Capitol Hill to help ensure proper access to medical care and those treatments.

This year, the ACR – along with more than 100 advocates – met with members of Congress to push for policies that will benefit people with rheumatic diseases. One key item on the agenda targets the use of step therapy.

“This year the ACR’s Government Affairs Committee had a list of several pieces of legislation that they are looking at heavily. [One bill is about] having brakes on what is called step therapy, which is a fairly egregious practice by many insurers that forces patients to use different medications than what the physician and patient decide in their mutual doctor-patient relationship before they can use the medicine that was originally decided upon,” he said. “The reasons for this practice mostly are financial in that insurers get kickbacks from certain pharmaceutical companies, and that is what they term as preferred drugs. It’s a lot more than just cost savings. It’s about the insurers financially benefiting from patients rather than doing the right thing and preserving the doctor-patient relationship.”

One bill in particular that has been highlighted by the ACR is the Safe Step Act of 2019 (H.R. 2279), introduced by Rep. Raul Ruiz, MD (D-Calif.), and Rep. Brad Wenstrup, DPM (R-Ohio), would put limits on step therapy and create a clear process for patients and physicians to seek exemptions.

Other legislative actions that patients and the ACR were advocating for during the visits for RDAM included the EMPOWER for Health Act (H.R. 2781), which would help increase the number of pediatric subspecialists, including pediatric rheumatologists, through loan repayment for health professionals who agree to work at least 2 years in pediatric medicine, and the REDI Act (H.R. 1554), which would defer the accumulation on student loan interest while future doctors serve in a medical internship or residency program.

“The reality of pediatrics is that they don’t get well compensated as a pediatric rheumatologist subspecialist, so there is an ultimate financial disincentive for training pediatricians to go into rheumatology,” Dr. Bhana said. “So we are trying to get support for loan repayment for pediatric rheumatologists or rheumatology fellowship programs, which may help to incentivize young pediatricians to go into rheumatology to at least expand access to care.”

The RDAM campaign also provides useful contacts for an annual survey that the ACR conducts. This year’s survey found that access issues for both physicians and treatments persist, informing the agenda for the advocacy on Capitol Hill.

For example, the 2019 survey found that more than 60% of respondents had to wait at least 31 days from a physician referral to an initial rheumatologist appointment. Dr. Bhana noted that, in his practice, the wait can be 3 months or longer. A little more than 36% of respondents were able to get that initial appointment after referral in 30 days or less.

Additionally, nearly 47% of respondents were subjected to step therapy in the past year.

Treatment pricing was also raised as a concern in the survey, with a little more than 57% of respondents reporting difficulty affording treatments in the past year, and 25% reporting annual out-of-pocket spending at greater than $1,000, with more than 6% reporting annual out-of-pocket spending of greater than $5,000.

Despite all the challenges that lay ahead, Dr. Bhana believes that, as the campaign continues in its fourth year, it is having a positive impact.

“I think there is more awareness among patients to look up their symptoms and prompt their providers to look into, if not test for, rheumatic diseases, direct referrals, and I think because of these campaigns, we’ve gotten some indication that from a social media awareness that more patients are talking about it, about trying to get into seeing a physician.”

gtwachtman@mdedge.com

With the help of a key celebrity spokesperson, the American College of Rheumatology is hoping Rheumatic Disease Awareness Month (RDAM) will continue to raise the profile of the related illnesses and help more patients recognize their symptoms and get on the road to treatment.

This year, the celebrity tapped to lead the now-annual campaign that began in September 2016 is tennis champion Venus Williams, who has been competing while battling Sjögren’s syndrome. She was diagnosed in 2011.

Having a high-profile individual like Venus Williams will “bring more awareness to not a specific illness but just rheumatic diseases in general,” Suleman Bhana, MD, chair of the ACR’s marketing and communications committee, said in an interview, adding that it is a way to help get attention from patients and their family members to be more aware of what they are facing when afflicted with a rheumatic disease.

It also helps to drive traffic to a website (simpletasks.org) set up to help build a community around rheumatic diseases, he noted.

“By signing up on the website, patients and others can get connected with wellness articles and can be informed about any advocacy opportunities in their local area or the national level,” said Dr. Bhana, a rheumatologist with Crystal Run Healthcare in Middletown, N.Y. “It helps us a lot from an ACR point of view just by getting the word out about rheumatic diseases.”

Dr. Bhana said that part of the success of the RDAM campaign is being measured by the number of people who sign up for the website. “Last year we had about 1,600 people sign up, which was more than double from the previous year and we are hoping to do even better this year now that we have Venus Williams as our spokesperson.”

But the campaign involves more than just a celebrity spokesperson and an online community to build awareness for rheumatic diseases and their associated symptoms and treatments. The ACR is working with patients to make sure their voices are heard on Capitol Hill to help ensure proper access to medical care and those treatments.

This year, the ACR – along with more than 100 advocates – met with members of Congress to push for policies that will benefit people with rheumatic diseases. One key item on the agenda targets the use of step therapy.

“This year the ACR’s Government Affairs Committee had a list of several pieces of legislation that they are looking at heavily. [One bill is about] having brakes on what is called step therapy, which is a fairly egregious practice by many insurers that forces patients to use different medications than what the physician and patient decide in their mutual doctor-patient relationship before they can use the medicine that was originally decided upon,” he said. “The reasons for this practice mostly are financial in that insurers get kickbacks from certain pharmaceutical companies, and that is what they term as preferred drugs. It’s a lot more than just cost savings. It’s about the insurers financially benefiting from patients rather than doing the right thing and preserving the doctor-patient relationship.”

One bill in particular that has been highlighted by the ACR is the Safe Step Act of 2019 (H.R. 2279), introduced by Rep. Raul Ruiz, MD (D-Calif.), and Rep. Brad Wenstrup, DPM (R-Ohio), would put limits on step therapy and create a clear process for patients and physicians to seek exemptions.

Other legislative actions that patients and the ACR were advocating for during the visits for RDAM included the EMPOWER for Health Act (H.R. 2781), which would help increase the number of pediatric subspecialists, including pediatric rheumatologists, through loan repayment for health professionals who agree to work at least 2 years in pediatric medicine, and the REDI Act (H.R. 1554), which would defer the accumulation on student loan interest while future doctors serve in a medical internship or residency program.

“The reality of pediatrics is that they don’t get well compensated as a pediatric rheumatologist subspecialist, so there is an ultimate financial disincentive for training pediatricians to go into rheumatology,” Dr. Bhana said. “So we are trying to get support for loan repayment for pediatric rheumatologists or rheumatology fellowship programs, which may help to incentivize young pediatricians to go into rheumatology to at least expand access to care.”

The RDAM campaign also provides useful contacts for an annual survey that the ACR conducts. This year’s survey found that access issues for both physicians and treatments persist, informing the agenda for the advocacy on Capitol Hill.

For example, the 2019 survey found that more than 60% of respondents had to wait at least 31 days from a physician referral to an initial rheumatologist appointment. Dr. Bhana noted that, in his practice, the wait can be 3 months or longer. A little more than 36% of respondents were able to get that initial appointment after referral in 30 days or less.

Additionally, nearly 47% of respondents were subjected to step therapy in the past year.

Treatment pricing was also raised as a concern in the survey, with a little more than 57% of respondents reporting difficulty affording treatments in the past year, and 25% reporting annual out-of-pocket spending at greater than $1,000, with more than 6% reporting annual out-of-pocket spending of greater than $5,000.

Despite all the challenges that lay ahead, Dr. Bhana believes that, as the campaign continues in its fourth year, it is having a positive impact.

“I think there is more awareness among patients to look up their symptoms and prompt their providers to look into, if not test for, rheumatic diseases, direct referrals, and I think because of these campaigns, we’ve gotten some indication that from a social media awareness that more patients are talking about it, about trying to get into seeing a physician.”

gtwachtman@mdedge.com

BOSTON – Adding elotuzumab to lenalidomide and dexamethasone can prolong overall survival in patients with relapsed/refractory multiple myeloma, according to final results from the ELOQUENT-2 trial.

At a minimum follow-up of 6 years, elotuzumab plus lenalidomide/dexamethasone (ELd) reduced the risk of death by 18% and prolonged the median overall survival by 8.7 months when compared to treatment with lenalidomide/dexamethasone (Ld).

“The combination of elotuzumab with lenalidomide and dexamethasone demonstrated a statistically significant and clinically meaningful 18% reduction in the risk of death,” said Meletios A. Dimopoulos, MD, PhD, of the National and Kapodistrian University of Athens. “This treatment combination is the only approved antibody-based regimen shown to prolong overall survival significantly in patients with relapsed or refractory myeloma in the context of a large, prospective, randomized trial.”

Dr. Dimopoulos presented results from this phase 3 trial at the International Myeloma Workshop, held by the International Myeloma Society.

The final analysis of ELOQUENT-2 included 646 patients with relapsed/refractory multiple myeloma who had received one to three prior lines of therapy at baseline. There were 321 patients randomized to ELd and 325 randomized to Ld. Baseline characteristics were well balanced between the treatment arms.

At the data cutoff of Oct. 3, 2018, 319 patients in the ELd arm and 316 in the Ld arm had received their assigned treatment. Ten percent (n = 33) of patients in the ELd arm and 4% (n = 14) in the Ld arm were still receiving their assigned treatment at the cutoff date.

The median number of treatment cycles was 19 (range, 9-42) in the ELd arm and 14 (range, 6-25) in the Ld arm. Most patients discontinued treatment due to disease progression (56% in the ELd arm and 57% in the Ld arm) or treatment-related toxicity (12% and 14%, respectively).
 

Survival

At a minimum follow-up of 71 months, the median overall survival was 48.3 months in the ELd arm and 39.6 months in the Ld arm. The hazard ratio was 0.82 (P = .0408).

The overall survival advantage with ELd was observed in all prespecified patient subgroups, Dr. Dimopoulos said. For example, overall survival favored ELd in patients aged 75 years and older (HR, 0.69), patients with International Staging System stage III disease at enrollment (HR, 0.74), those who had received two to three prior lines of therapy (HR, 0.71), and patients with del(17p) (HR, 0.71).

There were 212 deaths in the ELd arm and 225 in the Ld arm (67% and 71%, respectively). The most common causes of death were disease progression (41% in the ELd arm and 45% in the Ld arm), infection (9% and 6%, respectively), and “other” or unknown causes (7% and 9%, respectively). Two percent of patients in each arm (n = 7 in both) died from study treatment–related toxicity.

Dr. Dimopoulos pointed out that there were no imbalances in subsequent therapies between the ELd and Ld arms. The most common subsequent therapies (in the ELd and Ld arms, respectively) were bortezomib (38% and 42%), cyclophosphamide (30% in both arms), pomalidomide (26% and 29%), and lenalidomide (18% and 22%).

Safety

“Most of the adverse events which occurred throughout the study were due to the known side effects of lenalidomide and dexamethasone,” Dr. Dimopoulos said. “The contribution of elotuzumab to any kind of toxicity was minimal.”

Nearly all patients in both arms (99%) experienced adverse events. Serious adverse events were observed in 75% of patients in the ELd arm and 61% in the Ld arm. Adverse events leading to treatment discontinuation occurred in 36% and 33%, respectively, and grade 3-4 events leading to discontinuation occurred in 21% and 20%, respectively.

Grade 3-4 adverse events of special interest (in the ELd and Ld arms, respectively) were infections (35% and 27%), renal and urinary disorders (5% in both), cardiac disorders (6% and 8%), and lymphopenia (8% and 4%). Second primary malignancies occurred in 12% of patients in the ELd arm and 9% in the Ld arm.

This trial was sponsored by Bristol-Myers Squibb in collaboration with AbbVie. Dr. Dimopoulos reported relationships with Bristol-Myers Squibb, Amgen, Celgene, Janssen, and Takeda.

jensmith@mdedge.com

SOURCE: Dimopoulos MA et al. IMW 2019, Abstract OAB-021.

BOSTON – Adding elotuzumab to lenalidomide and dexamethasone can prolong overall survival in patients with relapsed/refractory multiple myeloma, according to final results from the ELOQUENT-2 trial.

At a minimum follow-up of 6 years, elotuzumab plus lenalidomide/dexamethasone (ELd) reduced the risk of death by 18% and prolonged the median overall survival by 8.7 months when compared to treatment with lenalidomide/dexamethasone (Ld).

“The combination of elotuzumab with lenalidomide and dexamethasone demonstrated a statistically significant and clinically meaningful 18% reduction in the risk of death,” said Meletios A. Dimopoulos, MD, PhD, of the National and Kapodistrian University of Athens. “This treatment combination is the only approved antibody-based regimen shown to prolong overall survival significantly in patients with relapsed or refractory myeloma in the context of a large, prospective, randomized trial.”

Dr. Dimopoulos presented results from this phase 3 trial at the International Myeloma Workshop, held by the International Myeloma Society.

The final analysis of ELOQUENT-2 included 646 patients with relapsed/refractory multiple myeloma who had received one to three prior lines of therapy at baseline. There were 321 patients randomized to ELd and 325 randomized to Ld. Baseline characteristics were well balanced between the treatment arms.

At the data cutoff of Oct. 3, 2018, 319 patients in the ELd arm and 316 in the Ld arm had received their assigned treatment. Ten percent (n = 33) of patients in the ELd arm and 4% (n = 14) in the Ld arm were still receiving their assigned treatment at the cutoff date.

The median number of treatment cycles was 19 (range, 9-42) in the ELd arm and 14 (range, 6-25) in the Ld arm. Most patients discontinued treatment due to disease progression (56% in the ELd arm and 57% in the Ld arm) or treatment-related toxicity (12% and 14%, respectively).
 

Survival

At a minimum follow-up of 71 months, the median overall survival was 48.3 months in the ELd arm and 39.6 months in the Ld arm. The hazard ratio was 0.82 (P = .0408).

The overall survival advantage with ELd was observed in all prespecified patient subgroups, Dr. Dimopoulos said. For example, overall survival favored ELd in patients aged 75 years and older (HR, 0.69), patients with International Staging System stage III disease at enrollment (HR, 0.74), those who had received two to three prior lines of therapy (HR, 0.71), and patients with del(17p) (HR, 0.71).

There were 212 deaths in the ELd arm and 225 in the Ld arm (67% and 71%, respectively). The most common causes of death were disease progression (41% in the ELd arm and 45% in the Ld arm), infection (9% and 6%, respectively), and “other” or unknown causes (7% and 9%, respectively). Two percent of patients in each arm (n = 7 in both) died from study treatment–related toxicity.

Dr. Dimopoulos pointed out that there were no imbalances in subsequent therapies between the ELd and Ld arms. The most common subsequent therapies (in the ELd and Ld arms, respectively) were bortezomib (38% and 42%), cyclophosphamide (30% in both arms), pomalidomide (26% and 29%), and lenalidomide (18% and 22%).

Safety

“Most of the adverse events which occurred throughout the study were due to the known side effects of lenalidomide and dexamethasone,” Dr. Dimopoulos said. “The contribution of elotuzumab to any kind of toxicity was minimal.”

Nearly all patients in both arms (99%) experienced adverse events. Serious adverse events were observed in 75% of patients in the ELd arm and 61% in the Ld arm. Adverse events leading to treatment discontinuation occurred in 36% and 33%, respectively, and grade 3-4 events leading to discontinuation occurred in 21% and 20%, respectively.

Grade 3-4 adverse events of special interest (in the ELd and Ld arms, respectively) were infections (35% and 27%), renal and urinary disorders (5% in both), cardiac disorders (6% and 8%), and lymphopenia (8% and 4%). Second primary malignancies occurred in 12% of patients in the ELd arm and 9% in the Ld arm.

This trial was sponsored by Bristol-Myers Squibb in collaboration with AbbVie. Dr. Dimopoulos reported relationships with Bristol-Myers Squibb, Amgen, Celgene, Janssen, and Takeda.

jensmith@mdedge.com

SOURCE: Dimopoulos MA et al. IMW 2019, Abstract OAB-021.

BOSTON – Adding elotuzumab to lenalidomide and dexamethasone can prolong overall survival in patients with relapsed/refractory multiple myeloma, according to final results from the ELOQUENT-2 trial.

At a minimum follow-up of 6 years, elotuzumab plus lenalidomide/dexamethasone (ELd) reduced the risk of death by 18% and prolonged the median overall survival by 8.7 months when compared to treatment with lenalidomide/dexamethasone (Ld).

“The combination of elotuzumab with lenalidomide and dexamethasone demonstrated a statistically significant and clinically meaningful 18% reduction in the risk of death,” said Meletios A. Dimopoulos, MD, PhD, of the National and Kapodistrian University of Athens. “This treatment combination is the only approved antibody-based regimen shown to prolong overall survival significantly in patients with relapsed or refractory myeloma in the context of a large, prospective, randomized trial.”

Dr. Dimopoulos presented results from this phase 3 trial at the International Myeloma Workshop, held by the International Myeloma Society.

The final analysis of ELOQUENT-2 included 646 patients with relapsed/refractory multiple myeloma who had received one to three prior lines of therapy at baseline. There were 321 patients randomized to ELd and 325 randomized to Ld. Baseline characteristics were well balanced between the treatment arms.

At the data cutoff of Oct. 3, 2018, 319 patients in the ELd arm and 316 in the Ld arm had received their assigned treatment. Ten percent (n = 33) of patients in the ELd arm and 4% (n = 14) in the Ld arm were still receiving their assigned treatment at the cutoff date.

The median number of treatment cycles was 19 (range, 9-42) in the ELd arm and 14 (range, 6-25) in the Ld arm. Most patients discontinued treatment due to disease progression (56% in the ELd arm and 57% in the Ld arm) or treatment-related toxicity (12% and 14%, respectively).
 

Survival

At a minimum follow-up of 71 months, the median overall survival was 48.3 months in the ELd arm and 39.6 months in the Ld arm. The hazard ratio was 0.82 (P = .0408).

The overall survival advantage with ELd was observed in all prespecified patient subgroups, Dr. Dimopoulos said. For example, overall survival favored ELd in patients aged 75 years and older (HR, 0.69), patients with International Staging System stage III disease at enrollment (HR, 0.74), those who had received two to three prior lines of therapy (HR, 0.71), and patients with del(17p) (HR, 0.71).

There were 212 deaths in the ELd arm and 225 in the Ld arm (67% and 71%, respectively). The most common causes of death were disease progression (41% in the ELd arm and 45% in the Ld arm), infection (9% and 6%, respectively), and “other” or unknown causes (7% and 9%, respectively). Two percent of patients in each arm (n = 7 in both) died from study treatment–related toxicity.

Dr. Dimopoulos pointed out that there were no imbalances in subsequent therapies between the ELd and Ld arms. The most common subsequent therapies (in the ELd and Ld arms, respectively) were bortezomib (38% and 42%), cyclophosphamide (30% in both arms), pomalidomide (26% and 29%), and lenalidomide (18% and 22%).

Safety

“Most of the adverse events which occurred throughout the study were due to the known side effects of lenalidomide and dexamethasone,” Dr. Dimopoulos said. “The contribution of elotuzumab to any kind of toxicity was minimal.”

Nearly all patients in both arms (99%) experienced adverse events. Serious adverse events were observed in 75% of patients in the ELd arm and 61% in the Ld arm. Adverse events leading to treatment discontinuation occurred in 36% and 33%, respectively, and grade 3-4 events leading to discontinuation occurred in 21% and 20%, respectively.

Grade 3-4 adverse events of special interest (in the ELd and Ld arms, respectively) were infections (35% and 27%), renal and urinary disorders (5% in both), cardiac disorders (6% and 8%), and lymphopenia (8% and 4%). Second primary malignancies occurred in 12% of patients in the ELd arm and 9% in the Ld arm.

This trial was sponsored by Bristol-Myers Squibb in collaboration with AbbVie. Dr. Dimopoulos reported relationships with Bristol-Myers Squibb, Amgen, Celgene, Janssen, and Takeda.

jensmith@mdedge.com

SOURCE: Dimopoulos MA et al. IMW 2019, Abstract OAB-021.

BOSTON – CT103A, a chimeric antigen receptor (CAR) T-cell therapy, is “active and effective” in patients with relapsed/refractory multiple myeloma, according to a speaker at the International Myeloma Workshop, held by the International Myeloma Society.

Jennifer Smith/MDedge News

The anti–B-cell maturation antigen (BCMA) CAR T-cell therapy produced a 100% response rate in patients with heavily pretreated multiple myeloma, and three of four patients who had failed a prior CAR T-cell therapy achieved a stringent complete response after CT103A.

Chunrui Li, MD, PhD, of Tongji Hospital and Tongji Medical College, Huazhong University of Science, Wuhan, China, presented these results at the workshop.

Dr. Li noted that anti-BCMA CAR T-cell therapy has produced responses in myeloma patients, but approximately half of patients typically relapse in about a year. CAR T-cell infusions after relapse have not been effective in these patients.

In an effort to change that, Dr. Li and his colleagues developed CT103A, a lentiviral vector containing a CAR structure with a fully human single-chain fragment variant; CD8a hinger; and transmembrane, 4-1BB co-stimulatory, and CD3z activation domains.

Dr. Li and his colleagues evaluated CT103A in a phase 0 trial (ChiCTR1800018137) of 18 patients who had received at least three prior lines of therapy and had disease refractory to a proteasome inhibitor and an immunomodulatory agent.

The patients’ median age was 53.3 years (range, 38-66 years), and their median time since diagnosis was 32 months (range, 8-92 months). They had received a median of 4 (range, 3-6) prior therapies. All had received prior bortezomib and lenalidomide, seven had undergone a transplant, and four had been treated on a trial of murine anti-BCMA CAR T-cell therapy.

For the current trial, patients received lymphodepletion with cyclophosphamide and fludarabine, followed by CT103A at 1x10⁶, 3x10⁶, or 6x10⁶ CAR T cells/kg.

There was one dose-limiting toxicity at the highest dose level – grade 4 cytokine release syndrome (CRS) in a patient who died at day 19 after CT103A infusion.

In all, 17 patients developed CRS, four with grade 1, eight with grade 2, four with grade 3, and one with grade 4 CRS. None of the patients developed neurologic toxicity.

Serious adverse events related to lymphodepletion and/or CT103A included prolonged cytopenia (n = 3), pulmonary infection (n = 2), herpes zoster (n = 1), pleuritis (n = 1), and hypoxemia (n = 1).

There were 17 patients evaluable for efficacy, and all of them achieved a response at some point. In eight patients, responses have lasted more than 200 days.

At the data cutoff, there were 10 stringent complete responses, two complete responses, and three very good partial responses. One patient progressed after achieving a very good partial response, and one patient achieved a partial response but ultimately died (likely of respiratory failure attributable to a lung infection).

Of the four patients who had previously received murine CAR T-cell therapy, one progressed, and three achieved a stringent complete response.

This study was funded by Nanjing Iaso Biotherapeutics. Dr. Li did not disclose any conflicts of interest.

jensmith@mdedge.com

SOURCE: Li C et al. IMW 2019, Abstract OAB-033.

BOSTON – CT103A, a chimeric antigen receptor (CAR) T-cell therapy, is “active and effective” in patients with relapsed/refractory multiple myeloma, according to a speaker at the International Myeloma Workshop, held by the International Myeloma Society.

Jennifer Smith/MDedge News

The anti–B-cell maturation antigen (BCMA) CAR T-cell therapy produced a 100% response rate in patients with heavily pretreated multiple myeloma, and three of four patients who had failed a prior CAR T-cell therapy achieved a stringent complete response after CT103A.

Chunrui Li, MD, PhD, of Tongji Hospital and Tongji Medical College, Huazhong University of Science, Wuhan, China, presented these results at the workshop.

Dr. Li noted that anti-BCMA CAR T-cell therapy has produced responses in myeloma patients, but approximately half of patients typically relapse in about a year. CAR T-cell infusions after relapse have not been effective in these patients.

In an effort to change that, Dr. Li and his colleagues developed CT103A, a lentiviral vector containing a CAR structure with a fully human single-chain fragment variant; CD8a hinger; and transmembrane, 4-1BB co-stimulatory, and CD3z activation domains.

Dr. Li and his colleagues evaluated CT103A in a phase 0 trial (ChiCTR1800018137) of 18 patients who had received at least three prior lines of therapy and had disease refractory to a proteasome inhibitor and an immunomodulatory agent.

The patients’ median age was 53.3 years (range, 38-66 years), and their median time since diagnosis was 32 months (range, 8-92 months). They had received a median of 4 (range, 3-6) prior therapies. All had received prior bortezomib and lenalidomide, seven had undergone a transplant, and four had been treated on a trial of murine anti-BCMA CAR T-cell therapy.

For the current trial, patients received lymphodepletion with cyclophosphamide and fludarabine, followed by CT103A at 1x10⁶, 3x10⁶, or 6x10⁶ CAR T cells/kg.

There was one dose-limiting toxicity at the highest dose level – grade 4 cytokine release syndrome (CRS) in a patient who died at day 19 after CT103A infusion.

In all, 17 patients developed CRS, four with grade 1, eight with grade 2, four with grade 3, and one with grade 4 CRS. None of the patients developed neurologic toxicity.

Serious adverse events related to lymphodepletion and/or CT103A included prolonged cytopenia (n = 3), pulmonary infection (n = 2), herpes zoster (n = 1), pleuritis (n = 1), and hypoxemia (n = 1).

There were 17 patients evaluable for efficacy, and all of them achieved a response at some point. In eight patients, responses have lasted more than 200 days.

At the data cutoff, there were 10 stringent complete responses, two complete responses, and three very good partial responses. One patient progressed after achieving a very good partial response, and one patient achieved a partial response but ultimately died (likely of respiratory failure attributable to a lung infection).

Of the four patients who had previously received murine CAR T-cell therapy, one progressed, and three achieved a stringent complete response.

This study was funded by Nanjing Iaso Biotherapeutics. Dr. Li did not disclose any conflicts of interest.

jensmith@mdedge.com

SOURCE: Li C et al. IMW 2019, Abstract OAB-033.

BOSTON – CT103A, a chimeric antigen receptor (CAR) T-cell therapy, is “active and effective” in patients with relapsed/refractory multiple myeloma, according to a speaker at the International Myeloma Workshop, held by the International Myeloma Society.

Jennifer Smith/MDedge News

The anti–B-cell maturation antigen (BCMA) CAR T-cell therapy produced a 100% response rate in patients with heavily pretreated multiple myeloma, and three of four patients who had failed a prior CAR T-cell therapy achieved a stringent complete response after CT103A.

Chunrui Li, MD, PhD, of Tongji Hospital and Tongji Medical College, Huazhong University of Science, Wuhan, China, presented these results at the workshop.

Dr. Li noted that anti-BCMA CAR T-cell therapy has produced responses in myeloma patients, but approximately half of patients typically relapse in about a year. CAR T-cell infusions after relapse have not been effective in these patients.

In an effort to change that, Dr. Li and his colleagues developed CT103A, a lentiviral vector containing a CAR structure with a fully human single-chain fragment variant; CD8a hinger; and transmembrane, 4-1BB co-stimulatory, and CD3z activation domains.

Dr. Li and his colleagues evaluated CT103A in a phase 0 trial (ChiCTR1800018137) of 18 patients who had received at least three prior lines of therapy and had disease refractory to a proteasome inhibitor and an immunomodulatory agent.

The patients’ median age was 53.3 years (range, 38-66 years), and their median time since diagnosis was 32 months (range, 8-92 months). They had received a median of 4 (range, 3-6) prior therapies. All had received prior bortezomib and lenalidomide, seven had undergone a transplant, and four had been treated on a trial of murine anti-BCMA CAR T-cell therapy.

For the current trial, patients received lymphodepletion with cyclophosphamide and fludarabine, followed by CT103A at 1x10⁶, 3x10⁶, or 6x10⁶ CAR T cells/kg.

There was one dose-limiting toxicity at the highest dose level – grade 4 cytokine release syndrome (CRS) in a patient who died at day 19 after CT103A infusion.

In all, 17 patients developed CRS, four with grade 1, eight with grade 2, four with grade 3, and one with grade 4 CRS. None of the patients developed neurologic toxicity.

Serious adverse events related to lymphodepletion and/or CT103A included prolonged cytopenia (n = 3), pulmonary infection (n = 2), herpes zoster (n = 1), pleuritis (n = 1), and hypoxemia (n = 1).

There were 17 patients evaluable for efficacy, and all of them achieved a response at some point. In eight patients, responses have lasted more than 200 days.

At the data cutoff, there were 10 stringent complete responses, two complete responses, and three very good partial responses. One patient progressed after achieving a very good partial response, and one patient achieved a partial response but ultimately died (likely of respiratory failure attributable to a lung infection).

Of the four patients who had previously received murine CAR T-cell therapy, one progressed, and three achieved a stringent complete response.

This study was funded by Nanjing Iaso Biotherapeutics. Dr. Li did not disclose any conflicts of interest.

jensmith@mdedge.com

SOURCE: Li C et al. IMW 2019, Abstract OAB-033.

As youth suicides continue to climb nationwide, a growing body of research shows that the deaths are happening at higher rates in rural communities.

Courtesy Dr. Kriechman

In 2017, suicides reached their highest point since 2000, a trend driven by a sharp rise in male suicides and in youth aged 15-19 years, according to an analysis published recently in JAMA (2019 Jun 18. doi: 10.1001/jama.2019.5054). Among youth aged 15-19 years, the suicide rate was 12 per 100,000 in 2017 (18 per 100,000 in males and 5 per 100,000 in females), compared with 8 per 100,000 in 2000, the study found. Across all age groups, the highest suicide rates and greatest rate increases are in rural counties, according to data from the Centers for Disease Control and Prevention (CDC).

Now, a unique initiative in New Mexico is working to combat those alarming trends through an alliance of community leaders that strives to strengthen resilience and build peer support for at-risk youth.

The Alliance-Building for Suicide Prevention & Youth Resilience (ASPYR) program, created by the University of New Mexico (UNM), Albuquerque, focuses on training professionals and advocates within New Mexico communities in a strength-based, youth-directed, collaborative approach for the assessment and treatment of suicidality. A diversity of community members undergo the training, including health and behavioral health care providers, peer support and community support workers, youth and community advocates, educators, and first responders. The initiative also supports and facilitates the development of a communitywide crisis intervention plan that promotes youth safety and resilience.

“ASPYR is unique, in that we actively involve youth to guide our program, versus an adult-only led program,” says Laura Rombach, program manager for ASPYR and a senior program therapist in the department of psychiatry and behavioral sciences at UNM. “Youth offer feedback about our training and ideas about how to best prevent suicide in their schools and communities. New Mexico is underresourced, and individuals living in rural/frontier areas do not always have access to licensed behavioral health providers, so our training is developed for licensed providers as well as peers and paraprofessionals to increase the knowledge of care for individuals experiencing a suicidal crisis.”
 

Rural populations present challenges

The many rural pockets of New Mexico pose numerous obstacles for antisuicide advocates.

Of the 33 counties in New Mexico, six are identified by the Census Bureau as completely “rural,” and an additional six are defined as mostly rural, according to the University of New Mexico Bureau of Business & Economic Research. Even among counties considered “urban” however, a considerable amount of the population lives in rural areas, according to the bureau. San Juan County, for example, which is considered urban by the Census Bureau, had an estimated 34% of residents living in rural areas in 2010.

Poverty adds to the difficulty. In 2017, nearly one in five New Mexicans (20%) lived below the poverty line, and the state had the second-highest rate of children under 18 years living in poverty in the country, according to a report by the New Mexico Department of Workforce Solutions.

“New Mexico is an impoverished state with limited capacity, especially in regards to behavioral health services,” said Avi Kriechman, MD, principal investigator for ASPYR at UNM and a child, adolescent, and family psychiatrist at the university. “It is also challenging to create a truly statewide effort where there is limited public transportation, problematic Internet connection, and other barriers to involving those who live and work in rural and frontier New Mexico.”

Addressing suicide among the many native and Indigenous people in rural New Mexico presents another unique set of challenges, said Mary Roessel, MD, a Santa Fe, N.M.–based psychiatrist who specializes in cultural psychiatry. Native and Indigenous residents often have a general mistrust of outsiders and a stigma against mental illnesses, Dr. Roessel said in an interview.

“One of the problems is being able to identify when a person has attempted suicide in some of these small, private, Pueblo communities because they are very closed,” she said. “At times, we don’t get the information to go in and help them. They’re trying to address or deal with the problem themselves.”

To address the many barriers of rural New Mexico, ASPYR works hard to recognize, identify, and support preexisting community resources that are often neglected in needs assessment and stakeholder identification, Dr. Kriechman said. This can include food banks, church care committees, youth advocacy groups, local caregiving, and spiritual traditions, among others. Frequently, many community caregivers and agencies have not connected or communicated with one another and often are unaware of all they have to offer, he said.

“We try to build capacity through community trainings, which include a widely diverse group of providers, advocates, and supports,” he continued. “Our trainings involve highlighting and building upon local and cultural practices and traditions of healing, caregiving, and support. A significant part of our onsite training involves assembling a representative group of local providers in health care, behavioral health care, peer & community support and advocacy, education, first responders to community crises, and government and nonprofit agencies, then facilitating a community conversation between the panel and training attendees about how best to move forward in a synergistic and systemic manner to support youth safety and resilience.”
 

Peers support peers

While ASPYR encompasses elements of other suicide prevention models, two unique cornerstones of the program are its emphasis on resilience and promotion of peer support. The strength-based, youth-directed approach includes creating a youth-directed safety plan, enlisting peers as support and reducing access to lethal means.

Regarding the youth safety plan, Dr. Kriechman explained that, rather than being prescribed and instructed in expert-selected and expert-driven coping skills, youth are offered a menu of options that most speak to their strengths, values, experience, and preferences. Young people also select a peer who, if they wish, accompanies them to sessions, and supports and coaches them at home.

“Peers are often more influential than parents, siblings, family members, and adults regarding youth behavior,” Dr. Kriechman said. “Most often, it is a peer that a youth-at-risk turns to for support, counsel, role models, and understanding. Youth who wish to offer their peers support can quickly be trained to provide early identification of youth at risk, motivational support to seek help, and a ‘warm hand-off’ to community resources.”

In addition, a Youth Advisory Council established as part of the program draws from young people across New Mexico to participate in state and national conferences, and conduct outreach efforts to peers.

ASPYR Youth council member Serenity Gomez, a senior at the Public Academy for Performing Arts in Albuquerque, became interested in ASPYR after volunteering for the American Foundation for Suicide Prevention in 2016. As a youth council member, Ms. Gomez said she helps create projects to raise suicide awareness, whether through posters, stickers, social media, poetry, or songs.

“My experience as a youth council member has really opened my eyes and has made me more motivated to help others,” she said in an interview. “It has also showed me that talking about suicide doesn’t always have to be a slideshow of facts. You can reach people through music, poetry, storytelling, and so much more. Many people are afraid to talk about suicide because it’s such a scary idea, but if we all talk about it and bring more awareness, then we can find the support everyone needs. In ASPYR, specifically, I hope to reach youth and help all youth learn to support each other.”

Since ASPYR launched in 2017, the program has provided both onsite and online trainings to hundreds of New Mexicans, and has helped rural and frontier communities start working on collaborative approaches to promoting youth safety and resilience, Dr. Kriechman said. Following community consultations, numerous rural communities have since formed systems of care to identify, support, and treat youth at risk. In addition to the youth council, an Advisory Community Council has also been established that welcomes any New Mexico resident interested in working on the mission of preventing youth suicide.

The program’s approach of focusing on strengths, rather than deficits, has resonated strongly with community providers with whom the program partners, Dr. Kriechman added. For example, the program shifts from “no-suicide contracts” to safety planning, focusing on reasons for living rather than reasons for dying, and shifting from prescribing coping skills to strengthening preexisting coping skills in young people.

“An ultimate hope for ASPYR is emphasizing that recovery from any of life’s challenges is far more than symptom reduction or agency collaboration,” Dr. Kriechman said. “It is the understanding that a life of value and meaning, the instillation of hope and support for the unique strengths, competencies, skills, and understandings of each individual, is honored, respected, and supported.”

agallegos@mdedge.com

As youth suicides continue to climb nationwide, a growing body of research shows that the deaths are happening at higher rates in rural communities.

Courtesy Dr. Kriechman

In 2017, suicides reached their highest point since 2000, a trend driven by a sharp rise in male suicides and in youth aged 15-19 years, according to an analysis published recently in JAMA (2019 Jun 18. doi: 10.1001/jama.2019.5054). Among youth aged 15-19 years, the suicide rate was 12 per 100,000 in 2017 (18 per 100,000 in males and 5 per 100,000 in females), compared with 8 per 100,000 in 2000, the study found. Across all age groups, the highest suicide rates and greatest rate increases are in rural counties, according to data from the Centers for Disease Control and Prevention (CDC).

Now, a unique initiative in New Mexico is working to combat those alarming trends through an alliance of community leaders that strives to strengthen resilience and build peer support for at-risk youth.

The Alliance-Building for Suicide Prevention & Youth Resilience (ASPYR) program, created by the University of New Mexico (UNM), Albuquerque, focuses on training professionals and advocates within New Mexico communities in a strength-based, youth-directed, collaborative approach for the assessment and treatment of suicidality. A diversity of community members undergo the training, including health and behavioral health care providers, peer support and community support workers, youth and community advocates, educators, and first responders. The initiative also supports and facilitates the development of a communitywide crisis intervention plan that promotes youth safety and resilience.

“ASPYR is unique, in that we actively involve youth to guide our program, versus an adult-only led program,” says Laura Rombach, program manager for ASPYR and a senior program therapist in the department of psychiatry and behavioral sciences at UNM. “Youth offer feedback about our training and ideas about how to best prevent suicide in their schools and communities. New Mexico is underresourced, and individuals living in rural/frontier areas do not always have access to licensed behavioral health providers, so our training is developed for licensed providers as well as peers and paraprofessionals to increase the knowledge of care for individuals experiencing a suicidal crisis.”
 

Rural populations present challenges

The many rural pockets of New Mexico pose numerous obstacles for antisuicide advocates.

Of the 33 counties in New Mexico, six are identified by the Census Bureau as completely “rural,” and an additional six are defined as mostly rural, according to the University of New Mexico Bureau of Business & Economic Research. Even among counties considered “urban” however, a considerable amount of the population lives in rural areas, according to the bureau. San Juan County, for example, which is considered urban by the Census Bureau, had an estimated 34% of residents living in rural areas in 2010.

Poverty adds to the difficulty. In 2017, nearly one in five New Mexicans (20%) lived below the poverty line, and the state had the second-highest rate of children under 18 years living in poverty in the country, according to a report by the New Mexico Department of Workforce Solutions.

“New Mexico is an impoverished state with limited capacity, especially in regards to behavioral health services,” said Avi Kriechman, MD, principal investigator for ASPYR at UNM and a child, adolescent, and family psychiatrist at the university. “It is also challenging to create a truly statewide effort where there is limited public transportation, problematic Internet connection, and other barriers to involving those who live and work in rural and frontier New Mexico.”

Addressing suicide among the many native and Indigenous people in rural New Mexico presents another unique set of challenges, said Mary Roessel, MD, a Santa Fe, N.M.–based psychiatrist who specializes in cultural psychiatry. Native and Indigenous residents often have a general mistrust of outsiders and a stigma against mental illnesses, Dr. Roessel said in an interview.

“One of the problems is being able to identify when a person has attempted suicide in some of these small, private, Pueblo communities because they are very closed,” she said. “At times, we don’t get the information to go in and help them. They’re trying to address or deal with the problem themselves.”

To address the many barriers of rural New Mexico, ASPYR works hard to recognize, identify, and support preexisting community resources that are often neglected in needs assessment and stakeholder identification, Dr. Kriechman said. This can include food banks, church care committees, youth advocacy groups, local caregiving, and spiritual traditions, among others. Frequently, many community caregivers and agencies have not connected or communicated with one another and often are unaware of all they have to offer, he said.

“We try to build capacity through community trainings, which include a widely diverse group of providers, advocates, and supports,” he continued. “Our trainings involve highlighting and building upon local and cultural practices and traditions of healing, caregiving, and support. A significant part of our onsite training involves assembling a representative group of local providers in health care, behavioral health care, peer & community support and advocacy, education, first responders to community crises, and government and nonprofit agencies, then facilitating a community conversation between the panel and training attendees about how best to move forward in a synergistic and systemic manner to support youth safety and resilience.”
 

Peers support peers

While ASPYR encompasses elements of other suicide prevention models, two unique cornerstones of the program are its emphasis on resilience and promotion of peer support. The strength-based, youth-directed approach includes creating a youth-directed safety plan, enlisting peers as support and reducing access to lethal means.

Regarding the youth safety plan, Dr. Kriechman explained that, rather than being prescribed and instructed in expert-selected and expert-driven coping skills, youth are offered a menu of options that most speak to their strengths, values, experience, and preferences. Young people also select a peer who, if they wish, accompanies them to sessions, and supports and coaches them at home.

“Peers are often more influential than parents, siblings, family members, and adults regarding youth behavior,” Dr. Kriechman said. “Most often, it is a peer that a youth-at-risk turns to for support, counsel, role models, and understanding. Youth who wish to offer their peers support can quickly be trained to provide early identification of youth at risk, motivational support to seek help, and a ‘warm hand-off’ to community resources.”

In addition, a Youth Advisory Council established as part of the program draws from young people across New Mexico to participate in state and national conferences, and conduct outreach efforts to peers.

ASPYR Youth council member Serenity Gomez, a senior at the Public Academy for Performing Arts in Albuquerque, became interested in ASPYR after volunteering for the American Foundation for Suicide Prevention in 2016. As a youth council member, Ms. Gomez said she helps create projects to raise suicide awareness, whether through posters, stickers, social media, poetry, or songs.

“My experience as a youth council member has really opened my eyes and has made me more motivated to help others,” she said in an interview. “It has also showed me that talking about suicide doesn’t always have to be a slideshow of facts. You can reach people through music, poetry, storytelling, and so much more. Many people are afraid to talk about suicide because it’s such a scary idea, but if we all talk about it and bring more awareness, then we can find the support everyone needs. In ASPYR, specifically, I hope to reach youth and help all youth learn to support each other.”

Since ASPYR launched in 2017, the program has provided both onsite and online trainings to hundreds of New Mexicans, and has helped rural and frontier communities start working on collaborative approaches to promoting youth safety and resilience, Dr. Kriechman said. Following community consultations, numerous rural communities have since formed systems of care to identify, support, and treat youth at risk. In addition to the youth council, an Advisory Community Council has also been established that welcomes any New Mexico resident interested in working on the mission of preventing youth suicide.

The program’s approach of focusing on strengths, rather than deficits, has resonated strongly with community providers with whom the program partners, Dr. Kriechman added. For example, the program shifts from “no-suicide contracts” to safety planning, focusing on reasons for living rather than reasons for dying, and shifting from prescribing coping skills to strengthening preexisting coping skills in young people.

“An ultimate hope for ASPYR is emphasizing that recovery from any of life’s challenges is far more than symptom reduction or agency collaboration,” Dr. Kriechman said. “It is the understanding that a life of value and meaning, the instillation of hope and support for the unique strengths, competencies, skills, and understandings of each individual, is honored, respected, and supported.”

agallegos@mdedge.com

As youth suicides continue to climb nationwide, a growing body of research shows that the deaths are happening at higher rates in rural communities.

Courtesy Dr. Kriechman

In 2017, suicides reached their highest point since 2000, a trend driven by a sharp rise in male suicides and in youth aged 15-19 years, according to an analysis published recently in JAMA (2019 Jun 18. doi: 10.1001/jama.2019.5054). Among youth aged 15-19 years, the suicide rate was 12 per 100,000 in 2017 (18 per 100,000 in males and 5 per 100,000 in females), compared with 8 per 100,000 in 2000, the study found. Across all age groups, the highest suicide rates and greatest rate increases are in rural counties, according to data from the Centers for Disease Control and Prevention (CDC).

Now, a unique initiative in New Mexico is working to combat those alarming trends through an alliance of community leaders that strives to strengthen resilience and build peer support for at-risk youth.

The Alliance-Building for Suicide Prevention & Youth Resilience (ASPYR) program, created by the University of New Mexico (UNM), Albuquerque, focuses on training professionals and advocates within New Mexico communities in a strength-based, youth-directed, collaborative approach for the assessment and treatment of suicidality. A diversity of community members undergo the training, including health and behavioral health care providers, peer support and community support workers, youth and community advocates, educators, and first responders. The initiative also supports and facilitates the development of a communitywide crisis intervention plan that promotes youth safety and resilience.

“ASPYR is unique, in that we actively involve youth to guide our program, versus an adult-only led program,” says Laura Rombach, program manager for ASPYR and a senior program therapist in the department of psychiatry and behavioral sciences at UNM. “Youth offer feedback about our training and ideas about how to best prevent suicide in their schools and communities. New Mexico is underresourced, and individuals living in rural/frontier areas do not always have access to licensed behavioral health providers, so our training is developed for licensed providers as well as peers and paraprofessionals to increase the knowledge of care for individuals experiencing a suicidal crisis.”
 

Rural populations present challenges

The many rural pockets of New Mexico pose numerous obstacles for antisuicide advocates.

Of the 33 counties in New Mexico, six are identified by the Census Bureau as completely “rural,” and an additional six are defined as mostly rural, according to the University of New Mexico Bureau of Business & Economic Research. Even among counties considered “urban” however, a considerable amount of the population lives in rural areas, according to the bureau. San Juan County, for example, which is considered urban by the Census Bureau, had an estimated 34% of residents living in rural areas in 2010.

Poverty adds to the difficulty. In 2017, nearly one in five New Mexicans (20%) lived below the poverty line, and the state had the second-highest rate of children under 18 years living in poverty in the country, according to a report by the New Mexico Department of Workforce Solutions.

“New Mexico is an impoverished state with limited capacity, especially in regards to behavioral health services,” said Avi Kriechman, MD, principal investigator for ASPYR at UNM and a child, adolescent, and family psychiatrist at the university. “It is also challenging to create a truly statewide effort where there is limited public transportation, problematic Internet connection, and other barriers to involving those who live and work in rural and frontier New Mexico.”

Addressing suicide among the many native and Indigenous people in rural New Mexico presents another unique set of challenges, said Mary Roessel, MD, a Santa Fe, N.M.–based psychiatrist who specializes in cultural psychiatry. Native and Indigenous residents often have a general mistrust of outsiders and a stigma against mental illnesses, Dr. Roessel said in an interview.

“One of the problems is being able to identify when a person has attempted suicide in some of these small, private, Pueblo communities because they are very closed,” she said. “At times, we don’t get the information to go in and help them. They’re trying to address or deal with the problem themselves.”

To address the many barriers of rural New Mexico, ASPYR works hard to recognize, identify, and support preexisting community resources that are often neglected in needs assessment and stakeholder identification, Dr. Kriechman said. This can include food banks, church care committees, youth advocacy groups, local caregiving, and spiritual traditions, among others. Frequently, many community caregivers and agencies have not connected or communicated with one another and often are unaware of all they have to offer, he said.

“We try to build capacity through community trainings, which include a widely diverse group of providers, advocates, and supports,” he continued. “Our trainings involve highlighting and building upon local and cultural practices and traditions of healing, caregiving, and support. A significant part of our onsite training involves assembling a representative group of local providers in health care, behavioral health care, peer & community support and advocacy, education, first responders to community crises, and government and nonprofit agencies, then facilitating a community conversation between the panel and training attendees about how best to move forward in a synergistic and systemic manner to support youth safety and resilience.”
 

Peers support peers

While ASPYR encompasses elements of other suicide prevention models, two unique cornerstones of the program are its emphasis on resilience and promotion of peer support. The strength-based, youth-directed approach includes creating a youth-directed safety plan, enlisting peers as support and reducing access to lethal means.

Regarding the youth safety plan, Dr. Kriechman explained that, rather than being prescribed and instructed in expert-selected and expert-driven coping skills, youth are offered a menu of options that most speak to their strengths, values, experience, and preferences. Young people also select a peer who, if they wish, accompanies them to sessions, and supports and coaches them at home.

“Peers are often more influential than parents, siblings, family members, and adults regarding youth behavior,” Dr. Kriechman said. “Most often, it is a peer that a youth-at-risk turns to for support, counsel, role models, and understanding. Youth who wish to offer their peers support can quickly be trained to provide early identification of youth at risk, motivational support to seek help, and a ‘warm hand-off’ to community resources.”

In addition, a Youth Advisory Council established as part of the program draws from young people across New Mexico to participate in state and national conferences, and conduct outreach efforts to peers.

ASPYR Youth council member Serenity Gomez, a senior at the Public Academy for Performing Arts in Albuquerque, became interested in ASPYR after volunteering for the American Foundation for Suicide Prevention in 2016. As a youth council member, Ms. Gomez said she helps create projects to raise suicide awareness, whether through posters, stickers, social media, poetry, or songs.

“My experience as a youth council member has really opened my eyes and has made me more motivated to help others,” she said in an interview. “It has also showed me that talking about suicide doesn’t always have to be a slideshow of facts. You can reach people through music, poetry, storytelling, and so much more. Many people are afraid to talk about suicide because it’s such a scary idea, but if we all talk about it and bring more awareness, then we can find the support everyone needs. In ASPYR, specifically, I hope to reach youth and help all youth learn to support each other.”

Since ASPYR launched in 2017, the program has provided both onsite and online trainings to hundreds of New Mexicans, and has helped rural and frontier communities start working on collaborative approaches to promoting youth safety and resilience, Dr. Kriechman said. Following community consultations, numerous rural communities have since formed systems of care to identify, support, and treat youth at risk. In addition to the youth council, an Advisory Community Council has also been established that welcomes any New Mexico resident interested in working on the mission of preventing youth suicide.

The program’s approach of focusing on strengths, rather than deficits, has resonated strongly with community providers with whom the program partners, Dr. Kriechman added. For example, the program shifts from “no-suicide contracts” to safety planning, focusing on reasons for living rather than reasons for dying, and shifting from prescribing coping skills to strengthening preexisting coping skills in young people.

“An ultimate hope for ASPYR is emphasizing that recovery from any of life’s challenges is far more than symptom reduction or agency collaboration,” Dr. Kriechman said. “It is the understanding that a life of value and meaning, the instillation of hope and support for the unique strengths, competencies, skills, and understandings of each individual, is honored, respected, and supported.”

agallegos@mdedge.com

Mark Williams, MD, MHM, FACP, recently was appointed chief quality and transformation officer for the University of Kentucky’s UK HealthCare (Lexington). Dr. Williams, a tenured professor in the division of hospital medicine at the UK College of Medicine, will serve as chair of UK HealthCare’s Executive Quality Committee. Dr. Williams will lead integration of quality improvement, safety, and quality reporting with data analytics.

Dr. Williams established the first hospitalist program at a public hospital (Grady Memorial Hospital) and academic hospitalist programs at Emory University, Northwestern University, and UK HealthCare. An inaugural member of SHM, he is a past president, was the founding editor-in-chief of the Journal of Hospital Medicine and led SHM’s Project BOOST.
 

Also at UK HealthCare, Romil Chadha, MD, MPH, SFHM, FACP, has been named interim chief of the division of hospital medicine and medical director of Physician Information Technology Services. Previously, he was associate chief of the division of hospital medicine, and he also serves as medical director of telemetry.

Dr. Chadha is the founder of the Kentucky chapter of SHM, where he is the immediate past president. He is also the codirector of the Heartland Hospital Medicine Conference.
 

Amit Vashist, MD, MBA, CPE, FHM, FACP, FAPA, has been named chief clinical officer at Ballad Health, a 21-hospital health system in Northeast Tennessee, Southwest Virginia, Northwest North Carolina, and Southeast Kentucky.

In his new role, he will focus on clinical quality, value-based initiatives to improve quality while reducing cost of care, performance improvement, oversight of the clinical delivery of care and will be the liaison to the Ballad Health Clinical Council. Dr. Vashist is a member of The Hospitalist’s editorial advisory board.
 

Nagendra Gupta, MD, FACP, CPE, has been appointed to the American Board of Internal Medicine’s Internal Medicine Specialty Board. ABIM Specialty Boards are responsible for the broad definition of the discipline across Certification and Maintenance of Certification (MOC). Specialty Board members work with physicians and medical societies to develop Certification and MOC credentials to recognize physicians for their specialized knowledge and commitment to staying current in their field.

Dr. Gupta is a full-time practicing hospitalist with Apogee Physicians and currently serves as the director of the hospitalist program at Texas Health Arlington (Tex.) Memorial Hospital. He also serves as vice president for SHM’s North Central Texas Chapter.
 

T. Steen Trawick Jr., MD, was named the CEO of Christus Shreveport-Bossier Health System in Shreveport, La., in August 2019.

Dr. Trawick has worked for Christus as a pediatric hospitalist since 2005 and most recently has served concurrently as associate chief medical officer for Sound Physicians. Through Sound Physicians, Dr. Trawick oversees the hospitalist and emergency medical programs for Christus and other hospitals – 14 in total – in Texas and Louisiana. He has worked in that role for the past 6 years.
 

Scott Shepherd, DO, FACP, has been selected chief medical officer of the health data enrichment and integration technology company Verinovum in Tulsa, Okla. Dr. Shepherd is the medical director for hospitalist medicine and a practicing hospitalist with St. John Health System in Tulsa, and also medical director of the Center for Health Systems Innovation at his alma mater, Oklahoma State University in Stillwater.

Amanda Logue, MD, has been elevated to chief medical officer at Lafayette (La.) General Hospital. Dr. Logue assumed her role in May 2019, which includes the title of senior vice president.

Dr. Logue has worked at Lafayette General since 2009. A hospitalist/internist, her duties at the facility have included department chair of medicine, physician champion for electronic medical record implementation, medical director of the hospitalist program, and most recently chief medical information officer.
 

Rina Bansal, MD, MBA, recently was appointed full-time president of Inova Alexandria (Va.) Hospital, taking the reins officially after serving as acting president since November 2018. Dr. Bansal has been at Inova since 2008, when she started as a hospitalist at Inova Fairfax (Va.).

Dr. Bansal created and led Inova’s Clinical Nurse Services Hospitalist program through its department of neurosciences and has done stints as Inova Fairfax’s associate chief medical officer, medical director of Inova Telemedicine, and chief medical officer at Inova Alexandria.
 

James Napoli, MD, has been named chief medical officer for Blue Cross and Blue Shield of Arizona (BCBSAZ). He has manned the CMO position in an interim role since March, taking those duties on top of his role as BCBSAZ’s enterprise medical director for health care ventures and innovation.

Dr. Napoli came to BCBSAZ in 2013 after more than a decade at Abrazo Arrowhead Campus (Glendale, Ariz.) At Abrazo, he was director of hospitalist services and vice-chief of staff, on top of his efforts as a practicing hospital medicine clinician.

Dr. Napoli was previously medical director at OptumHealth, working specifically in the medical management and quality improvement areas for the health management solutions organization’s Medicare Advantage clients.
 

Mercy Hospital Fort Smith (Ark.) has partnered with the Ob Hospitalist Group (Greenville, S.C.) to launch an obstetric hospitalist program. OB hospitalists deliver babies when a patient’s physician cannot be present, provide emergency care, and provide support to high-risk pregnancy patients, among other duties within the hospital.

The partnership has allowed Mercy Fort Smith to create a dedicated, four-room obstetric emergency department in its Mercy Childbirth Center. Eight OB hospitalists have been hired and will provide care 24 hours a day, 7 days a week.

Mark Williams, MD, MHM, FACP, recently was appointed chief quality and transformation officer for the University of Kentucky’s UK HealthCare (Lexington). Dr. Williams, a tenured professor in the division of hospital medicine at the UK College of Medicine, will serve as chair of UK HealthCare’s Executive Quality Committee. Dr. Williams will lead integration of quality improvement, safety, and quality reporting with data analytics.

Dr. Williams established the first hospitalist program at a public hospital (Grady Memorial Hospital) and academic hospitalist programs at Emory University, Northwestern University, and UK HealthCare. An inaugural member of SHM, he is a past president, was the founding editor-in-chief of the Journal of Hospital Medicine and led SHM’s Project BOOST.
 

Also at UK HealthCare, Romil Chadha, MD, MPH, SFHM, FACP, has been named interim chief of the division of hospital medicine and medical director of Physician Information Technology Services. Previously, he was associate chief of the division of hospital medicine, and he also serves as medical director of telemetry.

Dr. Chadha is the founder of the Kentucky chapter of SHM, where he is the immediate past president. He is also the codirector of the Heartland Hospital Medicine Conference.
 

Amit Vashist, MD, MBA, CPE, FHM, FACP, FAPA, has been named chief clinical officer at Ballad Health, a 21-hospital health system in Northeast Tennessee, Southwest Virginia, Northwest North Carolina, and Southeast Kentucky.

In his new role, he will focus on clinical quality, value-based initiatives to improve quality while reducing cost of care, performance improvement, oversight of the clinical delivery of care and will be the liaison to the Ballad Health Clinical Council. Dr. Vashist is a member of The Hospitalist’s editorial advisory board.
 

Nagendra Gupta, MD, FACP, CPE, has been appointed to the American Board of Internal Medicine’s Internal Medicine Specialty Board. ABIM Specialty Boards are responsible for the broad definition of the discipline across Certification and Maintenance of Certification (MOC). Specialty Board members work with physicians and medical societies to develop Certification and MOC credentials to recognize physicians for their specialized knowledge and commitment to staying current in their field.

Dr. Gupta is a full-time practicing hospitalist with Apogee Physicians and currently serves as the director of the hospitalist program at Texas Health Arlington (Tex.) Memorial Hospital. He also serves as vice president for SHM’s North Central Texas Chapter.
 

T. Steen Trawick Jr., MD, was named the CEO of Christus Shreveport-Bossier Health System in Shreveport, La., in August 2019.

Dr. Trawick has worked for Christus as a pediatric hospitalist since 2005 and most recently has served concurrently as associate chief medical officer for Sound Physicians. Through Sound Physicians, Dr. Trawick oversees the hospitalist and emergency medical programs for Christus and other hospitals – 14 in total – in Texas and Louisiana. He has worked in that role for the past 6 years.
 

Scott Shepherd, DO, FACP, has been selected chief medical officer of the health data enrichment and integration technology company Verinovum in Tulsa, Okla. Dr. Shepherd is the medical director for hospitalist medicine and a practicing hospitalist with St. John Health System in Tulsa, and also medical director of the Center for Health Systems Innovation at his alma mater, Oklahoma State University in Stillwater.

Amanda Logue, MD, has been elevated to chief medical officer at Lafayette (La.) General Hospital. Dr. Logue assumed her role in May 2019, which includes the title of senior vice president.

Dr. Logue has worked at Lafayette General since 2009. A hospitalist/internist, her duties at the facility have included department chair of medicine, physician champion for electronic medical record implementation, medical director of the hospitalist program, and most recently chief medical information officer.
 

Rina Bansal, MD, MBA, recently was appointed full-time president of Inova Alexandria (Va.) Hospital, taking the reins officially after serving as acting president since November 2018. Dr. Bansal has been at Inova since 2008, when she started as a hospitalist at Inova Fairfax (Va.).

Dr. Bansal created and led Inova’s Clinical Nurse Services Hospitalist program through its department of neurosciences and has done stints as Inova Fairfax’s associate chief medical officer, medical director of Inova Telemedicine, and chief medical officer at Inova Alexandria.
 

James Napoli, MD, has been named chief medical officer for Blue Cross and Blue Shield of Arizona (BCBSAZ). He has manned the CMO position in an interim role since March, taking those duties on top of his role as BCBSAZ’s enterprise medical director for health care ventures and innovation.

Dr. Napoli came to BCBSAZ in 2013 after more than a decade at Abrazo Arrowhead Campus (Glendale, Ariz.) At Abrazo, he was director of hospitalist services and vice-chief of staff, on top of his efforts as a practicing hospital medicine clinician.

Dr. Napoli was previously medical director at OptumHealth, working specifically in the medical management and quality improvement areas for the health management solutions organization’s Medicare Advantage clients.
 

Mercy Hospital Fort Smith (Ark.) has partnered with the Ob Hospitalist Group (Greenville, S.C.) to launch an obstetric hospitalist program. OB hospitalists deliver babies when a patient’s physician cannot be present, provide emergency care, and provide support to high-risk pregnancy patients, among other duties within the hospital.

The partnership has allowed Mercy Fort Smith to create a dedicated, four-room obstetric emergency department in its Mercy Childbirth Center. Eight OB hospitalists have been hired and will provide care 24 hours a day, 7 days a week.

Mark Williams, MD, MHM, FACP, recently was appointed chief quality and transformation officer for the University of Kentucky’s UK HealthCare (Lexington). Dr. Williams, a tenured professor in the division of hospital medicine at the UK College of Medicine, will serve as chair of UK HealthCare’s Executive Quality Committee. Dr. Williams will lead integration of quality improvement, safety, and quality reporting with data analytics.

Dr. Williams established the first hospitalist program at a public hospital (Grady Memorial Hospital) and academic hospitalist programs at Emory University, Northwestern University, and UK HealthCare. An inaugural member of SHM, he is a past president, was the founding editor-in-chief of the Journal of Hospital Medicine and led SHM’s Project BOOST.
 

Also at UK HealthCare, Romil Chadha, MD, MPH, SFHM, FACP, has been named interim chief of the division of hospital medicine and medical director of Physician Information Technology Services. Previously, he was associate chief of the division of hospital medicine, and he also serves as medical director of telemetry.

Dr. Chadha is the founder of the Kentucky chapter of SHM, where he is the immediate past president. He is also the codirector of the Heartland Hospital Medicine Conference.
 

Amit Vashist, MD, MBA, CPE, FHM, FACP, FAPA, has been named chief clinical officer at Ballad Health, a 21-hospital health system in Northeast Tennessee, Southwest Virginia, Northwest North Carolina, and Southeast Kentucky.

In his new role, he will focus on clinical quality, value-based initiatives to improve quality while reducing cost of care, performance improvement, oversight of the clinical delivery of care and will be the liaison to the Ballad Health Clinical Council. Dr. Vashist is a member of The Hospitalist’s editorial advisory board.
 

Nagendra Gupta, MD, FACP, CPE, has been appointed to the American Board of Internal Medicine’s Internal Medicine Specialty Board. ABIM Specialty Boards are responsible for the broad definition of the discipline across Certification and Maintenance of Certification (MOC). Specialty Board members work with physicians and medical societies to develop Certification and MOC credentials to recognize physicians for their specialized knowledge and commitment to staying current in their field.

Dr. Gupta is a full-time practicing hospitalist with Apogee Physicians and currently serves as the director of the hospitalist program at Texas Health Arlington (Tex.) Memorial Hospital. He also serves as vice president for SHM’s North Central Texas Chapter.
 

T. Steen Trawick Jr., MD, was named the CEO of Christus Shreveport-Bossier Health System in Shreveport, La., in August 2019.

Dr. Trawick has worked for Christus as a pediatric hospitalist since 2005 and most recently has served concurrently as associate chief medical officer for Sound Physicians. Through Sound Physicians, Dr. Trawick oversees the hospitalist and emergency medical programs for Christus and other hospitals – 14 in total – in Texas and Louisiana. He has worked in that role for the past 6 years.
 

Scott Shepherd, DO, FACP, has been selected chief medical officer of the health data enrichment and integration technology company Verinovum in Tulsa, Okla. Dr. Shepherd is the medical director for hospitalist medicine and a practicing hospitalist with St. John Health System in Tulsa, and also medical director of the Center for Health Systems Innovation at his alma mater, Oklahoma State University in Stillwater.

Amanda Logue, MD, has been elevated to chief medical officer at Lafayette (La.) General Hospital. Dr. Logue assumed her role in May 2019, which includes the title of senior vice president.

Dr. Logue has worked at Lafayette General since 2009. A hospitalist/internist, her duties at the facility have included department chair of medicine, physician champion for electronic medical record implementation, medical director of the hospitalist program, and most recently chief medical information officer.
 

Rina Bansal, MD, MBA, recently was appointed full-time president of Inova Alexandria (Va.) Hospital, taking the reins officially after serving as acting president since November 2018. Dr. Bansal has been at Inova since 2008, when she started as a hospitalist at Inova Fairfax (Va.).

Dr. Bansal created and led Inova’s Clinical Nurse Services Hospitalist program through its department of neurosciences and has done stints as Inova Fairfax’s associate chief medical officer, medical director of Inova Telemedicine, and chief medical officer at Inova Alexandria.
 

James Napoli, MD, has been named chief medical officer for Blue Cross and Blue Shield of Arizona (BCBSAZ). He has manned the CMO position in an interim role since March, taking those duties on top of his role as BCBSAZ’s enterprise medical director for health care ventures and innovation.

Dr. Napoli came to BCBSAZ in 2013 after more than a decade at Abrazo Arrowhead Campus (Glendale, Ariz.) At Abrazo, he was director of hospitalist services and vice-chief of staff, on top of his efforts as a practicing hospital medicine clinician.

Dr. Napoli was previously medical director at OptumHealth, working specifically in the medical management and quality improvement areas for the health management solutions organization’s Medicare Advantage clients.
 

Mercy Hospital Fort Smith (Ark.) has partnered with the Ob Hospitalist Group (Greenville, S.C.) to launch an obstetric hospitalist program. OB hospitalists deliver babies when a patient’s physician cannot be present, provide emergency care, and provide support to high-risk pregnancy patients, among other duties within the hospital.

The partnership has allowed Mercy Fort Smith to create a dedicated, four-room obstetric emergency department in its Mercy Childbirth Center. Eight OB hospitalists have been hired and will provide care 24 hours a day, 7 days a week.

Unreasonable step therapy and prior authorizations, overly expensive generic drugs, opposition to a 5-year Medicare pay freeze, surprise medical billing, and the risks and benefits of sunscreen use for the prevention of skin cancer.

These were just some of the hot button issues that 156 of my fellow dermatologists brought before a record-breaking American Academy of Dermatology Association Legislative Conference in Washington. We also were joined by 49 patients and practice administrators for this terrific meeting filled with classes and speakers. Members of Congress joined us at various sessions and social occasions with good food, fine wine, and great conversations. Radio personality and CNN host Michael Smerconish gave a very funny speech at dinner and had comments about civility in politics. The comradery was excellent and the intellectual food for thought was extraordinary – right up the alley of dermatologists who are also political junkies.

Most congressional representatives are not well versed in health care topics. As a result, we spent a good deal of time on education – speaking to junior staffers who are expected to keep the members of Congress updated on what they need to know about medical and, specifically, dermatologic issues. As many refer to Washington as “the swamp,” you can consider the House members to be the “big gators,” and the staffers the ”little gators.” Taking that analogy further, lobbying (or educating) then logically becomes “gator wrestling.”

Most of the time we met with little gators, although this year we also met with 84 big gators. We took turns telling them true stories based on our patients’ problems with abuses within our health care system. I think these stories are effective. This is your representative government in action!

On the last day of the conference, we made personal calls by state on the hill offices. Some groups, like Ohio, were nine strong! Everyone gets to speak. This year’s meeting was attended by a total of 31 dermatology residents, and the residents from Ohio State and Cleveland Clinic who participated in our state meetings were terrific. In all, we covered 228 offices – 157 Congressional and 71 Senate.

Rep. John Joyce, MD, FAAD (R-PA-13) was on hand and is the first dermatologist elected for a full term to Congress. Anyone at the meeting could have spent all the time they wanted with him discussing our issues. He is most knowledgeable and a great asset for our specialty. Dr. Joyce is recognized as a dermatologist by his fellow representatives, and even by Speaker Nancy Pelosi and President Trump. For 30 years, Dr. Joyce has been a proud member of the American Academy of Dermatology, as is his wife Dr. Alice Joyce, who also is a dermatologist and continues to run their practice, Altoona Dermatology Associates.

Dr. Joyce is a true asset to dermatology. As an individual, I advocate supporting his campaign financially if you get the chance, beyond just what SkinPAC can give him.

In sum, the AADA Legislative Conference is a lot of productive fun. You get to network with all the leaders of the AAD, as well as many of the leaders of the United States. If you donate $5,000 to SkinPAC, they will pay your way to the conference. If you contribute $1,000, you get to go to the high-donor dinner (The same goes for a $50 donation from residents, no typo!). What’s not to like about that? Most dermatologists like a good party. Next year’s meeting is Sept. 13-15, 2020. See you there!
 

Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Write to him at dermnews@mdedge.com.


 

Unreasonable step therapy and prior authorizations, overly expensive generic drugs, opposition to a 5-year Medicare pay freeze, surprise medical billing, and the risks and benefits of sunscreen use for the prevention of skin cancer.

These were just some of the hot button issues that 156 of my fellow dermatologists brought before a record-breaking American Academy of Dermatology Association Legislative Conference in Washington. We also were joined by 49 patients and practice administrators for this terrific meeting filled with classes and speakers. Members of Congress joined us at various sessions and social occasions with good food, fine wine, and great conversations. Radio personality and CNN host Michael Smerconish gave a very funny speech at dinner and had comments about civility in politics. The comradery was excellent and the intellectual food for thought was extraordinary – right up the alley of dermatologists who are also political junkies.

Most congressional representatives are not well versed in health care topics. As a result, we spent a good deal of time on education – speaking to junior staffers who are expected to keep the members of Congress updated on what they need to know about medical and, specifically, dermatologic issues. As many refer to Washington as “the swamp,” you can consider the House members to be the “big gators,” and the staffers the ”little gators.” Taking that analogy further, lobbying (or educating) then logically becomes “gator wrestling.”

Most of the time we met with little gators, although this year we also met with 84 big gators. We took turns telling them true stories based on our patients’ problems with abuses within our health care system. I think these stories are effective. This is your representative government in action!

On the last day of the conference, we made personal calls by state on the hill offices. Some groups, like Ohio, were nine strong! Everyone gets to speak. This year’s meeting was attended by a total of 31 dermatology residents, and the residents from Ohio State and Cleveland Clinic who participated in our state meetings were terrific. In all, we covered 228 offices – 157 Congressional and 71 Senate.

Rep. John Joyce, MD, FAAD (R-PA-13) was on hand and is the first dermatologist elected for a full term to Congress. Anyone at the meeting could have spent all the time they wanted with him discussing our issues. He is most knowledgeable and a great asset for our specialty. Dr. Joyce is recognized as a dermatologist by his fellow representatives, and even by Speaker Nancy Pelosi and President Trump. For 30 years, Dr. Joyce has been a proud member of the American Academy of Dermatology, as is his wife Dr. Alice Joyce, who also is a dermatologist and continues to run their practice, Altoona Dermatology Associates.

Dr. Joyce is a true asset to dermatology. As an individual, I advocate supporting his campaign financially if you get the chance, beyond just what SkinPAC can give him.

In sum, the AADA Legislative Conference is a lot of productive fun. You get to network with all the leaders of the AAD, as well as many of the leaders of the United States. If you donate $5,000 to SkinPAC, they will pay your way to the conference. If you contribute $1,000, you get to go to the high-donor dinner (The same goes for a $50 donation from residents, no typo!). What’s not to like about that? Most dermatologists like a good party. Next year’s meeting is Sept. 13-15, 2020. See you there!
 

Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Write to him at dermnews@mdedge.com.


 

Unreasonable step therapy and prior authorizations, overly expensive generic drugs, opposition to a 5-year Medicare pay freeze, surprise medical billing, and the risks and benefits of sunscreen use for the prevention of skin cancer.

These were just some of the hot button issues that 156 of my fellow dermatologists brought before a record-breaking American Academy of Dermatology Association Legislative Conference in Washington. We also were joined by 49 patients and practice administrators for this terrific meeting filled with classes and speakers. Members of Congress joined us at various sessions and social occasions with good food, fine wine, and great conversations. Radio personality and CNN host Michael Smerconish gave a very funny speech at dinner and had comments about civility in politics. The comradery was excellent and the intellectual food for thought was extraordinary – right up the alley of dermatologists who are also political junkies.

Most congressional representatives are not well versed in health care topics. As a result, we spent a good deal of time on education – speaking to junior staffers who are expected to keep the members of Congress updated on what they need to know about medical and, specifically, dermatologic issues. As many refer to Washington as “the swamp,” you can consider the House members to be the “big gators,” and the staffers the ”little gators.” Taking that analogy further, lobbying (or educating) then logically becomes “gator wrestling.”

Most of the time we met with little gators, although this year we also met with 84 big gators. We took turns telling them true stories based on our patients’ problems with abuses within our health care system. I think these stories are effective. This is your representative government in action!

On the last day of the conference, we made personal calls by state on the hill offices. Some groups, like Ohio, were nine strong! Everyone gets to speak. This year’s meeting was attended by a total of 31 dermatology residents, and the residents from Ohio State and Cleveland Clinic who participated in our state meetings were terrific. In all, we covered 228 offices – 157 Congressional and 71 Senate.

Rep. John Joyce, MD, FAAD (R-PA-13) was on hand and is the first dermatologist elected for a full term to Congress. Anyone at the meeting could have spent all the time they wanted with him discussing our issues. He is most knowledgeable and a great asset for our specialty. Dr. Joyce is recognized as a dermatologist by his fellow representatives, and even by Speaker Nancy Pelosi and President Trump. For 30 years, Dr. Joyce has been a proud member of the American Academy of Dermatology, as is his wife Dr. Alice Joyce, who also is a dermatologist and continues to run their practice, Altoona Dermatology Associates.

Dr. Joyce is a true asset to dermatology. As an individual, I advocate supporting his campaign financially if you get the chance, beyond just what SkinPAC can give him.

In sum, the AADA Legislative Conference is a lot of productive fun. You get to network with all the leaders of the AAD, as well as many of the leaders of the United States. If you donate $5,000 to SkinPAC, they will pay your way to the conference. If you contribute $1,000, you get to go to the high-donor dinner (The same goes for a $50 donation from residents, no typo!). What’s not to like about that? Most dermatologists like a good party. Next year’s meeting is Sept. 13-15, 2020. See you there!
 

Dr. Coldiron is in private practice but maintains a clinical assistant professorship at the University of Cincinnati. He cares for patients, teaches medical students and residents, and has several active clinical research projects. Dr. Coldiron is the author of more than 80 scientific letters, papers, and several book chapters, and he speaks frequently on a variety of topics. He is a past president of the American Academy of Dermatology. Write to him at dermnews@mdedge.com.


 

Barbara J. Howard, MD, will receive the 2019 C. Anderson Aldrich Award at the American Academy of Pediatrics annual meeting on Oct. 26 in New Orleans.

The award is given by the AAP Section on Developmental and Behavioral Pediatrics to “recognize physicians who have made outstanding contributions to the field of child development,” according to the AAP. Previous recipients of the award include pediatricians such as Benjamin M. Spock, MD, and T. Berry Brazelton, MD, as well as psychoanalyst Anna Freud and child psychologist Erik H. Erickson.

Dr. Howard is a developmental-behavioral pediatrician who is an assistant professor of pediatrics at Johns Hopkins University, Baltimore, where she codirected a fellowship program to train developmental and behavioral pediatricians. She is a creator of CHADIS, an innovative online system that provides previsit questionnaires that allows physicians “to collect patient-generated data that can be used to support clinical and shared decisions, track data, and create quality improvement reports,” according to the CHADIS website. She has given free monthly case conferences through a federal grant for 30 years, initially in person and more recently through a national webcast. Over the last 2 decades, Dr. Howard has written about practical approaches to developmental and behavioral problems children experience for this newspaper in her Behavioral Consult column.

Michael S. Jellinek, MD, professor emeritus of psychiatry and pediatrics at the Harvard Medical School, Boston, said in an interview, “Barbara’s dedication to the emotional health of children has made an enormous difference. In addition to her clinical care and writing, her development of CHADIS has helped pediatricians recognize and treat thousands upon thousands of children. She is most deserving of this high honor.”
 

cnellist@mdedge.com

Barbara J. Howard, MD, will receive the 2019 C. Anderson Aldrich Award at the American Academy of Pediatrics annual meeting on Oct. 26 in New Orleans.

The award is given by the AAP Section on Developmental and Behavioral Pediatrics to “recognize physicians who have made outstanding contributions to the field of child development,” according to the AAP. Previous recipients of the award include pediatricians such as Benjamin M. Spock, MD, and T. Berry Brazelton, MD, as well as psychoanalyst Anna Freud and child psychologist Erik H. Erickson.

Dr. Howard is a developmental-behavioral pediatrician who is an assistant professor of pediatrics at Johns Hopkins University, Baltimore, where she codirected a fellowship program to train developmental and behavioral pediatricians. She is a creator of CHADIS, an innovative online system that provides previsit questionnaires that allows physicians “to collect patient-generated data that can be used to support clinical and shared decisions, track data, and create quality improvement reports,” according to the CHADIS website. She has given free monthly case conferences through a federal grant for 30 years, initially in person and more recently through a national webcast. Over the last 2 decades, Dr. Howard has written about practical approaches to developmental and behavioral problems children experience for this newspaper in her Behavioral Consult column.

Michael S. Jellinek, MD, professor emeritus of psychiatry and pediatrics at the Harvard Medical School, Boston, said in an interview, “Barbara’s dedication to the emotional health of children has made an enormous difference. In addition to her clinical care and writing, her development of CHADIS has helped pediatricians recognize and treat thousands upon thousands of children. She is most deserving of this high honor.”
 

cnellist@mdedge.com

Barbara J. Howard, MD, will receive the 2019 C. Anderson Aldrich Award at the American Academy of Pediatrics annual meeting on Oct. 26 in New Orleans.

The award is given by the AAP Section on Developmental and Behavioral Pediatrics to “recognize physicians who have made outstanding contributions to the field of child development,” according to the AAP. Previous recipients of the award include pediatricians such as Benjamin M. Spock, MD, and T. Berry Brazelton, MD, as well as psychoanalyst Anna Freud and child psychologist Erik H. Erickson.

Dr. Howard is a developmental-behavioral pediatrician who is an assistant professor of pediatrics at Johns Hopkins University, Baltimore, where she codirected a fellowship program to train developmental and behavioral pediatricians. She is a creator of CHADIS, an innovative online system that provides previsit questionnaires that allows physicians “to collect patient-generated data that can be used to support clinical and shared decisions, track data, and create quality improvement reports,” according to the CHADIS website. She has given free monthly case conferences through a federal grant for 30 years, initially in person and more recently through a national webcast. Over the last 2 decades, Dr. Howard has written about practical approaches to developmental and behavioral problems children experience for this newspaper in her Behavioral Consult column.

Michael S. Jellinek, MD, professor emeritus of psychiatry and pediatrics at the Harvard Medical School, Boston, said in an interview, “Barbara’s dedication to the emotional health of children has made an enormous difference. In addition to her clinical care and writing, her development of CHADIS has helped pediatricians recognize and treat thousands upon thousands of children. She is most deserving of this high honor.”
 

cnellist@mdedge.com

Health care provider (HCP) well-being has become a central topic as health care agencies increasingly recognize that stress leads to turnover and reduced efficacy.¹ Financial health of HCPs is one aspect of overall well-being that has received little attention. We all work at the US Department of Veterans Affairs (VA) as psychologists and believe that there is a need to attend to financial literacy within the health care professions, a call that also has been made by physicians.² For instance, a frequently mentioned aspect of financial literacy involves learning to effectively manage student loan debt. Another less often discussed facet is the need to save money for retirement early in one’s career to reap the benefits of compound interest: This is a particular concern for HCPs who were in graduate/medical school when they would have optimally started saving for retirement. Delaying retirement savings can have significant financial consequences, which can have a negative effect on well-being.

A few years ago, we started teaching advanced psychology trainees about financial well-being and were startled at the students’ lack of knowledge. For example, many students did not understand basic financial concepts, including the difference between a pension and a 401k/403b system of retirement savings—a knowledge gap that the authors speculate persists throughout some professionals’ careers. Research suggests that lack of knowledge in an area feels aversive and may result in procrastination or an inability to move toward a goal.^3,4 Yet, postponing saving is problematic as it attenuates the effect of compound interest, thus making it difficult to accrue wealth.⁵ To address the lack of financial training among psychologists, the authors designed a seminar to provide retirement/financial-planning information to early career psychologists. This information fits the concept of “just in time” education: Disseminating knowledge when it is most likely to be useful, put into practice, and thus retained.⁶

Methods

In consultation with human resources officials at the VA, a 90-minute seminar was created to educate psychologists about saving for retirement. The seminar was recorded so that psychologists who were not able to attend in-person could view it at a later date. The seminar mainly covered systems of retirement (especially the VAspecific Thrift Savings Plan [TSP]), basic concepts of investing, ways of determining how much to save for retirement, and tax advantages of increased saving. It also provided simple retirement planning rules of thumb, as such heuristics have been shown to lead to greater behavior change than more unsystematic approaches.⁷ Key points included:

• Psychologists should try to approximately replace their current salary during retirement;
• There is no option to borrow money for retirement; the only sources of income for the retiree are social security, a possible pension, and any money saved;
• Psychologists and many other HCPs were in school during their prime saving years and tend to have lower salaries than that of other professional groups with similar amounts of education, so they should save aggressively earlier in their career;
• Early career psychologists should ensure that money saved for retirement is invested in relatively “aggressive” options, such as stock index funds (vs bond funds); and
• The tax benefits of allocating more income toward retirement savings in a tax-deferred savings plan such as the TSP can make it seem cheaper to invest, which can make it more attractive to immediately increase one’s savings.

As with any other savings plan, there are no guarantees or one-size-fits-all solutions, and finance professionals typically advise diversifying retirement savings (eg, stocks, bonds, real estate), to include both TSP and non-TSP plans in the case of VA employees.

To assess the usefulness of this seminar, the authors conducted a process improvement case study. The institutional review board of the Milwaukee VA Medical Center (VAMC) determined the study to be exempt as it was considered process improvement rather than research. Two assessment measures were created: a 5-item, anonymous measure of attendee satisfaction was administered immediately following the seminar, which assessed the extent to which presenters were engaging, material was presented clearly, presenters effectively used examples and illustrations, presenters effectively used slides/visual aids, and objectives were met (5-point Likert scale from “Needs major improvement” to “Excellent”).

Second, an internally developed anonymous pre- and postseminar survey was administered to assess changes in retirement- related knowledge, attitudes, and behaviors (3 months before the seminar [8 questions] and 2 months after [9 questions]). The survey assessed knowledge of retirement benefits (eg, difference between Roth and traditional retirement savings plans), general investment actions (eg, investing in TSP, investing in the TSP G fund, and investing sufficiently to earn the full employer match), and postseminar actions taken (eg, logging on to tsp.gov, increasing TSP contribution). Participants’ responses were anonymous, so the authors compared average behavior before and after the seminar rather than comparing individuals’ pre- and postseminar comments.

Results

About one-third (n = 28) of the Milwaukee VAMC psychologists attended, viewed, or presented/designed the seminar. Of the 12 participants who attended the seminar in person, all rated the presentation as excellent in each domain, with the exception of 1 participant (good). Anecdotally, participants approached presenters immediately after the presentation and up to 2 years later to indicate that the presentation was a useful retirement planning resource. A total of 27 psychologists completed the preseminar survey. Sixteen psychologists completed the postseminar survey and indicated that they attended/viewed the retirement seminar. Participants’ perceived knowledge of retirement benefits was assessed with response options, including nonexistent, vague, good, and sophisticated.

There was a significant change from preto postseminar, such that psychologists at postseminar felt that they had a better understanding of their retirement benefit options (Mann-Whitney U = 65.5, n₁ = 27, n₂ = 16, P < .01). The modal response preseminar was “vague” (67%) and postseminar was “good” (88%). There also were changes that were meaningful though not statistically significant: The percentage who had moved their money from the default, low-yield fund increased from 70% at preseminar to 88% at postseminar (Fisher exact test, 1-sided, P = .31). Also, fewer people reported on the postseminar survey that they were not sure whether they were invested in a Roth individual retirement account (IRA) or traditional TSP, indicating a trend toward significantly increased knowledge of their investments (Fisher exact test, 1-sided, P = .076).

Most important at follow-up, several behavior changes were reported. Most people (56%) had logged on to the TSP website to check on their account. A substantial number (26%) increased their contribution amount, and 6% moved money from the default fund. Overall, every respondent at follow-up confirmed having taken at least 1 of the actions assessed by the survey.

Conclusion

Based on the authors’ experience and research into financial education among HCPs, it is recommended that psychologists and other disciplines offer opportunities for retirement education at all levels of training. Financial education is likely to be most helpful if it is tailored toward a specific discipline, workplace, and time frame (eg, early career physicians may need more information about loan repayment and may need to invest in more aggressive retirement funds).⁸ Although many employers provide access to general financial education from outside companies, information provided by informed members of one’s field may be particularly helpful (eg, our seminar was curated for a psychology audience).

We found that the process of creating such a seminar was not burdensome and was educational for presenters as well as attendees. Further, it need not be intimidating to accumulate information to share; especially for those health care providers who have not made financial well-being a priority, learning and deploying a few targeted strategies can lead to increased peace of mind about retirement savings. Overall, we encourage a focus on financial literacy for all health care professions, including physicians who often may graduate with greater debts. Emphasizing early and aggressive financial literacy as an important aspect of provider well-being may help to produce healthier, wealthier, and overall better health care providers.²

Acknowledgments

This manuscript is partially the result of work supported with resources and the use of facilities at the Clement J. Zablocki VAMC, Milwaukee, Wisconsin. We thank Milwaukee VA retirement specialist, Vicki Heckman, for her invaluable advice in the preparation of these materials and the Psychology Advancement Workgroup at the Milwaukee VAMC for providing the impetus and support for this project.

Health care provider (HCP) well-being has become a central topic as health care agencies increasingly recognize that stress leads to turnover and reduced efficacy.¹ Financial health of HCPs is one aspect of overall well-being that has received little attention. We all work at the US Department of Veterans Affairs (VA) as psychologists and believe that there is a need to attend to financial literacy within the health care professions, a call that also has been made by physicians.² For instance, a frequently mentioned aspect of financial literacy involves learning to effectively manage student loan debt. Another less often discussed facet is the need to save money for retirement early in one’s career to reap the benefits of compound interest: This is a particular concern for HCPs who were in graduate/medical school when they would have optimally started saving for retirement. Delaying retirement savings can have significant financial consequences, which can have a negative effect on well-being.

A few years ago, we started teaching advanced psychology trainees about financial well-being and were startled at the students’ lack of knowledge. For example, many students did not understand basic financial concepts, including the difference between a pension and a 401k/403b system of retirement savings—a knowledge gap that the authors speculate persists throughout some professionals’ careers. Research suggests that lack of knowledge in an area feels aversive and may result in procrastination or an inability to move toward a goal.^3,4 Yet, postponing saving is problematic as it attenuates the effect of compound interest, thus making it difficult to accrue wealth.⁵ To address the lack of financial training among psychologists, the authors designed a seminar to provide retirement/financial-planning information to early career psychologists. This information fits the concept of “just in time” education: Disseminating knowledge when it is most likely to be useful, put into practice, and thus retained.⁶

Methods

In consultation with human resources officials at the VA, a 90-minute seminar was created to educate psychologists about saving for retirement. The seminar was recorded so that psychologists who were not able to attend in-person could view it at a later date. The seminar mainly covered systems of retirement (especially the VAspecific Thrift Savings Plan [TSP]), basic concepts of investing, ways of determining how much to save for retirement, and tax advantages of increased saving. It also provided simple retirement planning rules of thumb, as such heuristics have been shown to lead to greater behavior change than more unsystematic approaches.⁷ Key points included:

• Psychologists should try to approximately replace their current salary during retirement;
• There is no option to borrow money for retirement; the only sources of income for the retiree are social security, a possible pension, and any money saved;
• Psychologists and many other HCPs were in school during their prime saving years and tend to have lower salaries than that of other professional groups with similar amounts of education, so they should save aggressively earlier in their career;
• Early career psychologists should ensure that money saved for retirement is invested in relatively “aggressive” options, such as stock index funds (vs bond funds); and
• The tax benefits of allocating more income toward retirement savings in a tax-deferred savings plan such as the TSP can make it seem cheaper to invest, which can make it more attractive to immediately increase one’s savings.

As with any other savings plan, there are no guarantees or one-size-fits-all solutions, and finance professionals typically advise diversifying retirement savings (eg, stocks, bonds, real estate), to include both TSP and non-TSP plans in the case of VA employees.

To assess the usefulness of this seminar, the authors conducted a process improvement case study. The institutional review board of the Milwaukee VA Medical Center (VAMC) determined the study to be exempt as it was considered process improvement rather than research. Two assessment measures were created: a 5-item, anonymous measure of attendee satisfaction was administered immediately following the seminar, which assessed the extent to which presenters were engaging, material was presented clearly, presenters effectively used examples and illustrations, presenters effectively used slides/visual aids, and objectives were met (5-point Likert scale from “Needs major improvement” to “Excellent”).

Second, an internally developed anonymous pre- and postseminar survey was administered to assess changes in retirement- related knowledge, attitudes, and behaviors (3 months before the seminar [8 questions] and 2 months after [9 questions]). The survey assessed knowledge of retirement benefits (eg, difference between Roth and traditional retirement savings plans), general investment actions (eg, investing in TSP, investing in the TSP G fund, and investing sufficiently to earn the full employer match), and postseminar actions taken (eg, logging on to tsp.gov, increasing TSP contribution). Participants’ responses were anonymous, so the authors compared average behavior before and after the seminar rather than comparing individuals’ pre- and postseminar comments.

Results

About one-third (n = 28) of the Milwaukee VAMC psychologists attended, viewed, or presented/designed the seminar. Of the 12 participants who attended the seminar in person, all rated the presentation as excellent in each domain, with the exception of 1 participant (good). Anecdotally, participants approached presenters immediately after the presentation and up to 2 years later to indicate that the presentation was a useful retirement planning resource. A total of 27 psychologists completed the preseminar survey. Sixteen psychologists completed the postseminar survey and indicated that they attended/viewed the retirement seminar. Participants’ perceived knowledge of retirement benefits was assessed with response options, including nonexistent, vague, good, and sophisticated.

There was a significant change from preto postseminar, such that psychologists at postseminar felt that they had a better understanding of their retirement benefit options (Mann-Whitney U = 65.5, n₁ = 27, n₂ = 16, P < .01). The modal response preseminar was “vague” (67%) and postseminar was “good” (88%). There also were changes that were meaningful though not statistically significant: The percentage who had moved their money from the default, low-yield fund increased from 70% at preseminar to 88% at postseminar (Fisher exact test, 1-sided, P = .31). Also, fewer people reported on the postseminar survey that they were not sure whether they were invested in a Roth individual retirement account (IRA) or traditional TSP, indicating a trend toward significantly increased knowledge of their investments (Fisher exact test, 1-sided, P = .076).

Most important at follow-up, several behavior changes were reported. Most people (56%) had logged on to the TSP website to check on their account. A substantial number (26%) increased their contribution amount, and 6% moved money from the default fund. Overall, every respondent at follow-up confirmed having taken at least 1 of the actions assessed by the survey.

Conclusion

Based on the authors’ experience and research into financial education among HCPs, it is recommended that psychologists and other disciplines offer opportunities for retirement education at all levels of training. Financial education is likely to be most helpful if it is tailored toward a specific discipline, workplace, and time frame (eg, early career physicians may need more information about loan repayment and may need to invest in more aggressive retirement funds).⁸ Although many employers provide access to general financial education from outside companies, information provided by informed members of one’s field may be particularly helpful (eg, our seminar was curated for a psychology audience).

We found that the process of creating such a seminar was not burdensome and was educational for presenters as well as attendees. Further, it need not be intimidating to accumulate information to share; especially for those health care providers who have not made financial well-being a priority, learning and deploying a few targeted strategies can lead to increased peace of mind about retirement savings. Overall, we encourage a focus on financial literacy for all health care professions, including physicians who often may graduate with greater debts. Emphasizing early and aggressive financial literacy as an important aspect of provider well-being may help to produce healthier, wealthier, and overall better health care providers.²

Acknowledgments

This manuscript is partially the result of work supported with resources and the use of facilities at the Clement J. Zablocki VAMC, Milwaukee, Wisconsin. We thank Milwaukee VA retirement specialist, Vicki Heckman, for her invaluable advice in the preparation of these materials and the Psychology Advancement Workgroup at the Milwaukee VAMC for providing the impetus and support for this project.

Health care provider (HCP) well-being has become a central topic as health care agencies increasingly recognize that stress leads to turnover and reduced efficacy.¹ Financial health of HCPs is one aspect of overall well-being that has received little attention. We all work at the US Department of Veterans Affairs (VA) as psychologists and believe that there is a need to attend to financial literacy within the health care professions, a call that also has been made by physicians.² For instance, a frequently mentioned aspect of financial literacy involves learning to effectively manage student loan debt. Another less often discussed facet is the need to save money for retirement early in one’s career to reap the benefits of compound interest: This is a particular concern for HCPs who were in graduate/medical school when they would have optimally started saving for retirement. Delaying retirement savings can have significant financial consequences, which can have a negative effect on well-being.

A few years ago, we started teaching advanced psychology trainees about financial well-being and were startled at the students’ lack of knowledge. For example, many students did not understand basic financial concepts, including the difference between a pension and a 401k/403b system of retirement savings—a knowledge gap that the authors speculate persists throughout some professionals’ careers. Research suggests that lack of knowledge in an area feels aversive and may result in procrastination or an inability to move toward a goal.^3,4 Yet, postponing saving is problematic as it attenuates the effect of compound interest, thus making it difficult to accrue wealth.⁵ To address the lack of financial training among psychologists, the authors designed a seminar to provide retirement/financial-planning information to early career psychologists. This information fits the concept of “just in time” education: Disseminating knowledge when it is most likely to be useful, put into practice, and thus retained.⁶

Methods

In consultation with human resources officials at the VA, a 90-minute seminar was created to educate psychologists about saving for retirement. The seminar was recorded so that psychologists who were not able to attend in-person could view it at a later date. The seminar mainly covered systems of retirement (especially the VAspecific Thrift Savings Plan [TSP]), basic concepts of investing, ways of determining how much to save for retirement, and tax advantages of increased saving. It also provided simple retirement planning rules of thumb, as such heuristics have been shown to lead to greater behavior change than more unsystematic approaches.⁷ Key points included:

• Psychologists should try to approximately replace their current salary during retirement;
• There is no option to borrow money for retirement; the only sources of income for the retiree are social security, a possible pension, and any money saved;
• Psychologists and many other HCPs were in school during their prime saving years and tend to have lower salaries than that of other professional groups with similar amounts of education, so they should save aggressively earlier in their career;
• Early career psychologists should ensure that money saved for retirement is invested in relatively “aggressive” options, such as stock index funds (vs bond funds); and
• The tax benefits of allocating more income toward retirement savings in a tax-deferred savings plan such as the TSP can make it seem cheaper to invest, which can make it more attractive to immediately increase one’s savings.

As with any other savings plan, there are no guarantees or one-size-fits-all solutions, and finance professionals typically advise diversifying retirement savings (eg, stocks, bonds, real estate), to include both TSP and non-TSP plans in the case of VA employees.

To assess the usefulness of this seminar, the authors conducted a process improvement case study. The institutional review board of the Milwaukee VA Medical Center (VAMC) determined the study to be exempt as it was considered process improvement rather than research. Two assessment measures were created: a 5-item, anonymous measure of attendee satisfaction was administered immediately following the seminar, which assessed the extent to which presenters were engaging, material was presented clearly, presenters effectively used examples and illustrations, presenters effectively used slides/visual aids, and objectives were met (5-point Likert scale from “Needs major improvement” to “Excellent”).

Second, an internally developed anonymous pre- and postseminar survey was administered to assess changes in retirement- related knowledge, attitudes, and behaviors (3 months before the seminar [8 questions] and 2 months after [9 questions]). The survey assessed knowledge of retirement benefits (eg, difference between Roth and traditional retirement savings plans), general investment actions (eg, investing in TSP, investing in the TSP G fund, and investing sufficiently to earn the full employer match), and postseminar actions taken (eg, logging on to tsp.gov, increasing TSP contribution). Participants’ responses were anonymous, so the authors compared average behavior before and after the seminar rather than comparing individuals’ pre- and postseminar comments.

Results

About one-third (n = 28) of the Milwaukee VAMC psychologists attended, viewed, or presented/designed the seminar. Of the 12 participants who attended the seminar in person, all rated the presentation as excellent in each domain, with the exception of 1 participant (good). Anecdotally, participants approached presenters immediately after the presentation and up to 2 years later to indicate that the presentation was a useful retirement planning resource. A total of 27 psychologists completed the preseminar survey. Sixteen psychologists completed the postseminar survey and indicated that they attended/viewed the retirement seminar. Participants’ perceived knowledge of retirement benefits was assessed with response options, including nonexistent, vague, good, and sophisticated.

There was a significant change from preto postseminar, such that psychologists at postseminar felt that they had a better understanding of their retirement benefit options (Mann-Whitney U = 65.5, n₁ = 27, n₂ = 16, P < .01). The modal response preseminar was “vague” (67%) and postseminar was “good” (88%). There also were changes that were meaningful though not statistically significant: The percentage who had moved their money from the default, low-yield fund increased from 70% at preseminar to 88% at postseminar (Fisher exact test, 1-sided, P = .31). Also, fewer people reported on the postseminar survey that they were not sure whether they were invested in a Roth individual retirement account (IRA) or traditional TSP, indicating a trend toward significantly increased knowledge of their investments (Fisher exact test, 1-sided, P = .076).

Most important at follow-up, several behavior changes were reported. Most people (56%) had logged on to the TSP website to check on their account. A substantial number (26%) increased their contribution amount, and 6% moved money from the default fund. Overall, every respondent at follow-up confirmed having taken at least 1 of the actions assessed by the survey.

Conclusion

Based on the authors’ experience and research into financial education among HCPs, it is recommended that psychologists and other disciplines offer opportunities for retirement education at all levels of training. Financial education is likely to be most helpful if it is tailored toward a specific discipline, workplace, and time frame (eg, early career physicians may need more information about loan repayment and may need to invest in more aggressive retirement funds).⁸ Although many employers provide access to general financial education from outside companies, information provided by informed members of one’s field may be particularly helpful (eg, our seminar was curated for a psychology audience).

We found that the process of creating such a seminar was not burdensome and was educational for presenters as well as attendees. Further, it need not be intimidating to accumulate information to share; especially for those health care providers who have not made financial well-being a priority, learning and deploying a few targeted strategies can lead to increased peace of mind about retirement savings. Overall, we encourage a focus on financial literacy for all health care professions, including physicians who often may graduate with greater debts. Emphasizing early and aggressive financial literacy as an important aspect of provider well-being may help to produce healthier, wealthier, and overall better health care providers.²

Acknowledgments

This manuscript is partially the result of work supported with resources and the use of facilities at the Clement J. Zablocki VAMC, Milwaukee, Wisconsin. We thank Milwaukee VA retirement specialist, Vicki Heckman, for her invaluable advice in the preparation of these materials and the Psychology Advancement Workgroup at the Milwaukee VAMC for providing the impetus and support for this project.

You are seeing a 9-year-old for her annual health maintenance visit. A quick look at her growth chart easily confirms your first impression that she is obese. How are you going to address the weight that you know, and she probably suspects, is going to make her vulnerable to a myriad of health problems as she gets older?

SolStock/iStock/Getty Image

If she has been your patient since she was in preschool, this is certainly not the first time that her growth chart has been concerning. When did you first start discussing her weight with her parents? What words did you use? What strategies have you suggested? What referrals have you made? Maybe you have already given up and decided to not even “go there” at this visit because your experience with overweight patients has been so disappointing.

In her op ed in the New York Times, Dr. Perri Klass reconsiders these kinds of questions as she reviews an article in the journal Childhood Obesity (“Let’s Not Just Dismiss the Weight Watchers Kurbo App,” by Michelle I. Cardel, PhD, MS, RD, and Elsie M. Taveras, MD, MPH, August 2019) written by a nutrition scientist and a pediatrician who are concerned about a new weight loss app for children recently released by Weight Watchers. (The Checkup, “Helping Children Learn to Eat Well,” The New York Times, Aug. 26, 2019). Although the authors of the journal article question some of the science behind the app, their primary concerns are that the app is aimed at children without a way to guarantee parental involvement, and in their opinion the app also places too much emphasis on weight loss.

Their concerns go right to the heart of what troubles me about managing obesity in children. How should I talk to a child about her weight? What words can I choose without shaming? Maybe I shouldn’t be talking to her at all. When a child is 18 months old, we don’t talk to her about her growth chart. Not because she couldn’t understand, but because the solution rests not with her but with her parents.

At what age does a child’s obesity cease being simply a parenting problem and instead become something the child must solve? Does that point come when we have given up on the parents’ ability to create and maintain an environment that discourages obesity? Is that the point when we begin asking the child to unlearn a complex set of behaviors that have been enabled or at least tolerated and poorly modeled at home?

When we begin to talk to a child about his weight do we begin by telling him that he may not have been a contributor to the problem when it began but from now on he needs to be a major player in its management? Of course we don’t share that reality with an 8-year-old, but sometime during his struggle to manage his weight he will connect the dots.

If you are beginning to suspect that I have built my pediatric career around a scaffolding of parent blaming and shaming you are wrong. I know that there are children who have inherited a suite of genes that make them vulnerable to obesity. And I know that too many children grow up in environments in which their parents are powerless to control the family diet for economic reasons. But I am sure that like me you mutter to yourself and your colleagues about the number of patients you are seeing each day whose growth charts are a clear reflection of less than optimal parenting.

Does all of this mean we throw in the towel and stop trying to help overweight children after they turn 6 years old? Of course not. But, it does mean we must redouble our efforts to help parents manage their children’s diets and activity levels in those first critical preschool years.
 

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at pdnews@mdedge.com.

You are seeing a 9-year-old for her annual health maintenance visit. A quick look at her growth chart easily confirms your first impression that she is obese. How are you going to address the weight that you know, and she probably suspects, is going to make her vulnerable to a myriad of health problems as she gets older?

SolStock/iStock/Getty Image

If she has been your patient since she was in preschool, this is certainly not the first time that her growth chart has been concerning. When did you first start discussing her weight with her parents? What words did you use? What strategies have you suggested? What referrals have you made? Maybe you have already given up and decided to not even “go there” at this visit because your experience with overweight patients has been so disappointing.

In her op ed in the New York Times, Dr. Perri Klass reconsiders these kinds of questions as she reviews an article in the journal Childhood Obesity (“Let’s Not Just Dismiss the Weight Watchers Kurbo App,” by Michelle I. Cardel, PhD, MS, RD, and Elsie M. Taveras, MD, MPH, August 2019) written by a nutrition scientist and a pediatrician who are concerned about a new weight loss app for children recently released by Weight Watchers. (The Checkup, “Helping Children Learn to Eat Well,” The New York Times, Aug. 26, 2019). Although the authors of the journal article question some of the science behind the app, their primary concerns are that the app is aimed at children without a way to guarantee parental involvement, and in their opinion the app also places too much emphasis on weight loss.

Their concerns go right to the heart of what troubles me about managing obesity in children. How should I talk to a child about her weight? What words can I choose without shaming? Maybe I shouldn’t be talking to her at all. When a child is 18 months old, we don’t talk to her about her growth chart. Not because she couldn’t understand, but because the solution rests not with her but with her parents.

At what age does a child’s obesity cease being simply a parenting problem and instead become something the child must solve? Does that point come when we have given up on the parents’ ability to create and maintain an environment that discourages obesity? Is that the point when we begin asking the child to unlearn a complex set of behaviors that have been enabled or at least tolerated and poorly modeled at home?

When we begin to talk to a child about his weight do we begin by telling him that he may not have been a contributor to the problem when it began but from now on he needs to be a major player in its management? Of course we don’t share that reality with an 8-year-old, but sometime during his struggle to manage his weight he will connect the dots.

If you are beginning to suspect that I have built my pediatric career around a scaffolding of parent blaming and shaming you are wrong. I know that there are children who have inherited a suite of genes that make them vulnerable to obesity. And I know that too many children grow up in environments in which their parents are powerless to control the family diet for economic reasons. But I am sure that like me you mutter to yourself and your colleagues about the number of patients you are seeing each day whose growth charts are a clear reflection of less than optimal parenting.

Does all of this mean we throw in the towel and stop trying to help overweight children after they turn 6 years old? Of course not. But, it does mean we must redouble our efforts to help parents manage their children’s diets and activity levels in those first critical preschool years.
 

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at pdnews@mdedge.com.

You are seeing a 9-year-old for her annual health maintenance visit. A quick look at her growth chart easily confirms your first impression that she is obese. How are you going to address the weight that you know, and she probably suspects, is going to make her vulnerable to a myriad of health problems as she gets older?

SolStock/iStock/Getty Image

If she has been your patient since she was in preschool, this is certainly not the first time that her growth chart has been concerning. When did you first start discussing her weight with her parents? What words did you use? What strategies have you suggested? What referrals have you made? Maybe you have already given up and decided to not even “go there” at this visit because your experience with overweight patients has been so disappointing.

In her op ed in the New York Times, Dr. Perri Klass reconsiders these kinds of questions as she reviews an article in the journal Childhood Obesity (“Let’s Not Just Dismiss the Weight Watchers Kurbo App,” by Michelle I. Cardel, PhD, MS, RD, and Elsie M. Taveras, MD, MPH, August 2019) written by a nutrition scientist and a pediatrician who are concerned about a new weight loss app for children recently released by Weight Watchers. (The Checkup, “Helping Children Learn to Eat Well,” The New York Times, Aug. 26, 2019). Although the authors of the journal article question some of the science behind the app, their primary concerns are that the app is aimed at children without a way to guarantee parental involvement, and in their opinion the app also places too much emphasis on weight loss.

Their concerns go right to the heart of what troubles me about managing obesity in children. How should I talk to a child about her weight? What words can I choose without shaming? Maybe I shouldn’t be talking to her at all. When a child is 18 months old, we don’t talk to her about her growth chart. Not because she couldn’t understand, but because the solution rests not with her but with her parents.

At what age does a child’s obesity cease being simply a parenting problem and instead become something the child must solve? Does that point come when we have given up on the parents’ ability to create and maintain an environment that discourages obesity? Is that the point when we begin asking the child to unlearn a complex set of behaviors that have been enabled or at least tolerated and poorly modeled at home?

When we begin to talk to a child about his weight do we begin by telling him that he may not have been a contributor to the problem when it began but from now on he needs to be a major player in its management? Of course we don’t share that reality with an 8-year-old, but sometime during his struggle to manage his weight he will connect the dots.

If you are beginning to suspect that I have built my pediatric career around a scaffolding of parent blaming and shaming you are wrong. I know that there are children who have inherited a suite of genes that make them vulnerable to obesity. And I know that too many children grow up in environments in which their parents are powerless to control the family diet for economic reasons. But I am sure that like me you mutter to yourself and your colleagues about the number of patients you are seeing each day whose growth charts are a clear reflection of less than optimal parenting.

Does all of this mean we throw in the towel and stop trying to help overweight children after they turn 6 years old? Of course not. But, it does mean we must redouble our efforts to help parents manage their children’s diets and activity levels in those first critical preschool years.
 

Dr. Wilkoff practiced primary care pediatrics in Brunswick, Maine for nearly 40 years. He has authored several books on behavioral pediatrics, including “How to Say No to Your Toddler.” Email him at pdnews@mdedge.com.